Aim: To investigate the characteristics of severe abuse of children and possible differences in comparison with less severe abuse. Method: Cases of abuse reported to the police within a single police district (n = 142) in Sweden were studied. The severe cases were compared to all the remaining cases. Results: Severe abuse constituted 14% of the total cases and was reported by agencies to a greater degree than minor cases. The suspected perpetrators were socially disadvantaged people in both groups. Half of the most serious cases led to conviction in the courts, compared to 8% in the reference group. The children who had been subjected to abuse were often already known to social services and reports of child abuse had frequently been made. Conclusion: In comparison between cases of severe and minor child abuse reported to the police, the results did not show any crucial differences except the pattern of reporting and a higher occurrence of prosecution/conviction in the severe cases. This finding places a responsibility on agencies outside of the justice system to consider all cases of reported abuse as serious warning signals and to make independent evaluations to identify risks and the possible need for child protection. © 2007 The Author(s).

Objective: To investigate school performance, behavior and self-esteem of children with very low birth weight (VLBW). Methods: All children with birth weight below 1501 g (VLBW) and normal birth weight controls, born in the south-east region of Sweden during a 15-month period in 1987-88, were enrolled in a prospective follow-up study. At the age of 9 years, 81% and 82%, respectively, were re-examined regarding growth, neurofunctional classification, academic achievement tests, need for special education and behavioral problems. At 12 years, 89% and 76%, respectively, were re-examined regarding growth, neurofunctional classification, visual acuity and self-esteem. Results: VLBW children were shorter and lighter, and differed from the controls with regard to neurological functional classification. They produced poorer results in most academic achievement tests. When the comparison was restricted to children with normal intelligence, almost all the differences in other academic achievements disappeared. VLBW children had more reading difficulties but were less often than expected defined as dyslexics compared to control children. We did not find any major disparity in visual acuity and self-esteem between the groups. Low Apgar scores, intracranial hemorrhage and the need for mechanical ventilation neonatally were associated with poorer results in most outcome measures. Neurofunctional assessments in early childhood were associated with most outcome measures. The mother's education was related to delayed reading skills and need for special education. Conclusions: Although VLBW children performed less well in most academic achievement tests and on some behavioral subscales, those who had a normal intellectual capacity did not differ in any important aspects from the controls.

A family/systems approach allows us to see the individual in context. The family and the informal social network constitute the most important environment for a child. A basic assumption is that changes in family interaction patterns will have an impact on somatic as well as psychiatric symptoms in the child. In modern paediatric practice parents are routinely instructed to give their sick child the prescribed treatment and to implement preventive measures, they are recruited as part of the medical team. A family/systems approach helps families to identify their strengths and needs. The approach described here with a session transcript illustrates how understanding the ways in which family relatioinships interact with the course of illness and treatment can influence quality of life.

Aim: Breastfeeding seems to be favorable for cognitive development. Could levels of polyunsaturated fatty acids (PUFA) explain this? Methods: Pregnant mothers were recruited consecutively at maternity care centres. PUFA were analysed in colostrum and breast milk at 1 and 3 mo. The product-precursor ratios of n-6+n-3 PUFA were examined as measures of activity in respective steps in the fatty acid metabolic chain. Also, the quotient between DHA and AA was analysed. The children were tested with the full WISC-III at 6.5 y. Results: First, the influence of length of breastfeeding was analysed by multiple regression together with relevant cofactors (except for PUFA). In the best models, 46% of the variation in total IQ was explained. Length of breastfeeding contributed significantly to total IQ (beta = 0.228, p = 0.021), verbal IQ (beta = 0.204, p = 0.040) and performance IQ (beta = 0.210, p = 0.056). There were no significant single correlations between PUFA and measures of cognitive development. However, in multiple regression analysis of colostrum, significant beta-coefficients were found for steps 4+5 in the fatty acid metabolic chain (beta = 0.559, p = 0.002). If length of breastfeeding and gestation week were added to steps 4+5, this three-factor model could explain 67% of the variation of total IQ. Introducing length of breastfeeding and gestation week together with the quotient DHA/AA (beta = 0.510, p < 0.001) yielded a three-factor model, which explained 76% of the variation in total IQ. Conclusion: Our findings could be interpreted as supporting the importance of high levels of PUFA for cognitive development. However, the sample is small and the results must be interpreted with caution.

The role of psycho-social factors in the development of allergy was studied prospectively in 82 infants with a family history of atopy. The family participated in a standardized family test when the children were 18 months old. The ability to adjust to demands of the situation ('adaptability'), and the balance between emotional closeness and distance ('cohesion'), were assessed from videotapes by independent raters. Families rated as functional in both of these aspects were classified as 'functional', otherwise as 'dysfunctional'. The social network, life events, atopic symptoms (based on postal inquiries regarding symptoms answered by the parents, and on physical examinations), psychiatric symptoms, and socio-economic circumstances of the families were evaluated when the children were 18 months and 3 years of age. The children were classified as atopic (asthmatic symptoms or eczema) or as non-atopic. All but two children with atopic disease at 3 years of age had atopic disease before 18 months of age, while 32 of 60 children with atopic disease at 18 months of age had no problems by 3 years of age. An unbalanced family interplay at 18 months was associated with a relative risk (RR) of 1.99 for continuing atopic illness at 3 years of age (1.18

Objective: To describe the visual functions and relate them to MRI findings and the intellectual level in adolescents born with very low birth weight (VLBW). Design: Population-based case-control study. Patients: 59 15-year-old VLBW adolescents and 55 sex and age-matched controls with normal birth weight. Main outcome measures: Objective clinical findings (visual acuity, stereo acuity and cycloplegic refraction) were recorded. Structured history taking was used to identify visual difficulties. The intellectual level was assessed with the Wechsler Intelligence Scale for Children (WISC). All VLBW adolescents underwent MRI of the brain. Results: Significant differences were found between the VLBW adolescents and controls regarding visual acuity (median -0.11 and -0.2, respectively, p = 0.004), stereo acuity (median 60″ and 30″, respectively, p<0.001), prevalence of astigmatism (11/58 and 0/55, respectively, p<0.001) and in full-scale IQ (mean IQ 85 and 97, respectively, p<0.001) and performance IQ (mean 87 and 99, respectively, p = 0.002). The structured history also revealed a borderline significant difference between the groups (mean problems 0.46 and 0.15 respectively, p = 0.051). 30% (17/57) of the VLBW adolescents had abnormal MRI findings and performed worse in all tests, compared with both the VLBW adolescents without MRI pathology and the normal controls. Conclusion: This study confirms previous observations that VLBW adolescents are at a disadvantage regarding visual outcome compared with those with normal birth weight. In 47%, visual dysfunction was associated with abnormal MRI findings and in 33% with learning disabilities. The adolescents with abnormal MRI findings had more pronounced visual and cognitive dysfunction. The findings indicate a cerebral causative component for the visual dysfunction seen in the present study.

Basic ethical principles like autonomy, non-maleficence, beneficence and justice should be taken into consideration step by step when treating refugee children and their families. These principles may be considered from the point of view of each of the actors involved - patient, therapist and interpreter. This paper is focused on the role of the interpreter and on different aspects to be considered by the therapist when working with interpreters in psychotherapeutic treatment of refugee children and families. Elements of case histories are used to illustrate situations faced in working with an interpreter. An ethical analysis of a case where a teenage refugee received therapeutic treatment using an interpreter is made. © 2005 Taylor & Francis.

Basic ethical principles are worth analysing step by step when dealing with refugee children and their families. Three issues where potential ethical conflicts might arise for healthcare professionals in treating refugees with different cultural background are pointed out-traumatic life events, hierarchy and repatriation. An ethical analysis of the decision to admit a traumatized teenage refugee to a psychiatric ward is discussed with respect for the ethical principles autonomy, non-maleficence, beneficence and justice. There are both gains and losses, which are valued differently depending on the actors involved.

Objective: Deficits in executive functioning, including working memory (WM) deficits, have been suggested to be important in attention-deficit/ hyperactivity disorder (ADHD). During 2002 to 2003, the authors conducted a multicenter, randomized, controlled, double-blind trial to investigate the effect of improving WM by computerized, systematic practice of WM tasks. Method: Included in the trial were 53 children with ADHD (9 girls, 15 of 53 inattentive subtype), aged 7 to 12 years, without stimulant medication. The compliance criterion (>20 days of training) was met by 44 subjects, 42 of whom were also evaluated at follow-up 3 months later. Participants were randomly assigned to use either the treatment computer program for training WM or a comparison program. The main outcome measure was the span-board task, a visuospatial WM task that was not part of the training program. Results: For the span-board task, there was a significant treatment effect both post-intervention and at follow-up. In addition, there were significant effects for secondary outcome tasks measuring verbal WM, response inhibition, and complex reasoning. Parent ratings showed significant reduction in symptoms of inattention and hyperactivity/impulsivity, both post-intervention and at follow-up. Conclusions: This study shows that WM can be improved by training in children with ADHD. This training also improved response inhibition and reasoning and resulted in a reduction of the parent-rated inattentive symptoms of ADHD.

Child sexual behaviour has until recently remained largely unexplored in Sweden, despite theoretical interest in normal childhood sexuality. Issues about sexual abuse and its consequencies has, however, created a need for research on developmentally "normal" sexual behaviour and experiences among boys and girls, while growing up.

The overall purpose of the present thesis was to gain knowledge about sexual behaviour and experiences before adolescence, in normative groups of children in contemporary Sweden. The empirical work consists of five papers based on three separate quantitative studies. Two studies include preschool children (n=251 and n=185, and a sample from the USA, n=467) with questionnaires to parents and preschool staff. The thesis is also addressing adult views on child sexuality. One study focus on childhood sexual experiences up until the age of 13 (n=269), in which young adults (18-20 years old) answered questionnaires about solitary, mutual and nonconsensual childhood sexual activities.

A wide range of sexually related behaviour was observed, most of which was developmentally related. Parents reported more sexual behaviour in their children compared to preschool teachers' reports. Adult-like sexual behaviour, and behaviour of intrusive character, were extremely rare in the preschool children. Gender differences were explored and found on some aspects and there was a correlation between reported behaviour and family factors. A Swedish sample of preschool children's' behaviour according to parental reports, was compared to a similar sample from the USA, and similarities as well as cultural differences were found.

In self-reports from students, solitary experiences and mutual sexual activities together with a same-aged friend were common before adolescence. Non-consensual sexual activities, with same-aged children was relatively common. In other cases the non-consensual experiences happened together with an older teenager, or with an adult.

The results provide an incipient frame of reference for further studies on child sexual behaviour in Sweden. Observable behaviour is one very important factor to consider when clinicians and other child-care professionals are to make assessments of a child's developmental status and situation, and knowledge in this area therefore holds importantimplications. Child sexuality need to be addressed within paediatrics and child psychiatry, as well as in social work, not only in terms of risk andeffects after abuse, but also as an integral part of healthy child development.

Issues of what constitutes normal and healthy childhood sexual behaviour have acquired new implications in the light of child sexual abuse. Increased knowledge in this area is therefore of vital importance and studies in different countries are needed. In the present study parents of 231 children aged 3–6 y were asked to answer questionnaires about their child's behaviour at home. The questionnaire consisted of four sections: demographic data, a general behaviour checklist, a sexual behaviour inventory, and attitudinal questions to the parents. The results showed that children in Sweden exhibit a wide range of sexual behaviour, most of them developmentally related. Some behaviour appeared to be very rare in a normative sample of preschool children and included behaviours usually referred to as sexualized and problematic. Reports on sexual behaviour in the children were also related to general behaviour reports, the parent's socio-economic level, parental attitudes towards child sexuality and the openness of family habits.

Childhood sexuality and children’s sexual experiences have become increasingly important to study because our knowledge on the impact of sexually abusive experiences on children’s developing sexuality has increased. The main aim of this paper was to study aspects of young adults’ recollections of their sexual experiences before the age of 13, solitary and shared, mutual as well as coercive. Anonymous questionnaires were answered by 269 final year, senior high-school students, mean age 18.6 years; 82.9% of the students reported solitary sexual experiences and 82.5% had mutual experiences together with another child. Most of the children had their experiences together with a same-age friend. Girls had more same-sex experiences than boys did. Thirteen percent reported coercive experiences where they had been tricked, bribed, threatened, or physically forced into participation. Some children, 8.2%, had coerced another child into participation in sexual activities. The majority thought of their childhood experiences as normal. There were also 6.3% of the respondents who had had inappropriate sexual experiences with someone at least 5 years older, the majority being girls. Gender differences were evident in several respects: girls were more often coerced, they felt more guilt, and they had far less experience of masturbation, whereas boys were somewhat more active in explorative activities on their own as well as with peers. Some kind of coercive sexual experiences appears to be part of growing up for quite a few children, although in general the years before puberty seem to be years of frequent mutual sexual exploration and experimentation.

Objectives: The main purpose of the study was to compare observed range and frequency of sexual behavior in 3- to 6-year-olds in two different environments: the home and the daycare center. The study also aimed to investigate parental and staff opinions on child sexual behavior.

Methods: Parents and daycare teachers of 185 preschool children, from different socio-economic housing areas, answered extensive questionnaires about each child’s sexual and general behavior. They were also asked about their own opinions on child sexual behavior.

Results: Parents observed significantly more sexual behavior in their children at home compared to teachers’ observations at the daycare centers in all age groups, while teachers reported more general behavior problems. Significant gender differences on sexual behavior were displayed at the daycare centers but not at home. Rare behaviors at home were also very unusual at the daycare center. Parental and staff attitudes toward child sexuality were quite open, although 67% of the parents and 41% of the teachers never spoke to the children on sexual matters. One fifth of the adults used no term for genitals at all, and even fewer had a name for girls’ genitals.

Conclusions: The findings indicate that young children explore their sexuality more at home than in settings with groups of children where the daily activities may be more structured and monitored. It enhances the importance of looking at the context in which the sexual behavior is taking place when investigating problematic sexual behavior.

Studies of childhood sexual behaviour in a cross-cultural perspective are important in that they increase our knowledge of normative behaviour in general and enhance our understanding of cultural influences on child sexual development. Two studies, one from Sweden (n=185) and one from Minnesota, USA (n=467) of 3-6 year old children, were assessed with a 25-item scale derived from the Child Sexual Behaviour Inventory. Both studies were screened for the absence of sexual abuse. The Swedish parents completed the questionnaire about their child's behaviour at home and the US parents typically completed the questionnaire in the waiting room of a paediatric clinic. Pre-school children in Sweden exhibited more sexual behaviour than American children of the same age according to parental reports. These differences were most pronounced in boys. In both studies exhibitionistic or voyeuristic behaviour and touching behaviour was most frequent. Both intrusive and sexually explicit behaviour was very unusual. The results reflect how cultural context influences which behaviour is permitted in young children, and consequently what adults think constitutes normal and problematic childhood sexual behaviour.

Objectives: To assess the use of healthcare resources for preterm infants and to evaluate family function and socioeconomic support in a defined population from birth to 4 years of age. Methods: In a prospective case-control study, 39 singleton preterm infants without prenatal abnormalities born during an 18 month period were studied together with their families. The population consisted of 19 very preterm infants (less than 32 weeks) and 20 randomised moderate preterm infants (32-35 weeks), and the control group comprised 39 full term infants. Contacts with medical services, child health services, and the social welfare system were registered, and family function and life events were studied. Results: The preterm children were more often readmitted to hospital (odds ratio (OR) 6.6, 95% confidence interval (CI) 2.0 to 22.1) and had more outpatient attendances (OR 5.6, 95% CI 2.1 to 15.0) during their first year of life. Mothers in the preterm group more often used temporary parental allowance than the control mothers (p < 0.001). The number of contacts with the child health services and the social welfare system did not differ significantly from the controls. Neither was there any significant difference with regard to family function or life events at 4 years of age. Conclusions: A large proportion of the premature children used specialist care during the first years of life. However, the families of the preterm infants were socially well adapted up to four years after birth compared with the control families.

The frequency of sexual behaviors in a population of preschoolers (n = 251) attending Swedish daycare centers was studied using a questionnaire given to the staff. Some behaviors turned out to be frequently occurring, like searching for body contact and responding to such contact. However, several behaviors were very uncommon (1% or fewer): touching an adult's genitals; attempting to make the adult touch the child's genitals; using objects against own or other childs genitals/anus; to masturbate obsessively, without pleasure or in a way that caused pain. Other behaviors occurred more frequently but were still uncommon (less than 2% of the children displayed such a behavior “sometimes” or “often/daily”): exhibiting own genitals; playing sexually explorative games; initiating games with a similarity to adult sexual activity; using sexual words; attempting to touch a woman's breast. Only masturbation and clinging body contact were positively correlated with behavioral disturbance. The correlations between age and single behaviors may be summarized as manifestations of the process of socialization. The results offer an incipient frame of reference for statistically normal expected sexual behaviors in preschoolers at daycare centers. The rarity of certain behaviors implies that their occurrence in an individual case may necessitate special clinical attention.

This thesis was begun in 1998 at a time when increased numbers of police reports regarding child physical abuse was presented. The increase had been overshadowed by the research on the sexual abuse of children and showed that child physical abuse in Sweden had only been scarcely investigated since the institution of the Swedish anti spanking law in 1979.

The aim of this thesis was to investigate child physical abuse from a judicial, social, child- and adolescent psychiatric and a user perspective where a parent or equivalent was the perpetrator. One police district was investigated between 1986 and 1996 and all reports regarding child physical abuse were included. The abused children (n=126) were also followed through social services’ files and child and adolescent psychiatric service charts from birth to a 4-year follow up from the abuse incident studied. Finally, mothers of the physically abused children were interviewed.

The greatest increase in police reports during the years investigated, turned out to be concerned with violence between children. The incidence where a carer was the abuser proved to be comparable to the incidence in other Nordic countries, with the adjustment that first generation immigrants were found to abuse their children 8 times as often as native Swedish citizens and second generation immigrants. There were a wide variety of injuries inflicted on the children, where bruises were the most common. Only a few cases where injuries could be verified ended up in court. Social services contact was common among the abused children and their families prior to the abuse incident studied, as were previous reports on child abuse and neglect. Injuries from the abuse as well as familial and context characteristics had an impact on referred social services interventions. The two most important factors for a child still to be receiving social services interventions 4 years after the abuse incident were whether the mother was mentally ill and whether there had been reports on child abuse or neglect prior to the studied abuse incident. About half of the children had been receiving interventions from the mental health services at some point in time, but mainly due to other reasons than physical abuse. Mental health treatment for the physically abused children was rare even though many of the children had contact with the child and adolescent psychiatric services repeatedly before, at and after the abuse incident. The interviewed mothers conveyed a picture of satisfaction with the police’s work but were mainly critical towards the social services. The mental health service was considered to be doing a good job, but needed to do even better.

The results indicate that despite an environment that supports public values, attitudes and laws confirming a standpoint against violence towards children, there is still a gap between intentions and reality in Sweden. The thesis provides one way of looking at child physical abuse, but puts forward the urgent need of further studies.

There has been an increase in the number of child abuse cases reported to the police since mid 1980s. This has put increased pressure on institutions dealing with the abused children. In this paper, we describe how 5 biological mothers of physically abused children perceive interventions. The interviews concerned interventions from the police department, social services, and mental health services. The mothers narrated similar stories where their statements focused on a process dealing with restrictions, significant others, and living conditions. As previous studies have indicated and as the mothers of the physically abused children also narrated, there is a general acceptance of the police department and mental health services, while many are highly critical towards social services. The common conclusion in the mothers’ narratives is that representatives from the investigated authorities should be encouraged to cooperate and to be clear when explaining the process that awaits each family. In addition to listen and recognize cries for help and learn how to handle people in a crisis situation.

This study aims at describing and analysing what kinds of social services are provided for physically abused children in Sweden. The social services files were examined for 113 children under 15 years of age (67 boys and 46 girls) who had been reported to the police as having been physically abused by a parent or equivalent caretaker in a particular police district. The children's social services files indicated an increased risk of a parental abusive behaviour prior to the abuse incident. There had been former interventions in 81 per cent of the families and previous reports on neglect or abuse in 44 per cent of the 113 families. After the abuse incident, investigations were opened in 80 per cent of the cases. The three most common interventions were placement in foster care, referrals to Child and Adolescent Psychiatric Service and Social Services support contacts. The study shows that there was a tendency towards more proactive work with injured children, children of immigrant parents and children of mentally ill parents.

Since 1996-97, the Municipality of Linköping has been using a structured model for investigation and intervention in children with learning difficulties. In this model   pedagogical,   psychological,   and   child-   and   adolescent   psychiatric competences are linked to the child in the school environment.

The main purpose of this report has been to illustrate how such interventions from school and healthcare have worked for children with AD/HD and related disorders. A second purpose has been to increase knowledge on the situation of the  families  in  the  fields  of  work,  family  life  and  social  life.  Data  from interviews with 14 parents are summarised.

It appears  from the literature  that AD/HD  in a societal  perspective  has been sparsely  studied.  Life  with  an AD/HD  child  has been  described  by some  as chaotic,  filled  with  conflicts  and  exhausting.  Variations  between  countries, ethnical groups and between the sexes (boys are investigated more often than girls) are seen in help-seeking, aetiological explanations, other peoples’ attitudes and in intervention patterns. We have found only few scientific studies on how interventions were perceived by relatives.

In this study, time elapsed from onset of symptoms  until investigations  were undertaken was as long as 4-8 years in 9 out of 14 cases. Otherwise, a general impression is that in most cases diagnosing was helpful and that interventions facilitated   schooling,   maturation   and  development.   Today,   13  of  the  14 adolescents  are in upper secondary school. Most parents experience  that their child  performs  well.  Their  thoughts  on  how  the  situation  would  have  been without early interventions are quite pessimistic.

Most parents describe various impacts from their AD/HD child on their working hours, economy, family life and social life. In many cases both the family and a third person were extra involved in the supervision and care of the child.

This  study  shows  the  need  for  schools  and  healthcare  providers  to establish competence and efficient working methods for early diagnostics and treatment of  children  with  AD/HD  and  related  disorders.  Long  and  time-consuming admittance  procedures  should  be  avoided  when  efficient  interventions  and treatments  are  available.  The  model  in  the  Municipality  of  Linköping  is  a positive example that should be disseminated and further developed.

Aims: To investigate use of targeted self study material in type I diabetes patient education regarding dissemination, perceived patient benefit, and prevention of severe hypoglycaemia. Methods: In a randomised 1:1:1 controlled study, 332 patients with type I diabetes (aged 2.6-18.9 years) were studied, 313 completed clinical follow up, 261 completed endpoint questionnaire. The intervention group received videotapes and a brochure designed to review skills for self control and treatment, aimed at preventing severe hypoglycaemia. Two control groups received a videotape and brochure with general diabetes information, or traditional treatment only, respectively. Results: Yearly incidence of severe hypoglycaemia decreased from 42% to 27% in the intervention group, but not in controls. HbA1c remained unchanged. Levels of use ranged from 1 to 20 times (median 2), 40-49% had shown the materials to friends, relatives, school staff, sports coaches, etc (there was little difference between intervention and control groups). Higher benefit and learning levels resulted from the intervention material, especially in patients with severe hypoglycaemia. Conclusions: Mass distributed pedagogical devices such as high quality video programmes and brochures may contribute to the prevention of severe hypoglycaemia. Such self study materials can reach high dissemination levels and constitute a cost effective complement to regular visits to a diabetes team and to other types of education. The findings may have implications for other topics, other ages, and other diagnosis groups.

Aim: To study the long-term use of self-study material in type 1 diabetes patient education targeted at the prevention of severe hypoglycaemia. Methods: Randomized 1:1:1 control study in three local hospitals. We studied 332 type 1 diabetes patients from the geographic population, aged 2.6-18.9 y at entry. The intervention group received a videotape and brochure in which interviewed patients, parents and medical experts reviewed in detail practical skills for self-control and treatment, with the aim of preventing severe hypoglycaemia. There were two control groups: one received a videotape and brochure with general diabetes information and the other only traditional treatment. Primary endpoints were severe hypoglycaemia needing assistance by another person and HbA1c. Dissemination, reading/viewing level, patients' attitudes and extra contact with caregivers were also investigated. At 24 mo, 249 subjects provided data. Results: The yearly incidence of severe hypoglycaemia decreased at 24 mo from 42% to 25% (difference 17%, 95% CI 3-31, p = 0.0241) in the intervention group, but not in controls. HbA1c remained unchanged. Video use during months 13-24 was higher in the intervention group than in controls (p = 0.0477), ranging from 1-15 (median 2) times, among 37% of patients (months 1-12, 100%). Higher future use was anticipated for intervention material (p = 0.0003). Extra caregiver contact was related to severe hypoglycaemia (p = 0.0009). The cost of the material was

We have studied use of the Internet in search for diabetes-related information in a geographic population of type 1 diabetes children and adolescents. Using a randomised cross-sectional design, 90 out of 110 patients aged 5-20 years responded to a postal questionnaire. Thirty-eight subjects (42%) had searched for diabetes information on the Internet, at a median of 3 occasions, range 1-50. Out of the searching families, 32% had also shown diabetes information from the Internet to others, such as relatives, friends and school staff. Eighty-six percent had found information in Swedish, 32% in English and 68% indicated a need for more information in Swedish. 97% percent anticipated future use. Specific web-sites were suggested by 24%. Searchers as compared to non-searchers had a shorter diabetes duration (p = 0.0255) and more recent extra contacts with their caregivers (p = 0.0018). We conclude that Internet-based information and support may be requested at a high extent by patients, as a complement to regular visits to the diabetes team and other types of traditional care and education. The results suggest a great need for development of systems combining technical and human support, which is discussed. The findings may also have implications for other topics within diabetes education, other ages, and for other diagnosis groups.

Objective: To study perceived occurrence and magnitude of fear and other disturbances of severe hypoglycaemia in children and adolescents with type 1 diabetes mellitus (DM) receiving intensive treatment with active education and psychosocial support. Patients and Methods: Out of a geographic population of 112 patients <19 years of age and their families, with a DM duration >1 year, HbA1c mean ± SD 6.7 ± 0.9 (method 1.15% below DCCT level), 74 responded to a questionnaire. Visual analogue scales, 5-graded Likert scales and open questions were used. Results: Global quality of life was high, but lower among patients with severe hypoglycaemia within the last year (p = 0.0114). Worse perceived health was correlated to higher HbA1c year mean (r = 0.32, p = 0.0227). Patients and parents regard severe hypoglycaemia more as a problem (p <0.0001) and the risk of it more disturbing than mild hypoglycaemia (p <0.0001), insulin injections (p <0.0001) or blood glucose determinations (p <0.0001). The disturbance is higher during exercise, disco/party and in travel situations. Severe hypoglycaemia with unconsciousness causes more fear than severe hypoglycaemia needing assistance but without unconsciousness (p = 0.0001 or the potential late complications of DM (p = 0.0014). Severe hypoglcaemia needing assistance but without unconsciousness causes more fear than mild hypoglycaemia (p = 0.0001) and diabetic ketoacidosis (p <0.0001) but less than the potential late complications of DM (p = 0.0034). Conclusions: Severe hypoglycaemia frequently causes fear and various disturbances in spite of active education and psychosocial support. There is a potential for increased quality of life from interventions targeted at the prevention of severe hypoglycaemia. Further research and improved strategies for the prevention of severe hypoglycaemia are needed.

OBJECTIVE - To investigate whether risk of severe hypoglycemia is related to serum (S) ACE level during intensive treatment in type 1 diabetic children. RESEARCH DESIGN AND METHODS - A cohort of 86 intensively treated type 1 diabetic patients was studied during 1999-2000. In 1999, the age range was 7-19 years (median 12.8), diabetes duration was 1.2-14.7 years (5.3), insulin dose was 0,4-1.7 units ╖ kg-1 ╖ 24 h-1 (1.0), and the HbA1c year mean was 4.7-10.2% (6.8). HbA1c, insulin doses, and events of severe hypoglycemia (needing assistance from another person) were prospectively registered at regular visits, scheduled quarterly. S-ACE was determined once. RESULTS - Severe hypoglycemia was correlated to S-ACE (r = 0.22, 95% CI 0.0I-0.41, P = 0.0093). The square root of severe hypoglycemia was correlated to S-ACE (r = 0.27, 95% CI 0.06-0.45, P = 0.0093). Patients with S-ACE at the median level or above (n = 44) reported a mean of 3.0 yearly events of severe hypoglycemia compared with 0.5 events in patients with S-ACE lower than the median (n = 42) (P = 0.0079). Of the patients with an S-ACE at the median level or above, 27 (61%) reported severe hypoglycemia, compared with 17 (40%) patients with an S-ACE lower than the median (P = 0.0527). Insulin dose, HbA1c, age, onset age, duration, C-peptide, and sex did not differ between these two groups. S-ACE was negatively correlated with age (r = -0.27, 95% CI -0.46 to 0.07, P = 0.0265) but not with HbA1c, duration, or blood pressure. CONCLUSIONS - The elevated rate of severe hypoglycemia among patients with higher S-ACE suggests, among other factors, that a genetic determinant for severe hypoglycemia exists. Further evaluation is needed before the clinical usefulness of this test can be elucidated.

This volume provides insight into the young generation's relationship and experiences with pornography. Generation P? is based on a unique and comprehensive study giving voice to the words and opinions of the young people themselves. Never before have pornography and sexualized material been so readily available and pervasive in young people's everyday life. TV programmes, advertising, and the music industry exploit and play with pornographic codes and scenarios. The sex industry launches and promotes its products via youth channels and websites. How do young people navigate through this pornographic landscape? Does the omnipresence of pornography breed curiosity or resistance? How does pornography challenge the role of parents and teachers? Generation P? provides answers to these questions and presents a unique body of new research on youth, gender and pornography. The study shows that the vast majority of young people in the Nordic countries have seen porn. But young people do not swallow the pornographic messages without resistance, and some are very critical of or actively opposed to them. It is very seldom that the voices of young people are heard in the public debate on pornography. In Generation P? , focus is set on the voices, definitions and experiences with pornography of young people themselves. The book contains contributions from leading researchers from different academic fields: sociology, psychology, media research, social work and public health.

Objective: To examine the development of reading skills among very-low-birthweight (VLBW) children and to what extent reading difficulties at 9 years of age persist unchanged, are attenuated, or are enhanced at 15 years of age. Methods: Fifty-six VLBW and 52 normal birthweight (NBW) children were assessed on word decoding, word recognition, and reading comprehension at 9 and 15 years of age. Results: VLBW children showed deficits in reading skill at 9 years of age, while most differences obtained at 15 years of age did not reach significance. VLBW children improved their reading comprehension between 9 and 15 years of age more than NBW children, and when controlling for individual differences in IQ, VLBW children improved both their reading comprehension and word-recognition skill. Conclusion: The results suggest that VLBW children display positive changes over time in reading skills. © The Author 2006. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved.

With the aim to survey the seasonal pattern of diagnosis of type 1 diabetes we included all 1903 children <16 years of age and who had been diagnosed with type 1 diabetes between 1977 and 2001 in the south-east of Sweden. To investigate the seasonal pattern a mixture of two cosine functions was included in a logistic regression model.

There was a clear seasonal variation over the years (p < 0.001). Children in the oldest age group (11–15 years) showed the most obvious seasonal variation (p < 0.001). Children with a short duration of symptoms had about the same seasonal variation as children with a long duration. Both children with and without an infection 3 months prior to diagnosis showed significant seasonal variation (p < 0.001) although the seasonal pattern differed between the two groups (p < 0.001). As the incidence of diabetes increased during the 25 years the study period was divided into periods of 5 years and it was only during the two last periods that significant seasonal variation occurred.

There is a clear seasonal variation in diagnosis of type 1 diagnosis in children and the results suggest that children with a less aggressive disease process at diagnosis were most responsible for this variation. Children with and without prior infection showed a different seasonal pattern.

Norsk institutt for forskning om oppvekst, velferd og aldring.    

Adolescents reporting selling sex for payment were studied with respect to socioeconomic background, perceived mental health and health behavior, antisocial behavior, sexual experiences, including sexual abuse and abusive behaviors, and the use of pornography. The sample consisted of a representative sample of 4,339 students (response rate, 77.2%) from the third year of upper secondary schools in five Swedish cities. Of the participating adolescents, 1.8% of the boys and 1.0% of the girls indicated that they had sold sex for money or other reimbursements. Selling sex was associated with having an immigrant background, higher level of unemployment in the family, and studying a practical/vocational program. Adolescents with the experience of selling sex had an increased risk for different psychosocial problems, such as poorer mental health, weekly use of alcohol, and antisocial behaviors. The adolescents selling sex were also characterized by having had a greater number of sexual experiences, a greater preoccupation with sex, relatively early sexual debut, and experience with sexual abuse as victim and/or perpetrator. The index group students watched pornography more frequently than the majority and they also watched more deviant forms of pornography. The significance of the higher frequency among boys and the gray zone between normal sexual exploration and prostitution are discussed. © 2006 Springer Science+Business Media, Inc.

Of the 1,575 pregnant women registered at the public Antenatal Health Care Service in the city of Linköping, Sweden during 1983, an index group of 78 women was identified that met specific well-defined psychosocial risk criteria related to drug addiction, mental insufficiency, and particular social circumstances of possible relevance to problems of pregnancy and early child development. A further 78 pregnant women who did not meet the inclusion criteria were used as a reference group. The present study is a 16-year follow-up in which 43 (57%) of the original index children and 63 (82%) of the original reference children were examined on indices of mental health, and the presence of child abuse. Their mental health was assessed with the Child Behaviour Checklist (CBCL) completed by the mothers and the Youth Self-Report (YSR) completed by the adolescents. The incidence of child abuse and Social Welfare interventions was obtained from Social Welfare records. The index children, especially the boys, displayed significantly poorer mental health as assessed by both CBCL (p<0.05) and YSR (p<0.02). Being an index child increased the odds ratio 16-27 times for different Social Welfare interventions, and child abuse had been investigated in 27% of the index children compared to 1% of the reference children. © Steinkopff Verlag 2005.

In Europe, 10-20% of all women and 3-10% of all men have experienced sexual abuse before the age of 18, according to surveys. Psychosocial problems are often seen as both short- and long-term consequences of such abuse. Family dysfunction may be seen as both a risk factor for abuse and a result of the disclosure of abuse. The aim of this research was to study how adolescents and adults, sexually abused during their childhood, experienced their family life and family climate in their family of origin. A clinical sample of 18 adolescent girls and 20 adult women comprised the study group. The methods used were a semi-structured interview and the questionnaire Family Climate Test. The majority of the participants kept quiet about the abuse during their childhood. The abuse took place for an average of 2.5 years among the adolescents and 6 years in the adult group. Secrecy, isolation and family problems were typical attributes in the interviews. The majority of both adolescents and women described their relationships in the family of origin as deviant or interrupted, with a reversed (negative) pattern on the Family Climate Test. This meant a low level of closeness and a high level of distance in the families combined with a low level of spontaneity and a high level of chaos. The study, even if relatively small and based on clinical cases, gives support to earlier research, which shows that sexual abuse in general, but especially intra-familial sexual abuse, is associated with family dysfunction.

Background: There are few studies of couples that analyse satisfaction with treatment, adoption plans and relationships in couples after unsuccessful IVF. Methods: ENRICH marital inventory was used to describe marital dynamics and to gain information about treatment and adoption plans. A specially designed questionnaire was used. Of the 51 couples without previous children who were asked to participate after their first failed IVF cycle, 45 participated. The next stage of the study was carried out when the couples had reached the 6 months point after the first IVF cycle, and the last stage after the couples had been through one to three treatments, 1 1/2 years after the last treatment. Results: The couples displayed a stable relationship from the start as well as 1 year after the last IVF cycle. The vast majority of the couples had decided to go through with an adoption. Seventy-three percent of the women were interested in more IVF treatment compared to 33% of the men. Conclusion: The stresses associated with IVF treatment did not have a negative impact on the couples' appreciation of their relationships during and after the treatment period. After treatment had been completed, the couples seemed to have reoriented themselves toward other solutions to childlessness.

During a three-year period a total population of pregnant women attending antenatal clinics in Link÷ping, Sweden was screened for being at psychosocial risk. The prevalence of different psychosocial risk factors was compared with the corresponding prevalence in women referred to and accepting or declining to take part in a specialised training programme at a parent-baby clinic. In general, the present study showed that there was a constant proportion of about 4-5% of pregnant women with psychosocial risk factors. Psychiatric problems and social problems of relevance for pregnancies/parenthood were about equally frequent (i.e. 44 and 45%), while drug-addiction problems were at 11%. Only one in three women with risk factors were eventually referred to the parent-baby clinic, and every second woman referred finally took part in the programme. With the knowledge that an early intervention in families with psychosocial risk factors may alleviate some adverse or disadvantageous developments in children, it is a challenge to identify and to motivate these women to enrol in various support and training programmes. There are still too few pregnant women at risk who are ready to accept the further support that they may need, and the rationale for their reluctance must be better known.

Background: The aim of this study was to analyse relationships and parenthood in primiparous IVF couples and spontaneous primiparous couples. Method: In total, 110 consecutive IVF couples were studied. The control group was matched for women's age and selected out of the total spontaneous pregnant population in the study area. Questionnaires and semi-structured telephone interviews were used to gain information about sociodemographic data, couples' relationships, and the children's health, temperament and behaviour. Obstetrical variables concerning the course and outcome of pregnancy and delivery as well as the health status of the new-borns were obtained from standardized antenatal care and delivery files. Results: There weere no differences concerning gestational age, mode of delivery or neonatal health between the two groups. The IVF couples were more stable over time - from pregnancy until the child was 1 year old - in their relationship, while the control group experienced a decrease in marital satisfaction. The children in the IVF group were assessed by their parents as being more regular/habitual, sensitive and manageable than the control children. Conclusion: The differences present between the groups were in favour of the IVF families, and the effects of the infertility crisis were not notable when the children were 1 year old.

The objective of the study was to describe 20 matched pairs of children born to psychosocial risk mothers who have been followed from early pregnancy through their first 16 years of life. Interviews and standardized behavior measurements with a focus on the children's development were used. When considering the overall data from the different measurements done over the 16-year study period, the study group has significantly more negative results. Nine of the families in the study group had been investigated for abuse, neglect and inadequate parenting during the 16 years. In the rest of the 11 families from the study group, two siblings had been placed in foster care because of maltreatment. The study group mothers' characteristics from the start had a significantly negative impact on the children's behavior and mental health throughout their lives and when they reached 16 years.

Behavioural disturbances and symptoms of poor mental health in Swedish children were examined in conjunction with parental divorce and 2 years later, and in a group of immigrant and refugee children of divorced parents, on the basis of a semi-structured interview-instrument. The association between children's mental well-being and a number of background variables was analyzed. Children's self-image, charted by astandardized instrument, school achievement as assessed by final grades from compulsory school, and reactions to and experiences of divorce were studied. The reasons for the divorce, and differences in men's and women's experiences of changes a consequence of divorce were also studied. The study was based on a one-year-sample of divorcing couples and their young children, and 27 divorced irnmigranl/refugee families.

The presence of behavioural disturbances and symptoms of poor mental health was similar in children of divorce and in children of intact homes, although Swedish boys <5 years of age at the time of the divorce emerged a vulnerable group two years following the event Compared to Swedish children of divorce, immigrant children and especially refugee children of divorce displayed poorer mental health. Children 7-12 years of age reacted strongest to the divorce compared to younger and older children. Parental psychiatric vulnerability alcohol abuse, and a heart-rending divorce were factors associated with children's mental well-being. Especially a heart-rending divorce was noted to be a crucial variable in predicting the mental well-being of young boys at the time of divorce.

The self-image of children of divorce was similar to that of children of intact homes as assessed by standardized norms. Academic achievement was similar in' children of divorce and in children of intact homes.

Children devoted more thoughts to the divorce than their parents had realized, and boys and young children accepted the divorce less than the parents believed. The results indicated a lack of information and communication about the divorce between children and parents.

The divorce experience differed between men and women in several areas, especially with regard to the financial situation, relations with friends, work, physical health, mental well-being, and self-confidence, mostly favouring the women.

The main conclusion of the study was that the mental health of children of divorce is similar to children of intact homes at the time of divorce and two years later.

The aim of the present study was to make a 16-year follow-up of children of psychosocial risk mothers as concerns emotional/behavioural problems, self-esteem, life events, and academic grades. Forty-three teenagers (index group) and 61 reference teenagers were personally interviewed and asked to answer the Youth Self-report (YSR), the Self-image questionnaire I Think I Am, and a Life Event questionnaire. Their final grades from the 9-year compulsory school were studied. The results showed that boys, especially the sons from families with alcohol/drug problems, displayed poorer mental health, a more negative self-image, had experienced more negative life events, and had to a greater extent not successfully completed the 9-year compulsory school. More teenagers in the index group had been placed in foster care, had a less positive outlook about their future, were more often smokers, and more of them (girls) had seriously considered committing suicide than the teenagers in the reference group.

It was concluded that boys of psychosocial risk mothers are less well off than teenagers of non-risk mothers at the age of 16 as concerns psychosocial well being. It is of great importance to devote attention to these children at an early stage of life in order to be able to provide them with the support that may prevent development of future problems.