Pain in children and adolescents: prevalence, impact on daily life, and parents' perception, a school survey.

BACKGROUND: Pain problems in children and adolescents have increased during the last 20 years and have been identified as an important public health problem. AIMS: The specific aims of the study were to study the prevalence of pain, its association with age, gender, and socio-demographics, its frequency, duration, and type. A further aim is to describe the impact of pain on daily living, perceived triggers of pain, and correspondence between parents' and children's perceptions of pain. DESIGN: A cross-sectional study, with a descriptive, exploratory design. SETTINGS AND PARTICIPANTS: A cluster sample of children and adolescents (age 8-18 years N=1238) and parents (n=828), from 20 randomly selected schools in a region of Norway. METHODS: Data were collected using a structured self-report questionnaire, the Lübeck Pain-Screening Questionnaire (LPQ). The children filled in the questionnaires at school, while the parents completed the questionnaires at home. RESULTS: Sixty per cent of the children and adolescents reported pain within the previous 3 months. Pain increased with age, where girls aged 16-18 years reported the most pain. Total prevalence of chronic pain was 21%. Children reported impact on social life; inability to pursue hobbies, disturbed sleep, absence from school, and inability to meet friends because of pain. The girls reported significantly more frequently disturbed sleep, loss of appetite, and use of medication, compared to the boys. There was little agreement between parents and children regarding pain. CONCLUSIONS: Pain is a common problem and influences the daily lives of children and adolescents. Many parents are unaware of the pain experienced by their children. There is a need for preventive programmes that also involve parents, school nurses, and teachers.

Trends in incidence of ductal carcinoma in situ: the effect of a population-based screening programme.

BACKGROUND: The incidence of ductal carcinoma in situ (DCIS) has increased substantially in the western world in recent decades. The aim of this study was to investigate the incidence according to grade distribution, age, and implementation of a population-based screening programme. METHODS: Cases of primary pure DCIS (n = 3167) were obtained from the Cancer Registry of Norway. Poisson regression was used to estimate trends in incidence. RESULTS: Age-adjusted incidence of DCIS increased from 4 to 11 per 100, 000 women-years from 1993 to 2007, in parallel with the implementation of screening. Higher incidence was observed among prevalent (IRR 3.3) and subsequent (IRR 2.8) invited women compared with those not invited. The proportion of DCIS among breast malignancies increased throughout the period, most markedly in the age range of screening. CONCLUSION: The increased proportion of DCIS during the study period is probably due to improved diagnostics resulting from the implementation of population-based screening.

Redesigned community postpartum care to prevent and treat postpartum depression in women--a one-year follow-up study.

AIM: To investigate the effect of a redesigned follow-up care programme on prevention and treatment of postpartum depression. BACKGROUND: Postpartum depression may have negative consequences on child development, maternal health and the relationship between parents. Early identification and treatment might prevent longer-term depression. DESIGN: A quasi-experimental post-test design with non-equivalent groups. METHOD: The study population was postpartum women with a live-born child, residing in one of two municipalities in Norway. A total of 2247 women were enrolled: 1806 in the experimental municipality and 441 in the comparison municipality. Public health nurses (26) in the experimental municipality were trained to identify postpartum depression using the Edinburgh Postnatal Depression Scale and clinical assessment and to provide supportive counselling. MEASUREMENTS: The Edinburgh Postnatal Depression Scale at six weeks, three, six and 12 months postpartum and the Parenting Stress Index at 12 months postpartum. RESULTS: The redesigned postpartum care programme yielded a significant group difference in the Edinburgh Postnatal Depression Scale score at six weeks (p < 0.01), odds ratio (OR) 0.6, three months (p < 0.01), OR 0.4, six months (p < 0.01), OR 0.5 and 12 months postpartum (p < 0.01), OR 0.6. Women who had been depressed at least once during the first postpartum year reported significantly higher levels of parenting stress at 12 months. CONCLUSION: The findings of this study suggest that redesigned postpartum care comprising training of health professionals, increased focus on mental health problems and support for the parents is a useful approach to managing postpartum depression in the community. RELEVANCE TO CLINICAL PRACTICE: Public health nurses are well positioned to identify and treat depressed mothers and provide referrals when needed. A small investment in training nurses to identify and treat postpartum depression can be cost-effective in the longer term. These findings have implications for service delivery in public health.

The effect of a solution-focused approach to improve self-efficacy in socially withdrawn school children: a non-randomized controlled trial.

BACKGROUND: Socially withdrawn children can improve their social skills through increased self-efficacy. Previous studies have shown that socially withdrawn children are prone to low self-efficacy and problems at school. Therefore, we investigated the effects of an intervention on the self-efficacy of these school children. A solution-focused approach may be an appropriate tool in such interventions. OBJECTIVES: To explore the effects of a group intervention based on a solution-focused approach on the self-efficacy of a group of socially withdrawn children and to explore possible sex-based differences. DESIGN: This interventional study was a non-randomized controlled trial, with experimental and control groups. SETTING: The study was performed within the school health services of 14 primary schools in eastern Norway from 2006 to 2008. PARTICIPANTS: School children who were aged 12-13 years and identified as socially withdrawn participated: 156 at baseline, but 6 dropped out before the first measurement and an additional 6 did not complete the second measurement. METHODS: The participants completed questionnaires assessing general self-efficacy, social self-efficacy, and assertive self-efficacy at three different times. The first time was at baseline, the second was immediately after the 6-week intervention period, and the third was 3 months after the intervention. RESULTS: The general self-efficacy scores increased significantly among girls in the experimental group immediately after the intervention compared with those of the control group. The effect size was 0.60. No significant change was observed among the boys at the same time. From baseline to 3 months after the intervention, the general self-efficacy scores increased for both sexes in the experimental group and also in the control group. The assertive self-efficacy of the boys in the experimental group also increased (effect size, 0.29). CONCLUSION: This study demonstrates that socially withdrawn children can benefit from a solution-focused approach group intervention and reach their goals, probably because they learn from each other and share their feelings, experiences, and support. These results indicate that a solution-focused approach may be suitable for school nurses in their work with children with special needs. Solution-focused groups are also recommended for use in school health services.

Supportive counselling by public health nurses for women with postpartum depression.

AIM: This paper is a report of a study examining the effect of supportive counselling by public health nurses on postpartum depression. BACKGROUND: Depression is a common condition following childbirth and may have negative consequences for the child's development, the woman's health and the relationship between the parents. Psychological intervention is a treatment alternative to biological treatment options and may prevent longer-term postpartum depression. METHOD: The study was designed as a pragmatic trial. The study population comprised postpartum women, residing in two Norwegian municipalities, who had delivered a live-born child between June 2005 and December 2006. A total of 228 women were included in the study: 64 in the comparison municipality and 164 in the experimental municipality. Public health nurses (26) in the experimental municipality were trained in identifying postpartum depression and in providing supportive counselling. Pre-tests were conducted using the Edinburgh Postnatal Depression Scale at 6 weeks postpartum. Post-tests using the same Scale were performed at 3 and 6 months postpartum. RESULTS: The depression score decreased statistically significantly in the experimental group compared to the comparison group both at 3 and 6 months postpartum. CONCLUSION: Supportive counselling based on a non-directive counselling method provided by public health nurses is an effective treatment method for postpartum depression. Further research is required to assess the mothers' evaluation of the treatment and appraise methods used for management of postpartum depression in primary health care.

Associations between general self-efficacy and health-related quality of life among 12-13-year-old school children: a cross-sectional survey.

BACKGROUND: While research on school children's health has mainly focused on risk factors and illness, few studies have examined aspects of health promotion. Thus, this study focuses on health promotional factors including general self-efficacy (GSE) and health-related quality of life (HRQOL). GSE refers to a global confidence in coping ability across a wide range of demanding situations, and is related to health. The purpose of this study was to examine associations between GSE and HRQOL, and associations between HRQOL and socio-demographic characteristics. Knowledge of these associations in healthy school children is currently lacking. METHODS: During 2006 and 2007, 279 school children in the seventh grade across eastern Norway completed a survey assessing their GSE and HRQOL. The children were from schools that had been randomly selected using cluster sampling. T-tests were computed to compare mean subscale values between HRQOL and socio-demographic variables. Single and multiple regression analyses were performed to explore associations among GSE, HRQOL and socio-demographic variables. RESULTS: Regression analyses showed a significant relationship between increasing degrees of GSE and increasing degrees of HRQOL. In analyses adjusted for socio-demographic variables, boys scored higher than girls on self-esteem. School children from single-parent families had lower scores on HRQOL than those from two-parent families, and children who had relocated within the last five years had lower scores on HRQOL than those who had not relocated. CONCLUSION: The strong relationship between GSE and HRQOL indicates that GSE might be a resource for increasing the HRQOL for school children.

Prevalence of postpartum depression in two municipalities in Norway.

The objectives of this study were (i) to describe the prevalence of postpartum depression (PPD) in two Norwegian municipalities and (ii) to investigate whether mothers' age and parity are related to the development of PPD. A total of 2227 women, 437 from M1 and 1790 from M2 participated in the study. Mothers who had given birth between 1 May, 2005 and 31 December, 2006 completed The Edinburgh Postnatal Depression Scale (EPDS) at well baby clinics 6 weeks after delivery. The prevalence of PPD (EPDS >or= 10) was 10.1%. However, there was a significant difference between the municipalities, with a prevalence of 14.4% in M1 and 9% in M2. Primiparous mothers showed a higher prevalence than multiparous mothers did, and the oldest mothers (36 years and over) showed the highest prevalence. PPD is an issue of importance in Norway, as in many other countries. Public health services should be aware of the higher risk of PPD among primiparous mothers and especially among older primiparous mothers. A small difference in the information provided by nurses to the mothers in the two groups at the home visit 2 weeks postpartum may have produced a significant difference in the prevalence of PPD. The findings may have implications for service delivery in public health.

Incidence and tumor characteristics of breast cancer diagnosed before and after implementation of a population-based screening-program.

BACKGROUND: Randomized controlled trials and service screening programs have shown that breast cancer screening reduces the mortality from the disease. Several years of monitoring are needed to prove such an effect. In the meantime attention should be paid to early surrogate measures, such as histopathological tumor characteristics. The Norwegian Breast Cancer Screening Program started November 1995. This study compares incidence, prognostic tumor characteristics and surgical treatment in breast cancer cases diagnosed in the pre-screening (1987-1995, n=2 618) and screening period (1996-2004, n=5 417), in women aged 50-69 years, residing in the first four counties implementing the screening program. The screening period is divided into those invited versus those not invited to the screening program, and those exposed (participants) versus those not exposed to the program (non-participants). RESULTS: The incidence of invasive breast cancer rose from 170 per 100 000 women years (wy) in 1987 to 355 per 100 000 wy in 1997. The proportion of DCIS was 5% in the pre-screening period, and 14% in the screening period. Tumors 20 mm or less were diagnosed in 56% of the invasive cases in the pre-screening period, in 74% of the invited, and in 77% of the exposed women. The relative risk of diagnosing breast cancer with metastases was 0.85 (95% CI 0.84-0.87) for invited and 0.82 (95% CI 0.81-0.84) for exposed women, relative to those diagnosed in the pre-screening period. Ablation was performed in 85% of the invasive cases diagnosed in the pre-screening period, and in 45% of the cases in the screening period. CONCLUSION: Breast cancer diagnosed in the screening period had prognostically favorable tumor characteristics compared to breast cancer diagnosed in the pre-screening period. Implementation of organized population based screening and the time trend are considered possible reasons.

[Incidence of breast cancer before and after implementation of mammography screening]. / Brystkreftforekomst før og etter innføring av mammografiscreening.

BACKGROUND: A nationwide governmentally founded breast cancer screening program for women aged 50 - 69 years was gradually implemented in all Norwegian counties between November 1995 and February 2004 (the Norwegian Breast Cancer Screening Program, NBCSP). Such an implementation is expected to give an initial increased incidence followed by a decrease. We here present general and stage-specific incidences of breast cancer by age groups, in the first 9 counties that implemented the NBCSP. MATERIAL AND METHOD: The incidence of invasive breast cancer is shown for the counties Akershus, Hordaland, Oslo and Rogaland (AHOR), and Agder (east and west), Telemark, Troms and Finnmark (AgTmTF) for the period 1990-2003. AHOR started the NBCSP in 1995/1996, and AgTmTF started in 1999/2000. The incidence is based on recordings in the main database at the Cancer Registry, and is shown in rates per 100,000 women years. RESULTS: The incidence of breast cancer in women aged 50-69 years increased from 200 to 350 per 100,000 women years at start-up of the NBCSP and subsequently decreased to approximately 250. Before starting the program, the incidence was higher in women aged 70-74 years than in those aged 50 - 69. This changed in the subsequent period. During 1990-2003, the incidence of breast cancer was stable in women aged 20-49 and in those older than 74 years. At start-up of the NBCSP, a higher proportion of breast cancers in Stadium I were diagnosed as compared to the period before, especially among women aged 50-69 years. INTERPRETATION: Introduction of the NBCSP has changed the incidence of breast cancer in women aged 50-69 and in those aged 70-74 years.

[Waiting time for surgery of lung cancer]. / Ventetid på operasjon for lungekreft.

BACKGROUND: Surgical resection is the mainstay of curative treatment for lung cancer. It is important that the resection is done as soon as the disease is diagnosed. The waiting time in Norway can be longer than desirable. MATERIAL AND METHODS: Patients who underwent resection for primary lung cancer in the period 1998-2001 were identified in the Cancer Registry of Norway. When malignancy was confirmed preoperatively by histopathology or cytology, the time interval from diagnostic procedure to the pathologist's answer was calculated as response time and further the time from diagnosis to surgery was calculated as waiting time. Covariates important for waiting time were analysed by univariable and multivariable regression analyses. RESULTS: Of the 1351 patients that were operated in the period, 924 had a positive cytological or histological preoperative diagnosis. Pathology response time was median 3 days and waiting time for surgery was median 26 days (range 0-406 days). Multivariable regression analysis demonstrated that disease stage, histology and patient referral between hospitals contributed to waiting time from diagnosis to operation. Patients undergoing investigation and surgery at the same hospital had a median 9 days shorter waiting time than those referred from other hospitals. INTERPRETATION: Our investigation revealed a longer waiting time than desired. A high proportion of patients did not have a positive preoperative biopsy or cytology.

Number and characteristics of breast cancer cases diagnosed in four periods in the screening interval of a biennial population-based screening programme.

OBJECTIVE: To describe the distribution and prognostic tumour characteristics of interval breast cancers diagnosed in four periods after index screen (1-6, 7-12, 13-18 and 19+ months) in a population-based screening programme inviting women aged 50-69 years to biennial screening. SETTING: The Norwegian Breast Cancer Screening Programme (NBCSP) Methods: In all, 848 interval breast cancer cases were diagnosed in 437,235 screening examinations. The distribution and prognostic tumour characteristics of the interval cancers diagnosed in four periods in the screening interval will be described. Proportions and rates will be compared by chi(2)-test. RESULTS: A total of 70% of the interval cancers in the NBCSP were diagnosed in the second year of the interval. Except for tumour size (P = 0.027), we found no evidence of adverse prognostic breast characteristics (grade, lymph node involvement, oestrogen and progesterone receptor positive) in invasive tumours diagnosed during the second versus the first year of the screening interval (Chi square P > 0.05 for all). The prognostic characteristics of the tumours did not differ by age groups. It was a decreasing interval cancer rate per 10,000 women-years by age. CONCLUSION: The risk of interval cancer increases by time after index screen, and 70% of the interval cancers in the NBCSP were diagnosed in the second year of the interval. Prognostic histological tumour characteristics did not differ by time after index screen, thus mean sojourn time (tumour growth rate) seems important for stating an optimal screening interval in a population-based screening programme.

The influence of missing value imputation on detection of differentially expressed genes from microarray data.

MOTIVATION: Missing values are problematic for the analysis of microarray data. Imputation methods have been compared in terms of the similarity between imputed and true values in simulation experiments and not of their influence on the final analysis. The focus has been on missing at random, while entries are missing also not at random. RESULTS: We investigate the influence of imputation on the detection of differentially expressed genes from cDNA microarray data. We apply ANOVA for microarrays and SAM and look to the differentially expressed genes that are lost because of imputation. We show that this new measure provides useful information that the traditional root mean squared error cannot capture. We also show that the type of missingness matters: imputing 5% missing not at random has the same effect as imputing 10-30% missing at random. We propose a new method for imputation (LinImp), fitting a simple linear model for each channel separately, and compare it with the widely used KNNimpute method. For 10% missing at random, KNNimpute leads to twice as many lost differentially expressed genes as LinImp. AVAILABILITY: The R package for LinImp is available at http://folk.uio.no/idasch/imp.