Kestävät jalat - kettujen jalkaterveyden kehityshanke. Raportti nro 3

Luken kirjat, raportit, oppaat ja esitteet. Raportti nro 3201

Low mood in a sample of 5-12 year-old child psychiatric patients : a cross-sectional study

Background: Not much is known about low mood and its associates in child psychiatric patients. In this study, we examined the prevalence of low mood, how it associates with disruptive behaviour, and affects clinician-rated global functioning in child psychiatric outpatients. Methods: The study population consisted of 862 5-12 year-old child psychiatric patients. The study sample was a subsample of all 1251 patients attending a child psychiatric outpatient clinic at Helsinki University Hospital in 20132015 formed by excluding 4 year-old and 13 year-old patients and those with missing or incomplete data. The parentrated Strengths and Difficulties Questionnaire, collected as part of the routine clinical baseline measure, was used as a measure of psychiatric symptoms. The diagnoses were set according to ICD-10 by the clinician in charge after an initial evaluation period. The Children's Global Assessment Scale (CGAS) score set by clinicians provided the measure of the patients' global functioning. All information for the study was collected from hospital registers. Associations between emotional symptoms and conduct problems/hyperactivity scores were examined using ordinal regression in univariate and multivariate models, controlling for age and sex. The independent samples T test was used to compare the CGAS values of patient groups with low/normal mood. Results: In our sample, 512 children (59.4%) showed low mood. In multivariate ordinal regression analysis, low mood associated with conduct problems (OR 1.93, 95% CI 1.39-2.67), but no association was found between low mood and hyperactivity. Low mood was prevalent among children with oppositional defiant disorder or conduct disorder (51.8%). The global functioning score CGAS was lower among children with parent-reported low mood (52.21) than among children with normal mood (54.62, p <0.001). The same was true in the subgroup of patients with no depression diagnosis (54.85 vs. 52.82, p = 0.001). Conclusions: Low mood is prevalent in child psychiatric outpatients regardless of depression diagnosis and it has a negative effect on global functioning. Low mood and behavioural problems are often associated. It is important to pay attention to low mood in all child psychiatric patients. We recommend prevention measures and low-threshold services for children with low mood.Peer reviewe

A new model of Holocene peatland net primary production, decomposition, water balance, and peat accumulation

Peatland carbon and water cycling are tightly coupled, so dynamic modeling of peat accumulation over decades to millennia should account for carbon-water feedbacks. We present initial results from a new simulation model of long-term peat accumulation, evaluated at a wellstudied temperate bog in Ontario, Canada. The Holocene Peat Model (HPM) determines vegetation community composition dynamics and annual net primary productivity based on peat depth (as a proxy for nutrients and acidity) and water table depth. Annual peat (carbon) accumulation is the net balance above- and below-ground productivity and litter/peat decomposition – a function of peat hydrology (controlling depth to and degree of anoxia). Peat bulk density is simulated as a function of degree of humification, and affects the water balance through its influence on both the growth rate of the peat column and on peat hydraulic conductivity and the capacity to shed water. HPM output includes both time series of annual carbon and water fluxes, peat height, and water table depth, as well as a final peat profile that can be “cored” and compared to field observations of peat age and macrofossil composition. A stochastic 8500-yr, annual precipitation time series was constrained by a published Holocene climate reconstruction for southern Quebec. HPM simulated 5.4 m of ´ peat accumulation (310 kg C m−2 ) over 8500 years, 6.5% of total NPP over the period. Vascular plant functional types accounted for 65% of total NPP over 8500 years but only 35% of the final (contemporary) peat mass. Simulated age-depth and carbon accumulation profiles were compared to a radiocarbon dated 5.8 m, c.9000-yr core. The simulated core was younger than observations at most depths, but had a similar overall trajectory; carbon accumulation rates were generally higher in the simulation and were somewhat more variable than observations. HPM results were sensitive to centuryscale anomalies in precipitation, with extended drier periods (precipitation reduced ∼10%) causing the peat profile to lose carbon (and height), despite relatively small changes in NP

Eyberg Child Behavior Inventory (ECBI) : Normative data, psychometric properties, and associations with socioeconomic status in Finnish children

Assessment of behavioral disorders is one of the most commonly encountered tasks in child psychiatry. The Eyberg Child Behavior Inventory (ECBI) is a widespread measurement tool used for assessing conduct problems, though the psychometric properties of the tool have varied in different samples. In this study, the ECBI was evaluated in a Finnish population based sample of children aged 4 to 12 years (n = 1,715). Factor structure and internal consistency of the ECBI and associates of behavioral problems in Finnish children were evaluated. The results showed that a unidimensional one‐factor solution for the ECBI intensity scale was the best fit for the data. The ECBI mean scores were considerably higher in our sample compared to other Nordic countries. Boys scored higher than girls on both ECBI scales, and the mean scores decreased with child's age. Socioeconomic status (SES) was weakly connected to the ECBI scores. Our results highlight the need for country specific reference norms in order to improve the clinical utility of evidence‐based measures for assessing conduct problems.Peer reviewe

Parent- and teacher-reported long-term effects of parent training on child conduct problems in families with child protection and other support services : a randomized controlled trial

Background: This randomized controlled trial (RCT) evaluated the long-term effectiveness of the Incredible Years(R) (IY) Parenting Program in modifying children's externalizing problems among families in Child Protection Services (CPS) and using other special support services. We also examined whether parent-reported effects of the IY(R) generalize to the daycare/school setting as reported by teachers. Methods: Participants in the study were 3-7-year-old children with behavioural problems (N = 102 at baseline, N = 89 at one-year follow-up). Participants were randomized to intervention (N = 50) and control groups (N = 52) after the baseline assessment. The intervention group received 19-week IY(R) Parenting Program. The effectiveness of the intervention was analyzed using linear mixed model. Results: Our previously reported pre-post intervention effects on CBCL (Child Behavior Checklist) and ECBI (Eyberg Child Behavior Inventory) were not sustained to the one-year follow-up. Child conduct problems decreased from baseline to follow-up in both intervention and control groups. The positive changes were not observed at daycare/school from baseline to post-intervention or to the one-year follow-up, and there were no significant differences in changes between the groups. Conclusions: Evidence-based parenting program IY(R) seems to be an effective intervention for child conduct problems in the short term in families in the CPS context, but sustaining the positive effects and generalizing them to the daycare/school context are challenging.Peer reviewe

Parental Warmth and Hostility and the Development of Psychopathic Behaviors : A Longitudinal Study of Young Offenders

Parental behaviors may shape levels of psychopathic traits and antisocial outcomes among youth. To better evaluate the potential causality of these associations, we used eight follow-ups from the Pathways to Desistance study of 1354 offending adolescents (14.3% female; 40.1% black) and examined whether within-individual variation in parenting over time was associated with within-individual variation in psychopathic traits and offending. Multilevel regression models were adjusted for age, gender, ethnicity, contact with parental figure, and self-reported offending. Adolescent self-reported parental warmth was associated with lower psychopathic traits, and parental hostility with higher psychopathic traits. The results indicated that the more supportive and nurturing the parent, the lower the levels of psychopathic traits, whereas the more hostile the parent, the higher the levels, respectively. In addition, self-reported offending was predicted by higher parental hostility and lower maternal warmth. In time-lagged analysis, psychopathic traits did not predict parental behaviors. In young offenders parental warmth may protect against development of psychopathic traits in adolescence, whereas parental hostility may strengthen these traits. We conclude, that parenting quality matters in adolescence. Warm parenting style at this developmental period associates with lower psychopathic features among young offenders possibly lowering the risk of further criminal activity.Peer reviewe

Interpersonal Relationships as Protective and Risk Factors for Psychopathy : A Follow-up Study in Adolescent Offenders

Friendships and romantic relationships may function as protective and risk factors for psychopathic traits. To better understand potential causal associations, we investigated whether within-individual changes in relationship characteristics were related to changes in psychopathic traits over time. Data were derived from ten repeated measurements of the Pathways to Desistance longitudinal study of 1354 offending adolescents (14.3% female; 40.1% Black). Analyses were adjusted for age, gender, ethnicity, self-reported offending and living facilities. Relationships of high quality were associated with lower psychopathic traits, whereas antisocial behavior and antisocial influence in relationships were related to higher psychopathic traits. Within-individual analysis indicated that time-invariant individual characteristics did not confound these associations. The findings suggest that the quality and antisocial activities of interpersonal relationships can affect positively or negatively on the levels of psychopathy.Peer reviewe

Polypharmacy in children and adolescents initiating antipsychotic drug in 2008-2016 : a nationwide register study

Objective The use of antipsychotics in children and adolescents has increased rapidly. Little is known about psychotropic polypharmacy in children and adolescent initiating an antipsychotic drug. Thus, we investigated the frequency and predictors of polypharmacy during the first year of antipsychotic use in Finnish children and adolescents. Methods Between 2008 and 2016, 14 848 individuals aged 1-17 years initiating risperidone, quetiapine, aripiprazole, or olanzapine treatment were identified from Finnish Prescription Registry. Data on psychotropic drug prescriptions prior to and during antipsychotic treatment were collected. Associations between predictors and polypharmacy were analyzed with regression models. Results During the study period polypharmacy occurred in 44.9% of the new antipsychotic users, being more frequent in girls (55.5%) than in boys (44.5%, p < 0.001). The two most frequent concomitant psychotropic drug classes were antidepressants (66.2%) and psychostimulants/atomoxetine (30.8%). Adolescents aged 13-15 and 16-17 years, and girls showed an increased risk of polypharmacy during antipsychotic treatment (OR 2.37 [95% CI 1.91-2.92], OR 2.39 [95% CI 1.92-2.98], and OR 1.64 [95% CI 1.51-1.78], respectively). The use of psychostimulants/atomoxetine or antidepressants prior to initiation of antipsychotic treatment was strongly associated with polypharmacy during antipsychotic treatment (OR 8.39 [95% CI 7.49-9.41], OR 3.02 [95% CI 2.75-3.31]). Conclusions Polypharmacy was common in children and adolescents initiating antipsychotic treatment. Prior use of psychostimulants/atomoxetine and antidepressants increased the risk of polypharmacy. The use of antipsychotics was mainly off-label, thus, the risks of concomitant use of antipsychotics with other psychotropic drugs should be carefully weighed.Peer reviewe

New Users of Antipsychotics Among Children and Adolescents in 2008–2017: A Nationwide Register Study

IntroductionRecently, prescribing antipsychotics for children and adolescents has been increasing in many countries. These drugs are often prescribed off-label, although antipsychotics have been associated with adverse effects. We determined the recent incidence of antipsychotic use among children and adolescents in Finland.MethodsFinnish National Prescription Register including all Finnish inhabitants receiving reimbursement for pharmaceuticals was searched for subjects of 1 to 17 years of age who had started an antipsychotic drug between January 1, 2008, and December 31, 2017 (n = 26,353). Between 2008 and 2017, the range of number of Finnish children and adolescents aged 1 to 17 years was 1.01 to 1.03 million/year. The incidence was calculated by dividing the number of new users by all age- and sex-matched Finnish inhabitants in the year.ResultsBetween 2008 and 2017, the incidence of antipsychotic use among children and adolescents increased from 2.1 to 3.8 per 1000 individuals, respectively. In children aged 7 to 12 years, the incidence of antipsychotic use 1.4-folded (from 1.9 (95% CI: 1.8–2.0) to 2.7 (95% CI: 2.5–2.9) per 1000) with a cumulative increase of 0.2% per year (χ2 = 51.0, p <0.0001). In adolescents aged 13 to 17 years, the incidence 2.2-folded (from 4.3 (95% CI: 4.1–4.5) to 9.4 (95% CI: 9.1–9.8) per 1000) with a cumulative increase of 0.6% per year (χ2 = 590.3, p <0.0001). The increase in the incidence of use was steeper in girls (2.3-fold) than in boys (1.4-fold) (χ2 = 85.6, p <0.0001), especially between 2015 and 2017 (1.6-fold and 1.2-fold, respectively) (χ2 = 151.7, p <0.0001). The year 2011 was the turning point when the incidence in girls exceeded the incidence in boys, and the incidence of quetiapine use exceeded that of risperidone use.ConclusionsThe incidence of antipsychotic use increased between 2008 and 2017, especially in adolescent girls. The use of quetiapine increased, although it has few official indications in children and adolescents. Future studies should investigate the reasons for increasing use of antipsychotics, especially quetiapine, in children and adolescents.Peer reviewe

Pollution related effects on immune function and stress in a free-living population of pied flycatcher Ficedula hypoleuca

We investigated whether exposure to heavy metal pollution affected the immune function of individuals in a free living population of a small insectivorous passerine bird, the pied flycatcher Ficedula hypoleuca. We measured humoral immune responses in two study areas: a polluted area in the vicinity of a copper smelter and a control area far from the smelter. Plasma corticosterone level and blood heterophil/lymphocyte ratio (H/L) were used as more general physiological measures of stress. The immune response of F hypoleuca was not suppressed by pollution stress. In contrast, we found that F hypoleuca males showed stronger Immoral immune responses to a novel antigen (tetanus toxoid) in the polluted environment than in the unpolluted one. After the immunization of males, numbers of lymphocytes rose significantly more in the polluted area, leading to a smaller H/L ratio than in males from the control area. Females showed no pollution related effects on their immune responses. Corticosterone levels of males and nestlings were not related to pollution levels. Nestlings showed somewhat higher H/L ratios and lower fledging success in the polluted area, both factors indicating increased stress levels in a polluted area. Our results suggest that Immoral immune response of male F hypoleuca may be enhanced under moderate levels of heavy metal Pollution. Enhanced immune function may, however, also be costly for birds and the higher humoral immune responses in polluted areas may thus have negative effects on the birds' breeding performance and survival