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Purpose Current knowledge of the effect of prenatal caffeine exposure on the child’s neurodevelopment is contradictory. The current study aimed to study whether caffeine intake during pregnancy was associated with impaired child neurodevelopment up to 8 years of age. Method A total of 64,189 full term pregnancies from the Norwegian Mother, Father and Child Cohort Study were included. A validated food-frequency questionnaire administered at gestational week 22 was used to obtain information on maternal caffeine intake from different sources. To assess child neurodevelopment (behaviour, temperament, motor development, language difficulties) validated scales were used to identify difficulties within each domain at 6, 18, 36 months as well as 5 and 8 years of age. Adjusted logistic regression models and mixed linear models were used to evaluate neurodevelopmental problems associated with maternal caffeine intake. Results Prenatal caffeine exposure was not associated with a persistently increased risk for behaviour, temperament, motor or language problems in children born at full-term. Results were consistent throughout all follow-ups and for different sources of caffeine intake. There was a minor trend towards an association between consumption of caffeinated soft drinks and high activity level, but this association was not driven by caffeine. Conclusion Low to moderate caffeine consumption during pregnancy was not associated with any persistent adverse effects concerning the child’s neurodevelopment up to 8 years of age. However, a few previous studies indicate an association between high caffeine consumption and negative neurodevelopment outcomes.

Background Long-term sickness absences burden the economy in many industrialized countries. Both educational attainment and health behaviors are well-known predictors of sickness absence. It remains, however, unclear whether these associations are causal or due to confounding factors. The co-twin control method allows examining causal hypotheses by controlling for familial confounding (shared genes and environment). In this study, we applied this design to study the role of education and health behaviors in sickness absence, taking sex and cohort differences into account. Methods Participants were two cohorts of in total 8806 Norwegian twins born 1948 to 1960 (older cohort, mean age at questionnaire = 40.3, 55.8% women), and 1967 to 1979 (younger cohort, mean age at questionnaire = 25.6, 58.9% women). Both cohorts had reported their health behaviors (smoking, physical activity and body mass index (BMI)) through a questionnaire during the 1990s. Data on the twins’ educational attainment and long-term sickness absences between 2000 and 2014 were retrieved from Norwegian national registries. Random (individual-level) and fixed (within-twin pair) effects regression models were used to measure the associations between educational attainment, health behaviours and sickness absence and to test the effects of possible familial confounding. Results Low education and poor health behaviors were associated with a higher proportion of sickness absence at the individual level. There were stronger effects of health behaviors on sickness absence in women, and in the older cohort, whereas the effect of educational attainment was similar across sex and cohorts. After adjustment for unobserved familial factors (genetic and environmental factors shared by twin pairs), the associations were strongly attenuated and non-significant, with the exception of health behaviors and sickness absence among men in the older cohort. Conclusions The associations between educational attainment, health behaviors, and sickness absence seem to be confounded by unobserved familial factors shared by co-twins. However, the association between health behaviors and sickness absence was consistent with a causal effect among men in the older cohort. Future studies should consider familial confounding, as well as sex and age/cohort differences, when assessing associations between education, health behaviors and sickness absence.

We investigated whether children born preterm are at risk for language delay using a sibling-control design in the Norwegian Mother and Child Cohort Study (MoBa), conducted by the Norwegian Institute of Public Health. Participants included 26,769 siblings born between gestational weeks 23 and 42. Language delay was assessed when the children were 1.5, 3, and 5 years old. To adjust for familial risk factors, comparisons were conducted between preterm and full-term siblings. Pregnancy-specific risk factors were controlled for by means of observed variables. Findings showed that preterm children born before week 37 had increased risk for language delays at 1.5 years. At 3 and 5 years, only children born before week 34 had increased risk for language delay. Children born weeks 29–33 and before week 29 had increased risk for language delay at 1.5 years (RR = 4.51, 95% CI [3.45, 5.88]; RR = 10.32, 95% CI [6.7, 15.80]), 3 years (RR = 1.50, 95% CI [1.02, 2.21]; RR = 2.78, 95% CI [1.09, 7.07]), and 5 years (RR = 1.63, 95% CI [1.06, 2.51]; RR = 2.98, 95% CI [0.87, 10.26]), respectively. In conclusion, children born preterm are at risk for language delays, with familial confounders only explaining a moderate share of the association. This suggests a cause-effect relationship between early preterm birth and risk for language delay in preschool children.

Background As many countries face an aging workforce, it is becoming ever more relevant to understand the underlying causes of work incapacity across the entire working age. Previous twin studies have demonstrated that work incapacity is influenced by genetic as well as environmental factors. Furthermore, educational attainment and lifestyle behaviors are relatively stable from early adulthood and are associated with work incapacity. This association may be confounded by unobserved factors - both genetic and environmental. In two separate twin studies, we examine 1) the stability and change in genetic and environmental factors influencing work incapacity from age 18 until retirement, and sex differences in these effects, and 2) the associations and likelihood of causality between educational attainment, lifestyle and sickness absence. Methods study 1: A population-based sample of 28,759 twins were linked to high quality national registry data and followed for up to 23 years. We measured work incapacity as the total proportion of potential workdays lost due to sickness absence, rehabilitation, and disability benefits. study 2: Data from a subsample of 8,806 twins who completed health questionnaires were linked to registry data on sickness absence and educational attainment. Self-reported lifestyle behaviors were smoking, physical activity and BMI (height and weight). Results study 1: Structural equation modeling indicated moderate genetic influences on work incapacity throughout life in both men and women, with a high degree of genetic stability from young to old adulthood. study 2: Preliminary regression analyses indicated that genetic factors largely confound the associations between educational attainment, lifestyle and sickness absence. Conclusions Genetic factors seem to be a major issue in understanding causes of work incapacity. Largely the same genetic factors influence individual differences in work incapacity throughout working age.

Background For the past decade, researchers from the Nordic countries have taken the advantage of their large twin cohorts and reliable official registries to deepen our understanding of sick leave and disability pension. This presentation will give a brief summary of studies based on data from The Norwegian Twin Registry (NTR). Methods Monozygotic twins develop from one fertilized egg cell and are genetically identical, while dizygotic twins are the result of two fertilized egg cells and share, as ordinary siblings, in average 50% of their segregating genes. With data from large cohorts of twins reared together, it is possible to calculate the proportion of variance in an outcome that stems from genetic, shared and non-shared environmental factors respectively. Furthermore, when exploring the contribution from measured risk factors on specific outcomes, adjustment for unmeasured confounders (genes and shared environment) can bring us closer to determine causality in epidemiological studies. Both methods were applied in our studies. NTR now includes data from about 30 000 twins, but until recently we focused on a subsample of about 8 000 young adults (born 1967-1979). Data from questionnaires and interviews were linked to registries on sick leave and disability pension. Results In line with previous studies, we found that the liability to sick leave and disability pensioning, as well as the transition from the former to the latter, was strongly to moderately influenced by genetic factors. We found no evidence for “social transmission”, e.g. that environmental factors shared by the twins contributed to these outcomes. Further details and results from studies on measured risk factors, with emphasize on mental health, will be presented at the conference. Conclusions Twin studies cast light on different aspects of work incapacity, including reducing stigma such as those associated with theories of social transmission of health related benefits.

Children's personality traits are invaluable predictors of concurrent and later mental and physical health. Several validated longer inventories for assessing the widely recognized Five-Factor Model of personality in children are available, but short forms are scarce. This study aimed at constructing a 30-item form of the 144-item Hierarchical Personality Inventory for Children (HiPIC) (Mervielde & De Fruyt, ). Participants were 1543 children aged 6-12 years (sample 1) and 3895 children aged 8 years (sample 2). Sample 1 completed the full HiPIC, from which we constructed the HiPIC-30, and the Child Behaviour Checklist (Achenbach, ). Sample 2 completed the HiPIC-30. The HiPIC-30 personality domains correlated over r = .90 with the full HiPIC domains, had good Cronbach's alphas and correlated similarly with CBCL behaviour problems and gender as the full HiPIC. The factor structures of the HiPIC-30 were convergent across samples, but the imagination factor was not clear-cut. We conclude that the HiPIC-30 is a reliable and valid questionnaire for the Five-Factor personality traits in children. Copyright © 2016 John Wiley & Sons, Ltd.

Objective Our aim is to examine the associations of the Big Five personality factors with eating behaviors in children using a cross-sectional study in 1543 randomly Norwegian 7–12 year olds. Results Mothers rated the hierarchical personality inventory for children, and the child eating behaviour questionnaire to describe her child. Personality and eating behaviors were substantially associated in bivariate correlations and multivariate analyses of variance. The strongest predictors of eating behaviors were neuroticism, followed by agreeableness and conscientiousness. Neuroticism correlated the highest with slow eating, emotional undereating, food responsiveness, and emotional overeating, and showed minor associations with satiety responsiveness, and fussiness. Neuroticism was not associated with enjoyment of food. Agreeableness was associated with low fussiness, low emotional undereating, low food responsiveness and low emotional overeating, conscientiousness was associated with low satiety responsiveness, and food responsiveness, and extraversion and imagination were associated with high enjoyment of food.

How personality traits relate to structural brain changes in development is an important but understudied question. In this study, cortical thickness (CT) and surface area (SA), estimated using magnetic resonance imaging (MRI), were investigated in 99 participants aged 8-19 years. Follow-up MRI data were collected after on average 2.6 years for 74 individuals. The Big Five personality traits were related to longitudinal regional CT or SA development, but limited cross-sectional relations were observed. Conscientiousness, emotional stability, and imagination were associated with more age-expected cortical thinning over time. The results suggest that the substantial individual variability observed in personality traits may partly be explained by cortical maturation across adolescence, implying a developmental origin for personality-brain relations observed in adults. [ABSTRACT FROM AUTHOR]

International audience; The goal of this study is to examine the extent to which child temperament predicts the adiposity rebound, a steep increase in the body mass index (BMI) between ages 5 and 7 years. If this increase occurs at an earlier age, the risk for later obesity is elevated. To improve the accuracy of the examination, we use a genetically informed design, a sibling-control study, to control for genetic and familial confounding. We hypothesize that temperament traits tapping negative emotionality, approach and avoidance are associated with the adiposity rebound. Methods We repeatedly examined 25889 siblings within the Norwegian Mother and Child Cohort Study, following them from the mothers' pregnancy through child age 8 years. Information on the children's height and weight was collected by means of health registries and maternal reports. Information on the siblings' temperament was collected by questionnaires completed when they were 1.5, 3, and 5 years old. We examined the associations of temperament at different child ages with the timing of the adiposity rebound among siblings and controls by means of growth curve and multilevel analyses. Results Within siblings, high scores on the approach trait of sociability predicted an earlier adiposity rebound and high scores on the avoidance trait of shyness predicted a later adiposity rebound with timing differences ranging between 6 and 16 weeks. Surprisingly, negative emotionality did not predict the adiposity rebound. The associations between temperament and the adiposity rebound increased with increasing child age. The results within controls-comparing siblings with the population, broadly paralleled those within siblings, Conclusions The findings encourage the notion that child temperament functions as an early marker for the adiposity rebound. Future studies may advance our knowledge by including measures of child personality along the taxonomy of the adult Five Personality Factors.

Combining work and family responsibilities is challenging when children have special needs, and mothers commonly make employment-related adjustments. In this study, the authors examined associations between maternal work absence and child language impairment and behavior problems in preschool children. Questionnaire data at child age 3 years from 33,778 mothers participating in the prospective population-based Norwegian Mother and Child Cohort Study were linked to national register data on employment and long-term physician-certified sick leave at child age 3-5 years. Mothers who reported having a child with language impairment had a consistently higher risk of not being employed and were at increased risk of taking long-term sick leave at child age 5 years. Co-occurring problems were associated with excess risk. Language impairments in preschool children, in particular when they are co-occurring with behavior problems, are likely to have a range of negative short- and long-term consequences for the financial and overall health and well-being of mothers and their families.

Background.A congenital heart defect (CHD) can increase the risk of mental health problems in affected children and their parents. The extent to which risk factors for these problems are shared in families or are specific to the individual family member is unclear.Method.Prospective data from the Norwegian Mother and Child Cohort Study (MoBa; n = 93 009) were linked with a nationwide CHD registry, and 408 children with CHD were identified. Mothers' reports on child internalizing problems and their own distress were assessed by questionnaires at child ages 6, 18 and 36 months. A structural model was applied to distinguish between familial (shared) factors and individual-specific factors for mental health problems.Results.CHD was a substantial risk factor for problems in children and their mothers at all time points. CHD contributed on average 31% and 39% to the variance in children's and mothers' problems respectively. Both shared familial and individual-specific factors unique to CHD families contributed to risk for mental health problems. Whereas individual-specific risk factors contributed to the stability of problems in mothers, the effect of these factors lasted only a short time in children. Mutual influences over time were found between the mother's and the child's mental health at 18 and 36 months.Conclusions.The burden of CHD in a child is shared between family members but is also specific to the individual. This study points to a need for both an individual and a family-based approach to provide psychological support to children with CHD and their parents.

Objective To investigate the risk of communication impairments at age 18 and 36 months in children born early term (gestational weeks 37-38) and late preterm (gestational weeks 34-36). Study design A total of 39 423 children and their mothers participated in the Norwegian Mother and Child Cohort Study. The sample included 7109 children (18%) born early term and 1673 (4.2%) born late preterm. Information on gestational age and prenatal and postnatal risk factors was obtained from the Medical Birth Registry of Norway. Information on communication impairments was assessed using standardized questionnaires filled out by the mothers. Stepwise logistic regression analysis was applied to explore the associations between early term/late preterm birth and communication impairments at age 18 and 36 months. Results Compared with children born at term, children born early term and late preterm had an increased risk of communication impairments at age 18 and 36 months. In early term, the aOR was 1.27 (95% CI, 1.12-1.44) at 18 months for communication impairments and 1.22 (95% CI, 1.07-1.39) at 36 months for expressive language impairments. In late preterm, the aOR was 1.74 (95% CI, 1.41-2.14) at 18 months and 1.37 (95% CI, 1.09-1.73) at 36 months. Conclusion Not only children born late preterm, but also those born early term, are at increased risk for communication impairments. Given the large number of children potentially affected, this may result in significant health care costs.

This study explores the stability and change in maternal life satisfaction and psychological distress following the birth of a child with a congenital anomaly using 5 assessments from the Norwegian Mother and Child Cohort Study collected from Pregnancy Week 17 to 36 months postpartum. Participating mothers were divided into those having infants with (a) Down syndrome (DS; n = 114), (b) cleft lip/palate (CLP; n = 179), and (c) no disability (ND; n = 99,122). Responses on the Satisfaction With Life Scale and a short version of the Hopkins Symptom Checklist were analyzed using structural equation modeling, including latent growth curves. Satisfaction and distress levels were highly diverse in the sample, but fairly stable over time (retest correlations: .47-.68). However, the birth of a child with DS was associated with a rapid decrease in maternal life satisfaction and a corresponding increase in psychological distress observed between pregnancy and 6 months postpartum. The unique effects from DS on changes in satisfaction (Cohen's d = -.66) and distress (Cohen's d = .60) remained stable. Higher distress and lower life satisfaction at later assessments appeared to reflect a persistent burden that was already experienced 6 months after birth. CLP had a temporary impact (Cohen's d = .29) on maternal distress at 6 months. However, the overall trajectories did not differ between CLP and ND mothers. In sum, the birth of a child with DS influences maternal psychological distress and life satisfaction throughout the toddler period, whereas a curable condition like CLP has only a minor temporary effect on maternal psychological distress. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

Summary Background Personality may be an important yet understudied influence on childhood obesity. Objective We investigated the association between children's personality traits and weight status in a sample of 1533 6–12 year olds. Methods Mothers rated their child's personality using the Norwegian Hierarchical Personality Inventory for Children, and reported on their child's height and weight. Results Relative to their normal weight peers, overweight children were rated lower on energy, optimism, compliance, concentration, perseverance, and self-confidence, and higher on egocentricity, irritability, and anxiety. Conclusions These findings suggest possible mechanisms to investigate in future research relating personality to childhood obesity.

Objectives To investigate whether maternal negative affectivity, a tendency to frequent negative emotions and views, is associated with light alcohol use and binge drinking during pregnancy. Design Cohort. Setting Norway 1999–2008. Population The study includes complete information on 66 111 pregnant women and their partners. Methods We used data from the Norwegian Mother and Child Cohort study (MoBa) representing 39% of the pregnant population. Main outcome measures Light alcohol use (0.5–2 units one to four times per month) and binge drinking (an intake of 5 alcohol units or more) measured with the Alcohol Use Disorder Identification Test-Consumption (AUDIT-C). Results For each unit increase in maternal negative affectivity the odds for light alcohol use increased with 27% in the first trimester [95% confidence interval (CI) 1.19–1.36], and 28% in the second trimester (95% CI 1.18–1.39). With respect to binge drinking, each unit increase in maternal negative affectivity was associated with 55% higher odds in the first trimester (95% CI 1.44–1.67), and 114% higher odds in the second trimester (95% CI 1.70–2.69). Conclusions Negative affectivity is associated with both light alcohol use and binge drinking during pregnancy. The mechanisms mediating the relation between negative affectivity and alcohol use in pregnancy should be investigated further.

Objective To assess the level of partner relationship satisfaction among mothers of children with different severity of congenital heart defects (CHD) compared with mothers in the cohort. Methods Mothers of children with mild, moderate, or severe CHD (n = 182) and a cohort of mothers of children without CHD (n = 46,782) from the Norwegian Mother and Child Cohort Study were assessed at 5 time points from pregnancy to 36 months postpartum. A 5-item version of the Relationship Satisfaction scale was used, and relevant covariates were explored. Results The trajectories of relationship satisfaction among mothers of children with varying CHD severity did not differ from the trajectories in the cohort. All women in the cohort experienced decreasing relationship satisfaction from 18 months after delivery up to 36 months after delivery. Conclusions Having a child with CHD, regardless of severity, does not appear to exacerbate the decline in relationship satisfaction.

Background Many women temporarily reduce work hours or stop working when caring for small children. However, mothers of children with special health care needs may face particular challenges balancing childrearing responsibilities and employment demands. This study examines how the work participation among mothers of children with special health care needs compares with that of mothers in general during early motherhood, focusing in particular on the extent of the child's additional health care needs. Methods By linkage of the population-based Norwegian Mother and Child Cohort Study with national registers on employment, child health care needs, and social background factors, 41 255 mothers employed prior to childbirth were followed until child age 3 years to investigate associations between the child's care needs and mother's dropping out of employment. Results In total, 16.3% of the formerly employed mothers were no longer employed at child age 3 years. Mothers of children with mild care needs did not differ from mothers in general, whereas mothers of children with moderate [Risk Ratio (RR) 1.45; 95% confidence interval (CI) 1.17, 1.80] and severe care needs [RR 2.19; 95% CI 1.67, 2.87] were at substantial risk of not being employed at follow-up. The impact of the child's health care needs remained strong also after adjusting for several factors associated with employment in general. Conclusions Extensive childhood health care needs are associated with reduced short-term employment prospects and remain a substantial influence on mothers' work participation during early motherhood, irrespective of other important characteristics associated with maternal employment.

BACKGROUND: The international classification of diseases (ICD) provides guidelines for the collection, classification and dissemination of official cause-of-death statistics. New revisions of the ICD can potentially disrupt time trends of cause-of-death statistics and affect between-country comparisons. The aim of this study was to measure how switching from ICD-9 to ICD-10 affected mortality statistics for external causes of death, i.e. intentional and unintentional injuries, in Italy and Norway. METHODS: A sample of death certificates (N=454,897) were selected in Italy from the first year the ICD-10 was implemented (2003) and reclassified from ICD-10 to ICD-9 by the Italian National Institute of Statistics. A sample of death certificates was also selected in Norway (N=10,706) from the last year the ICD-9 was used (1995) and reclassified according to ICD-10 by Statistics Norway. The reclassification (double-coding) was performed by special trained personal in governmental offices responsible for official mortality statistics. Although the reclassification covered all causes of death (diseases and injuries) in the sample, our analysis focused on just one ICD chapter XX. This was external causes of mortality (injury deaths), and covered 15 selected categories of injuries. RESULTS: The switch from ICD-9 to ICD-10 had a significant net impact on 8 of the 15 selected categories. In Italy, accidental falls decreased by 76%; traffic accidents decreased by 9%; suicide by hanging decreased by 3%; events of undetermined intent decreased by 69%; and overall injury deaths decreased by 4%. These net decreases reflect the moving of death records from injury categories in ICD-9 to other injury or disease categories in ICD-10. In Norway, the number of records in three categories decreased significantly: transport accidents, 9%; traffic accidents, 13%; and suicide by self-poisoning, 18%. No statistically significant differences (net changes) were observed in the total number of accidents, suicides and homicides in either country. CONCLUSIONS: Switching to ICD-10 did not change the overall trends for accidents, homicides and suicides in either country. However, the number of records in some injury subcategories e.g. accidental falls and traffic accidents, decreased. Changing classification can thus affect the ranking of causes of injury mortality, with consequences for public health policy. Language: en

Background Recent findings has shown that late preterm births (gestational weeks 34–36) and early term births (gestational weeks 37–38) is associated with an increased risk of several psychological and developmental morbidities. In this article we investigate whether late preterm and early term births is associated with an increased risk of emotional and behavioral problems at 36 months of age and whether there are gender differences in risk of these outcomes. Methods Forty-three thousand, two hundred ninety-seven children and their mothers participating in the Norwegian Mother and Child Cohort Study (MoBa). One thousand, eight hundred fifty-three (4.3%) of the children in the sample were born late preterm and 7,835 (18.1%) were born early term. Information on gestational age and on prenatal and postnatal risk factors was retrieved from the Medical Birth Registry of Norway. Information on emotional and behavioral problems was assessed by standardized questionnaires (CBCL/ITSEA) filled out by the mothers. Gender-stratified logistic regression analyses were used to explore the association between late preterm / early term and emotional and behavioral problems at 36 months of age. Results We found a gender-specific increased risk of emotional problems in girls born late preterm (OR 1.47 95%CI 1.11–1.95) and in girls born early term (OR 1.21 95%CI 1.04–1.42). We did not find an increased risk of emotional problems in boys born late preterm (OR 1.09 95%CI 0.82–1.45) or early term (OR 0.93 95%CI 0.79–1.10). Behavioral problems were not increased in children born late preterm or early term. Conclusion Girls born late preterm and early term show an increased risk of emotional problems at 36 months of age. This finding suggests that gender should be taken into account when evaluating children born at these gestational ages.

Background Anxiety is associated with preterm deliveries in general (before week 37 of pregnancy), but is that also true for late preterm (weeks 34/0–36/6) and early term deliveries (weeks 37/0–38/6)? We aim to examine this association separately for spontaneous and provider-initiated deliveries. Methods Participants were pregnant women from the Norwegian Mother and Child Cohort Study (MoBa), which has been following 95 200 pregnant women since 1999. After excluding pregnancies with serious health complications, 81 244 participants remained. National ultrasound records were used to delineate late preterm, early term, and full-term deliveries, which then were subdivided into spontaneous and provider-initiated deliveries. We measured trait anxiety based on two ratings of the anxiety items on the Symptom Checklist-8 (Acta Psychiatr Scand 87:364–7, 1993). Trait anxiety was transformed into categorizing the score at the mean and at ± 2 standard deviations. Results Trait anxiety was substantially associated with late preterm and early term deliveries after adjusting for confounders. In the whole sample, women with the highest anxiety scores (+2 standard deviations) were more likely [(odds ratio (OR) = 1.7; 95 % confidence-interval (CI) 1.3-2.0)] to delivering late preterm than women with the lowest anxiety scores. Their odds of delivering early term were also high (OR = 1.4; CI 1.3-1.6). Women with spontaneous deliveries and the highest anxiety scores had higher odds (OR = 1.4; CI 1.1-1.8) of delivering late preterm and early term (OR = 1.3; CI = 1.3-1.5). The corresponding odds for women with provider-initiated deliveries were OR = 1.7 (CI = 1.2-2.4) for late preterm and OR = 1.3 for early term (CI = 1.01-1.6). Irrespective of delivery onset, women with provider-initiated deliveries had higher levels of anxiety than women delivering spontaneously. However, women with high anxiety were equally likely to have provider-initiated or spontaneous deliveries. Conclusions This study is the first to show substantial associations between high levels of trait anxiety and late preterm delivery. Increased attention should be given to the mechanism underlying this association, including factors preceding the pregnancy. In addition, acute treatment should be offered to women displaying high levels of anxiety throughout pregnancy to avoid suffering for the mother and the child.

The aim of this prospective study was to examine the etiology of post-traumatic stress symptoms following childbirth within a transactional framework of stress. Participants were women (N = 1,499) from the Akershus Birth Cohort. These women were followed from pregnancy to 8 weeks postpartum. We modeled predisposing factors (e.g., fear of childbirth) and precipitating factors (subjective and objective birth experiences) as predictors of post-traumatic stress symptoms. Post-traumatic stress symptoms were measured by means of the Impact of Event Scale, objective birth experiences by means of birth journals, and subjective birth experiences by means of three questions. A structural equation model showed that subjective birth experiences had the highest association with post-traumatic stress symptoms. Moreover, they mediated the effect of predisposing factors and objective birth experiences. The results suggest that women's subjective birth experiences are the most important factor in the development of post-traumatic stress symptoms following childbirth.

The role of children's personality traits in the consumption of potentially obesogenic foods was investigated in a sample of Norwegian children aged 6–12 years (N = 327, 170 boys, 157 girls). Mothers rated their child's personality on the traits of the Five Factor Model (i.e., Extraversion, Benevolence, Conscientiousness, Neuroticism, and Imagination). Mothers also completed a food frequency questionnaire assessing their child's consumption of sweet drinks, sweet foods, and fruit and vegetables, and reported their child's height and weight. Controlling for age and mothers' education, boys and girls who were less benevolent consumed more sweet drinks, and girls who were less conscientious and more neurotic consumed more sweet drinks. Boys and girls who were more benevolent and imaginative consumed more fruits and vegetables, and boys who were more extraverted, more conscientious, and less neurotic consumed more fruits and vegetables. Controlling for maternal education, boys and girls who were less extraverted, and girls who were less benevolent, less conscientious, and more neurotic were more likely to be overweight or obese. These findings suggest that children's personality traits play an important yet understudied role in their diet. Further investigation of mechanisms that relate child traits to obesogenic eating and overweight would be valuable.

Aims To investigate associations between maternal stress and smoking prior to, during and 6 months after the pregnancy. Design A prospective population-based cohort study. Setting Norway. Participants A total of 71 757 women in the Norwegian Mother and Child Cohort Study (MoBa) participating twice during pregnancy and at 6 months postpartum. Measurements Respondents' estimates of anxiety and depression, relationship discord and negative life events were measured, along with self-reports of smoking behaviour and demographic variables. Smoking was assessed at gestation weeks 17 and 30 and at 6 months postpartum. Findings Of the 27.5% women who smoked at conception, 55.8% quit smoking during pregnancy. At 6 months postpartum, 28.9% of quitters had relapsed to smoking. In total, 12.9% of the sample reported smoking during the pregnancy. Adjusted for well-known risk factors, women reporting high levels of anxiety and depression had a decreased likelihood of quitting smoking during pregnancy [odds ratio (OR) 0.80, 95% confidence interval (CI): 0.73, 0.88) and an increased likelihood of relapsing after delivery (OR 1.26, 95% CI: 1.11, 1.44). Both relationship discord (OR 0.82, 95% CI: 0.75, 0.90) and exposure to negative life events (OR 0.93, 95%: CI 0.90, 0.96) had a negative influence on quitting smoking during pregnancy but had no influence on relapse to smoking postpartum. Conclusions Maternal stress and relationship discord may inhibit smoking cessation during pregnancy and promote resumption of smoking after pregnancy in women who have achieved abstinence.

Background: Previous studies found notable rates of post-traumatic stress symptoms (PTSS) and post-traumatic stress disorder (PTSD) in pediatric patients and their parents and suggest a significant association between child and parent PTSS. However, little is known about mutual influences between child and parental PTSS over time. This study prospectively examined the presence of PTSS and PTSD and the mutual influence of child and parental PTSS in a large sample of pediatric patients with different medical conditions. Methods: A total of 287 children (aged 6.5-16 years) and their mothers (n = 239) and fathers (n = 221) were assessed at 5-6 weeks and 1 year after an accident or a new diagnosis of cancer or diabetes mellitus type 1 in the child. Results: At the first assessment 11.1% and at the second assessment 10.2% of the children had moderate to severe PTSS. At 5-6 weeks 29.3% of mothers and 18.6% of fathers met criteria for PTSD. At 1 year the rates were 14.6% for mothers and 7.9% for fathers. There were considerable differences of PTSS among different medical diagnostic groups in children and parents. Mothers were more vulnerable than fathers. Structural equation analysis revealed that initially high PTSS in mothers and fathers were longitudinally related to poorer recovery from PTSS in the child. Cross-lagged effects from the child to the parents and from one parent to the other were not significant. Conclusions: This study highlights the long-term influence of parental PTSS on the child's recovery after trauma and calls for a family systems approach and for early interventions in the treatment of traumatized pediatric patients. Language: en

OBJECTIVE To investigate whether children with varying severity of congenital heart defects (CHDs) have a higher risk of internalizing or externalizing emotional problems at 36 months of age. In addition, to analyze whether a history of emotional problems at 6 or 18 months of age increases the risk of emotional problems at 36 months in children with CHDs. METHODS Prospective data from the Norwegian Mother and Child Cohort Study, conducted by the Norwegian Institute of Public Health, was linked with a nationwide CHD registry, and 175 children with CHDs were identified in a cohort of 44,104 children aged 36 months. Maternal reports on child characteristics were assessed by questionnaires at child age 6, 18, and 36 months. RESULTS Children with CHDs did not have elevated scores on internalizing or externalizing problems at 36 months of age compared with controls. Not even the children with CHDs with a history of emotional problems at age 6 or 18 months showed an increased risk. CONCLUSIONS The absence of risk of emotional problems at 36 months of age in children with CHDs could be a consequence of the completion of the most extensive medical treatment.

Posttraumatic growth (PTG) can occur after various types of trauma but has not been studied prospectively in parents of children with chronic diseases. In this study, PTG was assessed in 126 parents of 67 children with type 1 diabetes or cancer three years after diagnosis. Most parents (62.7%) reported at least a moderate degree of PTG. Quality of family relationships, parental psychological distress and child medical characteristics assessed one month after diagnosis, and parents’ gender, explained 34 percent of PTG variance. The findings confirm that a severe disease of a child can lead to personal growth in the child’s parents.

Aim: To examine the association of the severity of congenital heart defects (CHDs) with internalizing problems in 18-month-olds and to explore the extent to which the internalizing problems are influenced by maternal distress and emotional reactivity in the child at age 6 months. Methods: We linked prospective data from the Norwegian Mother and Child Cohort Study, conducted by the Norwegian Institute of Public Health, with a nationwide CHD registry and identified 198 18-month-olds with CHDs in a cohort of 47 692 toddlers. Maternal reports on the children’s emotional reactivity at age 6 months, the children’s internalizing problems (anxiety, sleep problems, emotional reactivity) at age 18 months and maternal distress were assessed by questionnaires. Results: We found an association at age 18 months between the severity of the CHD and anxiety but not sleep problems or emotional reactivity. Children with severe but not with mild or moderate CHDs were twice as likely to experience the symptoms of anxiety compared with controls. These symptoms are not merely sequelae of earlier psychological reactions or concurrent maternal distress. Conclusion: Should these findings be replicated, future studies ought to investigate the mechanisms leading to elevated anxiety in toddlers with CHDs. In addition, clinical interventions should address the child’s anxiety as well as the interaction between the parents and the child.

Background With the advances in congenital cardiac surgery and medical management,mortality rates for congenital heart defects (CHD) have declined remarkably.As the number of CHD survivors have increased there is a growing focus on developmental morbidity.The objective of the current study is to compare symptoms of communication and social impairment in 18-month-old children with different severity of CHD with those of controls. Method We linked prospective data from the Norwegian Mother and Child Cohort Study, conducted by the Norwegian Institute of Public Health,with a nationwide medical CHD registry and identified 198 18-month-olds with CHD in a cohort of 47 692.Three groups of CHD were distinguished:mild/moderate (n = 122),severe (n = 54) and CHD with comorbidity (n = 22).Mothers reported on the child’s communication and social skills by completing items from the Ages and Stages Questionnaire as part of the Norwegian Mother and Child Cohort Study. Results Children aged 18 months old with CHD differed significantly from controls in levels of symptoms of communication impairment (P ! 0.0001) and social impairment (P ! 0.0001).The largest differences were found in children with CHD and comorbidity.Children with severe CHD also showed higher levels of both symptoms of communication and social impairment.Children with mild/moderate CHD showed a small difference only in symptoms of communication impairment. Conclusion Children with severe CHD and CHD with comorbidity show more symptoms of communication and social impairment compared with a large cohort at the age of 18 months.It is important to broaden the scope of inquiry to involve communication and social developmental domains.

The aims of the current study were to (1) identify dietary patterns in 3-year-old children; (2) investigate the extent to which negative affectivity, external parental locus of control and control-oriented child-feeding practices (pressure to eat and restriction) relate to these dietary patterns; and (3) to examine to what extent external parental locus of control and control-oriented child-feeding practices serve as mediators for these effects. This study was part of the Norwegian Mother and Child Cohort Study, comprising 14,122 mothers completing assessments at 6 months, 18 months and 3 years post-partum. Factor analysis of the children's diet identified two weakly correlated dietary patterns, labeled 'unhealthy' and 'wholesome'. Mothers high in negative affectivity perceived they had little control over their child's behaviour, which in turn was associated with both pressuring their child to eat and restricting the child's food intake and a less wholesome and a more unhealthy diet in the child. Pressuring the child to eat was independently associated with a less wholesome and a more unhealthy diet. Restricting the child's diet was associated with a more wholesome and a less unhealthy diet. These findings held after controlling for maternal smoking, education, age, body mass index, marital status, homemaker status and child gender.

Congenital heart defects (CHD) constitute the most common congenital malformation and occur in approximately 0.8% of all live-born infants (Eskedal et al., 2005). Advances in medical and surgical treatments have led to approximately 85% of these infants surviving to adulthood (Meberg, Lindberg, & Thaulow, 2005; Nieminen, Jokinen, & Sairanen, 2001; Thorne & Deanfield, 1996) transforming several previously fatal conditions into potentially survivable conditions. Still, although it offers the chance of prolonged or permanent remission of the underlying defect, medical and surgical treatment itself might be highly stressful for the infants and their mothers, possibly leaving them with long-term medical and psychosocial sequelae of the chronic condition (Apley, Barbour, & Westmacott, 1967; Davis, Brown, Bakeman, & Campbell, 1998). The clinical manifestations of the different types of CHD vary greatly, with broad variations in severity (mild, moderate, severe) and in the length and invasiveness of the different treatments. While infants with some forms of mild CHD [e.g., small ventricular septal defects (VSD)] may heal spontaneously within 6 months, infants with severe forms of CHD are usually clearly symptomatic at birth and the most acute medical interventions are carried out during the first year of life. Having a child with severe CHD therefore exposes mothers to a variety of stressors, such as the fear of losing their newborns, concerns related to the medical condition and its prognosis, and frequent, prolonged hospital visits (Glaser, Harrison, & Lynn, 1964; Van Horn, DeMaso, Gonzalez-Heydrich, & Erikson, 2001). Parents often respond with shock when the diagnosis is first made and the postpartum parenting of a child with a chronic illness is considered to be a highly stressful for the parents and family (Cohen, 1999; Davis, 1993). Even if treatment is successful and the infant eventually is discharged, many challenges might remain. The infant may show growth impairment and neurodevelopmental retardation, have respiratory problems, digestive problems, and/or breastfeeding problems (Clemente, Barnes, Shinebourne, & Stein, 2001; Dittrich et al., 2003; Saenz, Beebe, & Triplett, 1999) as a result of the cardiac defect, severe co-morbidities or repeated or prolonged surgical interventions. These challenges entail heightened levels of maternal stress that might complicate the postpartum period and affect mothers’ mental health. In fact, a study by Lawoko and Soares (Lawoko & Soares, 2002) showed that when comparing differences in distress (e.g., depression, anxiety, and suicide ideation) among parents of children with CHD, parents of children with other diseases, and parents of healthy children, mothers of children with CHD were generally at higher risk, reporting the highest levels of distress compared to the mothers in the other groups. Furthermore, the results showed that 24% of the mothers in the CHD group reported global levels of distress within or above norms for psychiatric outpatients. CHD severity was shown to have a weak, but positive correlation with scores on depression, i.e., the more severe the defect, the higher the risk of maternal depression. A second study by the same authors (Lawoko & Soares, 2006) saw these findings withstanding the test of time within a longitudinal design, with a large proportion of the same sample reporting long-standing symptoms of depression, anxiety, and somatisation over a period of 1 year, indicating prolonged psychosocial morbidity. On a similar note, a study by Goldberg, Morris, Simmons, Fowler and Levinson (Goldberg, Morris, Simmons, Fowler, & Levison, 1990) found that parents of infants with CHD reported the highest amount of stress within the child domain of the Parenting stress index compared to parents of infants with cystic fibrosis. On the other hand, Thompson and associates found that maternal adjustment in mothers of children with sickle cell disease was significantly more related to psychosocial processes, such as the presence of social support (Thompson Jr, Gil, Burbach, Keith, & Kinney, 1993). When incorporated in a transactional stress and coping model, the psychosocial processes accounted for variance in maternal adjustment over and above that explained by illness characteristics and/or severity. Moreover, a similar study by Uzark and Jones (Uzark & Jones, 2003) found that parents of children with heart defects were more likely than controls to report excessive parenting stress, but this was especially related to characteristics of the child that made them difficult to parent, not the heart defect severity in itself. The studies by Lawoko and Soares (2002) and Uzark and Jones (2003) included parents of children with a mean age of 8 and 6 years, respectively. Neither study provided information on the critical period from delivery to 6 months, where parents are most vulnerable (Cooper & Murray, 1998). Moreover, although information regarding the children’s CHD diagnosis was obtained, precise information regarding the classification criteria for CHD severity was not presented or deviated from the common CHD grouping of “mild”, “moderate” and “severe”, making it difficult to understand why only a weak association between CHD severity and parental distress was found. Since depression and anxiety in mothers have previously been shown to interfere with the quality and responsiveness of maternal care (Downey & Coyne, 1990), one could speculate that the mothers’ symptoms of depression and anxiety could become an additional burden for infants with CHD and lead to disturbances in their development. It is therefore important to elucidate the above mentioned findings further in order to isolate the impact of illness severity, and to better understand the needs of mothers of infants with CHD with regard to future development of interventions. Furthermore, most studies concerned with the prediction of maternal distress related to their children’s health have utilized retrospective or cross-sectional designs, whereas longitudinal designs with prenatal, maternal symptomatology baselines are missing. It is likely that psychological functioning during pregnancy account for the greatest amount of variance in postpartum functioning, and it is therefore important to assess mothers’ symptomatology both before and after childbirth. Only with this type of longitudinal design, can one begin to move from cross-sectional correlations to analyses that are temporally congruent with the causal ordering of the variables. In light of the aforementioned, the aim of the present study was to chart symptom trajectories of depression and anxiety from pregnancy to 18 months postpartum in mothers of infants with varying degrees of CHD severity. A large pregnancy cohort served as controls, establishing a normative, postpartum mental health trajectory. We hypothesised that CHD severity would affect the mothers’ mental health, i.e. the more severe the defect, the higher the risk of maternal distress, and that mothers of infants with CHD in general would be at greater risk of developing long-standing symptoms of depression and anxiety compared to controls within this especially vulnerable postpartum period.

Objective: To explore the prevalence of breast milk feeding (BMF) of infants with congenital heart defects (CHD) during first 6 months of life, as compared with general population. Design: The study is based on a subsample of the Norwegian Mother and Child Cohort Study conducted by Norwegian Institute of Public Health. A total of 60 600 mothers completed a questionnaire about infant feeding at 6 months postpartum. Infants with moderate/severe CHD (n = 131) were identified using nationwide CHD registry. A group of infants with CHD with comorbidity was also defined (n = 65). BMF was classified as predominant, continued, or no BMF. Month to month feeding status was analysed by means of Cox regression analyses. Results: Between child age 2–6 months, mothers of infants with CHD had a hazard ratio (HR) of 1.69 of weaning their child compared with mothers of controls. Mothers of infants with CHD with comorbidity weaned at an even faster rate (HR 3.54). At age 6 months, 9.9% of infants with CHD were fed with breast milk predominately, 64.1% continued to receive breast milk, and only 26% were fed no breast milk. For infants with CHD with comorbidity, corresponding percentages were 7.7%, 43.1% and 49.2%, respectively. Conclusions: Although CHD alone and particularly CHD with comorbidity increased risk that mothers wean earlier, a relatively high rate of continued breastfeeding was maintained. Future studies should investigate factors that support continued BMF even in the most severely affected children with CHD.

This study prospectively examined dyadic influences of parental personality on levels and change of family functioning in parents of a newly hospitalized child. A total of 183 couples whose child sought treatment for Type 1 diabetes, cancer, or an unintentional injury were assessed at 1 and 6 months posthospitalization with tests measuring personality, and family functioning. Analyses used structural equation modeling based on the actor–partner interdependence model. Family functioning in both parents showed substantial differential stability and interdependence. Mothers' Neuroticism and Agreeableness and fathers' Openness and Conscientiousness influenced their own family functioning. Fathers' Conscientiousness influenced their spouse's family functioning. Both parents' personalities influenced their family functioning over time, underlining that the parents' perspectives should be studied jointly.

The objective of this study was to analyze whether maternal negative affectivity assessed in pregnancy is related with subsequent infant food choices.The study design was a cohort study.The subjects were mothers (N=37 919) and their infants participating in the Norwegian Mother and Child Cohort Study conducted by the Norwegian Institute of Public Health.Maternal negative affectivity assessed prepartum (Hopkins Symptom Checklist 5 (SCL-5) at weeks 17 and 30 of pregnancy), introduction of solid foods by month 3 and feeding of sweet drinks by month 6 (by the reports of the mothers) were analyzed.Mothers with higher negative affectivity were 64% more likely (95% confidence interval 1.5-1.8) to feed sweet drinks by month 6, and 79% more likely (95% confidence interval 1.6-2.0) to introduce solid foods by month 3. These odds decreased to 41 and 30%, respectively, after adjusting for mother's age, body mass index (BMI) and education.The maternal trait of negative affectivity is an independent predictor of infant feeding practices that may be related with childhood weight gain, overweight and obesity.

Early dietary habits are formative for dietary habits later in life. Maternal personality might be an important factor in unhealthy feeding of children. The current study aims to assess the degree to which the personality trait of negative affectivity in mothers predicts their child's diet at age 18 months. This study is a part of the Norwegian Mother and Child Cohort Study conducted at the Norwegian Institute of Public Health. A total of 27 763 mothers completed 3 repeated assessments of negative affectivity before and after childbirth and of the child's diet when the child was 18 months old. Exploratory factor analysis was used to identify the dietary patterns, and structural equation modeling was used to investigate the relationship with negative affectivity adjusted for socio-demographical variables. Exploratory factor analysis of a foods frequency questionnaire revealed two dietary patterns in the child, labeled unhealthy diet and wholesome diet. The unhealthy diet comprised foods rich in sugar and fat; the wholesome diet comprised foods rich in fibre, vitamins and minerals. Mothers high in negative affectivity were more inclined to feed their child an unhealthy diet. The results were adjusted for maternal age, years of education, relative income, marital status, number of children, having the child in daycare, maternal smoking, maternal body mass index, and child gender. This study shows that a maternal personality trait, negative affectivity, is related to feeding the child an unhealthy diet after controlling for key socio-demographic variables.

Objective The relation between prenatal smoking and child behavioral problems has been investigated in children of school age and older, but prospective studies in younger children are lacking. Using the population-based prospective Norwegian Mother and Child Cohort Study, we examined the risk for externalizing behaviors among 18-month-old children after exposure to maternal smoking during pregnancy. Method Participants were 22,545 mothers and their 18-month-old children. Mothers reported their smoking habits at the 17th week of gestation and their child's externalizing behavior at 18 months of age by means of standardized questionnaires. Data were analyzed using logistic regression, with scores of externalizing behavior above the 88.6th percentile as the dependent variable and self-reported smoking as the independent variable. We examined the child's sex as a possible moderator. Results We documented a threshold effect of smoking 10 cigarettes or more per day during pregnancy on subsequent externalizing behaviors among 18-month-old children, even after adjusting for relevant confounders (odds ratio 1.32, 95% confidence interval 1.03–1.70). The child's sex did not moderate these effects (odds ratio 0.98, 95% confidence interval 0.83–1.16). Conclusions Maternal smoking during pregnancy increases offspring's subsequent risk for externalizing behavior problems at 18 months of age. The pattern of risk does not differ between boys and girls. Our findings suggest a population attributable risk of 17.5% (i.e., the proportion of externalizing cases that could potentially be avoided if prenatal smoking was eliminated or reduced to fewer than 10 cigarettes per day).

Objective: There is little knowledge on health-related quality of life (HRQOL) of injured children and adolescents after road traffic accidents (RTA). Although findings in injured adults suggest that post-traumatic stress symptoms (PTSS) may be important predictors of HRQOL, this issue has never been prospectively examined in children. The aim of the present study was therefore to prospectively assess HRQOL in children after RTA and specifically examine the impact of PTSS on HRQOL. Method: Sixty-eight children (aged 6.5–14.5 years) were interviewed 1 month and 1 year after an RTA using the Child PTSD Reaction Index and the Toegepast Natuurwetenschappelijk Onderzoek-Academisch Ziekenhuis Leiden (TNO-AZL) Questionnaire for Children's Health-Related Quality of Life. Parents and physicians were assessed with questionnaires. Results: Eleven children (16.2%) showed moderate to severe post-traumatic stress reactions at 1 month, and 12 children (17.6%) at 1 year. At 1 month, patients reported reduced motor functioning and autonomy and impairments in some parts of emotional functioning compared to a community sample. At 1 year all dimensions of HRQOL were within or above normal ranges. Multivariate analysis indicated that PTSS at 1 month significantly predicted HRQOL at 1 year. Conclusions: This prospective study provides evidence for a long-term negative influence of early PTSS on HRQOL in injured children. The return of injured children to pre-injury HRQOL may therefore not only depend on optimal medical care but also on awareness and timely interventions regarding PTSS.

Objective To assess the degree to which mothers' prepartum personality traits predict breastfeeding status at 6 months postpartum. Study design This prospective cohort study is part of the Norwegian Mother and Child Cohort Study, conducted at the Norwegian Institute of Public Health. A total of 27,753 mothers completed assessment of negative affectivity (NA) and general self-efficacy (GSE) at gestation weeks 17 and 30 and completed a questionnaire about infant feeding at 6 months postpartum. Feeding status was classified with a cutoff at 6 months in the categories of predominant breastfeeding, mixed breastfeeding, and bottle-feeding. Results After adjusting for maternal smoking, age, education, cesarean section, preterm birth, primiparity, and external daycare, NA increased the odds of mixed breastfeeding (odds ratio [OR], 1.16; 95% confidence interval [CI], 1.03 to 1.32) and bottle feeding (OR, 1.32; 95% CI, 1.14 to 1.53) compared with predominant breastfeeding. GSE decreased the odds of bottle feeding (OR, 0.90; 95% CI, 0.84 to 0.97) but not of mixed breastfeeding (OR, 0.98; 95% CI, 0.92 to 1.04) compared with predominant breastfeeding. The adjusting variables were also predictors of breastfeeding behavior in their own right. Conclusions Our results show that NA and GSE are important antenatal predictors of breastfeeding status at 6 months postpartum.

Aim Little is known about the influence of the personality of the child and the personalities of the child’s parents on glycaemic control in Type 1 diabetes. Our objective was to examine the extent to which glycaemic control is associated with the child’s and the parents’ stable personality traits, using the Big Five personality model as the basic framework. Methods Participants were 64 children (aged 6–16 years) with recent-onset Type 1 diabetes and their parents. Glycaemic control (HbA 1c ) was assessed at 6 months, 1 year and 2 years after diagnosis; personality was assessed at 4–6 weeks, 6 months and 1 year after diagnosis. Associations of personality with mean HbA 1c over 2 years were examined. Results Children with better glycaemic control had a personality pattern of high Agreeableness, high Conscientiousness and low Neuroticism. Mothers of children with better glycaemic control showed a similar personality pattern, whereas the personality of the father was only marginally related to glycaemic control. Children’s Conscientiousness and mothers’ Agreeableness together predicted 18% of the variability in mean HbA 1c . All associations were unchanged when we controlled for child’s age. Conclusions Glycaemic control in the child was associated with the same child and maternal personality characteristics that influence treatment adherence, health-promoting behaviours and general adjustment in adult populations. In future, studies are needed to examine attitudinal and behavioural mediators of this relationship. It is suggested that attention to the personalities of the child and the mother can help to tailor diabetes education to the individual child.

Since resources flow to those at the top of the hierarchy in all known groups, “getting ahead” is assumed to be one of the central human motivations. The present research project was designed to assess tactics of hierarchy negotiation, identify the robustness of their factor structure, and relate tactics use with personality traits, values, and salary. The participants were 315 professionals in two work settings. Measures included assessments of tactics of hierarchy negotiation, personality traits, life values, and work-related variables. The results established the robustness of three factors of hierarchy negotiation: Deception/Manipulation, Social Display/Networking, and Industriousness/Knowledge. These factors showed coherent links with personality traits and values and predicted salary above and beyond the effects of personality traits. The discussion focuses on implications of the results and directions for future research.

Aim: To assess the prevalence of specific coping strategies and predictors of coping strategy selection in 179 patients (mean age= 10.2 y). The children were investigated one month after the occurrence of an accident (n= 105), diagnosis of cancer (n= 26) or diagnosis of diabetes mellitus type I (n= 48). Results: Patients used a great variety of coping strategies. The most frequent strategies were cognitive avoidance, positive cognitive restructuring and avoidant actions. The strategies of seeking problem-focused support and emotion-focused support were rarely used. Diagnostic category, length of hospital stay, and gender were not associated with coping strategy use. Age, socioeconomic status and functional status of the patient were found to predict coping strategy selection. Younger children made less use of active coping, distraction and seeking support. Patients of lower socioeconomic status used religious coping strategies significantly more often, whereas patients with lower functional status used avoidance and support-seeking strategies more often. Conclusion: In this study it was found that paediatric patients used a wide variety of coping strategies, irrespective of diagnosis and gender. Age of the child and functional status were the most important predictors of coping strategy selection.

This study examines the associations of child temperament with overweight/obesity and breakfast habits. Participants were 17,409 five-year-olds whose mothers partake in the Norwegian Mother and Child Cohort Study (MoBa), and completed a questionnaire at the child’s 5th birthday. Temperament was assessed as externalizing, internalizing and sociable temperament. Breakfast habits differentiated between “every day”, “4 to 6 times a week”, and “0 to 3 times a week”. The child’s weight status was determined by Body Mass Index-percentiles and categorized as normal weight versus overweight/obese. Children with externalizing temperament had higher odds of being overweight and higher odds of not eating breakfast daily. Children high in internalizing temperament had higher odds of not eating breakfast daily, but not of being overweight. Children with average scores of sociability were more prone to being overweight but had normal breakfast habits. All results were adjusted for key confounders. That five-year-olds high in externalizing temperament had a higher risk to be overweight adds important information to the literature. The association of externalizing temperament with child breakfast habits so early in life is intriguing, as parents mostly control eating patterns in children that young. Mechanisms mediating this association should be explored.

Background Studies suggest that preterm delivery is a risk factor for early language delays, but knowledge is scarce about the persistence of the delays and whether the association is of a linear kind. To resolve this, effects of confounding risk factors that are both shared within a family and pregnancy specific need to be distinguished from effects of preterm delivery. Our study examines the association between early gestational age and language outcomes, using a sibling-control design. Methods The sample comprises 22,499 siblings from the Norwegian Mother and Child Birth Cohort Study, recruited between 1999 and 2008. Mothers rated child language comprehension and production at 18 and 36 months. Analyses compared siblings discordant on gestational age group (early preterm, delivery at week 22-33; late preterm, 34-36; early term, 37-38; full term, >38) and type of onset of delivery (spontaneous; provider-initiated), and compared these findings with conventional cohort analyses. Results The findings revealed inverse linear relations between the gestational age groups, and persistent but diminishing language delays. Effects of preterm delivery were substantial on both language production and comprehension at 18 months. By 36 months, the effects of preterm delivery were weaker, but still extensive, in particular for language production in provider-initiated births. When comparing sibling-control with cohort analyses, preterm group was less important among spontaneous births, but remained important in provider-initiated births. Familial and pregnancy risk factors partly explained this. Conclusions Distinctive factors seem to underlie effects of preterm delivery across spontaneous and provider-initiated births.

Objective Child-related stress following the birth of a child with special health care needs (SHCN) can take a toll on parental health. This study examined how the risk of sick leave due to psychiatric disorders (PD) among mothers of children with SHCN compares with that of mothers of children without SHCN during early motherhood. Methods Responses from 58,532 mothers participating in the Norwegian Mother and Child Cohort Study were linked to national registries and monitored for physician-certified sick leave from the month of their child’s first birthday until the month of their child’s fourth birthday. Results As compared with mothers of children without SHCN, mothers of children with mild and moderate/severe care needs were at substantial risk of a long-term sick leave due to PD in general and due to depression more specifically. Conclusions Extensive childhood care needs are strongly associated with impaired mental health in maternal caregivers during early motherhood. publishedVersion

Children's personality traits are invaluable predictors of concurrent and later mental and physical health. Several validated longer inventories for assessing the widely recognized Five-Factor Model of personality in children are available, but short forms are scarce. This study aimed at constructing a 30-item form of the 144-item Hierarchical Personality Inventory for Children (HiPIC) (MervieldeDe Fruyt, ). Participants were 1543 children aged 6-12 years (sample 1) and 3895 children aged 8 years (sample 2). Sample 1 completed the full HiPIC, from which we constructed the HiPIC-30, and the Child Behaviour Checklist (Achenbach, ). Sample 2 completed the HiPIC-30. The HiPIC-30 personality domains correlated over r = .90 with the full HiPIC domains, had good Cronbach's alphas and correlated similarly with CBCL behaviour problems and gender as the full HiPIC. The factor structures of the HiPIC-30 were convergent across samples, but the imagination factor was not clear-cut. We conclude that the HiPIC-30 is a reliable and valid questionnaire for the Five-Factor personality traits in children. Copyright © 2016 John WileySons, Ltd.

Findings about the influence of coping on psychological adjustment in children with different medical conditions are inconsistent and often based on cross-sectional data. This prospective study evaluated the effect of various coping strategies on children's post-traumatic stress symptoms and behavioral problems 1 month and 1 year after an accidental injury or the diagnosis of a chronic disease in 161 pediatric patients 6-15 years of age. Only minor positive effects of coping on psychosocial adjustment were found: Religious coping reduced post-traumatic stress symptoms. Active coping strategies had negative effects on internalizing and externalizing behavioral problems. Support seeking strategies, distraction, and avoidance had no impact on long-term psychosocial adjustment.

Objective To determine the prevalence, course, and predictors of posttraumatic stress disorder (PTSD) in mothers and fathers of children with newly diagnosed type 1 diabetes. Method Forty-nine mothers and 48 fathers of 52 children (response rate 65%) with newly diagnosed diabetes (age 6.5-15 years) were assessed at 6 weeks, 6 months, and 12 months after the diagnosis with the Posttraumatic Diagnostic Scale. Results The prevalence of current PTSD in mothers was 22.4% at 6 weeks, 16.3% at 6 months, and 20.4% at 12 months. In fathers, PTSD was found in 14.6%, 10.4%, and 8.3%, respectively. Mothers endorsed more symptoms of PTSD at all assessments. Multivariate analyses controlling for demographics, metabolic control, and threat appraisals revealed that in mothers, the number of preceding life events and PTSD symptoms at 6 months predicted PTSD at 12 months. In fathers, PTSD severity at 6 months was the only significant predictor for PTSD at 12 months. Conclusions The results suggest that the diagnosis and treatment of diabetes in their child constitute traumatic events for parents. The findings confirm the applicability of a posttraumatic stress model for investigating the psychological impact of diabetes on parents.