The purpose of this study was to explore and compare measures of socioeconomic status (SES) in a national sample of Canadian adolescents. Issues of missing data and interrelationships among the measures were addressed. Measures of SES included household income, parental education, two parental occupation-based measures, and four neighbourhood proxy indicators. The proportion of adolescents with missing data was largest for household income (21.1 percent). Data were not missing at random, as adolescents missing household income information were less likely to reside in a high income neighbourhood. Pair-wise Spearman correlations ranged from: 0.40-0.79 between neighbourhood SES measures; 0.12-0.37 between household/parental and neighbourhood indicators; and 0.36-0.87 between household/parental measures. Correlations were lower among rural adolescents, particularly for the neighbourhood SES measures. The results highlight both measurement and conceptual challenges for researchers who wish to gain insight into SES-health relationships for adolescents. In particular, the findings emphasize the importance of incorporating multiple measures of SES and suggest a need to further explore the meaning of socioeconomic position for this population.
An inverse association between depression and the n-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), primarily obtained from fish consumption, is observed in both observational and experimental research and is biologically plausible. Study objectives were to examine whether prenatal depressive symptoms were associated with lower intakes of fish or EPA+DHA. Pregnant women (n = 2394) completed a telephone interview between 10 and 22 weeks' gestation in London, Ontario, 2002-05. Depressive symptoms were measured using the Center for Epidemiologic Studies - Depression Scale (CES-D). Intakes of fish and EPA+DHA were measured using a validated food-frequency questionnaire. Sequential multiple regression was used to examine associations of depressive symptoms with intake of fish and EPA+DHA, respectively, while controlling for sociodemographic, health and lifestyle variables. The mean CES-D score was 9.9 (SD 8.0). Intake of EPA+DHA was dichotomised at the median value of 85 mg/day. Fish consumption and intake of EPA+DHA were not associated with prenatal depressive symptoms after adjustment for confounders; however, depressive symptoms were significantly higher for lower intakes of EPA+DHA among current smokers and women of single/separated/divorced marital status. The adjusted difference in CES-D scores between intake categories of EPA+DHA was -2.4 [95% CI -4.2, -0.4] for current smokers and -2.8 [95% CI -5.2, -0.4] for women of single marital status. Although pregnant women may be at risk for low concentrations of EPA and DHA, an association between low intakes of EPA+DHA and increased depressive symptoms was only observed among current smokers and women of single marital status.
The George Institute for International Health at the University of Sydney, Sydney, M201 Missenden Road, Camperdown, NSW 2050, Australia. amartiniuk@george.org.au
Epilepsy is the most common neurological disorder in the world, yet it is still widely misunderstood. A lack of knowledge and negative attitudes about epilepsy are largely blamed for the stigma felt by people with epilepsy and their families. Recent calls for research into stigma have been made by the World Health Organization and international epilepsy organizations. Our objective is to describe the development, structure, and psychometric properties of the Thinking about Epilepsy questionnaire.
A 36-item questionnaire was designed to assess Grade 5 (ages 9-11) students' knowledge of and attitudes about epilepsy and to evaluate changes in knowledge and attitudes following an epilepsy education program. The questionnaire contains 18 knowledge, 10 attitude, and 8 demographic questions.
Psychometric properties of the Thinking about Epilepsy questionnaire were ascertained using data from 783 Grade 5 students. Three items (one knowledge item and two attitude items) were removed prior to the factor analysis due to their low extraction communalities. Factor analysis revealed a bidimensional structure (knowledge and attitudes) with five knowledge factors and two attitude factors. The questionnaire was found to have good internal consistency reliability (Cronbach's alpha=0.74 for knowledge and 0.82 for attitudes). Both the knowledge and attitude measures were deemed to have acceptable face, content, and construct validity.
The final 33-item Thinking about Epilepsy questionnaire demonstrates adequate reliability for the knowledge measure, good reliability for the attitude measure, and excellent validity for both measures. The Thinking about Epilepsy questionnaire offers a viable option for assessing elementary school students' knowledge and attitudes regarding epilepsy in general or in conjunction with its affiliated Thinking about Epilepsy education program.
To determine the current practice and opinions of paediatric intensivists in Canada regarding tracheostomy in children with potentially reversible conditions which are anticipated to require prolonged mechanical ventilation.
Self-administered survey among paediatric intensivists within paediatrics critical care units (PCCU) across Canada.
All 16 PCCUs participated in the survey with a response rate of 81% (63 physicians). In 14 of 16 centres one to five tracheostomies were performed during 2006. Two centres did not perform any tracheostomies. The overall rate of tracheostomy is less than 1.5%. Percutaneous technique is used in 3/16 (19%) of centres. Readiness to undertake tracheostomy during the first 21[Symbol: see text]days of illness is influenced by patient diagnosis; severe traumatic brain injury 66% vs. 42% in a 2-year-old with Guillain-Barré syndrome, 48% in a 9-year-old with Guillain-Barré syndrome, and 12% in a child with isolated ARDS. In a child with ARDS 25% of respondents would never consider tracheostomy. Age does not affect timing nor keenness for tracheostomy. The majority, 81%, believe that the risks associated with the procedure do not outweigh the potential benefits. Finally, 51% believe that tracheostomy is underutilized in children.
Elective tracheostomy is rarely performed among ventilated children in Canada. However, 51% of physicians believe it is underutilized. The role of elective tracheostomy and the percutaneous technique in children requires further investigation.
Public service announcements (PSAs) are non-commercial advertisements aiming to improve knowledge, attitudes and/or behavior. No evaluations of epilepsy PSAs exist. This study sought to evaluate a televised PSA showing first aid for a seizure. A multilevel regression analysis was used to determine the effect of the PSA on epilepsy knowledge and attitudes taking into account school-level clustering as well as individual-level variables, including socioeconomic status, gender, language and familiarity with epilepsy. Of the 803 randomly selected Grade 5 (9-11 years) students, 406 (51%) had seen the epilepsy PSA. Those who saw the PSA scored significantly higher on knowledge (P
Factors associated with full breastfeeding (FBF) at 1 week and at 6 months postpartum were examined in a cohort of 856 mother-infant dyads. Questionnaires were mailed at 4 time points over the first 6 months postpartum. At 1 week, 68% of infants were FBF; at 6 months, 23% were FBF. Factors significantly associated with FBF at 1 week were hospital of delivery, residing with a smoker, maternal shiftwork during pregnancy, and having no prior breast-feeding experience. Cox proportional hazards regression analysis showed that residing with a smoker, having consumed caffeine during pregnancy, reporting elevated maternal trait anxiety at 1 week postpartum, having been employed full-time outside the home prior to delivery, and having received anesthesia/analgesia during labor/delivery were associated with earlier cessation of FBF, whereas not having previous breastfeeding experience predicted its continuation. Although most mothers are breastfeeding early on, a number of factors adversely affect its successful continuation.
Intake of fish and omega-3 fatty acids is inversely related to adverse health outcomes; however, these relationships may be confounded by socio-economic status and health behaviours. This study's purpose was to describe the socio-demographic, health and lifestyle correlates of fish consumption among pregnant women.
Pregnant women (n=2394) completed a telephone interview between 10-22 weeks' gestation (London, Ontario, 2002-5) containing questions on socio-demographic, health and lifestyle variables; dietary intake was measured using a 106-item validated food-frequency questionnaire. Unadjusted and adjusted risk ratios were obtained using a modified Poisson regression model.
Departments of Pediatrics and Epidemiology and Biostatistics, University of Western Ontario and Children's Health Research Institute, London, ON, Canada. kathy.speechley@lhsc.on.ca
The main objective was to compare parent-reported health-related quality of life (HRQL) of child and adolescent survivors of childhood cancer to that of controls who had no history of cancer.
We assessed HRQL of 800 child and adolescent survivors younger than 16 years and 923 randomly selected, age- and sex-matched controls from the general population in a national multicenter retrospective cohort study using the Child Health Questionnaire parent report. Participation was 69% among survivors and 57% among controls.
Survivors had means that were consistently lower than controls on the HRQL physical summary (PH; 49.9 v 55.3; P
Assessing health status in survivors of childhood cancer is increasingly important due to improved survival rates. However, there are limited estimates available for this population based on large samples and compared to population controls.
In a retrospective cohort study, 2,152 long-term survivors and 2,432 controls, aged 5-37, who had survived cancer during childhood or adolescence were compared on the Health Utilities Index Mark III (HUI3). Descriptive and logistic regression analyses were used to assess the effect of age at diagnosis, type of cancer and therapy received on HUI3 domains.
More survivors than controls showed deficits in dexterity, ambulation, hearing, speech and cognition but not in vision, emotion or pain. The largest numbers of survivors reporting excess impairment was found in the cognition attribute. Survivors of central nervous system tumors were most likely to show impairments across multiple domains. Lastly, impairments in cognition were found most commonly in survivors exposed to cranio-spinal radiation at young ages.
Seventy-five percent of childhood cancer survivors and 80% of controls were found to have two or fewer impaired attributes. Those reporting impairments that were most likely to be of clinical relevance were among survivors diagnosed with central nervous system and bone tumours, and those exposed to cranial radiation as young children. Tools assessing health status should be included in prospective trials to more clearly assess the contribution of therapy to reduced long-term health status.
Notes
Comment In: Qual Life Res. 2006 Feb;15(1):159-6016411039
The etiology of infant colic remains unknown, despite an abundance of research on the topic.
To determine whether breastfeeding has a protective effect in colic's development.
A prospective cohort study of 856 mother-infant dyads. Eligible participants included English-speaking adult residents of a region in Ontario, who gave birth, at term, to a live singleton whose birth weight was appropriate for gestational age. Self-administered questionnaires, mailed to mothers at 1 and 6 weeks post partum, requested information on several infant and maternal factors, including source of infant nutrition (exclusively breastfed, complementary fed, and exclusively formula fed). Cases of colic were identified by applying modified Wessel criteria to data recorded in the Barr Baby Day Diary or by interpreting responses to the Ames Cry Score.
Prevalence of colic among breastfed, formula-fed, and complementary-fed infants; and adjusted odds ratios (AORs) reflecting the prevalence of colic among formula- and complementary-fed infants relative to those who were breastfed.
Of 856 mothers, 733 (86%) completed the first questionnaire and 617 (72%) completed the second questionnaire. Overall, the prevalence of colic at 6 weeks was 24%. No association was seen between the source of infant nutrition and colic's development. In multivariate analyses, higher levels of maternal trait anxiety (AOR, 1.22; 95% confidence interval [CI], 0.96-1.54), maternal alcohol consumption at 6 weeks (AOR, 1.57; 95% CI, 1.03-2.40), and shift work during pregnancy (AOR, 1.27; 95% CI, 0.73-2.21) were associated with an increased likelihood of colic, after controlling for feeding method, maternal age, and parity. In these same analyses, being married or having a common-law partner (AOR, 0.30; 95% CI, 0.10-0.87) and being employed full-time during pregnancy (AOR, 0.60; 95% CI, 0.32-1.14) were associated with a reduced likelihood of colic.
Breastfeeding did not have a protective effect on the development of colic. Although colic was statistically associated with several variables, including preexisting maternal anxiety, much of colic's etiology remains unexplained.
