Health, economy and social capital in Nordic children and their families: a comparison between 1984 and 1996.

OBJECTIVE: The aim of the study was to analyse the development in the health of children that occurred in the five Nordic countries (Denmark, Finland, Iceland, Norway and Sweden) between 1984 and 1996 and relate it to the changes in economic growth and social capital in these countries during the same period. METHODS: Two cross-sectional studies covered a representative sample of children, aged 2-17 years in each country, a total of 10,291 in 1984 and 10,317 in 1996. The data were collected by mailed questionnaires. Statistical associations between a health indicator (the absence of psychosomatic complaints), economic indicators (social class, housing and disposable income) and social capital indicators (parents' and children's organized group activities, parents playing with their children and the absence of bullying) within samples and between corresponding values in different samples across subgroups (defined by country and area of residence) were evaluated using multiple linear regression. RESULTS: In both surveys, there was a statistically highly significant association between the health indicator and the social capital indicators, whereas the economy indicators were not related to either of the other two types of measure. Change in health was associated positively with change in social capital and negatively with change in economy. CONCLUSION: The study provides strong support for the concept of social capital as an important determinant of children's health.

Social equalization in the health of youth. The role of the school.

BACKGROUND: A study was made of the role of the school in the process of social equalization in the health of pre-adolescents and adolescents in the city of Bern, Switzerland. METHODS: Questionnaire data obtained from 578 13-year-olds and 476 15-year-olds within the frame of the evaluation of a health-promoting schools project were transformed to 30 indicators of well-being at school, health, emotional well-being, life-skills, and health behaviour and attitudes. RESULTS: Multiple logistic regression with gender, social class, ethnicity, and school climate as independent variables revealed the disappearance of social gradients by 15 years of age and the emergence of new inequalities related mainly to gender and school climate. CONCLUSIONS: The school contributes to the social equalization of the health of adolescents but creates at the same time new disparities, with probably long-lasting consequences. The factors determining the school climate have to be studied more in depth.

[Arguments and basic principles for continuous monitoring of social differences in the health of Swiss children]. / Argumente und Grundlagen für eine kontinuierliche Erfassung sozialer Unterschiede in der Gesundheit der Schweizer Kinder.

On the basis of the thesis that social inequality has increased during the nineties in all western societies, and that this development is a reason for considerable concern with respect to public health, the authors propose the establishment of a long term monitoring system within the Swiss school health services. A re-analysis of the data obtained in a Swiss epidemiological study of seven-year-olds in the eighties demonstrates that social class was an important determinant of health and development of these children also during a period of economic boom. For various health and developmental problems odds-ratios (lower class vs. upper class) between 1.7 and 6.4 were found. Social class of the parents is considered as a reliable indicator of the socio-economic situation of children also for future long term observations. The number of significant somatic health problems as well as disorders of motor and speech development of six- or seven-year-olds are proposed as indicators of health status which can be assessed repeatedly at reasonable cost and with standardised methodology. This project could be started rather easily within the newly established Swiss "Health Observatory".

Effect of environmental tobacco smoke exposure on respiratory symptoms in children. SCARPOL Team. Swiss Study on Childhood Allergy and Respiratory Symptoms with Respect to Air Pollution, Climate and Pollen.

AIMS: This study determines the prevalence of exposure to environmental tobacco smoke and its relation to respiratory and allergic symptoms among schoolchildren in Switzerland. METHODS: We studied 4470 children aged 6-14 years as part of a multicentre study (SCARPOL study--Swiss Study on Childhood Allergy and Respiratory Symptoms with Respect to Air Pollution, Climate and Pollen) conducted in Switzerland between 1992 and 1993. Environmental tobacco smoke exposure, maternal smoking during pregnancy and respiratory symptoms were assessed by means of a self-administered parental questionnaire. RESULTS: Forty-seven percent of all children were exposed to environmental tobacco smoke. Sixteen percent of the mothers smoked during pregnancy. Children exposed to environmental tobacco smoke at home had an increased risk of respiratory infections (odds ratio (OR) 1.19, 95% confidence intervals (CI) 1.03, 1.37). The risk increased if they were exposed to maternal smoking (OR 1.25, CI 1.06, 1.48) and if the mother also smoked during pregnancy (OR 1.42, CI 1.14, 1.76). Wheezing (OR 1.36, CI 1.03, 1.80) and repeated coughing (OR 1.36, CI 1.14, 1.61) were only associated with maternal smoking. Children exposed to more than 20 cigarettes per day were at highest risk for respiratory problems. CONCLUSION: Almost half of all schoolchildren in Switzerland, especially those from lower socioeconomic classes, are exposed to environmental tobacco smoke. Children with environmental tobacco smoke exposure suffer significantly more often from respiratory symptoms. Maternal smoking during pregnancy additional to current smoking further increases the risk of respiratory morbidity. These findings underline the importance of prevention strategies to reduce the prevalence of smoking and its impact on children's health.

Prevalence of hay fever and allergic sensitization in farmer's children and their peers living in the same rural community. SCARPOL team. Swiss Study on Childhood Allergy and Respiratory Symptoms with Respect to Air Pollution.

INTRODUCTION: Lower prevalence rates of allergic diseases in rural as compared with urban populations have been interpreted as indicating an effect of air pollution. However, little is known about other factors of the rural environment which may determine the development of atopic sensitization and related diseases. OBJECTIVE: The authors tested the hypothesis that children growing up on a farm were less likely to be sensitized to common aerollergens and to suffer from allergic diseases than children living in the same villages but in nonfarming families. MATERIALS AND METHODS: Three age groups of schoolchildren (6-7 years, 9-11 years, 13-15 years) living in three rural communities were included in the analyses. An exhaustive questionnaire was filled in by 1620 (86.0%) parents. A blood sample was provided by 404 (69.3%) of the 13-15 year olds to determine specific IgE antibodies against six common aeroallergens. RESULTS: Farming as parental occupation was reported for 307 children (19.0%). After adjustment for potential covariates such as family history of asthma and allergies, parental education, number of siblings, maternal smoking, pet ownership, indoor humidity and heating fuels, farming as parental occupation was significantly associated with lower rates of sneezing attacks during pollen season (adjusted OR 0.34, 95% CI 0.12-0.89) and atopic sensitization (adjusted OR 0.31, 95% CI 0.13-0.73) whereas the association with wheeze (adjusted OR 0.77 95% CI 0.38-1.58) and itchy skin rash (adjusted OR 0.86, 95% CI 0.49-1.50) was not statistically significant. The risk of atopic sensitization was lower in children from full-time farmers (adjusted OR 0.24, 95% CI 0.09-0.66) than from part-time farmers (adjusted OR 0.54, 95% CI 0.15-1.96). CONCLUSION: Factors directly or indirectly related to farming as parental occupation decrease the risk of children becoming atopic and developing symptoms of allergic rhinitis.

Comparison of responses to an asthma symptom questionnaire (ISAAC core questions) completed by adolescents and their parents. SCARPOL-Team. Swiss Study on Childhood Allergy and Respiratory Symptoms with respect to Air Pollution.

The primary objective of the study was to determine the impact of the identity of the respondent (parents versus adolescents) on prevalence estimates of asthma symptoms in Swiss adolescents. In addition, factors influencing agreement between parents' and adolescents' responses to the same questions were analysed. One thousand three hundred and seventy-four (78.4%) adolescents, aged 14 years, self-completed a questionnaire at school based on the International Study of Asthma and Allergy in Childhood (ISAAC) core questions on wheezing and asthma. The same questions were incorporated into a questionnaire to be completed by the parents at home. The adolescents' self-reported prevalence rates of current asthma symptoms and "asthma ever" were significantly higher than those obtained from the parental questionnaires. 856 (62.6%) parental questionnaires were filled in by parents without the help of the adolescents, 460 (37.4%) were completed by parents and adolescents and 51 (3.7%) were completed by the adolescents without the parents. Prevalence rates were higher when parents and adolescents completed the questionnaire jointly than when questionnaires were completed by parents alone. The level of agreement between parental and self-completed questionnaires was moderate to low (kappa coefficients 0.22-0.68). Agreement between parental and adolescents reports of asthma symptoms was best when questionnaires were completed jointly by parents and adolescents, when the adolescent was a girl, when a family history of asthma was recorded, when the adolescent was a non-smoker, and when the parental education was high. We conclude that the higher reporting of prevalence rates of current asthma symptoms by adolescents compared to reporting by their parents demonstrates the need to take the respondent to a questionnaire into account when comparisons are made between prevalence studies. The results also suggest that factors related to the family milieu influence symptom reporting.

Validation of a rhinitis symptom questionnaire (ISAAC core questions) in a population of Swiss school children visiting the school health services. SCARPOL-team. Swiss Study on Childhood Allergy and Respiratory Symptom with respect to Air Pollution and Climate. International Study of Asthma and Allergies in Childhood.

UNLABELLED: The primary aim of the study was to assess the validity of the ISAAC core questions on rhinitis in a population of Swiss school children by comparing them to skin prick test results. Second, the positive predictive value in detecting atopy among children with rhinitis symptoms was determined. Third, agreement between parental reports of hay fever and rhinitis symptoms was evaluated, since earlier Swiss prevalence surveys had exclusively relied on reported hay fever. MATERIAL AND METHODS: Two thousand nine hundred and fifty-four (81.2%) parents of 7, 10 and 14-year old children filled in an exhaustive questionnaire which included the ISAAC core questions on rhinitis. Two thousand one hundred and twenty children also underwent skin prick testing against six common aeroallergens (grass mixture, birch, mugwort, D. pteronyssinus, cat and dog dander). The analysis is restricted to children with both questionnaire data and skin prick test results. RESULTS: Sensitization to any allergen was most strongly associated with reported hay fever (OR = 5.7, 95% CI 4.4-7.4), nose problems accompanied by itchy-watery eyes (OR = 4.4, 95% CI: 3.3-5.7), symptoms occurring only during pollen season (March through September) (OR = 4.9, 95% CI: 3.6-6.5) and a combination of these latter two symptoms (OR = 5.8, 95% CI: 4.1-8.1). The association was stronger for a sensitization to outdoor allergens than for indoor allergens. The specificity of the various questions was high, ranging from 77.5% to 97.6%, but the sensitivity was low (2.6% to 42.7%). The positive predictive value for atopy among children with symptoms was 63% for sneezing accompanied by itchy-watery eyes, 67% for symptoms occurring only during the pollen season and 70% for reported hay fever. However, agreement between reported rhinitis symptoms and hay fever was only moderate. About one third of the children with symptoms indicative of seasonal rhinitis did not report the label "hay fever". CONCLUSIONS: We conclude from our analyses that the ISAAC core questions on rhinitis are highly specific and therefore useful in excluding atopy. In addition they have a high positive predictive value in detecting atopy among children with symptoms, but they are not helpful for detecting atopy in a general population of children (low sensitivity). To monitor time trends in the prevalence of allergic rhinitis in Switzerland, questions on rhinitis symptoms as well as on the diagnostic label "hay fever" have to be included in a questionnaire because they contain complementary information since under-diagnosis of allergic rhinitis is common.

Respiratory health and long-term exposure to air pollutants in Swiss schoolchildren. SCARPOL Team. Swiss Study on Childhood Allergy and Respiratory Symptoms with Respect to Air Pollution, Climate and Pollen.

The impact of long-term exposure to air pollution on respiratory and allergic symptoms and illnesses was assessed in a cross-sectional study of schoolchildren (ages 6 to 15 yr, n = 4,470) living in 10 different communities in Switzerland. Air pollution measurements (particulate matter less than 10 microns in diameter [PM10], nitrogen dioxide [NO2], sulfur dioxide [SO2], and ozone) and meteorologic data were collected in each community. Reported symptom rates of chronic cough, nocturnal dry cough, and bronchitis, adjusted for individual risk factors, were positively associated with PM10, NO2, and SO2. The strongest relationship was observed for PM10 (adjusted odds ratios for chronic cough, nocturnal dry cough, and bronchitis between the most and the least polluted community for PM10 were 3.07 [95% CI: 1.62 to 5.81], 2.88 [95% CI: 1.69 to 4.89], and 2.17 [95% CI: 1.21 to 4.89], respectively). The high correlation between the average concentrations of the pollutants makes the assessment of the relative importance of each pollutant difficult. No association between long-term exposure to air pollution and classic asthmatic and allergic symptoms and illnesses was found. There was some indication that frequency of fog is a risk factor of chronic cough and bronchitis, independent of air pollution. In conclusion, this study provides further evidence that rates of respiratory illnesses and symptoms among children augment with increasing levels of air pollution even in countries like Switzerland with moderate average air pollution concentrations.

Regulation of galanin by dexamethasone in the rat anterior pituitary and the uterus.

Galanin is a 29 amino acid neuropeptide widely distributed throughout the mammalian nervous and endocrine system. We have previously reported that estrogen dramatically increases galanin gene expression and protein synthesis in the anterior pituitary (AP), while the expression in the uterus (UT) of the same animals is transient and similar to the induction of protooncogenes (c-fos, c-jun, c-myc). In order to examine if this pattern of induction is specific to estrogen administration, we investigated the effect of glucocorticoids, another steroid, on the gene expression of galanin in the AP and in the UT of ovariectomized female rats and in the AP of male rats. Using Northern blot analysis, the AP and the UT showed almost undetectable levels of galanin mRNA, but in vivo treatment of female rats with 1 mg/kg body weight of dexamethasone (DEX) led to a significant increase of galanin mRNA levels in both AP and UT. Similarly, DEX (0.1-5 mg/kg i.p.) significantly stimulated galanin mRNA levels in the AP of the male rats. In both males and females the peak of induction was at 9 h after injection that is different from the 3-hour peak after estrogen administration. Daily injection of DEX for up to 7 days sustained the levels of galanin mRNA in both the AP and the UT, in contrast to the transient induction of galanin in the UT after estrogen administration. No change was noted in the galanin protein content of AP (control = 30 +/- 3.5 ng/mg protein; DEX treated = 38 +/- 4.2 ng/mg protein). Interestingly, in the UT of ovariectomized rats the combination of DEX and DES (diethylstilbestrol) treatment for 2 days resulted in a synergistic stimulation of galanin mRNA. In summary, these data demonstrate a tissue- and steroid-specific regulation of the galanin gene in AP and UT and suggest that DEX regulates the galanin gene possibly through a pathway different from estrogen.

Identification of macroprolactin in a patient with asymptomatic hyperprolactinemia as a stable PRL-IgG complex.

We characterize the molecular form of PRL in a female patient with asymptomatic, idiopathic hyperprolactinemia. Size exclusion chromatography revealed that PRL was present exclusively in the form of macroprolactin (> 200 kD mol wt). By immunoaffinity purification, Western blot analysis, and binding studies the molecule was identified as a PRL-IgG complex of extremely high stability. Sequence analysis revealed no mutations in the protein coding region of the hPRL gene using hPRL cDNA amplified from the patient's peripheral blood lymphocytes. In spite of full bioactivity in vitro, as determined by Nb2 bioassay, the complex apparently lacks bioactivity in vivo. Its high molecular weight may reduce its access to target organs in the periphery as well as centrally.

[School and child health]. / Die Schule und die Gesundheit des Kindes.

A roundtable discussion involving 2 educators and 4 pediatricians with widely varying experience sounded out the negative (pathogenic) and positive (healthy) influences to which a child is exposed in school and which decisively shape his/her physical, mental and psychic development. Concrete case reports and a systematic compilation of harmful factors show that this institution poses major threats to children's health of which pediatricians should be aware. An important cause of childhood suffering is the discrepancy between the uniform and inflexible institutional structures and the variability of children's needs conditioned by biology and social origin. Between ideal visions and the consequent school structures on the one hand, and social reality on the other hand, there are notable contradictions which must be recognized, lived with and--if possible--resolved by reforms. If he believes in the reformability of school, the pediatrician can make essential contribution to promoting health during school age.

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.

Rat prolactin-like protein A partial gene and promoter structure: promoter activity in placental and pituitary cells.

Rat prolactin-like protein A (rPLP-A) is a member of a rapidly expanding family of prolactin-related proteins that are expressed during pregnancy by the rat placenta according to specific developmental patterns. Although the factors involved in the pituitary-specific expression of the prolactin and growth hormone genes themselves have been extensively studied, essentially nothing is known of the factors responsible for the placental expression of these new family members. In this paper we describe the isolation of rPLP-A genomic clones, analyze a portion of the 5' flanking sequence of this gene and use the recently described rat choriocarcinoma cell line, Rcho, in transient transfection studies to show that a 975 base-pair (bp) fragment of 5' flanking sequence is sufficient to specify placental expression of the rPLP-A gene.

Steroids and tissue-specific modulation of galanin gene expression in the male rat reproductive system.

Galanin is a neuropeptide widely distributed throughout the vertebrate neural and endocrine system. Galanin can influence pituitary hormone secretion, intestinal motility, and other biological activities. The precise physiological role of galanin is unknown. We studied the control of galanin gene expression in peripheral organs in the male rat using Northern blot and in situ hybridization techniques. In the adrenals and prostate, galanin mRNA was undetectable in the controls and did not change after the administration of dexamethasone (0.0001-10.0 mg/kg, ip) and diethylstilbestrol (0.1 mg/kg, ip). In the testis, thymus, seminal vesicles, medial basal hypothalamus, and colon, galanin message was detectable, but was not influenced by steroids. On the other hand, dexamethasone (0.5-10.0 mg/kg) was very effective in enhancing galanin expression in the vas deferens and epididymis (4- to 7-fold in the vas deferens), with a peak 6-9 h after the treatment. Diethylstilbestrol (0.1 mg/kg) stimulated galanin mRNA transcription only in the vas deferens (2- to 3-fold), with a peak 1-3 h after the treatment. Dihydrotestosterone treatment (0.2-0.4 mg/kg) was ineffective in all tissues examined. In the vas deferens and seminal vesicles, galanin mRNA has been localized at a cellular level by in situ hybridization. In these tissues only fibroblast-like cells contained the message. These data demonstrate that galanin is expressed in the male rat reproductive system and that steroid hormones participate in the control of galanin gene expression in a tissue- and hormone-specific fashion.

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.