Eivind Meland

Self-rated health during adolescence: stability and predictors of change (Young-HUNT study, Norway)

Background: Self-rated health (SRH) is an important single-item variable used in many health surveys. It is a predictor for later mortality, morbidity and health service attendance. Therefore, it is important to study how SRH is influenced during adolescence. The present study examined the stability of SRH over a 4-year period in adolescence, and the factors predicting change in it. Methods: Analyses were based on 4-year longitudinal data from the Young-HUNT studies in Norway among adolescents aged 13–19 years. A total of 2800 students (81%) participated in the follow-up study, and 2399 of these were eligible for data analysis. Cross-tables for SRH at the start of the study (between 1995 and 1997) and 4 years later were used to estimate the stability over the period. Proportional odds logistic regression analyses of SRH during 2000–01 were carried out, controlling for initial SRH, independent variables at the start of the study and changes in the same independent variables over 4 years as covariates. Results: In 59% of the respondents, SRH remained unchanged through the 4-year observation period during adolescence. Fewer than 4% changed their ratings of SRH by two steps or more on a four-level scale. The self-assessed general well-being, health behaviour variables, being disabled in any way, and body dissatisfaction at the start of the study and the change of these predictors influenced SRH significantly during the 4-year observation. Being diagnosed with a medical condition, or specific mental or somatic health symptoms was of less importance for later SRH. Adolescents with more health service contacts at the start of the study, or who increase their attendance rate during the 4 years, report deterioration of SRH. Conclusion: SRH is a relatively stable construct during adolescence, and deteriorates consistently with a lack of general well-being, disability, healthcare attendance and health-compromising behaviour.

Self-rated health in adolescence : A multifactorial composite

Background and aims: Self-rated health is an important health predictor, and it has only rarely been studied in adolescents. This study examined the relationships between self-rated health and a broad spectrum of structural, medical, psychological, and social variables. The association between these variables and negative health rating through to good health rating versus good to very good health rating was also compared. Methods: Analyses were based on cross-sectional data from the Young-HUNT II study in Norway. A total of 2,800 students aged 16 to 20 years participated, with a response rate of 81%. Separate logistic regression analyses for each gender were performed for a broad set of independent variables with self-rated health as the dependent variable. The effect of the variables at the negative (poor/not good) and positive (very good) ends of the scale were estimated and compared. Results: Self-rated health in adolescence was significantly associated with a broad spectrum of independent variables reflecting medical, social, and personal factors. The associations were also present in multivariate analyses controlling for the interrelations between the independent variables. The negative and positive ends of the scale were affected in much the same way. The association with general well-being was especially strong. Conclusions: Adolescents conceptualize health as a construct related to medical, psychological, social, and lifestyle factors. Positive rating of health was affected in a similar manner to negative rating. However, the absolute importance of hampering positive health may be greater because of the higher prevalence of such health ratings.

Emotional, self-conceptual, and relational characteristics of bullies and the bullied.

Aims: To clarify distributions of emotional and somatic symptoms among different groups involved in bullying behaviour during early adolescence; to explore differences in social integration and self-perceptions; to explore how different cut-off limits for bullying behaviour may affect the impact of these measures; and to interpret our findings in the light of theories of identity that may suggest directions for interventions against bullying in schools. Methods: A cross-sectional study, based on self-completion questionnaire, of 1237 pupils aged 11—15 years in autumn 2000 in Ålesund, Norway. Results: Bullies and their victims reported similar and greater emotional impairments and psychosomatic complaints, lack of self-confidence, and pessimism than students not involved in bullying. With increasing involvement, bullies differed from non-involved students only in regard to depressive complaints and pessimism. The bullied group reported more depressive, somatic and anxiety complaints, and self-reproach with increasing victimisation. Both bullies and the bullied reported problems relating to school, parents, and teachers. Bullies enjoyed friendships to the same degree or better than their peers not involved in bullying, whereas the bullied group reported impaired peer relations and increasing problems with more serious involvement. Bullies, the bullied, and bully-victims reported diminishing peer support in their class with increasing involvement. Conclusions: Both the bullied and bullies share relational, emotional, and self-conceptual problems, but they also differ in whether they succeed in social arenas and to what extent they are affected by different emotional and self-conceptual problems. They are, however, fellow sufferers in many aspects.

Adolescent alcohol use, psychological health, and social integration

Aim: Alcohol use and intoxication are highly prevalent among adolescents and may be an important element of the socialization process in the teenage years. Significant short- and long-term health consequences seem evident. The aim of this study was to investigate the relationship between alcohol consumption and several aspects of psychological health and social integration in adolescents. Methods: The study is based on data from a 1997 cross-sectional survey of 828 Norwegian tertiary school students in Førde (91% of all students). Three hundred and eighty (46%) were female. The majority of students were aged 20 or younger, with 64% aged 15 - 17. Four groups were defined according to frequency of alcohol intoxication. Emotional health and social integration in the four groups are reported as means and the differences from the reference groups (with 95% confidence limits) were estimated. Control of confounding and interaction was performed. Results: The study reveals that alcohol intoxication is an established element of mid-teenage behaviour for both sexes. It was found that depressive complaints and psychosomatic problems increased with increasing frequency of intoxication. Alcohol use is not only associated with improving friendship quantity but also with an improved quality of friendships. Heavy consumers report greater problems with relations with school and with their parents, especially in early adolescence. Conclusions: Though adolescents with moderate and heavy alcohol consumption are more sociable with friends, abstainers and light drinkers appear emotionally healthier. They succeed to a greater extent in a wide variety of social arenas, particularly in comparison with heavy consumers.

Is self-rated health a stable and predictive factor for allostatic load in early adulthood? Findings from the Nord Trøndelag Health Study (HUNT)

Self-rated health (SRH) is a widely used health indicator predicting morbidity and mortality in a wide range of populations. However, little is known about the stability and biological basis of SRH. The aim of this study was to map the stability of SRH from adolescence to early adulthood, and to examine the relationships between SRH and biological dysregulation, in terms of allostatic load (AL). The AL score comprises the eleven biomarkers systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), cholesterol, high-density lipoprotein cholesterol (HDL), triglycerides, waist-hip ratio (WHR), diabetes risk profile, glucose, C-reactive protein (CRP) and body mass index (BMI). Eleven years prospective data from the Nord-Trøndelag Health Study (HUNT), Norway, were utilised. Baseline data were gathered from 9141 adolescents (mean age 15.9 years) in the Young-HUNT I survey (1995-1997) and follow-up data were gathered from the adult HUNT3 survey (2006-2008). Altogether, 1906 respondents completed both questionnaires and clinical measurements in both studies. Cross-tables for SRH at baseline and follow-up showed that SRH remained unchanged in 57% of the respondents. Only 3% of the respondents changed their ratings by two steps or more on a four-level scale. Further, linear regression analyses adjusted for age and gender revealed that SRH in adolescence predicted AL in young adulthood. Similar patterns were found for most of the individual biomarkers. The consistency found in SRH from adolescence to young adulthood, and its association with AL across time, indicate that routines for dealing with SRH early in life may be a central strategy to prevent morbidity in the adult population.

Salt restriction: effects on lipids and insulin production in hypertensive patients

The object of the study was to evaluate blood pressure, insulin and glucose metabolism, and serum lipids in hypertensive patients, during 8 weeks on a moderately salt-restricted diet. A double-blind, cross-over study was conducted with hypertensive patients following a moderately salt-restricted diet. Patients were randomised to sodium capsules in one period and placebo capsules during the other period. After a 1-month run-in period, 13 males and three females with mild to moderate essential hypertension (mean age 50 years) complied with a salt-reduced diet. They were randomized to a salt-supplemented group (5 capsules of 10 mmol sodium per capsule) or a salt reduced diet group (5 capsules of placebo) with cross-over after 8 weeks. Serum insulin, insulin C-peptide, and glucose were measured, fasting and 30 min after a 75-g glucose load. Serum lipids and lipoproteins constituting an atherogenic index were measured, along with blood pressure and 24-h urine excretion of sodium and chloride. Non-significant reductions of systolic and diastolic blood pressure (4 mmHg, p = 0.06, and 2 mmHg, p = 0.13, respectively) were observed during the reduced-salt period. The changes observed for fasting insulin, insulin C-peptide, glucose, serum lipids and the atherogenic index were also non-significant. It is concluded that moderate salt restriction seems not to adversely influence insulin resistance or serum lipids in hypertensive patients.

Assessment of clinical features predicting streptococcal pharyngitis.

A total of 133 patients who consulted 4 general practitioners in Bergen 1988/89 for sore throat were examined. 8 clinical parameters with expected predictive value for identifying streptococcal tonsillopharyngitis were recorded. Clinical examination was validated against bacteriologic examination at a microbiological laboratory. The prevalence of streptococcal infection (group A, C and G) was 29%. An algorithm was constructed which identifies 3 groups with varying probabilities of streptococcal infection. A positive predictive value of 62% in the group with highest prevalence and a negative predictive value of 90% in the group with lowest prevalence was found. The consequences of performing a confirmative test only on patients in the group with uncertain prediction for streptococcal disease was elaborated. Although slightly reduced accuracy was demonstrated, due to diminished sensitivity, selective testing is recommended. Another algorithm was constructed for use in situations where no confirmative testing is available. The positive predictive value in the group with highest probability of streptococcal infection was 51%, and the negative predictive value in the group with lowest probability was 84%.

Effectiveness of two preventive interventions for coronary heart disease in primary care

OBJECTIVES 1. To compare a patient-centred, self-directive intervention with conventional care; 2. To evaluate longitudinal within-group changes of coronary heart disease risk. METHODS Risk factor changes were evaluated in 110 men with high coronary heart disease risk attending a one year intervention study in general practice. The 22 participating general practice centres were randomly allocated to follow either a patient-centred, self-directive intervention or a conventional approach. RESULTS No significant between-group differences were found in any single risk factor or in the combined risk of coronary heart disease. The improvement of total risk from screening time to conclusion of the study corresponded with changes of relative risks of CHD to 0.64 (95% CI: 0.54-0.77) and 0.65 (0.54-0.77) in the patient-centred, self-directive and the conventional care group respectively (p < 0.0001 in both groups). CONCLUSION Everyday general practice clinical work seems as efficacious as a specific intervention method based on currently advocated behaviour change principles.

Norway’s new principles for primary prevention of cardiovascular disease: age differentiated risk thresholds

Norway decided not to follow European guidelines on preventing cardiovascular disease and instead developed its own with age based thresholds. Ole Norheim and colleagues explain the rationale behind them

Medical students proposing questions for their own written final examination: evaluation of an educational project

Background In order to emphasise learning more than control, from autumn 2000 we have invited medical students to propose questions for their own written examination in family medicine. One out of three students proposals was guaranteed to be a part of their coming written examination, possibly somewhat modified.