Cohort Profile: The Mater-University of Queensland Study of Pregnancy (MUSP).
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Adult↗
Biomedical subjects
J M Najman
Publications and source records attributed to J M Najman.
Is being overweight associated with behavioural problems in childhood and adolescence? Findings from the Mater-University study of pregnancy and its outcomes.
AIMS: To examine the associations between being overweight and behavioural problems at ages 5 and 14. METHODS: Birth cohort study of 2875 individuals who were born in Brisbane between 1981 and 1984 and who were followed up at ages 5 and 14 years. Behavioural problems were defined as scoring above the 90th centile on Achenbach's child behavioural checklist. RESULTS: In cross-sectional analyses there was no association between being overweight and behavioural problems in either females at age 5. At age 14 females who were overweight were more likely than those who were normal weight to experience behavioural problems. However, there was no association between being overweight and behavioural problems at age 14 among males. The prevalence of behavioural problems increased linearly across the distribution of body mass index in females at age 14. In prospective analyses, among participants who had no behavioural problems at age 5, there was no association between being overweight at age 5 and behavioural problems at age 14 in either sex. Females who were overweight at age 5 and normal weight at age 14 had reduced odds of behavioural problems at age 14. CONCLUSIONS: Among adolescent females there is a positive linear association between body size and behavioural problems. However, no such association was found in adolescent males, or in either sex at age 5 years, and in prospective analyses being overweight at age 5 was not associated with behavioural problems in either sex at age 14.
Adolescent↗
Family and early life factors associated with changes in overweight status between ages 5 and 14 years: findings from the Mater University Study of Pregnancy and its outcomes.
OBJECTIVE: To describe different patterns of overweight status between ages 5 and 14 y and examine the role of modifiable family and early life characteristics in explaining different patterns of change between these two ages. DESIGN: A population-based prospective birth cohort. SUBJECTS: A total of 2934 children (52% males) who were participants in the Mater-University study of pregnancy, Brisbane, and who were examined at ages 5 and 14 y. MAIN OUTCOME MEASURES: Four patterns of change in overweight/obesity status between ages 5 and 14 y: (i) normal at both ages; (ii) normal at 5 y and overweight/obese at 14 y; (iii) overweight/obese at 5 y and normal at 14 y; (iv) overweight/obese at both ages. RESULTS: Of the 2934 participants, 2018 (68.8%) had a normal body mass index (BMI) at ages 5 and 14 y, 425 (14.5%) changed from a normal BMI at age 5 y to overweight or obese at age 14 y, 175 (6.0%) changed from being overweight or obese at age 5 y to normal weight at age 14 y and 316 (10.8%) were overweight or obese at both ages 5 and 14 y. Girls were more likely to make the transition from overweight or obese at age 5 y to normal at 14 y than their boy counterparts. Children whose parents were overweight or obese were more likely to change from having a normal BMI at age 5 y to being overweight at 14 y (fully adjusted RR: 6.17 (95% CI: 3.97, 9.59)) and were more likely to be overweight at both ages (7.44 (95% CI: 4.60, 12.02)). Birth weight and increase in weight over the first 6 months of life were both positively associated with being overweight at both ages. Other explanatory factors were not associated with the different overweight status transitions. CONCLUSIONS: Parental overweight status is an important determinant of whether a child is overweight at either stage or changes from being not overweight at 5 y to becoming so at 14 y.
Adolescent↗
Beliefs and practices of patients with advanced cancer: implications for communication.
The aim of this study was to investigate the beliefs that patients with advanced cancer held about the curability of their cancer, their use of alternatives to conventional medical treatment, and their need to have control over decisions about treatment. Of 149 patients who fulfilled the criteria for participation and completed a self-administered questionnaire, 45 patients (31%) believed their cancer was incurable, 61 (42%) were uncertain and 39 (27%) believed their cancer was curable. The index of need for control over treatment decisions was low in 53 patients (35.6%) and high in only 17 patients (11.4%). Committed users of alternatives to conventional medical treatments were more likely to believe that their cancer was curable (P<0.001) and to have a higher need for control over decisions about treatment (P<0.004). The mean need for control scores were highest in patients who believed that their cancer was curable, or who were uncertain about the curability of their cancer, but who acknowledged that their oncologist had reported that the cancer was incurable. The diverse beliefs, attitudes and actions of these patients were consistent with a range of psychological adaptations to a life-threatening illness, some realistic and others illusory. Illusory responses influence what communication can achieve in daily oncology practice.
Attitude of Health Personnel↗
Illusions in advanced cancer: the effect of belief systems and attitudes on quality of life.
Patients with advanced cancer frequently express positive attitudes and can be unduly optimistic about the potential benefits of treatment. In order to evaluate an illusory domain in the context of advanced cancer, we developed a scale of will to live and characterized the beliefs that patients held about the curability of their cancer, and how committed they were to using alternative treatments. A measure of quality of life was used as the dependent variable in order to assess the association between these attributes. After a preliminary exploration confirmed the presence of an illusory domain, these concepts were prospectively tested in 149 ambulant patients with advanced cancer who attended for palliative systemic treatment, radiation treatment or supportive care. The scale of global quality of life was reliable (Cronbach's alpha coefficient 0.72). The distribution of the scores of will to live was skewed, with no respondent scoring poorly, and the scale was reliable (Cronbach's alpha coefficient 0.82). The scale of belief in curability showed diverse beliefs. In some cases, there was a discrepancy between respondents' beliefs in curability and what they believed to be the report by their doctors. There was also an association between a committed use of alternative treatments and a belief in the curability of the cancer (p<0.001). In a multiple regression analysis, both will to live and performance status remained associated with better quality of life scores after adjustment for other relevant variables (p<0.05 and <0.001, respectively). These results suggest that positive illusory beliefs can be measured and are an important component of adaption for some patients with advanced cancer. Furthermore, this illusory domain may influence the perception and measurement of quality of life.
Adaptation, Psychological↗
Early childhood factors influencing health-related quality of life in adolescents at 13 years.
OBJECTIVE: To understand the relationship of health-related quality of life (HR-QOL) to early life experience. METHODOLOGY: Eight thousand five hundred and fifty-six women enrolled in a prospective study at their first antenatal clinic visit. At 13 years, of 5345 women remaining, a consecutive sample of 901 mother/child pairs provided data on adolescent HR-QOL using the Child Health Questionnaire-Parent Report form (CHQ-PF50) and the Dartmouth COOP Functional Assessment Charts for Adolescents. The CHQ-PF50 yielded physical (PHS) and psychosocial (PSS) summary scores. We examined the relationship between health-related QOL and early childhood predictive variables. RESULTS: PHS was related to gestation, maternal health symptoms in pregnancy, maternal anxiety at 6 months, child health and hours of childcare at 5 years (P < 0.05). PSS was related to maternal age at index visit, maternal attitude to pregnancy, maternal satisfaction with care giving and maternal depression at 6 months, and child health and behaviour problems at 5 years (internalizing and social/attentional/thought (SAT) domains) (P < 0.05). Findings from adolescent self-reports were similar. CONCLUSIONS: This study has identified a number of early childhood determinants of adolescent HR-QOL. These findings add to evidence of the effects of early adversity on the developmental pathways of children and support the need for effective early intervention.
Adolescent↗
Association of bullying with adolescent health-related quality of life.
OBJECTIVE: To examine the relationship between being bullied and health-related quality of life (HR-QOL) in adolescence. METHODOLOGY: Subjects were a cohort of 805 adolescents with a mean age of 13.6 years (standard deviation 0.2 years). An adolescent questionnaire elicited the frequency of being bullied. HR-QOL was measured using the Child Health Questionnaire - Parent Report Form (CHQ-PF50) and Dartmouth COOP Functional Health Assessment Charts for Adolescents. RESULTS: Thirty-six per cent of boys and 38 per cent of girls reported being bullied at least weekly. Adolescent psychosocial HR-QOL was inversely related to frequency of being bullied, while physical HR-QOL was not related. CONCLUSION: Peer bullying is an important determinant of adolescent HR-QOL with a negative impact on psychosocial well-being.
Adolescent↗
Early adolescent smoking and a web of personal and social disadvantage.
OBJECTIVE: To examine concurrent physical, educational, behavioural, social and family factors associated with cigarette smoking in adolescents at 14 years. METHODOLOGY: This study reports cross-sectional data on 14-year-old adolescents and their mothers, drawn from a prospective cohort study commencing at the time of the first antenatal visit. At 14 years, 5247 adolescents completed questionnaires on current cigarette smoking. Adolescents and mothers completed health, psychological, school and social questionnaires relating to the youth. A total of 3864 adolescents were assessed physically, and undertook the Wide Range Achievement Test (WRAT) and Ravens Progressive Matrices Test. RESULTS: Cigarette smoking at 14 years was associated with externalizing and internalizing behaviour problems, school suspension, contact with children's services and alcohol/illicit drug use. Apart from internalizing behaviour problems, these problems were more prevalent in boys. Poor school performance on maternal/adolescent reports was associated with increased smoking quantity for both genders, though WRAT scores were only decreased in male smokers. The Ravens Progressive Matrices Test scores were lower for boys with greater smoking quantity. The trend was less marked in girls. Body mass index and exercise frequency were not associated with cigarette smoking at 14 years, though girls who smoked had a higher reported prevalence of asthma. Parental smoking, marital conflict, maternal depression, lower income, and mothers aged in their teens and with a lower level of education at the time of this pregnancy were also positively associated with adolescent tobacco use. CONCLUSION: Findings of this study indicate that cigarette smoking, at this critical time of smoking initiation, is associated with a broad spectrum of personal and social disadvantage that needs to be considered in intervention strategies.
Adolescent↗
Couple distress after sudden infant or perinatal death: a 30-month follow up.
OBJECTIVE: To examine, using a 30-month prospective study, patterns of anxiety, depression and alcohol use in couples following stillbirth, neonatal death or sudden infant death syndrome. METHODOLOGY: One hundred and thirty-eight bereaved and 156 non-bereaved couples completed standardized interviews at 2, 8, 15 and 30 months post-loss. RESULTS: At all interviews, bereaved couples were significantly more likely than non-bereaved couples to have at least one distressed partner. Rarely were both partners distressed in either group. For bereaved couples, 'mother only' distress declined from 21% to 10% during the study. 'Father only' distress ranged from 7% to 15%, peaking at 30 months. Bereaved mothers who were distressed at 2 months reported significantly lower marital satisfaction at 30 months. CONCLUSIONS: At the couple level, the experience of a baby's death is multifaceted. Gender differences are common and partners' needs may change over time. Early recognition of these differences may facilitate longer-term adjustment for both partners.
Adjustment Disorders↗
Health and demographic characteristics of respondents in an Australian national sexuality survey: comparison with population norms.
STUDY OBJECTIVE: To assess the representativeness of survey participants by systematically comparing volunteers in a national health and sexuality survey with the Australian population in terms of self reported health status (including the SF-36) and a wide range of demographic characteristics. DESIGN: A cross sectional sample of Australian residents were compared with demographic data from the 1996 Australian census and health data from the 1995 National Health Survey. SETTING: The Australian population. PARTICIPANTS: A stratified random sample of adults aged 18-59 years drawn from the Australian electoral roll, a compulsory register of voters. Interviews were completed with 1784 people, representing 40% of those initially selected (58% of those for whom a valid telephone number could be located). MAIN RESULTS: Participants were of similar age and sex to the national population. Consistent with prior research, respondents had higher socioeconomic status, more education, were more likely to be employed, and less likely to be immigrants. The prevalence estimates, means, and variances of self reported mental and physical health measures (for example, SF-36 subscales, women's health indicators, current smoking status) were similar to population norms. CONCLUSIONS: These findings considerably strengthen inferences about the representativeness of data on health status from volunteer samples used in health and sexuality surveys.
Adolescent↗
Bias influencing maternal reports of child behaviour and emotional state.
BACKGROUND: Previous research has indicated that there may be only a modest degree of agreement between different reporters of a child's behaviour (mental health). This raises the possibility that some descriptions of the child's behaviour may reflect the personal characteristics of the respondent. We examine two potential sources of bias that may influence reports of a child's behaviour/mental health. The first is the mental or emotional impairment of the respondent; the second concerns gender-related expectations of children. METHODS: Mothers (and their children after the birth) were assessed at first clinic visit, 3-5 days after the birth, then 6 months, 5 years and 14 years after the birth. Some 70% of respondents giving birth remained in the study at the 14-year follow-up, leaving some 5277 cases for this analysis. At the 14-year follow-up, child behaviour (mental health) was assessed using the Child Behaviour Check List and the Youth Self Report. Maternal mental health was determined using the anxiety and depression subscales of the Delusions-Symptoms-States Inventory. RESULTS: Mothers who were not emotionally impaired reported fewer child behaviour problems than did the children themselves. As the mother's current emotional impairment increased, so her reports of the child's behaviour problems increased, when compared with the child's own reports. Further, mothers attributed more internalising symptoms to female respondents, and more externalising symptoms to male respondents, than did the child respondents themselves. CONCLUSIONS: Mothers differ systematically from their children when they are reporting their child's behaviour (mental health). The more emotionally impaired the mother, the greater the degree to which she imputes the child to have behaviour problems. Further, female children are attributed to have more internalising behaviours and male children externalising behaviours.
Adolescent↗
The effect of breastfeeding on child development at 5 years: a cohort study.
OBJECTIVE: It is uncertain to what degree the relationship between breastfeeding and later cognitive development is a true biological effect, or is confounded by psychosocial factors. The study aim was to further investigate this relationship and the effect of duration of breast feeding on cognitive development. METHODS: A total of 3880 children were followed from birth. Breastfeeding duration was measured by questionnaire at 6 months of age and a Peabody Picture Vocabulary Test Revised (PPVT-R) was administered at 5 years. PPVT-R scores were adjusted for the effects of a large array of biological and psychosocial confounders. The relationship between breastfeeding and the mean PPVT-R scores were examined using analysis of variance and multiple linear regression. RESULTS: A strong positive relationship was demonstrated between breastfeeding and the PPVT-R scores with increasing scores with increased duration of breastfeeding. After adjusting for a wide range of biological and social factors, the adjusted mean for those breastfed for 6 months or more was 8.2 points higher for females and 5.8 points for males when compared to those never breastfed. CONCLUSION: These findings suggest a significant benefit to child development is conferred by breastfeeding and is related independently to longer periods of breastfeeding.
Adult↗
Improving pain management by nurses: A pilot Peer Intervention Program.
Significant pain continues to be reported by many hospitalized patients despite the numerous and varied educational programs developed and implemented to improve pain management. A theoretically based Peer Intervention Program was designed from a predictive model to address nurses' beliefs, attitudes, subjective norms, self-efficacy, perceived control and intentions in the management of pain with p.r.n. (as required) narcotic analgesia. The pilot study of this program utilized a quasi-experimental pre-post test design with a patient intervention, nurse and patient intervention and control conditions consisting of 24, 18 and 19 nurses, respectively. One week after the intervention, significant differences were found between the nurse and patient condition and the two other conditions in beliefs, self-efficacy, perceived control, positive trend in attitudes, subjective norms and intentions. The most positive aspects of the program were supportive interactive discussions with peers and an awareness and understanding of beliefs and attitudes and their roles in behavior.
Adult↗
Determinants of nurses' intention to administer opioids for pain relief.
A statewide cross-sectional survey was conducted in Australia to identify the determinants of registered nurses' intention to administer opioids to patients with pain. Attitudes, subjective norms and perceived control, the key determinants of the Theory of Planned Behavior, were found to independently predict nurses' intention to administer opioids to these patients. Perceived control was the strongest predictor. Nurses reported positive overall attitudes towards opioids and their use in pain management. However, many negative attitudes were identified; for example, administering the least amount of opioid and encouraging patients to have non-opioids rather than opioids for pain relief. The findings related to specific attitudes and normative pressures provide insight into registered nurses' management of pain for hospitalized patients and the direction for educational interventions to improve registered nurses' administration of opioids for pain management.
Attitude of Health Personnel↗
Commentary: General or cause-specific factors in explanations of class inequalities in health.
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Causality↗
Postnatal depression-myth and reality: maternal depression before and after the birth of a child.
BACKGROUND: Much has been written about postnatal depression as a clinical condition. There is some evidence to suggest that a substantial proportion of women who give birth experience a depression in the postnatal period. This paper reports the results of a longitudinal study of the mental health of a large sample of women who were in the early stages of pregnancy at entry to the study. METHODS: Each participant was assessed for symptoms of depression at the first clinic visit (entry to the study), and reassessed at various intervals--at 3-5 days, at 6 months, and again at 5 years after the birth of the child--using the DSSI-D (Delusions-Symptoms-States Inventory). RESULTS: Retrospective recall questions indicate that shortly after the birth the majority of women experienced some depressed mood. Of those who experienced depressed mood, the data suggest that the symptoms were not severe, nor did these symptoms generally continue beyond a few weeks. The longitudinal data indicate that levels of depression in our sample are highest either at the first clinic visit or at the 5-year follow-up. Rates of depression at the 6-month follow-up are relatively low by comparison. CONCLUSION: While most mothers experience periods of depressed mood after the birth of their baby, these periods are generally of short duration and of lesser intensity than a major depression. Mothers appear to experience increasing levels of symptoms of depression as their child grows up. Many of the "cases" of depression experienced at the 5-year follow-up represent a recurrence of a previous experience of depression.
Adolescent↗
Chronicity, severity, and timing of maternal depressive symptoms: relationships with child outcomes at age 5.
The relationships between severity, chronicity, and timing of maternal depressive symptoms and child outcomes were examined in a cohort of 4,953 children. Mothers provided self-reports of depressive symptoms during pregnancy, immediately postpartum, and when the child was 6 months old and 5 years old. At the age 5 follow-up, mothers reported on children's behavior and children completed a receptive vocabulary test. Results suggest that both the severity and the chronicity of maternal depressive symptoms are related to more behavior problems and lower vocabulary scores in children. The interaction of severity and chronicity of maternal depressive symptoms was significantly related to higher levels of child behavior problems. Timing of maternal symptoms was not significantly related to child vocabulary scores, but more recent reports of maternal depressive symptoms were associated with higher rates of child behavior problems.
Adult↗
Mothers' mental illness and child behavior problems: cause-effect association or observation bias?
OBJECTIVE: A number of studies have consistently found that a mother's mental health (particularly her level of depression) is a strong predictor of mental health problems experienced by her child(ren). However, the validity of this finding is in doubt because the majority of these studies have relied on maternal reports as indicators of children's behavior. METHOD: This prospective, longitudinal study examines data on the mental health of the mother from prior to the birth of her child to when the child reaches 14 years of age. Child behavior is measured at 14 years of age using reports from mother and child. Mother and child responses are compared to provide an indication of the possible magnitude of maternal observation bias in the reporting of child behavior problems. RESULTS: Anxious and/or depressed mothers tend to report more cases of child behavior problems than do their mentally healthy counterparts or children themselves. Differences between mothers and youths in reporting behavior problems appear to be related to the mothers' mental health. CONCLUSIONS: Current maternal mental health impairment appears to have a substantial effect on the reporting of child behavior problems by the mother, thereby raising questions about the validity of reports of child behavior by persons who are currently emotionally distressed.
Adolescent↗