Reza Hayatbakhsh

Are child and adolescent mental health problems increasing in the 21st century? A systematic review

Objective: Up to one in five children experience mental health problems. Social and cultural factors may influence emergence of mental health problems. The 21st century has led to changes in many of these factors, but it is unclear whether rates of internalizing and externalizing problems have also changed in recent cohorts of young people. Methods: A comprehensive literature search was undertaken to locate cohort or population studies that examined changes in mental health of children over time, where participants were aged 18 years and under, and the time frame for change was at least 10 years, with data for at least one time point in the 21st century being statistically compared to at least one time point in the 20th century. Studies were reviewed for quality and outcome. Results: Nineteen studies met criteria for review. These included studies of toddlers, children, and adolescents. Seventeen studies examined internalizing problems, and 11 studies examined externalizing problems. For both children and toddlers, recent cohorts did not exhibit worsening of mental health symptoms. In adolescents, the burden of externalizing problems appear to be stable. However, the majority of studies report an increase in internalizing problems in adolescent girls. The findings for internalizing problems in boys were mixed. Conclusions: These findings suggest that recent cohorts of adolescent girls are experiencing increases in internalizing symptoms compared to previous cohorts. Approaches for prevention and early intervention should be explored.

Effect of aquatic exercise training on fatigue and health-related quality of life in patients with multiple sclerosis

OBJECTIVE To examine the effectiveness of aquatic exercise training on fatigue and health-related quality of life (HRQOL) in women with multiple sclerosis (MS). DESIGN Randomized controlled trial, 4-week and 8-week follow-up. SETTING Referral center of a multiple sclerosis society. PARTICIPANTS Women (N=32) diagnosed with relapsing-remitting MS (mean age ± SD, 32.6±8.0y) were recruited into this study. After undergoing baseline testing by a neurologist, participants were randomly assigned to either an intervention (aquatic exercise) or a control group. INTERVENTIONS The intervention consisted of 8 weeks supervised aquatic exercise in a swimming pool (3 times a week, each session lasting 60min). MAIN OUTCOME MEASURES At baseline, 4 weeks, and 8 weeks, fatigue and HRQOL were assessed by a blind assessor using the Modified Fatigue Impact Scale and the Multiple Sclerosis Quality of Life-54 questionnaire, respectively. A mixed-model approach to repeated-measures analysis of variance was used to detect within- and between-subject effects. RESULTS Findings are based on 21 patients (10 from the exercise group and 11 from the control group) who had data available on outcomes. There was no significant difference between the 2 groups at the baseline. Patients in the aquatic exercise group showed significant improvements in fatigue and subscores of HRQOL after 4 and 8 weeks compared with the control group. Results obtained from the intention-to-treat analysis were consistent with those of per-protocol analysis. CONCLUSIONS The findings suggest that aquatic exercise training can effectively improve fatigue and HRQOL of patients with MS and should be considered in the management of this relatively common public health problem.

Do Antisocial Females Exhibit Poor Outcomes in Adulthood? An Australian Cohort Study

Objective: Antisocial behaviour in young people is common and associated with adverse effects in adulthood. The question whether these effects are observed in both genders remains controversial. A typology of antisocial behaviour that captures childhood limited (CL), adolescent onset (AO) and life course persistent behaviour (LCP) through both developmental stages is utilized to examine young adult outcomes in both sexes. Methods: The Mater–University of Queensland Study of Pregnancy (MUSP) data set is a longitudinal study following up a cohort of 7223 infants and mothers from antenatal care to the childs 21st year. Data on child antisocial behaviour was collected at ages 5 and 14 years. At the 21-year follow up, self-reported outcomes were collected on antisocial behaviour, use of alcohol, tobacco and cannabis, physical and mental health functioning. The relationship between the three antisocial sub-types and negative young adult outcomes was examined for both males and females using a series of logistic regressions. Results: Complete data across 21 years was available for 3173 participants. Males experienced higher levels of antisocial behaviour. In both males and females, AO and LCP groups exhibited elevated risk of negative outcomes including continuing antisocial behaviour, cannabis use, general health problems and depression/anxiety symptoms. The CL group exhibited poorer outcomes in physical and mental health but not in other domains. Conclusion: Both males and females exhibiting AO and LCP antisocial behaviour are at increased risk of serious adverse outcomes in young adulthood. The significant loss to follow up of high-risk groups suggests the important relationship between early antisocial behaviour and problems in adulthood have been underestimated. Further research is required to understand antisocial behaviour in adolescence, identify factors that reinforce its continuity into adulthood, and identify interventions which are able to modify adult outcomes.

Sites of Origin of Oral Cavity Cancer in Nonsmokers vs Smokers: Possible Evidence of Dental Trauma Carcinogenesis and Its Importance Compared With Human Papillomavirus

IMPORTANCE The relatively high and possibly rising incidence of mouth squamous cell carcinoma in nonsmokers, especially women, without obvious cause has been noted by previous authors. Is chronic dental trauma and irritation a carcinogen, and what is its importance compared with human papillomavirus (HPV) oropharyngeal cancer in nonsmokers? OBJECTIVE To determine whether oral cavity cancers occurred more commonly at sites of dental trauma and how the position of these cancers varied between nonsmokers lacking major identified carcinogens and smokers. If these cancers occurred more frequently at sites of chronic trauma, especially in nonsmokers, it would suggest chronic dental trauma as a possible carcinogen. DESIGN, SETTING, AND PARTICIPANTS A retrospective analysis of 881 patients with oral cavity or oropharyngeal cancers seen through a tertiary referral hospital between 2001 and 2011 was performed. MAIN OUTCOMES AND MEASURES Patient medical records were analyzed to determine the location of the tumor within the oral cavity and oropharynx and how it relates to patient demographics, smoking and alcohol histories, and comorbidities. Dental histories were also sought, including use of dentures. RESULTS Nonsmokers comprised 87 of 390 patients with mouth cancer (22%) and 48 of 334 patients with oropharyngeal cancer (14%). Female nonsmoking patients included 53 with oral cancer (61%) but only 12 with oropharyngeal squamous cell carcinoma (25%). Oral cancers occurred on the lateral tongue, a potential site of chronic dental trauma, in 57 nonsmokers (66%) compared with 107 smokers/ex-smokers (33%) (P < .001). Gingival and floor of mouth lesions occurred in older patients, possibly from chronic denture rubbing. Twenty-six patients had dental abnormalities recorded in close proximity to where their tumor developed. CONCLUSIONS AND RELEVANCE Oral cavity cancers occur predominantly at sites of potential dental and denture trauma, especially in nonsmokers without other risk factors. Recognizing teeth irritation as a potential carcinogen would have an impact on prevention and treatment strategies.

Early childhood predictors of early onset of smoking: a birth prospective study.

OBJECTIVE Early onset of smoking is associated with subsequent abuse of other substances and development of negative health outcomes. This study aimed to examine early life predictors of onset of smoking in an Australian young cohort. METHODS Data were from the Mater Hospital and University of Queensland Study of Pregnancy (MUSP), a population-based prospective birth cohort study (1981-2012). The present study is based on a cohort of 3714 young adults who self-reported smoking status and age of onset of smoking at the 21-year follow-up. Of these, data were available for 3039 on early childhood factors collected between the baseline and 14-year follow-up of the study. RESULTS Of 3714 young adults, 49.6% (49.9% males and 49.3% females) reported having ever smoked cigarettes. For those who had ever smoked, mean and median ages at first smoke were 15.5 and 16.0years, respectively. In multivariate Cox proportional hazard analysis mothers education, change in maternal marital status, maternal cigarette smoking and alcohol consumption, maternal depression and child externalizing when the child was 5years statistically significantly predicted early onset of smoking. CONCLUSIONS The data suggest that individuals exposed to personal and environmental risk factors during the early stage of childhood are at increased risk of initiation to cigarette smoking at an earlier age. Identification of the pathways of association between these early life factors and initiation to cigarette smoking may help reduce risk of tobacco smoking in adolescents and its adverse consequences.

Predictors of maternal drinking trajectories before and after pregnancy: evidence from a longitudinal study.

Little is known about patterns of change in alcohol consumption and predictors of these patterns over the prenatal to postnatal period.

Comparing dysphagia therapy in head and neck cancer patients in Australia with international healthcare systems

Abstract Purpose: The Australian healthcare system has invested heavily in multidisciplinary cancer care teams. Despite such investments, guidelines that clearly delineate standard of care dysphagia treatment are lacking and services provided to Head and Neck Cancer (HNC) patients are not always consistent. There is little consensus regarding the frequency and intensity of dysphagia therapy. This is largely due to a lack of well-designed clinical trials that establish the efficacy of any dysphagia therapy in this patient population. The aim of this study was to evaluate HNC dysphagia therapy patterns among Australian speech-language pathologists (SLPs). Method: A 22 question internet-based survey was administered to a web-based professional interest group. Results were analysed by institution type and individual clinical experience. Result: A response rate of 46% was achieved (67 out of 144 surveyed). This survey identified several aspects of dysphagia management that were provided uniformly in addition to many aspects of care that showed a lack of consensus. Conclusion: By comparing the results of this survey with existing international best-evidence treatment guidelines, the development of uniform Australian guidelines may be facilitated. However, more authoritative data on dysphagia treatment efficacy is needed to provide uniform evidence-based HNC dysphagia treatment guidelines.

How can data harmonisation benefit mental health research? An example of The Cannabis Cohorts Research Consortium

Peter Butterworth is supported by ARC Future Fellowship (FT130101444). Louisa Degenhardt is supported by an NHMRC Principal Research Fellowship (APP1041742). Delyse Hutchinson is supported by a ViceChancellor’s Postdoctoral Fellowship from the University of New South Wales. Richard P Mattick is supported by an NHMRC Principal Research Fellowship (APP1045318). Craig Olsson is supported by an Australian Research Council Principal Research Fellowship (DP 1311459). George Patton is supported by an NHMRC Senior Principal Research Fellowship (APP1019887).

Maternal and personal religious engagement as predictors of early onset and frequent substance use

BACKGROUND AND OBJECTIVE This study examined whether maternal and offsprings religiosity independently predict age of onset and frequency of substance use in offspring, and whether gender differentiates these associations. METHODS Data were from the Mater Hospital and University of Queensland Study of Pregnancy, a birth cohort study. Participants were a cohort of 3,537 persons who were born during 1981-83 and were followed-up to 21 years. Odds ratio (OR) and 95% confidence interval (CI) were used to estimate relative risk of substance use. RESULTS Both maternal and offsprings religious practice were associated with later onset and less frequent substance use. After adjustment for potential confounding and maternal religious background, offspring who were not attending church were more likely to report early onset of tobacco smoking (OR = 5.1; 95% CI: 2.8-9.4), alcohol drinking (OR = 17.4; 95% CI: 8.9-33.9) and cannabis use (OR = 7.5; 95% CI: 3.4-16.0). DISCUSSION AND CONCLUSIONS Findings of this study suggest family and personal religious practices are predictors of less substance use problems in adolescents and young adult males and females. SCIENTIFIC SIGNIFICANCE AND FUTURE DIRECTIONS Religious engagement functions as a deterrent to adolescent tobacco, alcohol, and cannabis use.

Women's frequency of alcohol consumption prior to pregnancy and at their pregnancy-booking visit 2001-2006: A cohort study

BACKGROUND With evidence of offspring harms and concern for younger womens drinking behaviours, this study uses a hospital cohort to trend the use and changes in womens reported alcohol consumption. AIMS To examine (i) the trend of womens reported alcohol consumption over time, (ii) whether any increases in the frequency of alcohol consumption prior to a pregnancy are accompanied by increases in the frequency of alcohol consumption in pregnancy and (iii) the characteristics of women consuming alcohol at these times. METHODS Midwives collected routine data on 19,699 women between 2001 and 2006. Data on womens alcohol use prior to pregnancy and at their pregnancy-booking visit were analysed using a non-parametric test for trend and with bivariate and multivariate tests adjusting for possible confounders. FINDINGS The proportion of women reporting at-least weekly alcohol use prior to pregnancy was 25.4% and 5.9% at their pregnancy-booking visit. A significant linear increase over time (p<0.001) was found in the rate of women aged 20 years and older reporting at-least weekly alcohol use prior to pregnancy. Tertiary-educated women were more likely to consume alcohol at-least weekly prior to pregnancy. Women aged less than 20 years were less likely to report at-least weekly alcohol use at both time points. Having more children and Asian ethnicity were associated with a lower risk of at-least weekly alcohol use at these times. CONCLUSION The majority of women reduce their alcohol consumption once they learn they are pregnant, with some evidence this trend may have increased in recent years.