Jackob M. Najman

Evaluating the impact of medical care and technologies on the quality of life: A review and critique

Recent publications by a number of critics of health care raise substantial questions about the benefits which derive from new medical technologies. The response of those who advocate these new technologies has broadened the argument, adding quality of life (QOL) considerations to previous claims which emphasize increased longevity. Unfortunately, the studies which purport to demonstrate an improved QOL do not incorporate relevant findings from a wide range of studies which emphasize the complex interplay of many subjective factors in the quantitative assessment of the QOL. There have been numerous studies of a wide range of medical interventions which employ QOL criteria. In the main, the inadequate research designs employed in these studies contrast with the sophisticated technology they purport to assess. A review of these studies indicates that few if any, procedures may be defended on the grounds that they improve the QOL. There is a need for studies involving adequately controlled samples using objective and subjective QOL indicators which address the manner in which objective QOL changes are subjectively interpreted. Until these studies become available, arguments for the impact of medical technologies on the QOL will be speculative and remain unconvincing.

Does breastfeeding protect against substantiated child abuse and neglect? A 15-year cohort study

OBJECTIVES. We explored whether breastfeeding was protective against maternally perpetrated child maltreatment. METHODS. A total of 7223 Australian mother-infant pairs were monitored prospectively over 15 years. In 6621 (91.7%) cases, the duration of breastfeeding was analyzed with respect to child maltreatment (including neglect, physical abuse, and emotional abuse), on the basis of substantiated child protection agency reports. Multinomial logistic regression was used to compare no maltreatment with nonmaternal and maternally perpetrated maltreatment and to adjust for confounding in 5890 cases with complete data (81.5%). Potential confounders included sociodemographic factors, pregnancy wantedness, substance abuse during pregnancy, postpartum employment, attitudes regarding infant caregiving, and symptoms of anxiety or depression. RESULTS. Of 512 children with substantiated maltreatment reports, >60% experienced ≥1 episode of maternally perpetrated abuse or neglect (4.3% of the cohort). The odds ratio for maternal maltreatment increased as breastfeeding duration decreased, with the odds of maternal maltreatment for nonbreastfed children being 4.8 times the odds for children breastfed for ≥4 months. After adjustment for confounding, the odds for nonbreastfed infants remained 2.6 times higher, with no association seen between breastfeeding and nonmaternal maltreatment. Maternal neglect was the only maltreatment subtype associated independently with breastfeeding duration. CONCLUSION. Among other factors, breastfeeding may help to protect against maternally perpetrated child maltreatment, particularly child neglect.

A Three Year Outcome Evaluation of a Theory Based Drink Driving Education Program

This study reports on the impact of a “drink driving education program” taught to grade ten high school students. The program which involves twelve lessons uses strategies based on the Ajzen and Madden theory of planned behavior. Students were trained to use alternatives to drink driving and passenger behaviors. One thousand seven hundred and seventy-four students who had been taught the program in randomly assigned control and intervention schools were followed up three years later. There had been a major reduction in drink driving behaviors in both intervention and control students. In addition to this cohort change there was a trend toward reduced drink driving in the intervention group and a significant reduction in passenger behavior in this group. Readiness to use alternatives suggested that the major impact of the program was on students who were experimenting with the behavior at the time the program was taught. The program seems to have optimized concurrent social attitude and behavior change.

Maternal Anxiety and Attention Problems in Children at 5 and 14 Years

Objective: This study examines the association between maternal anxiety from pregnancy to 5 years and child attention problems at 5 and 14 years. Method: Birth cohort of 3,982 individuals born in Brisbane between 1981 and 1983 are assessed. Self-reported measures of maternal anxiety are assessed at four time points. Maternal reports of child attention problems using Achenbach’s Child Behavior Checklist are assessed at 5 and 14 years. Results: Children of mothers experiencing anxiety during or after pregnancy are at greater risk of experiencing attention problems at 5 and 14 years. After adjusting for maternal age and child’s gender, antenatal anxiety is strongly associated with persistent attention problems (OR = 3.65, 95% CI = 2.19, 6.07). Children with chronically anxious mothers are 5.67 (95% CI = 3.56, 9.03) times more likely to have persistent attention problems. These associations remain consistent after adjusting for potential confounders. Conclusions: Maternal anxiety appears to increase the rate of child attention problems and identifies a need for treatment programs to have a dual focus—the mother and her child. (J. of Att. Dis. 2010; 13(6) 658-667)

A systematic review and meta-analysis of the association between unintended pregnancy and perinatal depression

BACKGROUND There is a growing interest in exploring maternal mental health effects of unintended pregnancies carried to term. However, the evidence base from a small number of available studies is characterised by considerable variability, inconsistency and inconclusive findings. We present a systematic review and meta-analysis of all available studies on unintended pregnancy as these are related to maternal depression. METHODS Using PRISMA guideline, we systematically reviewed and meta-analysed studies reporting an association between unintended pregnancy and maternal depression from PubMed, EMBASE, PsychINFO and Google Scholar. We used a priori set criteria and included details of quality and magnitude of effect sizes. Sample sizes, adjusted odds ratios and standard errors were extracted. Random effects were used to calculate pooled estimates in Stata 13. Cochrans Q, I(2) and meta-bias statistics assessed heterogeneity and publication bias of included studies. RESULTS Meta-bias and funnel plot of inverse variance detected no publication bias. Overall prevalence of maternal depression in unintended pregnancy was 21%. Unintended pregnancy was significantly associated with maternal depression. Despite statistically significant heterogeneities of included studies, sub-group analyses revealed positive and significant associations by types of unintended pregnancies, timing of measurements with respect to pregnancy and childbirth, study designs and settings. CONCLUSIONS The prevalence of perinatal depression is two-fold in women with unintended pregnancy. Perinatal care settings may screen pregnancy intention and depression of women backed by integrating family planning and mental health services.

Theories of disease causation and the concept of a general susceptibility: A review

Abstract Three views of disease causation may be identified from the literature. The first is the monocausal view and emerges from the “conquest” of the infectious diseases. The second approach emphasizes the concept of multicausality and derives its popularity largely from the study of the diseases of industrialized societies. Both these types of explanation of disease have weaknesses insofar as they fail to adequately account for a range of findings. These findings indicate that there are groups in some societies which are at an advantage or disadvantage for many apparently different causes of illness and death. The third view, the general susceptibility approach to disease causation, recognizes the existence of these patterns and directs attention to a number of possible explanations. The two most plausible of these explanations focus on the experience of stress (psychosomatic explanation) or the health consequences of particular lifestyles (sociosomatic explanation). Each of these explanations fails, in some respects, to account for all the available data. Despite these inadequacies, it is clear that a substantial body of evidence tends to verify the existence of a general susceptibility to disease and death. This evidence would appear to be sufficiently convincing to justify experimental intervention programs.

Sexually transmissible infections among sex workers and their clients: variation in prevalence between sectors of the industry

OBJECTIVES The risk of sexually transmissible infection (STI) among sex workers and their clients may be higher than the general population. However, many studies have categorised workers or clients into homogenous groups for the purposes of analysis. The aim of the present study was to assess variations in self-reported STI rates among licenced brothel, private and illegal sex workers and their clients. METHODS In 2003, self-report data were collected from female sex workers and their male commercial clients residing in the state of Queensland, Australia. Overall, 247 sex workers (aged 19-57 years) and 185 of their respective clients (aged between 19 and 72 years) completed anonymous questionnaires. RESULTS There was little variation in self-reported lifetime STI prevalence of licenced brothel, private and illegal (predominantly street-based) sex workers, although licenced brothel workers were less likely to report ever being diagnosed with gonorrhoea or pubic lice in the past (P = 0.035 and 0.004 respectively). In contrast, clients accessing illegal services reported higher lifetime STI (36.0%, 95% confidence interval (CI) 20.2-55.6) than men recruited through private sex workers (20.0%, 95% CI 11.4-32.5) and clients from licenced brothels (7.6%, 95% CI 3.7-14.5). CONCLUSIONS This study found high self-reported lifetime prevalence of infection among sex workers and their clients. It is notable, however, that lower STI rates were reported by clients and sex workers from licenced brothels. This would suggest that risk of infection is not equivalent across industry sectors and highlights some of the inherent risks associated with generalisation across the sex industry.

Cohort Profile: The Australian Parental Supply of Alcohol Longitudinal Study (APSALS)

The Australian Parental Supply of Alcohol Longitudinal Study (APSALS) was established in 2010 to investigate the short- and long-term associations between exposure to early parental alcohol provision, early adolescent alcohol initiation, subsequent alcohol use and alcohol-related harms, controlling for a wide range of parental, child, familial, peer and contextual covariates. The cohort commenced with 1927 parent-child dyads comprising Australian Grade 7 school students (mean age = 12.9 years, range = 10.8-15.7 years), and a parent/guardian. Baseline, 1- and 2-year follow-up data have been collected, with > 90% retention, and a 3-year follow-up is under way. The data collected include child, familial, parental and peer factors addressing demographics, alcohol use and supply, parenting practices, other substance use, adolescent behaviours and peer influences. The cohort is ideal for prospectively examining predictors of initiation and progression of alcohol use, which increases markedly through adolescence.

Parents Who Supply Sips of Alcohol in Early Adolescence: A Prospective Study of Risk Factors.

BACKGROUND: Parents are a major supplier of alcohol to adolescents, often initiating use with sips. Despite harms of adolescent alcohol use, research has not addressed the antecedents of such parental supply. This study investigated the prospective associations between familial, parental, peer, and adolescent characteristics on parental supply of sips. METHODS: Participants were 1729 parent–child dyads recruited from Grade 7 classes, as part of the Australian Parental Supply of Alcohol Longitudinal Study. Data are from baseline surveys (Time 1) and 1-year follow-up (Time 2). Unadjusted and adjusted logistic regressions tested prospective associations between Time 1 familial, parental, peer, and adolescent characteristics and Time 2 parental supply. RESULTS: In the fully adjusted model, parental supply was associated with increased parent-report of peer substance use (odds ratio [OR] = 1.20, 95% confidence ratio [CI], 1.08–1.34), increased home alcohol access (OR = 1.07, 95% CI, 1.03–1.11), and lenient alcohol-specific rules (OR=0.88, 95% CI, 0.78–0.99). CONCLUSIONS: Parents who perceived that their child engaged with substance-using peers were more likely to subsequently supply sips of alcohol. Parents may believe supply of a small quantity of alcohol will protect their child from unsupervised alcohol use with peers. It is also possible that parental perception of peer substance use may result in parents believing that this is a normative behavior for their child’s age group, and in turn that supply is also normative. Further research is required to understand the impacts of such supply, even in small quantities, on adolescent alcohol use trajectories.

Quality of life of people who inject drugs: characteristics and comparisons with other population samples

PurposeTo assess the quality of life (QOL) of persons who inject drugs.MethodsSome 483 current injecting drug users visiting a large NSP over a 2-week period in October 2009 were interviewed using a structured questionnaire. QOL was measured using the WHOQOL-BREF. Data were collected on age, gender, injecting patterns, current drug treatment status and hepatitis C status. Participant QOL profiles were compared to published domain scores for a range of other population groups.ResultsPeople who inject drugs (PWID) experience a very poor QOL irrespective of socio-demographic characteristics, injecting patterns, hepatitis C sero-status and drug treatment status. Sample participants (PWID) experience a QOL below that experienced by many population groups in the community affected by disabling chronic illnesses.ConclusionsInjecting drug use is associated with a poor QOL. Some PWID may be self-medicating for chronic non-malignant pain, and it is likely that these people had a low QOL prior to the decision to inject. Despite this caveat, it remains likely that injecting drug use does little to enhance the QOL of the user.