Poor family relationships in adolescence as a risk factor of in-patient somatic care across the life course: Findings from a 1953 cohort

Background

Prior research has shown that poor family relations during upbringing have long-term detrimental effects on mental health. Few previous studies have, however, focused on somatic health outcomes and studies rarely cover the life span until retirement age. The aims of the current study were, firstly, to examine the association between poor family relationships in adolescence and in-patient somatic care across the life course whilst adjusting for confounders at baseline and concurrent psychiatric in-patient care; and secondly, to compare the risks of somatic and psychiatric in-patient care across the life course.

Methods

Prospective data from the Stockholm Birth Cohort study were used, with 2636 participants born in 1953 who were followed up until 2016. Information on family relationships was collected from the participants’ mothers in 1968. Annual information on in-patient somatic and psychiatric care was retrieved from official register data from 1969 to 2016.

Results

Poisson regressions showed that poor family relationships in adolescence were associated with an increased risk of in-patient somatic care in mid- and especially in late adulthood (ages 44–53 and 54–63 years), even when controlling for the co-occurrence of psychiatric illness and a range of childhood conditions. No statistically significant association was observed in early adulthood (ages 16–43 years), when controlling for confounders. These findings are in sharp contrast to the analyses of inpatient psychiatric care, according to which the association with poor family relations was strongest in early adulthood and thereafter attenuated across the life course.

Conclusion

Poor family relationships in adolescence are associated with an increased risk of severe consequences for somatic health lasting to late adulthood even when controlling for confounders including in-patient psychiatric care, emphasising the potentially important role of early interventions.

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Using longitudinal data, the article investigates long term health consequences of poor family relationships in adolescence.

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We find an association between poor relations and increased risk of in-patient somatic care in mid- and in late adulthood.

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Conversely, the association between poor family relations and an in-patient psychiatric care is strongest in early adulthood.

Poor family relationships in adolescence as a risk factor of in-patient psychiatric care across the life course: A prospective cohort study

Background: Previous research has shown that poor family relations in childhood are associated with adverse mental health in adulthood. Yet, few studies have followed the offspring until late adulthood, and very few have had access to register-based data on hospitalisation due to psychiatric illness. The aim of this study was to examine the association between poor family relations in adolescence and the likelihood of in-patient psychiatric care across the life course up until age 55. Methods: Data were derived from the Stockholm Birth Cohort study, with information on 2638 individuals born in 1953. Information on family relations was based on interviews with the participants’ mothers in 1968. Information on in-patient psychiatric treatment was derived from administrative registers from 1969 to 2008. Binary logistic regression was used. Results: Poor family relations in adolescence were associated with an increased risk of later in-patient treatment for a psychiatric diagnosis, even when adjusting for other adverse conditions in childhood. Further analyses showed that poor family relations in adolescence were a statistically significant predictor of in-patient psychiatric care up until age 36–45, but that the strength of the association attenuated over time. Conclusions: Poor family relationships during upbringing can have serious negative mental-health consequences that persist into mid-adulthood. However, the effect of poor family relations seems to abate with age. The findings point to the importance of effective interventions in families experiencing poor relationships.

School effectiveness and students' future orientation: A multilevel analysis of upper secondary schools in Stockholm, Sweden

INTRODUCTION

Future orientation (FO) refers to individuals' beliefs and feelings about their future. Earlier research has primarily investigated correlates of FO at the individual and family level, but it seems likely that FO is also shaped by other central agents or institutions, such as the school. Earlier studies have found positive associations between "school effectiveness" and student performance, and negative associations in relation to e.g., bullying, delinquency, and health risk behaviors. The current study investigated three teacher-reported features of school effectiveness - school leadership, teacher cooperation and consensus, and school ethos - and their links with student-reported FO.

METHODS

Survey data were collected in 2016 among 5131 students (aged 17-18 years) and 1061 teachers in 46 upper secondary schools in Stockholm, Sweden, and merged with school-level register data. Two-level binary logistic regression analyses were performed.

RESULTS

The analyses showed that higher teacher ratings of school leadership and school ethos were associated with a greater likelihood of reporting an optimistic FO among students. Teacher cooperation and consensus was however not associated with students' FO.

CONCLUSION

The findings indicate that the school environment contributes to shaping students' beliefs about their future. Thus, enhancing features of school effectiveness may be a way of promoting a positive development and brighter objective future prospects for the young, via pathways such as good student-teacher relations and academic motivation and achievement.

Hur gick det för 1960- och 1970-talets svenska narkotikamissbrukare?

What happened to the Swedish problem drug users of the 1960's and 1970's?

AimS & DESIGN

– In this study we follow a Stockholm birth cohort born in 1953 (n= 14 294) from youth to middle age. The cohort members were in their teenage years when drug abuse was established as a considerable threat to Swedish society and some of the cohort members themselves became drug abusers (n=431).

Results

– As expected, life became dramatically worse for those with documented drug abuse when young, than for the rest of the cohort members. While 72 percent of those without documented drug abuse were socially included at the age of 56, the corresponding share among those with documented drug abuse was 18 per cent. And while 5 percent in the former group were diseased at 56, this was true for 38 percent in the latter group. Supplementary analyses showed that social inclusion was also less stable among those with documented drug abuse than among the rest of the cohort, and that the flow from exclusion to inclusion was virtually nonexistent, which was not the case for those without experience of drug abuse.

Conclusions

– Gender specific analyses showed that the situation, at least in absolute terms, tended to be even worse for male drug abusers than for women. Gender differences in alcohol abuse, criminality, and with respect to parenthood are suggested as possible explanations to be further studied in future research.

Personal exposures to particles and microbes in relation to microenvironmental concentrations

The aim of this study was to compare the personal exposures of particles and microbes with the exposure being assessed by stationary samplers in the main microenvironments, i.e. home and the workplace. A random sample of 81 elementary school teachers in eastern Finland were selected to perform the two wintertime 24-h measurement periods. Particle mass concentration, black smoke (BS) concentration and concentrations of viable and total microorganisms on the sampled filters were determined using personal exposure sampling and microenvironmental measurements in homes and workplaces. In this paper, the correlations between different pollutants in each environment and correlations between personal exposures and home and work concentrations are presented. The results show that personal BS exposures correlated with both home and work BS concentrations. Furthermore, the concentrations of viable fungi and bacteria were related between personal and home concentrations. The time weighted microenvironmental model underestimated the personal exposures of particle mass, viable fungi, total fungi and total bacteria concentrations but the model might satisfactorily assess personal exposure to concentrations of BS and viable bacteria. The mass concentration of total fungi and bacteria was <1% of the total particle mass concentration.

PRACTICAL IMPLICATIONS

Stationary samples are only surrogate measures of personal exposures. Personal exposure measurements conducted on individuals' breathing zone are needed to assess the exposure to particles and microbes. The time weighted microenvironmental model is a useful method to assess personal exposure to combustion related particles and viable bacteria concentrations but the model underestimates personal exposures of particle mass, viable fungi, total fungi and total bacteria concentrations.

Exposures to nitrogen dioxide in EXPOLIS-Helsinki: microenvironment, behavioral and sociodemographic factors

Personal exposures to nitrogen dioxide (NO(2)) were monitored for 176 randomly selected inhabitants (25-55 years old) of Helsinki Metropolitan area as a part of the EXPOLIS (Air Pollution Exposure Distributions Within Adult Urban Populations in Europe) study between October 1996 and December 1997. NO(2) measurements were 48-h averages collected by Palmes passive sampler tubes. Differences in personal exposures to NO(2) were analyzed between sub-populations stratified by microenvironment, behavioral, socioeconomic and demographic factors. Factors significantly associated with differences in exposures to NO(2) were home and work location, housing characteristics, traffic volume near home, season and keeping windows open at home. Exposure to environmental tobacco smoke (ETS) and use of gas stove were also associated with increased personal exposures, although only few participants had a gas stove in Helsinki, and other gas appliances are non-existent. Single adults had higher average exposures to NO(2) than married or cohabiting participants, suggesting differences in living conditions between these two groups. Increased education was associated with decreased exposures to NO(2) and employed men were more exposed than unemployed men. Increased exposures to NO(2) were not associated with age or occupational status in Helsinki. Thus, behavioral and sociodemographic factors may have significant impact on personal exposures to NO(2) and should be considered in addition to environmental determinants in any monitoring program.

Nitrogen dioxide exposure assessment and cough among preschool children

The association between exposure to ambient air nitrogen dioxide and cough was evaluated in a panel study among 162 children aged 3-6 y. The weekly average nitrogen dioxide exposure was assessed with Palmes-tube measurements in three ways: (1) personally, (2) outside day-care centers, and (3) inside day-care centers. Ambient air nitrogen dioxide concentrations were obtained from the local network that monitored air quality. The parents recorded cough episodes daily in a diary. The risk of cough increased significantly (relative risk = 3.63; 95% confidence interval = 1.41, 9.30) in the highest personal nitrogen dioxide exposure category in winter, and a nonsignificant positive trend was noted for the other assessment groups. In spring, risk increased nonsignificantly in all exposure-assessment groups, except for the fixed-site monitoring assessment. It is important that investigators select an exposure-assessment method sufficiently accurate to reflect the effective pollutant dose in subjects.

Personally measured weekly exposure to NO2 and respiratory health among preschool children

Nitrogen dioxide is known as a deep lung irritant. The aim of this study was to find out whether the relatively low ambient air NO2 concentrations in the northern city of Helsinki had an impact on the respiratory health of children. The association between personal exposure to ambient air NO2 and respiratory health was investigated in a 13-week follow-up study among 163 preschool children aged 3-6 yrs. Personal weekly average exposure to NO2 was measured by passive diffusion samplers attached to the outer garments. Symptoms were recorded daily in a diary by the parents. Among 53 children, peak expiratory flow (PEF) was measured at home in the mornings and evenings. The association between NO2 exposure and respiratory symptoms was examined with Poisson regression. The median personal NO2 exposure was 21.1 microg x m(-3) (range 4-99 microg x m(-3)). An increased risk of cough was associated with increasing NO2 exposure (risk ratio = 1.52; 95% confidence interval 1.00-2.31). There was no such association between personal weekly NO2 exposure and nasal symptoms, but a nonsignificant negative association was found between the exposure and the weekly average deviation in PEF. In conclusion, even low ambient air NO2 concentrations can increase the risk of respiratory symptoms among preschool children.

Urban commuter exposure to particle matter and carbon monoxide inside an automobile

In-vehicle exposures to different sizes of particles and carbon monoxide (CO) were determined while driving along a standardized route under a variety of traffic conditions in Kuopio, Finland during the 12-month period from January to December 1995. Arithmetic means of in-vehicle exposures during the morning rush hours were 5.7 parts per million (ppm) (geometric mean, GM = 3.1 ppm, geometric standard deviation, GSD = 1.7) for CO, 107 #/cm3 (GM = 75 #/cm3, GSD = 1.9) for fine particles (optical equivalent particle size range 0.3-1 micron) and 0.9 #/cm3 (GM = 0.6 #/cm3, GSD = 2.1) for coarse particles (optical equivalent particle size range 1-10 microns). Fine particles and CO behaved similarly in different weather and traffic conditions, while the behavior of coarse particles was usually different, and often opposite. The driving conditions that affected the passengers' exposures to CO and fine particles were the time of day (morning vs. afternoon) and average speed (decreasing). The meteorological parameters that affected the passengers' exposures to CO and fine particles were wind speed (decreasing) and relative humidity (increasing). Wind speed, relative humidity and driving speed all had opposite effects on the exposure levels to fine vs. coarse particles. Added exposures (due to commuting on top of the background levels) to CO and fine particles were considerably higher in the morning vs. the afternoon runs and also higher in the slower vs. the faster runs.

Personal NO2 exposures of preschool children in Helsinki

Weekly personal NO2 exposures of 246 children aged 3-6 years were measured with Palmes tubes during 13 weeks in winter and spring in 1991. Measurements were made in eight day-care centers in the downtown and suburban areas of Helsinki, Finland. At the same time, inside and outside NO2 concentration of the day-care centers and the ambient air fixed site measurements were conducted. Palmes tubes were found to be applicable for NO2 exposure measurements of preschool children, but rather high sample losses could be expected. The geometric mean of personal NO2 exposure levels of 13-week period was 26.5 micrograms/m3 in the downtown and 17.5 micrograms/m3 in the suburban area. Gas stove and smoking at home increased significantly personal exposure to NO2. The weekly population NO2 exposure correlated rather poorly with the fixed site ambient air NO2 levels (R2 = 0.37), but much better with the NO2 levels inside and outside the day-care centers (R2 = 0.88 and 0.86). In the suburban and downtown groups the between children variations in the NO2 exposures were only 14% and 28% of the total variations, which were dominated by the within child variation. Stationary measurements at the ambient air fixed sites and inside and outside the day-care centers explained the variation in personal exposures of the children well during the spring, but not during the winter. A regression model, where data from outside day-care center measurements, fixed ambient air monitors, residential area and home characteristics (i.e., gas stove, smoking inside at home, type of dwelling) were included, explained 32% of the personal NO2 exposure variation in winter and 67% in spring. In the absence of personal exposure measurements, both stationary measurements and questionnaire information are useful in estimating variations in personal exposures.

Characterization of air quality problems in five Finnish indoor ice arenas

The air quality in five Finnish ice arenas with different volumes, ventilation systems, and resurfacer power sources (propane, gasoline, electric) was monitored during a usual training evening and a standardized, simulated ice hockey game. The measurements included continuous recording of carbon monoxide (CO), nitric oxide (NO), and nitrogen dioxide (NO2) concentrations, and sampling and analysis of volatile organic compounds (VOCs). Emissions from the ice resurfacers with combustion engines caused indoor air quality problems in all ice arenas. The highest 1-hour average CO and NO2 concentrations ranged from 20 to 33 mg/m3 (17 to 29 ppm) and 270 to 7440 micrograms/m3 (0.14 to 3.96 ppm), respectively. The 3-hour total VOC concentrations ranged from 150 to 1200 micrograms/m3. The highest CO and VOC levels were measured in the arena in which a gasoline-fueled resurfacer was used. The highest NO2 levels were measured in small ice arenas with propane-fueled ice resurfacers and insufficient ventilation. In these arenas, the indoor NO2 levels were about 100 times the levels measured in ambient outdoor air, and the highest 1-hour concentrations were about 20 times the national and World Health Organization (WHO) health-based air quality guidelines. The air quality was fully acceptable only in the arena with an electric resurfacer. The present study showed that the air quality problems of indoor ice arenas may vary with the fuel type of resurfacer and the volume and ventilation of arena building. It also confirmed that there are severe air quality problems in Finnish ice arenas similar to those previously described in North America.

Seasonal exposure to NO2 and respiratory symptoms in preschool children

One hundred seventy-two preschool children, aged three to six years, who attended municipal day-care centers in central and suburban areas of Helsinki, were followed up for seven weeks during the winter season and for eight weeks during the spring season in 1991. For each child, the weekly average NO2 exposure was estimated using passive samplers attached to the outer garments of the children during their everyday activities. Respiratory symptoms were recorded in daily diaries by the parents. The median of personally measured seasonal NO2 exposures was 21 micrograms/m3 (range 11-45.8 micrograms/m3). The seasonal median NO2 exposure was significantly larger (p < 0.001) in the central area (27.4 micrograms/m3) than in the suburban area (18.2 micrograms/m3), reflecting a difference in exposure caused by automobile traffic. There also were significantly (p < 0.001) more days with stuffed nose (26% vs. 20%) and cough (18% vs. 15%) in the central area than in the suburban area. At the individual level, there was a nonsignificant positive correlation between personal NO2 exposure and cough during the spring season. Thus the areal difference in these symptoms was partly, but not completely, due to the difference in exposure to NO2.

Simultaneous gas chromatographic analysis of drugs of abuse on two fused-silica columns of different polarities

A convenient and rapid gas chromatographic method for analysis of drugs of abuse has been developed. By installing two differently coated columns in a common split-splitless injector and connecting the column ends to a nitrogen-phosphorus detector and a flame ionization detector, considerable and accurate chromatographic information could be obtained from a single run. Quantitative analyses of amphetamine and some other drugs have been performed with the same instrumental set-up. Calibration graphs were evaluated and showed linearity in the concentration range chosen (0.5-10 mg/ml). By using an auto-sampler in combination with a BASIC program, both types of analyses can be performed routinely.

The use of 13C NMR spectroscopy in forensic drug analysis

13C NMR spectroscopy has been used for analysis of fourteen compounds which, according to Swedish laws are defined as narcotic drugs or are substances often found in combination with these drugs. The carbon-13 NMR method seems to be well suited for analysis of complex forensic drug mixtures because no preliminary separation of components is required.