Gender differences in cardiovascular disease risk: Adolescence to young adulthood.

BACKGROUND AND AIMS: Gender differences in cardiovascular disease (CVD) have been well documented but rarely for young adults and the extent to which gender related lifestyle differences may contribute to gender differences in CVD risk experienced by young adults have not been reported. METHODS AND RESULTS: Data are from a long-running cohort study, the Mater-University of Queensland Study of Pregnancy (MUSP). We track gender differences in CVD related behaviours at 21 and 30 years (consumption of a Western Diet/Health-Oriented Diet, cigarette smoking, vigorous physical exercise, heavy alcohol consumption). At 30 years we compare males and females for CVD risk, and the extent to which lifestyle behaviours at 21 and 30 years contribute to CVD risk. At both 21 and 30 years of age, males more frequently consume a Western Diet and less often a Health Oriented Diet. By contrast, males are also much more likely to report engaging in vigorous physical activity. On most CVD markers, males exhibit much higher levels of risk than do females at both 21 and 30 years. At 30 years of age males have about five times the odds of being at high risk of CVD. Some lifestyle behaviours contribute to this additional risk. CONCLUSION: Young adult males much more frequently engage in most CVD related risk behaviours and males have a higher level of CVD risk. Gender differences in CVD risk remain high even after adjustment for CVD lifestyles, though dietary factors independently contribute to CVD risk at 30 years.

A randomised trial of topical polaprezinc to prevent oral mucositis in patients undergoing haematopoietic stem cell transplantation (ToPaZ study).

PURPOSE: Oral mucositis (OM) is a common complication in haematopoietic stem cell transplantation (HSCT). Polaprezinc, an anti-ulcer drug, has been shown to be effective to prevent OM in several studies when administered topically and systemically. This study aimed to evaluate the effectiveness of topical polaprezinc in patients undergoing HSCT. METHODS: This was an open-label randomised clinical trial comparing polaprezinc and sodium bicarbonate mouthwashes for the prevention of severe OM in HSCT patients. Adult patients who received conditioning regimens at moderate to high risk of developing OM were included. The primary endpoint was the incidence of severe (WHO grades 3-4) OM. The secondary endpoints included duration of grades 3-4 OM, incidence and duration of grades 2-4 OM, patient-reported pain and functional limitations. RESULTS: In total, 108 patients (55 test arm and 53 control arm) were randomised. There was no difference in the incidence of grades 3 to 4 OM (35% test arm versus 36% control arm). The secondary endpoints were not significantly different. In both arms, patients reported more throat pain compared to mouth pain. CONCLUSIONS: Topical polaprezinc had no effect in the prevention of OM in HSCT patients. Further research is required to evaluate the effects of systemic polaprezinc. The OM assessment tool needs to be reviewed as throat mucositis was a main issue in this study. TRIAL REGISTRATION: ACTRN12320001188921 (Date Registered: 10th November 2020).

A real-world accuracy of oral mucositis grading in patients undergoing hematopoietic stem cell transplantation.

PURPOSE: Oral mucositis is a common complication in patients undergoing hematopoietic stem cell transplantation. Accurate oral mucositis grading is essential for both clinical practice and oral mucositis research. This study aimed to evaluate the accuracy of daily oral mucositis grading by nurses in a tertiary hospital in Australia. METHODS: A retrospective study was undertaken to review the daily patient oral assessment record, including diet, pain, erythema, ulceration and the oral mucositis grade based on World Health Organization (WHO) oral mucositis grading scale. The accuracy of the grade was determined by the observations recorded, and reasons for inaccuracy were documented. Any repetition of the same error in the same patient was noted. RESULTS: In total, 6841 oral assessments in 373 patients, conducted between 2017 and 2020, were reviewed. A total of 70% (N = 4781) were graded correctly. Of these, 64% (N = 3043) were grade 0. When the grade 0 scores were excluded, the accuracy of grading was reduced to 46% (N = 1738). Common reasons for incorrect grading included: unable to grade due to diet not specified, no ulceration and no pain was scored grade 1, no ulceration was scored as grade 2-4, oral intake was not taken into account, and pain without ulcer was scored 0. A total of 77% of the errors were repeated in the same patient on consecutive days. CONCLUSIONS: Our results suggest there is frequent inaccurate evaluation of oral mucositis and a need for nurse training to accurately assess oral mucositis.

The incidence of severe oral mucositis in patients undergoing different conditioning regimens in haematopoietic stem cell transplantation.

PURPOSE: Oral mucositis is a common complication during haematopoietic stem cell transplantation (HSCT). This study aimed to assess the incidence of severe mucositis in patients undergoing different HSCT regimens. METHODS: This single-centre retrospective study reviewed daily oral assessment for 467 consecutive patients who underwent different transplant regimens for matched unrelated or related allogeneic HSCT with post-transplant methotrexate, haploidentical or mismatched HSCT with post-transplant cyclophosphamide (PTCy), or autologous HSCT. Oral care and cryotherapy with melphalan were used. Patient demographic data, oral mucositis WHO grade, use of total parenteral nutrition (TPN) and patient-controlled analgesia (PCA) were collected. RESULTS: Grade 3-4 oral mucositis was common in myeloablative total body irradiation (TBI)-based regimens cyclophosphamide/ TBI (CyTBI) (71%) and fludarabine/ TBI (FluTBI) with PTCy (46%), as well as reduced-intensity fludarabine/melphalan (FluMel) (43%) and carmustine/etoposide/cytarabine/melphalan (BEAM) autologous HSCT (41%). In contrast, grade 3-4 oral mucositis was less common in reduced-intensity haploidentical regimen melphalan/fludarabine/TBI with PTCy (19%), all non-myeloablative regimens (0-9%) and high-dose melphalan autologous HSCT (26%). TPN and PCA use were correlated to oral mucositis severity. CONCLUSIONS: Severe oral mucositis was associated with myeloablative TBI, methotrexate and melphalan in combination with methotrexate and in BEAM. Use of PTCy was preferable over methotrexate to prevent oral mucositis.

Learning on the run - a qualitative, longitudinal study of pharmacy educators' experiences implementing a hospital pharmacy residency program.

BACKGROUND: A hospital pharmacy foundation residency training program has been introduced in Australia, modelled on residency programs established in other countries. The program aims to support the professional development of early-career hospital pharmacists, in both clinical and non-clinical roles. Pharmacy educators are usually tasked with the implementation and maintenance of this program. This qualitative, longitudinal study aimed to investigate hospital pharmacy educators' expectations, perceptions and experiences with implementing and developing their residency program. METHODS: Qualitative data were collected at two timepoints, approximately 24 months apart, using either focus groups or interviews with pharmacy educators who were directly involved in the implementation of the residency program at their respective hospitals. During the early phases of implementation, and approximately 24 months later, participants were asked about their experiences and expectations of the residency program as well as any changes that had occurred within the residency program over time. RESULTS: Four focus groups and three semi-structured interviews were held with pharmacy educators and senior pharmacists from different hospital settings. These were audio recorded and transcribed verbatim. Transcripts were inductively analysed via thematic analysis. Fifteen hospital pharmacy educators and senior hospital pharmacists participated in the initial focus groups and interviews, and seven educators were retained for follow-up. Four main themes were established from the discussions: participants had great expectations of a positive impact of the residency on their workplace and residents' professional development; substantial effort, support and resources were needed to implement and maintain a residency program; self-motivation and engagement is needed by residents to succeed and experience timely completion and career acceleration; and lastly a balance between standardisation, consistency and flexibility in delivering the residency needs to be found. The role of educators changed with the implementation of a residency, with the addition of more managerial and supervisory aspects. CONCLUSION: The Australian hospital pharmacy foundation residency program is a complex workplace training program with multiple factors and prerequisites influencing its implementation, development and outcomes. Pharmacy educators are central to the successful implementation and ongoing sustainability of a residency program. They may benefit from formal training and qualifications to support their role.

Predicting Child Maltreatment over the Early Life Course: A Prospective Study.

A large number of early life exposures predict child maltreatment. Using data from a 30-year birth cohort study we examine 12 early life course risk factors of four types of self-reported childhood maltreatment recalled at the 30-year follow-up. Of the 7223 children in the sample at birth, 2425 responded to the Child Trauma Questionnaire at the 30-year follow-up. On adjusted analysis being a teenage mother predicts childhood physical and sexual abuse, as well as child neglect. More numerous maternal marital partner changes in the 5 years after the birth predict offspring experiences of emotional abuse, sexual abuse and childhood neglect. Policy responses should focus on the broad social context in which children are reared as the most effective approach to reducing the high level of childhood abuse and neglect.

Does the millennial generation of women experience more mental illness than their mothers?

BACKGROUND: There is concern that rates of mental disorders may be increasing although findings disagree. Using an innovative design with a daughter-mother data set we assess whether there has been a generational increase in lifetime ever rates of major depressive disorder, generalised anxiety disorder, panic disorder, and post-traumatic stress disorder (PTSD) experienced prior to 30 years of age. METHODS: Pregnant women were recruited during 1981-1983 and administered the Composite International Diagnostic Interview (CIDI) at the 27-year follow-up (2008-11). Offspring were administered the CIDI at the 30-year follow-up (2010-2014). Comparisons for onset of diagnosis are restricted to daughter and mother dyads up to 30 years of age. To address recall bias, disorders were stratified into more (≥12 months duration) and less persistent episodes (< 12 months duration) for the purposes of comparison. Sensitivity analyses with inflation were used to account for possible maternal failure to differentially recall past episodes. RESULTS: When comparing life time ever diagnoses before 30 years, daughters had higher rates of persistent generalised anxiety disorder, and less persistent major depressive disorder, generalised anxiety disorder and PTSD. CONCLUSIONS: In the context of conflicting findings concerning generational changes in mental disorders we find an increase in generational rates of persistent generalised anxiety disorders and a range of less persistent disorders. It is not clear whether this finding reflects actual changes in symptom levels over a generation or whether there has been a generational change in recognition of and willingness to report symptoms of mental illness.

Long term impact of the WHI studies on information-seeking and decision-making in menopause symptoms management: a longitudinal analysis of questions to a medicines call centre.

BACKGROUND: While women are taking a greater role in decisions about menopause symptom management, the legacy of the Women's Health Initiative (WHI) studies persist. Despite hormone therapy (HT) being effective in reducing all-cause mortality, many women seeking relief of menopausal symptoms exaggerate HT harms and overstate the perceived benefits or ignore the risks of alternative therapies. We aimed to explore the longitudinal impact of the widely-publicised WHI 2002 study on women's information-seeking and describe determinants of decision-making about managing menopausal symptoms. METHODS: In a longitudinal analysis of both quantitative and qualitative data, we explored consumer questions about menopause-related medicines received by two Australian medicines call centres (1996-2010) before, during, and after WHI 2002. We analysed calls by age and gender of caller and patient, their relationship, postcode, enquiry type, and motivation to help-seek. We compared calls regarding HT and herbal medicines (HM) with the rest of calls, and thematically analysed question narratives across the three time-periods. RESULTS: There were 1,829 menopause-related calls received of over this time-period, with a call surge, primarily from women in their mid-fifties, in the two months after the WHI 2002 publication. Two in three calls were motivated by negative media reports as women sought support for decision-making, primarily reassurance to cease HT. While HT safety concerns persisted for eight years post-publication, the nature of information-seeking changed over time. Callers subsequently sought reassurance to use menopause treatments together with their other medicines; and pursued HT substitutes, including HM, in response to HT product discontinuation. CONCLUSIONS: Women sought information or reassurance to support a decision, based on dynamic changes in internal (symptom or risk intolerance, attitude towards menopause and treatment preferences) and external factors (perceived source trust and changes in treatment availability). In assessing HT benefit versus risk, women tend to overestimate risk with HT safety concerns persisting over time. Decision-making in managing menopause symptoms is complex and dynamic. Reassurance to reach or justify decisions from a perceived trusted source can support informed decision-making.

The impact of an electronic hospital system on therapeutic drug monitoring.

WHAT IS KNOWN AND OBJECTIVE: Australian hospitals have undergone a transformation with both a review and expansion of traditional roles of healthcare professionals and the implementation of an ieMR. The implementation of an ieMR brings large scale organizational change within the health system especially for staff with direct patient contact. This is changing the future of healthcare and the roles of healthcare professionals. There is minimal research on the impact of these electronic systems on the people and processes required to realise the improvements in patient care such as therapeutic drug monitoring (TDM) and the role of the pharmacist within the TDM process. The literature has discussed the use of computerised programs to assist with the interpretation of results and calculating of doses but the impact of an ieMR on the TDM process has not been discussed. This study undertook a retrospective analysis at an Australian tertiary hospital to investigate the impact of a digital hospital system on TDM within the facility. METHODS: A 2-year retrospective audit was conducted on TDM at an Australian Tertiary Hospital. The periods were 2016 (a paper-based hospital) and 2018 (ieMR). Patients were identified using the pathology database. Patients were excluded if under the age of 18, in an outpatient setting or the emergency department. Progress notes, medication charts, ieMR and other relevant pathology were reviewed. They were assessed for appropriateness of the timing of collection, compliance to recommended TDM guidelines, and pharmacist documentation. RESULTS AND DISCUSSION: A total of 2926 observations were included in the analysis. There was as similar percentage of appropriately collected samples between the paper-based system (2016) and the digital hospital system (2018) with 59% and 58% respectively. Results of logistic regression analysis models show the effect of year was not significant with regards to TDM for either a sample being appropriate or the dose adjustment being appropriate. Samples for TDM were more likely to be appropriate if the pharmacist had documented advice but less likely with regards to appropriate dose adjustment. This study considered the effect of introducing a hospital wide digital system on TDM processes. Overall, the results indicate no difference between the paper-based system and ieMR for appropriate samples and doses adjustments. WHAT IS NEW AND CONCLUSION: To our knowledge, this is the first study of this kind looking at the impact of a digital hospital system on TDM. The introduction of a digital hospital system does not appear to have made improvement on the effective use of TDM. Inappropriate sampling as seen in this study can lead to ineffective clinical management of patients, inefficient use of time, and waste of financial resources. Further work is required to incorporate specific guidance and recommendations within the digital system to optimize TDM.

Child Maltreatment and Persistent Smoking From Adolescence Into Adulthood: A Birth Cohort Study.

OBJECTIVE: A prospective record-linkage analysis to examine whether notified and/or substantiated child maltreatment is associated with the prevalence and persistence of smoking in early adulthood. METHODS: The sample consisted of 3758 participants enrolled in a population-based birth cohort study in Brisbane, Australia, who were followed up at both 14 and 21 years of age. Suspected experience of child maltreatment was measured by linkage with state child protection agency data. The two main outcomes were the prevalence and persistence of smoking at 21-year follow-up, as well as the 12-month prevalence of nicotine use disorder for participants who completed the Composite International Diagnostic Interview-Auto version. RESULTS: Of the 3758 young people at the 21-year follow-up, 7.5% (n = 282) had a history of notified maltreatment by the age of 16 years. Of these, 167 cases were substantiated. There were 1362 (35.3%) smokers at 21-year follow-up, although only 220 (5.9%) smoked more than 20 cigarettes daily. Of the 602 participants who smoked at 14 years, 289 were still smoking 7 years later. On adjusted analyses, participants who had experienced any form of notified and/or substantiated maltreatment were approximately twice as likely to be smokers at 21 years old and persistent smokers from 14 years of age. Any form of maltreatment, except sexual abuse, was also associated with an increase in the 12-month prevalence of nicotine use disorders. CONCLUSIONS: Child maltreatment is associated with both an increased onset and persistence of smoking from adolescence into young adulthood. This may have implications for smoking cessation programs and early interventions for individuals who have experienced maltreatment.

Intimate partner violence and subsequent depression and anxiety disorders.

PURPOSE: The current longitudinal study examines the temporal association between different types of intimate partner violence (IPV) at early adulthood (21 years) and subsequent depression and anxiety disorders in young adulthood (30 years). METHODS: Participants were from the Mater-University of Queensland Study of Pregnancy. A cohort of 1529 was available for analysis. IPV was measured using the Composite Abuse Scale at 21 years. At the 21 and 30-year follow-ups, major depression disorder and anxiety disorders were measured using the Composite International Diagnostic Interview. RESULTS: We found a temporal relationship between almost all forms of IPV at 21 years and females' new cases of major depression disorder at 30 years. This association was not found for females who had previously been diagnosed with depression disorder. IPV did not predict the onset of new anxiety disorders, but it had a robust association with anxiety disorders in females with a previous anxiety diagnosis. We observed no significant link between IPV and males' subsequent major depression disorder. Interestingly, the experience of emotional abuse was a robust predictor of new cases of anxiety disorders but only for males. CONCLUSION: Our results suggest the need for sex-specific and integrated interventions addressing both IPV and mental health problems simultaneously. IPV interventions should be informed by the extend to which pre-existing anxiety and depression may lead to different psychological responses to the IPV experience. Increased risk of anxiety disorders predicted by emotional abuse experienced by males challenges beliefs about invulnerability of men in the abusive relationships and demands further attention.

Social Drinking Contexts and Their Influence on Problematic Drinking at Age 30.

Aims: Understanding the social contexts in which problematic drinking occurs can inform prevention strategies. In this article, we investigate gender-specific social contexts associated with problematic drinking and depression among adults aged 30 years. Because depression has been consistently linked with harmful alcohol consumption, we will also examine its association with drinking contexts. Methods: We used data from 2490 young adults who completed the 30-year follow-up phase of the Mater-University of Queensland Study of Pregnancy and its Outcomes, a prospective study commenced in 1981. Exploratory and confirmatory factor analyses were used to identify latent constructs of drinking contexts stratified by gender, with subsequent regression analysis to assess the role of these contexts in problematic drinking (measured using the Alcohol Use Disorders Identification Test). Results: Six distinct drinking contexts were identified, which differed by gender, three for men and three for women. For both men and women, "social drinking", was associated with problematic drinking. "Home drinking" was also common to men and women but associations with problematic drinking differed, being risky only among men. "Daytime drinking" (women) was associated with risk but "work-related drinking" (men) was not. Both "home drinking" (men) and "daytime drinking" (women) were linked to depression symptoms. Conclusion: Specific contexts appeared to be associated with problematic drinking for both sexes. Among both men and women, "social drinking" was associated with problematic drinking. Both "home drinking" (men) and "daytime drinking" (women) contexts, were associated with problematic drinking and depressive symptoms. Targeted alcohol-focused interventions need to address co-occurring mental health issues.

Acceptability and barriers to implementation of N-of-1 tests in Ethiopia - a qualitative study.

BACKGROUND: Locally produced generic drugs offer a cost-effective alternative to imported drugs to treat patients in Ethiopia. However, due to a lack of bioequivalence testing, additional assurance tests are needed to build trust in cheaper, locally made drugs. By testing bioequivalence of local drugs to gold standard, N-of-1 tests have the potential to promote patient centred quality use of medicines. METHOD: We sought to assess the acceptability of, and explore barriers to, conducting N-of-1 tests to evaluate local medicines in a resource limited clinical setting. We conducted a descriptive qualitative study, analysing four focus group discussions and five key informant interviews. Participants were senior drug regulatory authority members, institutional review board members, physicians and patients. All interviews were audio taped and transcribed verbatim. Patient interviews were conducted in Amharic and translated to English prior to analysis. Data analysis used an inductive, thematic process. RESULTS: Five major themes were identified; (1) Appropriateness of N-of-1 tests to determine the therapeutic equivalence of local drugs, (2) N-of-1 therapeutic equivalence tests: clinical care or research? (3) Ethical and regulatory requirements (IRB), (4) Potential barriers to implementing N-of-1 tests and (5) Possible solutions to identified challenges. The study demonstrated considerable support for using N-of-1 tests for clinical equivalence studies between local and imported medicines, but important impediments were very likely to impact the feasibility of conducting N-of-1 tests in Ethiopia. Key informants from the regulatory authority did not support additional tests of local drugs. There were also mixed opinions regarding ethical requirements for conducting N-of-1 tests. The Institutional Review Board (IRB) members believed that IRB approval was sufficient to conduct N-of-1 tests, however, the regulatory authority members considered that N-of-1 tests constituted a clinical trial, and required approval at the regulatory level. CONCLUSION: This study showed that there were key uncertainties that could impact the feasiblity of using N-of-1 testing local drugs in Ethiopia. Therefore, a number of protocol amendments to address contextual threats and regulatory challenges, would be needed before progressing to conducting these tests.

Child maltreatment and mental health problems in adulthood: birth cohort study.

BACKGROUND: Retrospective studies have shown a high association between child abuse and subsequent psychiatric morbidity. Prospective studies are rarer.AimsTo examine, using a prospective record-linkage analysis, whether substantiated child maltreatment is associated with adverse psychological outcomes in early adulthood. METHOD: The participants were 3778 mother and child pairs enrolled in a population-based birth cohort study in Brisbane, Australia. Exposure to suspected child maltreatment was measured by linkage with state child protection agency data. The primary outcomes were the internalising and externalising scales of the Youth Self-Report and the Centre for Epidemiological Studies-Depression scales (CES-D) at approximately 21 years of age. A subset completed the Composite International Diagnostic Interview-Auto version (CIDI-Auto). RESULTS: In total, 171 (4.5%) participants had a history of substantiated child maltreatment, most commonly emotional abuse (n = 91), followed by physical abuse (n = 78), neglect (n = 73) and sexual abuse (n = 54). After adjustment for potential confounders, depressive symptoms on the CES-D, as well as internalising and externalising behaviours were strongly associated with substantiated abuse in all forms, except sexual abuse. The results for the subset of the sample who completed the CIDI-Auto were less clear. Anxiety, especially post-traumatic stress disorder, showed the strongest association whereas the findings for depressive disorder were equivocal. However, across all diagnostic categories, emotional abuse and neglect, as well as multiple forms of abuse, showed a consistent association. CONCLUSIONS: Child maltreatment, particularly neglect and emotional abuse, has serious adverse effects on early adult mental health. These two warrant the attention given to other forms of child maltreatment. Children experiencing more than one type of maltreatment are at particular risk.Declaration of interestNone.

Does leaving an abusive partner lead to a decline in victimization?

BACKGROUND: This paper investigates gender differences in persistence of intimate partner violence (IPV), for those remaining or leaving an abusive relationship. We followed a sample of males and females to examine whether leaving an abusive partner may alter the continuity of victimization. METHODS: Data were taken from the 21 and 30-year follow-ups of the Mater Hospital and University of Queensland Study of Pregnancy (MUSP) in Australia. A cohort of 1265 respondents, including 874 females and 391 males, completed a 21-item version of the Composite Abuse Scale. RESULTS: We found proportionally similar rates of IPV victimization for males and females at both the 21 and 30 year follow-ups. Females who reported they had an abusive partner at the 21 year follow-up were more likely to subsequently change their partner than did males. Harassment and then emotional abuse appeared to have a stronger association for females leaving a partner. For males, a reported history of IPV was not significantly associated with leaving the partner. There was no significant association between leaving (or not) a previous abusive relationship and later victimization, either for male or female respondents. CONCLUSION: Changing a partner does not interrupt the continuity of victimization either for male or female respondents, and previous IPV victimization remained a determining factor of re-abuse, despite re-partnering.

Views and perceptions about locally manufactured medicines in Ethiopia: a qualitative study of physicians, patients and regulatory authorities.

BACKGROUND: Because of their cost, the use of locally produced, bioequivalent, generic drugs is universally recommended. In Ethiopia. while the government is committed to raising the market share and use of locally produced drugs, the process is hampered by the lack of a bioequivalence testing centre to strengthen the regulatory environment and deliver quality-assured local medicines. The purpose of this study is to assess the views and perceptions of key regulatory stakeholders, physicians and patients about locally produced generic medicines. METHODS: A descriptive qualitative study, using focus group discussions and key informant interviews, was conducted. Five key informant interviews (two senior regulatory authority members and 3 institutional review board members) as well as 4 focus group discussions (2 with physicians and 2 with patients) were held. Data were analysed using an inductive, thematic process. RESULTS: Four major themes emerged: awareness of lack of bioequivalence profiles associated with local medicines, perceptions about the quality and effectiveness of local medicines, quality and efficacy of imported medicines from developing countries and quality and efficacy of cheaper medicines. All institutional review board members were aware of bioequivalence issues. However, many physicians lacked detailed knowledge about bioequivalence, its clinical relevance and the lack of bioequivalence data for local medicines. All institutional review board members, physicians and male patients, but not female patients, were concerned about the quality and effectiveness of local medicines. Female patients were more confident about the locally produced drugs. In addition, some physicians and patients were not confident about the quality and effectiveness of cheaper drugs and drugs imported from developing countries. Government officials believed that local drugs are reliable. CONCLUSION: The success of promoting the use of inexpensive local medicines and changing the perception of the community depends not only on increasing the domestic market share held by local companies, but also on the capacity of the regulatory environment and companies to produce quality assured medicines and to overcome misconceptions. Among other initiatives, establishing an accredited bioequivalence centre in the country needs to be addressed urgently.

Gender Difference in Offspring's Alcohol Use Disorder by 21 Years: A Longitudinal Study of Maternal Influences.

AIMS: There is little known about the extent to which maternal alcohol consumption influences offspring's alcohol use disorder. This study aims to examine whether different maternal alcohol consumption trajectories predict gender difference in adolescent alcohol use disorder at child age 21 years. METHODS: Data are from a prospective cohort, the Mater-University of Queensland Study of Pregnancy (MUSP) and its outcomes. The study involves 2531 mother-child pairs for whom data are available at the 21-year follow-up survey. Maternal alcohol consumption trajectories were determined by group-based trajectory modelling. Offspring's lifetime ever alcohol use disorder was assessed using DSM-IV diagnostic criteria. RESULTS: Over 14 years of follow-up after the birth of a child, three distinct alcohol consumption trajectories were identified (abstainer, low-stable. and moderate-escalating drinker). A maternal trajectory of moderate-escalating alcohol consumption independently predicted offspring's lifetime ever alcohol use disorder at 21 years after adjustment for a range of potential confounders. "Cross-gender influence" is observed in the study. CONCLUSIONS: A maternal life course pattern of alcohol consumption may have an independent effect on offspring alcohol consumption, with male offspring being more vulnerable to the effects of maternal alcohol use than are female offspring. Programs intended to address alcohol consumption by adolescents and young adults need to focus on the behaviors of both parents but acknowledging that maternal patterns of alcohol consumption may be particularly important for male offspring.

Does substantiated childhood maltreatment lead to poor quality of life in young adulthood? Evidence from an Australian birth cohort study.

PURPOSE: To examine the independent effect of single and multiple forms of substantiated childhood maltreatment (CM) on quality of life (QoL), controlling for selected potential confounders and/or covariates, and concurrent depressive symptoms. METHODS: We used data from a prospective pre-birth cohort of 8556 mothers recruited consecutively during their first antenatal clinic visit at the Mater Hospital from 1981 to 1983 in Brisbane, Australia. The data were linked to substantiated cases of CM reported to the child protection government agency up to the age of 14 years. The sample consisted of 3730 (49.7% female) young adults for whom there were complete data on QoL at the 21-year follow-up. The mean age of participants was 20.6 years. Logistic regression models were used to assess the association between CM and QoL measured at the 21-year follow-up. RESULTS: There were statistically significant associations between exposure to substantiated CM and poorer QoL. This also applied to the subcategories of childhood physical abuse, childhood emotional abuse (CEA), and neglect. These associations were generally stable after adjusting for confounders/covariates and concurrent depressive symptoms, except physical abuse. CEA with or without neglect significantly and particularly predicted worse subsequent QoL. CONCLUSIONS: Exposure to any substantiated maltreatment substantially contributed to worse QoL in young adulthood, with a particular association with CEA and neglect. Prior experiences of CM may have a substantial association with subsequent poorer QoL.

Does having a difficult child lead to poor maternal mental health?

OBJECTIVES: Considerable evidence suggests maternal psychopathology influences that of their offspring. The probability of a reverse causal pathway has been only rarely considered but is a concern, given around 10% of children manifest mental impairment during their early years. This study determines the extent to which child behavior problems at ages 5 and 14 years are associated with mothers' mental health at 21 years post birth. STUDY DESIGN: Longitudinal study. METHODS: Data were taken from a sample of 3650 women from Mater and University of Queensland Study of Pregnancy birth cohort. Women's mental health was measured using the Mental Disorder Screening Tool at 21 years post birth. The Child Behavior Check List was used to measure internalizing, combined social/attention/thought disorder, and aggression at the age of 5 and 14 years. Logistic regression was used to derive odds ratios and 95% confidence intervals. A number of confounders were used to test for independence. RESULTS: Following all adjustments, child internalizing behaviors and combined social/attention/thought disorder at 5 years, and all measures of child behavior problem at 14 years were associated with mothers meeting criteria for mental health impairment at 21 years post birth. Moreover mothers of children with behavior problems at 14 years were approximately 2-3 times more likely to these meet these criteria. CONCLUSIONS: Mothers of children with behavior problems at 5 and 14 years of age were more likely to have mental health impairment at 21 years post birth. Child health professionals should be cognizant of the mother-child relationship having mutual mental health vulnerability.

The Use of a Brochure to Enable CAM-with-Chemotherapy Patient Education.

The majority of cancer patients receiving chemotherapy will consider taking complementary and alternative medicine (CAM) during their treatment. As biologically-active CAM may detrimentally interfere with chemotherapy treatment, cancer patients require evidence-based information on chemotherapy-CAM integration consequences. This study aimed to assess if the availability of a purpose-designed brochure within a cancer service aided doctors' discussions with their patients on CAM use and helped patients understand the effects of CAM during their chemotherapy treatment. Cancer care doctors consulting in an adult day unit completed a structured post-intervention feedback survey form (n = 17), and cancer patients receiving chemotherapy treatment were provided the brochure and completed the local health service consumer testing feedback form (n = 30). All cancer care doctors perceived a need for the brochure and recommended the brochure to their patients. All doctors thought the brochure made it easier for them to discuss CAM with their patients, and 59 % believed that it saved them time during patient consultations. Ninety percent of cancer patients reported the brochure had enough information to answer their CAM questions, and all patients thought the information was easy to read and understand. An evidence-based CAM-with-chemotherapy patient brochure was perceived to have enabled cancer care doctors to discuss CAM with their patients and to have answered patients' CAM questions.