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AIM AND OBJECTIVES: Continuous use of over-the-counter analgesics (OTCAs) may prevent adolescents from learning healthier options and might lead to lifelong use of such medicines. It is possible that parents' own use of OTCAs might influence adolescents, but little is known about this issue. Our research questions were; "What are the main factors leading to a high use of OTCAs among adolescents and how can health professionals support these adolescents in their pain management?" BACKGROUND: Frequent consumption of OTCAs may cause health problems such as drug-induced headache and liver failure. Some adolescents frequently use non-prescribed pain medication and their attitudes towards the use of OTCAs vary from responsible to careless. DESIGN: A "systematic search and review" was conducted between March 2017 and May 2018. Quantitative and qualitative studies were included. METHODS: We used the PRISMA Statement checklist, the PRISMA flow diagram and The Critical Appraisal Skills Programme for quality appraisal. Our search identified 3,386 possible sources, 2,043 articles were selected for title examination, and 70 articles underwent abstract review. Fourteen articles were reviewed entirety. Ten articles were of acceptable quality. RESULTS: The importance of parental influence on adolescent use of OTCAs is significant. These findings seem to be independent of country and culture. CONCLUSION: Parents are the most important source of information regarding the use of OTCAs; further, they are the main supplier of the medicine. A broad understanding of human development, health, pain and use of pain medication is needed to develop targeted information and support adolescents with high consumption of non-prescription pain medication. RELEVANCE TO CLINICAL PRACTICE: Information from professionals such as school nurses is important. Professionals must consider the physical, social and psychological aspects influencing the use of OTCAs. Information should be made available to adolescents, parents and society in general.
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Analgésicos/uso terapêutico , Medicamentos sem Prescrição/uso terapêutico , Relações Pais-Filho , Poder Familiar , Adolescente , Comportamento do Adolescente/psicologia , Feminino , Humanos , Masculino , Dor/tratamento farmacológico , Dor/psicologia , Pesquisa QualitativaRESUMO
BACKGROUND: Few areas of medicine demonstrate such international divergence as child development screening and surveillance. Many countries have nationally mandated surveillance policies, but the content of programmes and mechanisms for delivery vary enormously. The cost of programmes is substantial but no economic evaluations have been carried out. We have critically examined the history, underlying philosophy, content and delivery of programmes for child development assessment in five countries with comprehensive publicly funded health services (Denmark, Finland, Norway, Scotland and Sweden). The specific focus of this article is on motor, social, emotional, behavioural and global cognitive functioning including language. FINDINGS: Variations in developmental surveillance programmes are substantially explained by historical factors and gradual evolution although Scotland has undergone radical changes in approach. No elements of universal developmental assessment programmes meet World Health Organization screening criteria, although some assessments are configured as screening activities. The roles of doctors and nurses vary greatly by country as do the timing, content and likely costs of programmes. Inter-professional communication presents challenges to all the studied health services. No programme has evidence for improved health outcomes or cost effectiveness. CONCLUSIONS: Developmental surveillance programmes vary greatly and their structure appears to be driven by historical factors as much as by evidence. Consensus should be reached about which surveillance activities constitute screening, and the predictive validity of these components needs to be established and judged against World Health Organization screening criteria. Costs and consequences of specific programmes should be assessed, and the issue of inter-professional communication about children at remediable developmental risk should be prioritised.
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Desenvolvimento Infantil , Internacionalidade , Programas de Rastreamento/métodos , Sistema Nervoso/crescimento & desenvolvimento , Vigilância da População/métodos , Comportamento Infantil , Pré-Escolar , Cognição , Emoções , Humanos , Destreza Motora , Avaliação de Programas e Projetos de Saúde , Habilidades SociaisRESUMO
Correction to: BMC Public Health (2018) 18: 448. https://doi.org/10.1186/s12889-018-5324-x . In the original version of this article [1], published on 4 April 2018, there was 1 incorrect author family name. The redundant affiliation (5) has also been removed. The original article has been updated.
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BACKGROUND: Overweight and obese adolescents are reported to be less physically active than their peers. Research-based knowledge about their views may contribute to a better understanding of key factors that may foster or undermine motivation for physical activity, and provide knowledge for the future development of interventions. This paper explores experiences of physical activity among overweight adolescents, age 13-14 years, participants in Young & Active, a web-based controlled trial intervention to increase physical activity (ClinicalTrials.gov NCT01700309). The theoretical perspective is based on Self-Determination Theory. METHODS: Two qualitative post-intervention research interviews, with a nine-month interval, were conducted with 21 adolescents, 15 girls and 6 boys to study short-term and long-term changes. The informants were recruited from a total of 84 participants from the Young & Active intervention group. Data were analyzed using qualitative content analysis. RESULTS: The participants associated physical activity with organized sports and physical education classes at school, and as a means of promoting good health and attractive bodies. A majority of the adolescents said that they experienced their health as poorer than other youths, and expressed worries about their fitness and future health. Mastering a physical activity, being together with friends and having fun promoted motivation to perform sports. Not mastering an activity, or not knowing the others made them less motivated. None of the adolescents highlighted the importance of informal active living when asked about their understanding and experiences of physical activity. Consistency was found between the first and second interviews. CONCLUSION: This study adds to limited research on overweight and obese adolescents' experiences of physical activity. The participants' views reflect opinions in society about physical activity, and its importance for health. Viewing physical activity as conducted within organized sports makes it necessary to look into how these are organized, structured and led, and what can be done to support self-esteem, autonomous motivation and participation. The ability to choose among available, affordable and desirable physical activities, together with friends, may promote participation and maintenance.
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Atitude , Exercício Físico/psicologia , Sobrepeso/psicologia , Adolescente , Feminino , Promoção da Saúde , Humanos , Internet , Masculino , Sobrepeso/prevenção & controle , Pesquisa QualitativaRESUMO
BACKGROUND: Childhood obesity is a worldwide health challenge and risk factor for adult life obesity, which predisposes to development of type 2 diabetes and cardiovascular diseases. However, also thinness in early life has been related to these diseases, especially if followed by fat gain. In European countries, susceptibility to cardio-metabolic diseases varies considerably between ethnic groups. We investigated ethnic differences in overweight and thinness in a multi-ethnic, population-based cohort of preschool children in Norway, and associations with maternal and early postnatal factors. METHODS: Participants were children aged 4-5 years (n = 570) drawn from the population-based STORK Groruddalen cohort of healthy women and offspring followed from early pregnancy. Ethnic groups were: European (n = 298), South Asian (n = 154), and Middle East/North African (n = 118). Children's growth data were provided from routine visits at local Child Health Clinics. Weight status was defined by the International Obesity Task Force. Using multinomial logistic regression analysis, we explored ethnic differences in overweight and thinness, and associations with maternal-, pre, - and postnatal factors. RESULTS: Children of Middle East/North African origin had higher prevalence of overweight (22.0%) compared to European (12.8%) children, and in adjusted logistic regression analysis almost the double risk (OR 1.98; 95%CI: 1.08-3.63). Prevalence was lower in children of South Asian origin (5.2%). Children with South Asian background had higher prevalence of thinness (26.0%) compared to ethnic Europeans (10.4%), and the double risk (OR 2.20; 95%CI: 1.25-3.87) in adjusted models. Applying newly suggested BMI adjustments in South Asian children, taking into account their relatively increased adiposity, markedly increased the prevalence of overweight, and decreased the prevalence of thinness in this subgroup. Birthweight and maternal prepregnant overweight were strongly, positively associated with overweight, and inversely associated with thinness. Lower maternal age was associated with overweight only. CONCLUSIONS: In a multi-ethnic cohort we found strikingly different patterns of overweight and thinness among children of different ethnic groups at age 4-5 years, and a strong association between maternal BMI and their children's weight status. More knowledge is needed on what characterizes and what promotes healthy growth patterns in multi-ethnic populations.
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Povo Asiático/estatística & dados numéricos , População Negra/estatística & dados numéricos , Obesidade Infantil/etnologia , Magreza/etnologia , População Branca/estatística & dados numéricos , Adulto , Peso ao Nascer , Índice de Massa Corporal , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Masculino , Idade Materna , Mães/estatística & dados numéricos , Noruega/epidemiologia , Gravidez , Prevalência , Fatores de Risco , Adulto JovemRESUMO
AIMS AND OBJECTIVES: This study aims to describe conditions that may influence the development of identity in adolescents frequently using over-the-counter analgesics. BACKGROUND: Frequent self-medication with analgesics among adolescents is associated with several physical pain points, low self-esteem and low ambitions for the future. Continuous use of over-the-counter analgesics can keep adolescents from learning healthier coping strategies. DESIGN: Qualitative individual interviews with adolescents and their mothers were conducted and transcribed. Furthermore, they were analysed as dyads. SETTING AND PARTICIPANTS: Students aged 14-16 years in 9th and 10th grades in 10 Norwegian junior high schools self-reporting at least weekly use of analgesics were asked to participate. Those who wanted to take part took a consent letter to their parents, also inviting the parent to participate. RESULTS: Six girls, two boys and their mothers were included. The teenagers were highly dependent on their mothers. They had often been bullied, lacked good relationships with peers, avoided conflicts and strived to be accepted. Their mothers felt solely responsible for their upbringing and showed great concern for all the pain experienced by their child. A close relationship between mother and child influenced how the adolescent managed their pain, including their use of over-the-counter analgesics. Three main themes were identified in the stories of mother and child: "Vulnerable adolescents," "Mother knows best" and "Pain is a shared project." CONCLUSIONS: Pain among adolescents may be amplified by a difficult family situation and insecure relationships with peers. Strategies within the family may sustain pain as a shared project keeping the adolescent and main caregiver close together, and this might be hampering identity development. To help adolescents with pain and high consumption of over-the-counter analgesics, the adolescents' relationship with parents must be considered in designing an intervention. Guidance on pain assessment, pain management, including appropriate use of over-the-counter analgesics, should be included.
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Analgésicos/uso terapêutico , Medicamentos sem Prescrição/uso terapêutico , Dor/tratamento farmacológico , Autoimagem , Automedicação/psicologia , Adolescente , Comportamento do Adolescente/psicologia , Feminino , Humanos , Masculino , Relações Mãe-Filho , Mães/psicologia , Pesquisa QualitativaRESUMO
We investigated associations between serum 25-hydroxyvitamin D (25(OH)D) in pregnancy and birth weight and other neonatal anthropometric measures. The present study was a population-based, multiethnic cohort study of 719 pregnant women (59 % ethnic minorities) in Oslo, Norway, delivering a singleton neonate at term and with birth weight measurements. In a representative sample, anthropometric measurements were taken. Maternal 25(OH)D was measured at gestational weeks 15 and 28. Women with 25(OH)D <37 nmol/l were recommended vitamin D3 supplementation. Separate linear regression analyses were performed to model the associations between 25(OH)D and each of the outcomes: birth weight, crown-heel length, head circumference, abdominal circumference, sum of skinfolds, mid-upper arm circumference and ponderal index. In early pregnancy, 51 % of the women were vitamin D deficient (25(OH)D<50 nmol/l). In univariate analyses and in models adjusting for maternal age, parity, education, prepregnancy BMI, season, gestational age and neonate sex, maternal 25(OH)D was significantly associated with birth weight, head circumference, abdominal circumference and ponderal index (P<0·05 for all), when used as a continuous variable and categorised (consistently low, consistently high, increasing and decreasing level). However, after adjusting for ethnicity, 25(OH)D was no longer associated with any of the outcomes. Sex-specific associations for abdominal circumference and sum of skinfolds were found (P for interaction<0·05). In conclusion, in a multiethnic cohort of pregnant women with high prevalence of vitamin D deficiency, we found no independent relation between maternal vitamin D levels and any of the neonatal anthropometric measures, and the strong association between ethnicity and neonatal outcomes was not affected by maternal vitamin D status.
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Colecalciferol/uso terapêutico , Suplementos Nutricionais , Desenvolvimento Fetal , Retardo do Crescimento Fetal/prevenção & controle , Fenômenos Fisiológicos da Nutrição Materna , Complicações na Gravidez/fisiopatologia , Deficiência de Vitamina D/fisiopatologia , 25-Hidroxivitamina D 2/sangue , Adulto , Peso ao Nascer , Composição Corporal , Calcifediol/sangue , Estudos de Coortes , Feminino , Retardo do Crescimento Fetal/epidemiologia , Retardo do Crescimento Fetal/etiologia , Humanos , Recém-Nascido , Estudos Longitudinais , Masculino , Noruega/epidemiologia , Estado Nutricional , Gravidez , Complicações na Gravidez/sangue , Complicações na Gravidez/epidemiologia , Prevalência , Estudos Prospectivos , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/epidemiologiaRESUMO
BACKGROUND: Both vitamin D and iron deficiencies are widespread globally, and a relationship between these deficiencies has been suggested. However, there is a paucity of randomised controlled trials assessing the effect of vitamin D supplementation on iron status. PURPOSE: We aimed to investigate whether 16 weeks of daily vitamin D3 supplementation had an effect on serum ferritin, haemoglobin, serum iron and transferrin saturation. METHODS: Overall, 251 participants from South Asia, Middle East and Africa aged 18-50 years who were living in Norway were randomised to receive daily oral supplementation of 10 µg vitamin D3, 25 µg vitamin D3, or placebo for 16 weeks during the late winter. Blood samples from baseline and after 16 weeks were analysed for serum 25-hydroxyvitamin D (s-25(OH) D), serum ferritin, haemoglobin and serum iron. In total, 214 eligible participants completed the intervention (86 % of those randomised). Linear regression analysis were used to test the effect of vitamin D3 supplementation combined (10 or 25 µg) and separate doses 10 or 25 µg compared to placebo on change (T2-T1) in each outcome variable adjusted for baseline s-25(OH)D values. RESULTS: There was no difference in change in the levels of s-ferritin (1.9 µg/L, 95 % CI: -3.2, 7.0), haemoglobin (-0.02 g/dL, 95 % CI: -0.12, 0.09), s-iron (0.4 µg/L, 95 % CI: -0.5, 1.3) or transferrin saturation (0.7 %, 95 % CI: -0.6.1, 2.0) between those receiving vitamin D3 or those receiving placebo. Serum 25-hydroxyvitamin D increased from 29 nmol/L at baseline to 49 nmol/L after the intervention, with little change in the placebo group. CONCLUSIONS: In this population of healthy ethnic minorities from South Asia, the Middle East and Africa who had low vitamin D status, 16 weeks of daily supplementation with 10 or 25 µg of vitamin D3 did not significantly affect the haemoglobin levels or other markers of iron status.
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Anemia Ferropriva/etnologia , Colecalciferol/administração & dosagem , Suplementos Nutricionais , Ferro/sangue , Estado Nutricional , Deficiência de Vitamina D/etnologia , Adolescente , Adulto , Anemia Ferropriva/sangue , Ásia/etnologia , Proteína C-Reativa/metabolismo , Relação Dose-Resposta a Droga , Método Duplo-Cego , Etnicidade , Feminino , Ferritinas/sangue , Ácido Fólico/sangue , Hemoglobinas/metabolismo , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Oriente Médio/etnologia , Noruega/epidemiologia , Transferrina/metabolismo , Vitamina B 12/sangue , Deficiência de Vitamina D/sangue , Adulto JovemRESUMO
BACKGROUND: To investigate ethnic differences in vitamin D levels during pregnancy, assess risk factors for vitamin D deficiency and explore the effect of vitamin D supplementation in women with deficiency in early pregnancy. METHODS: This is a population-based, multiethnic cohort study of pregnant women attending Child Health Clinics for antenatal care in Oslo, Norway. Serum-25-hydroxyvitamin D [25(OH)D] was measured in 748 pregnant women (59% ethnic minorities) at gestational weeks (GW) 15 (SD:3.6) and 28 (1.4). Women with 25(OH)D <37 nmol/L at GW 15 were for ethical reasons recommended vitamin D3 supplementation. Main outcome measure was 25(OH)D, and linear regression models were performed. RESULTS: Severe deficiency (25(OH)D <25 nmol/L) was found at GW 15 in 45% of women from South Asia, 40% from the Middle East and 26% from Sub-Saharan Africa, compared to 2.5% in women from East Asia and 1.3% of women from Western Europe. Women from South Asia, the Middle East and Sub-Saharan Africa had mean values that were -28 (95 % CI:-33, -23), -24 (-29, -18) and -20 (-27, -13) nmol/L lower than in Western women, respectively. Ethnicity, education, season and intake of vitamin D were independently associated with 25(OH)D. At GW 28, the mean 25(OH)D had increased from 23 (SD:7.8) to 47 (27) nmol/L (p < 0.01) in women who were recommended vitamin D supplementation, with small or no change in women with sufficient vitamin D levels at baseline. CONCLUSIONS: Vitamin D deficiency was prevalent among South Asian, Middle Eastern and African women. The serum levels of 25(OH)D increased significantly from GW 15 to 28 in vitamin D deficient women who received a recommendation for supplementation. This recommendation of vitamin D supplementation increased vitamin D levels in deficient women.
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Suplementos Nutricionais/estatística & dados numéricos , Etnicidade/estatística & dados numéricos , Complicações na Gravidez/etnologia , Deficiência de Vitamina D/etnologia , Adulto , Povo Asiático/estatística & dados numéricos , População Negra/estatística & dados numéricos , Colecalciferol/uso terapêutico , Estudos de Coortes , Feminino , Humanos , Pessoa de Meia-Idade , Oriente Médio/etnologia , Noruega/epidemiologia , Gravidez , Complicações na Gravidez/sangue , Complicações na Gravidez/tratamento farmacológico , Segundo Trimestre da Gravidez/sangue , Segundo Trimestre da Gravidez/etnologia , Vitamina D/análogos & derivados , Vitamina D/sangue , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/tratamento farmacológico , Vitaminas/uso terapêutico , Adulto JovemRESUMO
BACKGROUND: Breastfeeding is considered the best infant-feeding method. Norway is one of the leading countries in terms of breastfeeding initiation and duration. To maintain this high breastfeeding rate, it is important to understand the factors that influence breastfeeding. A doctor s advice can improve the rates of breastfeeding initiation and duration, but not all doctors are competent in breastfeeding counselling. OBJECTIVES: The aim of this study was to identify the knowledge and beliefs of general practitioners (GPs) about breastfeeding in Norway and to investigate how important they considered guidance about breastfeeding initiation and duration before and after birth. DESIGN: A questionnaire study about knowledge and beliefs according to predefined correct responses and about self-perceived competence as an advisor. SUBJECTS: 122 GPs engaged in apprenticeship for medical students. RESULTS: The response rate was 57%, 69 GPs participated. The questions were answered correctly according to national consensus for 49 % for the knowledge items and 64 % of the belief items. The GPs believed that their guidance was more important after than before birth. Female GPs had more confidence in their guidance ability than male GPs. Confidence in the GPs own guidance after birth was associated with knowledge about contraindications to breastfeeding. CONCLUSION: Although the GPs expressed beliefs favouring breastfeeding they partly lacked basic knowledge. The GPs confidence in own guidance was better after than before birth and was higher among those with more knowledge. Improved knowledge and emphasis on guidance before birth should be promoted among GPs. Key points Breastfeeding is the best infant-feeding method. Doctors' advice improves the rates of breastfeeding, but not all doctors have sufficient knowledge. This study mapped the knowledge and beliefs among Norwegian GPs. The study revealed that: GPs partly lacked basic knowledge to effectively promote breastfeeding. GPs had less confidence as advisers during pregnancy than after delivery. Most GPs agreed that knowledge about breastfeeding is basic and should be taught as an integral part of medical school programmes.
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Atitude do Pessoal de Saúde , Aleitamento Materno/psicologia , Clínicos Gerais/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Centros Médicos Acadêmicos , Adulto , Competência Clínica , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Noruega , Padrões de Prática Médica , Distribuição por Sexo , Estudantes de Medicina , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Use of over-the-counter analgesics among adolescents has increased markedly. High consumption of over-the-counter analgesics among adolescents is associated with frequent pain, lower self-esteem, reduced sleep, lower educational ambition, binge drinking, higher caffeine consumption, and part-time employment. Knowledge about life experiences of adolescents who frequently use over-the-counter analgesics may be useful to prevent health problems. The purpose of the study was to increase knowledge about adolescents who suffer from frequent pain and have a high consumption of over-the-counter analgesics. METHODS: A qualitative study, employing one-on-one, in-depth interviews using a thematic interview guide. Data were collected in Norway in 2013-2014. Three boys and sixteen girls; aged 14-16 years, who continuously consumed over-the-counter analgesics were recruited from ten high schools in urban and suburban districts. Candidate participants were excluded if they were medically diagnosed with an acute or chronic illness, requiring extended use of over-the-counter analgesics within the last year. The interviews were taped, transcribed and analysed as text according to Kvale's three contexts of interpretation: self-understanding, common sense and theory. RESULTS: All participants disclosed unresolved physical and psychosocial distress characterized as pain. Frequent pain from various body parts made everyday life challenging. Methods of pain self-appraisal and over-the-counter analgesics use often mimicked maternal patterns. Participants reported being raised under unpredictable circumstances that contributed to long lasting family conflicts and peer-group problems. Participants wanted to feel appreciated and to be socially and academically successful. However, pain reduced their ability to manage everyday life, hampered experienced possibilities for success, and made social settings difficult. CONCLUSIONS: Childhood experiences influence how adolescents experience pain and use over-the-counter analgesics. Coping with difficult situations or attempting to mask symptoms with over-the-counter analgesics can perpetuate and amplify underlying problems. High consumption of over-the-counter analgesics and frequent pain may be warning signs of adolescents with possible health threatening conditions and reduced quality of life. These adolescent might be in need of support from school nurses and General Practitioners. This study identifies new perspectives that may lead to novel approaches to identify, guide, and support adolescents with frequent pain and high consumption of over-the-counter analgesics.
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AIMS: To examine characteristics of 15- to 16-year-old adolescents who used over-the-counter analgesics daily to weekly (high-frequency users) as compared to those who used less or no analgesics (low-frequency users). Further to analyse the differences in pain experience, lifestyle, self-esteem, school attendance and educational ambition. METHODS: An anonymous cross-sectional questionnaire-based study. The questionnaire covered the use of over-the-counter analgesics, pain experience, sociodemographics, lifestyle factors, self-esteem, school absence and future educational plans. The study took place in the 10th grade in six junior high schools in a medium-sized town in Norway. The local sales data for analgesics and antipyretics were close to the national average. We invited 626 adolescents to participate. Of the 367 adolescents (59%) who responded, 51% were girls. Associations between the frequency of use of over-the-counter analgesic and the mentioned variables were analysed using multiple logistic regression. RESULTS: In total, 26% (42 boys and 48 girls) used over-the-counter analgesics daily to weekly. These high-frequency users experienced more widespread pain, slept less, had more paid spare-time work, drank more caffeinated drinks, participated more often in binge drinking, had lower self-esteem, less ambitious educational plans and more frequent school absence than did the low-frequency users. These associations remained significant when controlling for gender, cultural background and self-evaluated economic status. CONCLUSION: Adolescent, who are high-frequency users of over-the-counter analgesics, suffer more pain and have identifiable characteristics indicative of complex problems. Their ability to handle stress appears to be discordant with the kind of situations to which they are exposed. The wear and tear associated with allostatic mechanisms counteracting stress may heighten their pain experience.
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Analgésicos/administração & dosagem , Medicamentos sem Prescrição/administração & dosagem , Adolescente , Estudos Transversais , Revisão de Uso de Medicamentos , Feminino , Humanos , Masculino , NoruegaRESUMO
BACKGROUND: Prevalence of overweight in children has increased significantly in many countries in the past decades. Few parents identify their own children as overweight, especially very young children. Motivating parents is difficult, and interventions to attain normal weight often fail. OBJECTIVE: To explore parents' views and experiences when health professionals identify their preschool child as overweight. METHODS: In-depth interviews were held with parents of 10 overweight children aged 2.5-5.5 years. Parents were recruited at well child clinics in rural parts of eastern Norway. Interviews were recorded digitally, transcribed verbatim and analysed thematically. RESULTS: Parents presented themselves and their toddlers as vulnerable. To protect their child from developing low self-esteem and eating disorders, some parents preferred their child not to be present when discussing overweight. Growth charts were looked upon as objective and useful. Parents talked readily about their own weight experiences. Being overweight themselves represented both a barrier to, and motivation for, dealing with their toddler's overweight. Parents appreciated support from professionals in kindergarten, but grandparents often undermined the parents' effort to make changes. CONCLUSIONS: Early childhood overweight should be addressed in a sensitive and respectful manner and should consider whether the index child should be present during discussion. It may be helpful for clinicians to discuss parents' own weight and dieting experiences and concerns about eating disorders. All the child's caretakers should be considered a target for intervention, and grandparents and kindergarten professionals should be included.
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Sobrepeso/psicologia , Pais/psicologia , Obesidade Infantil/psicologia , Relações Profissional-Família , Adulto , Pré-Escolar , Feminino , Pessoal de Saúde , Humanos , Masculino , Noruega , Atenção Primária à Saúde , Pesquisa QualitativaRESUMO
OBJECTIVE: To investigate vitamin D levels in patients with non-specific musculoskeletal pain, headache, and fatigue. DESIGN: A cross-sectional descriptive study. SETTING: A health center in Oslo, Norway, with a multi-ethnic population. SUBJECTS: A total of 572 patients referred by a general practitioner (GP) for an examination of hypovitaminosis D who reported musculoskeletal pain, headache, or fatigue. The patients' native countries were: Norway (n = 249), Europe, America, and South-East Asia (n = 83), and the Middle East, Africa, and South Asia (n = 240). Both genders and all ages were included. MAIN OUTCOME MEASURES: Vitamin D levels (25-hydroxyvitamin D) in nmol/L. RESULTS: Hypovitaminosis D (25-hydroxyvitamin D < 50 nmol/L) was found in 58% of patients. One-third of ethnic Norwegians had hypovitaminosis D, while 83% of patients from the Middle East, Africa, and South Asia had hypovitaminosis D with minimal seasonal variation of levels. One in two women from these countries had a vitamin D level below 25 nmol/L. Mean vitamin D level was lower in patients with headaches compared with patients with other symptoms. Some 15% of patients with low (< 50 nmol/L) vitamin D levels reported headaches, compared with 5% of those with normal vitamin D levels. CONCLUSION: Our study shows a high prevalence of hypovitaminosis D in patients with non-specific musculoskeletal pain, headache, or fatigue for whom the GP had suspected a low vitamin D level. Hypovitaminosis D was not restricted to immigrant patients. These results indicate that GPs should maintain awareness of hypovitaminosis D and refer patients who report headaches, fatigue, and musculoskeletal pain with minimal sun exposure and a low dietary vitamin D intake for assessment.
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Fadiga/sangue , Cefaleia/sangue , Doenças Musculoesqueléticas/sangue , Dor/sangue , Vitamina D/análogos & derivados , Adulto , Estudos Transversais , Fadiga/etiologia , Feminino , Cefaleia/etiologia , Humanos , Masculino , Doenças Musculoesqueléticas/etiologia , Noruega/epidemiologia , Noruega/etnologia , Dor/etiologia , Luz Solar , Vitamina D/administração & dosagem , Vitamina D/sangue , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/epidemiologia , Deficiência de Vitamina D/etnologiaRESUMO
BACKGROUND: OTC analgesics were released for sale outside pharmacies in Norway in 2003. This study assesses indications and frequency of use of these drugs among 15-16 year-old teenagers in Norway after 2003. MATERIAL AND METHOD: We developed a questionnaire, which contained 65 questions with one or more response options. This was given to all pupils in the final grade at six junior high schools in a town with 60,000 inhabitants (Drammen). RESULTS: 367 of 626 (58.6 %) pupils participated. 50 % of the boys and 71 % of the girls had used OTC analgesics during the last four weeks; 26 % of them on a daily or weekly basis. Girls experienced episodes of pain more frequently than boys, but the proportion of episodes treated with analgesics did not differ between the sexes. Headache and muscle pain were common. Half of those with severe headache/migraine used OTC analgesics on a daily or weekly basis. The teenagers reported several reasons for experiencing pain and discomfort, such as long time spent in front of various screens, tight time schedules with physical exercise and friends, drinking too little and much noise in the classroom. INTERPRETATION: Use of OTC analgesics has increased considerably among Norwegian teenagers. Drug-induced headache may occur as an adverse event. If more effort is made to improve life situations that adolescents perceive as painful and a cause of discomfort, the need for OTC analgesics may be reduced.
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Analgésicos/administração & dosagem , Medicamentos sem Prescrição/administração & dosagem , Dor/tratamento farmacológico , Adolescente , Analgésicos/efeitos adversos , Uso de Medicamentos , Feminino , Humanos , Masculino , Medicamentos sem Prescrição/efeitos adversos , Noruega/epidemiologia , Dor/epidemiologia , Automedicação , Fatores Sexuais , Inquéritos e QuestionáriosRESUMO
BACKGROUND: More information is needed on teenagers' attitudes to self-medication with OTC-analgesics, and their access to medicine and information. MATERIAL AND METHOD: An anonymous questionnaire study was performed among all tenth grade students in Drammen, a middle sized city in Norway, in spring 2007. RESULTS: 367 students participated in the study, 55 of them had a non-western background. 24 % of boys and 41 % of girls stated that analgesics could be used whenever they experienced pain. Among these, 91 % had taken analgesics during the previous four weeks, among those who thought that analgesics should not be used 50 % had taken it. The girls reported episodes of pain more often than the boys, but analgesics were used to treat pain to the same extent by all students, irrelevant of sex and cultural background. 77 % of students with a western origin and 62 % of those from non-western countries felt free to use OTC-analgesics at home without asking for permission. 31 % of western girls got analgesics from their friends. 8.5 % bought medicines at the pharmacy and 7.1 % bought them in grocery shops. Information on how to alleviate pain with medicine was usually given by the parents. INTERPRETATION: Teenagers in secondary school have different opinions on self-medication with OTC-analgesics. The parents assist their children in how to manage pain. 15 - 16 year-olds experience much pain, and mainly have free access to analgesics at home.
Assuntos
Analgésicos/administração & dosagem , Medicamentos sem Prescrição/administração & dosagem , Dor/tratamento farmacológico , Adolescente , Atitude Frente a Saúde/etnologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Noruega , Pais , Automedicação , Fatores Sexuais , Inquéritos e QuestionáriosRESUMO
Adolescents who are overweight or obese are reported to be less active than their peers. Motivation is a critical factor in sustaining physical activity and thereby positive health outcomes. This qualitative study explores how participation in a 12-week Internet-based intervention study, Young & Active, influenced the participants' short-term and long-term motivation to increase and sustain physical activity. The overall purpose of Young & Active was to design, test, and evaluate a health-promoting Internet-based program for use in the school health services in Norway. The program was informed by self-determination theory and motivational interviewing. Two postintervention qualitative research interviews were conducted with 21 adolescents, aged 13 to 14 years, with a 9- to 12-month interval. The adolescents were recruited from a total of 84 participants from the Young & Active study intervention group. Data were analyzed using qualitative content analysis. Self-determination theory was used as a theoretical and explanatory framework. Following the motivational continuum from self-determination theory, all adolescents showed changes in motivation, from extrinsic toward more intrinsic motivation, and for some, a reversal after completing the program. Analysis of the adolescents' utterances formed patterns that could be divided into four main categories: (a) reinforcement of a habit, (b) promotion of competence and enjoyment, (c) boost of temporary change, and (d) reinforcement of adverse habits. An Internet-based intervention may help adolescents increase and sustain physical activity if participation is based on self-choice and if they have sufficient support in their social environments. The intervention alone is not enough to support adolescents who are less motivated or have other challenges in life and may even provoke resistance and reinforce negative health behavior. Such a program may be used together with face-to-face counseling in school health services, provided that it is further refined on a larger scale and that the counseling is performed by qualified health service professionals.
RESUMO
OBJECTIVE: Functional abdominal pain occurs frequently in children and adolescents. It is an exclusion diagnosis; somatic diseases have to be ruled out. However little explanation is given for why the child is experiencing pain. The aim was to explore the experiences of parents of children with chronic abdominal pain discharged from hospital without a somatic explanation. DESIGN: The study has a qualitative design. The open questions concerned pain experiences and management. Interviews were conducted at the hospital, at the parents' workplace or in their homes, audiotape recorded and transcribed. A descriptive content analysis was used to analyse the transcribed text. SETTING: Parents of children referred from general practice located in urban and rural areas in two municipals in Norway. PARTICIPANTS: Fourteen parents of children with functional abdominal pain aged 5-15 years. RESULTS: Fourteen parents participated. Some explained that their child's disability glued the parents together on a common project to help the child. Other parents could tell that siblings got less attention and complained about too much fuss during pain. Parents wished for diagnosis that could be treated efficiently. Some were still anxious that an undetected condition triggered pain. They prompted their doctor to do further examinations. However, some parents knew that social factors could inflict pain and were concerned that their child was unable to distinguish sensations like anxiety and 'butterfly' tensions from physical pain. The parents and children needed professional guidance on how to manage the pain . CONCLUSION: The doctor's consultation should not end at the diagnosis of functional abdominal pain. Doctors may help these families further by focusing on pain management strategies.
Assuntos
Dor Abdominal/terapia , Crianças com Deficiência/psicologia , Manejo da Dor , Pais/psicologia , Adolescente , Ansiedade/etiologia , Criança , Pré-Escolar , Dor Crônica , Feminino , Medicina Geral/organização & administração , Humanos , Entrevistas como Assunto , Masculino , Noruega , Relações Profissional-Família , Pesquisa QualitativaRESUMO
Importance: With increasing prevalence of atopic dermatitis (AD) and its manifestation in most countries, together with the supporting evidence of the progression to other atopic phenotypes, AD has developed into a worldwide public health concern. The presence of the disease of has increased since the 1950s, but some recent studies suggest a stationary or decreasing trend. Objective: To analyze a nationwide health register based on prescription data to determine the incidence rate (IR) of AD in an entire pediatric population. Design, Setting, and Participants: All children resident in Norway younger than 6 years from January 1, 2009, through December 31, 2015, were included in this cohort study. Medical diagnoses and disease-specific medications were used as a proxy for identifying children with AD in this population-based prescription registry study. The prescription study was terminated in 2016. The total number of 295â¯286 disease-specific prescriptions was analyzed from August 2016 through December 2017. The hypothesis was formulated before, during, and after the data collection. Main Outcomes and Measures: All children with a medical diagnosis of AD or eczema based on at least 2 prescriptions of topical corticosteroids or at least 1 prescription of topical calcineurin inhibitors. Incidence rates per person-year (PY) and IR ratios were calculated. Results: A total of 295â¯286 disease-specific prescriptions were dispensed to 122â¯470 children, of whom 63â¯460 had AD and 56 009 (88.3%) had reimbursed prescriptions and associated AD diagnoses. The annual Norwegian study population (aged <6 years) increased from 357â¯451 children in 2009 to 373â¯954 in 2015. The overall IR increased from 0.028 per PY (95% CI, 0.028-0.029 per PY) in 2009 to 0.034 per PY (95% CI, 0.033-0.035 per PY) in 2014. For children younger than 1 year, the IR increased from 0.052 per PY (95% CI, 0.050-0.053 PY) in 2009 to 0.073 per PY (95% CI, 0.071-0.075 per PY) in 2014. In this age group, the IR was 53% higher in boys compared with girls (IR ratio, 1.53; 95% CI, 1.49-1.57; P < .001). The incidence proportion before the age of 6 years was 17.4% (95% CI, 17.2%-17.7%). The primary seasons for the onset of AD were winter and spring. Conclusions and Relevance: This nationwide study suggests an increase in the IR of pediatric AD, especially among children younger than 1 year. This study's findings suggest that increase occurred with a higher IR during winter and spring seasons. Atopic dermatitis had an earlier onset in boys than in girls. During the study period, more than 1 in 6 children younger than 6 years had, at some point, been affected by AD.
Assuntos
Saúde da Criança/tendências , Dermatite Atópica/epidemiologia , Eczema/epidemiologia , Saúde do Lactente/tendências , Corticosteroides/administração & dosagem , Corticosteroides/uso terapêutico , Inibidores de Calcineurina/administração & dosagem , Inibidores de Calcineurina/uso terapêutico , Criança , Pré-Escolar , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Incidência , Lactente , Masculino , Noruega/epidemiologia , Sistema de Registros , Estações do Ano , Fatores SexuaisRESUMO
CONTEXT: Autoimmune thyroid disorders have been linked to vitamin D deficiency, but an effect of vitamin D supplementation is not established. OBJECTIVE: Our objective was to test whether vitamin D compared with placebo could reduce thyroid autoantibodies. DESIGN: Predefined additional analyses from a randomized, double-blind, placebo-controlled trial. SETTING: The study was conducted in different community centers in Oslo, Norway. PARTICIPANTS: A total of 251 presumed healthy men and women, aged 18 to 50 years, with backgrounds from South Asia, the Middle East, and Africa were included. INTERVENTION: Daily supplementation with 25 µg (1000 IU) vitamin D3, 10 µg (400 IU) vitamin D3, or placebo for 16 weeks. OUTCOME MEASURE: Difference in preintervention and postintervention antithyroid peroxidase antibody (TPOAb) levels. Additional outcomes were differences in thyroid-stimulating hormone (TSH) and free fraction of thyroxine (fT4). RESULTS: There were no differences in change after 16 weeks on TPOAb (27 kU/L; 95% CI, -17 to 72; P = 0.23), TSH (-0.10 mU/L; 95% CI, -0.54 to 0.34; P = 0.65), or fT4 (0.09 pmol/L; 95% CI, -0.37 to 0.55; P = 0.70) between those receiving vitamin D supplementation or placebo. Mean serum 25(OH)D3 increased from 26 to 49 nmol/L in the combined supplementation group, but there was no change in the placebo group. CONCLUSION: Vitamin D3 supplementation, 25 µg or 10 µg, for 16 weeks compared with placebo did not affect TPOAb level in this randomized, double-blind study among participants with backgrounds from South Asia, the Middle East, and Africa who had low vitamin D levels at baseline.