Family poverty over the early life course and adult experiences of intimate partner violence: a cohort study.

OBJECTIVES: This study aimed to determine whether family poverty over the early childhood, adolescent, and adult periods of the life course independently predicts experiences of intimate partner violence (IPV) in adulthood. STUDY DESIGN: This was a birth cohort study in Brisbane, Australia, with pregnant women recruited at their first booking-in visit and their children, followed up to 30 and 40 years of age. METHODS: Family income was obtained from the mother when the child was 6 months, 5 and 14 years of age. Offspring reported their own family income at 21, 30, and 40 years of age. The offspring completed the Composite Abuse Scale at 30 and 40 years. Adjusted logistic regression models are used to predict experiences of IPV at 30 (n = 2157) and 40 (n = 1438) years. RESULTS: The findings at 30 and 40 years of age are consistent. Only poverty experienced concurrently with the assessment of IPV is strongly associated. At the 40-year follow-up, family poverty predicts higher ratios of all four forms of IPV; severe combined abuse (odds ratio [OR] = 2.24, 95% confidence interval [CI] = 1.24, 4.05), physical abuse (OR = 3.37, 95% CI = 1.95, 5.82), emotional abuse (OR = 2.09, 95% CI = 2.58, 8.57) and harassment (OR = 4.70, 95% CI = 2.58, 8.57). CONCLUSION: Concurrent family poverty is strongly and consistently associated with patterns of IPV. These associations are for cross-sectionally collected data with the prospectively collected data not replicating these findings. Although it is not possible to identify a specific causal pathway, the findings suggest that the immediate consequences of poverty are strongly associated with IPV. Programmes that address poverty reduction provide the best prospect for reducing societal levels of IPV.

Postoperative myocardial injury and platelet reactivity in patients undergoing vascular surgery: The platelet reactivity and postoperative myocardial injury after major vascular surgery (PROMISE) study.

BACKGROUND: Postoperative myocardial injury (PMI) after major vascular surgery, detected by elevated cardiac troponin (cTn), has been associated with morbidity and mortality. It is unclear whether the pathophysiology of PMI is determined by increased platelet activity. OBJECTIVE: To examine the relationship between platelet activation (P-selectin expression) and PMI in patients undergoing elective open abdominal aortic surgery. METHODS: This prospective, single-centre, observational, cohort study included 33 patients undergoing elective open abdominal aortic surgery between March 2018 and April 2021. Patients were routinely treated with aspirin. Unstimulated platelet activation was measured by platelet bound P-selectin expression (range 0-100 %). Explorative coagulation measurements were: stimulated platelet aggregation measured with the VerifyNow® assay (aspirin cartridge), with the Multiplate® analyzer (ASPI, ADP and TRAP) and stimulated coagulation status evaluated by the TEG® Hemostasis Analyzer System (global hemostasis cartridge). The primary outcome was cTn release assessed by the fifth generation high-sensitive cTn assay. Multivariable generalized linear mixed models were used to evaluate the association between platelet function and cTn concentrations over time. RESULTS: Ten patients (30.3 %) developed PMI. Increased P-selectin expression directly after surgery was associated with the cTn concentrations over 48 h (ß = 1.39 (1.1-1.75), P = 0.0064). No association was found between P-selectin measured later after surgery (at 24 h or 48 h) and cTn concentrations. Furthermore, there was no association between the explorative coagulation parameters and cTn release. CONCLUSION: Platelet reactivity, assessed by P-selectin expression measured directly after surgery is associated with PMI, assessed by elevated cTn concentrations in the early postoperative period in patients undergoing elective open abdominal aortic surgery.

Electrocardiogram-based mortality prediction in patients with COVID-19 using machine learning.

BACKGROUND AND PURPOSE: The electrocardiogram (ECG) is frequently obtained in the work-up of COVID-19 patients. So far, no study has evaluated whether ECG-based machine learning models have added value to predict in-hospital mortality specifically in COVID-19 patients. METHODS: Using data from the CAPACITY-COVID registry, we studied 882 patients admitted with COVID-19 across seven hospitals in the Netherlands. Raw format 12-lead ECGs recorded within 72 h of admission were studied. With data from five hospitals (n = 634), three models were developed: (a) a logistic regression baseline model using age and sex, (b) a least absolute shrinkage and selection operator (LASSO) model using age, sex and human annotated ECG features, and (c) a pre-trained deep neural network (DNN) using age, sex and the raw ECG waveforms. Data from two hospitals (n = 248) was used for external validation. RESULTS: Performances for models a, b and c were comparable with an area under the receiver operating curve of 0.73 (95% confidence interval [CI] 0.65-0.79), 0.76 (95% CI 0.68-0.82) and 0.77 (95% CI 0.70-0.83) respectively. Predictors of mortality in the LASSO model were age, low QRS voltage, ST depression, premature atrial complexes, sex, increased ventricular rate, and right bundle branch block. CONCLUSION: This study shows that the ECG-based prediction models could be helpful for the initial risk stratification of patients diagnosed with COVID-19, and that several ECG abnormalities are associated with in-hospital all-cause mortality of COVID-19 patients. Moreover, this proof-of-principle study shows that the use of pre-trained DNNs for ECG analysis does not underperform compared with time-consuming manual annotation of ECG features.

The WOEST 2 registry : A prospective registry on antithrombotic therapy in atrial fibrillation patients undergoing percutaneous coronary intervention.

BACKGROUND: Patients on oral anticoagulants (OACs) undergoing percutaneous coronary intervention (PCI) also require aspirin and a P2Y12 inhibitor (triple therapy). However, triple therapy increases bleeding. The use of non-vitamin K antagonist oral anticoagulants (NOACs) and stronger P2Y12 inhibitors has increased. The aim of our study was to gain insight into antithrombotic management over time. METHODS: A prospective cohort study of patients on OACs for atrial fibrillation or a mechanical heart valve undergoing PCI was performed. Thrombotic outcomes were myocardial infarction, stroke, target-vessel revascularisation and all-cause mortality. Bleeding outcome was any bleeding. We report the 30-day outcome. RESULTS: The mean age of the 758 patients was 73.5 ± 8.2 years. The CHA2DS2-VASc score was ≥ 3 in 82% and the HAS-BLED score ≥ 3 in 44%. At discharge, 47% were on vitamin K antagonists (VKAs), 52% on NOACs, 43% on triple therapy and 54% on dual therapy. Treatment with a NOAC plus clopidogrel increased from 14% in 2014 to 67% in 2019. The rate of thrombotic (4.5% vs 2.0%, p = 0.06) and bleeding (17% vs. 14%, p = 0.42) events was not significantly different in patients on VKAs versus NOACs. Also, the rate of thrombotic (2.9% vs 3.4%, p = 0.83) and bleeding (18% vs 14%, p = 0.26) events did not differ significantly between patients on triple versus dual therapy. CONCLUSIONS: Patients on combined oral anticoagulation and antiplatelet therapy undergoing PCI are elderly and have both a high bleeding and ischaemic risk. Over time, a NOAC plus clopidogrel became the preferred treatment. The rate of thrombotic and bleeding events was not significantly different between patients on triple or dual therapy or between those on VKAs versus NOACs.

Feasibility and safety of cangrelor in patients with suboptimal P2Y12 inhibition undergoing percutaneous coronary intervention: rationale of the Dutch Cangrelor Registry.

BACKGROUND: Despite the advances of potent oral P2Y12 inhibitors, their onset of action is delayed, which might have a negative impact on clinical outcome in patients undergoing percutaneous coronary intervention (PCI). Trials conducted in the United States of America have identified cangrelor as a potent and rapid-acting intravenous P2Y12 inhibitor, which has the potential of reducing ischemic events in these patients without an increase in the bleeding. As cangrelor is rarely used in The Netherlands, we conducted a nationwide registry to provide an insight into the use of cangrelor in the management of patients with suboptimal platelet inhibition undergoing (primary) PCI (the Dutch Cangrelor Registry). STUDY DESIGN: The Cangrelor Registry is a prospective, observational, multicenter, single-arm registry with cangrelor administered pre-PCI in: (1) P2Y12 naive patients with ad-hoc PCI, (2) patients with STEMI/NSTEMI with suboptimal P2Y12 inhibition including (3) stable resuscitated/defibrillated patients with out-of-hospital cardiac arrest (OHCA) due to acute ischemia and (4) STEMI/NSTEMI patients with a high thrombotic burden. Primary endpoint is 48 h Net Adverse Clinical Events (NACE), which is a composite endpoint of all-cause death, recurrent myocardial infarction (MI), target vessel revascularization (TVR), stroke, stent thrombosis (ST) and BARC 2-3-5 bleeding. The Dutch Cangrelor Registry will assess the feasibility and safety of cangrelor in patients with suboptimal P2Y12 inhibition undergoing (primary) PCI in the setting of acute coronary syndrome (ACS) and stable coronary artery disease (CAD) in the Netherlands.

The antecedents of non-affective psychosis in a birth-cohort, with a focus on measures related to cognitive ability, attentional dysfunction and speech problems.

OBJECTIVE: Adults with non-affective psychosis show subtle deviations in a range of developmental trajectories as children and adolescents. METHOD: Based on a birth-cohort (n = 3801), we examined the Peabody Picture Vocabulary Test (PPTV) at age 5, and Raven's Standard Progressive Matrices (RSPM) and Wide Range Achievement Test reading scale (WRAT-R) at age 14. Items related to speech problems and attentional dysfunction were available from maternal- or self-report. At age 21, we identified 60 cohort members who were screen-positive for non-affective psychosis (SP-NAP). RESULTS: Impaired performance on the PPVT and RSPM (but not WRAT-R) predicted SP-NAP for males only. Male cohort members in the highest quartile for attentional dysfunction at ages 5 and 14 were about 5-8 times more likely to develop SP-NAP. SP-NAP in males was significantly associated with speech problems at age 14. CONCLUSION: Males who develop non-affective psychoses have subtle impairments in cognitive capacity prior to the development of their psychotic disorder.

Longitudinal correlates of the persistence of irregular eating from age 5 to 14 years.

AIM: To report the stability of parent-perceived child irregular eating from 6 months to 14 years of age and to investigate a predictive model inclusive of child and parent factors. METHODS: Of the 7223 singleton children in a birth cohort, 5122 children were re-interviewed at 5 years and 4554 for the 14-year analysis. Information was obtained from structured interviews including questions answered by parents of the child at birth, 6 months, 5 years and 14 years; and by teenagers at age 14 years and from physical measures of the child. The mother's perception that the child was an irregular eater at age 14 years was the major outcome variable of interest. RESULTS: Approximately 40% of irregular eaters at age 5 will still be irregular eaters at age 14 years. This was not related to maternal education or socio-economic class. Significant at multivariate analysis were infant feeding problems and the children's ability to regulate their sleep and mood. Significant maternal factors were greater age, not feeling positive about the baby and persistent maternal anxiety during the child's early years. CONCLUSION: Irregular eating behaviour displays considerable continuity from childhood to mid-adolescence. Independent contributions to this behavioural phenotype include child biological and psychological factors and maternal anxiety during the child's early years.

Emotional and behavioural antecedents of young adults who screen positive for non-affective psychosis: a 21-year birth cohort study.

BACKGROUND: Birth cohort studies have shown that individuals who develop non-affective psychoses display subtle deviations in behaviour during childhood and adolescence. We had the opportunity to examine the widely used Child Behavior Checklist (CBCL) and the Youth Self-Report (YSR) to explore the antecedents of non-affective psychosis. METHOD: Based on a birth cohort of 3801 young adults, psychopathology was assessed at years 5 and 14 using the CBCL and/or the YSR. Screen-positive non-affective psychosis (SP-NAP) was assessed at year 21 by using the Composite International Diagnostic Interview (CIDI) or a self-report checklist. The association between childhood symptoms and SP-NAP was examined using logistic regression. RESULTS: Of the cohort, 60 subjects were classified as SP-NAP. In males, SP-NAP was associated with higher scores: (a) on year 5 CBCL 'Total', 'Aggression' and 'Social, Attention and Thought' scores; (b) on year 14 CBCL 'Social', 'Attention' and 'Delinquency' scores, and (c) YSR 'Total' and many YSR subscores. These associations were less clear for females. Hallucinations at year 14 were associated with SP-NAP for both sexes. Boys with high 'Total' scores at both years 5 and 14 were at greatest risk of SP-NAP (a 5-fold risk), followed by boys and girls whose 'Social, Attention and Thought' scores either increased or remained high from years 5 to 14 (3- to 13-fold risk). CONCLUSIONS: Individuals who screen positive for non-affective psychosis show increased psychopathology during childhood and adolescence. The psychopathological trajectory of children who go on to develop schizophrenia anticipates the heterogeneity associated with the full clinical syndrome.

Demographic correlates of psychotic-like experiences in young Australian adults.

OBJECTIVE: Psychotic-like experiences (PLE) in the general community are common. The aims of this study were to examine the prevalence and demographic correlates of PLE in young adults. METHOD: The sample consisted of 2441 subjects aged 18-23 years. Subjects completed the Composite International Diagnostic Interview (CIDI) and the 21-item Peters Delusional Inventory (PDI). Associations between age, gender, hallucinations and delusions were examined using logistic regression. RESULTS: Both CIDI hallucinations and delusions predicted high scores on the PDI. Younger age was significantly associated with endorsement of CIDI delusions [odds ratio (OR) = 0.66, 95% confidence interval (CI) 0.48-0.92) and with PDI total scores (OR = 0.68, 95% CI 0.55-0.83). Women were significantly more likely to endorse items related to hallucinations (OR = 1.49, 95% CI 1.14-1.95) but not delusions. CONCLUSION: PLE are common in young adults. The mechanisms underpinning the age and gender gradients in PLE may provide clues to the pathogenesis of psychotic disorders.

Predictors of depression in very young children--a prospective study.

BACKGROUND: There have been only a few previous population-based studies of symptoms of depression in young children. There are no previous population-based studies which examine the factors which might be casually associated with depression in very young children. METHODS: Data are from a cohort study of pregnant women who gave birth to a live singleton baby in a large public hospital in Brisbane, Australia. The Mater-University of Queensland Study of Pregnancy (MUSP) involves a 5-year follow-up, with mothers completing a short form of Child Behaviour Checklist (CBCL) describing the mental health of their child. Five groups of variables (socio-demographic, pre- and perinatal, maternal mental health, maternal lifestyle and maternal attitude to the child) were used to predict CBCL depression scores at the 5-year follow-up. RESULTS: There are many factors associated with maternal reports of symptoms of depression in 5-year-old children. These include marital partner changes, mother's health problems in pregnancy, child health over the first six months of life, maternal anxiety and marital satisfaction early in the child's development and the mother's attitude towards caregiving. A multiple risk factor model indicates higher rates of depression for children experiencing multiple exposures to risk. While a number of exposures are associated with increased risk, many of those children perceived to be depressed appear to lack any measured exposures. CONCLUSION: Many children as young as 5 years of age are observed to experience multiple symptoms of depression. The majority of children exposed to high levels of risk do not appear to become depressed; they appear to be resilient. The majority of children who experience multiple symptoms of depression appear to lack any known exposures to risk.

Is being overweight associated with behavioural problems in childhood and adolescence? Findings from the Mater-University study of pregnancy and its outcomes.

AIMS: To examine the associations between being overweight and behavioural problems at ages 5 and 14. METHODS: Birth cohort study of 2875 individuals who were born in Brisbane between 1981 and 1984 and who were followed up at ages 5 and 14 years. Behavioural problems were defined as scoring above the 90th centile on Achenbach's child behavioural checklist. RESULTS: In cross-sectional analyses there was no association between being overweight and behavioural problems in either females at age 5. At age 14 females who were overweight were more likely than those who were normal weight to experience behavioural problems. However, there was no association between being overweight and behavioural problems at age 14 among males. The prevalence of behavioural problems increased linearly across the distribution of body mass index in females at age 14. In prospective analyses, among participants who had no behavioural problems at age 5, there was no association between being overweight at age 5 and behavioural problems at age 14 in either sex. Females who were overweight at age 5 and normal weight at age 14 had reduced odds of behavioural problems at age 14. CONCLUSIONS: Among adolescent females there is a positive linear association between body size and behavioural problems. However, no such association was found in adolescent males, or in either sex at age 5 years, and in prospective analyses being overweight at age 5 was not associated with behavioural problems in either sex at age 14.

Early childhood factors influencing health-related quality of life in adolescents at 13 years.

OBJECTIVE: To understand the relationship of health-related quality of life (HR-QOL) to early life experience. METHODOLOGY: Eight thousand five hundred and fifty-six women enrolled in a prospective study at their first antenatal clinic visit. At 13 years, of 5345 women remaining, a consecutive sample of 901 mother/child pairs provided data on adolescent HR-QOL using the Child Health Questionnaire-Parent Report form (CHQ-PF50) and the Dartmouth COOP Functional Assessment Charts for Adolescents. The CHQ-PF50 yielded physical (PHS) and psychosocial (PSS) summary scores. We examined the relationship between health-related QOL and early childhood predictive variables. RESULTS: PHS was related to gestation, maternal health symptoms in pregnancy, maternal anxiety at 6 months, child health and hours of childcare at 5 years (P < 0.05). PSS was related to maternal age at index visit, maternal attitude to pregnancy, maternal satisfaction with care giving and maternal depression at 6 months, and child health and behaviour problems at 5 years (internalizing and social/attentional/thought (SAT) domains) (P < 0.05). Findings from adolescent self-reports were similar. CONCLUSIONS: This study has identified a number of early childhood determinants of adolescent HR-QOL. These findings add to evidence of the effects of early adversity on the developmental pathways of children and support the need for effective early intervention.

Early adolescent smoking and a web of personal and social disadvantage.

OBJECTIVE: To examine concurrent physical, educational, behavioural, social and family factors associated with cigarette smoking in adolescents at 14 years. METHODOLOGY: This study reports cross-sectional data on 14-year-old adolescents and their mothers, drawn from a prospective cohort study commencing at the time of the first antenatal visit. At 14 years, 5247 adolescents completed questionnaires on current cigarette smoking. Adolescents and mothers completed health, psychological, school and social questionnaires relating to the youth. A total of 3864 adolescents were assessed physically, and undertook the Wide Range Achievement Test (WRAT) and Ravens Progressive Matrices Test. RESULTS: Cigarette smoking at 14 years was associated with externalizing and internalizing behaviour problems, school suspension, contact with children's services and alcohol/illicit drug use. Apart from internalizing behaviour problems, these problems were more prevalent in boys. Poor school performance on maternal/adolescent reports was associated with increased smoking quantity for both genders, though WRAT scores were only decreased in male smokers. The Ravens Progressive Matrices Test scores were lower for boys with greater smoking quantity. The trend was less marked in girls. Body mass index and exercise frequency were not associated with cigarette smoking at 14 years, though girls who smoked had a higher reported prevalence of asthma. Parental smoking, marital conflict, maternal depression, lower income, and mothers aged in their teens and with a lower level of education at the time of this pregnancy were also positively associated with adolescent tobacco use. CONCLUSION: Findings of this study indicate that cigarette smoking, at this critical time of smoking initiation, is associated with a broad spectrum of personal and social disadvantage that needs to be considered in intervention strategies.

Association of bullying with adolescent health-related quality of life.

OBJECTIVE: To examine the relationship between being bullied and health-related quality of life (HR-QOL) in adolescence. METHODOLOGY: Subjects were a cohort of 805 adolescents with a mean age of 13.6 years (standard deviation 0.2 years). An adolescent questionnaire elicited the frequency of being bullied. HR-QOL was measured using the Child Health Questionnaire - Parent Report Form (CHQ-PF50) and Dartmouth COOP Functional Health Assessment Charts for Adolescents. RESULTS: Thirty-six per cent of boys and 38 per cent of girls reported being bullied at least weekly. Adolescent psychosocial HR-QOL was inversely related to frequency of being bullied, while physical HR-QOL was not related. CONCLUSION: Peer bullying is an important determinant of adolescent HR-QOL with a negative impact on psychosocial well-being.

Bias influencing maternal reports of child behaviour and emotional state.

BACKGROUND: Previous research has indicated that there may be only a modest degree of agreement between different reporters of a child's behaviour (mental health). This raises the possibility that some descriptions of the child's behaviour may reflect the personal characteristics of the respondent. We examine two potential sources of bias that may influence reports of a child's behaviour/mental health. The first is the mental or emotional impairment of the respondent; the second concerns gender-related expectations of children. METHODS: Mothers (and their children after the birth) were assessed at first clinic visit, 3-5 days after the birth, then 6 months, 5 years and 14 years after the birth. Some 70% of respondents giving birth remained in the study at the 14-year follow-up, leaving some 5277 cases for this analysis. At the 14-year follow-up, child behaviour (mental health) was assessed using the Child Behaviour Check List and the Youth Self Report. Maternal mental health was determined using the anxiety and depression subscales of the Delusions-Symptoms-States Inventory. RESULTS: Mothers who were not emotionally impaired reported fewer child behaviour problems than did the children themselves. As the mother's current emotional impairment increased, so her reports of the child's behaviour problems increased, when compared with the child's own reports. Further, mothers attributed more internalising symptoms to female respondents, and more externalising symptoms to male respondents, than did the child respondents themselves. CONCLUSIONS: Mothers differ systematically from their children when they are reporting their child's behaviour (mental health). The more emotionally impaired the mother, the greater the degree to which she imputes the child to have behaviour problems. Further, female children are attributed to have more internalising behaviours and male children externalising behaviours.

The effect of breastfeeding on child development at 5 years: a cohort study.

OBJECTIVE: It is uncertain to what degree the relationship between breastfeeding and later cognitive development is a true biological effect, or is confounded by psychosocial factors. The study aim was to further investigate this relationship and the effect of duration of breast feeding on cognitive development. METHODS: A total of 3880 children were followed from birth. Breastfeeding duration was measured by questionnaire at 6 months of age and a Peabody Picture Vocabulary Test Revised (PPVT-R) was administered at 5 years. PPVT-R scores were adjusted for the effects of a large array of biological and psychosocial confounders. The relationship between breastfeeding and the mean PPVT-R scores were examined using analysis of variance and multiple linear regression. RESULTS: A strong positive relationship was demonstrated between breastfeeding and the PPVT-R scores with increasing scores with increased duration of breastfeeding. After adjusting for a wide range of biological and social factors, the adjusted mean for those breastfed for 6 months or more was 8.2 points higher for females and 5.8 points for males when compared to those never breastfed. CONCLUSION: These findings suggest a significant benefit to child development is conferred by breastfeeding and is related independently to longer periods of breastfeeding.

Chronicity, severity, and timing of maternal depressive symptoms: relationships with child outcomes at age 5.

The relationships between severity, chronicity, and timing of maternal depressive symptoms and child outcomes were examined in a cohort of 4,953 children. Mothers provided self-reports of depressive symptoms during pregnancy, immediately postpartum, and when the child was 6 months old and 5 years old. At the age 5 follow-up, mothers reported on children's behavior and children completed a receptive vocabulary test. Results suggest that both the severity and the chronicity of maternal depressive symptoms are related to more behavior problems and lower vocabulary scores in children. The interaction of severity and chronicity of maternal depressive symptoms was significantly related to higher levels of child behavior problems. Timing of maternal symptoms was not significantly related to child vocabulary scores, but more recent reports of maternal depressive symptoms were associated with higher rates of child behavior problems.