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Loneliness has previously been linked to cognitive and attentional bias, and such biases may have a detrimental impact on perceived scholastic self-beliefs. Little is known about the relationship in school-aged adolescents. The current study examined the association between loneliness and scholastic self-beliefs in a nationally representative Danish sample of adolescents (aged 11-, 13- and 15 years, n = 3815, collected in 2014 by the Health Behaviour in School-aged Children study (HBSC)). Through binary logistic regressions, results demonstrated that higher levels of loneliness, measured by a single item and a composite score, were associated with poorer self-reported achievement perception, higher feelings of school dissatisfaction, and greater feelings of school pressure. Results also suggested gender played a moderating role. The current study highlights the importance of loneliness for scholastic self-beliefs, and provides a novel insight by utilising distinct loneliness measures. The implications, in relation to research and practise, are discussed.

Purpose: To investigate ophthalmic onset manifestations and the impact of diagnostic delay on the prognosis in infants (<1 year) diagnosed with a brain tumour. Methods: A retrospective population‐based nationwide study of infants diagnosed with a brain tumour between 2007 and 2017 in Denmark. Data was retrieved from the Danish Childhood Cancer Registry, the National Danish Health registries, and medical files. Primary outcome measures included symptoms, clinical findings, time to diagnosis and survival. Results: Thirty‐seven infants were diagnosed with a brain tumour in Denmark between 2007 and 2017. In total, 19/37 infants (51%, 95% CI: 34–68) had ophthalmic manifestations at any time prior to or at diagnosis; and in 6/37 (16%, 95% CI: 6–32) ophthalmic manifestations were the initial symptom. The most common ophthalmic manifestations were strabismus (n = 7), sunset eyes (n = 6), nystagmus (n = 4), reduced pupillary light reflex (n = 4), and/or decreased vision (n = 4). The median number of symptoms per infant at the time of diagnosis was three (range 0–9). The median diagnostic delay was 26 days (range 0–283, IQR: 6;90). 5‐year survival rate was 75% (95% CI: 61–90) and all children with diagnostic delay > 100 days (n = 9, 24%) were still alive at the end of follow‐up (median 6.3 years, range 2.2–10.2). Conclusion: We provide an overview of symptoms and clinical signs in a nation‐wide series of infants with CNS tumours and demonstrate that ophthalmic manifestations are frequently observed in infants prior to diagnosis, but, often in combination with other clinical signs. The diagnostic delay was substantial for a large part of the infants, but this was not associated with increased mortality. [ABSTRACT FROM AUTHOR]

Purpose: Within the framework of Health Promoting Schools "Up" is an intervention using a whole school approach aimed at promoting mental health by strengthening social and emotional competence among schoolchildren. Social and emotional competence is an integral part of many school-based mental health interventions but only a minority of interventions measure changes in competences. The purpose of this paper is to present the intervention "Up" and document changes in social and emotional competence among schoolchildren before and after the intervention. Design/methodology/approach: "Up" consists of four components: education and activities for schoolchildren; development of staff skills; involvement of parents; and initiatives in everyday life at school. "Up" was implemented in two Danish schools in 2010-2011. Social and emotional competence was measured among 11-15-year old schoolchildren before (response rate 96.2 per cent, n = 589) and after (response rate 83.9 per cent, n = 532) the intervention. Findings: Changes in level of social competence were assessed by the prevalence of a high level of social and emotional competence before (33.3 per cent) and after (40.8 per cent) the intervention (p-value = 0.01). Research limitations/implications: "Up" provides valuable experiences for adapting evidence-based mental health promotion to the Danish school system which is characterized by democracy, autonomy and inclusion. Future research should study the implementation and effect of "Up" in larger scale studies. Practical implications: The comprehensive description of "Up" serves as important information for policymakers and practitioners working with mental health promotion. Originality/value: The whole school approach intervention "Up" has the potential to promote social and emotional competence and reduce socioeconomic differences in social and emotional competence among schoolchildren.

Objective: To examine if students who re-visit the school nurse use medicines differently than other students when exposed to aches and psychological problems. Methods: The study includes all 11-, 13- and 15-year-old students from a random sample of schools in Denmark, response rate 87 per cent, n = 5,205. The data collection followed the internationally standardized HBSC questionnaire. This study includes an item about students' re-visits to the school nurse, items about frequency of four complaints (headache, stomach-ache, difficulties in getting to sleep, and nervousness) and medicine use in the past month for these four complaints. Results: In total, 8.6 per cent of the students had re-visited the school nurse. There was a strong and graded association between frequency of complaints and medicine use for the relevant complaint. Students who re-visited the school nurse had higher odds for medicine use than other students. The association between frequency of complaints and medicine use was stronger among students who had not re-visited the school nurse as compared to the students who had re-visited the school nurse. One example is the OR (95 per cent CI) for medicine use for headache among students who experienced headache monthly vs. seldom/never and at least weekly vs. seldom/never. Among students who did not re-visit the school nurse, the OR estimates were 5.32 (4.61-6.14) and 13.6 (10.5-17.6) and among students who did, OR estimates were 3.65 (2.32-5.75) and 7.07 (3.58-14.0). Conclusion: The school nurse may reduce the students' proneness to use medicine when they experience complaints. (Contains 3 tables and 1 figure.)

There is little information available on the topic of poor school satisfaction as a risk factor for cannabis use among adolescents. We examined if there was an association between poor school satisfaction, school class cannabis use and individual cannabis use. Further, we investigated if many cannabis users within the school class statistically interacted with poor school satisfaction upon the association with individual cannabis use. A cross-sectional study of 1317 Danish 15-year-olds in 95 school classes in a random sample of schools. The exposure variables were school satisfaction and school class cannabis use. The criterion variable was individual cannabis use, three times or more (last 12 months). Poor school satisfaction (OR 2.78, 95% CL = 1.83-4.23), attending a school class with greater than 2 cannabis users (OR 3.68, 95% CL = 2.21-6.12) were associated with cannabis use. In our study there was not a significant statistically interaction between number of cannabis users in school classes and poor school satisfaction upon individual cannabis use (p = 0.183). We found that poor school satisfaction and school class cannabis use where both associated with higher individual cannabis use. The risk factors did not significantly interact and may suggest that they function as individual exposure factors towards adolescent cannabis use. (Contains 2 tables.)

Background: School health services are important tools for health promotion among schoolchildren, but little is known about their effects. This article addresses the effects of dialogues with school health nurses among schoolchildren who were victims of bullying. Study population and methods: Cross-sectional and school-based survey, the Danish contribution to the international Health Behaviour in School-aged Children (HBSC) study. The study included all students in the fifth, seventh, and ninth grade (11, 13, and 15 year olds) in a random sample of schools. The participation rate was 98 per cent of the students present on the day of data collection and 88 per cent of the enrolled students, n = 5205. Measurements: Bullying was measured as recommended by Olweus. Outcome of the dialogue with the school health nurse was measured as self-reports of five responses: (1) reflected on the dialogue, (2) discussed the content with parents, (3) followed the advice from the school health nurse, (4) did what he (she) himself (herself) thought was best, and (5) visited the school health nurse again. Results: All outcome measures were more prevalent among students who were victims of bullying. The most pronounced association was that the odds ratio for visiting the school health nurse again was 1.8 (95 per cent CI 1.3-2.5) for students who were bullied at least weekly. Conclusion: Schoolchildren who are victims of bullying benefit from health dialogues with the school health nurse. (Contains 2 tables.)

Background: Underweight among adolescents is an important clinical and public health issue. It is associated with adverse health outcomes throughout the life-span and may reflect food poverty, unhealthy eating habits, or some underlying health conditions.Objective: To study prevalence and trends in underweight among adolescents 1998-2018, to examine social inequality in underweight, and whether social inequality changed over time.Methods: Data were derived from 6 cross-sectional school surveys from The Health Behaviour in School-aged Children study in Denmark. The study included 11-, 13-, and 15-year-old schoolchildren in random samples of schools in 1998, 2002, 2006, 2010, 2014, and 2018 (n = 22,177). Underweight was determined by body mass index-for-age thinness grade 2-3 (the Cole and Lobstein method). Socioeconomic status was determined using occupational social class (the Danish OSC Measurement).Results: The overall prevalence of underweight was 3.1% among boys and 5.3% among girls (P < 0.0001) and decreased by age (P < 0.0001) among both boys and girls. The prevalence of underweight was almost stable from 1998 to 2018. There was no observed absolute or relative social inequality in the prevalence of underweight among boys or girls.Conclusion: The prevalence of underweight in 11- to 15-year-olds was significantly higher among girls than boys. The prevalence remained stable from 1998 to 2018. There was no significant association between SES and prevalence of underweight. It is important to elucidate the underlying causes of underweight such as malnutrition, eating disorders, eating problems, loss of appetite, chronic diseases, insufficient knowledge of nutrients effects on bodily functions, and persistent pain. [ABSTRACT FROM AUTHOR]

Background: Some studies suggest that favourable socioeconomic circumstances are associated with better parent–child relations but the documentation of such an association is limited and inconsistent. Few studies focused on infancy, few studies relied on objective measurement of parent–infant relations, and few studies included more than one measurement of parent–infant relations in the first year of life. Aims: To report the prevalence of objectively measured problems in parent–infant relations during the first year of life and to examine the association between socioeconomic circumstances and parent–infant relations in an unselected community sample of infants. Methods: Cross-sectional study of a community sample of children from birth to 10 months in 15 municipalities in Denmark, n = 11,765. The exposure variables were population register data about socioeconomic circumstances: (a) parents' education, (b) family composition, (c) parents' origin, and (d) parents' occupational status. The outcome variable was the health visitor's concerns about the parent–infant relation assessed at four home visits from birth to 10 months after delivery. Results: The proportion of children with concerns about the parent–infant relation was 10.5%, 7.8% at one home visit and 2.8% at two or more home visits. Logistic regression analyses showed that all four indicators of socioeconomic circumstances were associated with concerns about the parent–infant relation in the first year of life. Conclusions : The risk of problematic parent–infant relations were significantly elevated among, children of immigrant parents, and children of parents with shorter education and not in education or work. [ABSTRACT FROM AUTHOR]

Chronic backpain among adolescents is important because the prevalence is high, above 10%, and more than 10% of all adolescents experience impacts on important day-to-day activities. Chronic backpain tracks into adulthood and is associated with several health problems. The objective was to study trends in the prevalence of chronic backpain among adolescents 1991–2018, to examine the association with socioeconomic status (SES), and whether this association changed over time. The study used data from eight comparable cross-sectional school surveys of nationally representative samples of 11–15-year-olds in 1991, 1994, 1998, 2002, 2006, 2010, 2014, and 2018, which constitute the Danish arm of the international Health Behaviour in School-aged Children (HBSC) study. The participation rate was 74.6% of the eligible study population, n = 29,952. Chronic backpain was defined as self-reported backpain daily or several days a week during the last 6 months. The prevalence of chronic backpain was 11.1%, significantly increasing from 8.9% in 1991 to 11.7% in 2018. The OR for chronic backpain was 1.20 (95% CI: 1.10–1.31) in middle, and 1.56 (95% CI: 1.41–1.73) in low compared to high SES. Sensitivity analyses with two other cut-points for backpain frequency showed similar associations. Conclusion: Chronic backpain is common among adolescents and the prevalence increased from 1991 to 2018. The prevalence was highest in lower SES families. We recommend increased efforts to prevent chronic backpain. What is Known: • Chronic backpain among adolescents is common, has a high burden of disability, is associated with several health problems, and tracks into adulthood. What is New: • The prevalence of chronic backpain among adolescents in Denmark increased from 8.9% in 1991 to 11.7% in 2018. • The prevalence was highest among adolescents from lower SES families. [ABSTRACT FROM AUTHOR]

Background Mental disorder in childhood is an important public health issue. We aimed to examine the prospective association between parental education at childbirth and diagnosed mental disorders in young children and explore whether this association was mediated or modified by parent–child relations in infancy. Methods Prospective cohort study of all newborn was from 2002 to 2010 from 16 municipalities in the capital region of Copenhagen, Denmark, with follow-up until their 8th birthday, N  = 40 762. Baseline data included information from national population registers and from health visitors' records at child aged 0 to 10 months. Outcome variable: any mental disorder diagnosed at hospital from age 11 months to 8 years. Results Low parental education was predictive of diagnosed child mental disorder, adjusted odds ratio (AOR) = 1.83 (95% CI 1.49–2.23). Problematic parent–child relation at age 8–10 months was also predictive of mental disorder, AOR = 2.06 (1.57–2.70) but did not mediate the association between parental education and mental disorder. AOR for mental disorders was 3.24 (2.03–5.16 for the combination vocational training and problematic parent–child relation and 2.49 (1.42–4.38) for the combination primary school and problematic parent–child relation. Conclusions Low parental education and problematic parent–child relation were independent risk factors for diagnosed mental disorders in the age span of 11 months to 8 years. [ABSTRACT FROM AUTHOR]

Aims: We examined the relationship between loneliness and health among young adolescents. We also investigated the validity of a single-item measure of loneliness by comparing this to a composite score. Methods: The current data come from a nationally representative sample of 11- to 15-year-old adolescents (N =3305; F =52%) from Denmark collected in 2014 as part of the Health Behaviour in School-aged Children (HBSC) collaborative cross-national survey. Results: A series of binary logistic regressions showed that higher loneliness among adolescents, whether measured using the single- or multi-item measurement, was associated with poorer self-rated health, higher frequency of headache, stomach ache, backache, difficulties sleeping, greater sleep disturbance and more instances of feeling tired in the morning. Those associations were relatively consistent across sex and age groups. Conclusions: Loneliness is associated with poorer self-reported health and sleep problems among young adolescents. Those findings are similar across two measures of loneliness, suggesting robust findings. The development of interventions and health-education efforts to fight loneliness in adolescence is important. [ABSTRACT FROM AUTHOR]

Aim: To examine trends in socioeconomic differences in daily smoking among 15-year-old Danes between 1991–2014, using occupational social class as indicator of socioeconomic status. Methods : The study included 15-year-olds participating in seven Danish Health Behaviour in School-aged Children studies between 1991–2014, n = 8,641. The analyses focused on absolute socioeconomic differences (prevalence difference between low and high occupational social class) and relative socioeconomic differences communicated by odds ratio for daily smoking. Results : The prevalence of daily smoking declined from 18.6% in 1991 to 4.5% in 2014. Across all surveys, the prevalence was 8.9% in high, 12.8% in middle and 16.5% in low occupational social classes (p < 0.0001). The absolute socioeconomic differences increased from 1991 to 2006 and declined thereafter. Across all survey years, the odds ratio (95% confidence interval) for daily smoking was 1.40 (1.19–1.65) in middle and 1.90 (1.56-2.32) in low versus high occupational social classes. The statistical interaction between occupational social class and survey year was significant (p = 0.0404), suggesting increasing relative socioeconomic differences from 1991 to 2014. Conclusions : There was a substantial decline in daily smoking among 15-year-olds between 1991–2014 in all occupational social class groups. The prevalence of daily smoking was highest in the low occupational social class during the entire period. The absolute socioeconomic differences in daily smoking increased between 1991–2006 and declined thereafter. The relative socioeconomic differences increased over 1991–2014. Studies of change in socioeconomic differences over time should address both absolute and relative socioeconomic differences as they may result in different conclusions and because important improvement in prevalence patterns may be disguised by exclusive focus on changes in relative socioeconomic differences. [ABSTRACT FROM AUTHOR]

Objective: To examine the trend in social inequality in low intake of vegetables among adolescents in Denmark from 2002 to 2014 using occupational social class (OSC) as socio-economic indicator.Design: Repeated cross-sectional school surveys including four waves of data collection in 2002-2014. The analyses focused on absolute social inequality (difference between high and low OSC in low vegetable intake) as well as relative social inequality (OR for low vegetable intake by OSC).Setting: The nationally representative Health Behaviour in School-aged Children (HBSC) study in Denmark.Subjects: The study population was 11-15-year olds (n 17 243).Results: Low intake of vegetables was defined as less than weekly intake measured by food frequency items. OSC was measured by student reports of parents' occupation. The proportion of participants who reported eating vegetables less than once weekly was 8·9 %, with a notable decrease from 11·9 % in 2002 to 5·9 % in 2014. The OR (95 % CI) for less than weekly vegetable intake was 2·28 (1·98, 2·63) in the middle compared with high OSC and 3·12 (2·67, 3·66) in the low compared with high OSC. The absolute social inequality in low vegetable intake decreased from 2002 to 2014 but the relative social inequality remained unchanged.Conclusions: The study underscores that it is important to address socio-economic factors in future efforts to promote vegetable intake among adolescents. The statistical analyses of social inequality in vegetable intake demonstrate that it is important to address both absolute and relative social inequality as these two phenomena may develop differently. [ABSTRACT FROM AUTHOR]

Aims: The aims of this study were: (a) to examine trends in daily emotional symptoms among 11- to 15-year-olds from 1991 to 2014 in Denmark, and (b) to examine trends in social inequality in daily emotional symptoms, that is, whether the differences in prevalence between adolescents with parents of varying occupational social class changed over time. Methods: We combined seven comparable cross-sectional Health Behaviour in School-aged Children surveys (N =31,169). Daily emotional symptoms were measured by the HBSC Symptom Check List and occupational social class (OSC) by students' reports about parents' occupation. We calculated absolute (per cent) differences in emotional symptoms between high and low OSC and relative differences by odds ratio for emotional symptoms by parents' OSC. Results: Eight per cent reported at least one daily emotional symptoms, with an increasing trend from 1991 to 2014 (p <0.001). The prevalence in high, middle and low OSC was 6.2%, 7.4% and 10.6% (p <0.0001). From 1991 to 2014, there was an increase in the prevalence of daily emotional symptoms in high (p <0.0001) and middle (p <0.0001) but not low OSC (p =0.4404). This resulted in a diminishing absolute social inequality in emotional symptoms. The statistical interaction between OSC and survey year was significant (p =0.0023) and suggests a diminishing relative social inequality in emotional symptoms from 1991 to 2014. Conclusions: There was an increasing prevalence of daily emotional symptoms from 1991 to 2014 and a diminishing social inequality in prevalence of daily emotional symptoms in terms of both absolute and relative social inequality. [ABSTRACT FROM AUTHOR]

Background Loneliness and social inequality in health are important public health concerns. We examined (i) trends in loneliness among adolescents from 1991 to 2014 in Denmark and (ii) trends in social inequality in loneliness. Methods Study population: 11–15-year olds in random samples of schools in 1991, 1994, 1998, 2006 and 2014, n = 19 096. Loneliness was measured by a single item and social background by parents' occupational social class (OSC). We calculated absolute (%) differences in loneliness between high and low OSC and relative differences by odds ratio for loneliness. Results Across all surveys, 6.3% reported feeling lonely. The prevalence increased from 4.4% in 1991 to 7.2% in 2014. The prevalence of loneliness in high, middle and low OSC was 5.8, 5.9 and 8.0%. The increase in loneliness was more pronounced in higher than lower OSC, resulting in a decreasing absolute social inequality in loneliness. The statistical interaction between OSC and survey year was significant, P = 0.0176, i.e. the relative social inequality in loneliness also decreased from 1991 to 2014. Conclusion The prevalence of loneliness increased from 1991 to 2014. The social inequality in loneliness decreased in both absolute and relative terms because of a rising prevalence of loneliness among children from high OSC. [ABSTRACT FROM AUTHOR]

Objective: To compare matrix metalloproteinase (MMP)-9 and the antiproteinase tissue inhibitor of metalloproteinases (TIMP)-1 in wound fluids and sera from patients with chronic non-healing or acute healing wounds. In addition, the functional consequences on MMP-9 activity and general gelatinase activity were assessed. Method: In this observational study, samples were collected from patients with venous leg ulcers (VLUs), patients with type 2 diabetes with neuropathic foot ulcers (DFUs), and from another cohort of VLU patients with sterile split-thickness skin graft donor sites after autologous skin grafting, serving as healing control wounds. MMP-9 and TIMP-1 concentrations were determined by enzyme-linked immunosorbent assays. MMP-9 and gelatinase activities were determined in wound fluids in subsets of the patients. Results: A total of 24 patients took part in the study. No significant differences in MMP-9 wound fluid levels were found among the three groups. TIMP-1 levels were markedly and significantly lower in the two chronic wound groups resulting in a severely unbalanced MMP-9/TIMP-1 ratio, especially notable in the VLU group and possibly in the elevated endogenous MMP-9 activity (p<0.01) compared with the acute wound fluids. At least 20% of the chronic wound fluids displayed atypical patterns on gelatin zymography and showed high general gelatinase activity that was not inhibited by either TIMP-1 or by a gelatinase inhibitor (AG3340). MMP-9 levels were higher in the sera of the patients with type 2 diabetes. Conclusion: We hypothesise that non-MMP proteinases contribute to matrix destruction in a significant number of chronic wounds. Blocking the excessive MMP-9 activity may be insufficient to normalise wound healing. The reasons and effects of the very low TIMP-1 levels in chronic wounds need further clarification. [ABSTRACT FROM AUTHOR]

Background: The association between socio-economic status (SES) and headache among adolescents is an understudied issue, and no study has examined whether such an association changes over time. The aim was to examine trends in socio-economic inequality in frequent headache among 11- to 15-year-olds in Denmark from 1991 to 2014, using occupational social class (OSC) as indicator of SES.Methods: The study applies data from the Danish part of the international Health Behaviour in School-aged Children (HBSC) study. HBSC includes nationally representative samples of 11-, 13- and 15-year-olds. This study combines data from seven data survey years from 1991 to 2014, participation rate 88.6%, n = 31,102. We report absolute inequality as per cent difference in frequent headache between high and low OSC and relative inequality as odds ratio for frequent headache by OSC.Results: In the entire study population, 10.4% reported frequent headache. There was a significant increase in frequent headache from 8.0% in 1991 to 12.9% in 2014, test for trend, p < 0.0001. This increasing trend was significant in all OSCs. The prevalence of frequent headache was significantly higher in low than high OSC, OR = 1.50 (95% CI: 1.34-1.67). This socio-economic inequality in frequent headache was persistent from 1991 to 2014.Conclusion: There was a significant and persistent socio-economic inequality, i.e. increasing prevalence of frequent headache with decreasing OSC. The association between socio-economic position and headache did not significantly change over time, i.e. the statistical interaction between OSC and survey year was insignificant.Significance: The prevalence of frequent headache among adolescents increases with decreasing SES. This socio-economic inequality has been persistent among adolescents in Denmark from 1991 to 2014. Clinicians should be aware of this social inequality. [ABSTRACT FROM AUTHOR]

More children from lower social backgrounds are physically inactive than those from higher ones. We studied whether bullying was a mediating factor between lower social background and physical inactivity. We also examined the combined effect of low social class and exposure to bullying on physical inactivity. The Danish sample of the Health Behaviour in School-aged Children ( HBSC) study 2006 included 6269 schoolchildren in three age groups: 11-, 13-, and 15-year-olds from a random sample of 80 schools. The students answered the internationally standardized HBSC questionnaire. The applied definition leaves 4.0% in the category physically inactive. The sex and age-adjusted OR (95% CI) for physical inactivity was 2.10 (1.39-3.18) among students with low social class and unclassifiable 3.53 (2.26-5.53). Exposure to bullying was associated with physical inactivity, sex and age-adjusted OR = 2.39 (1.67-3.41). Exposure to bullying did not explain the association between social class and physical inactivity. The association between social class and physical inactivity was more pronounced among participants also exposed to bullying. In conclusion, there was a significantly increased odds ratio for physical inactivity among students from lower social classes and for students exposed to bullying. There was a combined effect of low social class and bullying on physical inactivity. [ABSTRACT FROM AUTHOR]

Migration is an increasing worldwide phenomenon that creates multicultural societies with a growing number of adolescents who have experienced a process of migration or who have an ethnic background other than that of the majority. Migration may lead to loss of social relations and create challenges related to acculturation in the new country. These experiences may induce feelings of loneliness. Research on ethnic and migrant disparities in loneliness among adolescents is limited and inconsistent. The purpose of this study was to examine how adolescents’ immigration background and self-identified ethnicity are associated, independently and combined, with loneliness. We used data from the Danish 2010 Health Behaviour in School-aged Children survey which included a representative sample of 3083 13- and 15-year-olds. The results suggest that immigrants but not descendants of immigrants have an increased risk of loneliness compared to adolescents with a Danish origin. The results also suggest that adolescents’ self-identified ethnicity plays an essential role but differently for immigrants and descendants: identifying with the Danish majority was protective against loneliness among immigrants, whereas identifying with an ethnic minority group was protective against loneliness among descendants. [ABSTRACT FROM PUBLISHER]

The objectives of this study were (a) to examine the association between various kinds of parental social support and adolescents' physical activity ( PA) and (b) to examine whether various kinds of social support from mothers and fathers were differently associated with boys' and girls' PA. Data came from the Aarhus School Survey that included 2100 schoolchildren at 11, 13, and 15 years of age. Parental social support for PA was measured by items about encouragement to do PA, doing joint PA, parents watching PA, and talking about PA. PA was measured as at least 4 h of vigorous PA per week during leisure time. We used logistic regression analyses to estimate the associations for girls and boys separately, adjusted by age group, parents' occupational social class, family structure, and migration status. There were significant and graded associations between adolescents' PA and all four dimensions of parental support for PA. The association patterns were similar for mothers' and fathers' social support and similar for girls and boys. Social processes in the family are important for adolescents' participation in PA. It is important to continue to explore these social processes in order to understand why some adolescents are physically active and others are not. [ABSTRACT FROM AUTHOR]

Loneliness is a public health concern that increases the risk for several health, behavioral and academic problems among adolescents. Some studies have suggested that adolescents with an ethnic minority background have a higher risk for loneliness than adolescents from the majority population. The increasing numbers of migrant youth around the world mean growing numbers of heterogeneous school environments in many countries. Even though adolescents spend a substantial amount of time at school, there is currently very little non-U.S. research that has examined the importance of the ethnic composition of school classes for loneliness in adolescence. The present research aimed to address this gap by exploring the association between loneliness and three dimensions of the ethnic composition in the school class: (1) membership of ethnic majority in the school class, (2) the size of own ethnic group in the school class, and (3) the ethnic diversity of the school class. We used data from the Danish 2014 Health Behaviour in School-aged Children survey: a nationally representative sample of 4383 (51.2 % girls) 11-15-year-olds. Multilevel logistic regression analyses revealed that adolescents who did not belong to the ethnic majority in the school class had increased odds for loneliness compared to adolescents that belonged to the ethnic majority. Furthermore, having more same-ethnic classmates lowered the odds for loneliness. We did not find any statistically significant association between the ethnic diversity of the school classes and loneliness. The study adds novel and important findings to how ethnicity in a school class context, as opposed to ethnicity per se, influences adolescents' loneliness. [ABSTRACT FROM AUTHOR]

Objective: To investigate (i) associations between adolescents' frequency of breakfast and family functioning (close relations to parents, quality of family communication and family support) and (ii) if any observed associations between breakfast frequency and family functioning vary by sociodemographic factors. Design: School-based cross-sectional study. Students completed a web-based questionnaire. Associations were estimated by multilevel multivariate logistic regression. Setting: Danish arm of the Health Behaviour in School-aged Children study, 2014. Subjects: Adolescents aged 13 and 15 years (n 3054) from a random sample of forty-one schools. Results: Nearly one-quarter of the adolescents had low breakfast frequency. Low breakfast frequency was associated with low family functioning measured by three dimensions. The OR (95% CI) of low breakfast frequency was 1·81 (1·40, 2·33) for adolescents who reported no close relations to parents, 2·28 (1·61, 3·22) for adolescents who reported low level of quality of family communication and 2·09 (1·39, 3·15) for adolescents who reported low level of family support. Joint effect analyses suggested that the odds of low breakfast frequency among adolescents with low family functioning compared with high family functioning were highest among adolescents being girls, immigrants and living in other than a traditional family structure. Conclusions: Low breakfast frequency was associated with low family functioning measured by close relations to parents, quality of family communication and family support. Further, analyses suggested that the associations were more pronounced among girls, immigrants and adolescents from other family structure than traditional. The study highlights the importance of the family setting in promoting regular breakfast frequency among adolescents. [ABSTRACT FROM AUTHOR]

Objective: To investigate: (i) how lunch frequency of adolescents varies between schools and between classes within schools; (ii) the associations between frequency of lunch and individual sociodemographic factors and school characteristics; and (iii) if any observed associations between lunch frequency and school characteristics vary by gender and age groups.Design: Cross-sectional study in which students and school headmasters completed self-administered questionnaires. Associations were estimated by multilevel multivariate logistic regression.Setting: The Danish arm of the Health Behaviour in School-Aged Children study 2010.Subjects: Students (n 4922) aged 11, 13 and 15 years attending a random sample of seventy-three schools.Results: The school-level and class-level variations in low lunch frequency were small (intraclass correlation coefficient <2·1 %). At the individual level, low lunch frequency was most common among students who were boys, 13- and 15-year-olds, from medium and low family social class, descendants of immigrants, living in a single-parent family and in a reconstructed family. School-level analyses suggested that having access to a canteen at school was associated with low lunch frequency (OR=1·47; 95% CI 1·14, 1·89). Likewise not having an adult present during lunch breaks was associated with low lunch frequency (OR=1·44; 95% CI 1·18, 1·75). Cross-level interactions suggested that these associations differed by age group.Conclusions: Lunch frequency among Danish students appears to be largely influenced by sociodemographic factors. Additionally, the presence of an adult during lunch breaks promotes frequent lunch consumption while availability of a canteen may discourage frequent lunch consumption. These findings vary between older and younger students. [ABSTRACT FROM AUTHOR]

Objective: We examined associations between fast-food intake and perceived and objective fast-food outlet exposure.Design: Information from the Health Behaviours in School-aged Children Study was linked to fast-food outlets in seventy-five school neighbourhoods. We used multivariate multilevel logistic regression analyses to examine associations between at least weekly fast-food intake and perceived and objective fast-food outlet measures.Subjects: Data represent 4642 adolescents (aged 11-15 years) in Denmark.Results: Boys reporting two or more fast-food outlets had 34% higher odds consuming fast food at least weekly. We detected higher odds of at least weekly fast-food intake among 15-year-old 9th graders (ORall=1.74; 95% CI 1.40, 2.18; ORboys=2.20; 95% CI 1.66, 2.91; ORgirls=1.41; 95% CI 1.03, 1.92), Danish speakers (ORall=2.32; 95% CI 1.68, 3.19; ORboys=2.58; 95% CI 1.69, 3.93; ORgirls=2.37; 95% CI 1.46, 3.84) and those travelling 15 min or less to school (ORall=1.21; 95% CI 1.00, 1.46; ORgirls=1.44; 95% CI 1.08, 1.93) compared with 11-year-old 5th graders, non-Danish speakers and those with longer travel times. Boys from middle- (OR=1.28; 95% CI 1.00, 1.65) and girls from low-income families (OR=1.46; 95% CI 1.05, 2.04) had higher odds of at least weekly fast-food intake compared with those from high-income backgrounds. Girls attending schools with canteens (OR=1.47; 95% CI 1.00, 2.15) had higher odds of at least weekly fast-food intake than girls at schools without canteens.Conclusions: The present study demonstrates that perceived food outlets may impact fast-food intake in boys while proximity impacts intake in girls. Public health planning could target food environments that emphasize a better understanding of how adolescents use local resources. [ABSTRACT FROM AUTHOR]

This study examines whether social inequality in tooth brushing frequency among adolescents changed from 1991 to 2014. The data material was seven comparable cross-sectional studies of nationally representative samples of 11- to 15-year-olds in Denmark with data about frequency of tooth brushing and occupation of parents. The total number of participants was 31,464, of whom 21.7% brushed their teeth less than the recommended 2 times a day. The absolute social inequality measured as prevalence difference between low and high social class increased from 7.7% in 1991 to 14.6% in 2014. The relative social inequality assessed by odds ratios for infrequent tooth brushing also increased from 1991 to 2014. [ABSTRACT FROM AUTHOR]

The aim was to examine trends in social inequality in poor self-rated health (SRH) among adolescents in Denmark 1991–2014. The analysis included 18 996 11–15-year-old school children from the cross-sectional Health Behaviour in School-aged Children studies in 1991, 2002, 2006, 2010 and 2014. Across the five surveys, the prevalence of poor SRH was 14.2%, remaining almost unchanged from 1991 to 2014. The proportion with poor SRH was 12.2% in high, 14.3% in middle and 17.6% in low occupational social class. This social inequality in poor SRH was persistent during the entire study period, both in terms of absolute and relative social inequality. [ABSTRACT FROM AUTHOR]

Background: Large proportions of schoolchildren suffer from emotional symptoms and there are large variations across schools. It is unknown to what degree this variation is due to composition of schoolchildren in each school or to contextual factors. Objectives are to identify factors at individual, classroom and school levels associated with emotional symptoms. Method: Data stem from the Danish contribution to the international Health Behaviour in School-aged Children study 2010 including 4922 schoolchildren aged 11-15-years from a random sample of schools and including data from school leaders. Emotional symptoms are defined as daily presence of at least one of four symptoms: feeling low, irritable or bad tempered, nervous and having difficulties falling asleep. Multilevel multivariable logistic regression analyses are applied to identify and quantify factors at individual, classroom and school level. Results: Schoolchildren from low (odds ratio (OR) 1.70, 95% CI: 1.33-2.17) and medium (OR 1.50, 95% CI: 1.22-1.85) occupational social class (OSC), girls (OR 1.32, 95% CI: 1.13-1.56) and schoolchildren exposed to bullying (OR 3.82, 95% CI: 2.71-5.40), had increased odds for emotional symptoms. A negative classroom climate was associated with emotional symptoms (OR 1.29, 95% CI: 0.99-1.69) and so was being part of classrooms with a high prevalence of bullying (OR 1.28, 95% CI: 1.0-1.60). Conclusion: Female sex, low OSC, single parent family, exposure to bullying and a high prevalence of bullying within a class are all associated with emotional symptoms. Most variation across schools is explained by individual-level factors but psychosocial aspects of the classroom environment also play a role. [ABSTRACT FROM AUTHOR]

This study describes the secular trends in weekly intake of beer, wine, liquor, and drunkenness among 15-year-olds 1988-2010 (total N = 8,701), a period with several policy initiatives regarding alcohol in Denmark. Data from seven comparative and representative school surveys conducted in 1988, 1991, 1994, 1998, 2002, 2006, and 2010 were used. The proportion of 15-year-olds in Denmark who drank alcohol and were drunk increased from 1988 to 2002, but decreased substantially to 2010; for example, the proportion of 15-year-old girls who drank beer at least weekly increased from 15% in 1988 to 31% in 2002 and decreased to 7% in 2010. We hypothesize that age limits for purchasing alcohol may have resulted in a decrease in young people's alcohol use. [ABSTRACT FROM AUTHOR]

Background Investigations in several Western countries have reported ethnic differences in asthma prevalence and treatment among children and in some countries these differences are increasing. The aim of this study was to analyse whether there are inequalities in asthma treatment by country of birth and ancestry among children residing in Denmark, and whether this potential association may vary between different household income groups. Methods Data were obtained by linking the Danish Civil Registration System, the Central Taxpayers' Register and the Danish National Prescription Register. Population: the entire population of children in Denmark from 0 to 17 years of age in 2008 (n=1 209 091). Information on asthma treatment was obtained from the National Prescription Register. The analyses included multiple logistic regression models stratified by household income. Results Compared with ethnic Danes, immigrant children had the lowest OR for redeeming a prescription for asthma medication, both relief (OR 0.37; 95% CIs, 0.20 to 0.68) and preventive (OR 0.37; (0.22 to 0.59)). Similar associations were found among descendant children (OR for relief treatment 0.82 (0.79 to 0.89) and for preventive treatment 0.68 (0.61 to 0.75)). The pattern of the association remained after stratifying for household income. Conclusions We found that, inequalities that cannot be explained by household income alone exist in treatments to prevent asthma as well as to relieve symptoms in children residing in Denmark, by country of birth and ancestry. The difference between immigrants and descendants may indicate that unfamiliarity with the Danish healthcare system is a contributory cause of the inadequate treatment of asthma. [ABSTRACT FROM AUTHOR]

Aims To determine the prevalence of foot ulcers and the incidence of amputations in patients with Type 2 diabetes observed for 19 years after diagnosis. We investigated the role of gender, age and co-morbidities. Methods From the Diabetes Care in General Practice study, 1381 patients were included and examined at diabetes diagnosis, at 6 years and at 14 years after diagnosis. Register-based follow-up was for 19 years. Foot ulcers and amputations were related to gender, age and co-morbidities by odds and hazard ratios from logistic and Cox regression models, respectively. Results The incidence of any amputation and major amputation was 400 (95% CI 307-512) and 279 (95% CI 203-375) per 100 000 patient-years, respectively. At the three observation points, the foot ulcer prevalences were 2.76% (95% CI 1.89-3.63), 2.93% (95% CI 1.86-4.00) and 4.96% (95% CI 3.10-6.82). Multivariate analyses showed associations between foot ulcers and peripheral neuropathy, peripheral arterial disease, male gender, retinopathy and myocardial infarction. After multivariate adjustment, significant predictors (hazard ratio; 95% CI) of any amputation were peripheral neuropathy (hazard ratio 2.09; 95% CI 1.19-3.69), peripheral arterial disease (hazard ratio 3.43; 95% CI 1.65-7.12), microalbuminuria (hazard ratio 2.11; 95% CI 1.21-3.67), retinopathy (hazard ratio 6.42; 95% CI 2.59-15.90), impaired vision (hazard ratio 6.92; 95% CI 2.35-20.38) and male gender (hazard ratio 2.40; 95% CI 1.31-4.41). For women, the risk of amputation increased with age, but for men the risk was higher when diagnosed with diabetes at a younger age. Conclusions Despite improved treatment regimens, the incidence of amputations is still high in this population-based patient sample. Men diagnosed with diabetes before age 65 years and patients with diabetes-related co-morbidities are at particularly high risk of foot ulcers and amputations. [ABSTRACT FROM AUTHOR]

Background: Health and risk behaviours tend to be maintained from adolescence into adulthood. There is little knowledge on whether meal frequencies in adolescence are maintained into adulthood. We investigated whether breakfast, lunch and evening meal frequencies in early adolescence predicted meal frequencies in late adolescence and in early adulthood. Further, the modifying effect of gender and adolescent family structure were investigated. Methods: National representative sample of 15-year-olds in Denmark with 4 and 12 year follow-up studies with measurement of breakfast, lunch and evening meal frequencies. A total of 561 persons completed questionnaires at age 15 years (baseline 1990, n=847, response rate 84.6%), age 19 years (n=729, response rate 73.2%) and age 27 years (n=614, response rate 61.6%). Results: Low meal frequencies at age 15 years was a significant predictor for having low meal frequencies at age 19 years (odds ratio (OR, 95% CI)) varying between 2.11, 1.33-3.34 and 7.48, 3.64-15.41). Also, low meal frequencies at age 19 years predicted low meal frequencies at age 27 years (OR varying between 2.26, 1.30-3.91 and 4.38, 2.36-8.13). Significant predictions over the full study period were seen for low breakfast frequency and low lunch frequency (OR varying between 1.78, 1.13-2.81 and 2.58, 1.31-5.07). Analyses stratified by gender showed the same patterns (OR varying between 1.88, 1.13-3.14 and 8.30, 2.85-24.16). However, the observed predictions were not statistical significant among men between age 15 and 27 years. Analyses stratified by adolescent family structure revealed different lunch predictions in strata. Conclusions: Having low meal frequencies in early adolescence predicted low meal frequencies in late adolescence and early adulthood. We propose that promotion of regular meals become a prioritised issue within health education. [ABSTRACT FROM AUTHOR]

Background: The present study examines (i) if the level of vigorous physical activity (VPA) at age 15 predicts low VPA at ages 19 and 27 and (ii) whether the observed prediction pattern differs by childhood socio-economic position (SEP). In this way, prediction analyses are applied to study tracking behaviour. Methods: Data are from The Danish Longitudinal Health Behaviour Study. The baseline survey was conducted in 1990 at age 15, the first follow-up in 1994 at age 19, and the second follow-up in 2002 at age 27, n = 561. The study population was a random sample of the Danish population selected from the National Civic Registration System, and data were collected by anonymous postal questionnaires. The indicator of childhood SEP was family occupational social class. Prediction analyses are conducted by stratified logistic regression analyses. Results: There was a significant and marked predictive power of low levels of VPA in mid adolescence (aged 15) for low VPA in late adolescence (age 19) [odds ratio (OR)=4.95 (2.83−8.66)], from late adolescence (age 19) into early adulthood (age 27) [OR = 2.71 (1.61−4.55)] and also over the full study period from age 15 to age 27 [2.91 (1.72−4.94)]. Analyses stratified by SEP revealed that the predictive power of VPA at age 19 for low VPA at age 27 was only significant among participants from low SEP. Conclusion: These findings suggest that low VPA tracks through adolescence while tracking into adulthood only occurs among individuals with low childhood SEP. [ABSTRACT FROM AUTHOR]

Background: Packed lunch is the dominant lunch format in many countries including Denmark. School lunch is consumed unsupervised, and self-reported recalls are appropriate in the school setting. However, little is known about the accuracy of recalls in relation to packed lunch. Objective: To assess the qualitative recall accuracy of self-reported consumption of packed lunch among Danish 11-year-old children in relation to gender and dietary assessment method. Design: A cross-sectional dietary recall study of packed lunch consumption. Digital images (DIs) served as an objective reference method to determine food items consumed. Recalls were collected with a lunch recall questionnaire (LRQ) comprising an open-ended recall (OE-Q) and a pre-coded food group prompted recall (PC-Q). Individual interviews (INTs) were conducted successively. The number of food items was identified and accuracy was calculated as match rates (% identified by DIs and reported correctly) and intrusion rates (% not identified by DIs but reported) were determined. Setting and subjects: Three Danish public schools from Copenhagen. A total of 114 Danish 11-year-old children, mean (SE) age = 11.1 (0.03), and body mass index = 18.2 (0.26). Results: The reference (DIs) showed that girls consumed a higher number of food items than boys [mean (SE) 5.4 (0.25) vs. 4.6 (0.29) items (p =0.05)]. The number of food items recalled differed between genders with OE-Q recalls (p =0.005) only. Girls' interview recalls were more accurate than boys' with higher match rates (p =0.04) and lower intrusion rates (p =0.05). Match rates ranged from 67-90% and intrusion rates ranged from 13-39% with little differences between girls and boys using the OE-Q and PC-Q methods. Conclusion: Dietary recall validation studies should not only consider match rates as an account of accuracy. Intrusions contribute to over-reporting in non-validation studies, and future studies should address recall accuracy and inaccuracies in relation to gender and recall method. [ABSTRACT FROM AUTHOR]

ObjectiveWe examined the quality of food outlet addresses provided by secondary sources and determined whether they could be physically located in the field.DesignAddresses of food outlets in fourteen school districts in the northern part of Copenhagen were obtained from multiple business locators. We geocoded 202 addresses using a geographic information system and cross-referenced the sources against each other using a validation grid. Physical presence was determined via street survey. We applied gamma statistics and calculated positive predictive value, sensitivity and percentage agreement to assess the overall correspondence between our test of physical presence and each source of secondary information.SettingThe study took place within city boundaries of Copenhagen, Denmark.SubjectsFood outlets within fourteen school districts within Copenhagen.ResultsPositive predictive value between field results and secondary sources indicated good to excellent correspondence (range: 0·81–0·98), comparable with other studies. Gamma coefficients indicated low to high positive correspondence (range: 0·23–0·98).ConclusionsDespite moderately high correspondence between secondary sources of address information and field observation, the findings illustrate that the use of combined sources is recommended. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to examine the association between weight status and exposure to bullying among 11-, 13- and 15-year-old Danish school children. Furthermore, the purpose was to investigate the potentially mediating effect of body image. Methods: Data from the Danish contribution to the international cross-sectional research project Health Behaviour in School-aged Children (HBSC) 2002 was used. Data were assessed from questionnaires and 4781 students aged 11-, 13- and 15-years old were included in the analyses. Logistic regression was used for the analyses. Results: The regression analyses showed that overweight and obese students were more exposed to bullying than their normal weight peers. Among boys, odds ratios (ORs) for exposure to bullying were 1.75 (1.18–2.61) in overweight and 1.98 (0.79–4.95) in obese boys compared with normal weight. Among girls, the corresponding ORs were 1.89 (1.25–2.85) in overweight and 2.74 (0.96–7.82) in obese girls. The mediation analyses showed that body image fully mediated the associations between weight status and exposure to bullying in both boys and girls. Conclusions: This study shows that overweight and obese boys and girls are of higher odds of being exposed to bullying than their normal weight peers. Moreover, this study finds that body image may statistically explain this association between overweight and exposure to bullying. However, the study is cross-sectional, and hypotheses of possibilities for opposite causality are possible. [ABSTRACT FROM PUBLISHER]

Background: Medicine use as a strategy for coping with daily stressors is an under-studied issue. Studies show that stress is associated with use of over-the-counter medicine, but the underlying mechanisms are not well understood. The aim of this study was to examine whether sense of coherence (SOC) modifies the association between perceived stress and medicine use for headache. Methods: National cross-sectional study in Denmark. Study population: men and women aged 25–44 years, n = 990. The survey was conducted by web-based questionnaires and telephone interviews. The outcome measure was medicine use for headache. The independent variable was perceived stress. SOC and gender were investigated as moderators. Social class, headache prevalence and severity, and response method were included as co-variates. Results: Our study showed that SOC modified the association between stress and medicine use for headache (only statistically significant among women). The odds for medicine use among women who felt stressed were 2.30 (1.39–3.79) compared to women who did not feel stressed; among men who felt stressed the equivalent odds were 1.46 (0.80–2.66). In analysis stratified by SOC, the odds for medicine use when stressed were 2.09 (0.71–6.21) among women with high SOC, 2.21 (1.10–4.41) among women with medium SOC and 3.69 (1.09–12.47) among women with low SOC. The equivalent odds for men were 1.29 (0.33–5.04), 1.33 (0.59–3.04) and 2.47 (0.57–10.64), respectively. Conclusion: SOC modifies the association between stress and medicine use especially among women. Individuals with fewer coping resources may be more likely to use medicine beyond indication to treat stress. [ABSTRACT FROM AUTHOR]

Borup IK, Holstein BE. International Journal of Nursing Practice 2010; 16: 359–365 Overweight children's response to an annual health dialogue with the school nurse The objective of this study was to compare overweight and normal weight pupils' perceived outcome of the health dialogue with the school nurse. A random sample of schools in Denmark, where pupils age 11.6, 13.6 and 15.6 years old, answered a questionnaire (response rate 88%, n = 5205). The independent variable weight group was measured by self-reported height and weight and calculated as body mass index. Perceived outcome of the dialogue was measured as: (i) reflected on the dialogue; (ii) discussed the content with parents; (iii) followed the advice of the nurse; and (iv) visited the nurse again. Overweight boys reflected (odds ratio (OR) = 1.73), discussed the dialogue with at least one parent (OR = 1.38), followed the nurse's advice (OR = 1.42) and visited the nurse again (OR = 2.68). There was a significant statistical link between age group and perceived outcome among the boys, but not girls. The 11-year-old overweight boys perceived more positive effects from the dialogue with the school nurse. [ABSTRACT FROM AUTHOR]

Aims: To examine the association between perceived stress and use of over-the-counter analgesics among 25-44-year-olds, and to examine the association across various sociodemographic strata. Furthermore, to examine whether the association attenuates when controlled by stress-related symptoms. Methods: National cross-sectional study in Denmark. The study population consisted of men and women aged 25-44 years, n = 3461. The survey was conducted by face-to-face interviews followed by a self-administered questionnaire. The outcome measure was use of over-the-counter analgesics (OTCA). The determinant was perceived stress measured by the perceived stress scale (PSS). Demographic variables and complaints were included as co-variables. Results: Analyses stratified by gender, education, cohabiting status, and whether or not the respondents had children all showed a significant association between stress and OTCA use. The odds for OTCA use mounted with increasing stress. The association attenuated somewhat in analyses adjusted for sociodemographic variables and pain, but remained significant. The crude odds ratio (OR) for OTCA use was 1.5 (1.24-1.83) among participants with medium levels of perceived stress, and 2.26 (1.83-2.80) among participants with high levels of perceived stress, compared to participants with low levels of perceived stress. Conclusions: There was a significant association between perceived stress and OTCA use that could not be explained by potential stress-related pain across all the examined sociodemographic strata. OTCA may be used outside their indication to treat feelings of stress. Those in charge of dispensing medicines and policy makers should be aware of this potentially harmful use of products that are available without prescription. [ABSTRACT FROM AUTHOR]

Little is known about healthy young women's everyday experiences with medicine use and their general perceptions of medicines. In this article, we describe a user-perspective study involving in-depth qualitative interviews with 20 young women between the ages of 16 and 20 in Copenhagen, Denmark. Inspired by Schutz's phenomenology, informants' medicine-taking experiences were considered within the context of their life-worlds. Analysis revealed that the young women possessed predominantly negative perceptions of medicines, which were linked to a preference for complete avoidance of medicines and a desire to maintain a natural body ideal. The essence of participants' experiences was characterized by conflict, as most used medicines at least occasionally, despite the negative perceptions they held. Participants strove to make sense of their medicine-taking practices and provided rationales for their use of medicine, often based on perceptions of need and reduced personal risk. [ABSTRACT FROM AUTHOR]

Background and aim: In most northern European countries adolescent smoking is most prevalent in lower social classes but there is little information about time trends in social inequality. This paper describes trends in social inequality in daily smoking among adolescents from 1991 to 2006 by both absolute social inequality (prevalence difference between low and high social class) and relative social inequality (prevalence ratio). Methods: We analysed 15-year-olds from the Health Behaviour in School-aged Children (HBSC) study in Denmark in 1991, 1994, 1998, 2002 and 2006, total n=6703. The surveys were comparable because of similar procedures for sampling, data collection, and measurements of smoking and parents' occupational social class. Findings: From 1991 to 2006 the prevalence of daily smoking decreased from 15.9% to 10.9% among boys and from 20.1% to 10.6% among girls. The social inequality fluctuated over time and was different for boys and for girls. The prevalence difference between boys from low and high social class was 5.2% in 1991 and 9.3% in 2006, corresponding figures for girls were 4.8% and 7.0%. The prevalence ratio among boys was 1.38 (in 1991) and 2.19 (in 2006), among girls 1.28 and 1.95. Conclusions: Daily smoking was most prevalent among students from lower social classes and the level of inequality fluctuated over time. Conclusions on social inequality in adolescent smoking may appear differently when described by absolute and relative measures. The absolute and relative social inequality in adolescent smoking was higher in 2006 than in 1991. [ABSTRACT FROM AUTHOR]

Background: The purpose was to examine the association between aspects of alienation and symptom load among adolescents. Furthermore an integrated purpose was to construct and validate an index of alienation. Methods: Cross-sectional data from 5205 school children aged 11-15 years from a random sample of schools in Denmark were used. Data stems from the Danish contribution to the cross-national study Health and Behaviour in School-aged Children (HBSC). Alienation was measured with a new index fulfilling four criteria: (i) theoretical foundation, (ii) inter-correlation between items, (iii) correlation between each of the index's items and the outcomes and (iv) no differential item functioning. The final index included three indicators of alienation: helplessness, feeling left out of things and lack of confidentiality with parents. Symptom load was measured by HBSC Symptom Checklist and divided into physical and psychological symptoms respectively. High symptom load was defined as experiencing at least one symptom on a daily basis. Results: The odds-ratio (OR) for high symptom load increased with the degree of alienation. For students with all three indicators of alienation, the OR for high physical symptom load was 2.49 (1.05-5.87). The OR for high psychological symptom load for the corresponding degree of alienation was 6.50 (3.11-13.56). Conclusion: The index of alienation fulfilled psychometric criteria for scalability. Furthermore the analyses showed a graded and significant association between alienation and high symptom load. This suggests alienation to be taken into account in future health interventions among adolescents. In school settings this may be done using principles of empowerment. [ABSTRACT FROM AUTHOR]

In this study, the authors explore the context surrounding young women's use of analgesics to deal with headache. In-depth interviews were conducted with 20 young women between the ages of 16 and 20 in Copenhagen, Denmark. Interviews focused on the young women's experiences with medications within the context of their everyday lives. The central elements in the participants' accounts emerged via a phenomenological approach. Analysis revealed that participants attributed headache to stressful conditions in their everyday lives. Analgesic use in treating headache was found to serve highly valued performance- and participation-related functions. Accordingly, analgesics were employed as tools to reach these aims. The threshold for turning to analgesics varied across situations and among participants. Some relied heavily on analgesics, whereas others had success with non-medical strategies. This study's findings demonstrate a need for health education programs aimed at empowering young women to better manage headaches as well as everyday stress. [ABSTRACT FROM AUTHOR]

Background: Intermittent monitoring of fruit and vegetable intake at the population level is essential for the evaluation and planning of national dietary interventions. Yet, only a limited number of studies on time trends in fruit and vegetable intake among children and adolescents have been published internationally. In Denmark, national comprehensive campaigns to enhance fruit and vegetable consumption were initiated in 2001. This paper describes secular trends in fruit intake among Danish adolescents by six comparable school surveys from 1988 to 2006. The paper demonstrates and discusses the consequences of measurement changes introduced in long-term trend analyses. Methods: We used Danish data from the international Health Behaviour in School-aged Children (HBSC) study collected in 1988, 1991, 1994, 1998, 2002 and 2006. Analyses were conducted on comparable questionnaire-based data from students aged 11, 13 and 15 total (n = 23,871) from a random sample of schools. Data on fruit intake were measured by a food frequency questionnaire. Due to changes in number of response categories beween surveys, different cut-points were analysed. Results: The prevalence of students eating fruit at least once daily ranged from 78.3% among 13-year-old girls in 1988 to 17.3% among 15-year-old boys in 2002. Based on the six data collections, analyses of trends showed a significant decrease in prevalence of students eating fruit at least once daily from 1988 to 2002 (all p-values < 0.0001). In all age and gender groups, a significant increase in intake occurred between 2002 and 2006 (all p-values < 0.0065). Analyses of alternative cut-points revealed similar results. Conclusion: Fruit consumption among Danish schoolchildren decreased from 1988 to 2002 with an increase since 2002. We suggest that the increase may be attributable to a nation-wide initiative conducted in Denmark since 2001 to increase the intake of fruit and vegetables in the population. Still, the results imply that a substantial proportion of Danish schoolchildren do not meet the nationally recommended daily intake of fruit. Our analyses indicate that the observed trends are not solely caused by methodological biases related to changes in measurements. [ABSTRACT FROM AUTHOR]

Purpose: To examine, separately for boys and girls, whether socio-economic differences in drunkenness exist in adolescence, whether the level of exposure to school-related risk factors differ between socioeconomic groups, and whether the relative contribution of school-related risk factors to drunkenness differ between socio-economic groups. Methods: The study population was a random sample of 1453 Danish 15-year-old students. The outcome measure was drunkenness 10 times or more, as a lifetime measure. Predictor variables comprised five aspects of well-being at school. Socio-economic position (SEP) was measured by parental occupation. Results: Among girls, exposures to school-related risk factors were more prevalent in lower socio-economic groups. Poor school satisfaction was associated with drunkenness among girls from high SEP, odds ratio (OR) = 2.98 (0.73-12.16). Among boys from high SEP autonomy in decision-making was associated with drunkenness, OR = 2.74 (1.06-7.08), whereas poor school satisfaction was associated with drunkenness among boys from intermediate SEP, OR = 2.26 (0.98-5.22). Weak Parental Support in school-related matters, OR = 3.92 (1.16-13.24), and disliking school, OR = 9.12 (1.77-47.09), were associated with drunkenness among boys from low SEP. These associations were also seen among girls although not significant. Conclusion: We found that well-being at school had socially differential impact on drunkenness in adolescence. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to examine the cross‐sectional association between educational attainment and coping strategies with unemployment in a random sample of 37‐ to 56‐year‐old Danish men and women in long‐term unemployment. Methods: Data were based on a survey among 575 men and 1,064 women who had been unemployed at least 70% of the time during a three‐year period (October 1996 to October 1999). The outcome measures were two scales for coping with unemployment, one for problem‐solving coping, and one for avoidant coping. Educational attainment was measured by years of vocational training. Results: A significant association was found between low educational attainment and low use of problem‐solving coping among both men, OR = 1.81 (95% CI 1.19–2.75), and women, OR = 1.57 (1.13–2.18). Adjustment for cohabitation status, self rated health, economic strain, and unemployment status did not change this association substantially. High use of avoidant coping was associated with low educational attainment among men, OR = 1.57 (0.98–2.51). For women, medium educational attainment was significantly associated with low use of avoidant coping, OR = 0.60 (0.42–0.85). This result was not affected by adjustment for the covariates. Conclusions: Coping strategies are considered a potential modifier of the impact of unemployment on health and well‐being. In this study, differences in coping strategies with unemployment were associated with educational attainment. [ABSTRACT FROM AUTHOR]

Background: This study examined the effects of marital status over two and three generations on last generation's mortality, and tested the hypothesis of an effect of the latest status (proximity effect) as well as the hypothesis of an accumulative effect. Methods: The study population covers a random sample of all boys born in the the metropolitan area of Copenhagen with complete data from interviews and registers on two and three generation's marital status, socioeconomic position variables, and last generation's admission to psychiatric hospital, n=2614. Among these 105 deaths occurred. Cox proportional hazards regression models were used to estimate the effect of marital status on mortality. Results: Never married sons showed a considerably increased mortality compared with their married counterparts in the adjusted analyses. Mother's marital status at childbirth was also associated with increased mortality among the sons. There was no independent effect of maternal grandparent's experience of divorce on third generation's mortality. Son's marital status was the strongest marital status predictor of mortality. Accumulation of both two and three generations' marital status was significantly associated with mortality risk in a dose-response pattern. All analyses were adjusted for socioeconomic position variables and mental health. Conclusions: These results support the proximity hypothesis as son's marital status was the strongest predictor of mortality, and suggest an accumulative effect as each of the three non-married generations added to an increased mortality risk. [ABSTRACT FROM AUTHOR]

Recent research indicates that factors operating during childhood are related to adult health. Thus, longitudinal studies with information on subsequent phases may be key to understanding later health outcomes. The main objective of this paper is to describe the history and design of a Danish birth cohort, and its revitalisation. In 1965, information from birth certificates for 11 591 of a total of 12 270 males born in 1953 in the Metropolitan area of Copenhagen, Denmark were traced. These boys were the study population of a sociological investigation conducted with the aim of describing social mobility At age 12 years, 9537 of these cohort members completed a questionnaire in school, which included cognitive measures and information on social aspirations and leisure time activities. In 1966 educational performance tests were administered for these boys and, in 1968, mothers of 2890 cohort members were interviewed regarding family social backgrounds. With the establishment of the Civil Registration System (CRS) in 1968, it was possible to identify 11 532 cohort members. In 2002 we began the process of revitalising this study with the aim of investigating the influence of early life factors on later health. We succeeded in ascertaining the vital status of all subjects in the CRS. This showed that 863 subjects had died between 1968 and 2002. Linkages to the Register of Causes of Death, the National Hospital Register, Psychiatric Central Register and Danish Cancer Registry have been completed. In total, 7969 cohort members had been hospitalised for any somatic illness and, according to the Psychiatric Central Register, 1382 men had been admitted to a psychiatric hospital or ward. In the Cancer Registry we found 363 of our study participants. Analyses exploring the influence of social conditions in early life, birth dimensions, and childhood cognition on adult health experience are at various stages of completion. A questionnaire-based postal follow-up survey is planned. Thus, the Metropolit study provides an important opportunity to examine the processes by which factors that operate over the life course influence adult health. [ABSTRACT FROM AUTHOR]

1: In this study, intracellular Ca2+ was measured as the Fura-2 ratio (R) of fluorescence excited at 340 and 380?nm (F340/F380) in nonpressurized rat mesenteric small arterioles (\[emptyv] (lumen diameter) 10-25?µm). The response to depolarization using 75?mM KCl was an increase in R from a baseline of 0.96±0.01 ([Ca2+]i ~74?nM) to 1.04±0.01 (~128?nM) (n=80). 2: The response to 75?mM K+ was reversibly abolished in Ca2+-free physiological saline solution, whereas phentolamine (10?µM) or tetrodotoxin (1?µM) had no effects. LaCl3 (200?µM) inhibited 61±9% of the response. 3: A [K+]-response curve indicated that the Ca2+ response was activated between 15 and 25?mM K+. The data suggest that the Ca2+ response was caused by the activation of voltage-dependent Ca2+ channels. 4: Mibefradil use dependently inhibited the Ca2+ response to 75?mM K+ by 29±2% (100?nM), 73±7% (1?µM) or 89±7% (10?µM). Pimozide (500?nM) use dependently inhibited the Ca2+ response by 85±1%. 5: Nifedipine (1?µM) inhibited the Ca2+ response to 75?mM K+ by 41±12%. The response was not inhibited by calciseptine (500?nM), ?-agatoxin IVA (100?nM), ?-conotoxin MVIIA (500?nM), or SNX-482 (100?nM). 6: Using reverse transcriptase-polymerase chain reaction, it was shown that neither CaV2.1a (P-type) nor CaV2.1b (Q-type) voltage-dependent Ca2+ channels were expressed in mesenteric arterioles, whereas the CaV3.1 (T-type) channel was expressed. Furthermore, no amplification products were detected when using specific primers for the ß1b, ß2, or ß3 auxiliary subunits of high-voltage-activated Ca2+ channels. 7: The results suggest that the voltage-dependent Ca2+ channel activated by sustained depolarization in mesenteric arterioles does not classify as any of the high-voltage-activated channels (L-, P/Q-, N-, or R-type), but is likely to be a T-type channel. The possibility that the sustained Ca2+ influx observed was the result of a T-type window current is discussed.British Journal of Pharmacology (2004) 142, 709-718. doi:10.1038/sj.bjp.0705841 [ABSTRACT FROM AUTHOR]

Objectives. This study examines whether aspects of social relations at baseline are related to functional decline at 5year follow-up among nondisabled old men and women. Methods. The investigation is based on baseline and follow-up data on 651 nondisabled 75-year-old persons in Jyväskylä (Finland) and Glostrup (Denmark). The analyses are performed separately for men and women. Possible selection problems were considered by using three outcome measures: first, functional decline among the survivors (n = 425); second, functional decline, including death, assuming that death is part of a general decline pattern (n = 565); and third, mortality (n = 651). Social relations were measured at baseline by several items focusing on the structure and function of the social network. Results. In men, no weekly telephone contact was related to functional decline and mortality. Among women, less than weekly telephone contact, no membership in a retirement club, and not sewing for others were significantly related to functional decline and mortality. The associations were stronger when the dead were included in the outcome measure. Discussion. The results point to the importance of social relations in the prevention of functional decline in older adults. [ABSTRACT FROM AUTHOR]