Education differences in sickness absence and the role of health behaviors: a prospective twin study.

BACKGROUND: Long-term sickness absences burden the economy in many industrialized countries. Both educational attainment and health behaviors are well-known predictors of sickness absence. It remains, however, unclear whether these associations are causal or due to confounding factors. The co-twin control method allows examining causal hypotheses by controlling for familial confounding (shared genes and environment). In this study, we applied this design to study the role of education and health behaviors in sickness absence, taking sex and cohort differences into account. METHODS: Participants were two cohorts of in total 8806 Norwegian twins born 1948 to 1960 (older cohort, mean age at questionnaire = 40.3, 55.8% women), and 1967 to 1979 (younger cohort, mean age at questionnaire = 25.6, 58.9% women). Both cohorts had reported their health behaviors (smoking, physical activity and body mass index (BMI)) through a questionnaire during the 1990s. Data on the twins' educational attainment and long-term sickness absences between 2000 and 2014 were retrieved from Norwegian national registries. Random (individual-level) and fixed (within-twin pair) effects regression models were used to measure the associations between educational attainment, health behaviours and sickness absence and to test the effects of possible familial confounding. RESULTS: Low education and poor health behaviors were associated with a higher proportion of sickness absence at the individual level. There were stronger effects of health behaviors on sickness absence in women, and in the older cohort, whereas the effect of educational attainment was similar across sex and cohorts. After adjustment for unobserved familial factors (genetic and environmental factors shared by twin pairs), the associations were strongly attenuated and non-significant, with the exception of health behaviors and sickness absence among men in the older cohort. CONCLUSIONS: The associations between educational attainment, health behaviors, and sickness absence seem to be confounded by unobserved familial factors shared by co-twins. However, the association between health behaviors and sickness absence was consistent with a causal effect among men in the older cohort. Future studies should consider familial confounding, as well as sex and age/cohort differences, when assessing associations between education, health behaviors and sickness absence.

Personality and overweight in 6-12-year-old children.

BACKGROUND: Personality may be an important yet understudied influence on childhood obesity. OBJECTIVE: We investigated the association between children's personality traits and weight status in a sample of 1533 6-12 year olds. METHODS: Mothers rated their child's personality using the Norwegian Hierarchical Personality Inventory for Children, and reported on their child's height and weight. RESULTS: Relative to their normal weight peers, overweight children were rated lower on energy, optimism, compliance, concentration, perseverance, and self-confidence, and higher on egocentricity, irritability, and anxiety. CONCLUSIONS: These findings suggest possible mechanisms to investigate in future research relating personality to childhood obesity.

Exploring causal pathways of child behavior and maternal mental health in families with a child with congenital heart disease: a longitudinal study.

BACKGROUND: A congenital heart defect (CHD) can increase the risk of mental health problems in affected children and their parents. The extent to which risk factors for these problems are shared in families or are specific to the individual family member is unclear. METHOD: Prospective data from the Norwegian Mother and Child Cohort Study (MoBa; n = 93,009) were linked with a nationwide CHD registry, and 408 children with CHD were identified. Mothers' reports on child internalizing problems and their own distress were assessed by questionnaires at child ages 6, 18 and 36 months. A structural model was applied to distinguish between familial (shared) factors and individual-specific factors for mental health problems. RESULTS: CHD was a substantial risk factor for problems in children and their mothers at all time points. CHD contributed on average 31% and 39% to the variance in children's and mothers' problems respectively. Both shared familial and individual-specific factors unique to CHD families contributed to risk for mental health problems. Whereas individual-specific risk factors contributed to the stability of problems in mothers, the effect of these factors lasted only a short time in children. Mutual influences over time were found between the mother's and the child's mental health at 18 and 36 months. CONCLUSIONS: The burden of CHD in a child is shared between family members but is also specific to the individual. This study points to a need for both an individual and a family-based approach to provide psychological support to children with CHD and their parents.

A burst drug release caused by imperfection of polymeric film-coated microparticles prepared by a fluidized bed coater.

The aim of this study was to investigate the drug release from microparticles coated with various polymeric films. Ibuprofen-loaded microparticles with diameter of 250 and 300 microm were prepared by a fluidized bed granulator. Five polymers were used as coating materials, i.e., ethylene vinyl acetate, ethyl cellulose, ethyl cellulose aqueous dispersion, polyethacrylate or Eudragit NE 30D, and carnauba wax. The coating was performed with a fluidized bed coater. Afterwards the coated microparticles were characterized in terms of particle size, morphology, and drug content. The drug dissolution was also investigated in pH 7.4 phosphate buffer. In our attempts for production of extended release ibuprofen microparticles coated with polymeric films, it was shown that the coating process had a significant effect on drug release. The undesired burst release of ibuprofen was observed in all film-coated microparticulate formulations, resulting from the imperfection of coating films.

Symptoms of communication and social impairment in toddlers with congenital heart defects.

BACKGROUND: With the advances in congenital cardiac surgery and medical management, mortality rates for congenital heart defects (CHD) have declined remarkably. As the number of CHD survivors have increased there is a growing focus on developmental morbidity. The objective of the current study is to compare symptoms of communication and social impairment in 18-month-old children with different severity of CHD with those of controls. METHOD: We linked prospective data from the Norwegian Mother and Child Cohort Study, conducted by the Norwegian Institute of Public Health, with a nationwide medical CHD registry and identified 198 18-month-olds with CHD in a cohort of 47,692. Three groups of CHD were distinguished: mild/moderate (n= 122), severe (n= 54) and CHD with comorbidity (n= 22). Mothers reported on the child's communication and social skills by completing items from the Ages and Stages Questionnaire as part of the Norwegian Mother and Child Cohort Study. RESULTS: Children aged 18 months old with CHD differed significantly from controls in levels of symptoms of communication impairment (P≤ 0.0001) and social impairment (P≤ 0.0001). The largest differences were found in children with CHD and comorbidity. Children with severe CHD also showed higher levels of both symptoms of communication and social impairment. Children with mild/moderate CHD showed a small difference only in symptoms of communication impairment. CONCLUSION: Children with severe CHD and CHD with comorbidity show more symptoms of communication and social impairment compared with a large cohort at the age of 18 months. It is important to broaden the scope of inquiry to involve communication and social developmental domains.

Emotional reactivity in infants with congenital heart defects: findings from a large case-cohort study in Norway.

AIM: Advances in medical treatment in recent years have led to dramatically improved survival rates of children with severe congenital heart defects (CHD). However, very little is known about the psychological consequences for these children, particularly during and after the early period of invasive treatment. In this study, we investigated the extent to which the severity of the CHD affects the child's emotional reactivity at 6 months of age. METHOD: We linked prospective data from the Norwegian Mother and Child Cohort Study, conducted by the Norwegian Institute of Public Health with a nationwide medical CHD registry and identified 212 infants with CHD in a cohort of 61 299 infants. Mothers reported on their child's emotional reactivity at age 6 months by means of a standardized questionnaire. RESULTS: Infants with severe to moderate CHD had 60% higher odds for severe emotional reactivity (cut-off at the 85 percentile) compared with healthy infants, after controlling for important maternal and child confounders. CONCLUSION: Our study is the first to show elevated emotional reactivity in children with moderate to severe CHD, suggesting a need for special parental attention to soothe their distress. Follow-up studies will show whether this emotional reactivity is transient or an early marker of continuing emotional or behavioural problems.

Feeding infants with CHD with breast milk: Norwegian Mother and Child Cohort Study.

OBJECTIVE: To explore the prevalence of breast milk feeding (BMF) of infants with congenital heart defects (CHD) during first 6 months of life, as compared with general population. DESIGN: The study is based on a subsample of the Norwegian Mother and Child Cohort Study conducted by Norwegian Institute of Public Health. A total of 60,600 mothers completed a questionnaire about infant feeding at 6 months postpartum. Infants with moderate/severe CHD (n = 131) were identified using nationwide CHD registry. A group of infants with CHD with comorbidity was also defined (n = 65). BMF was classified as predominant, continued, or no BMF. Month to month feeding status was analysed by means of Cox regression analyses. RESULTS: Between child age 2-6 months, mothers of infants with CHD had a hazard ratio (HR) of 1.69 of weaning their child compared with mothers of controls. Mothers of infants with CHD with comorbidity weaned at an even faster rate (HR 3.54). At age 6 months, 9.9% of infants with CHD were fed with breast milk predominately, 64.1% continued to receive breast milk, and only 26% were fed no breast milk. For infants with CHD with comorbidity, corresponding percentages were 7.7%, 43.1% and 49.2%, respectively. CONCLUSIONS: Although CHD alone and particularly CHD with comorbidity increased risk that mothers wean earlier, a relatively high rate of continued breastfeeding was maintained. Future studies should investigate factors that support continued BMF even in the most severely affected children with CHD.

Mothers' negative affectivity during pregnancy and food choices for their infants.

OBJECTIVE: The objective of this study was to analyze whether maternal negative affectivity assessed in pregnancy is related with subsequent infant food choices. DESIGN: The study design was a cohort study. SUBJECTS: The subjects were mothers (N=37 919) and their infants participating in the Norwegian Mother and Child Cohort Study conducted by the Norwegian Institute of Public Health. MEASUREMENTS: Maternal negative affectivity assessed prepartum (Hopkins Symptom Checklist 5 (SCL-5) at weeks 17 and 30 of pregnancy), introduction of solid foods by month 3 and feeding of sweet drinks by month 6 (by the reports of the mothers) were analyzed. RESULTS: Mothers with higher negative affectivity were 64% more likely (95% confidence interval 1.5-1.8) to feed sweet drinks by month 6, and 79% more likely (95% confidence interval 1.6-2.0) to introduce solid foods by month 3. These odds decreased to 41 and 30%, respectively, after adjusting for mother's age, body mass index (BMI) and education. CONCLUSION: The maternal trait of negative affectivity is an independent predictor of infant feeding practices that may be related with childhood weight gain, overweight and obesity.

Child and parental personality are associated with glycaemic control in Type 1 diabetes.

AIM: Little is known about the influence of the personality of the child and the personalities of the child's parents on glycaemic control in Type 1 diabetes. Our objective was to examine the extent to which glycaemic control is associated with the child's and the parents' stable personality traits, using the Big Five personality model as the basic framework. METHODS: Participants were 64 children (aged 6-16 years) with recent-onset Type 1 diabetes and their parents. Glycaemic control (HbA(1c)) was assessed at 6 months, 1 year and 2 years after diagnosis; personality was assessed at 4-6 weeks, 6 months and 1 year after diagnosis. Associations of personality with mean HbA(1c) over 2 years were examined. RESULTS: Children with better glycaemic control had a personality pattern of high Agreeableness, high Conscientiousness and low Neuroticism. Mothers of children with better glycaemic control showed a similar personality pattern, whereas the personality of the father was only marginally related to glycaemic control. Children's Conscientiousness and mothers' Agreeableness together predicted 18% of the variability in mean HbA(1c). All associations were unchanged when we controlled for child's age. CONCLUSIONS: Glycaemic control in the child was associated with the same child and maternal personality characteristics that influence treatment adherence, health-promoting behaviours and general adjustment in adult populations. In future, studies are needed to examine attitudinal and behavioural mediators of this relationship. It is suggested that attention to the personalities of the child and the mother can help to tailor diabetes education to the individual child.

[Laryngomalacia. Definition, diagnosis and therapy]. / Laryngomalazie. Definition, Diagnose und Therapie.

Laryngomalacia, a rarely mentioned clinical entity in the German literature, is reviewed in this article. The clinical picture, diagnostics and pathogenesis are presented. The prognosis is favorable. Usually the inspiratory stridor disappears after the second year of life in most of the children. However, 7-22% of those involved develop life threatening symptoms which require surgical intervention. We performed laser supraglottoplasty, the method of choice, on five children with severe laryngomalacia. Intraoperative pre and post surgical findings and the surgical procedure are documented. The abnormally enlarged cuneiform cartilages within the aryepiglottic folds were the striking morphological feature in all of our cases. Inspiratory collapse affected only these structures. After laser supraglottoplasty, all of our children were immediately free of symptoms. Because of this high success rate, which is also reflected in literature, we recommend children with severe symptoms to have early surgery, thus preventing troublesome months in expectation of a spontaneous recovery.

The alcohol-related accident risk in Germany: procedure, methods and results.

This paper presents the first reliable estimation of the alcohol-related accident risk in Germany by comparing a representative sample of accidents to a representative sample of trips not leading to a crash. The information about the trips was taken from the German Roadside Survey 1992-1994 (n=9087) conducted in Unterfranken, part of Bavaria. These data were weighted according to a representative study of driving in Germany (KONTIV 89). The accident study comprises a representative sample of accidents in Unterfranken in 1993 (n=1968). Relating accident risk to BAC, the global risk function indicates an exponential increase of accident risk for BACs above 0.05%. Controlling for correlating factors leads to an overall lower estimation with, however, the same structure, indicating that alcohol is consumed by drivers in circumstances which further increase the risk introduced by alcohol. Analyzing the attributable risk (AR) shows that about 12% of all accidents are attributable to alcohol. Over 96% of these happen with BACs of 0.05% and above. Thus, measures aimed at reducing the alcohol-related accident risk must focus on larger BACs, especially of 0.08% and above.

Predictors of coping strategy selection in paediatric patients.

AIM: To assess the prevalence of specific coping strategies and predictors of coping strategy selection in 179 patients (mean age = 10.2 y). The children were investigated one month after the occurrence of an accident (n = 105), diagnosis of cancer (n = 26) or diagnosis of diabetes mellitus type I (n = 48). RESULTS: Patients used a great variety of coping strategies. The most frequent strategies were cognitive avoidance, positive cognitive restructuring and avoidant actions. The strategies of seeking problem-focused support and emotion-focused support were rarely used. Diagnostic category, length of hospital stay, and gender were not associated with coping strategy use. Age, socioeconomic status and functional status of the patient were found to predict coping strategy selection. Younger children made less use of active coping, distraction and seeking support. Patients of lower socioeconomic status used religious coping strategies significantly more often, whereas patients with lower functional status used avoidance and support-seeking strategies more often. CONCLUSION: In this study it was found that paediatric patients used a wide variety of coping strategies, irrespective of diagnosis and gender. Age of the child and functional status were the most important predictors of coping strategy selection.

[The transactional stress model for the animal keeper]. / Transaktionales Stressmodell beim Tierhalter.

A health problem of an animal or a group of animals represents a potential stress situation for the animal keeper. In this article, the transactional stress model, which was developed in social psychology was applied on the animal keeper and shows, how he perceives the influence of animal care. If veterinary help is considered relevant, it may lead to an improved coping, which affects the health of the animal keeper and the animal as well. This viewpoint leads to a cycle, in which cause, success, coping and utility are closely linked together.

Personality and stress.

Recent years have witnessed an upsurge of interest in how personality affects the stress process. This paper reports on a broad spectrum of findings on the relationships between personality and stress, taking transactional stress theory as the point of departure. A first part outlines the different approaches stress research has taken within personality psychology as opposed to research based on transactional stress theory and discusses the debate between these two paradigms. The second part gives an overview of empirical findings, with a focus on the Big Five personality factors, in order to demonstrate that personality affects the stress process in every aspect. The discussion suggests that we address unresolved problems of transactional stress research in the framework of interactionist personality psychology. Special attention ought to be given to developing a better understanding of situational characteristics, stress-producing mechanisms, and the functions of situational choices and coping strategies for personality.

Detecting intoxicated drivers in Germany -- estimating the effectiveness of police tests.

The most important prerequisite for deterring people from driving while intoxicated is to persuade them of the likelihood of being detected by the police. Detection requires the police (1) to stop intoxicated drivers and (2) to detect the intoxication. The latter is not a simple task in Germany as the police is only allowed to obtain a breath sample when indications of an intoxication are present. The paper estimates the effectiveness of police tests in detecting intoxicated driving by comparing data from the German Roadside Survey and the Unterfranken Accident Study to a study of usual police routine and to official accident statistics. Both the German Roadside Survey and the Unterfranken Accident study were conducted in such a way that breath alcohol testing was carried out for nearly every driver, thus giving an estimate of the number of intoxicated trips and accidents in Germany. Comparing these numbers to the intoxicated trips and accidents detected by the police allows a detailed analysis of different components of detection. From those, suggestions are given for increasing the effectiveness of police work.

[Surgery of acquired laryngotracheal stenoses in childhood. Experiences and results from 1988-1998. II: The cricotracheal resection]. / Die Chirurgie der erworbenen laryngotrachealen Stenosen im Kindesalter. Erfahrungen und Ergebnisse von 1988-1998. Teil II: Die cricotracheale Resektion.

Approximately 90% of infants and children with severe acquired laryngotracheal stenoses are tracheotomy dependent and therefore impaired in their physical and speech developments. In addition, tracheotomized infants can be endangered by the cannula due to the possible crusting of secretions or its dislocation. Thus, early repair of a stenosis is mandatory. Within the last 10 years, we successfully operated on 18 children with severe laryngotracheal stenoses. Ten children were treated with a modified Cotton technique. This paper reports our results of cricotracheal resection performed in 8 children since 1994 (age distribution: 7 months through age 15 years). Four children had Cotton grade II stenoses, three had grade III stenoses and one grade IV stenoses. In 3 patients a tracheotomy had been performed at another institution. Since their tracheostomas were too far caudal, they could not be included in the primary resection. All 8 children have been successfully decannulated. Five children without tracheotomies could be extubated uneventfully on the 5th postoperative day. All three primarily tracheotomized children needed further endotracheal stenting with T-tubes because of stomal and suprastomal collapse. Two of these latter children additionally required a tracheoplasty with rib cartilage grafts in order to stabilize the suprastomal trachea prior to decannulation. No patient experienced injuries to the recurrent laryngeal nerves or insufficiencies of the anastomosis. All children's voices were not impaired. This is the third report in literature of cricotracheal resections in infants and children, indicating that this effective, one-stage procedure is superior to laryngotracheal reconstruction with rib cartilage.

[Surgery of acquired laryngotracheal stenoses in childhood. Experiences and results from 1988 to 1998. I: Laryngotracheal reconstruction]. / Die Chirurgie der erworbenen laryngotrachealen Stenosen im Kindesalter. Erfahrungen und Ergebnisse von 1988 bis 1998. Teil I: Die Laryngotracheale Rekonstruktion.

Subglottic laryngotracheal stenosis represents the most severe intubation injury and is increasingly encountered in children due to long-term ventilation during intensive care treatment. Since more than 90% of these children have tracheostomies their physical, psychosocial and speech development can be greatly impaired. A tracheostomy in infants can also be a potentially life-threatening condition, making necessary resolution of the laryngotracheal stenosis and removal of the tracheostoma as soon as possible. During the past 10 years, we have treated 46 children with laryngotracheal problems, including 18 children with severe laryngotracheal stenosis. Ten children (3 with grade II stenosis and 7 with grade III stenosis) were treated by laryngotracheal reconstruction using an anterior rib cartilage graft as described by Cotton. One child with posterior glottic stenosis required a posterior laminotomy with a second rib cartilage graft. Differing from the original method, we stabilized the enlarged endotracheal lumen postoperatively with a Montgomery t-tube. This was kept in place for 10 months on average (shortest period, 6 months; longest period, 12 months). All 10 children could be decannulated, and the tracheostoma closed. Three of the children were operated in other institutions and had a different technique prior to our intervention. Two of our operations failed initially. However, both patients were treated successfully by a second intervention (which was the fourth operation for one of the patients). The reasons for our modification, the operative technique and tips for postoperative management, as well as possible pitfalls and complications, are discussed.

Stimulus processing by type II hair cells in the mouse utricle.

In type II and neonatal hair cells in the mouse utricle, the receptor potentials evoked by low-frequency sinusoidal deflections of the hair bundle are attenuated by adaptation of the mechanoelectrical transduction current and the voltage-dependent activation of a large potassium (K)-selective outwardly rectifying conductance, gDR. These processes may contribute to high-pass filtering of the responses of some utricular afferents to sinusoidal linear accelerations below 2 Hz. Depolarizing receptor potentials are more attenuated by gDR than are hyperpolarizing receptor potentials. It may therefore reduce nonlinear distortion introduced by mechanoelectrical transduction, which generates larger depolarizing currents than hyperpolarizing currents. The discharge properties of utricular afferents vary according to whether they innervate the striolar or extrastriolar zones of the sensory epithelium. Regional variation in hair-cell properties is likely to contribute. Preliminary results suggest that the outwardly rectifying K conductances of type II cells are slower and larger in the striola than in the extrastriola, consistent with regional variation in the relative numbers of delayed rectifier and A-current K channels.

Math1: an essential gene for the generation of inner ear hair cells.

The mammalian inner ear contains the cochlea and vestibular organs, which are responsible for hearing and balance, respectively. The epithelia of these sensory organs contain hair cells that function as mechanoreceptors to transduce sound and head motion. The molecular mechanisms underlying hair cell development and differentiation are poorly understood. Math1, a mouse homolog of the Drosophila proneural gene atonal, is expressed in inner ear sensory epithelia. Embryonic Math1-null mice failed to generate cochlear and vestibular hair cells. This gene is thus required for the genesis of hair cells.

Coping styles predict change in personality disorders.

The present follow-up study is the first to investigate whether dispositional coping styles prospectively influence change in the Millon Clinical Multiaxial Inventory (MCMI-II) personality disorders. The sample consisted of 155 psychiatric outpatients who where investigated twice--namely six and seven years after their admission to the clinic. Coping styles prospectively predicted change in most of the MCMI-II personality disorders, whereas sex and age did not affect the outcome. The use of problem-focused coping and the seeking of social support improved the patient levels on the MCMI-II personality disorder scores. Dysfunctional coping styles such as selfdistraction, disengagement, use of alcohol or drugs, and venting of emotions, however, aggravated the patient MCMI-II personality disorders. Furthermore, the effects of coping patterns tended to be specific for single personality disorders.