Intrauterine exposure to caffeine and inattention/overactivity in children.

AIM: To determine the association between intrauterine exposure to timing and sources of caffeine and inattention/overactivity, suggesting ADHD in the child. METHOD: This study used prospectively collected data from the large population-based study, The Norwegian Mother and Child Cohort Study (MoBa). Participants were 25 343 mothers and their 18-month-old children. Mothers reported on consumption of a number of caffeine sources at the 17th week and 30th week of gestation, as well as child inattention/overactivity at 18 months. Data were analysed using univariate analyses of covariance (ancova). RESULTS: Once we controlled for confounders, there was a small effect of caffeine intake at 17th week of gestation on inattention/overactivity combined, and both 17th and 30th week of gestation on overactivity, when investigated separately from inattention. Surprisingly, the caffeine effect was only found for soft drinks, not tea or coffee. CONCLUSION: Intrauterine exposure to soft drinks rather than coffee, the traditional focus, is associated with maternal reports of overactive behaviour in children aged 18 months.

Job adjustment and absence from work in mid-pregnancy in the Norwegian Mother and Child Cohort Study (MoBa).

BACKGROUND: Pregnant women at work have special needs, and sick leave is common. However, job adjustment in pregnancy is addressed in European legislation. Our main objective was to examine if job adjustment was associated with reduced absence. METHODS: This study is based on the Norwegian Mother and Child Cohort Study (MoBa) conducted by the Norwegian Institute of Public Health. 28,611 employed women filled in questionnaires in weeks 17 and 30 in pregnancy. The risk of absence for more than 2 weeks was studied among those who were not absent in week 17 (n = 22,932), and the probability of return to work in week 30 among those who were absent in week 17 (n = 5679). Data were based on self-report. The influence of job adjustment (three categories: not needed, needed but not obtained, needed and obtained) was analysed in additive models in multivariable binomial regression. Associations with other job characteristics and work environment factors were also analysed. RESULTS: The risk of absence for more than 2 weeks was 0.308 and the probability of return to work was 0.137. Compared with women who needed but did not achieve job adjustment, obtained job adjustment was associated with a 0.107 decreased risk of absence (95% confidence interval 0.090 to 0.125) in a model including other job characteristics and work environment factors. Job adjustment was correspondingly associated with a 0.041 (0.023 to 0.059) increased probability of return to work. Absence was associated with adverse work environment, whereas the opposite pattern was found for return to work among those who started off being absent. CONCLUSIONS: Job adjustment was associated with reduced absence from work in pregnancy. Results should be interpreted cautiously because of low participation in MoBa and potential information bias from self-reported data.

Antibody dependent cell mediated cytotoxicity against anti-D sensitized human erythrocytes. Influence of various effector cells and enzyme treatment of the target cells.

Antibody dependent cell mediated cytotoxicity (ADCC) was measured against anti-D sensitized erythrocytes using various mononuclear cell populations from peripheral blood in a chromium release assay. Adherent effector cells gave stronger cytotoxicity than unseparated and non-adherent cells, and were less dependent on pretreatment of the target cells with papain. However, close correlations were found between the cytotoxicity obtained with the various effector cell populations, indicating that either of them might be used for the purpose of establishing in vitro methods to determine the clinical significance of erythrocyte antibodies. The optimal choice of effector cells is discussed.

Parental reported bullying among Nordic children: a population-based study.

BACKGROUND: Bullying has been shown to be a serious problem amongst school children, but few studies have been population-based and included pre-school children. METHODS: The study is part of a cross-sectional comparative study in 1984 and 1996, focusing on children's and their families' health and welfare in the Nordic countries. At each point of time parents of 3000 randomly selected children aged 2-17 years in each of five Nordic countries received a postal questionnaire. Altogether approximately 20,000 questionnaires were completed. The prevalence of bullying, risk factors for bullying and possible effect factors were analysed. RESULTS: Parents reported bullying of their child in 15.1% of the cases. Bullying varied from 7.2% in Sweden to about 20% in Denmark and Finland. There was a small increase in bullying from 13.7% in 1984 to 16.4% in 1996. Bullying was most frequent in boys (OR: 1.4) and in children 2-6 and 7-12 years old (OR: 2.0 and 2.2 compared with older children). Children of single parents and of parents with low education had increased risks (OR: 1.4 and 1.4). Children with chronic conditions had higher risks for being bullied (OR: 2.3). In 1996 children with psychiatric/nervous problems and hyperactivity had high risks for being bullied (OR: 8.8 and 10.5) and for bullying others (3.9 and 3.5). Being bullied was associated with poor thriving and psychosomatic and psychological problems. No countries had national interventions before 1984, but Sweden had early focused on the problem and implemented a strong national policy before 1996. After 1996 national anti-bullying policies were strengthened in the Nordic countries, most in Sweden and Norway. CONCLUSION: Bullying is common among Nordic children, including pre-school children. Bullying is a threat to children's health, and augments problems in children with chronic conditions. The low prevalence of bullying in Sweden may be a result from sustained, strong anti-bullying policies. There is still a need for continuing interventions.

[Academic degrees and changing ceremonies]. / Akademiske grader og skiftende sans for seremonier.

The traditions and ceremonies regarding doctoral dissertations in Europe date back to early medieval times, to the school of health at Salerno. The University of Oslo, founded in 1811, inherited the traditions from Denmark. Up to 1845, the dissertations were held in Latin, which was a burden on the candidates. The first four candidates who presented a thesis for a doctorate were all from the Faculty of Medicine. After 1845, the Norwegian language was permitted, but up to the end of the century there were still only few dissertations, and a doctorate degree was not highly valued. The number has since increased, and this degree is more highly esteemed. The ceremonies around the dissertations have also changed. The first promotions included solemn procedures in Latin, but later on the promotion ceremonies disappeared for 91 years. Promotion ceremonies reappeared in 1933, but changes have been observed more recently, probably related to changing cultural opinions and trends. The policy today seems to indicate a trend towards more ceremony, accompanied by festivity.

Cross-reactions in the HLA system revealed by red blood cells expressing HLA determinants, with particular reference to cross-reaction between HLA-A2 and B17.

Sera with cytotoxic and haemagglutinating activity towards HLA-A2/28 were also shown to react with red blood cells (RBC) expressing the HLA-B17 antigen determinant. Absorption procedures with white blood cells (WBC) indicated that this was due to an HLA-A2/B17 cross-reaction. Absorption experiments with some other sera which previously had shown cytotoxic and haemagglutinating activity towards different HLA specificities, revealed broad cross-reaction related to HLA-B locus antigens.

Association between HLA and red cell antigens. VI. Family studies.

The reactivity of the HLA antigens A28, B7 and B8 on red blood cells (RBC) has been studied, and the inheritance of the strength of reactivity examined in 13 families where the HLA haplotypes could be determined. Examination of individuals possessing more than one of the three antigens showed that the antigens seemed to be expressed independently of each other on RBC. The family studies showed that the HLA reactivity of RBC does not invariably follow the HLA haplotype determining the particular antigen. It was also shown that heterozygosity/homozygosity did not seem to have much influence on the strength of reactivity. Our conclusion is that several factors are likely to be responsible for the great variation in HLA reactivity of RBC.

Association between HLA and red cell antigens. V. A further study of the nature and behaviour of the HLA antigens on red blood cells and their corresponding haemagglutinins.

The variation in the reactivity of red blood cells (RBC) with HLA haemagglutinins was studied, and the influence of some variable factors evaluated. A comparison of the HLA reactivity of RBC with automated and manual methods, showed the superiority of the Auto-Analyzer technique. The similarity in the nature and behaviour of HLA RBC antigens and the related Chido and Rg antigens is discussed. Inhibition/adsorption experiments were performed, and the results did not support the theory that HLA antigens on RBC originate from serum-HLA-active substance. The strength of the HLA reactivity of RBC from a donor was shown to vary from time to time without evidence of clinical disease.

Association between HLA and red cell antigens. IV. Further studies of haemagglutinins in cytotoxic HLA antisera.

Cytotoxic HLA antisera of various specificities were examined on the AutoAnalyzer against red blood cells (RBC) from a great number of HLA-typed donors. HLA-associated haemagglutinins of different specificities were demonstrated. In cytotoxic anti-HLA-A9 and anti-HLA-A10, as well as in anti-HLA-B12, anti-HLA-Bw15 and anti-HLA-B17 sera, haemagglutinins of apparently corresponding specificities were found. This indicates that several HAL antigens may be present on RBC, but they are demonstrable only on RBC from a limited number of donors who possess the corresponding antigens on their white cells. Some antigens, like HLA-A28 and HLA-B7, are relatively strong RBC antigens, whereas others, like HLA-B12 or HLA-Bw15 seem to be much weaker. In cytotoxic anti-HLA-A1 and anti-HLA-B13 sera, no corresponding haemagglutinins were demonstrated. However, haemagglutinins of anti-HLA-B7 specificity were shown to be present in two cytotoxic anti HLA-A1 and three anti-HLA-B13 sera. No cytotoxic anti-HLA-B7 was found in these sera. Cross-reacting antibodies also seem to be frequent amoung HLA associated haemagglutinins.

HLA antigens on red blood cells. Two donors with extraordinarily strong reactivity.

We have shown exceptionally strong HLA reactivity of the red blood cells (RBC) of two healthy blood donors, concerning several HLA antigens. HLA antigens not usually detectable on RBC are also expressed on the RBC of these donors. The RBC show a broad spectrum of reactivity with sera containing HLA antibodies. Absorption/elution experiments with these RBC and HLA antisera proved successful. Absorption studies with leucocytes showed that HLA-A2 and A28 behaved as separate specificities also on RBC, even though antisera always seem to contain heamagglutinins that react with both specificities. We found no evidence that HLA is associated with beta2-microglobulin on the RBC membrane.

["Rough pleasures"--and the good outdoor life. Physicians as pioneers of the outdoor life]. / "Barske glaeder"--og det gode friluftsliv. Om friluftslivets pionerer blant medisinere.

From the middle of the last century, mountain tourism has become an important part of our national tradition and culture. The physical activity and the pleasure and relaxation achieved by walking in wild areas is believed to have beneficial effects on health. Several colleagues in the medical profession were early pioneers in mountain walking and in the discovery and description of former "white spots" on maps. They communicated their feeling and love for nature, and the pleasure gained from their eventful expeditions. They taught us respect and concern for our special environment, with its great opportunities for a variety of leisure time adventures.

[Neonatal alloimmune thrombocytopenia. Serological studies]. / Neonatal alloimmun trombocytopeni. Serologiske undersøkelser.

Alloimmune neonatal thrombocytopenia is most often caused by immunization towards the platelet-specific, glycoprotein IIIa-associated antigen HPA-1a (previous nomenclature PlA1, Zwa), but other defined platelet-specific antigens may also be involved. An HPA-1a-negative mother carrying an HPA-1a-positive child occurs in 1/50 of all pregnancies. However, HPA-1a-immunization occurs only in 1/1000 of all pregnancies, and only a proportion of the children are clinically affected. If the mother is positive for HLA-B8/DR3 she is known to be at risk for immunization. The serological diagnosis of thrombocyte immunization requires careful typing and investigation of antibodies, and reliable typing reagents. The quantitation of the mother's antibody is of little predictive value for the child's outcome, but intrauterine cord sampling can be a useful tool for improving the prenatal diagnosis.

[To put one's femininity at stake. Admission of women to medical studies; Marie Spångberg and other pioneers]. / Om å sette sin kvinnelighet på spill. Kvinners adgang til det medisinske studium; Marie Spångberg og andre pionerer.

In 1993, 100 years have passed since the first woman graduated in medicine from the University of Oslo. Her name was Marie Spångberg. A long-lasting "battle" had previously taken place to allow women to enter the University and to study medicine in particular. The first proposal to the Storting (the Norwegian national assembly) on this matter was made by Mr. L. Smitt, who strongly argued for the admittance of women to medical studies at the University. The Storting agreed, but the Medical Faculty protested violently in a note which was regarded as one of the most reactionary statements of the time on the nature of women. However, on 23 June 1884, an Act allowing women to graduate in all University studies was finally passed. In spite of the earlier resistance from the Medical Faculty, the female students did not experience any discrimination of women during their studies. They did meet difficulties, however, after their graduation, both in continuing their education and in obtaining a position.

HLA antigens in alcoholics, with special reference to alcoholic cirrhosis.

HLA antigen determination showed that the frequency of HLA-B40 was significantly increased (49%) in 43 patients with alcoholic cirrhosis, compared with the frequency found in 234 healthy blood donors (18%). The HLA-B40 frequency was not increased in three other patient groups: 36 patients with alcoholic liver disease without cirrhosis (14%), 21 patients with miscellaneous liver disease (24%), and 26 alcoholics without liver disease (24%). We could not confirm the previously reported association between advanced alcoholic liver damage and HLA-B8, which has been taken as support for the relation to autoimmune mechanisms. The association with HLA-B40, however, favours the idea that genetically determined individual susceptibility to alcoholic liver cirrhosis may exist.

Association between HLA and red cell antigens. VII. Survival studies of incompatible red blood cells in a patient with HLA-associated haemagglutinins.

Serum from a multitransfused patient with bladder papilloma was examined. The serum contained anti-Kell as well as polyspecific, cytotoxic HLA antibodies and HLA-associated haemagglutinins. The HLA haemagglutinins were demonstrated by the Auto Analyzer method and reacted predominantly with red blood cells (RBC) from HLA-A28-positive individuals, and were distinctly weaker with all other test cells. Survival studies with 51Cr-RBC from an HLA-A28-positive, Kell-negative donor with strong A28 RBC reactivity were performed. A small component of the RBC showed clearly reduced survival time, while the main component showed nearly normal survival.

Survival studies of 51Cr Ch(a+) red blood cells in a patient with anti-Cha, and massive transfusion of incompatible blood.

Survival studies of 51Cr, Ch(a+) red blood cells in a patient with anti-Cha, showed normal survival time in the observation period of 6 days. Successive massive transfusion of Ch(a+) blood was performed without any complication. A very strong secondary immune response to the Ch antigen was observed.

An evaluation of some factors affecting the detection of blood group antibodies by automated methods.

Some factors affecting the sensitivity of the automated methods for blood group antibody detection have been evaluated. The experiments revealed influencing differences between various albumin preparations. In the BMC method, one lot of albumin permitted no significant antibody detection. In the LISP technique, a plateau of maximum Polybrene activity was found. The beginning of this plateau depended on both the albumin preparation and the Polybrene lot. In the BMC method, methyl cellulose gave optimal sensitivity within a concentration range of 0.3 to 0.5 per cent. The stability of test cells stored in ACD at 4 C was studied. All test cells could be used safely up to two weeks. Cells from different donors showed variable reactivity after three weeks.

[Compatibility problems in transfusion. Special reference to the delayed hemolytic transfusion reaction]. / Forlikelighetsproblemer ved transfusjon. Spesiell omtale av den senhemolytiske transfusjonsreaksjon.

During 1988, our laboratory (The National Blood Group Reference Laboratory) detected clinically significant alloantibodies (excluding anti-D and anti-C + D) in samples from 72 patients from 24 different hospitals, transfusing about 40,000 units of red cells in this period of time. The simultaneous presence of autoantibodies complicated the serological diagnosis in a number of cases. Two patients had suffered acute haemolytic transfusion reactions due to antibodies not being discovered in the pretransfusion testing (anti-c and anti-Fya). 13 showed serological evidence of delayed haemolytic transfusion reaction not noted in the local hospital. We believe that delayed haemolytic transfusion reaction is seldom recognized. We stress the importance of quality control programmes in blood group serology.