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Aims Methods Results Conclusions To identify a subgroup of mothers at high risk of preterm delivery, defined by empirical classes of multimorbidity and recurrence across three consecutive births.The data were extracted from the perinatal data collection (PDC) of all inpatient live births (n = 435 912) occurring in the Australian state of Queensland between January 2009 and December 2015. Within this data, a total of 7714 primiparous mothers delivered three consecutive singleton live births (total births = 23 142), and comprise the sample for all analyses.The LCA indicated a four‐class solution fit the data best at each time point, including (i) a ‘normative’ or healthy class with little morbidity (including >80% of the sample at each birth); (ii) a preterm, high morbidity class (<2% of the sample); (ii) a delivery morbidity class (4–8% of the sample); and (iii) preterm, low morbidity class (5–6% of the sample). Each group exhibited unique and consistent associations with maternal and pregnancy‐related factors across births. After accounting for these factors, the high morbidity class and preterm, low morbidity class strongly predicted these same classes across consecutive births, and from birth 1 to birth 3 (second‐order transition).A small but highly morbid class of neonatal deliveries emerged, exhibiting strong continuity across consecutive births (odds ratios >10), independent of a range of maternal and pregnancy‐related factors. This group of women, if subject to further investigation, could provide valuable insight into the aetiology of prematurity and associated morbidity, perhaps providing information to improve birth outcomes among all women. [ABSTRACT FROM AUTHOR]

Anxiety disorders is ranked as the most common class of mental illness disorders globally, affecting hundreds of millions of people and significantly impacting daily life. Developing reliable predictive models for anxiety treatment outcomes holds immense potential to help guide the development of personalised care, optimise resource allocation and improve patient outcomes. This research investigates whether community mental health treatment for anxiety disorder is associated with reliable changes in Kessler psychological distress scale (K10) scores and whether pre-treatment K10 scores and past health service interactions can accurately predict reliable change (improvement). The K10 assessment was administered to 46,938 public patients in a community setting within the Western Australia dataset in 2005–2022; of whom 3794 in 4067 episodes of care were reassessed at least twice for anxiety disorders, obsessive–compulsive disorder, or reaction to severe stress and adjustment disorders (ICD-10 codes F40–F43). Reliable change on the K10 was calculated and used with the post-treatment score as the outcome variables. Machine learning models were developed using features from a large health service administrative linked dataset that includes the pre-treatment K10 assessment as well as community mental health episodes of care, emergency department presentations, and inpatient admissions for prediction. The classification model achieved an area under the receiver operating characteristic curve of 0.76 as well as an F1 score, precision and recall of 0.69, and the regression model achieved an R2 of 0.37 with mean absolute error of 5.58 on the test dataset. While the prediction models achieved moderate performance, they also underscore the necessity for regular patient monitoring and the collection of more clinically relevant and contextual patient data to further improve prediction of treatment outcomes. [ABSTRACT FROM AUTHOR]

Background: Research exploring the relationship between prenatal infection and child behavioural outcomes would benefit from further studies utilising full‐population samples with the scale to investigate specific infections and to employ robust designs. We tested the association among several common infections requiring inpatient admission during and after pregnancy with a range of childhood behavioural outcomes, to determine whether any negative impact was specific to the period of foetal development. Methods: The sample included all mother–offspring pairs from the Australian state of New South Wales (NSW) for whom the child commenced their first year of full‐time schooling in 2009 (~age 5 years; n = 77,302 offspring), with records linked across four health administrative data sets including the NSW perinatal data collection (PDC), the NSW admitted patient data collection (APDC) and the NSW component of the 2009 Australian Early Development Census (AEDC). Multivariable linear regression was used to test associations between a number of infections requiring inpatient admission during and after pregnancy with a range of teacher assessed behavioural outcomes. Results: Associations specific to the prenatal period were only found for streptococcus A although this would need to be reproduced in external samples given the low prevalence. Otherwise, 12 out of 15 selected infections either showed no association prenatally or also demonstrated associations in the 12 months after pregnancy. For example, prenatal hepatitis C, influenza and urinary E. coli infections were associated with lower scores of several domains of childhood behaviour, but even stronger associations were found when these same maternal infections occurred after pregnancy. Conclusions: The prenatal infections we tested appeared not to impact childhood behaviour by altering foetal neurodevelopment. Rather, the strong associations we found among infections occurring during and after pregnancy point to either residual socioeconomic/lifestyle factors or a shared familial/genetic liability between infections and behavioural problems. [ABSTRACT FROM AUTHOR]

Introduction This study aims to explore association between maternal depressive symptoms and infant feeding practice at hospital discharge. Methods Data were obtained from a birth cohort study based in Australia that linked to health administrative records. Maternal demographic data, mental health status derived from the Edinburgh Postnatal Depression Scale (EPDS), feeding practices of livebirths of at least 400 g or gestation periods of at least 20 weeks recorded during July-December 2015 were included (n = 14,658). Logistic regression models were performed to test association between presence of depressive symptoms and exclusive breast or formula feeding within 24 h prior to hospital discharge while adjusting for covariates known to be associated with breastfeeding. Results About 12% of women self-reported having depressive symptoms (EPDS score [greater than or equal to] 10). Although only 7% of women (n = 1012) exclusively formula fed their babies, having depressive symptoms was associated with a 51% higher likelihood of exclusive formula feeding at hospital discharge. The association remains significant after adjustment for maternal age, gestational weeks, number of previous pregnancies, socioeconomic and partner status (p < 0.001) and all other covariates (p = 0.009). Conclusions for Practice Having depressive symptoms was associated with increased likelihood of exclusive formula feeding. Routine measurement post-delivery and early management of maternal depressive symptoms may influence infant feeding practice and reduce prevalence of exclusive formula feeding at hospital discharge., Author(s): HuiJun Chih [sup.1] , Kim Betts [sup.1] , Jane Scott [sup.1] , Rosa Alati [sup.1] Author Affiliations: (1) grid.1032.0, 0000 0004 0375 4078, School of Public Health, Faculty of [...]

Objectives We assessed the impact of caesarean delivery on offspring respiratory and intestinal infection. Methods Data were extracted from all live births (n = 429,058) occurring in the Australian state of Queensland between January 2009 and December 2015, and followed for 12 months. Births were categorised as either non-medically indicated caesarean or vaginal delivery and each offspring had a record (present/absent) of respiratory and intestinal infection hospitalisation for each month from birth to 12 months. Results Infants delivered by non-medically indicated caesarean were more likely to experience respiratory infection [OR = 1.51 (1.15, 1.99)] and intestinal infection [OR = 1.74 (1.19, 2.55)] than those born by vaginal delivery. In the propensity score weighted analyses the estimate for respiratory infection was similar but non-significant [OR = 1.52 (0.99, 2.31)], while the association with intestinal infection strengthened [OR = 2.21 (1.25, 3.89)]. Conclusions for Pratice Our findings provide strong evidence for a specific and clinically meaningful link between non-medically indicated caesarean delivery and infant intestinal infection., Author(s): Kim S. Betts [sup.1] , Ricardo J. Soares Magalhães [sup.2] [sup.3] , Rosa Alati [sup.1] Author Affiliations: (1) grid.1032.0, 0000 0004 0375 4078, School of Public Health, Curtin University, [...]

Open in new tab Download slide OBJECTIVES The aim of this study was to assess the early outcomes and risk factors of paediatric patients requiring extracorporeal membrane oxygenation after cardiac surgery (post-cardiotomy). METHODS Retrospective binational cohort study from the Australia and New Zealand Congenital Outcomes Registry for Surgery database. All patients younger than 18 years of age who underwent a paediatric cardiac surgical procedure from 1 January 2013 to 31 December 2021 and required post-cardiotomy extracorporeal membrane oxygenation (PC-ECMO) in the same hospital admission were included in the study. RESULTS Of the 12 290 patients included in the study, 376 patients required post-cardiotomy ECMO (3%). Amongst these patients, hospital mortality was 35.6% and two-thirds of patients experienced a major complication. Hypoplastic left heart syndrome was the most common diagnosis (17%). The Norwood procedure and modified Blalock–Taussig shunts had the highest incidence of requiring PC-ECMO (odds ratio of 10 and 6.8 respectively). Predictors of hospital mortality after PC-ECMO included single-ventricle physiology, intracranial haemorrhage and chylothorax. CONCLUSIONS In the current era, one-third of patients who required PC-ECMO after paediatric cardiac surgery in Australia and New Zealand did not survive to hospital discharge. The Norwood procedure and isolated modified Blalock–Taussig shunt had the highest incidence of requiring PC-ECMO. Patients undergoing the Norwood procedure had the highest mortality (48%). Two-thirds of patients on PC-ECMO developed a major complication. [ABSTRACT FROM AUTHOR]

Objective Knowledge of the factors which influence repeat pregnancy can inform much needed evidence-based prevention programs. This study aims to identify correlates of repeat pregnancy in the Philippines. Methods We used data from five Philippine Demographic and Health Surveys (1993-2013). A total of 4757 women 15-24 years old who had experienced [greater than or equal to] 1 pregnancy were included. Individual and partner-related factors were fitted into a series of logistic regression stepwise models with deformalized survey weights. Stratified analyses using two age groups (15-19, 20-24) were also conducted. Interaction terms were included to test for statistical differences between the groups. Results Lower wealth quintiles [odds ratio (OR) 1.71, 95% confidence interval (CI) 1.17-2.49] and partner characteristics such as age of [greater than or equal to] 30 years (OR = 1.99, CI = 1.41-2.82), multiple partners (OR = 4.19, CI = 1.57-11.19) and live-in status (OR = 1.38, CI = 1.02-1.87) were found to be highly correlated with repeat pregnancy in fully adjusted analysis. Receiving prenatal care from traditional healers (OR = 1.93, CI = 1.02-3.63) during the first pregnancy and giving birth for the first time before 18 years of age (OR = 1.12, CI = 1.04-1.20) showed increased risks among 15-19 years old compared to 20-24 years old in stratified analysis. Conclusions for practice In general, partner characteristics were associated with repeat pregnancy among young women suggesting male involvement, especially older partners, in family planning. High risks for repeat pregnancy were observed among adolescent women who reported younger age at first birth and received prenatal care from a traditional healer which entail promotion of trained prenatal care. Further analysis is needed to validate these findings in other developing countries., Author(s): Joemer C. Maravilla [sup.1] [sup.2] , Kim S. Betts [sup.1] , Rosa Alati [sup.1] Author Affiliations: (Aff1) 0000 0000 9320 7537, grid.1003.2, Institute for Social Science Research, The University [...]