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The association of air pollution and greenspace with respiratory pathogen acquisition and respiratory health was investigated in a community-based birth-cohort of 158 Australian children. Weekly nasal swabs and daily symptom-diaries were collected for 2-years, with annual reviews from ages 3-7-years. Annual exposure to fine-particulate-matter (PM2.5), nitrogen-dioxide (NO2), and normalised-difference-vegetation-index (NDVI) was estimated for pregnancy and the first 2-years-of-life. We examined rhinovirus, any respiratory virus, Streptococcus pneumoniae, Moraxella catarrhalis, and Haemophilus influenzae detections in the first 3-months-of-life, age at initial pathogen detection, wheezing in the first 2-years, and asthma at ages 5-7-years. Our findings suggest that higher NDVI was associated with fewer viral and M. catarrhalis detections in the first 3-months, while increased PM2.5 and NO2 were linked to earlier symptomatic rhinovirus and H. influenzae detections, respectively. However, no associations were observed with wheezing or asthma. Early-life exposure to air pollution and greenspace may influence early-life respiratory pathogen acquisition and illness. [ABSTRACT FROM AUTHOR]

Adolescents with intellectual disability have substantial health needs. This retrospective analysis of data from the Ask Study describes reasons for primary care encounters and the prevalence and incidence of chronic physical and mental conditions among a cohort of community-dwelling adolescents with intellectual disability. Participants attended secondary schools in southern Queensland, Australia. Primary care data were extracted from primary care records. Demographic and health information was collected using carer-completed questionnaires. Reasons for primary care encounters, disease prevalence at age 16 years, and disease incidence through adolescence were reported. Data were obtained for 432 adolescents with intellectual disability (median follow-up: 4.1 years). Skin problems (29.4 per 100 encounters) were the most common reason patients presented for primary care, followed by psychological and behavioural problems (14.4 per 100 encounters) and musculoskeletal problems (13.8 per 100 encounters). Conditions with the highest prevalence were autism spectrum disorder (18.6%) and asthma (18.1%). The prevalence of epilepsy, visual impairment, and cerebral palsy were 14.7, 11.1, and 8.0%, respectively. Gastroesophageal reflux had the highest incidence (9.4 cases per 1000 person-years). Adolescents with intellectual disability have significant healthcare needs, which general practitioners need to be aware of and address. Study findings should inform the development of training programs for general practitioners. [ABSTRACT FROM AUTHOR]

Aim: To describe the development of social function in children with cerebral palsy (CP) classified in all levels of the Communication Function Classification System (CFCS). Method: This prospective, longitudinal population‐based cohort study recruited children with CP born in Queensland, Australia. Social functioning was measured using the Pediatric Evaluation of Disability Inventory (PEDI) social function domain at 2 years, 2 years 6 months, 3 years, 4 years, and 5 years, and the PEDI Computer Adaptive Test (PEDI‐CAT) social/cognitive domain at 8 to 12 years. Results: Seventy‐four children provided 356 observations. PEDI‐CAT social/cognitive scaled scores at 8 to 12 years were (mean [SD] n) CFCS level I, 68.6 (2.7) 45; CFCS level II, 64.0 (3.4) 10; CFCS level III, 63.5 (3.7) 4; CFCS level IV, 56.8 (5.0) 9; CFCS level V, 47.2 (5.8) 6. Scores within expected range for age (not less than 2 SD below mean) at 8 to 12 years were achieved by 35 (78%) children in CFCS level I and four (14%) in CFCS levels II to V. Forty‐nine per cent of children scored at least two standard deviations below the population mean on a proxy measure of fluid intelligence. Intellectual impairment was associated with lower PEDI‐CAT social/cognitive scaled scores in univariable analysis (β = −8.3, 95% confidence interval − 10.91 to −5.63; p < 0.001) but had a smaller effect when modelled together with CFCS. Interpretation: Social function attained by 8 to 12 years of age was strongly related to level of communication function (CFCS). The small number of children classified in CFCS levels II to V necessitates caution when viewing these individual CFCS level trajectories. What this paper adds: There is a strong relation between social functioning and Communication Function Classification System (CFCS) levels.At 8 to 12 years, 35 out of 45 children in CFCS level I met social functioning age expectations.Twenty‐five out of 29 in CFCS levels II to V had social functioning below that expected for age.CFCS and age were more strongly associated with development of social functioning than Gross Motor Function Classification System or Manual Ability Classification System and age. What this paper adds: There is a strong relation between social functioning and Communication Function Classification System (CFCS) levels.At 8 to 12 years, 35 out of 45 children in CFCS level I met social functioning age expectations.Twenty‐five out of 29 in CFCS levels II to V had social functioning below that expected for age.CFCS and age were more strongly associated with development of social functioning than Gross Motor Function Classification System or Manual Ability Classification System and age. This original article is commented on by Eslinger on pages 596–597 of this issue. [ABSTRACT FROM AUTHOR]

Background: In a cohort of adults with intellectual disability who were followed for up to 16‐years, we investigated characteristics associated with frequent emergency department (ED) presentations, hospitalisation, and psychiatric care. Method: Community‐dwelling adults with intellectual disability residing in Queensland, Australia, were followed from 1999 to 2015. Healthcare presentations were extracted from administrative databases. Adults who presented frequently were identified and characteristics associated with frequent presentations were identified. Results: Data from 445 adults were analysed. Chronic disease and challenging behaviour were associated with frequent ED presentations (adjusted odds ratio = 1.8, 95% confidence interval = 1.1–3.0 and aOR = 2.2, 95% CI = 1.2–3.9 respectively). Chronic disease and severe/profound intellectual disability were associated with frequent hospitalisations (aOR = 1.9, 95% CI = 1.2–3.2 and aOR = 2.0, 95% CI = 1.2–3.3 respectively). Psychotropic medication use was associated with frequent psychiatric presentations (aOR = 1.9, 95% CI = 1.0–3.4). Conclusions: Adults at high risk of frequent healthcare presentations should be identified for programmes of optimising health system use, and potentially improving health care quality. [ABSTRACT FROM AUTHOR]

Aim: To describe development of gross motor capacity and mobility performance in children with cerebral palsy. Method: This longitudinal cohort study measured gross motor capacity with the Gross Motor Function Measure and mobility performance with the Pediatric Evaluation of Disability Inventory (PEDI) between 18 months and 5 years, and the PEDI – Computer Adaptive Test (PEDI‐CAT) between 8 years and 12 years. Longitudinal analyses used mixed‐effects regression modelling with interaction between age and Gross Motor Function Classification System (GMFCS). Stability of GMFCS levels over time was measured using agreement. Results: Two hundred and twenty‐two children provided 871 observations (median 4 observations, range 1–7). Children classified in GMFCS level I improved in both capacity and performance until 8 to 12 years. Children classified in GMFCS levels II and III continued to develop mobility performance after gross motor capacity had plateaued at 5 years. Children classified in GMFCS level IV plateaued at 5 years in capacity and performance. Children classified in GMFCS level V showed no changes in capacity or performance between 18 months and 8 to 12 years. Stability of GMFCS levels was 73%. Interpretation: Change in mobility performance over time somewhat reflected gross motor capacity trajectories. Continued improvement in mobility performance after plateau of gross motor capacity for children classified in GMFCS levels II and III suggests importance of other personal or environmental factors. [ABSTRACT FROM AUTHOR]

Objective: To develop and validate a difficult intravenous access risk assessment and escalation pathway, to increase first time intravenous insertion success in paediatrics.Methods: Mixed methods underpinned by literature and co-production principles. Iterative development of the instrument was informed through semi-structured interviews and stakeholder workshops. The instrument includes a risk assessment, inserter skill self-assessment, and escalation pathways. Reproducibility, reliability, and acceptability were evaluated in a prospective cohort study at a quaternary paediatric hospital in Australia.Results: Interview data (three parents, nine clinicians) uncovered two themes: i) Recognition of children with DIVA and subsequent escalation is ad hoc and problematic; and ii) Resources and training impact inserter confidence and ability. Three workshops were delivered at monthly intervals (February-April 2020) involving 21 stakeholders culminating in the co-production of the "DIVA Key". The DIVA Key was evaluated between May-December 2020 in 78 children; 156 clinicians. Seventy-eight paired assessments were undertaken with substantial agreement (concordance range = 81.5 to 83.0%) between the assessors. Interrater reliability of the DIVA risk assessment was moderate (kappa = 0.71, 95% CI 0.63-0.80). The DIVA Key predicted multiple insertion attempts for red (high risk) DIVA classification (relative risk ratio 5.7, 95% CI 1.2-27.1; reference low risk). Consumer and clinician satisfaction with DIVA Key was high (median (IQR) = 10 [8-10]; 8 [8-10 respectively).Conclusion: The DIVA Key is a straightforward, reliable instrument with inbuilt escalation pathway to support the identification of children with difficult intravenous access. [ABSTRACT FROM AUTHOR]

Objectives: Point‐of‐care ultrasound (POCUS) diagnosis of distal forearm fractures relies on the identification of buckling or breach of hyperechoic bone cortex. We describe the pronator quadratus hematoma (PQH) formation visualized on POCUS, the PQH sign, as it may aid diagnosis of pediatric distal forearm cortical breach fractures. Methods: A prospective cohort of children presenting to an emergency department with isolated, clinically non‐angulated distal forearm injuries received POCUS by an expert emergency physician sonologist who identified the presence or absence of the PQH sign. They secondarily recorded the difference between the size of the pronator quadratus (PQ) muscle on both the affected and non‐affected forearms (PQ delta thickness). Children received an x‐ray subsequent to POCUS and were diagnosed based on an x‐ray reported by a radiologist masked to POCUS findings. Results: Thirty‐eight children were recruited. All 22 patients with cortical breach fracture had PQH sign present (100%; 95%CI: 85–100%), while all 16 patients without cortical breach fracture had PQH sign absent (100%; 95%CI: 79–100%). PQ delta thickness ranged from 2.1 to 10.2 mm in cortical breach fractures, 0.0 to 1.1 mm in buckle fractures, and 0.2 to 0.8 mm in patients without fracture. Conclusions: The PQH sign correctly distinguished all children with, and without, cortical breach fractures. All PQ delta thicknesses were ≧2.1 mm when cortical breach fracture was present and ≦1.1 mm when cortical breach fracture was absent. The PQH sign and PQ delta thickness are promising measurements to identify pediatric distal forearm cortical breach fractures, and their utility should be confirmed in larger studies with sonologists of different abilities. [ABSTRACT FROM AUTHOR]

Background Hospital-based studies identify parechovirus (PeV), primarily PeV-A3, as an important cause of severe infections in young children. However, few community-based studies have been published and the true PeV infection burden is unknown. We investigated PeV epidemiology in healthy children participating in a community-based, longitudinal birth cohort study. Methods Australian children (n = 158) enrolled in the Observational Research in Childhood Infectious Diseases (ORChID) study were followed from birth until their second birthday. Weekly stool and nasal swabs and daily symptom diaries were collected. Swabs were tested for PeV by reverse-transcription polymerase chain reaction and genotypes determined by subgenomic sequencing. Incidence rate, infection characteristics, clinical associations, and virus codetections were investigated. Results PeV was detected in 1423 of 11 124 (12.8%) and 17 of 8100 (0.2%) stool and nasal swabs, respectively. Major genotypes among the 306 infection episodes identified were PeV-A1 (47.9%), PeV-A6 (20.1%), and PeV-A3 (18.3%). The incidence rate was 144 episodes (95% confidence interval, 128–160) per 100 child-years. First infections appeared at a median age of 8 (interquartile range, 6.0–11.7) months. Annual seasonal peaks changing from PeV-A1 to PeV-A3 were observed. Infection was positively associated with age ≥6 months, summer season, nonexclusive breastfeeding at age <3 months, and formal childcare attendance before age 12 months. Sole PeV infections were either asymptomatic (38.4%) or mild (32.7%), while codetection with other viruses in stool swabs was common (64.4%). Conclusions In contrast with hospital-based studies, this study showed that diverse and dynamically changing PeV genotypes circulate in the community causing mild or subclinical infections in children. Parechovirus can cause severe illnesses in children. However, studies focus mainly on hospitalized populations. True disease burden in the community remains largely unknown. From our community-based cohort, we found diverse parechovirus genotypes in the community, causing mild or subclinical infections in children. Clinical Trials Registration NCT01304914. [ABSTRACT FROM AUTHOR]

Copyright of Developmental Medicine & Child Neurology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Developmental Medicine & Child Neurology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

There is a strong association between access to early intervention (EI) services by 6 months of age and improved speech and language outcomes for children with permanent hearing loss (PHL). This study identified factors impacting on age of engagement and timing of engagement in EI services by families of 377 children with PHL. This retrospective cohort study included a group of children diagnosed with PHL born between 2011 and 2013 in Brisbane, Australia. The study investigated the association of demographic, social and diagnostic characteristics of children with age of engagement and timing of engagement in EI services. Factors significantly associated with later age of engagement, longer time between diagnosis and engagement, and no engagement with EI services included premature birth, unilateral hearing loss, mild hearing loss and not using a hearing aid. This study provided evidence for the efficacy of tailored support for families to achieve the best possible communication outcomes for their children with PHL. [ABSTRACT FROM AUTHOR]

Introduction: Viral acute respiratory infections (ARIs) cause substantial child morbidity. Sensitive molecular-based assays aid virus detection, but the clinical significance of positive tests remains uncertain as some viruses may be found in both acutely ill and healthy children. We describe disease-pathogen associations of respiratory viruses and quantify virus-specific attributable risk of ARIs in healthy children during the first 2 years of life.Methods: One hundred fifty-eight term newborn babies in Brisbane, Australia, were recruited progressively into a longitudinal, community-based, birth cohort study conducted between September 2010 and October 2014. A daily tick-box diary captured predefined respiratory symptoms from birth until their second birthday. Weekly parent-collected nasal swabs were batch-tested for 17 respiratory viruses by PCR assays, allowing calculation of virus-specific attributable fractions in the exposed (AFE) to determine the proportion of virus-positive children whose ARI symptoms could be attributed to that particular virus.Results: Of 8100 nasal swabs analysed, 2646 (32.7%) were virus-positive (275 virus codetections, 3.4%), with human rhinoviruses accounting for 2058/2646 (77.8%) positive swabs. Viruses were detected in 1154/1530 (75.4%) ARI episodes and in 984/4308 (22.8%) swabs from asymptomatic periods. Respiratory syncytial virus (AFE: 68% (95% CI 45% to 82%)) and human metapneumovirus (AFE: 69% (95% CI 43% to 83%)) were strongly associated with higher risk of lower respiratory symptoms.Discussion: The strong association of respiratory syncytial virus and human metapneumovirus with ARIs and lower respiratory symptoms in young children managed within the community indicates successful development of vaccines against these two viruses should provide substantial health benefits. [ABSTRACT FROM AUTHOR]

Background. Rotavirus vaccines have reduced moderate-to-severe gastroenteritis episodes in infants and young children. Nevertheless, knowledge gaps exist concerning rotavirus vaccine shedding and vaccine impact upon mild and asymptomatic wildtype infections. Our primary objective was to investigate vaccine shedding in Australian infants where the multivalent human-bovine reassortant rotavirus vaccine, RotaTeq, was part of the routine vaccination schedule. Methods. The Observational Research in Childhood Infectious Diseases (ORChID) birth cohort study was conducted in Brisbane, Australia, from September 2010 to October 2014. Newborn infants were enrolled progressively and followed until their second birthday. Parents recorded daily symptoms and mailed weekly stool swab samples from their infants to the laboratory where reverse-transcription polymerase chain reaction testing was performed, and rotavirus-positive samples underwent genotyping to distinguish between vaccine and wild-type strains. Results. Rotavirus was detected in 1068 of 11 139 (9.6%) stool swabs from 158 infants, and 994 (93.1%) were genotyped. RotaTeq vaccine strains accounted for 951 of 994 (95.7%) typed rotavirus-positive swabs. Proportions of infants shedding RotaTeq after the first, second, and third vaccine doses were 87.0%, 57.4%, and 47.3%, respectively, and median (interquartile range) shedding duration after vaccine doses 1-3 was 3 (1-8), 1.5 (1-3), and 1 (1-2), weeks, respectively. In contrast, the incidence rate of wild-type rotavirus episodes was 10.3 (95% confidence interval, 6.8-15.6) per 100 child-years of observation. Conclusions. RotaTeq vaccine virus was detected in stool samples from 47%-87% of infants after each vaccine dose. Genotyping is an essential tool for differentiating between rotavirus vaccine and wild-type strains and monitoring vaccine impact in children. [ABSTRACT FROM AUTHOR]

Purpose: We examine timing of motherhood in a longitudinal cohort of young Australian women, and its relationship with mental health-related quality of life (SF-36 MHI-5), and with sociodemographic, health behaviour and health-related variables.Methods: We analysed longitudinal self-report data from a nationally representative cohort of 10,332 Australian women born 1973-1978, surveyed 6 times between 1996 (aged 18-23) and 2012 (aged 34-39).Results: Group-based trajectory modelling identified four groups. Normative Mothers (46%, mean age at motherhood 30.5 years) made the transition to motherhood close to the Australian median age. Early Mothers (25%, 25.2 years) and Very Early Mothers (7%, 20.0 years) made this transition earlier; Not Mothers (22%) had not given birth. Generalised linear mixed models showed that all groups improved mean MHI-5 scores over time. Patterns of group differences were complex: Normative and Early Mothers scored consistently highest; Very Early Mothers scored lowest at most surveys; Not Mothers' scores increased relative to others over time. Most effects disappeared after adjustment for confounders. Early and Very Early Mothers showed multiple indicators of social disadvantage, while Not Mothers had very low rates of marriage.Conclusions: Timing of motherhood is embedded in sociodemographic and personal contexts. Women with socioeconomic advantages were characterised by higher mental health-related quality of life and later transition to motherhood, but adjustment for relative advantage attenuated differences in mental health-related quality of life. The overall findings suggest a pattern of positive adaptation to circumstances, with mental health-related quality of life improving through early adulthood regardless of timing of motherhood. [ABSTRACT FROM AUTHOR]

Background: Determining timing of first virus detection episodes (fVDEs) for different respiratory viruses in infants identifies risk periods and informs preventive interventions, including vaccination. We describe the ages and nature of fVDEs in an infant birth cohort and explore factors associated with increased odds of symptomatic fVDEs.Methods: The Observational Research in Childhood Infectious Diseases (ORChID) study is a community-based birth cohort describing acute respiratory infections in infants until their second birthday. Parents recorded daily symptoms and collected nose swabs weekly, which were batch-tested using polymerase chain reaction assays for 17 respiratory viruses.Results: One hundred fifty-eight infants participated in ORChID. The median age for fVDEs was 2.9 months for human rhinovirus (HRV) but was ≥13.9 months for other respiratory viruses. Overall, 52% of HRV fVDEs were symptomatic, compared with 57%-83% of other fVDEs. Respiratory syncytial virus and human metapneumovirus fVDEs were more severe than HRV fVDEs. Older age and the winter season were associated with symptomatic episodes.Conclusions: Infants do not always experience respiratory symptoms with their fVDE. Predominance of early HRV detections highlights the need for timing any intervention early in life. fVDEs from other respiratory viruses most commonly occur when maternal vaccines may no longer provide protection. [ABSTRACT FROM AUTHOR]

Background: People with intellectual disability are difficult to retain in longitudinal studies. Research on determinants of study retention for individual-carer dyads, and their reasons for drop-out, are limited.Aims: To investigate characteristics associated with drop-out, and to investigate whether characteristics varied by stage of drop-out.Methods and Procedures: Data are from an Australian randomized trial with adolescents with intellectual disability living in the community. Characteristics of both the adolescent and their nominated carer were collected at baseline. Carers were sent an exit questionnaire approximately two years after enrolment.Outcomes and Results: Baseline information was available for 566 adolescents: 72(13.0%) withdrew during the study, and 96(17.3%) didn't return exit questionnaires. Characteristics associated with drop-out during the study were being in the intervention group, the carer being younger, and the carer not being one of the adolescent's parents. Characteristics associated with withdrawal at exit were carer having lower education and carer having lower socioeconomic status. No adolescent characteristic was associated with drop-out.Conclusions and Implications: Characteristics of drop-outs weren't related to the adolescent and differed according to timing. Drop-out during the study was associated with study burden, whereas characteristics of drop-outs at exit interview were associated with lower social position. [ABSTRACT FROM AUTHOR]

Copyright of Developmental Medicine & Child Neurology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim: To investigate longitudinal changes of habitual physical activity (HPA) and sedentary time in children with cerebral palsy (CP) aged 1 year 6 months to 5 years across all functional abilities.Method: At study entry, 95 children (62 males, 33 females) were classified using the Gross Motor Function Classification System (GMFCS) at levels I (50), II (9), III (16), IV (6), and V (14). Physical activity was recorded on a total of 159 occasions at four possible time points: 1 year 6 months to 2 years; 2 years 6 months to 3 years; 4 years; and 5 years using ActiGraph for 3 days. Mixed-effects regression models were used for analyses.Results: Participants classified at GMFCS levels I and II had stable HPA as they aged. HPA significantly decreased at 5 years in children classified at GMFCS levels III to V. Sedentary time significantly increased at 4 years and 5 years in all participants. Annual HPA significantly reduced in children classified at GMFCS levels III to V (-123 counts/min, 95% confidence interval [CI] -206 to -40) while annual sedentary time significantly increased in all participants (GMFCS levels I-II: 2.4%, 95% CI 0.7-4.1; GMFCS levels III-V: 6.9%, 95% CI 4.6-9.2).Interpretation: Children with CP at all GMFCS levels should be encouraged to be physically active from early childhood as HPA levels start to decline from 4 years. Breaks in sedentary time are required for all children with CP from the age of 3 years. [ABSTRACT FROM AUTHOR]

Aim: To determine (1) the reproducibility of the Eating and Drinking Ability Classification System (EDACS); (2) EDACS classification distribution in a population-based cohort with cerebral palsy (CP); and (3) the relationships between the EDACS and clinical mealtime assessment, other classifications, and health outcomes.Method: This was a cross-sectional population-based cohort study of 170 children with CP at 3 years to 5 years (mean 57.6mo, standard deviation [SD] 8.3mo; 105 males, n=65 females). Functional abilities were representative of a population sample (Gross Motor Function Classification System level I=74, II=34, III=21, IV=18, V=23). The EDACS was the primary classification of mealtime function. The Dysphagia Disorders Survey was the clinical mealtime assessment. Gross motor function was classified using the Gross Motor Function Classification System.Results: EDACS classification had 88.3% intrarater agreement (κ=0.84, intraclass correlation coefficient=0.95; p<0.001) and 51.7% interrater agreement (κ=0.36, intraclass correlation coefficient=0.79; p<0.001). In total, 56.5% of children were classified as EDACS level I. There was a strong stepwise relationship between the Dysphagia Disorders Survey and EDACS (r=0.96, p<0.001). Parental stress (odds ratio=1.3, p=0.05) and feeding tubes (odds ratio=6.4, p<0.001) were significantly related to more limited function on the EDACS.Interpretation: The EDACS presents a viable adjunct to clinical assessment of feeding skills in children with CP for use in surveillance trials and clinical practice. A rating addendum would be a useful contribution to the tool to enhance reproducibility. [ABSTRACT FROM AUTHOR]

Background: Preterm infants follow an altered neurodevelopmental trajectory compared to their term born peers as a result of the influence of early birth, and the altered environment. Infant massage in the preterm infant has shown positive effects on weight gain and reduced length of hospital stay. There is however, limited current evidence of improved neurodevelopment or improved attachment, maternal mood or anxiety. The aim of this study is to investigate the effects of infant massage performed by the mother in very preterm (VPT) infants. Effects on the infant will be assessed at the electrophysiological, neuroradiological and clinical levels.  Effects on maternal mood, anxiety and mother-infant attachment will also be measured.Methods/design: A randomised controlled trial to investigate the effect of massage therapy in VPT infants. Sixty VPT infants, born at 28 to 32 weeks and 6 days gestational age, who are stable, off supplemental oxygen therapy and have normal cranial ultrasounds will be recruited and randomised to an intervention (infant massage) group or a control (standard care) group. Ten healthy term born infants will be recruited as a reference comparison group. The intervention group will receive standardised massage therapy administered by the mother from recruitment, until term equivalent age (TEA). The control group will receive care as usual (CAU). Infants and their mothers will be assessed at baseline, TEA, 12 months and 24 months corrected age (CA), with a battery of clinical, neuroimaging and electrophysiological measures, as well as structured questionnaires, psychoanalytic observations and neurodevelopmental assessments.Discussion: Optimising preterm infant neurodevelopment is a key aim of neonatal research, which could substantially improve long-term outcomes and reduce the socio-economic impact of VPT birth. This study has the potential to give insights into the mother-baby relationship and any positive effects of infant massage on neurodevelopment. An early intervention such as massage that is relatively easy to administer and could alter the trajectory of preterm infant brain development, holds potential to improve neurodevelopmental outcomes in this vulnerable population.Trial Registration: Australian New Zealand Clinical Trials Registry: ACTRN12612000335897 . Date registered: 22/3/2012. [ABSTRACT FROM AUTHOR]

This article used data from 5,171 young women participating in the Australian Longitudinal Study on Women's Health, a nationally representative longitudinal cohort study, to identify longitudinal trajectory patterns of mental health across 6 surveys over 16 years of early adulthood, from age 18-23 to age 34-39. In addition, we identified both predictors and outcomes of these trajectories. Using group-based trajectory modeling, we identified 4 distinct trajectory groups of mental health. The mental health of most participants (55%) was consistently high, with 12% improving, 24% varying, and 9% frequently low. The authors considered characteristics at the beginning and end of the trajectory period, taking a life-course perspective to understand vulnerabilities to, and outcomes of, low or variable poor mental health trajectories. Financial difficulties, poor general health, and weight or shape dissatisfaction were characteristics at Survey 1 that distinguished all other trajectory groups from those with consistently high mental health. Other differences were specific to 1 or 2 groups. By the end of the trajectory period, the improving mental health group showed few differences from those with consistently high mental health. However, those with varying and low mental health showed evidence of social disadvantage, poor physical and emotional health, and unhealthy behaviors, and were less likely to be mothers. The ability to identify distinct trajectories of mental health in early adulthood, and their correlates, provides evidence to underpin population health interventions targeting the prevention of mental health problems among this population group. [ABSTRACT FROM AUTHOR]

Aim: To determine the texture constitution of children's diets and its relationship to oropharyngeal dysphagia (OPD), dietary intake, and gross motor function in young children with cerebral palsy (CP). Method: A cross-sectional, population-based cohort study comprising 99 young children with CP (65 males, 35 females) aged 18 to 36 months (mean age 27mo; Gross Motor Function Classification System [GMFCS] level I, n=45; II, n=13; III, n=14; IV, n=10; V, n=17). CP subtypes were classified as spastic unilateral (n=35), spastic bilateral (n=49), dyskinetic (n=5), and other (n=10), in accordance with the criteria of the Surveillance of Cerebral Palsy in Europe. Habitual dietary intake of food textures, energy, and water were determined from parent-completed 3-day weighed food records. Parent-reported feeding ability of food textures was reported on the Pediatric Evaluation of Disability Inventory and a feeding questionnaire. OPD was classified based on clinical feeding assessment using the Dysphagia Disorders Survey (rated by a certified assessor, KAB) and a subjective Swallowing Safety Recommendation (classified by a paediatric speech pathologist, KAB). Results: Food/fluid textures were modified for 39% of children. Children with poorer gross motor function tended to receive a greater proportion of energy from fluids (GMFCS levels IV-V: β=0.9, p=0.002) in their diets and fewer chewable foods (level III: β=-0.7, p=0.03; levels IV-V: β=-1.8, p<0.001) compared to level I to II participants. Fluids represented a texture for which children frequently had OPD and the texture most frequently identified as unsafe (or recommended for instrumental assessment). Interpretation: These findings indicate that swallowing safety, feeding efficiency, and energy/water intake should be considered when providing feeding recommendations for children with CP. [ABSTRACT FROM AUTHOR]

Purpose: Although social support is a significant contributor to health and well-being, little is known about patterns of perceived social support over time in young adulthood. It is also unclear which personal characteristics are associated with different patterns, and whether there is an association between social support and mental health over time. We explore these issues in a large national cohort of young women. Methods: We used six waves of longitudinal data spanning 16 years, from 10,369 women from the Australian Longitudinal Study on Women's Health, initially aged 18-23. We used group-based trajectory modelling to identify patterns of social support across Surveys 2-6; multinomial logistic regression to identify socio-demographic and health-behaviour predictors at Survey 1 and correlates at Survey 6 for each trajectory group; and generalised linear mixed modelling to estimate mean levels of mental health over the trajectory period for each group, adjusted for confounders. Results: Four distinct trajectory groups of social support were identified: 'High' (58.5 %), 'Decreasing' (20.6 %), 'Low' (9.3 %), and 'Increasing' (11.6 %). Poor health and living outside metropolitan areas at both Surveys 1 and 6 were characteristics of women in all trajectory groups other than the 'High' group, as were early motherhood and being un-partnered at age 34-39. Other characteristics were specific to one or two trajectory groups. Patterns of mental health over time were consistent with patterns of social support. Conclusion: Longitudinal trajectory patterns of social support are associated with mental health, health behaviours, and demographic factors even in early adulthood. [ABSTRACT FROM AUTHOR]

Background Stillbirth is a profoundly distressing event. Little evidence exists to guide best practice bereavement care in the perinatal setting. Aims To document parents' experiences and outcomes in relation to seeing and holding a stillborn baby at a hospital with a specialist perinatal bereavement service. Materials and Methods Prospective cohort study of 26 mothers and 11 fathers who experienced a stillbirth at the Mater Mothers' Hospital, Brisbane from September 2007-December 2008. Mailed self-report questionnaires were completed at 6-8 weeks and 6 and 13 months postloss. Validated measures assessed regret regarding the decision to see and hold the baby, parental grief and mental health. Results Of 78 fetal deaths, 26 mothers and 11 fathers participated. Most (20 mothers; 9 fathers) chose to see and hold their stillborn infant. Little regret was reported, irrespective of the decision. For mothers, seeing and holding was associated with higher 'active grief' at 6-8 weeks (mean difference ( MD) = 10.5; 95% CI = 3.3-17.8; P < 0.01), 6 months ( MD = 8.0; 95% CI = 0.6-15.4; P = 0.03) and 13 months ( MD = 9.9; 95% CI = 1.8-17.9; P = 0.01), but not with 'not coping' or 'despair', or mental health. Fathers reported poorer mental health but small numbers mean estimates are imprecise. Conclusions More intense grief does not equate with poorer mental health for mothers who choose to see and hold a stillborn infant. Fathers' experiences warrant further study. Supported decision-making is important for bereaved parents, and rigorous evaluation of bereavement care is essential. [ABSTRACT FROM AUTHOR]

Purpose: The influence of social support on health and quality of life has been well documented. There is less evidence on whether health status affects social support, and little is known about longitudinal relationships between social support and health in early adulthood. This study investigates these associations using both concurrent and time-lagged measures at 5 time-points over 12 years during early adulthood. Methods: A population-based cohort of 9,758 young women from the Australian Longitudinal Study on Women's Health was used. Women were aged 22-27 in 2000 and 35-39 in 2012. The General Health subscale of the SF-36 and the MOS Social Support Survey 6-item Scale were used, with scores standardised to a range of 0-100. Longitudinal tobit models were used, because both social support and general health data were left skewed, with marked ceiling effects. All models were adjusted for status of the outcome of interest at the immediately previous survey. Results: With both concurrent and time-lagged measures, there was a statistically significant difference in mean general health scores across social support quintiles after adjusting for demographic and behavioural covariates: lower general health was associated with lower social support. In reverse, social support mean scores were also significantly different across general health quintiles in both concurrent and time-lagged fully adjusted models. Conclusion: Social support is significantly associated with both current and subsequent general health in early adulthood. The significance of the reverse associations indicates that the two mutually influence each other. This study highlights the importance of social support as a health-related quality of life issue. [ABSTRACT FROM AUTHOR]

Background: Pleural manometry can predict the presence of trapped lung and guide large-volume thoracentesis. The current technique for pleural manometry transduces pressure from the needle or intercostal catheter, necessitating intermittent cessation of fluid drainage at the time of pressure recordings. Objectives: To develop and validate a technique for performing continuous pleural manometry, where pressure is transduced from an epidural catheter that is passed through the drainage tube to sit within the pleural space. Methods: Pleural manometry was performed on 10 patients undergoing thoracentesis of at least 500 ml, using the traditional intermittent and new continuous technique simultaneously, and pleural pressures were recorded after each drainage of 100 ml. The pleural elastance (PEL) curves and their 95% confidence intervals (CIs), derived using measurements from each technique, were compared using the analysis of covariance and Student's paired t test, respectively. Results: There was no significant difference in PEL calculated using each method (p > 0.1); however, there was a trend towards the CI for the PEL derived from the continuous method being narrower (p = 0.08). Fully automated measurement of drainage volume and pleural pressure, with real-time calculation and display of PEL, was achieved by connecting the system to a urodynamics machine. Conclusions: Pleural manometry can be transduced from an epidural catheter passed through the drainage tube into the pleural space, which gives continuous recording of the pleural pressure throughout the procedure. This allows for automated calculation and display of the pleural pressure and PEL in real time, if the system is connected to a computer with appropriate software. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objective: Strategies such as reminders are frequently used to maximize baseline recruitment and for this reason are collectively termed "usual practice." The objective of this study was to investigate substitution sampling as an alternative recruitment strategy. Study Design and Settings: Data are from the Living with Diabetes Study, which is a prospective cohort study providing a comprehensive examination of health care utilization. Baseline information was collected for 3,197 of 11,470 eligible individuals between November 2008 and October 2009. Follow-up occurred 12 months after recruitment, with outcome of interest being emergency department attendance. Biases resulting from the two recruitment programs were investigated through the comparison of adjusted logistic regression coefficients and absolute relative biases (ARBs). Results: Corresponding estimates resulting from both programs were similar except for age (75+ years). This effect was significant (β: -0.59; 95% confidence interval [CI]: -1.04, -0.13) under substitution sampling, but not under "usual practice" (β: -0.36; 95% CI: -0.78, 0.07). Analysis using the ARB metric reinforced similarity, with the Wilcoxon signed-rank test failing to detect significant difference between programs (median difference: -1.01; 95% CI: -5.88, 2.02). Conclusion: Substitution sampling deserves consideration as a recruitment option alongside "usual practice," as concerns about additional bias may be unwarranted. [ABSTRACT FROM AUTHOR]

The article discusses the results of a study that examined the association of intellectual disability and prevalence of co-occurring mental disability among prisoners. Out of the 1,279 subject prisoners on the Hayes Ability Screening Index (HASI), 24 percent scored below the recommended cut off for more diagnostic assessment of intellectual disability. It concluded that prisoners with intellectual disability have elevated rates of psychiatric comorbidity and unmet treatment needs.

Background: Participation in coronary heart disease secondary prevention programs is low. Innovative programs to meet this treatment gap are required. Purpose: To aim of this study is to describe the effectiveness of a telephone-delivered secondary prevention program for myocardial infarction patients. Methods: Four hundred and thirty adult myocardial infarction patients in Brisbane, Australia were randomised to a 6-month secondary prevention program or usual care. Primary outcomes were health-related quality of life (Short Form-36) and physical activity (Active Australia Survey). Results: Significant intervention effects were observed for health-related quality of life on the mental component summary score ( p = 0.02), and the social functioning ( p = 0.04) and role-emotional ( p = 0.03) subscales, compared with usual care. Intervention participants were also more likely to meet recommended levels of physical activity ( p = 0.02), body mass index ( p = 0.05), vegetable intake ( p = 0.04) and alcohol consumption ( p = 0.05). Conclusions: Telephone-delivered secondary prevention programs can significantly improve health outcomes and could meet the treatment gap for myocardial infarction patients. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVES: The coronavirus (CoV) disease 2019 pandemic has drawn attention to the CoV virus family. However, in community settings, there is limited information on these viruses in healthy children. We explored the epidemiology of the 4 endemic (non--severe acute respiratory syndrome CoV 2) human coronaviruses (HCoVs) by species, including acute illness episodes, risk factors, and health care burden in Australian children in the first 2 years of life. METHODS: The Observational Research in Childhood Infectious Diseases community-based cohort was a prospective study of acute respiratory illnesses in children from birth until their second birthday. Parents recorded daily symptoms, maintained an illness-burden diary, and collected weekly nasal swabs, which were tested for 17 respiratory viruses, including HCoVs, by real-time polymerase chain reaction assays. RESULTS: Overall, 158 children participating in Observational Research in Childhood Infectious Diseases provided 11 126 weekly swabs, of which 168 were HCoV-positive involving 130 incident episodes. HCoV-NL63 and HCoV-OC43 were most commonly detected, accounting for two-thirds of episodes. Whereas 30 children had different HCoVs detected on different occasions, 7 were reinfected with the same species. HCoV incidence in the first 2 years of life was 0.76 episodes per child-year (95% confidence interval [CI] 0.63 to 0.91), being greatest in the second year (1.06; 95% CI 0.84 to 1.33) and during winter (1.32; 95% CI 1.02 to 1.71). Fifty percent of HCoV episodes were symptomatic, and 24.2% led to health care contact. CONCLUSIONS: In children, HCoV infections are common, recurrent, and frequently asymptomatic. In future studies, researchers should determine transmission pathways and immune mechanisms. [ABSTRACT FROM AUTHOR]

To examine the joint influences of physical activity (PA) and family history (FH) of diabetes on subsequent type 2 diabetes (T2D), the authors pooled and analyzed data from 2 community-based urban adult prospective cohort studies in 2011 in Nanjing, China. Among 4550 urban participants, the 3-year cumulative incidence of T2D was 5.1%. After adjustment for potential confounders, compared with those with FH+ and insufficient PA, the adjusted odds ratio (95% confidence interval) of developing T2D was 0.42 (0.18, 0.98) for participants with sufficient PA and FH+, 0.32 (0.22, 0.46) for participants with insufficient PA and FH−, and 0.15 (0.08, 0.28) for participants with sufficient PA and FH−. Such significant graduated associations between PA/FH and risk of developing T2D were also identified in either men or women, separately. Sufficient PA and FH− may jointly reduce the risk of developing T2D in urban Chinese adults. [ABSTRACT FROM PUBLISHER]

A response to a letter to the editor about the article "Quality of Reporting of Observational Longitudinal Research," published in a previous issue, is presented.

Objectives: Minimizing attrition is a key objective in longitudinal research, with possible consequences being additional bias and reduced generalizability. Identifying determinants of attrition is essential in determining attrition prevention strategies. The objective of this study was to investigate a number of these determinants, with an emphasis on contactability. Study Design and Setting: Data were taken from the Passports project, a randomized controlled trial of an intervention to provide postrelease support to ex-prisoners in Queensland, Australia. Measures of contactability included intervention intensity, baseline collaterals, and follow-up telephone calls, with attrition at follow-up being the outcome event. Multivariable modeling was used to assess the independent effects of these measures on attrition. Results: Attrition was found to be more likely among those who were not contacted between the release and follow-up (adjusted odds ratio [AOR]: 2.93; 95% confidence interval [CI]: 1.87, 4.60), did not provide collaterals (AOR: 2.58; 95% CI: 1.68, 3.97), and received more than four telephone calls (AOR: 2.42; 95% CI: 1.61, 3.63). Evidence of dose-response relationships between attrition and the measures of collaterals and telephone calls was also seen to exist. Conclusion: These findings have implications for sample size maintenance, especially those involving hard-to-reach populations. Subject to cost constraints and possible diminishing returns, researchers should endeavor to implement a study protocol that facilitates continued contact during follow-up. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore whether post-release employment reduces the risk of re incarceration after controlling for known predictors of reincarceration including mental health vulnerability, substance abuse risk, gender, age, indigenous status, and prior imprisonment. The study was a secondary analysis of data from a multisite randomized control trial (N=774) conducted in Queensland, Australia across seven prisons between August 2008 and July 2010. Data were collected at a baseline interview prior to release, and at three follow-up telephone interviews at one, three and six months post-release. Vulnerability to mental illness and risk of substance abuse (adjusted hazard ratios ranged from 2.0-3.1), and limited employment post-release (adjusted hazard ratio 1.5, 95% confidence interval 1.1-2.1) increased the risk of reincarceration over and above the known effects of younger age, male gender, and prior incarceration history. The characteristics most associated with reincarceration can be used to triage candidates for more intensive forms of community based vocational rehabilitation. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To determine the progression of oropharyngeal dysphagia (OPD) in preschool- aged children with cerebral palsy (CP) according to gross motor function. It was hypothesized that fewer children would have OPD at 60 months compared with 18 to 24 months (predominately Gross Motor Function Classification System [GMFCS] I--II). METHODS: Longitudinal population-based cohort of 179 children (confirmed CP diagnosis, born in Queensland in 2006-2009, aged 18-60 months at study entry [mean = 34.1 months ± 11.9; 111 boys; GMFCS I = 46.6%, II = 12.9%, III = 15.7%, IV = 10.1%, and V = 14.6%]). Children had a maximum of 3 assessments (median = 3, total n = 423 assessments). OPD was classified by using the Dysphagia Disorders Survey part 2 and rated from video by a certified pediatric speech pathologist. GMFCS was used to classify children's gross motor function. RESULTS: OPD prevalence reduced from 79.7% at 18 to 24 months to 43.5% at 60 months. There were decreasing odds of OPD with increasing age (odds ratio [OR] = 0.92 [95% confidence interval (CI) 0.90 to 0.95]; P < .001) and increasing odds with poorer gross motor function (OR = 6.2 [95% CI 3.6 to 10.6]; P < .001). This reduction was significant for children with ambulatory CP (GMFCS I-II, OR = 0.93 [95% CI 0.90 to 0.96]; P < .001) but not significant for children from GMFCS III to V (OR [III] = 1.0 [95% CI 0.9 to 1.1]; P = .897; OR [IV-V] = 1.0 [95% CI 1.0 to 1.1]; P = .366). CONCLUSIONS: Half of the OPD present in children with CP between 18 and 24 months resolved by 60 months, with improvement most common in GMFCS I to II. To more accurately detect and target intervention at children with persisting OPD at 60 months, we suggest using a more conservative cut point of 6 out of 22 on the Dysphagia Disorders Survey for assessments between 18 and 48 months. [ABSTRACT FROM AUTHOR]

Introduction: Infants with asymmetric brain injury (asymBI) are at high risk of Unilateral Cerebral Palsy (UCP). The Grasp and Reach Assessment of Brisbane (GRAB) was developed to detect asymmetries in unimanual/bimanual upper limb (UL) reach and grasp behaviours in infants with asymBI. This study reports the development of the GRAB and evaluates its construct validity and internal consistency.Material and Methods: Prospective study of twenty four infants with asymBI and twenty typically developing (TD) infants at 18 weeks corrected age (C.A.) in a structured play session. Three different coloured toys were presented at the midline in a block design of six 30-s trials of toy presentation, separated by five 30-s trials of no toy presentation. The number and duration of: (i) unimanual contacts; (ii) unimanual grasps; (iii) bimanual midline grasps; and (iv) duration of other unimanual behaviours (e.g. prehensile movements and transport phase) were measured. An Asymmetry Index (AI) was calculated to determine asymmetries between ULs. Possible AI values ranged from 0 to 100%, indicating proportion of toy presentation time that unimanual behaviours were asymmetric between ULs. Internal consistency of both the Time Phase (TP) and Toy Colour Phase (TCP) test items were determined by calculating Cronbach's alpha coefficients. Each assessment occasion was split into six TPs and two TCPs; whereby one TP comprised one 30-s trial of one toy presentation and one TCP comprised two 30-s trials of the same toy presentation.Results: For TP, seven out of nine unimanual behaviours and two out of three bimanual behaviours demonstrated strong internal consistency (Cronbach's alpha coefficients 0.72-0.89). No unimanual activity demonstrated the strongest IC (0.89). For TCP, six out of nine unimanual behaviours demonstrated strong IC (0.73-0.82). Number of unimanual contacts and duration of unimanual prehensile movements demonstrated the strongest IC (0.82). Duration of unimanual contribution to hands at midline and duration of bimanual midline behaviour demonstrated the weakest IC for both TP and TCP (0.46-0.50). For unimanual contacts, the asymBI group were more asymmetric between ULs (mean AI=50%) compared to the TD group (mean AI=30%). For unimanual grasps, both groups were similarly asymmetric (both mean AI=40%). The TD group were almost twice as likely to demonstrate bimanual grasps as the asymBI group (incidence rate ratio IRR 1.9, 95% CI 1.4 to 2.5, p<0.001). Infants with asymBI were less likely to use the impaired UL compared to the unimpaired UL for grasping (IRR 0.6, 95% CI 0.5 to 0.8, p<0.001); and used the impaired UL for a shorter proportion of time compared to the unimpaired UL for grasping (mean difference -9.1%, 95% CI -16.6 to -1.7, p=0.02).Conclusions: The GRAB is a criterion-referenced research measure that detects and quantifies the presence or absence of unimanual and bimanual reach and grasp behaviours at 18 weeks C.A. in infants at risk of UCP. The GRAB demonstrated moderate to strong construct validity and strong IC within an assessment occasion. There was no toy preference or warm-up effect for TP or TCP for either group; confirming that the GRAB is a consistent measure across toy presentations within an assessment occasion. In this study, the GRAB identified that infants with asymBI demonstrated a paucity of bimanual grasping compared to TD infants; and demonstrated asymmetric unimanual grasping between ULs at 18 weeks C.A. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To describe the longitudinal relationship between height-for-age z score (HZ), growth velocity z score, energy intake, habitual physical activity (HPA), and sedentary time across Gross Motor Function Classification System (GMFCS) levels I to V in preschoolers with cerebral palsy (CP). METHODS: Children with CP (n = 175 [109 (62.2%) boys]; mean recruitment age 2 years, 10 months [SD 11 months]; GMFCS I = 83 [47.2%], II = 21 [11.9%], III = 28 [15.9%], IV = 19 [10.8%], V = 25 [14.2%]) were assessed 440 times between the age of 18 months and 5 years. Height/length ratio was measured or estimated via knee height. Population-based standards were used to calculate HZ and growth velocity z-score by age and sex categories. Feeding method (oral or tube) and gestational age at birth (GA) were collected from parents. Three-day ActiGraph and food diary data were used to measure HPA/sedentary time ratio and energy intake, respectively. Oropharyngeal dysphagia was rated with the Dysphagia Disorder Survey (part 2, Pediatric). Analysis was undertaken with mixed-effects regression models. RESULTS: For GMFCS level I, height and growth velocity did not differ from population-level growth standards. Children in levels II to V were significantly shorter, and those in levels III to V grew significantly more slowly than those in level I. There was a significant positive association between HZ and GA at all GMFCS levels. Energy intake, HPA, sedentary time, Dysphagia Disorder Survey score, and feeding method were not significantly associated with either height or growth velocity once GMFCS level was accounted for. CONCLUSIONS: Functional status and GA should be considered when assessing the growth of a child with CP. Research into interventions aimed at increasing active movement in GMFCS levels III to V and their efficacy in improving growth and health outcomes is warranted. [ABSTRACT FROM AUTHOR]

Introduction/Purpose: To evaluate differences in sedentary time and compare levels of physical activity and sedentary behavior to the Australian physical activity recommendations between toddlers with cerebral palsy (CP) according to functional capacity (Gross Motor Function Classification System [GMFCS]) and age-matched children with typical development (CTD). Methods: Children (2.4 ± 0.5 yr old) were split into CTD (n = 20), GMFCS I-II (n = 32), GMFCS III (n = 14), and GMFCS IV-V (n = 12) groups and wore a triaxial ActiGraph® for 3 d. Validated cut points were applied to identify sedentary and active time and the number and duration of sedentary bouts and breaks for each group. Analysis of variance (ANOVA) with post hoc testing, chi-square analysis, and the Fisher exact test were used to compare groups. Results: No difference between the CTD group (49%) and GMFCS I-II group (52%) was found for sedentary time as a percentage of wear time. The GMFCS III group was more sedentary than both these groups (62%, P < 0.05). The GMFCS IV-V group was more sedentary than all the other groups (74%, P G 0.05). The CTD group and GMFCS I-II group was more likely to spend 180 min or longer in active play on all 3 d than the GMFCS IV-V group (P < 0.05). The GMFCS IV-V group was more likely to have sedentary bouts ≥60 min or longer than all other groups (P < 0.05). Conclusion: Differences in sedentary behavior between the CTD and mildly impaired children with CP (GMFCS I-II) are not evident in the toddler years. Children with moderate-to-severe functional impairment are progressively more sedentary and less likely to meet physical activity guidelines. Further research into the health implications of high levels of sedentary behavior in toddlers is required. [ABSTRACT FROM AUTHOR]

Highlights: [•] A large community-based cohort of women were followed for 21years. [•] Women’s mental health were assessed 6 times using the personal disturbance scale. [•] Mokken scale analysis was applied to 14 items of the scale at each time point. [•] A common hierarchical scale with 10 items was identified. [•] The scale can be used to measure changes in women’s mental health over time. [Copyright &y& Elsevier]

Objectives: Longitudinal studies are a major tool for public health research, but their value can be undermined by attrition. Identification of factors associated with attrition through modeling depends on the efficient use of data and is conditional on modeling assumptions being met. The primary aim of this study was to compare the performance of four models in analyzing attrition risk. Study Design and Setting: Data from participants who were lost to follow-up from The Nambour Skin Cancer Study between 1992 and 2000 were analyzed using logistic and survival models, for all-cause and nondeath attritions. Results: During follow-up, 321 (19.8%) of 1,621 participants were lost to follow-up; 70 (4.3%) because of death and 251 (15.5%) for other reasons. Using survival models showed skin cancer diagnosis to be associated with increased all-cause attrition (hazard ratio: 2.3; 95% confi- dence interval [95% CI]: 1.5, 3.4) and nondeath attrition (subhazard ratio: 1.9; 95% CI: 1.0, 3.3). Using logistic regression resulted in inverse associations being observed for both all-cause attrition (odds ratio [OR]: 0.7; 95%CI: 0.5, 1.1) and nondeath attrition (OR: 0.5; 95%CI: 0.3, 1.0). Conclusion: These results demonstrate the relative inadequacy of a logistic as opposed to a survival approach when analyzing attrition risk in the presence of time-varying covariates and multiple timepoints [ABSTRACT FROM AUTHOR]