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Background Questionnaires can be used to assess perceived indoor air quality and symptoms in schools. Questionnaires for primary school aged children have traditionally been parent-administered, but self-administered questionnaires would be easier to administer and may yield as good, if not better, information. Our aim was to compare the repeatability of self- and parent-administered indoor air questionnaires designed for primary school aged pupils. Methods Indoor air questionnaire with questions on child’s symptoms and perceived indoor air quality in schools was sent to parents of pupils aged 7–12 years in two schools and again after two weeks. Slightly modified version of the questionnaire was administered to pupils aged 9–12 years in another two schools and repeated after a week. 351 (52%) parents and 319 pupils (86%) answered both the first and the second questionnaire. Test-retest repeatability was assessed with intra-class correlation (ICC) and Cohen’s kappa coefficients (k). Results Test-retest repeatability was generally between 0.4–0.7 (ICC; k) in both self- and parent-administered questionnaire. In majority of the questions on symptoms and perceived indoor air quality test-retest repeatability was at the same level or slightly better in self-administered compared to parent-administered questionnaire. Agreement of self- and parent administered questionnaires was generally

BackgroundInflammatory processes contribute to the pathophysiology of multiple chronic conditions. Genetic factors play a crucial role in modulating the inflammatory load, but the exact mechanisms are incompletely understood.ObjectiveTo assess genetic determinants of 16 circulating cytokines and cell adhesion molecules (inflammatory phenotypes) in Finns.MethodsGenome-wide associations of the inflammatory phenotypes were studied in Northern Finland Birth Cohort 1966 (N=5284). A subsequent meta-analysis was completed for 10 phenotypes available in a previous genome-wide association study, adding up to 13 577 individuals in the study. Complementary association tests were performed to study the effect of the ABO blood types on soluble adhesion molecule levels.ResultsWe identified seven novel and six previously reported genetic associations (p−9). Three loci were associated with soluble vascular cell adhesion molecule-1 (sVCAM-1) level, one of which was the ABO locus that has been previously associated with soluble E-selectin (sE-selectin) and intercellular adhesion molecule-1 (sICAM-1) levels. Our findings suggest that the blood type B associates primarily with sVCAM-1 level, while the A1 subtype shows a robust effect on sE-selectin and sICAM-1 levels. The genotypes in the ABO locus associating with higher soluble adhesion molecule levels tend to associate with lower circulating cholesterol levels and lower cardiovascular disease risk.ConclusionThe present results extend the knowledge about genetic factors contributing to the inflammatory load. Our findings suggest that two distinct mechanisms contribute to the soluble adhesion molecule levels in the ABO locus and that elevated soluble adhesion molecule levels per se may not increase risk for cardiovascular disease.

Background Mindfulness-Based Interventions (MBIs) have shown promising effects on mental health among children and adolescents, but high-quality studies examining the topic are lacking. The present study assessed the effects of MBI on mental health in school-setting in an extensive randomised controlled trial. Methods Finnish school children and adolescents (N = 3519), aged 12–15 years (6th to 8th graders), from 56 schools were randomized into a 9 week MBI group, and control groups with a relaxation program or teaching as usual. The primary outcomes were resilience, socio-emotional functioning, and depressive symptoms at baseline, at completion of the programs at 9 weeks (T9), and at follow-up at 26 weeks (T26). Results Overall, mindfulness did not show more beneficial effects on the primary outcomes compared to the controls except for resilience for which a positive intervention effect was found at T9 in all participants (β=1.18, SE 0.57, p = 0.04) as compared to the relaxation group. In addition, in gender and grade related analyses, MBI lowered depressive symptoms in girls at T26 (β=−0.49, SE 0.21, p = 0.02) and improved socio-emotional functioning at T9 (β=−1.37, SE 0.69, p = 0.049) and at T26 (β=−1.71, SE 0.73, p = 0.02) among 7th graders as compared to relaxation. Limitations The inactive control group was smaller than the intervention and active control groups, reducing statistical power. Conclusions A short 9-week MBI in school-setting provides slight benefits over a relaxation program and teaching as usual. Future research should investigate whether embedding regular mindfulness-based practice in curriculums could intensify the effects.

Context: Metabolic inflammation contributes to the development of insulin resistance (IR), but the roles of different inflammatory and other cytokines in this process remain unclear. Objective: We aimed at analyzing the value of different cytokines in predicting future IR. Design, Setting, and Participants: We measured the serum concentrations of 48 cytokines from a nationwide cohort of 2200 Finns (the Cardiovascular Risk in Young Finns Study), and analyzed their role as independent risk factors for predicting the development of IR 4 years later. Main Outcome Measures: We used cross-sectional regression analysis adjusted for known IR risk factors (high age, body mass index, systolic blood pressure, triglycerides, smoking, physical inactivity, and low high-density lipoprotein cholesterol), C-reactive protein and 37 cytokines to find the determinants of continuous baseline IR (defined by homeostatic model assessment). A logistic regression model adjusted for the known risk factors, baseline IR, and 37 cytokines was used to predict the future IR. Results: Several cytokines, often in a sex-dependent manner, remained as independent determinants of current IR. In men, none of the cytokines was an independent predictive risk marker of future IR. In women, in contrast, IL-17 (odds ratio, 1.42 for 1-SD change in ln-transformed IL-17) and IL-18 (odds ratio, 1.37) were independently associated with the future IR. IL-17 levels also independently predicted the development of incident future IR (odds ratio, 1.48). Conclusions: The systemic levels of the T helper 1 cell cytokine IL-18 and the T helper 17 cell cytokine IL-17 thus may have value in predicting future insulin sensitivity in women independently of classical IR risk factors.

INTRODUCTION Although underage pregnancies often end in induced abortion, data on girls who undergo termination of pregnancy are lacking. Our aim was to identify determinants of underage induced abortion and compare them with those of childbirth. MATERIAL AND METHODS All girls born in 1987 in Finland surviving the perinatal period (n = 29 041) were included in the study and divided into three study groups: Girls undergoing induced abortion (n = 1041, 3.6%) or childbirth (n = 395, 1.4%) at

Background Frequent attenders (FAs) use a disproportionately large share of the resources of general practitioners (GPs) working in primary healthcare centres. The aim of this study was to estimate the proportion of FAs among all patients in the primary health care centres of a medium-sized city in Finland, and to examine whether providing GPs with administrative information about their frequent attenders (names and numbers of visits per year) can reduce the number of FAs and the frequency of their visits. Methods Statistic data on all GP visits (n = 1.8 million) to 11 public healthcare centres in one city were collected from the electronic patient records covering the period from 2001 to 2010. A FA-patient was defined as a person who made10 or more visits to GPs during one year. The baseline situation in 2001 was compared with the situation in 2006 after administrative information had been provided three times to all GPs working in the healthcare centres. Poisson’s regression analysis was used, and FA numbers and consultation rates in the years 2002–2005 were compared with the year 2006; figures for 2006 were also compared with those for the follow-up period 2007–2010. Results During the years 2001–2006, the proportion of visits of FA-patients fell overall from 9.1 to 8.5%, a decline of 0.6% (p

Forest fires are a common natural disturbance in forested ecosystems and have a large impact on the microbial communities in forest soils. The response of soil fungal communities to forest fire is poorly documented. Here, we investigated fungal community structure and function across a 152-year boreal forest fire chronosequence using high-throughput sequencing of the internal transcribed spacer 2 (ITS2) region and a functional gene array (GeoChip). Our results demonstrate that the boreal forest soil fungal community was most diverse soon after a fire disturbance and declined over time. The differences in the fungal communities were explained by changes in the abundance of basidiomycetes and ascomycetes. Ectomycorrhizal (ECM) fungi contributed to the increase in basidiomycete abundance over time, with the operational taxonomic units (OTUs) representing the genera Cortinarius and Piloderma dominating in abundance. Hierarchical cluster analysis by using gene signal intensity revealed that the sites with different fire histories formed separate clusters, suggesting differences in the potential to maintain essential biogeochemical soil processes. The site with the greatest biological diversity had also the most diverse genes. The genes involved in organic matter degradation in the mature forest, in which ECM fungi were the most abundant, were as common in the youngest site, in which saprotrophic fungi had a relatively higher abundance. This study provides insight into the impact of fire disturbance on soil fungal community dynamics.

Background: Mental health problems in childhood and adolescence are an important public health concern. The general aim of Finnish health policy is to offer equal services for all inhabitants according to need, irrespective of socio-economic background or place of residence. Here, we assess equity in access to psychiatric care in a long-term nationwide follow-up study from birth to early adulthood. Methods: All 60 069 children born in Finland in 1987 were followed up through health registers from 1987 to 2008. The cohort members’ use of specialized psychiatric outpatient and inpatient care was assessed and linked to their socio-economic status and residential area. Results: Altogether, 14.4% of the cohort members had received specialized psychiatric care during the follow-up. Females used significantly more specialized psychiatric outpatient care than males. In addition, the use of specialized psychiatric care was more common among young people with a poor socio-economic background and those living in urban areas. Conclusions: A notable number of the young adults born in Finland in 1987 used specialized psychiatric care during their childhood and adolescence. Use was clearly defined by sex and residential area, as well as by parental socio-economic status and education. The data indicate that equity in access to mental health services should be highlighted in health policies, as contemporary outpatient mental health care has not been equally available for people living within and outside urban areas.

To study prevalence changes of self-reported pain, sleep problems, and fatigue among 8-year-old children, and to examine the co-occurrence and associated psychosocial variables of these symptoms.3 cross-sectional representative samples were compared in 1989, 1999, and 2005. The frequency of headache, abdominal pain, other pains, sleep problems, and fatigue were studied. In addition, sociodemographic information and child's psychiatric problems were inquired.The prevalence of abdominal pain, sleep problems, and fatigue, in addition to headache in boys and other pains in girls increased significantly (p .05) from 1989 to 2005, with cumulative odds ratio (95% confidence intervals) varying from 1.6 (1.2-2.1) to 2.4 (1.7-3.3). All symptoms were associated with each other and with the child's psychiatric problems. However, psychiatric problems did not explain the observed increase in the symptom frequencies.Finnish children's self-reported pain, sleep problems, and fatigue have increased remarkably. Studies providing information on the causes and prevention possibilities are warranted.

Objective: To study the rate of, and factors associated with, recognition of psychiatric disorders andself-perceived problems among 18-year-old adolescent boys. Method: The study population consistedof 2347 Finnish boys born during 1981 attending military call-up (79.7% of the original sample). At age8, the boys were evaluated by parental and teacher Rutter scales and by self-reports using the ChildDepression Inventory (CDI). At military call-up 10 years later, the boys filled in the Young Adult Self-Report (YASR). Information about psychiatric disorders recognized at the military call-up healthexamination was obtained from the national military register. Results: About 4.6% of boys wererecognized as having a psychiatric disorder at the military call-up medical examination. In addition,23.1% of boys reported emotional, behavioral or relational difficulties but were not recognized as havingan ICD 10 psychiatric diagnosis at the military call-up medical examination. A higher level of psycho-pathology, problems across different life domains and early onset of problems were more stronglyassociated with recognition of psychiatric disorder than with self-reports of difficulties without arecognized psychiatric disorder. All informant sources, parents, teachers and children themselves atage 8, independently predicted recognition of psychiatric disorders and perceived difficulties 10 yearslater. Conclusions: Only a minority of adolescents with psychiatric problems are recognized as havinga psychiatric disorder in the health services. Efforts to prevent psychiatric disturbance in early life areemphasized. The use of screening methods in school health settings to detect children in need of childmental health services is justified. Keywords: Child psychiatry, epidemiology, psychopathology,follow-up.Longitudinal studies on psychiatric symptoms anddisorders among children are needed for planningmental health services and improving clinical prac-tices, as well as for preventive interventions. How-ever, there are only a few community-basedlongitudinal studies from early childhood to lateadolescence or adulthood. Previous studies usingthe Child Behavior Checklist at baseline and theYoung Adult Self Report or Young Adult BehaviorChecklist as outcome measures in late adolescenceor early adulthood show a considerable stability ofproblem behavior (Achenbach, Howell, McConau-ghy, & Stranger, 1995; Ferdinand & Verhulst, 1995;Hofstra, van der Ende, & Verhulst, 2000, 2002;Verhulst & van der Ende, 1995). In a prospectivelongitudinal study as part of the Dunedin Study,including repeated structural diagnostic interviewsfrom age 11 to age 26, half of the individuals who metthe criteria for a major DSM-IV diagnosis at 26 yearsof age had a diagnosable disorder at 11 to 15 years ofage (Kim-Cohen et al., 2003). Among treatment-using young adults at age 26, almost 60% had beengiven a psychiatric diagnosis before 15 years of age.Furthermore, in the Dunedin Study, subjects wereclassified at age 3, on the basis of behavioral obser-vations, into groups of undercontrolled, inhibited,well-adjusted, confident and reserved children(Caspi, Moffitt, Newman, & Silva, 1996). It wasshown that undercontrolled and inhibited childrenwere at risk of psychiatric problems at age 21. Spe-cific behavioral styles at age 3 were connected tospecific psychiatric problems in early adulthood.Previous studies have shown that childhood rule-breaking behavior and conduct/oppositional dis-order have a particularly high predictive value forpsychiatric maladjustment in late adolescence andearly adulthood (Caspi et al., 1996; Hofstra et al.,2000, 2002; Kim-Cohen et al., 2003; Lavigne et al.,1998).Many studies have shown that only a minority ofadolescents with psychiatric disorders have contactswith specialized mental health services (Offord,Boyle, Fleming, Blum, & Rae-Grant, 1989; Leafet al., 1996; Meltzer, Gatward, Goodman, & Ford,2000; Sawyer et al., 2001). In our previous report,only 2% of Finnish 18-year-old boys had used men-tal health services within the preceding 12 months(Sourander et al., 2004). Furthermore, the majority

Objectives. The aims of the study were to determine whether the prevalence of children's somatic symptoms, such as headache, abdominal pain, other pain, and nausea and vomiting, changed from 1989 to 1999 and to study the similarity of parents' and children's reports of the child's symptoms. Furthermore, the aims were to explore possible comorbidity in somatic symptoms and to investigate the associations between somatic and psychiatric symptoms.Methods. Two cross-sectional, representative samples were compared. All children born in 1981 (1989 sample, n = 985) and 1991 (1999 sample, n = 962) and living in selected school districts in southwest Finland served as study samples. The response rate for the 1989 sample was 95% and that for the 1999 sample was 86%. Both children and parents were asked about the children's somatic symptoms, whereas parents, children, and teachers were asked about psychiatric symptoms. To study psychiatric symptoms, the Children's Depression Inventory and Rutter's parent and teacher scales were used.Results. The prevalence of frequent headaches and abdominal pain increased somewhat from 1989 to 1999. Parents often failed to recognize their children's psychosomatic problems. Child-reported somatic symptoms were associated with conduct and hyperactivity symptoms, in addition to a previously well-documented association with depression. In associations between somatic symptoms and psychiatric symptoms, there were some differences between the 1989 and 1999 samples.Conclusions. In clinical work, questions about somatic and psychiatric symptoms should also be addressed to children themselves, because parents and teachers do not always recognize children's symptoms. When somatic problems are being evaluated, psychiatric symptoms should be asked about, and vice versa. More research is needed to explore the reasons for the increased prevalence of somatic symptoms and their associations with psychiatric symptoms.

Objective To study the differences in children's psychiatric symptoms and child mental health service use at two time points: 1989 and 1999. Method Two cross-sectional representative samples of 8- to 9-year-old children from southern Finland were compared. The 1989 sample consisted of 985 children, of whom 95% participated, and the 1999 sample consisted of 962 children, of whom 86% participated. Information was gathered from parents and teachers using Rutter's questionnaires and other related determinants of service use and from children using the Child Depression Inventory. The sampling, procedure, and methods were similar at both time points. Results The overall rate of children's problems assessed by parents and teachers had not increased during the period 1989 to 1999. Boys had fewer psychiatric symptoms in 1999 than in 1989, whereas no clear change had occurred in girls' symptoms, except that, according to parents, girls in 1999 had more hyperactive symptoms. However, children themselves reported more depressive symptoms in the 1999 than in the 1989 sample. In 1989, 2.3% and in 1999, 5.3% of children had used child mental health services. The increase in service use among girls was fourfold. Parental evaluations of child psychopathology and teacher evaluations whether the child was psychologically healthy were the strongest determinants for referral at both time points. Parents preferred to seek help for their children's problems from teachers, school nurses, and school psychologists rather than from specialized child psychiatric services. Conclusions There has been an increase in mental health service use especially among girls as well as a convergence of symptom levels by gender. It is important to develop child psychiatric services that are as close to the child's living environment as possible to further reduce the threshold for seeking help and to promote early detection and intervention.

Background Schools provide a natural context to promote children’s mental health. However, there is a need for more evidence-based, high quality school intervention programs combined with an accurate evaluation of their general effectiveness and effectiveness of specific intervention methods. The aim of this paper is to present a study protocol of a cluster randomized controlled trial evaluating the “Together at School” intervention program. The intervention program is designed to promote social-emotional skills and mental health by utilizing whole-school approach and focuses on classroom curriculum, work environment of school staff, and parent-teacher collaboration methods. Methods/Design The evaluation study examines the effects of the intervention on children’s socio-emotional skills and mental health in a cluster randomized controlled trial design with 1) an intervention group and 2) an active control group. Altogether 79 primary school participated at baseline. A multi-informant setting involves the children themselves, their parents, and teachers. The primary outcomes are measured using parent and teacher ratings of children’s socio-emotional skills and psychological problems measured by the Strengths and Difficulties Questionnaire and the Multisource Assessment of Social Competence Scale. Secondary outcomes for the children include emotional understanding, altruistic behavior, and executive functions (e.g. working memory, planning, and inhibition). Secondary outcomes for the teachers include ratings of e.g. school environment, teaching style and well-being. Secondary outcomes for both teachers and parents include e.g. emotional self-efficacy, child rearing practices, and teacher-parent collaboration. The data was collected at baseline (autumn 2013), 6 months after baseline, and will be collected also 18 months after baseline from the same participants. Discussion This study protocol outlines a trial which aims to add to the current state of intervention programs by presenting and studying a contextually developed and carefully tested intervention program which is tailored to fit a national school system. Identification of effective intervention elements to promote children’s mental health in early school years is crucial for optimal later development. Trial registration ClinicalTrials.gov register: NCT02178332. Electronic supplementary material The online version of this article (doi:10.1186/1471-2458-14-1042) contains supplementary material, which is available to authorized users.

In this study we evaluated how well maternal serum screening and abortions for Down syndrome were accepted among midwives and public health nurses, and compared how those who accepted and did not accept abortions for Down syndrome differed from each other. The questionnaire was mailed in 1998 to 400 midwives and 400 public health nurses. 79 per cent responded. The majority said that all pregnant women should be offered a screening test for Down syndrome, but less than half accepted abortion for Down syndrome. Thus, the 'informative part' of the screening (serum screening itself) is supported more often than the 'operative part' (selective abortion)-or at least the 'operative part' was found to be a more difficult question. We suggest that whereas screening may be perceived as a question of more choices, information and self-determination, abortion is more clearly a moral question. The professional background characteristics and attitudes of those accepting and not accepting abortion for Down syndrome were relatively similar, but having a midwife's education, practical involvement in serum screening and having patients with Down syndrome were associated with a somewhat higher percentage of acceptance and a lower percentage of 'don't know' responses.

Aims: The study examined how prenatal screening tests are presented to women, factors associated with women’s participation in screening, their experience of decision-making and intentions concerning pregnancy termination, and hospital data on rates of selective terminations. Methods: Questionnaires were given to pregnant women visiting maternity centres in two Finnish towns in which serum screening was offered (n = 1,035) and in one town where midtrimester ultrasound screening was offered (n = 497). Response rates to the questionnaires were 88 and 85%, respectively. Other questionnaires asking about selective terminations following detected fetal disorders were sent in 1993 to all public hospitals with obstetrics or gynaecology departments (response rate 100%). Results: The serum screening test had usually been offered to women as a free choice, but for 22% of them it was presented as a routine procedure. Most women (92%) underwent serum screening and most (86%) found the decision to participate or not easy. In almost every aspect of presentation and participation studied, serum and ultrasound screening differed from each other. 85% of respondents to ultrasound screening answered that it was offered as a routine procedure. Close acquaintance with a person with congenital disability was negatively associated with participation in serum screening and with the intention to terminate pregnancy in case of a detected disability. 27% of women in the serum screening survey and 22% in the ultrasound survey declared that they would have declined pregnancy termination if a fetal disorder had been detected. However, according to the hospitals’ data, only 13% of pregnancies with a serious fetal disorder detected were continued. Conclusions: All prenatal screening tests, including ultrasound examinations, require an adequate process of informed consent. Because the aim of such tests is to detect fetal malformations and syndromes, health care professionals should discuss the implications with women before they decide. Because acquaintance with a disabled person was found to associate with participation in screening and with intentions about selective termination, women’s perceptions of lives of the disabled should receive more attention in future studies.

With serum screening (MS-AFP and hCG testing for Down's syndrome) women have to make several decisions in a limited time: whether to participate in the screening in the first place; then, if increased risk for fetal abnormality is detected, whether to have a diagnostic test, and finally, what to do if fetal abnormality is detected. The aim of this study was to examine how women themselves in an unselected population describe their decision-making in the different phases of serum screening. Women receiving a positive result from serum screening in two Finnish towns from September 1993 to March 1994 and a group of individually matched controls were invited to semistructured interviews; 45 index and 46 control women (79% of those invited) participated between their 29th and 37th weeks of gestation (mean 31 weeks). Although serum screening was most often presented as voluntary or as an option, half the women described participation as a routine or self-evident act; only one-fourth of the women described actively deciding about participation. After a positive screening result, women's reactions to diagnostic tests, and their intentions if disability would be detected, varied greatly. Most of the women actively decided about having diagnostic tests, but for 23% participation in diagnostic testing was called a self-evident act. Women's intentions regarding abortion varied from a firm decision to abort to a firm decision not to abort, and many remained ambivalent. Prenatal screening, which demands the making of several decisions in a limited time and is offered to all pregnant women as part of established maternity care, is not based on every participant's active decision-making and thus creates an ethical problem. This problem should receive special attention from those who develop, introduce and decide on new health care practices.

Udgivelsesdato: 1998-Feb Along with the rapid biomedical development of prenatal screening tests, target groups' attitudes and decision-making about, and the acceptance of, screening procedures have come into focus. To understand users' decision-making, it is essential to understand users' knowledge and perceptions of a procedure. The aim of this study was to examine Finnish women's knowledge and perceptions of, and stated reasons to participate in, two prenatal screening tests: serum screening and mid-trimester ultrasound screening. Subjects (n=1035) for the serum screening survey were catered for in the maternity care centres of two Finnish towns, where serum screening is available for all pregnant women. After one reminder, 88 per cent returned the questionnaire. Subjects (n=497) for the mid-trimester ultrasound screening survey were catered for in the obstetrical and gynaecological outpatient clinic of the city hospital of another town; the response rate was 85 per cent. Women's perceptions of the studied prenatal screening tests, serum screening and mid-trimester ultrasound screening, differed significantly, even though both are used to detect fetal malformations. Serum screening was far more often perceived to be connected with finding diseases or abnormalities than ultrasound screening. Another interesting finding was that the stated reasons for screening in general and the subjective reasons for participation were different. Reassurance was the personal reason most often mentioned in both the serum screening and the ultrasound group. Almost all women had the most superficial knowledge about serum screening; they knew whether it had been offered and that it is done to screen for Down syndrome. The greatest gaps in knowledge concerned the sensitivity of serum screening, its use in screening for congenital nephrosis, and diagnostic tests and their risks. Knowledge was poorer among women without a high school education. When counselling women about prenatal screening tests, more emphasis should be given to the sensitivity of serum screening, all of its screening uses, and the possible diagnostic tests and their risks. The fact that ultrasound screening can detect conditions which may lead to the possibility of a selective abortion should also be explained more fully.

Approximately 150 cervical cancer cases are diagnosed in Finland annually. Both incidence and mortality have decreased by 80% since organised screening began. Recently, screening based on primary HPV-testing with Pap-smear triage has been shown to be more sensitive and more specific among women over 35 years old in randomised studies and thus may be implemented in routine. Abnormal findings in Pap smears indicate management. Confirmed CIN1 lesions are followed up and CIN2 and worse lesions treated. Follow-up after treatment should be reliably arranged, because elevated risk of cancer remains over 20 years after treatment. Quality control is of utmost importance.

According to studies carried out in various countries, many parents (7-28%) contact some professionals due to a child's behavioral or emotional disorder, but a large part of children presenting psychic symptoms has remained outside of mental health services. Seeking for care has strongly increased in Finland over the last few years. Schools and day care centers are important not only in recognizing the problems but also in providing support and directing to specialized services.

There are only few population-based time-trend studies on changes in prevalence of bullying and victimization among children. The main aim of this study was to find out whether changes have occurred in prevalence rates of bullying and victimization from 1989 to 1999 among eight-year-old children. The associations between victimization and bullying and psychiatric symptoms and their possible differences in the statistical strengths of associations between the years 1989 and 1999 were also studied. Two cross-sectional, representative samples from southern Finland were compared. All children born in 1981 (1989 sample, n = 985, response rate 95%) and 1991 (1999 sample, n = 962, response rate 86%) and living in the selected school district were included in the study samples. Children, parents and teachers were asked about bullying and victimization. The Children’s Depression Inventory and Rutter’s parent and teacher scales were used to study psychiatric symptoms. In 1999, fewer 8-year-old children were victims of bullying than in 1989. There was a decrease in the number of bullies but the change was statistically significant only in the parental reports. The statistical strengths of associations of victimization and bullying with psychiatric symptoms were mainly the same in 1989 as in 1999. Slightly decreased levels of victimization among 8-year-old Finnish children is a promising result, but further time-trend studies are needed, as well as qualitative studies, to obtain a deeper understanding of the bullying phenomenon and the factors reducing it. It might be that especially young children are suspectible to influences diminishing victimisation and bullying.

Objective: To study differences in children's psychiatric symptoms and child mental health service use at three time points: 1989, 1999, and 2005. Method: Three cross-sectional representative samples of 8-year-old children were compared from southern Finland. The sampling, procedure, and methods were similar at all three time points. Information was gathered from parents and teachers using Rutter questionnaires and other related determinants of service use and from children using the Children's Depression Inventory. The participation rate at the three time points was 96% in 1989, 86% in 1999, and 84% in 2005. Results: Overall, parent and teacher reports of children's problems did not show a significant increase during the 16-year period. Parent reports of boys' conduct symptoms decreased from 1989 to 1999. However, self-reported depressive symptoms among girls increased from 1989 to 2005. Low parental education level, broken family, and negative life events were associated with depressive symptoms among girls. Although 4% of boys and 1% of girls had used child mental health services in 1989, the respective figures in 2005 were 12% and 4%. The majority of children who were screen positive on either parent or teacher ratings of emotional and behavioral problems using Rutter scales had received some educational support from school in 2005. Conclusions: Reports of depressive symptoms increased among girls, and this finding merits further studies. Use of services has continuously increased. School services play an important role in providing support and early detection of children who need to be referred to child mental health services.

This article describes the development of a collaborative relationship between a child psychiatry clinic and an adult oncology clinic within a university hospital. The interest of the child psychiatry clinic was to pay attention to children of parents with cancer, and to propose an intervention to support them. A child-centred family counselling model was designed for this purpose. The preparation, implementation, and results of this project are described. Positive results, as well as mistakes and failures are discussed, and recommendations are made regarding this kind of collaboration.

The objective was to study the utility of the graded chronic pain (GCP) scale of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) for the purpose of recognizing TMD pain profiles in primary health care. The GCP scale was used to gather data from 93 consecutive TMD patients seeking treatment in a primary health care setting. The GCP data were compared with pain profiles assessed by scales similar to the more complicated multidimensional pain inventory (MPI). The scales used were able to produce the similar ‘dysfunctional profiles’ in the TMD patients as the original MPI scale in the sample of chronic pain patients. Also, the original MPI profiles of ‘adaptive copers’ and ‘interpersonally distressed’ were produced with distinctive features. The GCP grades distributed almost identically among the subgroups produced by the pain profiles. Most grade I patients were classified as adaptive copers (82–86%), most grade II patients were interpersonally distressed (59%) and all except one of the grade III patients were classified as dysfunctional (83%). The results seem to support the main assumption of our study that the GCP scale is a simple screening tool suitable for identifying primary care TMD patients with various types of pain profiles. Im Rahmen dieser Studie sollte der Nutzen der Graduierung chronischer Schmerzen (GCP) nach den Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) untersucht werden, um TMD-Schmerzprofile im Bereich der primararztlichen Versorgung erkennen zu konnen. Anhand der GCP-Skala wurden die Daten von 93 aufeinanderfolgenden TMD-Patienten erfasst, die sich im Rahmen einer medizinischen Grundversorgung behandeln liesen. Die GCP-Daten wurden mit den Schmerzprofilen verglichen, die mittels Schemata beurteilt wurden, die dem komplizierteren Multidimensional Pain Inventory (MPI) glichen. Anhand der verwendeten Skalen konnten ahnliche funktionsgestorte Profile“ bei den TMD-Patienten wie bei der Original MPI-Skala in der Stichprobe der chronischen Schmerzpatienten gewonnen werden. Auserdem wurden die ursprunglichen MPI-Profile von adaptiven Kampfern“ und interpersonal Leidenden“ mit ausgepragten Merkmalen erstellt. Die GCP-Stufen verteilten sich identisch unter den Subgruppen, die sich aus den Schmerzprofilen ergaben. Die meisten Stufe-I-Patienten wurden als adaptive Kampfer (82–86%) klassifiziert, die meisten Stufe-II-Patienten als interpersonal Leidende (59%) und alle Stufe-III-Patienten mit Ausnahme eines Patienten als funktionsgestort (83%). Die Ergebnisse scheinen die Hauptannahme unserer Studie zu bekraftigen, dass die GCP-Skala ein einfaches Screening-Tool ist, mit dem sich in der medizinischen Grundversorgung TMD-Patienten mit den unterschiedlichsten Arten von Schmerzprofilen ermitteln lassen. El objetivo fue evaluar la utilidad de la escala de gradacion del dolor cronico (EGDC) contenida en los Criterios diagnosticos para la investigacion de las afecciones temporomandibulares (CID/ATM), para identificar mediante la misma los perfiles de dolor de las ATM en centros de atencion primaria. Se utilizo la EGDC para recolectar datos pertenecientes a 93 pacientes consecutivos con ATM que acudieron a centros de atencion primaria de salud en busca de tratamiento. Estos datos se compararon con los perfiles de dolor obtenidos utilizando escalas similares al complicado inventario multidimensional del dolor (IMD). Las escalas utilizadas revelaron ≪perfiles de disfuncion≫ en los pacientes con ATM iguales a los hallados usando la escala original del IMD para una muestra de pacientes con dolor cronico. Ademas, los perfiles originales del IMD de ≪afrontamiento adaptativo≫ y de ≪distres interpersonal≫ se obtuvieron con iguales caracteristicas distintivas. Los grados de la EGDC se distribuyeron de manera casi identica a los subgrupos creados usando los perfiles de dolor. La mayoria de los pacientes clasificados como grado I fueron definidos como pacientes con afrontamiento adaptativo (82-86%); la mayorias de los pacientes clasificados como grado II, como pacientes con distres interpersonal (59%); y todos los pacientes clasificados como grado III, excepto uno, fueron definidos como disfuncionales (83%). Los resultados parecen confirmar la hipotesis principal de nuestro estudio de que la EGDC es una herramienta simple de evaluacion apropiada para identificar, en centros de atencion primaria, a pacientes con ATM que presentan varios tipos de perfiles de dolor. L'objectif etait d'etudier l'utilite de l'echelle de la douleur chronique graduee (GCP) employee par les criteres de diagnostic de recherche sur les troubles temporomandibulaires (RDC/TMD) en vue d'identifier les profils de douleur TMD dans les situation de soins primaires. L'echelle GCP a ete employee pour recueillir des informations sur 93 patients consecutifs souffrant de TMD, demandeurs de traitement dans un cadre de sante primaire. Les donnees de GCP ont ete comparees avec les profils de douleur obtenus a partir d'echelles similaires a l'inventaire sur la douleur multidimensionnel (MPI), plus complexe. Les echelles employees ont produit des "profils dysfonctionnels" chez les patients TMD similaires aux resultats obtenus a partir de l'inventaire MPI chez un echantillon de patients souffrant de douleurs chroniques. Les profils MPI originaux classant les patients selon leur "capacite d'adaptation" et leurs "difficultes rationnelles"ont egalement donne des caracteristiques distinctives. La distribution des grades GCP a ete pratiquement identique parmi les sous-groupes obtenus a partir des profils de douleur. La plupart des patients de grade I ont ete classes comme presentant de bonnes capacites d'adaptation (82–86%), la plupart des patients de grade II souffraient de difficultes rationnelles (59%) et tous les patients de grande III, a l'exception d'un seul, etaient consideres comme dysfonctionnels. Les resultats semblent confirmer la principale hypothese de notre etude selon laquelle le GCP est un outil simple permettant d'identifier les patients TMD en soins primaires presentant des profils de douleur divers.

Objective To study prevalence and factors associated with mental health service use among 18-year-old adolescent boys. Method Predictors at age 8 and factors at age 18 associated with mental health service use during the preceding 12 months were studied in a general population sample of 2,316 Finnish boys born in 1981 attending military call-up (79% of the original sample). Results Within the preceding 12 months, 2.1% of the boys had used mental health services. At age 18, internalizing, anxious-depressive, and withdrawal symptoms; health problems; not living with parents; use of illicit drugs; high level of alcohol use; and regular smoking were independently associated with service use. At age 8, a high level of emotional and behavioral symptoms, need for referral, and low school performance according to teacher evaluations predicted service use 10 years later. Conclusions Only a minority of adolescents with severe problems had used mental health services. Because of the wide range of problems and comorbidity among service users, there is a need for integration of different services. Education services have a central role in the early detection of those who will later use mental health services.

Background: The aim was to study the prevalence of, and factors associated with, suicidal ideation and suicide attempts among child and adolescent inpatients during hospital treatment. Methods: The target group included all the child and adolescent psychiatric inpatients (n=504) in Finland on a chosen day. Suicidality was determined by the psychiatrist responsible for the inpatient treatment, using a questionnaire also exploring demographic, diagnostic, and treatment characteristics, as well as traumatic events of the patient. Results: The rate of suicidal ideation was 37.6%, and suicide attempts 10.8%. The factors independently associated with suicidal ideation in multivariate analysis were the following: being affected by open adult sexual behaviour (OR 3.2), having depression (OR 2.5) or conduct disorder (OR 2.4) diagnosis, and manifesting violent acts (OR 2.4). The factors independently associated with suicide attempts were: manifesting violent acts (OR 8.1), having depression diagnosis (OR 5.3), being affected by open adult sexual behaviour (OR 4.9), involuntary treatment (OR 4.7), and being of the female sex (OR 3.7). Suicidal ideation was particularly prevalent among boy patients having conduct disorders, manifesting violent acts, and belonging to the age group under 13 years old. Suicide attempts were particularly prevalent among depressive adolescent girl patients. Limitations: Suicidality was based solely on the clinician’s evaluation. Conclusions: Suicidal ideation and suicide attempts are common among child and adolescent psychiatric inpatients. Particular attention should be directed to inpatients who manifest violent acts or have depressive disorder.

Objective To investigate the views of Finnish doctors concerning fetal screening. Design Anonymous, questionnaire survey conducted in 1996–1997. Population A representative sample of gynaecologists, paediatricians and general practitioners in Finland. Both leading doctors and ordinary practitioners were included. Results Most doctors said that serum screening for Down's syndrome and ultrasound screening for structural abnormalities should be available for all pregnant women. In response to more direct questions, doctors acknowledged many drawbacks to Down's serum screening, notably the worry due to false positives. Only a few were against abortion, and a fifth said fetal screening is partly based on a eugenic ideology. There were some differences between the different doctor groups, but the overall impression was of similarity rather than divergence, both between the different specialist groups, and by the position of the doctor (leading vs ordinary). Conclusions Finnish doctors support current fetal screening, but many acknowledged resulting ethical, psychological, and social problems.

The purpose of this survey was to find out whether Finnish physicians had thought about or had observed resource or organizational effects due to the offering of prenatal screening.A mailed questionnaire survey sent in 1996-1997 in Finland to all leading Finnish obstetrician-gynecologists, to a random sample of obstetrician-gynecologists providing prenatal care, to general practitioners providing maternity care, and to other general practitioners. The number of respondents was 322 (response rate 70%).Most physicians supported the screening programs currently in wide use in Finland (serum screening for Down's syndrome and ultrasound for malformations), and over a third wanted to introduce the two genetic carrier screenings asked about. Most thought Down's screening took up resources, but they did not consider this to be important. The impact of screening on public or customer images of prenatal care was not an important issue. Instead, a diversity of opinions was expressed on whether the increasing numbers of prenatal screenings require organizational changes in current prenatal care provided within primary care, or whether a shift to hospital clinics is necessary to achieve more specialized care.Most physicians were not concerned by the potential organizational and resource implications of prenatal screening, and apparently they judge screening more from a health and individual patient point of view.

Background Pregnancy triggers well-known alterations in maternal glucose and lipid balance but its overall effects on systemic metabolism remain incompletely understood. Methods Detailed molecular profiles (87 metabolic measures and 37 cytokines) were measured for up to 4260 women (24–49 years, 322 pregnant) from three population-based cohorts in Finland. Circulating molecular concentrations in pregnant women were compared to those in non-pregnant women. Metabolic profiles were also reassessed for 583 women 6 years later to uncover the longitudinal metabolic changes in response to change in the pregnancy status. Results Compared to non-pregnant women, all lipoprotein subclasses and lipids were markedly increased in pregnant women. The most pronounced differences were observed for the intermediate-density, low-density and high-density lipoprotein triglyceride concentrations. Large differences were also seen for many fatty acids and amino acids. Pregnant women also had higher concentrations of low-grade inflammatory marker glycoprotein acetyls, higher concentrations of interleukin-18 and lower concentrations of interleukin-12p70. The changes in metabolic concentrations for women who were not pregnant at baseline but pregnant 6 years later (or vice versa) matched (or were mirror-images of) the cross-sectional association pattern. Cross-sectional results were consistent across the three cohorts and similar longitudinal changes were seen for 653 women in 4-year and 497 women in 10-year follow-up. For multiple metabolic measures, the changes increased in magnitude across the three trimesters. Conclusions Pregnancy initiates substantial metabolic and inflammatory changes in the mothers. Comprehensive characterisation of normal pregnancy is important for gaining understanding of the key nutrients for fetal growth and development. These findings also provide a valuable molecular reference in relation to studies of adverse pregnancy outcomes. Electronic supplementary material The online version of this article (doi:10.1186/s12916-016-0733-0) contains supplementary material, which is available to authorized users.

Background Mindfulness has shown positive effects on mental health, mental capacity and well-being among adult population. Among children and adolescents, previous research on the effectiveness of mindfulness interventions on health and well-being has shown promising results, but studies with methodologically sound designs have been called for. Few intervention studies in this population have compared the effectiveness of mindfulness programs to alternative intervention programs with adequate sample sizes. Methods/design Our primary aim is to explore the effectiveness of a school-based mindfulness intervention program compared to a standard relaxation program among a non-clinical children and adolescent sample, and a non-treatment control group in school context. In this study, we systematically examine the effects of mindfulness intervention on mental well-being (primary outcomes being resilience; existence/absence of depressive symptoms; experienced psychological strengths and difficulties), cognitive functions, psychophysiological responses, academic achievements, and motivational determinants of practicing mindfulness. The design is a cluster randomized controlled trial with three arms (mindfulness intervention group, active control group, non-treatment group) and the sample includes 59 Finnish schools and approx. 3 000 students aged 12–15 years. Intervention consists of nine mindfulness based lessons, 45 mins per week, for 9 weeks, the dose being identical in active control group receiving standard relaxation program called Relax. The programs are delivered by 14 educated facilitators. Students, their teachers and parents will fill-in the research questionnaires before and after the intervention, and they will all be followed up 6 months after baseline. Additionally, students will be followed 12 months after baseline. For longer follow-up, consent to linking the data to the main health registers has been asked from students and their parents. Discussion The present study examines systematically the effectiveness of a school-based mindfulness program compared to a standard relaxation program, and a non-treatment control group. A strength of the current study lies in its methodologically rigorous, randomized controlled study design, which allows novel evidence on the effectiveness of mindfulness over and above a standard relaxation program. Trial registration ISRCTN18642659. Retrospectively registered 13 October 2015. Keywords Children and adolescents School-based intervention Mindfulness Health promotion Mental health Well-being