Barbro Hagander

Infantile colic—less common than previously estimated?

A two‐part population‐based study investigating the occurrence of infantile colic was undertaken. in which 92% of mothers with newborn healthy infants were reached. In the prospective part 152 mothers (“diary group”) registered crying and fussing in their infants during 12 weeks. In the retrospective part 224 mothers (“interview group”) were contacted by telephone at an infant age of 5‐7 months. The colic occurrence was determined according to four different definitions; the rates varied from 3.3 to 17.1%. The classical “Wessel‐type” colic was present in 9.3%. Colic defined as “crying seen as a problem by parent” was present in 12.1% of the “interview group”, but in only 3.3% of the “diary group”. Some earlier studies may have overestimated colic occurrence. Another possibility is an actual decline. The contributive part of preventive measures is discussed.

Infantile colic. Follow-up at four years of age : still more emotional

This paper presents a follow‐up at 4 y of formerly colicky infants and controls, with respect to behaviour, temperament, eating and sleeping habits, psychosomatic complaints, number of hospital stays, growth and “family climate”. There were no differences between the two groups in most parameters studied. However, ex‐colicky children displayed more negative emotions according to the temperament scale. There were also more negative moods during meals, and more reported stomach‐ache. Although relationships regarding crying and mother‐infant interaction remain extremely complex, the findings point toward a possible temperamental contribution to the pathogenesis of the infantile colic syndrome.

Early patient contact in primary care : a new challenge

The Medical School of Lund University, Sweden, has introduced an early patient contact course, including training in communication and examination skills. The course runs parallel with theoretical subjects during the students’ first two‐and‐a‐half years. General practitioner (GP) participation is gradually increasing, and in the last half‐year of the course GPs in all health centres in the area are involved. Little is known about the GPs’ interest, competence and time for this new task.

Infantile colic and the role of trait anxiety during pregnancy in relation to psychosocial and socioeconomic factors

Aims: A study was undertaken to assess the impact of psychological, psychosocial and socioeconomic factors on the risk of having a child with infantile colic. Methods: Psychosocial and psychological factors were assessed by self-administered questionnaires in the 17th, and by telephone interviews in the 35th—37th pregnancy weeks; infantile colic occurrence was assessed by telephone interviews at infant age 5 weeks; subjects were 1,099 mother—infant dyads. Results: High trait anxiety increased the colic risk; OR 2.04 (95% CI: 1.16, 3.59), and so did affirming a perceived risk of spoiling young infants with too much physical contact; OR 1.77 (1.07, 2.91). In the final step of a multivariate model, not cohabiting with the childs father was the factor with the strongest association with colic; OR 3.48 (1.38, 8.77). Analyses of effect modification showed that high education seemed to protect from the influence of high trait anxiety. Young women were particularly high in trait anxiety, and being exposed to both these risk factors seemed to act synergistically on the risk of having a colicky infant; OR 2.41 (1.12, 5.18). Conclusions: Psychological and psychosocial factors were found to be significantly related to an increased risk for infantile colic, and these factors interacted with age, parity, social support, and educational level in a complex manner. Even though no single most important psychosocial risk factor was identified, the findings lend support to the strategy of offering special attention in terms of information and support in the maternal healthcare system to very young women, women who do not cohabit with the father, and women with high trait anxiety.

Colicky infants according to maternal reports in telephone interviews and diaries: a large Scandinavian study.

ABSTRACT. In this population-based study the colic incidence was 9.4%, according to telephone interviews with the parents made when the infants were 5 weeks of age (n = 1628), and parental concern about infant crying was common. However, 7-day diaries of colicky and control infants (n = 116 + 119) revealed low distress amounts in colicky infants in general. In the subgroup of Wessel-colicky infants (n = 37), distress episodes were frequent and long lasting, and there was a high proportion of colicky crying versus fussing and normal crying. Even if there may be a reduction in the infantile colic incidence and support for the hypothesis that infantile colic is at least partially “in the eye of the beholder,” that is, the concerned parent, a subgroup of infants may be more “genuinely colicky.” Women who had stated in late-pregnancy interviews that there is a risk of spoiling an infant with too much physical contact were more likely to have infants with colic, and their infants were more distressed, even when given the same amount of physical contact. This finding warrants further elucidation.

Satiety effects of spinach in mixed meals: comparison with other vegetables

The effects of vegetables in mixed meals on satiety were evaluated by varying the dose (portions 150 and 250 g containing 4.3 and 7.2 g of dietary fibre, respectively) and structure (cut and minced) of microwaved spinach. A control meal without spinach and the test meals with spinach were balanced regarding energy (2000 kJ) and digestible carbohydrates (59 g, 51 E%) and with protein and fat as far as possible similar. The meals were served in the morning, after an overnight fast, to ten healthy male volunteers. Satiety was registered and blood glucose as well as plasma insulin and C-peptide were analysed at regular intervals until 3.5 h postprandially. The largest spinach portions augmented satiety and reduced the postprandial glucose response. The total satiety scores seemed to be correlated positively to both the dietary fibre and the water content in the vegetable. Differences in structure had no influence on satiety scores.

Influence of processing and cooking of carrots in mixed meals on satiety, glucose and hormonal response

The influence of processing and cooking on the metabolic response to carrots in mixed meals was explored in two consecutive harvest years. The contribution of dietary fibre (4.4 g 1989 and 6.6 g 1990) from carrots was chosen to be different in order to compare effects with varying doses. The meals, composed of carrots, creamed potatoes, meat balls, lingonberry jam, white bread and light beer, were served in the morning after an overnight fast to 10 healthy male volunteers. Carrots were investigated raw, processed (blanched and frozen) and variously cooked (thawed, boiled and microwaved). The amount of dietary fibre from the vegetable, and the content of energy, digestible carbohydrates, fat and protein were similar in the meals compared. Significantly lower glucose, insulin and C-peptide responses and higher satiety scores were elicited with raw carrots than with microwaved ones, harvest year 1989. The next year, with a higher dietary fibre intake from carrots, there were significant effects of processing only on the glucose response. Plasma beta-carotene levels tended to be higher postprandially with raw carrots than with microwaved ones. Hence, ordinary processing and cooking of vegetables can affect the metabolic response to a mixed meal. However, the influence seems to be varying and of minor importance in ordinary meals. Increasing vegetable portions entailing a higher soluble fibre content and a higher viscosity could further reduce the influence of processing.

Rye products in the diabetic diet: Postprandial glucose and hormonal responses in non-insulin-dependent diabetic patients as compared to starch availability in vitro and experiments in rats*

Rye flakes, rye bread and white wheat bread were given as suspensions to rats and in standardized breakfast meals to non-insulin-dependent diabetics. In both cases the postprandial glucose response was lower after rye bread than after wheat bread. A larger amount of starch remained in the stomach of the rats 15 min after ingesting rye bread compared to wheat bread, indicating that delayed gastric emptying may be one factor explaining the lower response after rye bread. Although the incremental postprandial glucose areas after rye flakes and wheat bread were similar, the rate of decrease of the glucose curve was slower after flaked rye. This would point to a prolonged absorption of some starch in the rye flakes, also indicated by higher late immunoreactive insulin (IRI) values after that product. In the rats the content of starch in the stomachs 15 min after feeding was higher after rye flakes compared to wheat bread. In vitro incubations with alpha-amylase showed lower availability of the starch in rye flakes than in the breads, indicating that several factors may contribute to the differential postprandial glucose response after the wheat and rye products. The levels of insulin, C-peptide, gastric inhibitory polypeptide (GIP), glucagon, somatostatin, triglyceride and glycerol were followed after the breakfast meals. No pronounced differences of these parameters were seen. However, wheat bread gave significantly higher glucagon and GIP responses than did rye flakes. In conclusion, the absorption pattern and metabolic response after rye bread seems preferable to that after wheat bread. The flaked rye on the other hand was not effective in reducing postprandial glycaemia despite a lower availability of starch in vitro.

Antenatal care in southern Sweden: A population-based prospective study describing the diagnostic panorama of pregnancy

All pregnant women from the catchment areas of three health centres in southern Sweden, registered for antenatal care during the calender year 1986, were included in the study population. Four hundred and nine women could be prospectively followed throughout pregnancy. By 15 completed weeks, 95% of the women were registered at an antenatal clinic. Only 2 women had no antenatal care at all. During the course of pregnancy the 409 women made altogether 6,058 (mean 14.8) visits to the health and medical services, most of them (95%) were to an antenatal clinic. Common obstetrical problems were vaginitis, symphysiolysis, threat of preterm labour, and vaginal bleeding; and common non‐obstetrical problems were low back pain and respiratory tract infections. During pregnancy 42% of the women were prescribed some sort of medication, and 53% were sicklisted on one or more occasions. The outcome of pregnancy was comparable to figures for all Sweden.