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Screening for prediabetes in the general child population: maternal attitude to participation
Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
2001 (English)In: Pediatric Diabetes, ISSN 1399-543X, Vol. 2, no 4, 170-174 p.Article in journal (Refereed) Published
Abstract [en]

Screening to predict serious diseases in the general population has been regarded as unethical as it is supposed to make people anxious. Therefore we have evaluated whether mothers become anxious when their babies participate in a project to predict diabetes in the general child population. Out of 21 700 newborn children, 16 300 (75%) entered the ABIS project (All Babies in South-east Sweden). The parents (usually the mothers) answered a questionnaire at the child's birth and then again after 1 yr. A total of 10 868 representative birth questionnaires had been analyzed. To the question, 'How do you feel when you know that your child is participating in this study?', only 2.5% of mothers of children with type 1 diabetes in the family answered 'more anxious/much more anxious', and even fewer (1.5%) of the mothers in the general population (p < 0.01). A total of 52.5% of the general population answered 'calmer/more reassured' (29.3% 'calmer' and 23.2% 'much calmer'), while 43.3% felt unaffected. Those 1.5% of mothers who reported becoming more anxious were more likely to be in an unstable social situation (unemployed, p < 0.001; born abroad, p < 0.001; low education, p < 0.001).

At the 1-yr follow-up, 4948 unselected questionnaires had been analyzed. Only 1.2% of the mothers felt 'more anxious', while the overwhelming majority felt either unaffected (58.7%) or calmer (38.6%). At this follow-up, most of those who had felt 'more anxious' at birth did not feel that way any longer, and none of those with diabetes in the family.

We conclude that large-scale screening studies for the prediction of diabetes in the general population can be performed without causing increased anxiety. A few parents, most often found in the group with known social problems, might need extra information and support.

Place, publisher, year, edition, pages
2001. Vol. 2, no 4, 170-174 p.
Keyword [en]
attitudes, children, ethics, prediction, screening, type 1 diabetes
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-13628DOI: 10.1034/j.1399-5448.2001.20405.xOAI: oai:DiVA.org:liu-13628DiVA: diva2:21078
Available from: 2004-03-26 Created: 2004-03-26 Last updated: 2009-08-19
In thesis
1. The Stress Hypothesis: Implications for the induction of diabetes-related autoimmunity in children?
Open this publication in new window or tab >>The Stress Hypothesis: Implications for the induction of diabetes-related autoimmunity in children?
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Second to Finland, Sweden has the world’s highest incidence of type 1 diabetes. Experiences of serious life events have retrospectively been shown to constitute a risk factor for the development of this disease, probably via the biological stress response. Parenting stress and maternal attachment insecurity are other important sources of stress in early childhood.

Psychological stress increases the need for insulin and may induce insulin resistance, which might add extra pressure on the insulin-producing beta cells in the pancreas (beta-cell stress).

The aim of the current thesis was to propose and start investigating a stress hypothesis – namely that psychological stress may induce insulin resistance leading to beta-cell stress, which could trigger an autoimmune reaction towards beta-cells in genetically predisposed children. When all the beta cells have been destroyed, insulin can no longer be produced in the body and type 1 diabetes becomes manifest.

Methods: Families from the prospective population-based ABIS-project, which follows approximately 17 000 children, participated in the empirical studies of the current thesis. The mothers completed questionnaires, including various measures of psychological stress (e.g. parenting stress and experiences of serious life events) and socio-demographic background, at the birth of the child and when the child was 1 as well as 2.5 years of age. Maternal attachment insecurity was assessed with the Adult Attachment Interview. Blood samples drawn from the children at 1 and 2.5 years of age were analyzed for type 1 diabetes-related autoantibodies towards Tyrosine phosphatase (IA-2) and Glutamic Acid Decarboxylase (GAD).

Findings and Conclusions: Parenting stress and experiences of serious life events like divorce and maternal exposure to violence were associated with the induction of diabetes-related autoimmunity in early childhood, possibly via insulin resistance and beta-cell stress. The risk of developing diabetesrelated autoimmunity after parental divorce or mothers’ exposure to violence was about threefold. None of the results were explained by any of the potential confounding factors analyzed. These results support and strengthen the stress hypothesis, which warrants further investigation.

Mothers’ attachment insecurity was not associated with the induction of diabetes-related autoimmunity in their infants. However, this lack of association was perhaps due to methodological constraints.

The vast majority of the parents were calmed or unaffected concerning their participation in the ABIS-project, suggesting that large-scale medical screening-projects in the general population are not in themselves a cause for worry and can be performed without causing increased anxiety.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2004. 77 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 838
Keyword
Psychological stress, parenting stress, attachment security, serious life events, children, attitudes, Type I diabetes, beta-cell autoantibodies, prediction, etiology
National Category
Clinical Science
Identifiers
urn:nbn:se:liu:diva-5177 (URN)91-7373-810-7 (ISBN)
Public defence
2004-03-05, Aulan, Hälsans hus, Campus US, Linköpings universitet, Linköping, 13:00 (English)
Opponent
Supervisors
Note
On the day of the public defence the working title of article III was: Psychosocial correlates of parenting stress, lack of support and lack of confidence – A study of all babies in Southeast Sweden (ABIS). The status of article IV was: Manuscript to be submitted shortly; the status of article V was: Manuscript in preparation.Available from: 2004-03-26 Created: 2004-03-26 Last updated: 2012-01-25Bibliographically approved

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Ludvigsson, JohnnySepa, Anneli

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