The Association between the Preference for Active Play and Neurological Development in Toddlers: A Register-Based Study.

Active play is regarded as physical activity during early childhood. Physical activity has many benefits for children's physical and psychosocial health and wellbeing, as well as for their cognitive development. The aim of this study was to investigate associations between the preference for active play and neurological development in toddlers. The study was conducted as a register-based study, and the data were collected from a public-health clinic's electronic health records. The register data about active play used in this study were originally assessed by parents at home and by early years teachers at nurseries. Neurological development was assessed by the public health nurses in public child-health clinics. The data eligible for this study were available from 717 toddlers aged 2.5-3.0 years old (mean: 2.5 years ± 2 months). The majority of toddlers (85%) showed a preference for active play, both at home and at the nursery. The prevalence of delays in the neurological development of toddlers varied in different developmental areas (by 1-15%). Delays in gross motor competence, auditory perception, and self-help skills were associated with a lower preference for active play in nursery settings, but none of the neurodevelopmental items were found to be associated with toddlers' preference for active play at home. Nurseries need to encourage children to actively play and support their gross motor competence and self-help skills.

The Weighty Matter intervention: a family-centered way to tackle an overweight childhood.

The complexity of childhood overweight and obesity requires that researchers continue to investigate potential solutions. We developed "The Weighty Matter" intervention to prevent obesity in mildly overweight 4- and 6-year-old children. This article describes the intervention protocol, the health habits of families (n=86), and the effect of the intervention on children's weight for height, parents' body mass indices, and family health habits after a 12-month follow-up. Positive changes were seen in families' health habits, although the results did not reach statistical significance. As a result of this study, a new and practical method was developed to focus on the issue of family health habits.

Deficit in speech development at the age of 5 years predicts alexithymia in late-adolescent males.

OBJECTIVE: Assessment of the etiology of alexithymia is in most studies hindered by recall bias. The aim of the present study was to assess the significance of individual developmental factors at the age of 5 years for alexithymia in late adolescence. By using data from a child welfare center check-up at the age of 5 years, it was possible to avoid recall bias. METHODS: The sample consisted of 723 subjects who were comprehensively examined at the age of 5 years at a child welfare center where their state of health and verbal, gross motor, visuomotor, socioemotional, and cognitive development were assessed. In late adolescence (mean age, 19 years) their alexithymic features were measured using the 20-item Toronto Alexithymia Scale. RESULTS: In females, none of the developmental factors remained associated with later alexithymic features in the multivariate analyses. However, in males, emphasis on the variables measuring speech development was important. In particular, a variable measuring the ability to comply with multipart instructions, thus receptive language skills, was strongly related with alexithymic features in late adolescence. CONCLUSION: The results suggest that speech development is a significant factor in the developmental process of alexithymia, at least in males. It is possible that children who have impaired language skills and therefore struggle in social situations have a higher risk of developing alexithymia. This emphasizes the need for further research to assess how the inadequate speech development predisposes to the emergence of alexithymic features and whether it is a sex-specific phenomenon.

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.

Does perceived social support and parental attitude relate to alexithymia? A study in Finnish late adolescents.

The aim of the present study was to explore the associations of perceived social support and parental attitude with alexithymia in a Finnish adolescent population sample. Of the initial sample of 935 adolescents, 729 (78%) answered the questionnaire and formed the final sample. The mean age of the subjects was 19 years (range 17-21 years). The 20-item Toronto Alexithymia Scale (TAS-20) was used for assessment of alexithymia. Perceived social support from family, friends, and significant other people was measured using the Multidimensional Scale of Perceived Social Support (MSPSS). Perceived parental care and overprotection were assessed using the Parental Bonding Instrument (PBI), and separately for mother and father. After controlling for the sociodemographic factors, alexithymia was significantly associated with a lower degree of experienced social support and higher parental overprotection both in females and males. Maternal overprotection was associated (p<0.04) with TAS-20 total score as well as the Difficulty Identifying Feelings (DIF) and Difficulty Describing Feelings (DDF) subscales. The lack of social support from friends appeared to predict alexithymia more strongly than lack of support from family and significant other people. Against our hypothesis, maternal and paternal care was not directly associated with alexithymic features. This study highlights the significance of intrusive and overprotective parental attitudes as a possible risk factor for development of alexithymia. However, to assess causality, we need longitudinal studies. The results also emphasize the need for further studies to establish the significance of peer relationships in the development of alexithymia.

Alexithymia and eating disorder symptoms in adolescents.

An increasing amount of evidence indicates an association between alexithymia and eating disorder symptoms. This possible association was evaluated in a non-clinical sample of late adolescents. Seven hundred and twenty nine adolescents completed the questionnaire and formed the final sample. Alexithymia was measured using the 20-item Toronto Alexithymia Scale and eating disorder symptoms were assessed using the SCOFF questionnaire. The rate of alexithymia was 8.2%, without any gender difference. The mean SCOFF scores differed significantly between alexithymic and non-alexithymic subjects, and the share of SCOFF positive subjects was significantly higher among alexithymics. The results suggest that eating disorder symptoms are more common in alexithymic adolescents.

Alexithymia is associated with anxiety among adolescents.

BACKGROUND: The aim of this study was to explore the possible association between alexithymia and anxiety in a non-clinical sample of late adolescents. METHODS: The questionnaire was sent to 935 adolescents of whom 729 (78%) responded, thus forming the final sample. The mean age of the subjects was 19 years (range 17-21 years). The Finnish versions of the following scales were used: the 20-item Toronto Alexithymia Scale (TAS-20) was used to assess alexithymia, and anxiety symptoms were measured using the State-Trait Anxiety Inventory (STAI). Alcohol consumption was assessed using the Alcohol Use Disorders Identification Test (AUDIT), and depression symptoms were evaluated using the short form of the Beck Depression Inventory, as modified by Raitasalo (RBDI). RESULTS: The prevalence of alexithymia in the sample was 8.2%, with no statistically significant gender difference. The alexithymic subjects had significantly (p<0.001) higher mean STAI scores than the non-alexithymic subjects. A vast majority of the alexithymic subjects were highly anxious, in contrast to the low proportion among the non-alexithymic subjects. The highly anxious alexithymic subjects differed statistically and significantly from the highly anxious non-alexithymic subjects, with higher scores both in the AUDIT and the RBDI. LIMITATIONS: The results are based on self-reported material alone and the cross-sectional design used in this study precludes the assessment of causal links. CONCLUSIONS: The results suggest that anxiety symptoms are independently associated with alexithymia among late adolescents in general population.

Parental experiences and attitudes regarding the management of acute otitis media--a comparative questionnaire between Finland and The Netherlands.

BACKGROUND: Both treatment guidelines and the amount of antibiotics used for acute otitis media (AOM) vary across western countries. Parental expectations and their awareness of antimicrobial use and resistance, which may also be influenced by the guidelines, are not yet completely known. OBJECTIVE: To compare parental experiences and opinions regarding the management of AOM in children with AOM in Finland and The Netherlands. METHODS: We sent the questionnaires via public day care in Turku, Finland, and Utrecht, The Netherlands. We asked about family background, child's history of AOM and parental experiences and attitudes about AOM treatment and antimicrobial resistance. RESULTS: Of 1151 participants, 83% in Finland and 49% in The Netherlands had had at least one episode of AOM. Antibiotics were used more frequently in Finland than in The Netherlands, 99% versus 78%, respectively. More Finnish parents reported to believe that antibiotics are necessary in the treatment of AOM as compared to Dutch parents. Use of analgesics for AOM was similar (80% in Finland and 86% in The Netherlands). One-third of the parents had discussed resistance with their doctor. According to parental experiences, antimicrobial resistance had caused more problems in Finland than in The Netherlands (20% versus 2%). Finally, 88% of parents in Finland and 65% in The Netherlands were worried that bacteria could become resistant to antibiotics. CONCLUSIONS: Treatment practices and parental expectations seem to interact with each other. Therefore, if we aim to change AOM treatment practices, we have to modify both guidelines and parental expectations.

Uncovering hidden eating disorders using the SCOFF questionnaire: cross-sectional survey of adolescents and comparison with nurse assessments.

BACKGROUND: The majority of individuals with an eating disorder remain undetected in healthcare. To improve the situation, screening for eating disorder symptoms is suggested to be a routine part of the health examination of adolescents. Given the busy practice of school healthcare, the screening tool needs to be brief and efficient. OBJECTIVES: To evaluate the feasibility of the Finnish version of the SCOFF questionnaire in screening for eating disorder symptoms among adolescents. DESIGN: A natural design with cross-sectional surveys. SETTING: School healthcare in a major city in southwestern Finland. PARTICIPANTS: Students, aged 14-16 years, attending the 8th grade (n=1036, response rate=71%) and the 9th grade (n=855, response rate=62%) at Finnish-speaking secondary schools during the academic years 2003-2005, and their school nurses (n=14). Adolescents attending special classes for those with learning disabilities were excluded from the study. METHODS: Students self-administered the SCOFF questionnaire as part of a health examination. Background information was obtained from the students' healthcare records. Data from school nurses were collected with semi-structured questionnaires designed for this study. Confirmatory factor analysis was used to identify the best factor model of SCOFF for girls and boys. Descriptive statistics were used to assess the efficiency of SCOFF in comparison with established health examination practice for the purpose of detecting potential eating disorder cases among adolescents. RESULTS: Confirmatory factor analyses indicated a good fit of both the unidimensional and a two-factor model of SCOFF and yielded support for the gender-free interpretation of the screening results in mid-adolescent populations. Altogether 81% of the students who self-reported eating disorder symptoms in SCOFF remained undetected in a health examination where no eating disorder questionnaire was used. CONCLUSIONS: SCOFF was found to be an appropriate instrument for screening for eating disorder symptoms in mid-adolescent populations within school healthcare. It may be a useful tool for detecting disordered eating, especially when no objective features of eating disorders appear. However, screening shall not replace a health examination but it is recommended to include it to health examinations so as to best take advantage of both procedures.

Towards understanding gender differences in disordered eating among adolescents.

AIMS AND OBJECTIVES: The aim of the study was to enhance the detection of disordered eating in adolescents. The objectives were to examine gender differences in the prevalence of eating disorder symptoms, in occurrence of health-risk factors and susceptibility to these and to investigate associations between health-risk factors and eating disorder symptoms. BACKGROUND: Disordered eating has a strong female preponderance. Reasons for the gender discrepancy are not well known. However, to develop effective strategies for eating disorder prevention, we need to understand gender differences in disordered eating and the related factors. DESIGN: This is a school-based, cross-sectional cohort study with a natural design. METHODS: The SCOFF and the R-BDI questionnaires were administered to students (14-15 years old) attending the eighth grade of secondary school. Information about health-risk factors was obtained from the adolescents' school health-care records. RESULTS: The results were based on data from 1036 (71% of the sample) students. Self-reported eating disorder symptoms were prevalent in 24% of the girls and 16% of the boys. Girls reported many of the health-risk factors studied at a higher rate than boys. However, there were no gender differences in susceptibility to these factors. Dissatisfaction with appearance or weight, use of tobacco, lack of regular meals and poor communication with parents increased the likelihood of eating disorder symptoms in both genders. CONCLUSIONS: Gender differences in disordered eating are relatively small in adolescence. To enhance the detection of eating disorder symptoms, both girls and boys should be screened for these problems in secondary school. RELEVANCE TO CLINICAL PRACTICE: The results can help nurses to use the information obtained from adolescents' health-care records, their annual health examinations and their responses to the SCOFF questionnaire to identify those who need further intervention, including adolescent boys.

Adolescents with fluctuating symptoms of eating disorders: a 1-year prospective study.

AIM: This paper is a report of a study to investigate the stability of self-reported eating disorder symptoms, factors associated with them and the predictors of their recurrence. BACKGROUND: In western cultures, eating-related problems during adolescence are common but usually temporary. However, in approximately 10% of cases disordered eating is sustained, increasing the risk of a full-blown eating disorder. To distinguish adolescents with temporary eating problems from those whose problems are likely to continue, healthcare providers need to understand the progress of disordered eating and the features of high-risk adolescents. METHODS: The two-stage prospective survey was conducted with a school-based sample of adolescents aged 15-17 years. At baseline, in 2003-2004, the SCOFF ('Sick', 'Control', 'One', 'Fat' and 'Food') questionnaire was administered to students in the 9th year of schooling in Finland. Follow-up assessment took place 1 year later, and 372 students provided data at both assessments. Binary logistic regression analysis was performed to investigate which factors predict the recurrence of eating disorder symptoms, defined as the occurrence of eating disorder symptoms at both assessments. RESULTS: Five per cent of the students reported eating disorder symptoms at both assessments. Typically, they had multiple psychological problems and health complaints. Anxiety perceived earlier in adolescence resulted in an estimated odds ratio of the logistic model of 20 for the recurrence of eating disorder symptoms. CONCLUSION: Earlier anxiety rather than dissatisfaction with appearance had a statistically significant effect on the progress of eating problems. Longitudinal research is needed to confirm the results. Until further knowledge is available, nurses should follow-up all adolescents with disordered eating to identify a possible need for intervention.