Reproductive history of parous women and urinary incontinence in midlife: A National Birth Cohort follow-up study.

OBJECTIVE: To investigate how reproductive history was associated with urinary incontinence in midlife. DESIGN: A follow-up study. SETTING: Denmark. POPULATION: A total of 39 977 mothers who participated in the Maternal Follow up (2013-2014) in the Danish National Birth Cohort. National registries provided their reproductive history. METHODS: How parity, mode of birth and obstetric tears associated with urinary incontinence were estimated with adjusted odds ratios (OR) and 95% CI using logistic regression. MAIN OUTCOME MEASURES: Self-reported urinary incontinence including subtypes stress, urge and mixed urinary incontinence. RESULTS: At an average age of 44 years, the prevalence of any urinary incontinence was 32% (21% stress, 2% urge, and 8% mixed urinary incontinence). Women with two births more often had urinary incontinence than women with one birth (OR 1.20, 95% CI 1.10-1.31). Compared with women with only spontaneous births, a history of only caesarean sections was associated with much lower odds of urinary incontinence (OR 0.39, 95% CI 0.35-0.42) and a history of instrumental births with slightly lower odds (OR 0.92, 95% CI 0.86-0.98). Compared with no tear/first-degree tear as the largest tear, episiotomy was associated with less urinary incontinence (OR 0.91, 95% CI 0.86-0.97) whereas third/fourth-degree tears were associated with more (OR 1.14, 95% CI 1.04-1.25). Findings were mainly explained by similar associations with stress and mixed urinary incontinence. CONCLUSIONS: Vaginal birth was associated with a higher risk of long-term urinary incontinence, but our results indicate that this risk may be reduced by shortening the second stage of birth.

Urinary Incontinence in Midlife According to Weight Changes Across and After Childbearing Years.

INTRODUCTION AND HYPOTHESIS: The objective was to investigate how weight change across and after the childbearing years was associated with urinary incontinence (UI) in midlife. METHODS: Data were obtained from 35,645 women responding to the Maternal Follow-up questionnaire in the Danish National Birth Cohort in 2013-2014. Outcome was self-reported UI and its subtypes. Exposures were changes in body mass index (BMI) across and after the childbearing years. Adjusted odds ratios were estimated using logistic regression. RESULTS: At follow-up, the mean age was 44 years and 32% experienced UI. Compared with stable weight, weight gain across the childbearing years of > 1 to 3, > 3 to 5 or > 5 BMI units increased the odds of any UI by 15%, 27%, and 41% respectively. For mixed UI, the odds increased by 23%, 41%, and 68% in these groups. Weight gain after childbearing showed the same pattern, but with a higher increase in the odds of mixed UI (25%, 60%, and 95% in the respective groups). Women with any weight loss during this period had 9% lower odds of any UI than women with a stable weight. CONCLUSIONS: Weight gain across and after childbearing increased the risk of UI in midlife, especially the subtype mixed UI. Weight loss after childbearing decreased the risk.

Parity, mode of birth, and long-term gynecological health: A follow-up study of parous and nonparous women in the Australian Longitudinal Study on Women's Health cohort.

BACKGROUND: Although gynecological health issues are common and cause considerable distress, little is known about their causes. We examined how birth history is associated with urinary incontinence (UI), severe period pain, heavy periods, and endometriosis. METHODS: We studied 7700 women in the Australian Longitudinal Study on Women's Health with an average follow-up of 10.9 years after their last birth. Surveys every third year provided information about birth history and gynecological health. Logistic regression was used to estimate how parity, mode of birth, and vaginal tears were associated with gynecological health issues. Presented results are adjusted odds ratios (OR) with 95% confidence intervals. RESULTS: UI was reported by 16%, heavy periods by 31%, severe period pain by 28%, and endometriosis by 4%. Compared with women with two children, nonparous women had less UI (OR 0.35 [0.26-0.47]) but tended to have more endometriosis (OR 1.70 [0.97-2.96]). Also, women with only one child had less UI (OR 0.77 [0.61-0.98]), but more severe period pain (OR 1.24 [1.01-1.51]). Women with 4+ children had more heavy periods (OR 1.42 [1.07-1.88]). Compared with women with vaginal birth(s) only, women with only cesarean sections or vaginal birth after cesarean section had less UI (ORs 0.44 [0.34-0.58] and 0.55 [0.40-0.76]), but more endometriosis (ORs 1.91 [1.16-3.16] and 2.31 [1.25-4.28]) and heavy periods (ORs 1.21 [1.00-1.46] and 1.35 [1.06-1.72]). Vaginal tear(s) did not increase UI after accounting for parity and birth mode. CONCLUSION: While women with vaginal childbirth(s) reported more urinary incontinence, they had less menstrual complaints and endometriosis.

Women and partners' experience of major postpartum haemorrhage: a qualitative study.

OBJECTIVE: To examine women and their partners' experience of major postpartum haemorrhage (PPH). DESIGN: A qualitative interview study. SETTING: Two Labour and Delivery Units in Denmark. POPULATION: Women who experienced major PPH (≥1 litre within 2 hours after vaginal birth). METHODS: Semi-structured interviews were conducted with 15 women and nine partners (nine joint interviews, six individual interviews). Interviews were analysed using thematic analysis. MAIN OUTCOME MEASURES: A qualitative description of women and their partners' experiences. RESULTS: Three major themes were identified. (1) 'From birth to emergency' included factors that increased concern in women and their partners, such as 'incomprehensible' medical terminology, a tense atmosphere, and alarm call. Transfer to the operating theatre was experienced as the most devastating part of major PPH. (2) 'Feeling safe during an emergency' described factors that supported the women and their partners' management of the situation such as brief explanations from a few healthcare professionals and reassurance that the healthcare professionals were in control of the situation. The pain was experienced as severe, but acceptable. (3) 'Family unity challenged' described how family bonding was supported by positioning the partner at the head of the bed and by keeping the baby on the woman's chest. CONCLUSIONS: Several factors such as small gestures from healthcare professionals and appropriate organisation of the PPH can make a difference to the woman and her partner's experience of major PPH. Particularly, efforts that support family bonding are greatly valued by women and their partners.

Body mass index, waist circumference, and urinary incontinence in midlife: A follow-up of mothers in the Danish National Birth Cohort.

BACKGROUND: Obesity is a modifiable risk factor for urinary incontinence, yet few studies have investigated how waist circumference as compared to body mass index (BMI) influences the risk of urinary incontinence. OBJECTIVE: To estimate how BMI and waist circumference associates with risk of urinary incontinence in midlife and determine which of the two is the strongest predictor of urinary incontinence. METHODS: Cohort study among mothers in the Danish National Birth Cohort. Weight and waist circumference were self-reported 7 years after cohort entry. Symptoms of urinary incontinence in midlife were self-reported using the International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) and analyzed continuously and as presence or absence of any, stress (SUI), urgency (UUI), and mixed (MUI) urinary incontinence. Linear and log binomial regressions were used to calculate mean differences and risk ratios (RR) with 95% confidence intervals (CI). Restricted cubic splines were generated to explore nonlinear relationships. RESULTS: Among 27 254 women at a mean age of 44.2 years, any urinary incontinence was reported by 32.1%, SUI by 20.9%, UUI by 2.4%, and MUI by 8.6%. For all outcomes, increases in risk were similar with higher BMI and waist circumference. The estimates of association were strongest for MUI (RR 1.10, 95% CI 1.08;1.12 and RR 1.12, 95% CI 1.10;1.14 for half a standard deviation increase in BMI and waist circumference, respectively). While increases in risk of the other outcomes were seen across the entire range of BMI and waist circumference, the risk of SUI rose until BMI 28 kg/m2 (waist circumference 95 cm), and then fell slightly. CONCLUSIONS: Symptoms of urinary incontinence and prevalence of any urinary incontinence, SUI, UUI, and MUI increased with higher BMI and waist circumference. Self-reported BMI and waist circumference were equally predictive of urinary incontinence.

Implementation through translation: a qualitative case study of translation processes in the implementation of quality improvement collaboratives.

BACKGROUND: Quality improvement collaboratives (QICs) are used extensively to implement quality improvement in healthcare, and current research is demonstrating positive yet varying evidence. To interpret the effectiveness results, it is necessary to illuminate the dynamics of QIC implementation in specific contexts. Using Scandinavian institutionalist translation theory as a theoretical framework, this study aims to make two contributions. First, we provide insights into the dynamics of the translation processes inherent in QIC implementation. Second, we discuss the implications of the translation processes as experienced by participating actors. METHODS: We used empirical data from a qualitative case study investigating the implementation of QICs as an approach to quality improvement within a national Danish healthcare quality program. We included two diverse QICs to allow for exploration of the significance of organizational complexity for the translation processes. Data comprised qualitative interviews, participant observation and documentary material. RESULTS: Translation was an inherent part of QIC implementation. Key actors at different organizational levels engaged in translation of their implementation roles, and the QIC content and methodology. They drew on different translation strategies and practices that mainly materialized as kinds of modification. The translations were motivated by deliberate, strategic, and pragmatic rationales, contingent on combinations of features of the actors' organizational contexts, and the transformability and organizational complexity of the QICs. The findings point to a transformative power of translation, as different translations led to various regional and local QIC versions. Furthermore, the findings indicate that translation affects the outcomes of the implementation process and the QIC intervention. Translation may positively affect the institutionalization of the QICs and the creation of professional engagement and negatively influence the QIC effects. CONCLUSION: The findings extends the current research concerning the understanding of the dynamics of the translation processes embedded in the local implementation of QICs, and thus constitute a valuable contribution to a more sustainable and effective implementation of QICs in healthcare improvement. For researchers and practitioners, this highlights translation as an embedded part of the QIC implementation process, and encourages detailed attention to the implications of translation for both organizational institutionalization and realisation of the expected intervention outcomes.

Understanding trajectories of externalizing problems: Stability and emergence of risk factors from infancy to middle adolescence.

Despite considerable efforts to understand the processes that underlie the development of externalizing behavior problems, it is still unclear why externalizing problems remain chronically high for some children, emerge early and cease by late childhood for others, and arise in adolescence in some cases. The purpose of this study was to examine how a wide range of child and family risk factors are linked to trajectories of externalizing behavior and how these relationships vary from infancy to middle adolescence. We used data from the community-based Norwegian Tracking Opportunities and Problems (TOPP) study sample (n = 921). A Cholesky factorization model was specified to separate stable and emerging risk doses across four developmental periods (infancy, early and middle childhood, and middle adolescence). Children in the High Stable class were characterized by substantially elevated risk levels in multiple domains throughout the study period. Children in the High Childhood Limited class had very high levels of temperamental emotionality, internalizing symptoms, and maternal mental distress, suggesting a substantial intrinsic emotional basis for their externalizing problems. Intrinsic factors seemed less salient for the Adolescent Onset class. These findings emphasize the need for a dynamic perspective on risk factors and support the importance of prevention and intervention efforts across multiple domains from early childhood and throughout adolescence.

[Coronavirus Pandemic - #STAYHOME: How Are You Holding Up? Questions And Tips For 11-18-Year-Olds To Make It Better].

PURPOSE: Adolescents have to cope with several challenges and restrictions due to the COVID-19 pandemic, with many of those incongruent with the typical developmental tasks of adolescent age. Some adolescents might be particularly vulnerable in this situation, including those who are deprived of psychological, social or health care services and/or are exposed to abuse or neglect in their home environment. The aims of the current international multicentre follow-up study are to: 1. collect data on the mental health and quality of life of adolescents during and after the pandemic; 2. improve their mental health by providing an online prevention program that addresses their actual needs; 3. accelerate the development of culturally adapted prevention programs by involving an international team, and 4. to contribute to adequate preparation for any potentially occurring, similar situationin the future. METHODS: Participants aged 11-18 years and their parents/caregivers from diff erent parts of Europe and non-European countries are recruited online. Data are collected regularly in a follow-up study by means of structured self-administered online questionnaires on adolescents' mental health, quality of life and current attitudes and needs. The baseline data collection was in March 2020 at first restrictions of the COVID pandemic in Europe. It is followed up several times (at the beginning weekly, later monthly, bi-monthly, three-monthly) to study changes in mental health, quality of life and attitudes of children and adolescents during the coronavirus disease pandemic. Data were collected by means of structured questionnaires (see below). The time frame of the study is set to one year from study start, March 2021. The last data collection was done in December 2020. The prevention program is developed and provided based on continuously analysed incoming data. CONCLUSIONS: Prevention based on the results of the study is expected to contribute to maintaining adolescents' mental health, improve their quality of life, increase their and their environment's cooperation with the necessary restrictions during the pandemic, and to make reintegration easier once the restrictions are over. Furthermore, the study has the potential to inform on the wellbeing of children and adolescents in extreme situations in general, thus contribute to future preventive measures and policymaking. Implications and Contribution: The proposed international online follow-up study is expected to provide scientifi c evidence for 1. possible changes in the mental health and quality of life of adolescents during and after a pandemic situation, 2. the eff ectiveness of a culturally adapted prevention program developed to address challenges associated with these changes.

Predicting hazardous drinking in late adolescence/young adulthood from early and excessive adolescent drinking - a longitudinal cross-national study of Norwegian and Australian adolescents.

BACKGROUND: Research has consistently shown that early onset of drinking (EOD) is associated with alcohol-related problems in adulthood. However, recent reviews have identified several limitations in the early onset literature, including the use of retrospective reports, insufficient control for potential confounders, ambiguous definitions of the concept, and an assumption that early onset is independent of cultural norms and national alcohol policies. This study addresses these limitations by examining whether EOD, independent of early onset of excessive drinking (EOE), prospectively predicts hazardous drinking in late adolescence/young adulthood in Norway and Australia, two countries with different drinking cultures. METHODS: Data were drawn from two population-based longitudinal studies; the Norwegian Tracking Opportunities and Problems Study (n = 329) and the Australian International Youth Development Study (n = 786). Data were collected prospectively from mid adolescence (14-16 years) to late adolescence/young adulthood (18-25 years) and a modified Poisson regression approach was used to estimate prevalence ratios. Adolescent self-reports included measures of EOD and EOE. Young adults completed the Alcohol Use Disorders Identification Test (AUDIT). The results were adjusted for adolescent factors; age, gender, impulsivity, hyperactivity, conduct problems, smoking, early sexual intercourse and friends' substance use, and family factors; alcohol and drug use in the family, maternal education, family management and monitoring. RESULTS: Hazardous drinking was identified in 46.8 and 38.9% of young adults in Norway and Australia, respectively. Both EOD and EOE in adolescence were significantly related to an increased risk of alcohol-related problems in late adolescence/young adulthood in both studies, even when adjusting for possible confounders. CONCLUSION: Our findings indicate that adolescent drinking behaviour is an indicator of alcohol-related problems in late adolescence/young adulthood, even when controlling for a variety of covariates. This finding is in contrast to previous research on older adults, where no association between adolescent drinking and later alcohol-related problems were found when controlling for covariates. The divergence in findings may suggest that the impact of EOD/EOE is limited to the late adolescent and young adult period. Preventing drinking in early adolescence may thus have some impact on the drinking patterns in late adolescence/young adulthood.

Nuancing the role of social skills- a longitudinal study of early maternal psychological distress and adolescent depressive symptoms.

BACKGROUND: Social skills might play an important role for the relationship between maternal psychological distress and subsequent development of depressive symptoms. The majority perspective is that social skills is adaptive and protective, but there is a need to also highlight the potential maladaptive effect of social skills in some settings or for some sub groups. The current study examined the longitudinal interplay between maternal-reported psychological distress in early childhood (age 1.5), and offspring reports on social skills and depressive symptoms in early (age 12.5) and middle adolescence (age 14.5). METHODS: We used data from the Tracking Opportunities and Problems Study (TOPP), a community-based longitudinal study following Norwegian families to examine direct links and interactions between early maternal distress (measured with the Hopkins Symptom Checklist) and early adolescent offspring social skills (measured with the Social Skills Rating System) and middle adolescent depressive symptoms (measured with the Moods and Feelings Questionnaire) in 370 families (in total 740 mothers and adolescents). RESULTS: Exposure to childhood maternal distress predicted offspring depressive symptoms in middle adolescence. Higher social skills in early adolescence predicted lower levels of depressive symptoms for girls, but not for boys, in middle adolescence. An interaction effect was found in which adolescents exposed to early maternal distress who reported high social skills in early adolescence had the highest level of depressive symptoms in middle adolescence. CONCLUSIONS: The findings highlight the nuances in the role of social skills for adolescent depressive symptoms - having the potential to be both adaptive as well as maladaptive for some subgroups (those experiencing maternal psychological distress). This has important implications for social skill programs.

Parental Child-Rearing Conflicts Through Adolescence: Trajectories and Associations With Child Characteristics and Externalizing Patterns.

Research on longitudinal interparental conflict patterns and offspring development is scarce. The population-based TOPP study (N = 459) was used to investigate (1) child-rearing conflict trajectories through four time points during childhood and adolescence (ages 8-16), and (2) associations between conflict trajectories and child characteristics (i.e., birth order, gender, externalizing patterns from early childhood). Latent profile analysis identified six distinct trajectories. Conflict levels decreased for most respondents over the adolescent offspring period, but offspring's birth order and externalizing problems were related to less typical trajectories and higher levels of conflict. Onset of externalizing problems was of additional importance for the course of parental child-rearing conflicts. The results highlight the perception of the whole family as an interwoven system.

Predicting Well-Being and Internalizing Symptoms in Late Adolescence From Trajectories of Externalizing Behavior Starting in Infancy.

This study aimed to examine the long-term prediction of well-being and internalizing symptoms from trajectories of externalizing behavior problems in 921 children from a population-based sample. We found that a high stable trajectory of externalizing behavior from infancy (age 1.5) to mid-adolescence (age 14.5) predicted lower scores on life satisfaction and flourishing for both girls and boys (age 18.5). The high stable trajectory also predicted higher levels of depressive symptoms in boys and anxiety symptoms in girls (age 18.5). The findings are noteworthy as they document how a person-oriented study of externalizing behavior problems starting in infancy can predict well-being and internalizing in late adolescence. The findings underline the importance of early health promotion and problem intervention efforts.

Engaging health care professionals in quality improvement: A qualitative study exploring the synergies between projects of professionalisation and institutionalisation in quality improvement collaborative implementation in Denmark.

OBJECTIVE: To examine the projects of professionalisation and institutionalisation forming health care professions' engagement in quality improvement collaborative (QIC) implementation in Denmark, and to analyse the synergies and tensions between the two projects given the opportunities afforded by the QICs. METHODS: This was a cross-sectional interview study with professionals involved in the implementation of two national QICs in Denmark involving 23 individual interviews and focus group discussions with 75 people representing different professional groups. We conducted a reflexive thematic analysis of the data, drawing on institutional contributions to organisational studies of professions. RESULTS: Study participants engaged widely in QIC implementation. This engagement was formed by a constructive interplay between the professions' projects of professionalisation and institutionalisation, with only few tensions identified. The project of professionalisation relates to a self-oriented agenda of contributing professional expertise and promoting professional recognition and development, while the project of institutionalisation focuses on improving health care processes and outcomes and advancing quality improvement. Both projects were largely similar across professional groups. The interplay between the two projects was enabled by the bottom-up approach to implementation, participation of QI specialists, and a clear focus on developing and delivering high-quality patient care. CONCLUSIONS: Future strategies for QIC implementation should position QICs as a framework that promotes the integration of professions' projects of professionalisation and institutionalisation to successfully engage professionals in the implementation process, and thereby optimise the effectiveness of QICs in health care.

Trajectories of maternal symptoms of depression and anxiety over 13 years: the influence of stress, social support, and maternal temperament.

BACKGROUND: Depression and anxiety are the most common mental health problems among women, with various negative impacts both for the women concerned and their families. Greater understanding of developmental trajectories of maternal symptoms of depression and anxiety over the child rearing period would have significant benefits for public health, informing prevention and treatment approaches. The aim of the current study was to examine whether stressors related to child rearing and living conditions, social support, and maternal temperament, predicted mothers' membership in groups with different trajectories of symptoms of depression and anxiety during 13 years of the child rearing phase. METHODS: The data were from a prospective, longitudinal study of 913 mothers in Norway followed from when their children were 18 months old (time 1) until they were 14.5 years (time 6) (the TOPP study). Multinomial logistic regression analyses were used to test whether child related stressors, stressors related to the living conditions, social support and maternal temperament at time 1 predicted membership in groups based on maternal symptoms of depression and anxiety over the subsequent 13 years. RESULTS: Temperamental distress, followed by child related stressors, were the strongest predictors of membership in a group with high symptoms of depression and anxiety over time. Stressors related to living conditions, and social support from partner and friends/family were also significant predictors. No interaction effects among predictors were found. CONCLUSIONS: This study indicates that factors present early in the child rearing phase may provide substantial prediction of the variance in maternal symptoms of depression and anxiety over the following 13 years. Temperamental distress and child related stressors were the strongest predictors of membership in different depression and anxiety symptom trajectory groups.

The Danish health care quality programme: Creating change through the use of quality improvement collaboratives.

Policy-makers worldwide place quality in health care high on their agendas. Inspired by global trends within health care governance, there has been an increase in patient-oriented and network-based models for quality improvement. In 2015, the Danish Government introduced the Danish Health Care Quality Programme (DHCQP) for the entire Danish health care system in line with this development. For the first time in Denmark, the DHCQP introduced network-based quality improvement collaboratives (QICs) as a model for the implementation of a national quality improvement reform. This article presents the organisational set up and anticipated effects of using QICs within the DHCQP. The Danish set-up is related to the common international use of QICs and the existing evidence for their effectiveness and implementation. The analysis demonstrates a novel organisational set-up embedded in the organisation of the QICs. Furthermore, the article points to two main trends in the DHCQP, namely, centralisation of quality improvement strategies and integration of quality improvement work in clinical practices, and furthermore proposes a need for future research concerning implementation of QICs. Particularly, there is a need to investigate the different activities and organisational mechanisms in the implementation process and how these influence the implementation and functioning of QICs.

Fatty Acid Profiles from Routine Milk Recording as a Decision Tool for Body Weight Change of Dairy Cows after Calving.

Cows mobilize body reserves during early lactation, which is reflected in the milk fatty acid (FA) profile. Milk FA can be routinely predicted by Fourier-transform infrared (FTIR) spectroscopy, and be, thus, used to develop an early indicator for bodyweight change (BWC) in early lactating cows in commercial dairy farms. Cow records from 165 herds in Denmark between 2015 and 2017 were used with bodyweight (BW) records at each milking from floor scales in automatic milking systems. Milk FA in monthly test-day samples was predicted by FTIR. Predictions of BWC were based on a random forest model and included parity, stage of lactation, and test day milk production and components (fat, protein, and FA). Bodyweight loss was mainly explained by decreased short-chain FA (C4:0-C10:0) and increased C18:0 FA. The root mean square error (RMSE) of prediction after cross-validation was 1.79 g/kg of BW (R2 of 0.94). Model evaluation with previously unseen BWC records resulted in reduced prediction performance (RMSE of 2.33 g/kg of BW; R2 of 0.31). An early warning system may be implemented for cows with a large BW loss during early lactation based on milk FA profiles, but model performance should be improved, ideally by using the full FTIR milk spectra.

Dynamics of distributed leadership during a hospital merger.

Purpose Mergers have become an influential part of public hospital development, and the successful implementation of such mergers requires skillful management. Recent studies have pointed to the impact of the distribution of leadership tasks amongst employees for implementing planned radical changes, yet this lacks examination with regard to hospital mergers. The purpose of this paper is to investigate the emergence of distributed leadership and this leadership's influence on the implementation of a hospital merger. Design/methodology/approach The emergence of distributed leadership is examined through a qualitative case study of two Danish hospital units in the context of a large hospital merger. The data consist of 21 interviews and documents collected over a three-year period. Findings The findings suggest dynamics of widened and restricted distributed leadership being influenced by and influencing the merger at hospital and local-unit levels, respectively. Importantly, the perceived purpose of widened and restricted distributed leadership mediated the actual effects of widened and restricted distributed leadership on the implementation of a merger. Moreover, the findings show that mergers on both the hospital and local level lead to variations in top-down and bottom-up distributed leadership across pre-merger organizational boundaries. Practical implications Perceived purposeful widening and restriction of distributed leadership at various hospital levels enables merger integration and collaboration across organizational boundaries and hierarchies. Originality/value The paper addresses the need to understand the complex dynamics of widened and restricted leadership distribution in a merger context.

Childhood problem behaviours as precursors of drinking to intoxication trajectories - from age 1.5 to 19.

OBJECTIVE: We examined behaviour problem precursors (i.e. internalising and externalising) in childhood (ages 1.5 to 8.5) and early adolescence (age 12.5) and consequences (i.e. harmful alcohol use) in emerging adulthood (age 19), of developmental trajectories of drinking to intoxication across adolescence (ages 14.5-19). DESIGN AND OUTCOME MEASURES: Data from 921 children and their parents followed for 18 years from the population-based Tracking Opportunities and Problems (TOPP) Study were used to examine adolescent trajectories of drinking to intoxication. Logistic regression was used to examine predictors of trajectory group membership. RESULTS: We identified 3 trajectory classes: low / abstainer (41%), late onset high (31%) and early onset high (28%) using latent class analyses. Logistic regression analyses showed that childhood high externalising characterised early onset of intoxication vs. other classes, while early adolescence externalising discriminated both early and late onset of intoxication. High early childhood internalising characterised those consistently low or abstinent on alcohol intoxication, while early adolescent internalising characterised those having an early onset of intoxication. However, after additional adjustment for co-occurring externalising, there were no evidence for a link between early adolescent internalising and intoxication. CONCLUSIONS: The findings suggest that both child and early adolescent-focused prevention efforts may be warranted.

Only When the Societal Impact Potential Is High? A Panel Study of the Relationship Between Public Service Motivation and Perceived Performance.

Many studies find positive associations between public service motivation (PSM) and performance, but much of this literature is based on cross-sectional data prone to endogeneity and common method bias. Moreover, we know little about potential moderators. In this study, we test the moderating role of societal impact potential (SIP)-the degree to which the job is perceived to provide opportunities to contribute to society. We use cross-sectional data from 13,967 employees in 2010 and 2012 aggregated to construct longitudinal data for 42 organizations. As expected, the association between PSM and individual perceived performance is positive when SIP is high. However, when SIP is low, PSM is only weakly or not at all related to performance. This is an important insight for organizations that try to enhance performance through PSM. Our findings suggest that this can only be done when the employees think that their jobs allow them to contribute to society.

Mortality (including euthanasia) among Danish dairy cows (1990-2001).

Mortality among Danish dairy cows was examined using data from the Danish Cattle Database (DCD) and a questionnaire survey. Mortality risk has increased from approximately 2% in 1990 to approximately 3.5% in 1999. The increased mortality was seen for all dairy breeds and all age groups. Mortality among older dairy cows (parity 3 and older) was approximately twice the mortality among younger cows. 30-40% of deaths were during the first 30 days of the lactation. Approximately, 58% of dead dairy cows had been euthanised. Replies from the questionnaire indicate that the proportion of euthanised cows has increased in the past 5 years. In 86% of all deaths (questionnaire survey) a primary reason could be identified; 25% were for locomotor disorders.