Arja Rimpelä

Bullying, depression, and suicidal ideation in Finnish adolescents: school survey.

Abstract Objective: To assess the relation between being bullied or being a bully at school, depression, and severe suicidal ideation. Design: A school based survey of health, health behaviour, and behaviour in school which included questions about bullying and the Beck depression inventory, which includes items asking about suicidal ideation. Setting: Secondary schools in two regions of Finland. Participants: 16410 adolescents aged 14-16. Results: There was an increased prevalence of depression and severe suicidal ideation among both those who were bullied and those who were bullies. Depression was equally likely to occur among those who were bullied and those who were bullies. It was most common among those students who were both bullied by others and who were also bullies themselves. When symptoms of depression were controlled for, suicidal ideation occurred most often among adolescents who were bullies. Conclusion: Adolescents who are being bullied and those who are bullies are at an increased risk of depression and suicide. The need for psychiatric intervention should be considered not only for victims of bullying but also for bullies. Key messages About 1 in 10 schoolchildren report being bullied weekly at school Adolescents who are bullied or who are bullies have an increased risk of depression and suicidal ideation Bullies are often as depressed as those who are bullied, and suicidal ideation is even more common among bullies Interventions aimed at reducing bullying in schools, as well as psychiatric assessment and treatment of bullies and those who are bullied, might also prevent depression and suicidal ideation

Radiation dose and second cancer risk in patients treated for cancer of the cervix

The risk of cancer associated with a broad range of organ doses was estimated in an international study of women with cervical cancer. Among 150,000 patients reported to one of 19 population-based cancer registries or treated in any of 20 oncology clinics, 4188 women with second cancers and 6880 matched controls were selected for detailed study. Radiation doses for selected organs were reconstructed for each patient on the basis of her original radiotherapy records. Very high doses, on the order of several hundred gray, were found to increase the risk of cancers of the bladder [relative risk (RR) = 4.0], rectum (RR = 1.8), vagina (RR = 2.7), and possibly bone (RR = 1.3), uterine corpus (RR = 1.3), cecum (RR = 1.5), and non-Hodgkins lymphoma (RR = 2.5). For all female genital cancers taken together, a sharp dose-response gradient was observed, reaching fivefold for doses more than 150 Gy. Several gray increased the risk of stomach cancer (RR = 2.1) and leukemia (RR = 2.0). Although cancer of the pancreas was elevated, there was no evidence of a dose-dependent risk. Cancer of the kidney was significantly increased among 15-year survivors. A nonsignificant twofold risk of radiogenic thyroid cancer was observed following an average dose of only 0.11 Gy. Breast cancer was not increased overall, despite an average dose of 0.31 Gy and 953 cases available for evaluation (RR = 0.9); there was, however, a weak suggestion of a dose response among women whose ovaries had been surgically removed. Doses greater than 6 Gy to the ovaries reduced breast cancer risk by 44%. A significant deficit of ovarian cancer was observed within 5 years of radiotherapy; in contrast, a dose response was suggested among 10-year survivors. Radiation was not found to increase the overall risk of cancers of the small intestine, colon, ovary, vulva, connective tissue, breast, Hodgkins disease, multiple myeloma, or chronic lymphocytic leukemia. For most cancers associated with radiation, risks were highest among long-term survivors and appeared concentrated among women irradiated at relatively younger ages.

Back, neck, and shoulder pain in Finnish adolescents: national cross sectional surveys

Abstract Objectives: To study changes in pain of the back and neck in adolescents between 1985 and 2001 and pain of the neck, shoulder, and lower back between 1991 and2001. Design: Biennial nationwide postal surveys, 1985-2001, and annual classroom surveys, 1996-2001. Setting: Finland. Participants: 62 677 12, 14, 16, and 18 year olds and 127 217 14-16 year olds. Main outcome measures: Pain in the back and neck, neck and shoulder, or lower back, at least weekly. Results: Prevalence of pain in the back and neck was greater in the 1990s than in the 1980s and increased steadily from 1993 to 1997. Pain of the neck and shoulder and pain of the lower back was much more common in 1999 than in 1991 and in 2001 than in 1999. Pain was more common among girls and older groups: pain of the neck and shoulder affected 24% of girls and 12% of boys in 14 year olds, 38% of girls and 16% of boys in 16 year olds, and 45% of girls and 19% of boys in 18 year olds; pain in the lower back affected 8% of girls and 7% of boys in 14 year olds, 14% of girls and 11% of boys in 16 year olds, and 17% of boysand 13% of girls in 18 year olds. Conclusion: Pain in the neck, shoulder, and lower back is becoming morecommon in Finnish adolescents. This pain suggests a new disease burden of degenerativemusculoskeletal disorders in future adults.

Secular trends in overweight and obesity among Finnish adolescents in 1977-1999

OBJECTIVE: To study the trends in overweight and obesity among Finnish adolescents in 1977–1999.DESIGN: Mailed surveys every other year.SUBJECTS: Nationally representative samples of 12, 14, 16 and 18-y-olds (n=64 147, response rate 78.9%).METHODS: Overweight and obesity were measured by body mass index (BMI) and relative weight (RW) based on self-reported height and weight. BMI ≥the 85th percentile cut-off point for BMI in each age- and sex-specific group in the entire data set was considered as overweight, and BMI ≥95th percentile cut-off point as obesity. RW ≥110% and ≥120%, calculated as the individuals weight divided by the mean weight in each age- and sex-specific height percentile group in the entire data set, were considered as overweight and obesity, respectively. The trends in overweight and obesity are described by the change in the 85th and 95th percentile cut-off points of BMI over time. The prevalence of overweight and obesity is also reported using BMI reference values recommended for international comparisons. Because of the similarity of the BMI and the RW criteria in classifying adolescents as overweight and obese, only results based on BMI are presented.RESULTS: Overweight and obesity increased linearly in all sex and age groups from 1977 to 1999. Depending on the age group, the average increase in the 85th percentile cut-off point of the BMI per 10 y was 0.6–1.1 kg/m2 in boys and 0.3–0.7 kg/m2 in girls. The 95th percentile cut-off point of the BMI for boys and girls increased by 1.1–1.6 kg/m2 and by 0.6–1.0 kg/m2 per 10 y, respectively. In boys, the increase in overweight and obesity was largest in the two youngest age groups. In girls, the increase in overweight was largest in the oldest age group, and that of obesity both in the 14 and 18-y-olds. Overweight and obesity increased more in boys than in girls in all age groups except in the 18-y-olds among whom the increase was similar in both sexes. Examination of the entire BMI distribution showed that there was little or no change over time at the lower (5th, 15th) and middle (50th) percentiles, but increasing differences at the upper end of the distribution, the increases in the 95th percentile being even more marked than those in the 85th percentile curves. According to international reference values, the age-standardized prevalence of overweight increased in boys from 7.2 to 16.7%, and in girls from 4.0 to 9.8%, between 1977 and 1999. The prevalence of obesity in boys was 1.1% in 1977 and 2.7% in 1999, and in girls 0.4 and 1.4%, respectively.CONCLUSION: Overweight and obesity increased remarkably among Finnish adolescents from 1977 to 1999. The changes concentrated at the upper end of the BMI distribution, suggesting that factors behind this development have influenced only a part of the adolescent population.

INTERNET ADDICTION? POTENTIALLY PROBLEMATIC USE OF THE INTERNET IN A POPULATION OF 12-18 YEAR-OLD ADOLESCENTS

On-line surveys indicate harmful excessive use of the Internet resulting in psychosocial problems (Internet addiction). Population studies are scarce, particularly on adolescents who are a vulnerable group in the middle of their personality development. The prevalence of features suggesting harmful use of the Internet is studied in a representative sample of 12–18 year-old Finns (N = 7292) in a postal survey in 2001. Criteria were tailored analogously to the criteria of pathological gambling, fulfilling four of the seven criteria operationalised as Internet addiction. Eighty five percent used the Internet. Among daily users 4.6% of boys and 4.7% of girls fulfilled the four criteria, infrequent users 0.3 and 0.5%, and all respondents 1.7 and 1.4%, respectively. The “addicts” spent more hours (mean = 2.7) in the Internet daily than the “non-addicts” (mean = 1.3). Some adolescents reported a potentially harmful relationship with the Internet comparable to addictive disorders. Although not common now, it will most likely increase with the increasing Internet use.

Use of information and communication technology and prevalence of overweight and obesity among adolescents.

BACKGROUND:The prevalence of overweight and obesity has increased among children and adolescents, as well as among adults, and television viewing has been suggested as one cause. Playing digital games (video, computer and console games), or using computer may be other sedentary behaviors related to the development of overweight and obesity.OBJECTIVE:To study the relationships of times spent on viewing television, playing digital games and using computer to overweight among Finnish adolescents.DESIGN:Mailed cross-sectional survey.SUBJECTS:Nationally representative samples of 14-, 16-, and 18-y-old (N=6515, response rate 70%) in 2001.METHODS:Overweight and obesity were assessed by body mass index (BMI). The respondents reported times spent daily on viewing television, playing digital games (video, computer and console games) and using computer (for e-mail, writing and surfing). Data on timing of biological maturation, intensity of weekly physical activity and familys socio economic status were taken into account in the statistical analyses.RESULTS:Increased times spent on viewing television and using computer were associated with increased prevalence of overweight (obesity inclusive) among girls: compared to girls viewing television <1 h daily, the adjusted odds ratio (OR) for being overweight was 1.4 when spending 1–3 h, and 2.0 when spending ≥4 h daily on viewing television. In girls using computer ≥1 h daily, the OR for being overweight was 1.5 compared to girls using computer <1 h daily. The results were similar in boys, although not statistically significant. Time spent on playing digital games was not associated with overweight.CONCLUSION:Overweight was associated with using information and communication technology (ICT), but only with certain forms of ICT. Increased use of ICT may be one factor explaining the increased prevalence of overweight and obesity at the population level, at least in girls. Playing digital games was not related to overweight, perhaps by virtue of game playing being less sedentary or related to a different lifestyle than viewing television and using computer.

Distribution and heritability of BMI in Finnish adolescents aged 16y and 17y: a study of 4884 twins and 2509 singletons.

OBJECTIVE:1) To estimate the heritability of body mass index (BMI) in twins aged 16 y and 17 y, with a special emphasis on gender-specific genetic effects and 2) to compare heights, weights, BMIs, and prevalences of ‘overweight’ (BMI≥≥25 kg/m2) in these twins and in singletons aged 16.5 y.DESIGN:Cross-sectional and longitudinal epidemiological questionnaire study of twins at ages 16 y and 17 y, and cross-sectional study of singletons at age 16.5 y.MEASUREMENTS:BMI (kg/m2) was calculated from self-reported heights (m) and weights (kg).SUBJECTS:4884 twins (2299 boys, 2585 girls) at baseline (age 16 y), 4401 twins (2002 boys, 2399 girls) at age 17 y, and 2509 singletons (1147 boys, 1362 girls) at age 16.5 y. Both twin and singleton samples are nationally representative.RESULTS:At the ages of 16 y and 17 y, genetic effects accounted for over 80% of the interindividual variation of BMI. The correlations for male–female pairs were smaller than for either male-male or female–female dizygotic pairs. The singletons, especially the boys, had a higher BMI than the twins. Nine percent of singleton boys, but only 4–6% of twin boys and twin and singleton girls were ‘overweight’ (BMI≥≥25 kg/m2).CONCLUSIONS:Among adolescents, genetic factors play a significant role in the causes of variation in BMI. The genetic modelling suggested that the sets of genes explaining the variation of BMI may differ in males and females. At this age, the twin boys, but not girls, seem to be leaner than singletons. Further follow-up will indicate whether these small differences disappear, and if not, what implications it might have to the generalizability of twin studies.

The risk for a cruciate ligament injury of the knee in adolescents and young adults: a population-based cohort study of 46 500 people with a 9 year follow-up

Objectives: The knee joint is the most common site for injury among younger people, the injury often resulting in expensive (surgical) treatment, long-term rehabilitation and permanent functional impairment and disability. Methods: We investigated the incidence and risk factors for a major knee-ligament injury in an adolescent Finnish population. A population-based cohort of 46 472 adolescents was followed for an average of 9 years. All patients hospitalised with the diagnosis of anterior or posterior cruciate ligament injury (ACL or PCL injury) were included in the analysis. Results: 265 (0.6%) people (194 male and 71 female subjects) from the total cohort of 46 472 were treated for a cruciate ligament injury of the knee during the follow-up period, giving an injury incidence of 60.9 (95% CI 53.6 to 68.2) per 100 000 person-years. When the socioeconomic, health and lifestyle background variables were taken into account, the adjusted hazard ratio for a cruciate ligament injury of the knee was 8.5 (95% CI 4.3 to 16.4) for female and 4.0 (95% CI 2.7 to 6.1) for male subjects who participated in organised sports ⩾4 times/week. Conclusions: The general risk for a cruciate ligament injury of the knee is relatively low among adolescents and young adults, but participation in organised sports increases the risk significantly. The risk is especially high in active young women. Preventive measures should be adopted to decrease the short-term and long-term burden of these severe injuries.

Neck or shoulder pain and low back pain in Finnish adolescents.

The aim of this study was to investigate the prevalence and determinants of self-reported neck or shoulder pain (NSP) and low back pain (LBP) among 12-18-year-olds. A questionnaire was mailed to a nationally representative sample of 11,276 12-, 14-, 16- and 18-year-olds in 1991. The response rate was 77%. NSP was perceived at least once a week by 15% of 12-18-year-olds and LBP by 8%. Both symptoms were more prevalent among girls than among boys, and the prevalence increased with age. Among the determinants investigated, the number of perceived psychosomatic symptoms had the strongest association with NSP and LBP. Our study confirmed the co-morbidity of NSP and LBP, and indicated that NSP is more frequent than believed among 16-18-year-old girls. The strong association of psychosomatic symptoms with NSP and LBP suggests that the latter two pain states could be more psychosomatic than nosiceptive in character.

Cancers of affluence: Positive social class gradient and rising incidence trend in some cancer forms

This study shows that, unlike most diseases, some cancer forms are more common in upper social classes. All cancer cases diagnosed in Finland in 1971-75 aged 30-69 and recorded in the Finnish Cancer Registry (n = 36,500) were linked to the file of the 1970 Population Census of Finland with data on socio-economic status and education. Cancers related to both high socio-economic status and high level of education in men were colon, prostate, testis, kidney and melanoma of the skin, and in women colon, breast, and corpus uteri. Since 1953, the incidence of all these cancers had been rising, although that of the testicular cancer had levelled off in the seventies.