Fertility treatment pathways and births for women with and without polycystic ovary syndrome-a retrospective population linked data study.

OBJECTIVE: To study the fertility treatment pathways used by women with and without polycystic ovary syndrome (PCOS) and which pathways were more likely to result in a birth. DESIGN: This retrospective national community-based cohort study used longitudinal self-report survey data (collected 1996-2022; aged 18-49 years) from women born in 1973-1978 who are participants in the Australian Longitudinal Study on Women's Health. The study also used linked administrative data on fertility treatments (1996-2021). PATIENTS: Of the 8,463 eligible women, 1,109 accessed fertility treatment and were included. EXPOSURE: Polycystic ovary syndrome diagnosis was self-reported. MAIN OUTCOME MEASURE: use of ovulation induction (OI), intrauterine insemination, and/or in vitro fertilization (IVF) was established through linked administrative data. Births were self-reported. RESULTS: One in 10 of the eligible participants had PCOS (783/7,987, 10%) and 1 in 4 of the women who used fertility treatment had PCOS (274/1,109, 25%). Women with PCOS were 3 years younger on average at first fertility treatment (M = 31.4 years, SD = 4.18) than women without PCOS (M = 34.2 years, SD = 4.56). Seven treatment pathways were identified and use differed by PCOS status. Women with PCOS were more likely to start with OI (71%; odds ratio [OR] 4.20, 95% confidence interval [CI]: 2.91, 6.07) than women without PCOS (36%). Of the women with PCOS who started with OI, 46% required additional types of treatment. More women without PCOS ended up in IVF (72% vs. 51%). Overall, 63% (701/1,109) had an attributed birth, and in adjusted regressions births did not vary by last type of treatment (IVF: 67%, reference; intrauterine insemination: 67%, OR 0.94 95% CI: 0.56, 1.58; OI: 61%, OR 0.71, 95% CI: 0.52, 0.98), or by PCOS status (OR 1.27, 95% CI: 0.91, 1.77). By age, 74% of women under 35 years (471/639) and 49% of women 35 years or older had a birth. CONCLUSION: More women with PCOS used fertility treatment but births were equivalent to women without PCOS. Most women followed clinical recommendations. Births did not differ between pathways, so there was no disadvantage in starting with less invasive treatments (although there may be financial or emotional disadvantages).

Adherence to 24-h movement behaviour guidelines in families with multiple children.

BACKGROUND: In 2019, the World Health Organization (WHO) launched the first global movement guidelines for children that combined sleep, physical activity and screen time. Our previous research showed that adherence to age-specific guidelines for screen time was challenging for families with children in different age groups. We aimed to determine whether families with children in different age-based movement guideline categories have poorer adherence to the broader 24-h movement guidelines than those with all children in the same age category. METHODS: Data were from the 1973-1978 cohort of the Australian Longitudinal Study on Women's Health (seventh survey, 2015) and the women's three youngest children (aged ≤12) (Mothers and their Children's Health sub-study, 2016/2017). The sample was 1787 women (families) with 4064 children (mean age 7.2 [SD 2.9]). Whether children in the family were in the same or different age-based category was determined by matching children's ages in a family against age-based guideline categories for the 24-h movement behaviours. The association between children in the family being in the same or different age-based guideline category on adherence to 24-h movement guidelines, both collectively and individually, was analysed by adjusted logistic regression (binary and multinomial). RESULTS: Families with children in the same age guideline categories had double the odds of having all children meet 24-h movement guidelines (adjusted odds ratio [OR] 1.95 [95% confidence interval, CI: 1.32, 2.86]). Families with children in the same age categories on the screen guideline had higher odds of all children meeting (2.25 [1.73, 2.93]) and lower odds of some meeting/some failing the screen guideline (0.18 [0.14, 0.25]), than families with all children in different age categories. Families with children in the same age categories on the physical activity guideline had lower odds of all children meeting (0.57 [0.43, 0.75]) or some meeting/some failing the physical activity guideline (0.08 [0.06, 0.12]). No associations were found for sleep guidelines. CONCLUSIONS: Families with multiple children may need practical advice and strategies on how to adhere to guidelines when children span age categories. This could form part of public health strategies that raise awareness of the guidelines and may improve guideline adherence.

Does Timing Matter? Associations Between Intimate Partner Violence Across the Early Life Course and Internalizing and Externalizing Behavior in Children.

The association between exposure to intimate partner violence (IPV) and child behavior problems is well established. However, questions remain about whether the timing during the child's early life course matters. We used a structured life course approach to investigate associations between the timing of IPV and children's internalizing and externalizing behaviors. Participants were from the Australian Longitudinal Study on Women's Health (ALSWH), a national, randomly sampled community-based study that has surveyed women every 3 years since 1996. For this study, mothers born 1973 to 1978 (N = 2,163) provided data on their three youngest children under 13 years (N = 3,697, 48.5% female) as part of the Mothers and their Children's Health (MatCH) study in 2016/2017. Mothers indicated IPV in ALSWH using the Community Composite Abuse Scale in early (M = 0.99 years, SD = 0.88 years) and middle childhood (M = 3.98 years, SD = 0.92 years), and before birth (preconception). Mothers rated child internalizing and externalizing behavior in MatCH (child age: M = 8.15 years, SD = 2.37 years) using the Strengths and Difficulties Questionnaire. We tested critical period, sensitive period, and accumulation hypotheses by comparing the fit of nested linear regression models (separately for girls and boys). Mothers were predominantly Caucasian (>90%) and university educated (65.5%), and 41.7% reported financial stress. Most children were not exposed to IPV (68.1%). Of those who were, 55.2% were exposed at one time, 28.7% at two times, and 16.1% at all three. Accumulation was the best model for externalizing in boys and girls and for internalizing in girls. A critical period in middle childhood was identified for internalizing in boys. Overall, the duration of exposure was more important than the timing. This suggests early detection is essential in mitigating the impact of IPV on children, with particular attention needed for boys exposed to IPV in middle childhood.

What happens after menopause? (WHAM): A prospective controlled study of symptom profiles up to 12 months after pre-menopausal risk-reducing salpingo-oophorectomy.

OBJECTIVE: Understanding how symptoms cluster after premenopausal risk-reducing salpingo-oophorectomy (RRSO) can inform patient expectations but information is lacking. We aimed to identify symptom profiles after RRSO, changes over time, and the effect of hormone therapy (HT). METHOD: Participants were premenopausal women from a longitudinal controlled study (What Happens After Menopause? (WHAM)). Menopausal symptoms were prospectively measured in three groups: pre-menopausal comparisons who retained their ovaries (n = 99), RRSO HT users (n = 57) and RRSO non-HT users (n = 38). Symptoms (hot flashes, night sweats, low desire, vaginal dryness, poor sleep, anxiety/depression) were measured at baseline (pre-surgery) and at 3, 6 and 12 months using standardised questionnaires. Latent transition analysis was used to identify symptom profiles post-RRSO, and the probability of changing profiles over time. RESULTS: Three symptom profiles were identified: Most Symptoms (81-87% non-HT; 36-41% HT; 7-9% comparisons), Few Symptoms (7-13% non-HT; 36-42% HT; 77-80% comparisons), and Sexual Symptoms (0-10% non-HT; 17-27% HT; 14-15% comparisons). Most of the non-HT group reported Most Symptoms at 3 months with only a 2% chance of improvement by 12 months. The HT group were split between profiles at 3 months with a 5-13% chance of improvement by 6 months (14% chance of worsening), and a 12-32% chance of improvement by 12 months (4-25% chance of worsening). CONCLUSIONS: Symptoms cluster into distinct profiles after premenopausal RRSO. Most non-HT users are highly symptomatic with little chance of improvement by 12 months. In contrast, two-thirds of HT users have fewer symptoms and a much higher chance of improvement. These findings can inform patient decision-making and expectations.

History of pre-pregnancy maternal symptoms of binge eating and childhood behavioral problems in girls and boys.

OBJECTIVE: To explore whether children of mothers with pre-pregnancy binge eating (BE) symptoms have more behavioral difficulties compared with those without and whether associations are moderated by ED symptoms and other maternal health and social factors measured during childhood. METHOD: Pre-pregnancy BE symptoms were collected by the Australian Longitudinal Study on Women's Health at Survey 1 (in 1996) and/or at Survey 2 (in 2000) using questions mapped to DSM BE criterion 1. In 2016/7, 2180 women from the 1973-78 cohort provided data on externalizing and internalizing behavior, measured by Strengths and Difficulties Questionnaire, on 4054 of their children (2-12 years) in the Mothers and their Children's Health study. Covariates were markers of other ED symptoms, sociodemographic, social support, and mental health factors collected proximally to the child outcomes. Hierarchical multivariable regression models, using generalized estimating equations accounting for clustering of children within mothers, were used. RESULTS: Pre-pregnancy BE symptoms were associated with child behavior, with associations only moderated after adjustment for proximal markers of ED (girls internalizing behavior, b (95%CI) .30 (-.02, .61); boys externalizing behavior .34 (-.04, .73)) or social support (girls externalizing behavior 0.26 (-.08, .61)). Pre-pregnancy BE symptoms were not associated with boys internalizing behavior (-.27 (-.02, 0.57)). DISCUSSION: Studies with repeated ED measures should test hypotheses that these associations vary by timing of ED measurement. Identification of young women at risk of BE symptoms pre-pregnancy, as well as when children are older, may enable health services, treatment programs, and supports to minimize longer term effects on children. PUBLIC SIGNIFICANCE STATEMENT: A history of binge eating symptoms up to 10 years pre-pregnancy in mothers is associated with behavior problems in their girls and boys at average age of 7. However, the association is moderated by behaviors of eating disorders and social support in the mothers during childhood. Identification of ED symptoms prior to pregnancy, and then after childbirth, might enable health services to intervene to maximize child and mother outcomes.

Association between residential greenspace and health-related quality of life in children aged 0-12 years.

INTRODUCTION: Greenspaces generate several perceived health benefits, including an overall improvement in the quality of life. However, little is known about the effects of greenspaces through pregnancy and early childhood in promoting health-related quality of life (HRQoL) among children. METHOD: Participants were from the Mothers and their Children's Health Study (MatCH), a 2016/17 sub-study of a national prospective study since 1996 known as the Australian Longitudinal Study on Women's Health (ALSWH). Mothers (n=3,048) self-reported on their three youngest children aged under 13 years (n=5,799, mean=7.0 years, s.d=3.2 years) using the Pediatric Quality of Life Inventory (PedsQL) to measure their HRQoL. Since 1996, annual exposure to green and non-green vegetation was measured using two remote sensing indicators: Normalized Difference Vegetation Index (NDVI) and fractional cover of non-photosynthetic vegetation (fNPV), respectively, for 100 m and 500 m buffer zone around maternal residential address. Multiple exposure windows were calculated including during pregnancy, the first year of life and child's lifetime exposure. Generalised estimating equations (GEE) models, adjusting for potential confounders, were used for analyses. RESULTS: A 1 standard deviation increase in NDVI greenness within 500 m buffer around the home at early life and during childhood was positively associated with higher HRQoL in the total scores and psychological health summary scores in the crude model only. No association was found between fNPV (non-green vegetation) at 100 m and 500 m circular buffers and children's HRQoL. The overall findings from our models remained consistent based on a series of sensitivity analyses, including the impact of maternal residential mobility status and geocoding method on the effect estimates. CONCLUSION: Our study revealed that surrounding residential greenspace was not associated with children's HRQoL. Further longitudinal studies are required to better understand the influence of greenspace at different periods of exposure on the health and wellbeing of children.

Residential greenspace and early childhood development and academic performance: A longitudinal analysis of Australian children aged 4-12 years.

INTRODUCTION: Exposure to greenspaces has beneficial effects on children's mental health and development. This study explores the association between residential exposure to greenspace and early childhood development and academic outcomes. METHODS: Children were from Mothers and their Children's Health (MatCH) study, a sub-study of the Australian Longitudinal Study on Women's Health. We obtained data on early childhood development from the Australian Early Development Census (AEDC), a population-wide census data (n = 936 children, mean age: 5.3, SD: 0.5 years). Academic performance relative to the national minimum standard (NMS) (i.e., in reading, writing, grammar and punctuation, spelling, and numeracy) of children with Year 3 and 5 data were from the 'National Assessment Program - Literacy and Numeracy' (NAPLAN) (n = 1679 children). Annual exposure to green and non-green vegetation was measured using the Normalized Difference Vegetation Index (NDVI) and fractional cover of non-photosynthetic vegetation (fNPV), respectively, within 100 m and 500 m buffer zone of maternal residential address. We calculated greenspace exposure at the year of test and average exposure throughout childhood. Greenspace exposures were standardised and odds ratio (ORs) with 95% confidence intervals (95% CI) were estimated using generalised estimating equation models, adjusting for potential confounders. RESULTS: Exposure to fNPV within 500 m buffer of homes at the year of test and during child's lifetime was associated with academic scores below/at NMS at Year 3 (baseline) and Year 5 (follow-up) for the domains of reading, writing, and grammar and punctuation. Surrounding residential greenness was not significantly associated with NAPLAN scores. No association was found between residential greenspace and developmental vulnerability on one or more AEDC domains across both exposure windows. CONCLUSION: Our study revealed that long-term and short-term exposure to non-green vegetation around homes is linked to poor academic performance in children. Further research on fNPV is required to verify these findings, with additional longitudinal studies.

What Did We Miss? Analysis of Military Personnel Responses to an Open-Ended Question in a Post-Deployment Health Survey.

INTRODUCTION: Post-deployment health surveys completed by military personnel ask about a range of deployment experiences. These surveys are conducted to determine if there are links between experiences and poor health. Responses to open-ended questions in these surveys can identify experiences that might otherwise go unreported. These responses may increase knowledge about a particular deployment and inform future surveys. This study documented deployment experiences described by Australian Defence Force personnel who were deployed to the Middle East. MATERIALS AND METHODS: A survey completed by 14,032 personnel examined health outcomes and over 100 experiences relating to their Middle East deployment. Responses to two open-ended questions captured additional experiences. Descriptive statistics reveal the characteristics of those who did and did not describe additional experiences, and a content analysis details the nature and frequency of the experiences reported. The study was approved by an Institutional Review Board. RESULTS: Five percentage (n = 692) of personnel who completed the survey described additional deployment experiences. The most frequently reported experiences were specific Navy experiences; experiences of poor leadership; administrative or organizational issues; the anthrax vaccine; and traumatic events/potentially morally injurious experiences. CONCLUSIONS: The findings suggest that post-deployment health surveys should have questions about certain deployment experiences tailored by military service (i.e., Air Force, Army, and Navy). Researchers could consider including questions about personnel experiences of leadership for its impact on health and about potentially morally injurious experiences that may help explain adverse mental health. Clear wording of open-ended questions and participant instructions may improve response rates and reduce response biases.

Maternal and Childhood Ambient Air Pollution Exposure and Mental Health Symptoms and Psychomotor Development in Children: An Australian Population-Based Longitudinal Study.

BACKGROUND: Accumulating evidence indicates early life exposure to air pollution, a suspected neurotoxicant, is negatively associated with children's neurodevelopment. OBJECTIVES: To explore the role of multiple exposure periods to ambient particulate matter with diameter <2.5 µm (PM2.5) and nitrogen dioxide (NO2) on emotion and behaviour, and early development in children <13 years. METHODS: We used data from Mothers and their Children's Health (MatCH) study, a 2016/17 sub-study from a prospective longitudinal study, the Australian Longitudinal Study on Women's Health. Annual PM2.5 and NO2 estimates since 1996 were obtained from a land-use regression model. Maternal residential proximity to roadways were used as a proxy measure of exposure to traffic-related air pollution. Child outcomes were maternal-rated emotional and behavioural problems (Strengths and Difficulties Questionnaire; SDQ, aged 2-12 years, n = 5471 children) and developmental delay in communication and gross motor skills (Ages and Stages Questionnaire; ASQ, aged 1-66 months, n = 1265 children). Defined exposure periods were early life exposure ('during pregnancy' and 'first year of life') and 'children's lifetime exposure'. Ambient air pollution was divided into tertiles and logistic regression was performed to estimate odds ratio (OR) for each child outcome, adjusting for potential confounders. RESULTS: Children exposed to moderate and high PM2.5 exposure, compared to low exposure, across all periods, had higher odds of emotional and behavioural problems, and gross motor delay. Children's lifetime exposure to moderate levels of PM2.5 (5.9-7.1 µg/m3) was associated with 1.27 (95% confidence interval 1.03, 1.57) fold higher odds of emotional/behavioural problems. Similar associations were found for moderate PM2.5 levels at 'first year of life' in a two-pollutant model only (OR: 1.30; 1.05, 1.60). However, there was insufficient evidence to suggest that NO2 exposure or living within 200 m of major roads was associated with emotional and behaviour problems or developmental delay across any exposure periods. CONCLUSION: We found isolated evidence that early life and childhood exposure to PM2.5 may be associated with emotional and behavioural problems and delays in gross motor skills, but most associations were null. Due to the limited number of longitudinal studies on low-exposure settings, further studies with more temporally refined exposure assessment are warranted.

Screen time and child behaviour and health-related quality of life: Effect of family context.

This study investigated family contextual effects on the association between screen time, behaviour and health-related quality of life (HRQOL) in child siblings. Data were from 1772 participants in the Australian Longitudinal Study of Women's Health 1973-78 cohort and their three youngest children (N = 4010 siblings) aged two to 12, collected in Mothers and their Children's Health cross-sectional sub-study (2016/17). The exposure was average daily recreational screen time (televisions, computers, tablets, mobile phones, electronic games). Outcomes were child overall behaviour and prosocial behaviour, and psychosocial and physical HRQOL. Multilevel models were used to test 1) the absolute effect of screen time, and 2) change in the child's outcomes when their own screen time changes relative to their siblings (within-family contextual effects) and change in the child's outcomes when the sibling average screen time changes (between-family contextual effects). The children were average 7.37 years (SD 2.76). There was an absolute effect of screen time on behaviour and HRQOL. Between-family effects were found for child total behaviour (0·22 (95%CI, 0.06, 0.37)) and prosocial behaviour (-0.10 (-0.17, -0.04)), but there were no within-family effects. For HRQOL, within-family effects were found for psychosocial (-0.97 (-1.91, -0.02)) and physical (-1.32 (-2.25, -0.39)) HRQOL, but no between-family effects were found. In conclusion, the higher the average screen time by all children in the family, the worse the child's behaviour, while the greater the deviation of the child's screen time from their siblings, the poorer their HRQOL. Family contextual factors should be considered in screen time research and screen time recommendations.

What happens after menopause? (WHAM): A prospective controlled study of vasomotor symptoms and menopause-related quality of life 12 months after premenopausal risk-reducing salpingo-oophorectomy.

OBJECTIVE: To measure menopausal symptoms and quality of life up to 12 months after risk-reducing salpingo-oophorectomy (RRSO) and to measure the effects of hormone therapy. METHODS: Prospective observational study of 95 premenopausal women planning RRSO and a comparison group of 99 who retained their ovaries. Vasomotor symptoms and menopausal-related quality of life (QoL) were measured by the Menopause-Specific QoL Intervention scale at baseline, 3, 6 and 12 months. Chi-square tests measured differences in prevalence of vasomotor symptoms between RRSO vs the comparison group and by hormone therapy use. Change in QoL were examined with multilevel modelling. RESULTS: Three months after RRSO hot flush prevalence increased from 5.3% to 56.2% and night sweats from 20.2% to 47.2%. Symptoms did not worsen between 3 and 12 months and remained unchanged in the comparison group (p<0.001). After RRSO, 60% commenced hormone therapy. However, 40% of hormone therapy uses continued to experience vasomotor symptoms. After RRSO, 80% of non-hormone therapy users reported vasomotor symptoms. Regardless of hormone therapy use, 86% categorized their vasomotor symptoms as "mild" after RRSO. Following RRSO, Menopause-related QoL deteriorated but was stable in the comparison group (adjusted coefficient = 0.75, 95%CI = 0.55-0.95). After RRSO, QoL was better in hormone therapy users vs non-users (adjusted coefficient = 0.49, 95%CI = 0.20-0.78). CONCLUSIONS: Vasomotor symptoms increase by 3 months after RRSO but do not worsen over the next 12 months. Hormone Therapy reduces but does not resolve vasomotor symptoms and may improve QoL, but not to pre-oophorectomy levels.

What happens after menopause? (WHAM): A prospective controlled study of sleep quality up to 12 months after premenopausal risk-reducing salpingo-oophorectomy.

OBJECTIVE: Sleep difficulties impair function and increase the risk of depression at menopause and premenopausal oophorectomy may further worsen sleep. However, prospective data are limited, and it remains uncertain whether Hormone Therapy (HT) improves sleep. This prospective observational study measured sleep quality before and up to 12 months after risk-reducing salpingo-oophorectomy (RRSO) compared to a similar age comparison group who retained their ovaries. METHODS: Ninety-five premenopausal women undergoing RRSO and 99 comparisons were evaluated over a 12-month period using the Pittsburgh Sleep Quality Index (PSQI). RESULTS: Almost half reported poor sleep quality at baseline. Overall sleep quality was not affected by RRSO until 12 months (p = 0.007). However, sleep disturbance increased by 3 months and remained significantly elevated at 12 months (p < 0.001). Trajectory analysis demonstrated that 41% had increased sleep disturbance after RRSO which persisted in 17.9%. Risk factors for sleep disturbance included severe vasomotor symptoms, obesity and smoking. Around 60% initiated HT after RRSO. Sleep quality was significantly better in HT users vs non users (p = 0.020) but HT did not restore sleep quality to baseline levels. CONCLUSIONS: Overall sleep quality is not affected by RRSO, but new onset sleep disturbance is common, particularly in those with severe vasomotor symptoms. Clinicians should be alert to new-onset sleep disturbance and the potential for HT to improve sleep quality.

What Happens After Menopause? (WHAM): A prospective controlled study of cardiovascular and metabolic risk 12 months after premenopausal risk-reducing bilateral salpingo-oophorectomy.

OBJECTIVE: To prospectively measure cardiometabolic risk 12 months after premenopausal risk-reducing bilateral salpingo-oophorectomy (RRBSO) compared to a similar age comparison group, and the effects of Hormone Therapy (HT) on cardiometabolic risk. METHODS: Prospective observational study of 95 premenopausal women planning RRBSO and 99 comparisons who retained their ovaries. At baseline and 12 months, blood pressure (BP), Body Mass Index (BMI), waist and hip circumference, fasting total, HDL and LDL cholesterol, triglycerides, high-sensitivity C-reactive protein, glucose and insulin were measured and HOMA-IR was calculated. Chi-square tests, t-tests and adjusted logistic regression models were used to compare groups. RESULTS: Baseline cardiometabolic phenotypes were similar between groups but more RRBSO participants were overweight/obese with higher waist/hip ratios. By 12 months, BP and cardiometabolic phenotypes were largely unchanged. Paired t-tests showed statistically significant increases in BMI (p = 0.037) and weight (p = 0.042) and larger increases in waist circumference (p < 0.001) and waist-hip ratio (p = 0.009) after RRBSO vs comparisons. However, these were not significant when adjusted for baseline values. After RRBSO 60% initiated Hormone Therapy (HT). Paired t-tests demonstrated that non-HT users had a significantly greater mean increase in waist circumference of 4.3 cm (95% CI 2.0-6.5) compared to 1.3 cm in HT users (95% CI -0.2-2.7, p < 0.001), which remained significant when adjusted for baseline values (p = 0.02). At 12 months, mean waist circumference was 2.94 cm greater in non-HT users compared to HT users. CONCLUSIONS: Cardiometabolic risk markers are largely unchanged 12 months after RRBSO. Hormone Therapy after RRBSO may prevent against an increase in waist circumference.

What happens after menopause? (WHAM): A prospective controlled study of depression and anxiety up to 12 months after premenopausal risk-reducing bilateral salpingo-oophorectomy.

OBJECTIVE: Risk-reducing bilateral salpingo-oophorectomy (RRBSO) substantially reduces ovarian cancer risk in women with pathogenic gene variants and is generally recommended by age 34-45 years. Natural menopause is a vulnerable period for mood disturbance, but the risk of depression and anxiety in the first 12 months after RRBSO and potential modifying effect of hormone therapy are uncertain. METHODS: Prospective controlled observational study of 95 premenopausal women planning RRBSO and a Comparison group of 99 premenopausal women who retained their ovaries,- 95% of whom were at population level risk of ovarian cancer. Clinically significant symptoms of depression and anxiety were measured using standardised instruments at baseline, 3, 6 and 12 months. Chi-square tests and adjusted logistic regression models compared differences between groups. RESULTS: Baseline symptoms and previous depression or anxiety did not differ between groups. At 3 months after RRBSO clinically significant depressive symptoms were doubled (14.5% vs 27.1%, p = 0.010), which persisted at 12 months. Depressive symptoms were stable in comparisons. At 3 months after RRBSO, clinically significant anxiety symptoms almost trebled (6.1% vs 17.7%, p = 0.014) before plateauing at 6 months and returning to baseline at 12 months. Compared to comparisons, RRBSO participants were at 3.0-fold increased risk of chronic depressive symptoms (Wald 95% CI 1.27-7.26), 2.3-fold increased risk of incident depression (95% Wald CI 1.08-5.13) and 2.0-fold increase of incident anxiety (Wald 95% CI 0.78-5.00). Depression and anxiety were slightly more common in Hormone Therapy users after RRBSO vs non-users. CONCLUSIONS: RRBSO leads to a rapid increase in clinically significant depressive and anxiety symptoms despite Hormone Therapy use.

Which Australian Women Do Not Exclusively Breastfeed to 6 Months, and why?

BACKGROUND: Rates of exclusive breastfeeding in Australia lag behind international targets. Reasons for non-exclusive breastfeeding are poorly understood. RESEARCH AIMS: To describe demographic profiles of participants reporting different feeding practices, and reasons for not exclusively breastfeeding to 6 months. METHODS: Demographics for 2888 mothers (5340 children) and reasons for 1879 mothers (3018 children) from the Mothers and Their Children's Health Study (a sub-study of the Australian Longitudinal Study on Women's Health) were examined using descriptive statistics and multivariable regression. RESULTS: Only 34.4% of children were exclusively breastfed to 6 months. Five non-exclusive feeding practices were identified: never breastfed (3.9%), breastfed < 6 months (20.8%), and breastfed to 6 months but had formula (6.8%), solids (24.5%), or both formula and solids (9.7%). Mothers of children who received < 6 months of human milk were more likely to have a lower education, be overweight/obese, smoke, and live in cities (compared to mothers of children exclusively breastfed). Reasons for never breastfeeding and for breastfeeding < 6 months were primarily insufficient milk and breastfeeding difficulties (e.g., latching issues). Reasons for introducing solids were primarily cues for solids (e.g., showing interest). Reasons for formula were insufficient milk and practical considerations (e.g., return to work). Reasons for both solids and formula were diverse, including insufficient milk, weaning cues, and practical considerations. CONCLUSIONS: Mothers who did not exclusively breastfeed to 6 months were a heterogeneous group, indicating that both targeted and universal strategies are required to increase rates of exclusive breastfeeding. Support should encompass the broad range of feeding practices.

Associations between feeding practices in infancy and fruit and vegetable consumption in childhood.

A diet rich in fruits and vegetables may reduce the risk of chronic diseases. However, in many countries, the majority of children do not eat the recommended quantities of fruits and vegetables. The present study aimed to understand associations between feeding practices in infancy (breast-feeding and first complementary food) and fruit and vegetable consumption in childhood (frequency and variety). Data were from the national, observational, cross-sectional Mothers and their Children's Health study conducted in 2016/2017, a sub-study of the national Australian Longitudinal Study on Women's Health. Mothers completed a written survey on feeding practices in infancy (breast-feeding duration, use of formula, first complementary food) and children's fruit and vegetable frequency (number of times eaten) and variety (number of different types eaten) in the past 24 h, using the Children's Dietary Questionnaire. Children (n 4981, mean 7·36 (sd 2·90) years) ate vegetables 2·10 (sd 1·11) times and fruits 2·35 (sd 1·14) times and ate 3·21 (sd 1·35) different vegetables and 2·40 (sd 1·18) different fruits, on average. Compared with breast-feeding for <6 months, breast-feeding for ≥6 months was associated with higher vegetable variety. Compared with cereal as the first complementary food, fruits or vegetables were associated with higher vegetable frequency and variety, and higher fruit frequency. Overall, infancy is a window of opportunity for dietary intervention. Guidance to parents should encourage the use of fruits and vegetables at the beginning of complementary feeding.

How rates of perinatal mental health screening in Australia have changed over time and which women are missing out.

OBJECTIVES: To report rates of perinatal mental health screening from 2000 to 2017 and investigate factors associated with not being screened both antenatally and postnatally more recently (2013-2017). METHODS: A longitudinal community-based study of self-reported perinatal mental health screening with a national sample of 7,566 mothers from the Australian Longitudinal Study on Women's Health reporting on 9,384 children. The main outcome measure was whether mothers were asked about their emotional wellbeing by a health professional, including completing a questionnaire. RESULTS: From 2000 to 2017, the percentage of women not screened decreased from 40.6% to 1.7%. The percentage of women screened both antenatally and postnatally increased from 21.3% to 79.3%. From 2013 to 2017, women who were older (aOR, 0.65; 95%CI, 0.52-0.81) or had reported emotional distress (aOR, 0.77; 95%CI, 0.60-0.99) were less likely to have been screened both antenatally and postnatally. CONCLUSIONS: Despite improvements, perinatal mental health screening is not yet universal. One-in-five women are not screened both antenatally and postnatally, including women in high-risk populations such as those who have reported emotional distress. Implications for public health: Women are in regular contact with health professionals in the perinatal period. This opportunity to detect women at risk of perinatal mental health issues is too important to be missed.

Testing the role of the timing and chronicity of maternal depressive symptoms in the associations with child behaviour and development.

BACKGROUND: There is debate regarding whether the association between maternal depressive symptoms (MDS) and child outcomes is due to the timing or chronicity of symptoms. OBJECTIVES: To investigate whether critical periods, sensitive periods, or accumulation models provided the best explanation for the association between MDS and children's behaviour and development. METHODS: Data on mothers (N = 892) were collected from 1996 to 2015 as part of the Australian Longitudinal Study on Women's Health, a prospective longitudinal epidemiological study. Data on children (N = 978, 2-12 years) were collected in 2016/17 as part of the Mothers and their Children's Health study. Mothers were categorised according to whether they reported MDS (scored ≥ 10 on the CESD-10) before pregnancy, during pregnancy, or in early childhood. Child outcomes were maternal-rated behaviour problems (Strengths and Difficulties Questionnaire; SDQ) and teacher-rated development (Australian Early Development Census; AEDC). We used a structured life course approach to rigorously test critical period, sensitive period, and accumulation (ie chronicity) theories by comparing the fit of a series of models. RESULTS: Most mothers did not report MDS at any time (69.2%), 16.9% reported MDS before pregnancy, 13.2% during pregnancy, and 16.5% in early childhood. High/very high total behaviour problems were reported for 7.0% of children, and developmental vulnerability/risk was reported for 15.9% for social competence and 15.7% for emotional maturity. An accumulation model was the best fit, with each period of MDS associated with an increase of 1.71 points (95% CI 1.26, 2.17) on the SDQ and decreases of 0.31 (95% CI -0.50, -0.12) and 0.29 points (95% CI -0.49, -0.08) on AEDC social competence and emotional maturity, respectively. CONCLUSIONS: Chronic MDS were associated with poorer child outcomes than MDS at any single time. Sensitive and critical period models were not supported. This suggests chronicity of symptoms may be more important than timing.

Military Personnel Ratings of a Deployment and Their Positive and Negative Deployment Experiences.

INTRODUCTION: There is limited investigation of how military personnel evaluate their deployment experiences. An understanding of their perceptions would help unit psychologists to advise commanders on ways to improve the deployment experience (and therefore mental well-being) of personnel. This study examined the interplay between deployment overall ratings, personnel characteristics and positive and negative deployment experiences in aid of such understanding. MATERIALS AND METHODS: The participants were 1,226 Australian Defence Force personnel who deployed to East Timor and (through a survey) provided an overall rating of their deployment and comments on major positive and negative deployment experiences. Descriptive statistics detail ratings by personnel characteristics, and a hybrid content/thematic analysis details the positive and negative experiences. The study was approved by an Institutional Review Board. RESULTS: Over 80% of the participants rated their overall East Timor deployment experience as positive, with 13% rating it as neutral and 7% as negative. Intrinsic rewards (eg, ability to use skills) were the most commonly expressed major positive experiences of the deployment, with deployment administration and military leadership the most common negatives. Most intrinsic rewards were reported more often in participants with a positive deployment rating, while poor leadership was most frequent in those with a negative rating. CONCLUSIONS: Military leadership is corroborated as a negative experience of military deployment, while a new finding indicates that intrinsic rewards are a common feature in positive evaluations of deployment. Leadership is a factor that Defence Forces can address to improve the deployment experience. The study strength is the range and size of the sample, with a limitation the potential for recall bias (the data were collected, on average, 5 years postdeployment). Future research should replicate this type of analysis to build a picture of the experiences and evaluations of personnel from a range of different deployments.