Bruno Hägglöf

The epidemiology of diabetes in Swedish children 0-14 years--a six-year prospective study.

SummarySince 1 July 1977, all newly diagnosed diabetic children in Sweden aged 0–14 years have been reported to a central register. During the first 6 years, 2300 newly diagnosed diabetic children out of a population of 1.6 million children were registered. The degree of certainty was close to 100%. The mean of the yearly incidence rate for the whole 6 year period was 23.6 per 100000. The prevalence of insulin dependent diabetes mellitus on 1 July 1980 was 1.48 per 1000 and 1.52 on 1 July 1983. Comparing the first and second 3-year periods, an increase was found (22.7–25.1 per 100000). This increase was consistent when analyzing incidence rates by age, sex, and geographical distribution. Cumulative incidence rates revealed a risk of developing diabetes by the age of 15 years of 3.6 per thousand for boys and 3.2 per thousand for girls. The higher incidence for boys was consistent throughout the study period. Seasonal variations in the incidence rate were also consistent, showing yearly incidence peaks in the autumn and winter months. Incidence peaks were noted for both sexes in the pubertal ages. Age- and sex-standardized morbidity ratios varied significantly within the country. 12.8% of the probands had a first degree relative with Type 1 diabetes, and it was twice as common that this relative was a father as a mother. The high and rapidly increasing incidence of Type 1 diabetes in a genetically stable population such as Sweden calls for case-control studies directed towards the identification of environmental pathogens.

Does maternal prenatal attachment predict postnatal mother-infant interaction?

The current study examined whether maternal prenatal attachment is associated with the mother-infant relationship. One hundred pregnant women and their infants at 12 weeks participated in the study. The sample was part of the Umeâ Child and Family Development project and was randomly recruited by midwives or health visitors. The expectant women completed a self-administered questionnaire, the PAI (the Prenatal Attachment Inventory) measuring prenatal attachment towards their unborn baby. At about 12 weeks postpartum, mothers and their infants were observed and videotaped during an en face interaction. The results revealed that maternal prenatal attachment towards the unborn baby is a good predictor of the early mother-infant relationship. Mothers who were high on the PAI-factor fantasy, for example, in general showed more involvement while interacting with their babies. Mothers rated highly on PAI-factors such as interaction and affection stimulated their infants by using more proximal stimulation, while those rated highly on differentiation of self with the unborn baby used more distal stimulation. Maternal responsive behaviour was only predicted by infant attentive behaviour. This study demonstrated that maternal prenatal attachment during the third trimester of pregnancy is associated with the postnatal maternal involvement, and can serve as an important diagnostic aid in identifying those women for whom the mother-child interaction is likely to be sub-optimal.

Mental Health and Social Competencies of 10- to 12-Year-Old Children Born at 23 to 25 Weeks of Gestation in the 1990s: A Swedish National Prospective Follow-up Study

OBJECTIVE. We investigated a national cohort of extremely immature children with respect to behavioral and emotional problems and social competencies, from the perspectives of parents, teachers, and children themselves. METHODS. We examined 11-year-old children who were born before 26 completed weeks of gestation in Sweden between 1990 and 1992. All had been evaluated at a corrected age of 36 months. At 11 years of age, 86 of 89 survivors were studied and compared with an equal number of control subjects, matched with respect to age and gender. Behavioral and emotional problems, social competencies, and adaptive functioning at school were evaluated with standardized, well-validated instruments, including parent and teacher report questionnaires and a child self-report, administered by mail. RESULTS. Compared with control subjects, parents of extremely immature children reported significantly more problems with internalizing behaviors (anxiety/depression, withdrawn, and somatic problems) and attention, thought, and social problems. Teachers reported a similar pattern. Reports from children showed a trend toward increased depression symptoms compared with control subjects. Multivariate analysis of covariance of parent-reported behavioral problems revealed no interactions, but significant main effects emerged for group status (extremely immature versus control), family function, social risk, and presence of a chronic medical condition, with all effect sizes being medium and accounting for 8% to 12% of the variance. Multivariate analysis of covariance of teacher-reported behavioral problems showed significant effects for group status and gender but not for the covariates mentioned above. According to the teachers’ ratings, extremely immature children were less well adjusted to the school environment than were control subjects. However, a majority of extremely immature children (85%) were functioning in mainstream schools without major adjustment problems. CONCLUSIONS. Despite favorable outcomes for many children born at the limit of viability, these children are at risk for mental health problems, with poorer school results.

The Swedish childhood diabetes study : indications of severe psychological stress as a risk factor for type 1 (insulin-dependent) diabetes mellitus in childhood

SummaryThis study is part of a nationwide case-referent study. All recent-onset Type 1 (insulin-dependent) diabetic children aged 0–14 years in Sweden were invited to participate. Referent subjects matched for age-, sex- and geographical distribution were selected. In all, 338 patients and 528 referent subjects took part. Life events during the last year prior to clinical onset of Type 1 diabetes were recorded on a questionnaire. The total frequency of life events did not differ between diabetic and referent children. However, qualitatively the life events reported by diabetic children revealed a tendency to increased severity. Events related specifically to actual or threatened losses within the family — events that may affect children differently in different age groups — were reported with a significantly higher frequency by diabetic patients than by referent subjects, aged 5–9 years. The relative risk that such events in fact comprise a risk factor for Type 1 diabetes was 1.82 (95% confidence limits 1.09, 3.03). The relative risk was significantly increased even when standardized for possible confounding factors such as age, sex and indices of social status of the family. We conclude that stressful life events, related to actual or threatened losses within the family, occurring in the vulnerable age group of 5–9 years, are associated with the onset of childhood Type 1 diabetes. Such stressful events may in fact be a risk factor for the disease.

Psychological Stress and the Onset of IDDM in Children: A case-control study

OBJECTIVE The purpose of the study was to determine whether psychosocial stress during different life periods could be a risk factor in the etiology/pathogenesis of insulin-dependent diabetes mellitus (IDDM) in children. RESEARCH DESIGN AND METHODS In a population-based sample of 67 case patients 0–14 years of age and 61 matched healthy control subjects, life events during the entire lifespan before the onset of IDDM were recorded as well as measures of child behavior before onset, social support, and family function. RESULTS Negative life events occurring during the first 2 years of life, life events with difficult adaptation, child behavioral deviances, and a more chaotic family function were more common in the case group. A stepwise logistic regression indicated that negative life events in the first 2 years increased the risk of IDDM and that premorbid child behavior as well as dysfunctional hierarchical family pattern affect the risk. CONCLUSIONS Stress early in life may increase the risk for IDDM, presumably by affecting the autoimmune process. To confirm these results, it is necessary to make a truly prospective study.

The incidence of diabetes mellitus in Swedish children 0-14 years of age. A prospective study 1977-1980.

ABSTRACT. This is a prospective study of the incidence of insulin‐dependent diabetes mellitus (IDDM) in children 0–14 years of age, including all newly diagnosed cases in the whole of Sweden from July 1, 1977 until June 90, 1980. All 45 Swedish departments of paediatrics participated. During the three‐year‐period studied, 1108 Swedish children, 0–14 years of age had their onset of diabetes. That means around 369 new diabetics yearly in the age groups studied. The mean yearly incidences in the years 1977–80 were 22.6, 22.8 and 22.6 per 100000 children, respectively. Mean prevalence on June 30, 1980 was 1.48 per 1000 children 0–14 years with a wide range of 0.71‐2.65. The age distribution at onset showed a gradual increase and peak incidences at 11 years of age for the girls and 4 and 13 years of age for the boys. There was a consistently higher incidence for boys in the younger age groups during the three‐year‐period studied. Peak incidences of new cases were reached in January, March and July through October for the age groups 5–9 and 10–14 years of age. No such seasonal variation was seen for children 0–4 years of age. The cumulative incidence of IDDM at 14 years of age was 3.2 per 1000 for the boys and 2.9 per 1000 for the girls. The degree of ascertainment in this study was 93.4 %.

Impaired health-related quality of life in children with recurrent pain.

OBJECTIVE: The goal of the current study was to investigate self-reported, health-related quality of life (HRQoL) in a general population of young schoolchildren with recurrent pain (ie, headache, stomachache, or backache). METHODS: The study was performed in Umeå, a university city in Sweden. All children in grades 3 and 6 were invited, and 97% participated (313 girls and 292 boys in grade 3 [mean age: 9.7 years]; 386 girls and 464 boys in grade 6 [mean age: 12.6 years]). Pain and HRQoL were measured with questionnaires. RESULTS: Two thirds of the children reported recurrent pain (at least monthly). One third reported weekly pain, and 4 of 10 experienced pain from multiple locations. HRQoL impairment was twice as common among children with recurrent pain, compared with children without pain. All aspects of HRQoL (ie, physical, emotional, social, and school functioning and well-being) were impaired. The level of impairment was classified as considerable, especially for children who experienced pain from multiple body sites and children with weekly pain (Cohens d = 0.6–0.8). CONCLUSIONS: This study shows that young schoolchildren with recurrent pain have considerable impairment of their HRQoL.

A prospective analysis of antibodies reacting with pancreatic islet cells in insulin-dependent diabetic children

SummaryIslet cell cytoplasmic and cell surface antibodies along with other autogenic tissue antibodies were determined prospectively from the day of diagnosis of insulin-dependent diabetes in a group of children and adolescents. Prior to the initiation of insulin therapy 30 out of 33 were antibody-positive, 67% having islet cytoplasmic antibodies and 67% islet cell surface antibodies. Among 74 age- and sex-matched non-diabetic individuals 1% had islet cell cytoplasmic antibodies and 3% had islet cell surface antibodies. A prospective analysis in 17 patients showed a diminishing prevalence of islet cell antibodies with increasing duration of diabetes. Islet cell cytoplasmic or cell surface antibodies were found independently of each other or in combination and with various patterns of persistence. The results indicate a strong association of islet cell antibodies with the onset of insulin-dependent diabetes in childhood and adolescence.

Psychometric properties of the Swedish PedsQL, Pediatric Quality of Life Inventory 4.0 generic core scales

Aim:  To study the psychometric performance of the Swedish version of the Pediatric Quality of Life Inventory (PedsQL) 4.0 generic core scales in a general child population in Sweden.

Attention-deficit-hyperactivity disorder with and without oppositional defiant disorder in 3- to 7-year-old children

Attention-deficit-hyperactivity disorder (ADHD) is a common neurodevelopmental disorder with a high degree of associated behavioural problems. In order to study characteristics of ADHD with and without oppositional defiant disorder (ODD) in a representative group of young children with clinical impairment in Sweden, 131 children (101 males, 30 females) with ADHD (mean age 5 years, SD 1 year 5 months; range 3 to 7 years) were clinically examined, and their parents interviewed. Independent questionnaire data (Child Behavior Checklist, ADHD Rating Scale-IV, ODD Rating Scale-IV, Conners Hyperactivity Index) were collected. For comparison 131 children without ADHD were matched for sex, age, marital status, and socioeconomic status (115 males, 16 females; mean age 4 years 10 months, SD 1 year 5 months; range 3 to 7 years). Sixty percent of those with ADHD met full DSM-IV criteria for ODD. Only 10 of the 131 children with ADHD had no symptoms of ODD at all. The rate of children meeting full diagnostic criteria for ODD was similar across all age cohorts. Males were overrepresented in ODD, as were children of divorced parents and of mothers with low socioeconomic status. ADHD combined subtype was a stable independent factor influencing the diagnosis of ODD, regardless of psychosocial factors. Those with ADHD with ODD consistently showed higher rates of ADHD symptoms than did those with ADHD without ODD. The prevalent comorbidity of ADHD with ODD indicates that all children presenting with ADHD or ODD symptoms need to be assessed with a view to exploring both types of problem behaviours. The link between ODD and some psychosocial variables indicates the need to address these, possibly by measures such as parent training and network support.