Finnish Children Research Articles

Is Physical Intimate Partner Violence a Risk Factor for Physical Child Maltreatment in a Nationally Representative Sample of Finnish School Children?

Previous studies have found a high co-occurrence between intimate partner violence and child maltreatment. However, little is known about the nuanced association between physical intimate partner violence (pIPV) and physical child maltreatment (pCM) in countries where corporal punishment is prohibited by law. Furthermore, there is a lack of information on the co-occurrence from children's perspectives and nationally representative surveys. The main objective of this study was to examine the connection between pIPV and pCM in a nationally representative sample of 12 to 13 and 15- to 16-year-old Finnish children (N = 6,825) after controlling for other known risk factors. The χ2 test and the logistic regression model were used. Around 47.3% of the children who had been exposed to pIPV had also experienced pCM during the past year, whereas 6.7% of those who had not been exposed to pIPV reported pCM. Children exposed to pIPV were almost three times more likely to experience pCM than children who were not exposed to pIPV. The connection remained statistically significant after controlling for other risk factors. Prevention and early identification of pIPV might reduce pCM in families. Targeted prevention efforts and interventions aimed at physical family violence are necessary to reduce its occurrence and mitigate the impact of abuse on children and families.

Finnish children born very preterm have good reading comprehension but weak reading fluency at age 11 years – a longitudinal cohort study

ABSTRACT Children born very preterm (<32 gestational weeks and/or birth weight ≤1500 g) are at elevated risk for reading difficulties. This study aimed to investigate reading fluency and reading comprehension at 11 and to analyze the associations between literacy skills at 7 and reading skills at 11 in 134 Finnish-speaking very preterm children. At 11, reading fluency and reading comprehension were evaluated. At 7, pre-reading skills, decoding, and writing were assessed. Results showed that there were more preterm children with weak skills in reading fluency compared to a normative test population. Reading comprehension was age appropriate. Additionally, 62% to 68% of the children with weak literacy skills at 7 had weak reading fluency at 11, compared to those with more advanced skills (43% to 33%, p < 0.001 to 0.026). Respectively, 30% to 50% of the children with weak literacy at 7 had weak reading comprehension at 11 compared to those with more advanced skills (13% to 17%, p < 0.001 to 0.005). Findings highlight the importance of screening reading fluency until 11 years and providing support for the continuum between literacy skills in the beginning of schooling and reading outcome at later school age.

Immune or inherited thrombocytopenia? A population-based cohort study on children and adolescents presenting with a low platelet count.

Thrombocytopenia is a common hematologic finding in children and adolescents. Immune thrombocytopenia (ITP) is the most common cause of this finding, but the differential diagnosis includes a growing list of genetic disorders. We aimed to report differences in phenotypes of patients with ITP, inherited platelet disorder (IPD)/primary immunodeficiency disorder (PID), and other causes, with a focus on differentiating ITP from inherited thrombocytopenia. This retrospective, population-based observational cohort from 2006 to 2020 involved 506 Finnish children under 16years of age presenting with isolated thrombocytopenia. Of the 506 participants, 79.7% had ITP, 6.7% had IPD/PID, and 13.6% had other causes of thrombocytopenia. A platelet count of ≤12 × 109/L best distinguished between ITP and other reasons with a sensitivity of 60% and a specificity of 80%. Among patients with the lowest platelet count of less than 10 × 109/L, 95.9% had ITP, 3.3% had IPD/PID, and 0.8% had other causes. Severe bleeding events were reported in 20 patients (4.0%), but there were no cases of intracranial or fatal bleeding due to thrombocytopenia. Up to 50% of patients with a high suspicion of inherited thrombocytopenia remained without a specific diagnosis despite genetic testing. ITP remains the most common cause of thrombocytopenia. A platelet count of ≤12 × 109/L often leads to an ITP diagnosis. Genetic disorders are rare but should be suspected in patients with persisting thrombocytopenia, especially with platelet counts constantly above 12 × 109/L, a positive family history, or atypical clinical features.

Predicting Adolescent Arithmetic and Reading Dysfluency.

The long-term negative consequences of learning difficulties have been acknowledged. Nonetheless, research is still scarce regarding the prediction of adolescent difficulties in reading and arithmetic skills. The present study examines at which age phase and with what kind of constellation of parent- and child-related factors can adolescent difficulties in arithmetic and/or reading fluency be successfully predicted. A sample of Finnish children (N = 941) was followed from the onset of kindergarten (at age 6) through adolescence (ages 13-16). Children's cognitive skills were assessed in kindergarten, and arithmetic and reading fluency were examined in Grades 2, 4, 6, 7, and 9. Parents' self-report data were collected on their own learning difficulties and educational level. Scoring below the 16th percentile in both Grades 7 and 9 was set as the criterion for dysfluency either in reading (N = 87, 9.2%) or arithmetic (N = 84, 8.9%). Adolescent dysfluency in both domains was moderately predicted by parental measures and kindergarten cognitive skills. Although adding school-age fluency measures clearly increased both the predictability and specificity of models up to Grade 4 for both skills, knowledge of letters' names, counting, and visuospatial skills remained unique predictors of dysfluency in adolescence.

The association of economic difficulties with social and health care costs of children-target trial emulation using complete birth cohort data in Finland.

It is unclear how much costs economic difficulties in families with children incur to the health and social care sector. We examined the health and social service costs after families entered into, and transitioned out of, social assistance used as a proxy measure for economic difficulties. We analyzed register data on all Finnish children born in 1997 and used the non-randomized target trial framework. The two target trials of entry to economic difficulties (social assistance) and continued economic difficulties included 697 680 and 71 131 children-year observations, respectively, in total. Inverse probability treatment weighting techniques were used to make the comparison group similar to the treatment group in terms of health, socioeconomic and demographic-related pretreatment variables. Entry to social assistance use was associated with some 1511-2619€ (50% compared to the control group) higher cumulative health and social care costs of the children three years after their families transitioned to social assistance, compared to the group that did not enter to social assistance system. This difference was primarily attributed to higher social care costs. Continued social assistance use was associated with some 1007-2709€ (31%) higher costs compared to the comparison group that exited social assistance. These findings support an economic argument to prevent families from entering economic difficulties and to help those in such situations to transition out.

Limited input and the acquisition of Finnish: The evolution of a child speaker in a multilingual environment

Aims and Objectives/Research Question: This is a case study of a toddler acquiring Finnish in a trilingual (Finnish–Spanish–English) setting. Despite the apparent ease of the child’s acquisition of Finnish, the pressure of the majority language (English) suppresses the use of the acquired minority language. Is it feasible to expect an early-childhood minority language to be maintained at the level of production? Design/Methodology: Video-recordings were collected in domestic settings, mostly with the Finnish-speaking mother in interactions with the child, who was between the ages of 3;6 and 4;6. The approach follows loosely the principles of interactional sociolinguistics. Data and Analysis: The data were collected in 2008, when the child was 3 years old, and the follow-up data 8 months later, when the child was four. Samples of this corpus are analyzed in detail for the emerging target-like Finnish case endings and verbal inflections, as well as for deviations from adult Finland Finnish. The mother’s strategies of maximizing the effects of the limited input are also discussed. Findings/Conclusions: Even though the input the child receives is limited, his acquisition of Finnish morphosyntax follows monolingual patterns and shows overgeneralizations typical of monolingual Finnish children’s language. Some transfer from the contact with English and Spanish languages is present. The question of ultimate attainment in a heritage-language situation is addressed. Originality: The study is rare, as it documents the rapid transition from the child’s well acquired minority language to English, the majority language, in the matter of months. Significance: This article confirms the vulnerability of childhood bilingualism: even a few months between the two longitudinal datasets show a sharp decline in the child’s output in the heritage Finnish, but the dichotomy between “maintenance” versus “loss” is challenged because the decline in output does not necessarily extend to the loss of comprehension.

Prenatal and Postnatal Exposure to Antibiotics and the Risk of Type 1 Diabetes in Finnish Children: A Registry-based Study

ObjectiveTo study whether prenatal and postnatal exposure to antibiotics is associated with the risk of type 1 diabetes in childhood. Study designA case-cohort study including 2,869 children diagnosed with type 1 diabetes by the end of 2009, born January 1, 1996, to December 31, 2008, in Finland and a reference cohort (n =74,263) representing 10% of each birth cohort. Exposure to antibiotics was assessed in different time periods. The data were derived from Special Reimbursement Register, Drug Prescription Register, and Population Register and analyzed with weighted Cox proportional hazards regression models. ResultsExposure to any antibiotics before or during pregnancy, in the neonatal ward, during the first year of life, or during the two first years of life, was not associated with the risk of type 1 diabetes in the offspring. Exposure to macrolides in the year preceding pregnancy (adjusted HR 1.17 [95% CI 1.02, 1.33]) and to sulfonamides and trimethoprim during pregnancy (adjusted HR 1.91 [1.07, 3.41]) was associated with an increased risk of type 1 diabetes in the offspring. Exposure to sulfonamides and trimethoprim during first two years of life was associated with decreased risk of type 1 diabetes (adjusted HR 0.84 [0.73, 0.97]). Number of antibiotic purchases among mothers or children was not associated with type 1 diabetes risk. ConclusionsPrenatal and postnatal exposure to antibiotics in general did not increase the risk of type 1 diabetes in the offspring. However, type of antibiotic and timing of exposure may play a role in type 1 diabetes risk.

Longitudinal relationship between organised and non-organised physical activities and overall physical activity in children aged 3-11years.

Young children's physical activity (PA) has been decreasing while their sports participation has been increasing. Therefore, the aim of this research was to longitudinally examine whether and, if so, how organised and non-organised PA participation by early childhood education and care (ECEC)-aged children (T1; 3-8years) predicted their accelerometer-measured PA at primary school age (T2; 7-11years). Secondarily, changes in organised and non-organised PA participation over time were investigated. The cluster-randomised study participants comprised 501 Finnish children (52.3% girls: T1, Mage=5.57±1.06; T2, Mage=8.80±1.07). PA participation was queried via guardian questionnaire at T1 and T2. Organised PA participation was operationalised as non-participation, participation in one sport or multisport (two or more) participation; non-organised PA was operationalised as time spent outdoors on weekdays and on weekend days. PA at T2 was measured using accelerometers. The primary outcome was tested using linear regressions, while a paired sample t-test and Mann-Whitney U test assessed differences between T1 and T2. The results showed outdoor time and organised sports participation increased from T1 to T2. Moreover, outdoor time at T1 predicted more moderate-to-vigorous PA (MVPA) and less sedentary time at T2, while multisport participation predicted significantly more MVPA and less sedentary time at T2. Overall, being outdoors and multisport participation at younger ages appear to have predicted Finnish children's later (MV) PA and sedentary behaviour.

Association of IL-17A and IL-10 Polymorphisms with Juvenile Idiopathic Arthritis in Finnish Children.

To analyze the role of interleukin IL-17A and IL-10 polymorphisms in susceptibility to juvenile idiopathic arthritis (JIA), 98 Finnish children and adolescents with JIA were studied. Data from the 1000 Genomes Project, consisting of 99 healthy Finns, served as the controls. The patients were analyzed for four IL-17A and three IL-10 gene-promoter polymorphisms, and the serum IL-17A, IL-17F, IL-10, and IL-6 levels were determined. The IL-17A rs8193036 variant genotypes (CT/CC) were more common among the patients than controls, especially in those with polyarthritis (OR 1.93, 95% CI 1.11-3.36; p = 0.020). IL-17A rs2275913 minor allele A was more common in patients (OR 1.45, 95% Cl 1.08-1.94; p = 0.014) and especially among patients with oligoarthritis and polyarthritis than the controls (OR 1.61, 95%CI 1.06-2.43; p = 0.024). Carriers of the IL-17A rs4711998 variant genotype (AG/AA) had higher serum IL-17A levels than those with genotype GG. However, carriers of the variant genotypes of IL-17A rs9395767 and rs4711998 appeared to have higher IL-17F levels than those carrying wildtype. IL-10 rs1800896 variant genotypes (TC/CC) were more abundant in patients than in the controls (OR 1.97, 95%CI 1.06-3.70; p = 0.042). Carriers of the IL-10 rs1800896 variant genotypes had lower serum levels of IL-17F than those with wildtype. These data provide preliminary evidence of the roles of IL-17 and IL-10 in the pathogenesis of JIA and its subtypes in the Finnish population. However, the results should be interpreted with caution, as the number of subjects included in this study was limited.

Reading and emotional-behavioural development in Finnish children: a longitudinal study of associations

AbstractPoor reading has been linked to negative outcomes on a wide range of emotional-behavioural dimensions in children. However, little is known about the time course of these associations. In this study we analyse data from a sample of Finnish children (N = 199; 106 boys) which included measures of reading fluency in grade 1 (age 7 or 8), and emotional (anxiety, depression, and somatization) and behavioural (adaptability, aggression, attention, atypicality, hyperactivity, social skills, and withdrawal) development at ages 4, 5, 6 (pre-school) and 9 (school-aged). In a series of stepwise regression models that controlled for non-verbal IQ and family risk for dyslexia, we tested if pre-school emotional-behavioural measures were associated with school-aged reading fluency, and whether school-aged reading fluency was associated with later emotional-behavioural development. We also tested if these associations were moderated by reported gender. Consistent with previous longitudinal studies, we found that poorer attention before school was associated with poorer reading in the early school years which in turn was associated with higher levels of anxiety and inattention in children in middle school. None of these associations were moderated by gender.

Predictors of dropout, time spent on the program and client satisfaction in an internet-based, telephone-assisted CBT anxiety program among elementary school children in a population-based sample.

Increasing evidence has shown that childhood anxiety can be effectively treated by Internet-based cognitive behavioral therapy (ICBT). Being able to predict why participants decide to drop out of such programs enables scarce resources to be used appropriately. The aim of this study was to report dropout predictors for a population-based ICBT intervention aimed at children with anxiety, together with the time they and their parents spent on the program and client satisfaction rates. The study focused on 234 Finnish children aged 10-13 who received an ICBT intervention, with telephone support, for anxiety symptoms, as a part of a randomized control trial. Their parents also had access to Internet-based material and participated in the weekly telephone calls with the coach. Possible drop out factors were explored and these included various family demographics, child and parent psychopathology and therapeutic alliance. Just under a fourth (23.9%) of the children dropped out of the intervention. The risk was higher if the child did not fulfill the criteria for any anxiety diagnosis or reported a poorer therapeutic alliance. Family demographics and the COVID-19 pandemic did not increase the risk. The families spent an average of 127min on the webpage each week and an average of 32min on the phone calls. The overall satisfaction with the program was 87% for the children and 95% for the parents. Both the children and the parents found the telephone calls helpful. These findings are important in clinical practice when assessing a family's eligibility for ICBT.

Rights-based social work as a practice. The role of child welfare social work in the repatriations of Finnish children from the camps in north-eastern Syria

ABSTRACT In this article, we present an interdisciplinary analysis that combines perspectives of law and social work on the role of child welfare social work in Finnish repatriations of children from camps in north-eastern Syria after the territorial losses of the terrorist organisation ISIS in 2019. We used qualitative data that consists of interviews of professionals, which we analysed using thematic analysis. The findings show how a rights-based approach to the issue of repatriation helped to decrease tension in a highly politicised situation, making children’s rights the starting point of the decision making process followed by a professionally led bureaucratic process in which several children were repatriated from the camps in Syria. Social workers’ decisions in individual cases both affected the legal obligations of the state to repatriate and the repatriation processes. The actions taken by the social workers emerge as practices of rights-based social work. Importantly, the role of social workers has been essential in how rights of the children were negotiated and understood in an evolving process between authorities.

Gut Inflammation Markers, Diet, and Risk of Islet Autoimmunity in Finnish Children – A Nested Case-Control Study

BackgroundGut dysbiosis and increased intestinal permeability have been reported to precede type 1 diabetes-related autoimmunity. The role of gut inflammation in autoimmunity is not understood. ObjectivesThis study aimed to assess whether gut inflammation markers are associated with risk of islet autoimmunity and whether diet is associated with gut inflammation markers. MethodsA nested case-control sample of 75 case children with islet autoimmunity and 88 control children was acquired from the Finnish Type 1 Diabetes Prediction and Prevention cohort. Diet was assessed with 3-d food records, and calprotectin and human β-defensin-2 (HBD-2) were analyzed from stool samples at 6 and 12 mo of age. Conditional logistic regression analysis was used in a matched case-control setting to assess risk of autoimmunity. Analysis of variance, independent samples t test, and a general linear model were used in secondary analyses to test associations of background characteristics and dietary factors with inflammation markers. ResultsIn unadjusted analyses, calprotectin was not associated with risk of islet autoimmunity, whereas HBD-2 in the middle (odds ratio [OR]: 3.23; 95% confidence interval [CI]: 1.03, 10.08) or highest tertile (OR: 3.02; 95% CI: 1.05, 8.69) in comparison to the lowest at 12 mo of age showed borderline association (P-trend = 0.063) with higher risk of islet autoimmunity. Excluding children with cow milk allergy in sensitivity analyses strengthened the association of HBD-2 with islet autoimmunity, whereas adjusting for dietary factors and maternal education weakened it. At age 12 mo, higher fat intake was associated with higher HBD-2 (β: 0.219; 95% CI: 0.110, 0.328) and higher intake of dietary fiber (β: −0.294; 95% CI: −0.510, −0.078), magnesium (β: −0.036; 95% CI: −0.059, −0.014), and potassium (β: −0.003; 95% CI: −0.005, −0.001) with lower HBD-2. ConclusionsHigher HBD-2 in infancy may be associated with higher risk of islet autoimmunity. Dietary factors play a role in gut inflammatory status.

Physical activity has decreased in Finnish children and adolescents from 2016 to 2022.

Varying trends in children's and adolescents' physical activity (PA) have been reported during the last 10-20 years. Trends in sedentary behavior (SB) have been studied only rarely. The purpose of the present study was to describe population-based trends in accelerometer-measured PA, standing and SB, among Finnish 7-15-year-old children and adolescents, and to evaluate the potential influence of the COVID-19 pandemic on these behaviors. A cross-sectional population-based Finnish school-aged physical activity Study (FSPA) measured daily steps, vigorous (VPA), moderate (MPA), moderate-to-vigorous (MVPA), light physical activity (LPA), standing, and SB by an accelerometer for seven consecutive days in 2016, 2018, and 2022 (n = 7.080, 57% girls). The data was analyzed by multivariate regression analysis. In 2016, participants took on average 10.305 steps per day, and spent 0:15 (h: min) in VPA, 1:37 in MPA, 1:52 in MVPA, 3:48 in LPA, 0:55 in standing and 7:52 in SB. From 2016 to 2018, daily steps, MPA, LPA, and standing increased [229 steps (95% Confidence Interval, CI 70-387), 0:03 (CI 0:01 - 0:04), 0:11 (CI 0:09 - 0:14), and 0:07 (CI 0:05 - 0:08), respectively], while VPA and SB decreased [0:01 (CI 0:00-0:02) and 0:20 (CI 0:16 - 0:24), respectively]. From 2018 to 2022, daily PA and standing declined [751 steps (CI 562-939), VPA 0:02 (CI 0:01 - 0:03), MPA 0:09 (CI 0:07 - 0:11), MVPA 0:11 (CI 0:09 - 0:14), LPA 0:08 (CI 0:05 - 0:11), and standing 0:01 (CI 0:01 - 0:03)] while SB increased 0:21 (CI 0:16 - 0:25) indicating potential influence of the pandemic. Children and adolescents became physically less active from 2016 to 2022. The potential effects of the COVID-19 were seen as declined PA and increased sedentariness from 2018 to 2022.

Cognitive, social, and mental health functions of refugee children – screening and supportive actions at school: a study protocol

BackgroundDespite a world-leading educational system, an achievement gap in educational outcomes exists between children of refugee background and native-born peers in Finland. To offer targeted support for children at schools, we need to be able to reliably assess and understand the interplay of the aspects of children’s cognitive, social, and mental health functions that may explain the underachievement of refugee children.This study tests a novel research-based, universally applicable screening battery for evaluating cognitive, social, and mental health functioning of children at schools and planning supportive actions. It aims to answer research questions about a) the cognitive, social, and mental health functioning of refugee children compared with non-refugee immigrant and native-born children, b) the interplay of these different functions among refugee and other children, c) whether implementing a screening battery can inform schools in planning supportive actions for (refugee) children, and d) whether such supportive actions result in improvements in cognitive, social, and mental health functioning.MethodsFour hundred fifty children aged 10–12 will be recruited from primary schools, including 150 children of refugee background, 150 of non-refugee immigrant background, and 150 native-born Finnish children. A screening battery including tasks and questionnaires on different aspects of cognitive, social, and mental health functioning will be used to assess the children in their classrooms at the start and end of a school year. Supporting information will also be collected from parents and teachers. The information gathered will be collated into class-level feedback reports for teachers and, with parental permission, individualized reports for multiprofessional student welfare bodies, for informing supportive actions. Correlational and latent profile analyses, ANOVAs, and linear regression will be used to answer the research questions.DiscussionThis study will help clarify how the interplay of cognitive, social, and mental health factors may explain underachievement at school among refugee children. It will provide evidence about the extent to which a standardized screening battery could be helpful in informing and planning supportive actions for children at schools, and whether such supportive actions can lead to positive cognitive, social, or mental health outcomes.Trial registrationThe study will be preregistered on the Open Science Framework.

Process- and Product-Oriented Fundamental Movement Skills in Early Childhood as Predictors of Later Health-Related Fitness.

The skill domains of fundamental movement skills (FMS), emphasizing gross motor movements, including locomotor skills (LMS) and object control skills (OCS), along with process- and product-oriented measures of FMS, may predict cardiorespiratory fitness (CRF) and muscular fitness (MF) differently. This study investigates the longitudinal relationship from early childhood FMS, focusing on process-oriented LMS and OCS and product-oriented FMS, to CRF and MF in late childhood. The study involved 441 Finnish children (49.9% female; mean age at baseline, 5.5 yr) over a 6-yr period. FMS was evaluated using the Test of Gross Motor Development, third version, for process-oriented LMS and OCS, and the Körperkoordinationstest Für Kinder (KTK) was used to evaluate the product-oriented FMS. CRF was assessed through the total number of laps completed in the 20-m shuttle run test, whereas MF was measured via repetitions of curl-ups and push-ups. Employing a two-level cross-classified regression analysis and Cholesky decomposition, this study aimed to determine the contributions of product-oriented KTK and process-oriented LMS and OCS. Adjustments for variations in age, measurement intervals, and maturation were achieved through residualization. In addition, gender and body mass index were incorporated as covariates in the analysis. The analysis revealed that process-oriented LMS (CRF: Δ R2 = 0.016; MF: Δ R2 = 0.014) significantly predicted later health-related fitness, whereas OCS did not. However, KTK exhibited a better ability to predict both CRF (Δ R2 = 0.092) and MF (Δ R2 = 0.032), overshadowing process-oriented measures. In conclusion, the findings suggest that KTK, which potentially encompasses a broader spectrum of fitness elements along with FMS, more effectively predicts health-related fitness components than process-oriented FMS.

ST2 and IL-33 polymorphisms and the development of childhood asthma: a prospective birth cohort study in Finnish children.

The ST2/IL-33 signaling pathway has an important role in the host inflammatory response. Here we aimed to study the association of ST2 and IL-33 polymorphisms with serum soluble (s) ST2 and IL-33 concentrations in healthy Finnish children and, in addition, their association with childhood asthma. In total, 146 children were followed from birth to the age 7 years for the development of asthma. Single-nucleotide polymorphisms (SNPs) in ST2 and IL-33 were determined, and associations of the SNP variants with serum levels of sST2 and IL-33 at age of 13 months and with recurrent wheezing and childhood asthma at 7 years of age were analyzed. Children with ST2 rs1041973 AC/AA genotypes had significantly lower level of serum sST2 (2453 pg/mL; IQR 2265) than those with CC genotype (5437 pg/mL; IQR 2575; p = < 0.0001). Similar difference was also observed with ST2 rs13408661. No differences were observed between subjects with studied IL-33 SNPs. Children who carried genetic variants of ST2 rs1041973 or rs13408661 seemed to have a higher risk of asthma. In contrast, children who carried genetic variants of IL-33 rs12551268 were less often diagnosed with asthma. Even though these SNPs seemed to associate with asthma, the differences were not statistically significant.

Incidence of ADHD medication use among Finnish children and adolescents in 2008-2019: a need for practice changes?

This study examined the incidence of attention-deficit/hyperactivity disorder medication among children and adolescents by sex and age group in Finland during 2008-2019. The data on children and adolescents aged 6-18 years receiving reimbursement for any attention-deficit/hyperactivity disorder medication was collected from the nationwide register on reimbursed purchases. The incidence was calculated as a ratio of the number of new users and the number of age and sex-matched population at risk. Negative binomial models were used to calculate rate ratios (RRs). In 2019, the incidence of attention-deficit/hyperactivity disorder medication was 13.4 per 1000 boys and 4.8 per 1000 girls. Among boys, the incidence became 3.7 times greater during the observed years (RR 95% confidence interval (CI) 2.0, 6.5, P<0.0001), whereas in girls it was 7.6 times greater (RR 95% CI 2.1, 27.4, P=0.0019). The boys had 2.8 times the incidence rate compared with the girls (RR 95% CI 2.2, 3.6, P<0.0001). The increase was associated with age only among boys (P=0.0001). The highest incidence rate 23.4 per 1000 individuals (95% CI 22.5, 24.4) was found in 2019 among 6-8-year-old boys. The incidence of attention-deficit/hyperactivity disorder medication use among children and adolescents increased significantly in Finland during the study period. Incidence was higher among boys, but the increase was greater among girls. The most common group to start attention-deficit/hyperactivity disorder medication was 6-8-year-old boys. These findings warrant critical evaluation of the diagnostic and treatment policies currently available in Finland for the treatment of attention-deficit/hyperactivity disorder and related symptoms.

Facial emotion recognition and social-emotional problems in middle childhood: Assessment of directional effects

Research has consistently shown that difficulties in facial emotion recognition (FER) are associated with peer problems and internalizing symptoms during middle childhood. However, no longitudinal research has investigated the direction of effects, that is, how these constructs influence each other across time. In this preregistered three-wave panel study, we tested the directional effects between FER, peer problems, and internalizing symptoms among Finnish school-aged children (n = 3,607; Mage = 8.20, SDage = 0.86; 51% female). The results of random-intercept cross-lagged panel models showed that a low FER accuracy and high biases toward happiness and sadness correlated with higher levels of peer problems and internalizing symptoms at the between-person level. However, we found no evidence of directional effects at the within-person level. Overall, our findings suggest that these constructs might be associated because of shared underlying causes, rather than mutually influencing one another in middle childhood.

Clinical Picture and Risk Factors for Poor Outcome in Streptococcus pneumoniae Meningitis of Childhood on Three Continents.

Streptococcus pneumoniae meningitis (SpM) remains a major health burden worldwide, particularly in low- and middle-income countries. Identifying the patients at highest risk for mortality and disabling sequelae may reveal potentially avoidable predisposing factors and identify patients most in need of intensive care. We searched for factors that do not require laboratory facilities. This study was a secondary analysis of prospectively collected data from 5 clinical trials of childhood bacterial meningitis on 3 continents between 1984 and 2017. SpM cases were analyzed by study site and predictors for poor outcome (death or severe sequelae) were identified from the whole series, Latin America and Angola. Among a total of 1575 children (age range: 2 months to 15 years), 505 cases were due to pneumococci. Compared to other etiologies, SpM doubled the death rate (33% vs. 17%) and tripled poor outcome (15% vs. 6%). In SpM, Glasgow Coma Score <13 [odds ratio (OR): 4.73] and previous antibiotics in Angola (OR: 1.70) were independent predictors for death. Predictors for poor outcome were age <1 year (OR: 2.41) and Glasgow Coma Score <13 (OR: 6.39) in the whole series, seizures in Latin America (OR: 3.98) and previous antibiotics in Angola (OR: 1.91). Angolan children had a 17-fold increased risk for poor outcome when compared with Finnish children ( P = 0.011). Our study proved the severity of SpM when compared with other etiologies. The outcome was especially poor in Angola. Most patients at risk for poor outcome are easily identified by clinical factors on admission.