Fiona Mensah

Treating infant colic with the probiotic Lactobacillus reuteri: double blind, placebo controlled randomised trial

Objective To determine whether the probiotic Lactobacillus reuteri DSM 17938 reduces crying or fussing in a broad community based sample of breastfed infants and formula fed infants with colic aged less than 3 months. Design Double blind, placebo controlled randomised trial. Setting Community based sample (primary and secondary level care centres) in Melbourne, Australia. Participants 167 breastfed infants or formula fed infants aged less than 3 months meeting Wessel’s criteria for crying or fussing: 85 were randomised to receive probiotic and 82 to receive placebo. Interventions Oral daily L reuteri (1×108 colony forming units) versus placebo for one month. Main outcomes measures The primary outcome was daily duration of cry or fuss at 1 month. Secondary outcomes were duration of cry or fuss; number of cry or fuss episodes; sleep duration of infant at 7, 14, and 21 days, and 1 and 6 months; maternal mental health (Edinburgh postnatal depression subscale); family functioning (paediatric quality of life inventory), parent quality adjusted life years (assessment of quality of life) at 1 and 6 months; infant functioning (paediatric quality of life inventory) at 6 months; infant faecal microbiota (microbial diversity, colonisation with Escherichia coli), and calprotectin levels at 1 month. In intention to treat analyses the two groups were compared using regression models adjusted for potential confounders. Results Of 167 infants randomised from August 2011 to August 2012, 127 (76%) were retained to primary outcome; of these, a subset was analysed for faecal microbial diversity, E coli colonisation, and calprotectin levels. Adherence was high. Mean daily cry or fuss time fell steadily in both groups. At 1 month, the probiotic group cried or fussed 49 minutes more than the placebo group (95% confidence interval 8 to 90 minutes, P=0.02); this mainly reflected more fussing, especially for formula fed infants. The groups were similar on all secondary outcomes. No study related adverse events occurred. ConclusionsL reuteri DSM 17938 did not benefit a community sample of breastfed infants and formula fed infants with colic. These findings differ from previous smaller trials of selected populations and do not support a general recommendation for the use of probiotics to treat colic in infants. Trial registration Current Controlled Trials ISRCTN95287767.

Poverty, Maternal Depression, Family Status and Children's Cognitive and Behavioural Development in Early Childhood: A Longitudinal Study

Improving childrens lives is high on the UK policy agenda. In this study for a recent birth cohort of UK children we examine how three aspects of parental resources - income, mothers mental well-being and family status - in early childhood enhance or compromise their childrens cognitive and behavioural development. As well as examining how these three aspects of parental resources separately and jointly affect childrens well-being, we also enquire whether persistent poverty or persistent maternal depression are more deleterious for childrens current well-being than periodic episodes of poverty and depression. We find strong associations between poverty and young childrens intellectual and behavioural development, and persistent poverty was found to be particularly important in relation to childrens cognitive development. Maternal depression (net of other factors) was more weakly related to cognitive development but strongly related to whether children were exhibiting behaviour problems, and persistent depression amplified the situation. Family status, net of other factors (most noticeably poverty), was only weakly associated with childrens development.

Poverty, family resources and children’s early educational attainment: the mediating role of parenting

This study uses longitudinal data from the UK Millennium Cohort Study to show the extent to which episodic and more persistent poverty in early childhood and the lack of other family resources disadvantage children at the start of their school careers in terms of whether they have achieved the target indicator of ‘good level of achievement’ on the Foundation Stage Profile. Positive parenting is shown to be an important contributor to school achievement that matters for children, regardless of poverty experience or family disadvantage. It is also shown to be an important mediator in redressing the effects of poverty and disadvantage.

Adverse impact of hepatitis C virus infection on renal replacement therapy and renal transplant patients in Australia and New Zealand.

Background. Understanding the impact of hepatitis C virus (HCV) infection in patients with end-stage renal disease before and after renal transplantation requires more data. We examined the outcomes of HCV antibody positive (HCVAb+) dialysis and renal transplant patients using the Australian and New Zealand Dialysis and Transplant registry. Methods. Two cohorts of dialysis (n=23,046) and transplant (n=7572) patients were identified. Survival outcomes, causes of mortality, and causes of graft failure were examined. Results. Dialysis Cohort: 362 (1.6%) were HCVAb+ve. The cause of end-stage renal disease in the HCVAb+ve group was more likely to be glomerulonephritis or diabetes. Survival figures were similar at 5 years (48% vs. 47%) and 10 years (22% and 20%) for HCVAb+ve and HCVAb negative (HCVAb−ve) groups; however, the adjusted hazard ratio (aHR) for mortality was increased, 1.25 (95% confidence interval [CI], 1.07–1.46), for the HCVAb+ve cohort. Liver failure was more likely. Renal Transplantation Cohort: 140 (1.8%) were HCVAb+ve. Patient survival among HCVAb+ve and HCVAb−ve groups was 77% vs. 90% and 50% vs. 79% at 5 and 10 years, respectively. The aHR for patient death was 2.38 (95%CI, 1.69–3.37). Higher rates of death due to cardiovascular disease (aHR=2.74), malignancy (aHR=2.52), and hepatic failure (aHR=22.1) were observed. The aHR for graft loss was 1.71 (95%CI, 1.28–2.29) for HCVAb+ve patients; and glomerulonephritis, chronic allograft neuropathy, and death were more frequent causes of graft failure. Conclusion. On dialysis, HCVAb+ve patients had a slightly worse outcome. After renal transplantation, the HCVAb+ve cohort had a markedly worse patient and graft outcome. The impact of viral eradication on these outcomes is unknown.

Impact of a behavioural sleep intervention on symptoms and sleep in children with attention deficit hyperactivity disorder, and parental mental health: randomised controlled trial

Objective To examine whether behavioural strategies designed to improve children’s sleep problems could also improve the symptoms, behaviour, daily functioning, and working memory of children with attention deficit hyperactivity disorder (ADHD) and the mental health of their parents. Design Randomised controlled trial. Setting 21 general paediatric practices in Victoria, Australia. Participants 244 children aged 5-12 years with ADHD attending the practices between 2010 and 2012. Intervention Sleep hygiene practices and standardised behavioural strategies delivered by trained psychologists or trainee paediatricians during two fortnightly consultations and a follow-up telephone call. Children in the control group received usual clinical care. Main outcome measures At three and six months after randomisation: severity of ADHD symptoms (parent and teacher ADHD rating scale IV—primary outcome), sleep problems (parent reported severity, children’s sleep habits questionnaire, actigraphy), behaviour (strengths and difficulties questionnaire), quality of life (pediatric quality of life inventory 4.0), daily functioning (daily parent rating of evening and morning behavior), working memory (working memory test battery for children, six months only), and parent mental health (depression anxiety stress scales). Results Intervention compared with control families reported a greater decrease in ADHD symptoms at three and six months (adjusted mean difference for change in symptom severity −2.9, 95% confidence interval −5.5 to −0.3, P=0.03, effect size −0.3, and −3.7, −6.1 to −1.2, P=0.004, effect size −0.4, respectively). Compared with control children, intervention children had fewer moderate-severe sleep problems at three months (56% v 30%; adjusted odds ratio 0.30, 95% confidence interval 0.16 to 0.59; P<0.001) and six months (46% v 34%; 0.58, 0.32 to 1.0; P=0.07). At three months this equated to a reduction in absolute risk of 25.7% (95% confidence interval 14.1% to 37.3%) and an estimated number needed to treat of 3.9. At six months the number needed to treat was 7.8. Approximately a half to one third of the beneficial effect of the intervention on ADHD symptoms was mediated through improved sleep, at three and six months, respectively. Intervention families reported greater improvements in all other child and family outcomes except parental mental health. Teachers reported improved behaviour of the children at three and six months. Working memory (backwards digit recall) was higher in the intervention children compared with control children at six months. Daily sleep duration measured by actigraphy tended to be higher in the intervention children at three months (mean difference 10.9 minutes, 95% confidence interval −19.0 to 40.8 minutes, effect size 0.2) and six months (9.9 minutes, −16.3 to 36.1 minutes, effect size 0.3); however, this measure was only completed by a subset of children (n=54 at three months and n=37 at six months). Conclusions A brief behavioural sleep intervention modestly improves the severity of ADHD symptoms in a community sample of children with ADHD, most of whom were taking stimulant medications. The intervention also improved the children’s sleep, behaviour, quality of life, and functioning, with most benefits sustained to six months post-intervention. The intervention may be suitable for use in primary and secondary care. Trial registration Current Controlled Trials ISRCTN68819261.

Maternal depression from early pregnancy to 4 years postpartum in a prospective pregnancy cohort study: implications for primary health care

To describe the prevalence of maternal depression from pregnancy to 4 years postpartum, and the risk factors for depressive symptoms at 4 years postpartum.

Preventing Early Infant Sleep and Crying Problems and Postnatal Depression: A Randomized Trial

OBJECTIVE: To evaluate a prevention program for infant sleep and cry problems and postnatal depression. METHODS: Randomized controlled trial with 781 infants born at 32 weeks or later in 42 well-child centers, Melbourne, Australia. Follow-up occurred at infant age 4 and 6 months. The intervention including supplying information about normal infant sleep and cry patterns, settling techniques, medical causes of crying and parent self-care, delivered via booklet and DVD (at infant age 4 weeks), telephone consultation (8 weeks), and parent group (13 weeks) versus well-child care. Outcomes included caregiver-reported infant night sleep problem (primary outcome), infant daytime sleep, cry and feeding problems, crying and sleep duration, caregiver depression symptoms, attendance at night wakings, and formula changes. RESULTS: Infant outcomes were similar between groups. Relative to control caregivers, intervention caregivers at 6 months were less likely to score >9 on the Edinburgh Postnatal Depression Scale (7.9%, vs 12.9%, adjusted odds ratio [OR] 0.57, 95% confidence interval [CI] 0.34 to 0.94), spend >20 minutes attending infant wakings (41% vs 51%, adjusted OR 0.66, 95% CI 0.46 to 0.95), or change formula (13% vs 23%, P < .05). Infant frequent feeders (>11 feeds/24 hours) in the intervention group were less likely to have daytime sleep (OR 0.13, 95% CI 0.03 to 0.54) or cry problems (OR 0.27, 95% CI 0.08 to 0.86) at 4 months. CONCLUSIONS: An education program reduces postnatal depression symptoms, as well as sleep and cry problems in infants who are frequent feeders. The program may be best targeted to frequent feeders.

Parents’ mental health and children’s cognitive and social development

BackgroundThe development of children of parents who are experiencing mental health difficulties is a continuing cause of concern for professionals working in health, social care and education as well as policy makers. In light of this interest our study investigates the interplay between the mental health of mothers and fathers and family socioeconomic resources, and the impact for children’s cognitive and social development.MethodsThe study uses survey data from the Millennium Cohort Study linked with the Foundation Stage Profile assessment for children in the primary year of school in England between 2005 and 2006. The study includes 4,781 families from England where both parents’ mental health had been assessed using the Kessler 6 scale. Associations between parents’ mental health and children’s cognitive and social development were estimated using regression models. Multivariate models were used to explore the mediating role of the families’ socioeconomic resources. Gender interaction models were used to explore whether effects of parents’ mental health differ for girls and boys.ResultsThe study finds lower attainment in communication, language and literacy, mathematical development and personal, social and emotional development among children whose parents were experiencing high levels of psychological distress. Parents’ age and qualifications and families’ socioeconomic resources strongly mediated the effects of parents’ psychological distress on children’s attainment, and although independent effects of mother’s mental health were maintained, effects of father’s mental health were not. Stronger effects of mothers’ mental health were found for boys than for girls.ConclusionsThese findings highlight the interplay between the mental health of parents, families’ socioeconomic resources and children’s development which speaks for the need for close integration of mental health and social interventions to improve the well being of families.

Gender differences in educational attainment: influences of the family environment

There are gender differences in educational attainment amongst British children and there is evidence that these differences emerge early in life. In this study we investigate whether boys’ and girls’ early educational attainment levels are similarly related to disadvantage in the family environment. This study uses survey data from the Millennium Cohort Study linked with the teachers Foundation Stage Profile assessment for children in the primary year of school in England between 2005 and 2006. The study finds lower attainment in communication, language and literacy and mathematical development for both boys and girls in families experiencing socio‐economic disadvantage. Early motherhood, low maternal qualifications, low family income and unemployment most strongly predict lower scores. Tests for gender interaction shows boys in families where mothers are young, where they lack qualifications or if they are living in poor quality areas are more disadvantaged compared to girls in similar circumstances.

Early Puberty and Childhood Social and Behavioral Adjustment

PURPOSE Early puberty has been linked to higher rates of mental health problems in adolescence. However, previous studies commencing after the initiation of puberty have been unable to explore whether early puberty is preceded by higher rates of these problems. In a large national study, we aimed to determine whether difficulties in behavior and psychosocial adjustment are evident before as well as during the early pubertal transition. METHODS The Longitudinal Study of Australian Children recruited a nationally representative cohort of 4,983 children at age 4-5 years in 2004. This analysis includes 3,491 of these children (70.1%) followed up at ages 6-7, 8-9, and 10-11 years, with a completed parent report of stage of pubertal maturation at age 8-9 years. Parents reported behavior difficulties (Strengths and Difficulties Questionnaire) and psychosocial adjustment (Pediatric Quality of Life Inventory) at all four waves from ages 4-5 to 10-11 years. RESULTS Both boys and girls who entered puberty early (i.e., by age 8-9 years) also experienced poorer psychosocial adjustment at this age. These psychosocial differences were already evident at ages 4-5 and 6-7 years, and persisted to at least age 10-11 years. Similar patterns were evident for behavior difficulties, but only for boys; early puberty was not related to behavior difficulties in girls. CONCLUSIONS Children with early puberty have different patterns of behavior and social adjustment from the preschool years through early adolescence. At least in part, the association between early-onset puberty and poor mental health appears to result from processes under way well before the onset of puberty.