Hearing thresholds and cognitive flexibility in young healthy individuals with normal hearing.

Objective: Pure tone audiometry may seem to be a relatively easy task for the participant but it may involve cognitive as well as sensory abilities. The aim of this study is to examine the relationship between hearing thresholds in the frequency range 0.125-8 kHz and the core executive function cognitive flexibility in healthy individuals with normal hearing.Design: Experimental study measuring correlations between different pure-tone hearing threshold measures and cognitive flexibility. Pure tone air conduction audiometry (frequencies 0.125-8.0 kHz) and two tests of cognitive flexibility (information updating and shifting ability) were conducted.Study sample: Seventy-two subjects (aged between 21 and 36) with normal hearing (<20 dB HL) for the tested frequencies.Results: Four measures of average pure tone hearing thresholds were negatively correlated with cognitive flexibility.Conclusions: Pure-tone air conduction hearing thresholds seem to be related to cognitive flexibility in healthy individuals with normal hearing.

Listening Effort: Order Effects and Core Executive Functions.

BACKGROUND: Listening effort seems to depend on input-related listening demands and several factors internal to the individual listener. Input-related demands may be listening in noise compared with listening in quiet, and internal factors may be cognitive functions. PURPOSE: The purpose was to apply measures of listening effort and perceived listening effort in participants with normal hearing, to determine if there are any presentation order effects, and to explore the relationship between listening effort measured as accuracy, response times, efficiency of information encoding into long-term memory, perceived listening effort, and core executive functions. RESEARCH DESIGN: A within-subject design with repeated measures was used and a study of relationships between variables was made. STUDY SAMPLE: Thirty-two healthy adults with normal hearing. DATA COLLECTION AND ANALYSIS: Participants were tested individually by a listening task using a dual-task paradigm. The listening task was performed in quiet and in multitalker babble noise at 10 dB signal-to-noise ratio (SNR). Perceived listening effort and core executive functions (working memory, inhibitory control, and cognitive flexibility) were also assessed. RESULTS: The measures of listening effort (correct responses, response times, and immediate and delayed listening comprehension) failed to demonstrate increased listening effort in multitalker babble noise (10 dB SNR) compared with quiet, although a significant test order effect was seen for correct responses indicating that participants who first listened in noise did not improve in quiet. Perceived listening effort increased significantly in noise compared with quiet. No relationship was found between measures of listening effort and ratings of perceived listening effort. Working memory and cognitive flexibility were not related to ratings of perceived listening effort. In contrast, better inhibitory control was related to higher ratings in both quiet and in noise. CONCLUSIONS: It is possible that the SNR and measures used were not as sensitive as required to measure listening effort behaviorally. In the present experimental setup, prior noise exposure impedes the beneficial effects of performing a task in quiet. Self-reports seem to provide a valid measure of perceived listening effort that is related to the individual's inhibitory control. The present findings suggest that participants with better inhibitory control are more susceptible to the task demand level both in quiet and in noise.

Extended high-frequency pure tone hearing thresholds and core executive functions.

OBJECTIVE: To examine the relationship between extended high-frequency pure tone hearing thresholds (frequencies 10 to 14 kHz) and working memory capacity (WMC), inhibitory control, and cognitive flexibility. DESIGN: Experimental study measuring correlations between different high-frequency hearing threshold measures and cognitive measures. STUDY: Pure tone audiometry was assessed in the extended high-frequency (frequencies 10, 12.5 and 14 kHz). Subjects were also tested regarding WMC, inhibitory control (response inhibition), and cognitive flexibility (information updating and shifting ability). SAMPLE: Forty-three subjects between 20 and 29 years old with normal hearing (≤ 20 dB HL) in the frequency range between 0.125 to 8 kHz. RESULTS: No significant correlations were seen between high-frequency hearing thresholds defined as average best and worst ear high-frequency hearing thresholds and the cognitive measures. Differences between the best and the worst ear showed significant negative correlations with inhibitory control and global executive function (combination score for WMC, inhibitory control and cognitive flexibility). CONCLUSIONS: The present study suggests that global executive functions, more specifically response inhibition, and hearing threshold asymmetry in the extended high-frequency range are interrelated.

Metabolic Signature Profiling as a Diagnostic and Prognostic Tool in Pediatric Plasmodium falciparum Malaria.

Background. Accuracy in malaria diagnosis and staging is vital to reduce mortality and post infectious sequelae. In this study, we present a metabolomics approach to diagnostic staging of malaria infection, specifically Plasmodium falciparum infection in children. Methods. A group of 421 patients between 6 months and 6 years of age with mild and severe states of malaria with age-matched controls were included in the study, 107, 192, and 122, individuals, respectively. A multivariate design was used as basis for representative selection of 20 patients in each category. Patient plasma was subjected to gas chromatography-mass spectrometry analysis, and a full metabolite profile was produced from each patient. In addition, a proof-of-concept model was tested in a Plasmodium berghei in vivo model where metabolic profiles were discernible over time of infection. Results. A 2-component principal component analysis revealed that the patients could be separated into disease categories according to metabolite profiles, independently of any clinical information. Furthermore, 2 subgroups could be identified in the mild malaria cohort who we believe represent patients with divergent prognoses. Conclusions. Metabolite signature profiling could be used both for decision support in disease staging and prognostication.

Risk and protective factors for peer victimization: a 1-year follow-up study of urban American students.

This study examined whether internalizing problems, parental warmth and teacher support were associated with adolescents' experience of future peer victimization in school. Data were drawn from two rounds of the longitudinal Social and Health Assessment (SAHA). Study subjects comprised 593 US urban adolescents (aged 13.8 ± 0.8 years; 56 % female). Results showed that there was a substantial degree of continuity in peer victimization over a 1-year period. The presence of internalizing (anxiety, depressive and somatic) symptoms at baseline was associated with an increased risk of peer victimization over time. Both parental warmth and teacher support were uniquely associated with a lower risk for peer victimization. Implications of these findings for prevention efforts are discussed.

A multi-centre cohort study shows no association between experienced violence and labour dystocia in nulliparous women at term.

BACKGROUND: Although both labour dystocia and domestic violence during pregnancy are associated with adverse maternal and fetal outcome, evidence in support of a possible association between experiences of domestic violence and labour dystocia is sparse. The aim of this study was to investigate whether self-reported history of violence or experienced violence during pregnancy is associated with increased risk of labour dystocia in nulliparous women at term. METHODS: A population-based multi-centre cohort study. A self-administrated questionnaire collected at 37 weeks of gestation from nine obstetric departments in Denmark. The total cohort comprised 2652 nulliparous women, among whom 985 (37.1%) met the protocol criteria for dystocia. RESULTS: Among the total cohort, 940 (35.4%) women reported experience of violence, and among these, 66 (2.5%) women reported exposure to violence during their first pregnancy. Further, 39.5% (n = 26) of those had never been exposed to violence before. Univariate logistic regression analysis showed no association between history of violence or experienced violence during pregnancy and labour dystocia at term, crude OR 0.91, 95% CI (0.77-1.08), OR 0.90, 95% CI (0.54-1.50), respectively. However, violence exposed women consuming alcoholic beverages during late pregnancy had increased odds of labour dystocia, crude OR 1.45, 95% CI (1.07-1.96). CONCLUSIONS: Our findings indicate that nulliparous women who have a history of violence or experienced violence during pregnancy do not appear to have a higher risk of labour dystocia at term, according to the definition of labour dystocia in this study. Additional research on this topic would be beneficial, including further evaluation of the criteria for labour dystocia.

Infantile colic, maternal smoking and infant feeding at 5 weeks of age.

BACKGROUND: Many parents seek help from health professionals because of their infants' persistent crying in the early months. The aetiology of this condition, often labelled ;;infantile colic'', is still unclear. AIMS: To assess whether smoking during pregnancy, and/or smoking at infant age 5 weeks, is associated with infantile colic, and to describe how feeding at infant age 5 weeks and smoking are related to colic. METHODS: This was a community-based study, with telephone interviews in late pregnancy, and at infant age 5 weeks, covering 1,625 mother-infant dyads, i.e. 86% of the eligible population. RESULTS: Daily maternal smoking in pregnancy was related to subsequent colic, with an age-adjusted odds ratio (OR) of 1.74 (95% confidence interval 1.08-2.82). In the multivariate model, the OR was largely unaltered. The association between smoking at infant age 5 weeks and colic did not reach statistical significance. The subgroups based on smoking and infant feeding were small, but the results suggest that exclusive breast-feeding was protective against colic, including for infants of smoking mothers. CONCLUSIONS: This study presents yet another argument why smoking in pregnancy should be discouraged - some cases of infantile colic may be avoided. With regard to mothers who are not able to give up smoking, the results add some support for the conclusion that if a mother is worried about colic, she certainly should not refrain from breast-feeding even if she smokes.

The experience of Middle Eastern men living in Sweden of maternal and child health care and fatherhood: focus-group discussions and content analysis.

OBJECTIVE: To describe how men from the Middle East experience Swedish maternity and child health care. An integral part of the aim of this study has also been to describe the experiences of men from the Middle East when becoming and being a father in Sweden. DESIGN, SETTING AND PARTICIPANTS: an exploratory, qualitative study using focus-group discussions and individual interviews, with a semi-structured interview guide and content analysis. A total of 16 men participated. Ten Arabic-speaking men from the Middle East living in Sweden participated in three focus-group discussions. Six men from the Middle East living in Sweden, and speaking Swedish, participated in individual interviews. FINDINGS: three main categories were developed: meeting empathic professionals; finding new positions within the family; and experiencing social demands. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: seeing their partners being met individually and with empathy by midwives and child health-care nurses encouraged men to become involved in areas not previously open to them (i.e. pregnancy, childbirth and the care of babies and young children). As the women often lacked knowledge of Swedish, they depended on the help of their partners when meeting maternity and child health-care professionals. The men found the experience of living in an alien country difficult. They were often unemployed, felt they were a burden to their wives after emigrating to Sweden, and that they were no longer a suitable role model for their children.

Middle Eastern mothers in Sweden, their experiences of the maternal health service and their partner's involvement.

BACKGROUND: Traditional patterns relating to how to handle pregnancy and birth are often challenged due to migration. The purpose of this study was to describe Middle Eastern mothers' experiences of the maternal health care services in Sweden and the involvement of their male partner. METHODS: Thirteen immigrant mothers from the Middle East who had used the maternal health services in Sweden were interviewed using focus group discussions and individual interviews. These were taped, transcribed and analysed according to Content analysis. RESULTS: The four main categories that developed were:* Access to the professional midwife* Useful counselling* Stable motherhood in transition* Being a family living in a different culture CONCLUSION: According to the respondents in this study, understanding the woman's native language or her culture was not vital to develop a good relationship with the midwife. Instead the immigrant woman developed trust in the midwife based on the knowledge and the empathy the midwife imparted.Increasing the amount of first trimester antenatal visits could avoid spontaneous visits to the emergency clinic. There was a greater need for involvement and support by the father during the perinatal period, such as caring for older children and carrying out household chores since the mothers' earlier female network was often lost. CLINICAL IMPLICATIONS: There is a need to involve immigrant parents in the available parental education in order to prepare them for parenthood in their new country as well as to explore their altered family situation. Collecting immigrant women and their partner's, experiences of maternal health care services offers a possibility to improve the existing care, both in content, access and availability where the timing of visits and content require further evaluation.

Utilisation of antenatal care by country of birth in a multi-ethnic population: a four-year community-based study in Malmö, Sweden.

BACKGROUND: The aim of this study was to investigate differences in use of antenatal care in a multi-ethnic population in Malmö, Sweden, over a 4-year period. Age, parity, cohabiting status, use of an interpreter, and tobacco-use were examined to assess the potential effects of confounding factors. METHODS: A 4-year (2000-2003) retrospective community-based register study was performed. Low-risk singleton pregnancies (n=5,373) registered for antenatal care at 5 municipal clinics and at the delivery ward at Malmö University Hospital were included, and divided into 6 subgroups by country of origin. The odds for utilisation of antenatal care were analysed by means of logistic regression. RESULTS: Significantly increased odds of lower utilisation of planned antenatal care were found among some groups of foreign-born women. Women born in Eastern and Southern Europe, Iraq and Lebanon, and Asia had fewer antenatal visits than recommended, and all foreign-born women (except for women born in Iraq and Lebanon, and South and Central America) had a late first visit compared to Swedish-born women. Foreign-born women had, in general, fewer unplanned visits to a physician at the delivery ward, but women originating from Asia, Iraq and Lebanon, and Africa had higher utilisation visits to midwives at the delivery ward compared to Swedish-born women. CONCLUSIONS: Foreign-born women had lower utilisation of planned antenatal care. Approximately 50% of women had higher utilisation of care, by making unplanned visits to the delivery ward. This puts strain on both economical as well as staff resources. The delivery clinic at the hospital level is not intended to handle routine visits, and, moreover, some of these women do not receive the full benefits of planned routine antenatal care.

Compliance with child accident precautions by child health nurses.

The aim of this study was to investigate the extent to which parents follow advice from child health nurses about child accident prevention. The study was performed in one of the 10 districts in the city of Malmö, Sweden. Parents to 90, 10-month old children in southern Sweden participated. These parents completed a questionnaire that prompted responses related to parents' background and socio-economic factors as well as questions about any precautions they have taken to decrease hazards to children in their home. Odds ratios, confidence intervals and multiple logistic regression analysis was performed. The results indicated that lower educated parents (i.e. those with 12 years' education or less) and foreign-born parents complied with a significantly lower level. These results support the need to increase efforts in child accident prevention work. It is important for child health nurses to concentrate their efforts on foreign parents and on less educated parents. Information should be relayed regularly to these parents in a motivational way, in order to decrease risks of child accidents at home.

Health education to prevent anemia among women of reproductive age in southern India.

In this study, we used a narrow, but easily measured, indicator of how communication proceeded among health workers and women in Southern India. Anemia prevention during pregnancy was studied using a semistructured questionnaire. Participants included 5 nurses, 10 health aides, and 10 (traditional birth attendants) TBAs working with maternal health care and education, as well as 32 women seeking maternal health care. Those women who received health education where they lived, from health workers they knew, and together with participants familiar to them learned more about anemia prevention than others.

Burn injuries in small children, a population-based study in Sweden.

AIMS AND OBJECTIVES: The aim of this study was to describe characteristics in burn injuries in children (zero to six years old), consulting primary care and hospital-based care in Malmö, Sweden. Burn-injured children consulting the University Hospital or the 21 Health Centres, during year 1998 and year 2002, were included. BACKGROUND: Epidemiological studies of burns in children have mostly been hospital-based and the cases that never reached the hospital have been excluded. DESIGN: The study had a retroperspective design with data collected from medical records. METHODS: Chi-squared test was used to analyse differences in nominal data and cross tables were used to analyse the proportions between the characteristics of the injuries and sex, age and nationality. RESULTS: The burn-injured children were 148 and 80% of those were scalds, caused by hot liquid (71%) or hot food (29%). The greatest number was boys between one and two years old. Children to foreign born parents were more frequently affected and the extent of the injuries often larger. Almost all the accidents (96%) occurred in home environment, while a family member was next to the child. The Health Centres received more often children affected on hand/arm and by causes like hot food than the University Hospital. CONCLUSIONS: Our data demonstrate the importance of developing a programme for the prevention of paediatric scalds with education of family members to be aware of the danger. With present study the knowledge about the occurrence of injuries in scald accidents in children has become deeper. This knowledge may contribute to more individual adept child accident prevention programme, to use in the child health care.

Low psychosocial resources during early pregnancy are not associated with prolonged labour.

OBJECTIVES: To examine if a low level of psychosocial resources in early pregnancy is associated with the occurrence of prolonged labour. STUDY DESIGN: A cross sectional study of 644 women expecting their first child. Participants were asked to complete a questionnaire at their first antenatal visit, measuring psychosocial resources defined as social network and support, work-related psychosocial factors, control of daily life and health characteristics. Outcome was prolonged labour at the end of the pregnancy. RESULTS: A low level of psychosocial resources was not associated with prolonged labour. The majority of women reported that the degree of support was high in early pregnancy. CONCLUSIONS: A perceived low level of psychosocial resources in early pregnancy did not increase the risk of prolonged labour at the subsequent delivery.

Physicians as clinical directors: working conditions, psychosocial resources and self-rated health.

BACKGROUND: Physicians in clinical directors' positions fulfil their commitments in demanding work environments characterized by organizational changes and economic cutbacks. Little is known about the self-rated health of this group. AIM: To investigate whether self-rated health was associated with psychosocial working conditions, professional networks, job support, social networks and social support, sick leave and salary in Swedish physicians working as clinical directors. METHODS: A self-reported questionnaire was sent to 373 clinical directors. Odds ratios (ORs) were used for estimating the bivariate association between self-rated health and psychosocial resources. RESULTS: A total of 274 clinical directors agreed to participate in the study. The response rate was 73%. The clinical directors exposed to high job demands had a significantly higher probability of low self-rated health [OR = 3.4 and 95% confidence interval (CI) = 1.6-7.0] than those who were not in this situation. Furthermore, participants who were exposed to high job demands had an increased risk of low self-rated health (OR = 3.8 and 95% CI = 1.8-8.1) irrespective of available social support inside or outside work. High average working hours more than doubled the risk of low self-rated health (OR = 2.2 and 95% CI = 1.1-4.4). CONCLUSION: The job demands on physicians in clinical directors' positions may exceed ordinary means of support with consequent adverse effects on self-rated health. More research is needed to investigate the interaction between job demands and support systems in this group of health care workers.

Country of origin, social support and the risk of small for gestational age birth.

AIMS: This study investigates the risk of small for gestational age (SGA) in relation to country of origin of the mother. The role of psychosocial resources, socioeconomic and lifestyle factors was examined in different causal models. METHODS: Among all pregnant nulliparous women in the city of Malmö, Sweden, who gave birth in 1991--92, 872 (87.7%) women completed a questionnaire during their first antenatal visit. The study was carried out among women whose pregnancies resulted in a singleton live birth (n = 826); 22% (n = 182) of these women were foreign-born. RESULTS: Fifty-five (6.7%) of the infants were classified as SGA, 37 (5.7%) of mothers of Swedish origin and 18 (9.7%) of foreign origin. SGA deliveries were much more prevalent among Middle East- and North Africa-born women (22%) and sub-Saharan-born women (15%). In all, women of foreign origin had increased odds for delivering SGA babies (OR = 1.8, 95% CI = 1.0,3.2). In a multivariate analysis psychosocial and socioeconomic factors explained 30% and 40%, respectively, of the increased SGA risk. Psychosocial factors seemed to be more prominent risk factors for SGA among mothers of foreign origin. A possible synergistic relation was demonstrated between foreign origin of the mother and low social anchorage. CONCLUSIONS: This study showed that psychosocial factors, most probably linked to a disadvantaged social situation, could be the theoretically most important focus for preventing SGA in immigrant women. This could also further support a hypothesis of a link between psychosocial stress and SGA in general. However, this should not exclude the need for intervention in the antenatal care system in terms of specially tailored support and education.

Psychosocial factors, lifestyle, and fetal growth: the added value of both pre- and post-natal assessments.

BACKGROUND: Psychosocial resources as well as lifestyle habits during pregnancy have been shown to effect the risk of having a small-for-gestational-age (SGA) child. Most previous studies are based on a single assessment of these exposures, which does not take into account the possibility of different effects during early and late stages of pregnancy. METHODS: The impact of psychosocial and lifestyle factors on the risk of giving birth to an SGA child (as measured by ultrasound) was examined among 747 nulliparous Swedish women who completed both a prenatal baseline, and a post-partum assessment. RESULTS: Those registering low social participation on both assessments showed increased risk of giving birth to an SGA infant (OR = 2.44 and 95% CI: 1.06-5.66), while at one assessment (OR = 1.70 and 95% CI: 0.74-3.91). Maternal smoking confirmed by both or one assessments yielded an OR = 2.72 and 95% CI: 1.37-5.39 and OR = 1.60 and 95% CI: 0.58-4.46, respectively. During early pregnancy, poor instrumental support, maternal smoking, or passive smoking yielded increased risks of SGA, adjusted for confounding (OR = 2.39 and 95% CI: 1.11-5.17; OR = 2.38 and 95% CI: 1.27-4.49; OR = 2.92 and 95% CI: 1.17-7.32, respectively). In late pregnancy, only maternal smoking yielded a significant association (OR = 2.34 and 95% CI: 1.24-4.41). CONCLUSION: Scheduling repeated assessments of psychosocial resources and lifestyle factors during pregnancy yielded additional information. The findings suggest that there can be differential effects of such exposures depending on gestational stage. This information is of importance when designing appropriate intervention strategies for maternal health services as well as for public health relevant policy formulation (e.g. regarding exposure to environmental tobacco during pregnancy).