Biomedical subjects

Irma Moilanen

Publications and source records attributed to Irma Moilanen.

18 recordsLinked to original sources

PubMed2005

Childhood predictors of psychiatric disorders among boys: a prospective community-based follow-up study from age 8 years to early adulthood.

OBJECTIVE: To study early childhood predictors for early adulthood psychiatric disorders. METHOD: The sample included 2,712 Finnish boys born in 1981. Information about the 8-year-old boys' problem behavior was obtained from parents, teachers, and children. The 10-15-year follow-up information about psychiatric disorders in early adulthood was based on the national military register between the years 1999 and 2004. RESULTS: According to the military register, 10.4% of men had a psychiatric disorder. All informant sources, parents, teachers, and the children themselves predicted early adulthood psychiatric disorders. Conduct symptoms at age 8 independently predicted substance abuse, antisocial personality, and psychotic disorders in early adulthood. Self-reported depressive symptoms, poor school performance, and living in a nonintact family had an independent predictive association with antisocial personality and depressive disorders. Parent-reported emotional symptoms and self-reported psychosomatic symptoms independently predicted anxiety disorders. About one third of those who had used services at age 8 had a psychiatric disorder in early adulthood. Among service users, conduct and hyperkinetic symptoms predicted psychiatric disorders in early adulthood. CONCLUSIONS: Efforts to prevent early adult psychiatric disturbance already present in childhood are emphasized. Active screening to detect children in need of early interventions in childhood to prevent negative development in early adulthood is justified.

Adolescent↗

PubMed2005

Recognition of psychiatric disorders, and self-perceived problems. A follow-up study from age 8 to age 18.

OBJECTIVE: To study the rate of, and factors associated with, recognition of psychiatric disorders and self-perceived problems among 18-year-old adolescent boys. METHOD: The study population consisted of 2347 Finnish boys born during 1981 attending military call-up (79.7% of the original sample). At age 8, the boys were evaluated by parental and teacher Rutter scales and by self-reports using the Child Depression Inventory (CDI). At military call-up 10 years later, the boys filled in the Young Adult Self-Report (YASR). Information about psychiatric disorders recognized at the military call-up health examination was obtained from the national military register. RESULTS: About 4.6% of boys were recognized as having a psychiatric disorder at the military call-up medical examination. In addition, 23.1% of boys reported emotional, behavioral or relational difficulties but were not recognized as having an ICD 10 psychiatric diagnosis at the military call-up medical examination. A higher level of psychopathology, problems across different life domains and early onset of problems were more strongly associated with recognition of psychiatric disorder than with self-reports of difficulties without a recognized psychiatric disorder. All informant sources, parents, teachers and children themselves at age 8, independently predicted recognition of psychiatric disorders and perceived difficulties 10 years later. CONCLUSIONS: Only a minority of adolescents with psychiatric problems are recognized as having a psychiatric disorder in the health services. Efforts to prevent psychiatric disturbance in early life are emphasized. The use of screening methods in school health settings to detect children in need of child mental health services is justified.

Adolescent↗

PubMed2005

Co-twin dependence modifies heritability of abstinence and alcohol use: a population-based study of Finnish twins.

The role of co-twin dependence (twins' closeness or reliance on the co-twin) was examined as a moderator of genetic and environmental influences on alcohol use in adolescence and early adulthood in a large longitudinal population-based study of Finnish twins (FinnTwin16). The associations between co-twin dependence and alcohol use were studied first at an individual level in adolescence (n = 3362) and early adulthood (n = 2912). Then, maximum likelihood models were fit to the two waves of data from same-sex twin pairs to assess the differences and changes in genetic and environmental influences on alcohol use (abstinence, drinking frequency, intoxication frequency); N = 1342 pairs in adolescence, and N = 1078 pairs in early adulthood. Overall, no significant associations were found between co-twin dependence and individual alcohol use. However, co-twin dependence importantly modulated genetic effects on drinking habits, especially in adolescence, but also in early adulthood. Co-twin-dependent twins reported greater similarity in their alcohol-related behavior across all alcohol-use measures at both time points, and the role of genes and environments varied according to co-twin dependence. Shared environmental factors explained most of the variation in drinking among co-twin-dependent twins in adolescence and contributed to drinking to intoxication during early adulthood. In contrast, among co-twin-independent twin pairs, genetic variance contributed significantly to all alcohol-use measures at both time-points. An interdependent sibling relationship is an important modifier of drinking habits, and it appears to reduce the impact of inherited liabilities on alcohol-related behavior especially in adolescence.

Adolescent↗

PubMed2005

Intervention,treatmentand care in autistic disorder. Challenging case reports from northern Finland.

OBJECTIVES: Autism produces characteristic patterns of behaviour, and individuals with autistic disorder (AD) have a lot in common in terms of behaviour and mannerisms. Individuals with autism, however, also have their own overall personalities, which both underlie and interact with their autism. This article focuses on challenges of identifying AD and delivering appropriate services in face of long distances and limited resources. STUDY DESIGN: This study is a retrospective descriptive chart review and cases series. Hospital records and data on the treatment/habilitation status of 187 children and adolescents with autistic disorder aged 3-18 years were evaluated from Northern Finland. METHODS: Nine subjects, representing the age group of 9- to 17-year-olds, did not show any improvement on the Childhood Autism Rating Scale (CARS) and in the clinical examination during the follow-up period 1990--97. In this study, these children and adolescents with AD were evaluated more carefully. RESULTS: The treatment programs and therapies varied, depending on the availability of trained staff. There were various reasons for the absence of the most suitable treatment, or habilitation, at the individual level. The difficulties also varied over time and between individuals. In addition, after the follow-up period, four of the nine (55.6%) individuals showed more positive outcome when the level of autism had been taken into account in the planning of the intervention for, treatment and care of AD. CONCLUSION: The possible reasons for poor outcome included the level of mental disability, impairments of speech and communication, lack of knowledge of autism at the municipal level, long distance to services, severe epilepsy, additional medical diagnosis, parental acceptance of the child's autism and late start of the intervention for, or habilitation of autism.

Adolescent↗

PubMed2004

Factors associated with depressive symptoms among 18-year-old boys: a prospective 10-year follow-up study.

BACKGROUND: The aim is to study associative and predictive factors for self-reported depressive symptoms among 18-year-old boys. METHODS: The participants in this community-based 10-year follow-up study consisted of 2348 boys born during 1981. At baseline, three informant sources were used: parents, teachers, and the children themselves. At follow-up, self-report questionnaires were used to study 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 within family and in education, having fewer than two close friends, somatic health problems, and using illicit drugs were all independently associated with a high level of depressive symptoms in the cross-sectional data at age 18. Self-reported depressive symptoms (Children's Depression Inventory, CDI) at age 8 independently predicted an increased number of depressive symptoms 10 years later. LIMITATIONS: Only self-reported questionnaires were used at follow-up. CONCLUSIONS: The high association between depressive symptoms at age 8 and at age 18 gives grounds for paying special attention to children's own intimations of distress already in the early school years. Using self-report screening questionnaires in school health care may help identify children's depressive symptoms.

Adolescent↗

PubMed2004

Seasonal variation in postnatal depression.

BACKGROUND: We evaluated the occurrence of postnatal depression in general and during different seasons as part of a larger longitudinal mother-child follow-up study. METHOD: One hundred and eighty-five mothers, from the maternity wards of University Hospital of Oulu, Finland, completed a self-rating depression scale, the Edinburgh Postnatal Depression Scale (EPDS) twice: first at hospital 2-7 days after delivery and the second time at home 4 months after the delivery. Different psychosocial variables were mapped out to avoid any confounding factors. The year was divided in two separate ways: first, three different time periods were selected by the amount of sunlight: dark (October-January), intermediate (February, March, August, September) and light (April-July), and second, the year was divided by seasons. The results were analysed by the chi(2)-test for multinomials. RESULTS: Sixteen percent (16.2) of mothers were scored as being depressed using 13 as a cut-off point immediately after the infant was born. Thirteen percent (13.0) were depressed measured 4 months postpartum. There was more mild depression in the autumn (ratio observed/expected 1,62; 95% confidence interval 1.05-2.19) immediately after delivery, using 10 as a cut-off, and less depression in the spring (0.27; 0.00-0.62) measured at home later, using 13 as a cut-off. When using classification by the amount of light there was more depression during the dark time (1.58; 1.05-2.11) immediately postpartum. LIMITATIONS: The group sizes and the amount of sample sizes collected within each month are quite small. CONCLUSIONS: It should be borne in mind that seasonal changes and alterations in the amount of light might influence the occurrence of postnatal depression.

Depression, Postpartum↗

PubMed2004

Mental health service use among 18-year-old adolescent boys: a prospective 10-year follow-up study.

OBJECTIVE: To study prevalence and factors associated with mental health service use among 18-year-old adolescent boys. METHOD: Predictors at age 8 and factors at age 18 associated with mental health service use during the preceding 12 months were studied in a general population sample of 2,316 Finnish boys born in 1981 attending military call-up (79% of the original sample). RESULTS: Within the preceding 12 months, 2.1% of the boys had used mental health services. At age 18, internalizing, anxious-depressive, and withdrawal symptoms; health problems; not living with parents; use of illicit drugs; high level of alcohol use; and regular smoking were independently associated with service use. At age 8, a high level of emotional and behavioral symptoms, need for referral, and low school performance according to teacher evaluations predicted service use 10 years later. CONCLUSIONS: Only a minority of adolescents with severe problems had used mental health services. Because of the wide range of problems and comorbidity among service users, there is a need for integration of different services. Education services have a central role in the early detection of those who will later use mental health services.

Adolescent↗

PubMed2004

Does pain relief during delivery decrease the risk of postnatal depression?

BACKGROUND: To test the hypothesis that sufficient pain relief during delivery decreases the risk of postnatal depression. METHODS: As part of a prospective follow-up study of the risk factors for postnatal depression and its impact on the mother-infant interaction and child development, 185 parturients filled in the Edinburgh Postnatal Depression Scale (EPDS), first during the first postpartum week and again (n = 162) 4 months later. The incidence and the risk of high EPDS scores was calculated according to the mode of delivery and the mode of pain relief during vaginal delivery, also after adjusting for the length of labor. RESULTS: Mothers who received epidural/paracervical blockade during their delivery spent less time in the delivery room than mothers in the nitrous oxide/acupuncture group (p = 0.033) or mothers with no pain relief (p = 0.026) and had shorter length of labor than mothers without pain relief (p = 0.04). The adjusted risk of depressive scores at the first postnatal week was decreased in the epidural/paracervical group when compared with no analgesia group (OR: 0.25, 95% CI: 0.09-0.72). This difference was not shown at 4 months postpartum. Elective or emergency cesarean section did not increase the risk of high EPDS scores at the first week or at 4 months postpartum. CONCLUSION: The mode of pain relief during vaginal delivery seems to be associated with the incidence of postpartum depression, especially immediately after delivery.

Adult↗

PubMed2004

Associated medical disorders and disabilities in children with autistic disorder: a population-based study.

A population-based survey was conducted among 152,732 Finnish children and adolescents aged under 16 years and living in northern Finland. Diagnoses and associated medical conditions were derived from the hospital and institutional records of this area. One hundred and eighty-seven children with DSM-IV autistic disorder were identified. Associated medical disorders or associated disorders of known or suspected genetic origin were found in 12.3 percent, including tuberous sclerosis, Down syndrome, fragile X syndrome, Klinefelter syndrome, XYY syndrome, chromosome 17 deletion, chromosome 46, XX, dup(8) (p) and mitochondriopathy. Other associated medical disorders identified were epilepsy, hydrocephalus, foetal alcohol syndrome and cerebral palsy. Hearing impairments were found in 8.6 percent and severe impairment of vision in 3.7 percent of the individuals with autistic disorder. Medical disorders seem to have a special impact on the genesis of autistic disorder and need to be thoroughly examined in each child with autistic disorder.

Adolescent↗

PubMed2004

Videoconferencing in child and adolescent telepsychiatry: a systematic review of the literature.

A systematic review of child and adolescent telepsychiatry was conducted. It was based on a search of the electronic databases MEDLINE and PsycINFO covering the period 1966 to June 2003. Studies were selected for review if they concerned videoconferencing for patient care or consultation, evaluated a clinical service or education, or assessed satisfaction with videoconferences. Twenty-seven articles were identified that fulfilled the selection criteria. These comprised two reports of randomized controlled experiments, 10 of descriptive questionnaire studies or observational surveys, seven case studies and eight other reports. Only three of the studies presented some calculations of cost-effectiveness. When classified by 'Quality of Evidence' criteria, only two studies were in category I (the highest), one was in II-2 and the rest fell into category III (the lowest). Most studies of child and adolescent telepsychiatry examined satisfaction with videoconferencing or described programmes or care regimens. Videoconferencing seemed to improve the accessibility of services and served an educational function. Some papers also mentioned savings in time, costs and travel. Problems with non-verbal communication and the audiovisual quality of the videoconference were mentioned as drawbacks. Telepsychiatry therefore seems to offer several benefits, at least in sparsely populated regions. Well designed and properly controlled trials are required to evaluate the clinical value of this promising method in child psychiatry, where there is a constantly increasing need for services.

Adolescent↗

PubMed2003

Deficient auditory processing in children with Asperger Syndrome, as indexed by event-related potentials.

Asperger Syndrome (AS) is characterized by normal language development but deficient understanding and use of the intonation and prosody of speech. While individuals with AS report difficulties in auditory perception, there are no studies addressing auditory processing at the sensory level. In this study, event-related potentials (ERP) were recorded for syllables and tones in children with AS and in their control counterparts. Children with AS displayed abnormalities in transient sound-feature encoding, as indexed by the obligatory ERPs, and in sound discrimination, as indexed by the mismatch negativity. These deficits were more severe for the tone stimuli than for the syllables. These results indicate that auditory sensory processing is deficient in children with AS, and that these deficits might be implicated in the perceptual problems encountered by children with AS.

Acoustic Stimulation↗

PubMed2003

Traumatic injuries of children and adolescents--are they associated with psychiatric contacts?

Our aim was to investigate whether a large number of hospital visits by children and adolescents because of injuries are associated with psychiatric treatments and subsequent suicides. We examined the case records of 250 randomly chosen patients, 156 (62%) boys and 94 (38%) girls, out of 2306 outpatients who were 0-16 years old and had been treated because of traumatic injuries in Oulu University Hospital in 1984 and were alive in 1997. Boys with seven or more accidents had had psychiatric treatments more commonly than did boys with fewer accidents (39% vs. 8%). In addition, the case records of the patients who had died before the end of 1997 out of the 2306 patients were examined. Twenty-one (0.9%) patients (20 males and one female) had died, and seven (0.3%) of them had committed suicide. The traumatically injured male patients had a twofold suicide rate compared to the national average. The researchers also re-coded the causes of death from the death certificates. There seems to be a tendency to interpret adolescent suicides as accidental, as one of the seven registered suicides (14%), but six of the seven re-coded suicides (86%) had occurred before the age of 20.

Accidents, Traffic↗

PubMed2003

Maternal smoking and hyperactivity in 8-year-old children.

OBJECTIVE: To investigate the association between maternal smoking during pregnancy and hyperactivity in 8-year-old children. METHOD: The study population consisted of children from the Northern Finland 1985/86 Birth Cohort. At 8-year follow-up 9,357 children were alive. Mothers provided information both during pregnancy and at age 8. Teachers assessed children's behavior by the Children's Behavior Questionnaire (Rutter B2). Unadjusted analyses and stratification were used to study associations and confounding variables. A multivariate logistic regression model was fitted to assess the independent association between smoking and outcome. RESULTS: Maternal smoking was associated with hyperactivity even after adjustment for sex, family structure, socioeconomic status, maternal age, and maternal alcohol use (odds ratio 1.30; 1.08-1.58). The association was particularly notable among children of young mothers with low social standing. A positive dose-response relationship was seen between maternal smoking and hyperactivity. CONCLUSION: This study, the largest population-based prospective follow-up on fetal nicotine exposure and later behavioral disorders, confirms earlier descriptions of the link between maternal smoking during gestation and childhood hyperactivity. Discontinuation or decreased use of cigarettes during pregnancy might improve behavioral outcome of children.

Adult↗

PubMed2003

Maternal lifestyle factors in pregnancy risk of attention deficit hyperactivity disorder and associated behaviors: review of the current evidence.

OBJECTIVE: The purpose of this review was to examine the literature assessing the relationship between prenatal exposure to nicotine, alcohol, caffeine, and psychosocial stress during pregnancy to the risk of developing behavioral problems related to attention deficit hyperactivity disorder (ADHD) in childhood. METHOD: PubMed, MEDLINE, EMBASE, and PsycINFO were searched systematically. Studies using DSM diagnostic criteria and other validated diagnostic or screening instruments for ADHD and those examining ADHD symptoms were included. A narrative approach was used because the studies differed too much in methods and data sources to permit a quantitative meta-analysis. RESULTS: Twenty-four studies on nicotine (tobacco smoking), nine on alcohol, one on caffeine, and five on psychosocial stress were identified. All were published between 1973 and 2002. In spite of inconsistencies, the studies on nicotine indicated a greater risk of ADHD-related disorders among children whose mothers smoked during pregnancy. Contradictory findings were reported in the alcohol studies, and no conclusion could be reached on the basis of the caffeine study. Results from studies on psychological stress during pregnancy were inconsistent but indicated a possible modest contribution to ADHD symptoms in the offspring. Many studies suffered from methodological shortcomings, such as recall bias, crude or inaccurate exposure assessments, low statistical power, and lack of or insufficient control of confounders. A general lack of information on familial psychopathology also limited the interpretations. CONCLUSIONS: Exposure to tobacco smoke in utero is suspected to be associated with ADHD and ADHD symptoms in children. Other maternal lifestyle factors during pregnancy may also be associated with these disorders. Further studies are needed to reach conclusions.

Adolescent↗

PubMed2003

Inter-twin relationships and mental health.

We evaluated dominance-submissiveness between co-twins and its relationship to mental health in a cohort study of 419 twins followed from pregnancy to 22-30 years of age. Dominance-submissiveness between co-twins was assessed from three separate perspectives: physical dominance, psychological dominance, and verbal dominance. Depressive, nervous, and psychosomatic symptoms were analyzed in different twin groups. In the physical domain, males were more commonly dominant than females at school age and in adulthood. Before and at school age, girls were more dominant than boys in the psychological and verbal domains, as well as in total dominance. These differences disappeared in adulthood, and 81% of adult twins felt themselves equal to their co-twin in total dominance. Submissiveness in the psychological domain seemed to be associated with increased depressiveness, nervous complaints and psychosomatic symptoms in males of male-female twin pairs. Verbally submissive males in same-sex twin pairs had more depression and psychosomatic symptoms. Among females of same-sex twin pairs, submissiveness in the psychological domain was most clearly associated with depressive symptoms, whereas psychological or verbal dominance-submissiveness among females from male-female twin pairs was not associated with symptoms. Psychologically dominant males and females of same-sex twin pairs expressed greater nervousness than did their co-twins. We conclude that being submissive, especially in the psychological domain, to a female twin partner seems to be stressful, whereas it is easier, especially for females, to be submissive to a male twin partner.

Adult↗

PubMed2002

Effects of family interaction on the child's behavior in single-parent or reconstructed families.

The effects of the family interaction on children's behavior were studied in single-parent or reconstructed families (N = 63) in a white population in Finland. The focus was on the spousal and the parent-child interaction. Teachers assessed children's behavior and parents were interviewed. The interviews were analyzed qualitatively using the grounded-theory method. The boundary ambiguity theory developed by Pauline Boss was used to examine the interaction in the families. About two fifths of the parents reported that their spousal interaction was good, family boundaries were clear, and the children were taken care of together. Another two fifths interacted only because of the child and family boundaries were ambiguous. In 14 families the involvement of the noncustodial parent was both physically and psychologically low. The physically close but psychologically distant parent-child interaction seemed to affect the child's behavior detrimentally, whereas children with physically and psychologically close interaction with their parents showed less behavioral problems. The children with behavioral problems were more likely to have problems with both parents. They were also more likely to have a stepparent with whom they had conflicts. In conclusion, a good interaction between the parents and clarified family boundaries protect children's mental health after their parents' divorce or separation.

Adaptation, Psychological↗

PubMed2002

Some aspects of treatment and habilitation of children and adolescents with autistic disorder in Northern-Finland.

Hospital records and data on the treatment/habilitation status of 187 children with autism aged 3-18 years were gathered from Northern Finland. The treatment programs and therapies varied, depending on the trained staff available. One-hundred and fifty-two (82.9%) children and adolescents with autism received more than one therapeutic intervention or specific training program. The most common therapies were physiotherapy as well as speech, occupational and music therapy. 43.9% of the children and adolescents with autism received specific training according to TEACCH (Treatment and Education of Autistic and related Communication-Handicapped Children), 10.2% according to Lovaas and 30.5% according to the Portage program. Antiepileptic medication had been prescribed to 23.9% and psychopharmacological interventions to 14.9% of the individuals with autistic disorder (AD). One hundred and seventy-eight subjects out of 187 showed some improvement on the Childhood Autism Rating Scale (CARS), even if no statistically significant difference was found between the outcome of the available habilitation methods.

Adolescent↗

PubMed2002

Psychiatric disorders of children and adolescents--a growing problem at school.

The purpose is to present the views of comprehensive school and senior secondary school teachers working in the Oulu province in Northern Finland concerning the behavioural and emotional disorders of their pupils, the actions taken by teachers to refer pupils for consultation, and the functionality of mental health services. The data were collected by questionnaires in 1998 and 2000. According to the teachers' estimates, the behavioural and emotional disorders of pupils have both increased in number and become more severe at all levels of primary and secondary education. The teachers of comprehensive schools and special schools mostly contacted the parents when a pupil was found to have psychiatric symptoms. At the early stages of referral the teachers often also consulted with the pupil welfare team for support. The teachers of senior secondary schools contacted primarily the school nurse and secondarily the parents. Teachers were content with the psychiatric health care services if their pupils benefited from them, but the availability of services and the flow of information were problems. It was also difficult to decide when to refer a pupil for consultation and treatment. The responsibilities and obligations for the availability and functionality of mental health services for children and adolescents were re-defined and specified in a statute enforced as of January 2001. The question is how can we convert responsibilities and obligations into practical action?

Adolescent↗