Gender differences in risk-taking behaviour in youth with epilepsy: a Norwegian population-based study.

OBJECTIVES: It is well known that behavioural problems and psychiatric disorders occur with greater prevalence in children and adolescents with epilepsy. Youth with epilepsy (YWE) may also be more susceptible to risk-taking behaviour, but this has seldom been studied. The aim of this study was to explore risk-taking behaviour in YWE. MATERIAL AND METHODS: In this study, 19,995 young people (age range: 13-19 years) participated and completed an extensive questionnaire, including The Strengths and Difficulties Questionnaire self-report. A variable, risk-taking behaviour, was identified, including daily consumption of alcohol, substance abuse or having committed a criminal offence such as being in a fight with a weapon, committing a burglary or using threats to obtain money. RESULTS: Two hundred and forty-seven youths reported currently having, or having had, epilepsy (lifetime prevalence: 1.2%). Of these, 8.3% reported daily alcohol consumption (1.0% in controls; P<0.001), 12.4% had tried illegal substances (5.5% of controls; P<0.001), and 19.7% had committed criminal offences (8.5% in controls; P<0.001). A gender difference was found: girls with epilepsy did not exhibit risk-taking behaviour more frequently than controls, but having epilepsy was a risk factor for such behaviour in boys (OR: 3.2). CONCLUSION: Boys with epilepsy exhibit risk-taking behaviour more frequently than controls. Other risk factors for this behaviour were living with a single parent, low family income and psychiatric symptoms. This behavioural association should be addressed as it probably contributes to the negative social outcomes that frequently occur in the adult epilepsy population.

Children are reliable reporters of common symptoms: results from a self-reported symptom diary for primary school children.

BACKGROUND: Collecting information on subjective symptoms in children by parental reports or physician's interview is indirect and not suited for prospective data collection over extended time periods. AIM: To examine the reliability of a diary for symptom self-reports by primary school children. METHODS: Children aged 7-8 or 11-12 were recruited from primary school and a paediatric outpatient department. A picture-based symptom diary was completed individually. Children were asked about presence of 10 specified subjective symptoms for five time periods covering the previous 24 h. The diary was completed twice for test-retest and answers were compared with semi structured physician's interviews. RESULTS: Test-retest reliability for reporting a symptom during the previous 24 h gave reliable kappa values of 0.64-0.91. Comparison with physician's interview gave kappas of 0.18-0.68. Requiring correct time of day for each symptom reduced reliability and validity. Kappa values for test-retest and child-physician agreement for the individual symptoms were respectively: sneezing, 0.80 and 0.30; sore throat, 0.89, 0.30; tiredness, 0.88, 0.65; headache, 0.64, 0.66; runny nose, 0.91, 0.68; sore eyes, 0.67, 0.18; cough, 0.73, 0.58; stomach ache, 0.69, 0.45. CONCLUSION: Our symptom diary gives reliable self-report data from primary school children. It may be used for prospective symptom monitoring.

Agreement of a child's respiratory symptom diary with parental reports and peak expiratory flow.

OBJECTIVE: To assess the agreement of a self-completed diary to monitor respiratory symptoms in children aged 6-12 years with parental symptom reports and fluctuations in lung function. DESIGN: We created a text- and symbol-based questionnaire for daily completion by children at school. Using a screening questionnaire completed by the parents, we selected 101 children with lower respiratory symptoms in the last year or doctor-diagnosed asthma to complete the diary. We assessed the agreement with a parent-completed daily symptom diary and measurements of peak expiratory flow (PEF) over 5 weeks, estimating % agreement and the kappa statistic (kappa) for pairwise comparisons. RESULTS: Simple agreement between PEF variability, parent-reported and child-reported symptoms was moderate to high. Using kappa, agreement between children's and parents' reports of respiratory symptoms was only fair to moderate, and agreement with lung function measurements was poor for both parent- and child-reported symptoms. CONCLUSION: Agreement between children's and parents' reports on day-to-day respiratory symptoms was fair to moderate. The children's symptom diary agreed poorly with lung function measurements, but was neither worse nor better than the parent-completed diary.

Cognitive behavioural therapy for men who physically abuse their female partner.

BACKGROUND: In national surveys between 10 % and 34 % of women have reported being physically assaulted by an intimate male partner. Cognitive behavioural therapy (CBT) or programmes with elements of CBT are frequently used treatments for physically abusive men. Participants either enroll voluntarily or are obliged to participate in CBT by means of a court order. CBT not only seeks to change behaviour using established behavioural strategies, but also targets the thinking patterns and beliefs that are thought to contribute to violence. OBJECTIVES: To measure the effects of CBT and similar interventions on men's physical abuse of their female partners. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register (CENTRAL), C2-SPECTR, MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, Care Data/Social Care Online, Sociological Abstracts, Criminal Justice Abstracts, Bibliography of Nordic Criminology (all to late 2006), and SIGLE to 2003. Santé mentale au Québec was handsearched from 1976 to 2003 and reference lists of articles. We also contacted field experts and the authors of included studies. SELECTION CRITERIA: Randomised controlled trials (including cluster-randomised and quasi-randomised trials) of cognitive behavioural therapy with men who physically abuse their partners and reporting effects on continued violence. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial quality and extracted data. We contacted study authors for additional information. MAIN RESULTS: Six trials, all from the USA, involving 2343 people, were included. A meta-analysis of four trials comparing CBT with a no-intervention control with 1771 participants, reported that the relative risk of violence was 0.86 (favouring the intervention group) with a 95% confidence interval (95% CI) of 0.54 to 1.38. This is a small effect size, and the confidence interval is so wide that there is no clear evidence for an effect. One study (Wisconsin Study) compared CBT with process-psychodynamic group treatment and found a relative risk of new violence of 1.07 (95% CI 0.68 to 1.68). Even though the process-psychodynamic treatment did marginally better than CBT, this result is also equivocal. Finally, one small study (N = 64) compared a combined treatment for substance abuse and domestic violence (SADV) with a Twelve-Step Facilitation (TSF) group. An analysis involving 58 participants investigated the effect on reduction in frequency of physical violence episodes. The effect size was 0.30 (favouring TSF) with 95% confidence interval from -0.22 to 0.81. AUTHORS' CONCLUSIONS: There are still too few randomised controlled effect evaluations to conclude about the effects of cognitive behaviour therapy on domestic violence.

PM10 elemental composition and acute respiratory health effects in European children (PEACE project). Pollution Effects on Asthmatic Children in Europe.

The ability of particles with a 50% cut-off aerodynamic diameter of 10 microm (PM10) to cause respiratory health effects possibly depends on their composition. This study evaluated whether the soluble elemental concentrations in PM10 were related to acute respiratory health effects. The Pollution Effects on Asthmatic Children in Europe (PEACE) study is a multicentre study of the acute effects of PM10 and other air pollution components on the respiratory health of children with chronic respiratory symptoms in urban and suburban panels. Children, 1208, divided among 17 panels were followed for > or =2 months. Exposure to air pollution was monitored on a daily basis. Health status was monitored by twice daily peak expiratory flow (PEF) measurements and a symptom diary. Median concentrations of iron ranged 105-1,110 ng x m(-3) in the urban and 32-517 ng x m(-3) in the suburban locations. The daily concentrations of most elements were not associated with daily variation in PEF, prevalence of respiratory symptoms or bronchodilator use. Silicon and iron concentrations tended to be negatively associated with PEF, and positively associated with the prevalence of phlegm. In two pollutant models, PM10 effect-estimates on phlegm prevalence were reduced and lost significance, whereas the effect-estimates of iron or silicon remained essentially unchanged. The effects of silicon and iron could not be separated. In conclusion, this study provides only weak support for the hypothesis that daily fluctuations in soluble elemental concentrations in ambient particulate matter are responsible for acute health effects.

Inhomogeneity in response to air pollution in European children (PEACE project).

OBJECTIVES: The PEACE study is a multicentre panel study of the acute effects of particles with a 50% cut off aerodynamic diameter of 10 microns (PM10), black smoke (BS), sulphur dioxide (SO2), and nitrogen dioxide (NO2) on respiratory health of children with chronic respiratory symptoms. In the complete panels no consistent association between air pollution and respiratory health was found. The study evaluated whether potentially more sensitive subgroups in the panels did show effects of air pollution. METHODS: To evaluate heterogeneity in response to air pollution, effect estimates of air pollution on peak expiratory flow (PEF) and respiratory symptoms were calculated in subgroups based on presence of chronic respiratory symptoms, use of respiratory medication, atopy, sex, and baseline lung function. RESULTS: The association between PEF and air pollution was positive in asthmatic children who used respiratory medication whereas the associations tended to be negative in children who did not use respiratory medication selected only on cough. No consistent association was found among asthmatic children who did not use medication. The association between daily prevalence of symptoms and concentrations of air pollution was not different between these subgroups. CONCLUSION: None of the predefined potentially more sensitive subgroups showed a consistent association between air pollution, PEF, and respiratory symptoms.

Air pollution exposure monitoring and estimating. Part I. Integrated air quality monitoring system.

This paper presents an integrated exposure monitoring system, based on an expansion of existing air quality monitoring systems using dispersion modelling. The system allows: (1) identifying geographical areas whose inhabitants are most exposed to ambient pollution; (2) identifying how many people in an area are exposed to concentrations of pollution exceeding air quality guidelines; (3) describing the exposure of population subgroups (e.g. children); (4) planning pollution abatement measures and quantifying their effects; (5) establishing risk assessment and management programs, and (6) investigating the short- and long-term effects of both pollutants and pollution sources on public health. The effect of pollution is rarely very large and in order to discover it, exposure estimation must provide data that reflects both spatial and temporal variations. Estimates of pollution exposure are obtained using an integrated approach that combines results of measurements from monitoring programs with dispersion calculations. These values can serve as estimates for individual short-term or long-term exposure. The grouped data allows the expression of ambient pollution concentrations as the spatial distribution of estimates such as the mean or 98th percentile of such compounds as SO2, O3, NO2, PM10 and PM2.5. This integrated approach has been combined into a single software package, AirQUIS.

Air pollution exposure monitoring and estimation. Part III. Development of new types of air quality indicators.

The temporal pattern of exposure to a specific compound may affect health in several ways. Exposure to pollution can have short-term effects or long-term effects. For some compounds there is a threshold under which there is no presumed measurable effect, whereas for other compounds, there is no presumed threshold. For short-term effects, the exposure to a high concentration of a compound one day may either increase or decrease the response if values of the same compound become high again the next day. Adaptation to effects of short-term exposure to ozone, for example, is reported. Similarly, health response to sudden high peaks of concentration may also possibly differ in effect from those to peaks attained more gradually. For long-term effects of some compounds, the cumulative exposure may be more decisive in influencing health. This paper proposes and describes in detail several air quality indicators that reflect the time variability and the episodic nature of air pollution exposure, as an attempt to represent the temporal aspects of pollution exposure that may have important effects on health. Mean concentrations, 98th percentile and maximum values are the traditional indicators for estimating exposure. The temporal variability of particulate matter (PM10) and NO2, however, is here described by means of: (1) the rate of change of pollution as the difference between two consecutive hourly or daily values, and of (2) episodes, described in terms of number, duration and inter-episode period, maximum concentration in the episode, and integrated episode exposure.

Air pollution exposure monitoring and estimation. Part IV. Urban exposure in children.

In the winter of 1994, 2300 school-age children in Oslo participated in a panel study of the role of traffic pollution on the exacerbation of diseases of the respiratory system and other symptoms of reduced health and well being in children. The children filled out a diary daily with information for five time points over six weeks. In order to quantify exposure-effect relationships for the symptoms, individual exposure to NO2 and particulate matter (PM2.5) was estimated, using the DINEX method a combination of information from the diary as to the children's whereabouts during the five time points each day, coupled with continuous dispersion modelling. An individual exposure estimate for each time point for each child was defined. Individual exposure estimated using dispersion modelling can be used to examine patterns of exposure such as isolating geographic areas with higher concentrations or describing concentrations of pollution by time of day. The diary allowed the time-use of the children to be described.

Air pollution exposure monitoring and estimation. Part V. Traffic exposure in adults.

In Oslo, traffic has been one of the dominating sources of air pollution in the last decade. In one part of the city where most traffic collects, two tunnels were built. A series of before and after studies was carried out in connection with the tunnels in use. Dispersion models were used as a basis for estimating exposure to nitrogen dioxide and particulate matter in two fractions. Exposure estimates were based on the results of the dispersion model providing estimates of outdoor pollutant concentrations on an hourly basis. The estimates represent concentrations in receptor points and in a square kilometre grid. The estimates were used to assess development of air pollution load in the area, compliance with air quality guidelines, and to provide a basis for quantifying exposure-effect relationships in epidemiological studies. After both tunnels were taken in use, the pollution levels in the study area were lower than when the traffic was on the surface (a drop from 50 to 40 micrograms m-3). Compliance with air quality guidelines and other prescribed values has improved, even if high exposures still exist. The most important residential areas are now much less exposed, while areas around tunnel openings can be in periods exposed to high pollutant concentrations. The daily pattern of exposure shows smaller differences between peak and minimum concentrations than prior to the traffic changes. Exposures at home (in the investigation area) were reduced most, while exposures in other locations than at home showed only a small decrease. Highest hourly exposures are encountered in traffic.

Air pollution exposure monitoring and estimation. Part VI. Ambient exposure of adults in an industrialised region.

This paper presents methodology and results of a dynamic individual air pollution exposure model (DINEX) that calculates the hourly exposure for each adult in a panel study. Each of over 260 participants, through the use of a diary, provided information used in the model to calculate his/her personal, individualised exposure. The participants filled out the diary daily, hour by hour, over two, two month periods. The exposure assessment model coupled the diary information and results of an indoor/outdoor measurement program, with the results of dispersion modelling on an hourly basis for an industrial area in Norway. The estimated air pollution concentrations from the dispersion model, based on continuous meteorological measurements, were calibrated with air pollutant concentrations measured continuously.

Childhood asthma in four regions in Scandinavia: risk factors and avoidance effects.

BACKGROUND: The high and increasing prevalence of childhood asthma is a major public health issue. Various risk factors have been proposed in local studies with different designs. METHODS: We have made a questionnaire study of the prevalence of childhood asthma, potential risk factors and their relations in four regions in Scandinavia (Umeå and Malmö in Sweden, Kuopio in eastern Finland and Oslo, Norway). One urban and one less urbanized area were selected in each region, and a study group of 15962 children aged 6-12 years was recruited. RESULTS: The prevalence of symptoms suggestive of asthma varied considerably between different areas (dry cough 8-19%, asthma attacks 4-8%, physician-diagnosed asthma 4-9%), as did the potential risk factors. Urban residency was generally not a risk factor. However, dry cough was common in the most traffic polluted area. Exposure to some of the risk factors. such as smoking indoors and moisture stains or moulds at home during the first 2 years of life, resulted in an increased risk. However, current exposure was associated with odds ratios less than one. CONCLUSIONS: Our findings were probably due to a combination of early impact and later avoidance of these risk factors. The effects of some risk factors were found to differ significantly between regions. No overall pattern between air pollution and asthma was seen, but air pollution differed less than expected between the areas.

Exposure to environmental chemicals relevant for respiratory hypersensitivity: European aspects.

The need for assessing air pollution exposure on the individual and population levels is urgent, as health effects are observed at concentrations even below existing air quality guidelines (AQG). Typical European concentrations and trends over time of four main air quality indicators (nitrogen dioxide, sulphur dioxide, ozone and particulate matter) are presented, together with their revised WHO AQG. In order to describe concentrations of pollutants each individual and population groups are exposed to, methods have been developed that estimate these concentrations using different forms of modelling. The EXPO model, developed to assess European exposure to air quality contaminants, estimates exceedances of AQG in many European cities and serves as an initial step in estimating European population exposure. Individual pollution exposure is estimated by measuring/estimating pollution concentrations at the home and/or by following and integrating exposure in different micro-environments. Examples of these methods are presented.

Prevalence of bronchial asthma in schoolchildren in Oslo, Norway. Comparison of data obtained in 1993 and 1981.

In 1993, 4521 schoolchildren in Oslo, Norway, participated in a European study on air pollution and respiratory health. Incorporated in the primary questionnaire were five questions taken from a study performed 12 years earlier on 1772 schoolchildren in the same city. The response rate was 85% in 1993 vs 95% in 1981. The current and cumulative prevalences of doctor-diagnosed asthma in 1993 were 4.2% and 8.0%, respectively, compared to 2.2% (P < 0.01) and 3.4% (P < 0.01) in 1981. Attacks of breathlessness during the last 3 years were experienced by 7.1% in 1993 and 3.3% in 1981 (P < 0.05). Wheezing or breathlessness on exposure to pollen in 1993 and 1981 was reported by 6.1% and 3.7% (P < 0.01), respectively; to animals by 4.0% and 2.8% (P < 0.05); and to exercise by 10.2% and 4.8% (P < 0.01). The prevalence of occasional wheezing and the cumulative prevalence of doctor-diagnosed eczema, urticaria, and hay fever were not significantly altered. To summarize, a higher prevalence of both doctor-diagnosed asthma and symptoms of obstructive airways disease was reported by children attending primary school in Oslo in 1993 than 12 years earlier. No increase was observed in the prevalence of other atopic diseases.

Cohort study of the relationship between air pollution and short term health effects as determined by peak expiratory flow measurements.

The aim of the study was to establish if air pollution has short term effects on health and well-being for individuals living in an industrialized area of Norway. A cohort study was designed so that two groups (one randomly selected from the general population and one with preexisting lung disease) were followed hour by hour during two months in the winter and in the summer of 1988. In order to minimize the problems of confounding factors, each individual served as her/his own control. Each participant described through the use of a diary the presence of symptoms from the upper and lower respiratory tract as well as general symptoms of ill health. Measurements of lung function by the use of peak expiratory flow meters were done four times a day. In addition, every second week the participants were subjected t a full spirometric test. Samples of urine and blood were examined, and bacteriological test from the throat was performed at the beginning and at the end of the study. A comprehensive measurement program of outdoor air contaminants (including nitrogen oxides, sulphur dioxide) is presented. Estimation of each participant's exposure was performed hour by hour based on detailed modelling of the measured levels, known emissions of pollutants and meteorological conditions, as well as diary information on the participant's movements through the various micro-environments. The estimated exposures were generally low. In this presentation, a linear regression model and their corresponding parameter estimates were applied on an individual basis to evaluate any effect of air contamination on lung function.(ABSTRACT TRUNCATED AT 250 WORDS)

Quantification of health effects related to SO2, NO2, O3 and particulated matter exposure : report from the Nordic Expert Meeting, Oslo, 15-17 October 1995

Estimates of exposure-response relationships are needed to assess the health impact of environmental factors. Based on available research evidence, the relationships for the common air pollutants - particulate matter, sulphur dioxide (SO2), ozone (O3) and nitrogen dioxide (NO2) - were reviewed by the Nordic Expert Meeting. The Meeting was organized by the Norwegian Institute for Air Research in collaboration with the WHO European Centre for Environment and Health, and with the financial support of the Nordic Council of Ministers. The report of the Meeting summarizes the discussion and the working papers that provide the background to the discussion. The limitations of current data and restrictions on their application are also addressed. The Meeting concluded by quantifying exposure-response relationships for particulate matter, SO2 and ozone; the relationship for NO2 was not quantified. The Meeting also identified other exposure-response relationships that were felt to be substantiated, but for which the available data did not provide sufficient background to quantify the risk. The reported concentration-response associations relate to short-term changes in risk due to changes in levels of pollutants. For chronic effects of prolonged exposures the data were judged to be insufficient for quantification. More research is necessary on the chronic and other effects identified but not quantifiable. Work needs to be done on health outcomes that give an early warning of a disease process. Greater comparability in definition of health outcomes and in research methods, as well as better reporting of study results, are necessary to allow general conclusions to be drawn

A model for car exhaust exposure calculations to investigate health effects of air pollution.

This paper presents a model for car exhaust exposure calculations, which improves the air pollution exposure estimates necessary to study relationships between health and air pollution. The model enables calculation of hour-by-hour air pollution concentrations at receptor points in an area. Combined with a diary method, in which participants in the study give data on their movement in the area, the model enables personal air pollution exposure values to be calculated. The paper shows examples of comparison between measured and calculated exposure.

PCDD and PCDF in human milk from Scandinavia, with special emphasis on Norway.

Levels of polychlorinated dibenzo-p-dioxins (PCDD) and polychlorinated dibenzofurans (PCDF) were measured in human milk in a collaborative Scandinavian study with 10 samples from each of 7 locations in Norway and Sweden (total 70 samples) and 10 samples from Denmark. Four locations represented areas with different PCDD and PCDF sources and three background areas. Norwegian results are presented and related to the Danish and Swedish values. No geographical differences were found in total dioxins expressed as Nordic TCDD equivalents. Mean equivalent values (pg/g fat basis) were 15-18 in Norway and Denmark and 20-24 in Sweden, lower than those reported from parts of Western Europe but higher than in the undeveloped countries. When looking at the individual compounds, the highest values of PCDD congeners were observed in industrialized areas of Sweden, while the highest PCDF values were found in a Norwegian area known for dioxin contamination from a magnesium-producing factory.

Dental amalgam and mercury.

The mercury concentrations in blood (HgB) and urine (HgU) samples, and in exhaled air (HgAir) were measured in 147 individuals from an urban Norwegian population, using cold vapour atomic absorption spectrometry. The study aimed to estimate the mercury exposure from the dental restorations, by correlating the data to the presence of amalgam restorations. Mean values were HgB = 24.8 nmol/l, HgU = 17.5 nmol/l and HgAir = 0.8 micrograms/m3. HgU correlated with HgAir, and both HgU and HgAir with the number of amalgam restorations, amalgam restored surfaces and amalgam restored occlusal surfaces. HgB showed poor correlation to HgU and HgAir and the presence of amalgam restorations. A differentiation of the mercury absorption due to exposure from dental amalgams and from the dietary intake, necessitates measurements of both organic and inorganic mercury in the plasma, and in the erythrocytes. The results suggest that individuals with many amalgam restorations, i.e., more than 36 restored surfaces, absorb 10-12 micrograms Hg/day.