Does informal care reduce public care expenditure on elderly care? Estimates based on Finland's Age Study.

BACKGROUND: To formulate sustainable long-term care policies, it is critical first to understand the relationship between informal care and formal care expenditure. The aim of this paper is to examine to what extent informal care reduces public expenditure on elderly care. METHODS: Data from a geriatric rehabilitation program conducted in Finland (Age Study, n = 732) were used to estimate the annual public care expenditure on elderly care. We first constructed hierarchical multilevel regression models to determine the factors associated with elderly care expenditure. Second, we calculated the adjusted mean costs of care in four care patterns: 1) informal care only for elderly living alone; 2) informal care only from a co-resident family member; 3) a combination of formal and informal care; and 4) formal care only. We included functional independence and health-related quality of life (15D score) measures into our models. This method standardizes the care needs of a heterogeneous subject group and enabled us to compare expenditure among various care categories even when differences were observed in the subjects' physical health. RESULTS: Elder care that consisted of formal care only had the highest expenditure at 25,300 Euros annually. The combination of formal and informal care had an annual expenditure of 22,300 Euros. If a person received mainly informal care from a co-resident family member, then the annual expenditure was only 4,900 Euros and just 6,000 Euros for a person living alone and receiving informal care. CONCLUSIONS: Our analysis of a frail elderly Finnish population shows that the availability of informal care considerably reduces public care expenditure. Therefore, informal care should be taken into account when formulating policies for long-term care. The process whereby families choose to provide care for their elderly relatives has a significant impact on long-term care expenditure.

Smoking during pregnancy and risk of autism spectrum disorder in a Finnish National Birth Cohort.

BACKGROUND: Results of previous population-based studies examining associations between smoking during pregnancy and autism spectrum disorders (ASD) are contradictory. Furthermore, there is a lack of population-based studies examining the relationship between smoking during pregnancy and the main diagnostic subtypes of ASD. METHODS: We conducted a population-based nested case-control study based on the Finnish Prenatal Study of Autism (FIPS-A) among liveborn infants delivered in Finland between 1987 and 2005. Data on maternal smoking during pregnancy were available from the Finnish Medical Birth Register (FMBR) since October 1990. Data on ASD in the offspring were obtained from the Finnish Hospital Discharge Register (FHDR). RESULTS: Among the three subtypes of ASD, maternal smoking during the whole pregnancy was associated with an increased risk of pervasive developmental disorder (PDD) (odds ratio 1.2, 95% confidence interval 1.0, 1.5). The increase in odds persisted after controlling for maternal age, mother's socio-economic and psychiatric status, and infant's weight for gestational age. However, smoking exposure limited to the first trimester was not associated with PDD or any of the other ASD subtypes. CONCLUSIONS: Maternal smoking is related to a modest increase in risk of PDD, while no associations were observed for childhood autism and Asperger's syndrome.

Parental age and risk of autism spectrum disorders in a Finnish national birth cohort.

Aim of the study was to examine the associations between parental age and autism spectrum disorders (ASD). Data were based on the FIPS-A (Finnish Prenatal Study of Autism and Autism Spectrum Disorders), a case-control study with a total of 4,713 cases with childhood autism (n = 1,132), Asperger's syndrome (n = 1,785) or other pervasive developmental disorder (PDD) (n = 1,796), which were ascertained from the Finnish Hospital Discharge Register. Controls were selected from the Finnish Medical Birth Register. Conditional logistic regression models were used for statistical analyses. Advanced paternal age (35-49 years) was associated with childhood autism in offspring, whereas advanced maternal age was associated with both Asperger's syndrome and PDD in offspring (35 years or more and 40 years or more, respectively). Teenage motherhood (19 years or less) was associated with PDD in offspring. The main finding was that maternal and paternal ages were differentially associated with ASD subtypes. In addition to advanced parental age, teenage pregnancy seems to incur a risk for PDD in offspring.

Do antenatal and postnatal parental psychological distress, and recognized need of help predict preadolescent's psychiatric symptoms? The Finnish Family Competence Cohort study.

In a prospective population-based study, mothers and fathers of 1,247 children reported their physical and mental health during pregnancy, after delivery, within the child's first 18 months of life, and at 12 years. Additionally, maternal health clinic nurses rated parents' well-being and perceived need for support. At age 12, child outcomes were also measured using CBCL and YSR externalizing and internalizing scales. Results indicate that both ante- and postnatal maternal distress predicted future externalizing problems in offspring. Conversely, fathers' postnatal distress predicted subsequent internalizing problems. Furthermore, mother's depressed mood in the first trimester best predicted the child's externalizing problems at age 12. Nurses's ratings of mother's antenatal and perinatal need for support, perinatal distress, and family's need for support were associated with both internalizing and externalizing problems at age 12. Maternal antenatal distress increases the risk of offspring's externalizing problems in preadolescense, and postnatal distress in either parent increases the risk of internalizing problems. Parental self-reports and indirect ratings from health care providers during pregnancy and infancy may therefore reliably recognize offspring at risk for subsequent psychiatric symptomatology.

Unrecognised obstructive sleep apnoea is common in severe peripheral arterial disease.

Patients needing surgery for peripheral arterial disease (PAD) represent a severe form of atherosclerosis with an overall 5-yr mortality of 30% after revascularisation. The aetiology for poor post-operative clinical outcome in these high-risk patients is not fully established. Obstructive sleep apnoea (OSA) is associated with atherosclerosis and is an independent risk factor for fatal and nonfatal cardiac events. Here, we determine the prevalence of undiagnosed OSA in a homogenous group of PAD patients undergoing subinguinal surgical revascularisation. 82 consecutive patients (mean age 67±9 yrs, 52 males) with sinus rhythm and without congestive heart failure or previously diagnosed OSA were enrolled for pre-operative polysomnography and echocardiography. OSA was present in 70 (85%) patients (95% CI 75-93%), of whom 24 (34%) had severe OSA. OSA was mostly asymptomatic, and age- and sex-adjusted multivariate regression analysis showed no relation to obesity, metabolic syndrome or any manifestation of atherosclerosis, other than PAD. Left ventricular ejection fraction (p = 0.002) and high-density lipoprotein/total cholesterol ratio (p = 0.03) were the only independent predictors for the severity of OSA. Thus, prevalence of OSA is unexpectedly high in patients with PAD and is not related to classical risk factors of sleep apnoea.

Increased use of antidepressants in women decreases suicides in men: an ecological study.

OBJECTIVE: The suicide rate has decreased in many countries, while the use of antidepressants has increased. In our previous study, the decrease in suicide rate between 1994 and 2001 was greater in men than in women, but the increase in use of antidepressants was greater in women than in men. We hypothesized that the increase in the use of antidepressants in women associates with the decrease in suicide rate in men. METHOD: Population-based suicide rate and reimbursed antidepressant prescriptions, an indicator of antidepressant use, between 1994 and 2001 in Finland were analyzed in the whole population. Variance in the suicide rates in men and women was explained by antidepressant prescriptions for men and women, age, time period, and geographical region in Poisson regression analyses. RESULTS: The decrease in suicide rate in men associated significantly with the increase in antidepressant prescriptions in women even though the model took into account the effect of increased antidepressant prescriptions in men, as well as the effects of age, time, and region (risk ratio [RR] = 0.70, P = .004, in the model without age; RR = 0.89, P = .048 in the complete model). However, the decrease in suicide rate in women did not associate with the increase in antidepressant prescriptions in men. CONCLUSIONS: Increased prescription of antidepressants in women associates with a decreased suicide rate in men. Increased use of antidepressive medication in women may decrease depressiveness in their microsocieties and thereby reduce the risk of suicides also in men.

SUBSTANCE-ABUSING MOTHERS IN RESIDENTIAL TREATMENT WITH THEIR BABIES: IMPORTANCE OF PRE- AND POSTNATAL MATERNAL REFLECTIVE FUNCTIONING.

A residential treatment program has been developed specifically for substance-abusing pregnant and parenting women in Finland, focusing on simultaneously supporting maternal abstinence from substances and the mother-baby relationship. The aims of the study are to explore maternal pre- and postnatal reflective functioning and its association with background factors, maternal exposure to trauma, and psychiatric symptoms, postnatal interaction, child development, and later child foster care placement. Participants were 34 mother-baby pairs living in three residential program units during the pre- to postnatal period. We employed self-report questionnaires on background, trauma history, and psychiatric symptoms (Brief Symptom Inventory: L.R. Derogatis, 1993; Edinburgh Postnatal Depression Scale: J.L. Cox, J.M. Holden, & R. Sagovsky, 1987; Traumatic Antecedents Questionnaire: B. Van der Kolk, 2003), videotaped mother-child interactions coded for sensitivity, control, and unresponsiveness (Care Index for Infants and Toddlers: P. Crittenden, 2003); a standardized test of child development (Bayley Scales of Infant Development-II: N. Bayley, 1993); and semistructured interviews for maternal reflective functioning (Pregnancy Interview: A. Slade, E. Bernbach, J. Grienenberger, D.W. Levy, & A. Locker, 2002; Parent Development Interview: A. Slade et al., 2005). Pre- and postnatal maternal reflective functioning (RF) was on average low, but varied considerably across participants. Average RF increased significantly during the intervention. Increase in RF level was found to be associated with type of abused substance and maternal trauma history. Mothers who showed lower postnatal RF levels relapsed to substance use more often after completing a residential treatment period, and their children were more likely to be placed in foster care. The intensive focus on maternal RF is an important direction in the development of efficacious treatment for this very high risk population.

Childhood predictors of becoming a teenage mother among Finnish girls.

OBJECTIVE: To study predictive associations between psychosocial factors at age 8 and becoming a mother under the age of 20. DESIGN: Prospective follow-up study. SETTING: Finland. POPULATION: 2867 girls born in 1981. METHODS: Information on family background and psychiatric symptoms was collected at age 8. The associations between these factors and becoming a teenage mother were analyzed using logistic regression analysis. MAIN OUTCOME MEASURES: Data on births by the age of 20 collected from the hospital discharge register. RESULTS: 128 girls (4.8%) had given birth at the age of 15-19 years. Childhood conduct problems and hyperactive problems, having young mother and family structure other than two biological parents had an independent association with becoming a teenage mother. CONCLUSIONS: Girls with externalizing type of problems in childhood have an increased risk of becoming teenage mothers. These problems may also complicate their motherhood.

Factors associated with the utilization and costs of health and social services in frail elderly patients.

BACKGROUND: Universal access is one of the major aims in public health and social care. Services should be provided on the basis of individual needs. However, municipal autonomy and the fragmentation of services may jeopardize universal access and lead to variation between municipalities in the delivery of services. This paper aims to identify patient-level characteristics and municipality-level service patterns that may have an influence on the use and costs of health and social services of frail elderly patients. METHODS: Hierarchical analysis was applied to estimate the effects of patient and municipality-level variables on services utilization. RESULTS: The variation in the use of health care services was entirely due to patient-related variables, whereas in the social services, 9% of the variation was explained by the municipality-level and 91% by the patient-level characteristics. Health-related quality of life explained a major part of variation in the costs of health care services. Those who had reported improvement in their health status during the preceding year were more frequent users of social care services. Low informal support, poor functional status and poor instrumental activities of daily living, living at a residential home, and living alone were associated with higher social services expenditure. CONCLUSIONS: The results of this study showed municipality-level variation in the utilization of social services, whereas health care services provided for frail elderly people seem to be highly equitable across municipalities. Another important finding was that the utilization of social and health services were connected. Those who reported improvement in their health status during the preceding year were more frequently also using social services. This result suggests that if municipalities continue to limit the provision of support services only for those who are in the highest need, this saving in the social sector may, in the long run, result in increased costs of health care.

Psychosocial factors associated with becoming a young father in Finland: a nationwide longitudinal study.

BACKGROUND: Little is known about the characteristics of boys who become fathers at young age. Some studies have suggested that antisocial adolescents are more likely to be young fathers. The aim of this study was to examine the associations of psychosocial factors in childhood with becoming a young father, and to assess if they are independent of criminal behavior in adolescence. METHODS: The baseline assessment in 1989 included 2,946 boys born in 1981. Information about psychiatric symptoms at age eight was collected with Rutter questionnaires from parents and teachers and with the Child Depression Inventory from the children themselves. Data on criminal offenses at age 16-20 was collected from a police register. Register-based follow-up data on becoming a father under the age of 22 was available for 2,721 boys. RESULTS: The factors measured at age eight, which were associated with becoming a young father independently of adolescent criminality, were conduct problems, being born to a young father and having a mother with a low educational level. Having repeatedly committed criminal offences in adolescence was associated with becoming a young father independently of psychosocial factors in childhood. CONCLUSIONS: Antisocial tendencies both in childhood and adolescence are associated with becoming a young father. They should be taken into consideration when designing preventive or supportive interventions.

Childhood predictors of antipsychotic use among young people in Finland.

OBJECTIVE: Information on who uses antipsychotic medication is limited to cross-sectional data. The objective of this study was to study the patterns of psychopathology at age 8 years and antipsychotic use between the ages of 12 and 25 years. METHODS: A total of 5525 subjects from the Finnish Nationwide 1981 birth cohort were linked to the National Prescription Register and the Hospital Discharge Register between 1994 and 2005. Information about parent-reported and teacher-reported conduct, hyperkinetic and emotional symptoms, and self-reported depressive symptoms was gathered at age 8 years. Information about antipsychotic use and about psychiatric disorders treated in hospitals between the ages of 12 and 25 years was register based. Diagnostic classes of hospital treatment included non-affective psychoses, affective disorders, and other psychiatric disorders. RESULTS: The cumulative incidence of antipsychotic use by age 25 years was 2.8% among men (n = 69) and 2.1% among women (n = 55). In both sexes, living with other than two biological parents at age 8 years was associated with antipsychotic use, and three fourths of antipsychotic users had been treated for psychiatric disorders in a hospital. Among men, the most common hospital diagnosis was non-affective psychoses (44% of all antipsychotic users), and antipsychotic use was associated with childhood conduct problems. Among women, the most common hospital diagnosis was affective disorders (38% of all antipsychotic users), and antipsychotic use was associated with emotional problems and self-reported depressive symptoms in childhood. CONCLUSIONS: Antipsychotic use in adolescence and young adulthood is different among men versus women both with regard to hospital diagnoses and childhood psychiatric problems.

Association of repeated exposure to antibiotics with the development of pediatric Crohn's disease--a nationwide, register-based finnish case-control study.

To determine whether childhood exposure to antibiotics is associated with the risk of developing inflammatory bowel disease (IBD), the authors conducted a national, register-based study comprising all children born in 1994-2008 in Finland and diagnosed with IBD by October 2010. The authors identified 595 children with IBD (233 with Crohn's disease and 362 with ulcerative colitis) and 2,380 controls matched for age, gender, and place of residence. The risk of pediatric Crohn's disease increased with the number of antibiotic purchases from birth to the index date and persisted when the 6 months preceding the case's diagnosis were excluded (for 7-10 purchases vs. none, odds ratio = 3.48, 95% confidence interval: 1.57, 7.34; conditional logistic regression). The association between Crohn's disease and antibiotic use was stronger in boys than in girls (P = 0.01). Cephalosporins showed the strongest association with Crohn's disease (for 3 purchases vs. nonuse, odds ratio = 2.82, 95% confidence interval: 1.65, 4.81). Antibiotic exposure was not associated with the development of pediatric ulcerative colitis. Repeated use of antibiotics may reflect shared susceptibility to childhood infections and pediatric Crohn's disease or alternatively may trigger disease development.

Psychosocial determinants of headache, abdominal pain, and sleep problems in a community sample of Finnish adolescents.

The aims of this study were to examine the prevalence, co-occurrence, and psychosocial determinants of self-perceived headache, abdominal pain, and sleep problems among adolescents. The adolescents from two cities in Finland (n = 2,215, 90.9% of the target population) attending 7th and 9th grade (age range 13-18 years) participated in the cross-sectional survey inquiring about frequency of headache, abdominal pain, sleep problems, and psychosocial difficulties. The 6-month prevalence of weekly headache was 13%, abdominal pain 6%, and sleep problems 27%. All three symptoms were strongly associated with each other. Of the adolescents suffering from one symptom, 32% reported one co-occurring symptom and 17% two co-occurring symptoms. In the multivariate analysis, female gender, experience of psychological difficulties, emotional symptoms, smoking, victimization, and feeling not cared about by teachers were independently associated with all the individual symptoms, as well as an increasing number of symptoms. Sleep problems were associated with older age and peer and alcohol problems. Abdominal pain was associated with conduct problems, and both headache and abdominal pain were linked with immigration background. An increasing number of symptoms was associated with older age, having a chronic illness, and conduct and alcohol problems. Adolescents' headache, abdominal pain and sleep problems were common and often co-occurred. An increasing frequency of each symptom and number of symptoms were associated with psychosocial factors in a similar way. Screening for psychiatric symptoms, substance use, victimization and difficulties with teachers should be included in the assessment of adolescents who suffer from recurrent headache, abdominal pain or sleep problems.

Prevalence changes of pain, sleep problems and fatigue among 8-year-old children: years 1989, 1999, and 2005.

OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: Finnish children's self-reported pain, sleep problems, and fatigue have increased remarkably. Studies providing information on the causes and prevention possibilities are warranted.

Evidence of diminished coronary flow in pulmonary hypertension: explaining angina pectoris in this patient group?

BACKGROUND: Many patients with pulmonary hypertension (PH) have symptoms of angina without evidence of occlusive coronary artery disease. For the first time, this study addresses the influence of progressively increasing pulmonary artery pressure (PAP) on left anterior descending artery flow in a rat model of PH. The role of pulmonary artery dilatation, septal wall motion abnormality, cardiac output or diastolic blood pressure in determining coronary blood flow (CBF) during PH was determined. METHODS: Pulmonary hypertension was induced in 6-week-old female nude rats (n = 44) using monocrotaline. Animals underwent right heart catheterization and echocardiography, and blood pressure measurement was taken at baseline, 21 and 35 days. RESULTS: A total of 103 echocardiographic studies were carried out at three fixed time points in rats with variable PAP. CBF decreased from 46·6 ± 14·3 to 24·7 ± 12·3 cm s(-1) (P<0·001) over time. Pulmonary artery diameter increased from 2·30 ± 0·19 to 2·83 ± 0·30 mm (P<0·001), and left ventricular (LV) cardiac output decreased from 143 ± 23 to 78 ± 30 ml min(-1) (P<0·001). Using observed solution estimates of 0·00170 (P = 0·0005) and -1·75 (P = 0·006) for these variables, we calculated that CBF increased by 5·90 cm s(-1) (15·6%, CI: 14·5-17·1%) or decreased by -4·86 cm s(-1) (-12·9%, CI: -14·1-11·9%) for every standard deviation increase in LV cardiac output or pulmonary artery diameter, respectively. CBF decreased significantly with increasing PAP. Pulmonary artery diameter and LV cardiac output appear to be independent determinants of coronary flow in PH. CONCLUSIONS: Coronary flow reduction in murine PH has potential to be clinically meaningful and should therefore further studied in a clinical trial.

Regional differences and secular trends in the incidence of epilepsy in Finland: a nationwide 23-year registry study.

PURPOSE: Regional variations and temporal trends in the incidence of new-onset epilepsy are clinically important and may offer clues on how to prevent epilepsy. METHODS: We examined regional differences and secular trends in the incidence of new-onset epilepsy in the Finnish population based on the nationwide full-refundable antiepileptic drug registry and the population registry in the years 1986-2008. KEY FINDINGS: The overall incidence of epilepsy was significantly higher in eastern Finland than in middle [risk ratio (RR) 1.08 (95% confidence interval, CI 1.05-1.12)), p < 0.0001] and western Finland [RR 1.32 (1.30-1.35), p < 0.0001] but it was declining from 1986 to 2008 in all regions [RR 0.83 (0.81-0.84), p < 0.0001]. The mean annual decline was 0.6%. Although the incidence of epilepsy was falling from 1986 to 2008 in childhood [annual decline 1.9%, RR 0.80 (0.75-0.86), p < 0.0001] and in middle age [annual decline 0.8%, RR 0.88 (0.84-0.93), p < 0.0001], it increased significantly in the elderly (age 65 years or older) in all of Finland [annual increase 3.5%, RR 1.25 (1.18-1.33), p < 0.0001], and particularly in east versus west Finland [RR 1.48 (1.42-1.55), p < 0.0001]. As a result, starting with the year 2000, the incidence rate of epilepsy was higher in the elderly than in children for all of Finland. SIGNIFICANCE: In view of the falling incidence of epilepsy in childhood and middle-age in all of Finland from 1986 to 2008, the significant increase in the incidence of epilepsy in the elderly is of concern. The regional increase of epilepsy may offer clues for allocating resources and, possibly, population epileptogenesis between west and east Finland and for strategies to prevent epilepsy in the elderly.

Childhood predictors of use and costs of antidepressant medication by age 24 years: findings from the Finnish Nationwide 1981 Birth Cohort Study.

OBJECTIVE: Prior studies on antidepressant use in late adolescence and young adulthood have been cross-sectional, and prospective associations with childhood psychiatric problems have not been examined. The objective was to study the association between childhood problems and lifetime prevalence and costs of antidepressant medication by age 24 years. METHOD: A total of 5,547 subjects from a nation-wide birth cohort were linked to the National Prescription Register. Information about parent- and teacher-reported conduct, hyperkinetic and emotional symptoms, and self-reported depressive symptoms was gathered at age 8 years. The main outcome measure was national register-based lifetime information about purchases of antidepressants between ages 8 and 24 years. In addition, antidepressant costs were analyzed using a Heckman maximum likelihood model. RESULTS: In all, 8.8% of males and 13.8% of females had used antidepressants between age 13 and 24 years. Among males, conduct problems independently predicted later antidepressant use. In both genders, self-reported depressive symptoms and living in other than a family with two biological parent at age 8 years independently predicted later antidepressant use. Significant gender interactions were found for conduct and hyperkinetic problems, indicating that more males who had these problems at age 8 have used antidepressants compared with females with the same problems. CONCLUSIONS: Childhood psychopathology predicts use of antidepressants, but the type of childhood psychopathology predicting antidepressant use is different among males and females.

The role of gender, affectivity and parenting in the course of disordered eating: a 4-year prospective case-control study among adolescents.

BACKGROUND: Prolonged eating disturbances increase the risk for a full-blown eating disorder and lifelong health impairment. Screening will improve early detection of eating pathology, but the major question still remains: who will benefit from early treatment and who needs little or no intervention. To answer this question, information about the factors that predict the course of disordered eating is valuable. OBJECTIVES: To investigate the course of eating disturbance from middle to late adolescence, to test certain individual and parental factors potentially explaining the differences in the course of eating disturbance, and to estimate the predictive power of these factors in terms of the recurrence of eating disturbance and the onset of new presentations of eating pathology after mid-adolescence. DESIGN: A four-year follow-up study with a case-control design. SETTINGS: School health care and community settings in south-western Finland. PARTICIPANTS: Students who had reported eating disturbance at baseline (n=208, response rate 69%) and a group of non-symptomatic controls (n=514, response rate 81%) were enrolled and matched by school, grade, and gender. METHODS: At baseline assessment, mid-adolescent students (mean age 14.9 years) self-administered the SCOFF eating disorder questionnaire as part of their regular health examination. Background information, including self-reported mood questionnaire RBDI, was obtained from the students' health care records. Four years later, the participants (mean age 19.0 years) responded to the questionnaire by mail. Logistic regression analyses were used to assess the recurrence and onset of eating disturbance and the associated factors. RESULTS: Altogether 52% of girls and 17% of boys who reported eating disorder symptoms in the baseline assessment remained symptomatic at follow-up. Depressiveness--even transient--in mid-adolescence predicted recurrence of eating disturbance in late adolescence. Prolonged dissatisfaction with appearance predicted the onset of eating disturbance in previously symptom-free girls. In general, experience of average parenting was good enough for the girls in terms of recovering from eating disturbance and avoiding the onset of eating problems after mid-adolescence. CONCLUSIONS: Adolescent girls who report both eating disturbance and negative affectivity may benefit from extra support. The beneficial role that parents may have in helping these girls must not be forgotten.

Finnish Prenatal Study of Autism and Autism Spectrum Disorders (FIPS-A): overview and design.

This article presents an overview of the Finnish Prenatal Study of Autism and Autism Spectrum Disorders (FIPS-A), a new study designed to examine the relationship between prenatal serologic factors, mediating and moderating developmental antecedents, and risk of autism spectrum disorders (ASD). The FIPS-A is based on register linkages between births from 1987 to 2005 ascertained from the Finnish Medical Birth Register (FMBR) and other national registers on treatment for this group of disorders. All subjects were members of the Finnish Maternity Cohort (FMC), which consists of virtually all births in Finland from 1983 to the present, and which includes archived maternal serum samples. This study also capitalizes on other registry information, such as systematically collected data on pregnancy, prenatal and neonatal complications and manual data collection from well-child clinics providing developmental data from birth to the age of 7 years. In this paper, we describe the methods used in the FIPS-A study, including a description of the national registers, available data and case ascertainment procedures. Finally, we discuss implications of the data for future work on uncovering putative aetiologies of ASD and key strengths and limitations of the design.

Factors associated with reported childhood depressive symptoms at age 8 and later self-reported depressive symptoms among boys at age 18.

AIMS: This study aimed to study conditions associated with depressive symptoms at ages 8 and 18 in a representative birth cohort of Finnish males. METHODS: The participants in this community-based 10-year follow-up study consisted of 2,348 boys born in 1981. At age 8, three informant sources were used: parents, teachers, and the children themselves. Depressive symptoms were established using the Children's Depression Inventory (CDI). At age 18, self-report questionnaires were used to study the boys' family factors, life events, adaptive functioning, and substance use. Depressive symptoms at age 18 were established using Beck's Depression Inventory (BDI). RESULTS: Poor adaptive functioning at age 18 was independently associated with both child and late adolescent depressive symptoms. Use of illicit drugs and somatic health problems were independently associated with later depressive symptoms. Parental divorce in early childhood independently predicted depressive symptoms both in childhood and in late adolescence. Teacher reports of child's total problems at age 8 independently predicted depressive symptoms at age 18. CONCLUSIONS: Depression in males at ages 8 and 18 is particularly associated with stressful life events in childhood, whereas late depression is associated with somatic health problems and substance use. Further population-based studies comparing conditions associated with childhood and adolescent depression are needed.