Yarning about fetal alcohol spectrum disorder: Outcomes of a community-based workshop.

INTRODUCTION: There is a lack of neurodevelopmental assessment services in rural and remote locations in Australia that consider fetal alcohol spectrum disorder as a possible outcome. METHODS: Eighty-seven participants attended a workshop to support community-based professional development and co-design of a novel assessment approach. Qualitative data collection included video recording of the workshop, and small group discussions, for which a narrative analysis was utilised. Quantitative data collection included self-report questionnaires to understand current community practices and three key constructs: practitioner knowledge, attitudes, and intentions for future practice. RESULTS: The narrative analysis highlighted the ongoing impacts of colonisation, in terms of intergenerational trauma and alcohol use, experienced in the community today, and the potential high rates of fetal alcohol spectrum disorder. To address these issues, multiple strategies were discussed, including the recognition of First Nations knowledge and expertise and a focus on the next generation and community organisations working collaboratively. The pre-and post-questionnaires demonstrated that practitioners' knowledge and attitudes were enhanced after attending the workshop, however practitioner intentions were not. The lack of significance for the intentions variable may have been due to the small number of available responses for that variable, in comparison to the other two constructs. DISCUSSION: The current study identified key learnings from workshop facilitators and participants. The findings call attention to the importance of a co-design approach, where collaboration is vital to support the appropriate adaption of evidence-based practice to suit the local context.

Psychometric properties of the stress control mindset measure in university students from Australia and the UK.

INTRODUCTION: Beliefs about the consequences of stress, stress mindsets, are associated with health and performance outcomes under stress. This article reports the development and examination of the psychometric properties of a measure of stress mindset: The Stress Control Mindset Measure (SCMM). The measure is consistent with theory on mindsets about self-attributes and conceptualizes stress mindset as the extent to which individuals endorse beliefs that stress can be enhancing. METHODS: The study adopted a correlational cross-sectional survey design in two student samples. Undergraduate students from an Australian university (Sample 1, N = 218) and a UK university (Sample 2, N = 214) completed the SCMM and measures of health and well-being outcomes. RESULTS: Confirmatory factor analyses supported a four-factor structure and strict measurement invariance across samples (ΔCFI < 0.01). Reliability, convergent validity, discriminant validity, and concurrent validity of the overall SCMM were supported in both samples. Incremental validity was supported for most outcomes, accounting for significantly more variance (between 2.2% and 5.9%) in health and well-being outcomes than an existing measure. CONCLUSIONS: Current data provide preliminary support for the SCMM as a reliable and valid measure with good psychometric properties and theoretically consistent relations with health outcomes under stress. Findings provide initial evidence supporting the potential utility of the SCMM in future research examining relations between stress mindsets and health and performance outcomes.

Evaluating the Implementation of a Multi-Component Intervention to Prevent Surgical Site Infection and Promote Evidence-Based Practice.

BACKGROUND: Published clinical practice guidelines on surgical site infection prevention are available; however, adherence to these guidelines remains suboptimal. AIMS: The aim of this study was to evaluate the effectiveness and perceived benefits of intervention and implementation strategies co-created by researchers and clinicians to prevent surgical site infections. METHODS: This mixed-method evaluation study involved an audit of nurses' wound care practices, followed by focus group and individual interviews to understand the perceived benefits of the intervention and implementation strategies. Descriptive statistical analyses were used to compare post-intervention audit data with baseline results. Deductive and inductive content analyses were undertaken on the qualitative data. RESULTS: The audit showed improvements in using aseptic technique and wound care documentation practices following intervention implementation. Nurses perceived the change champion as effective in role-modelling good practice. Education strategies including a poster and using a scenario-based quiz were viewed as easy to understand and helpful for nurses to apply aseptic technique in practice. The instructions and education conducted to improve documentation were considered important in the success of the Wound Care Template implementation. LINKING EVIDENCE TO ACTION: The integrated knowledge translation approach used in this study ensured the intervention and the implementation strategies employed were appropriate and meaningful for clinicians. Such strategies may be used in other intervention studies. The change champion played an important role in driving change and acted as a vital partner during the co-creation and the implementation processes. Ongoing education, audit and feedback became integrated in the ward nurses' routine practice, which has the potential to continuously improve and sustain evidence-based practice.

Perceptions of IBD within patient and community samples: a systematic review.

Objective: Inflammatory bowel disease (IBD) is a chronic, gastrointestinal condition that involves a range of debilitating bowel symptoms. Adjustment to living with IBD can be negatively impacted by maladaptive cognitive and behavioural factors (e.g. negative illness representations and repressing emotions). Patient samples also report negative reactions from the general public and such perceptions can further negatively impact people living with IBD. Therefore, we aimed to systematically review literature investigating the illness perceptions, perceived stigmatisation, and negative emotional reactions toward IBD within patient and community samples. We also aimed to review how these factors impact those living with IBD (i.e. adjustment, psychological health). Design: A range of databases (e.g. Psych INFO, PubMed) were searched over two years. One reviewer individually screened titles and abstracts using the specified inclusion criteria, and this process was repeated by a second reviewer. Subsequently, the full text articles were screened and data were extracted for the 82 articles that satisfied the inclusion criteria. Following data extraction, a narrative synthesis was conducted.Results: The review of 82 studies suggested that negative illness perceptions are linked to poorer psychosocial outcomes, that patient samples frequently anticipate stigmatisation, fear relating to bowel accidents was the most common emotion reported, and that the general public direct little enacted stigma towards IBD.Conclusion: For people living with IBD: (i) poorer psychological adjustment was reported by those who held more negative perceptions and reactions toward their illness; and (ii) their concerns regarding public perceptions of IBD warrants further empirical attention. Results emphasise the importance of targeting perceptions, and facilitating education and adaptive responding during treatment.

Women's experiences of messages relating to alcohol consumption, received during their first antenatal care visit: An interpretative phenomenological analysis.

BACKGROUND: Despite greater awareness of fetal alcohol spectrum disorder, there has not been similar attention paid to research regarding effective strategies for prevention. AIMS: To explore and interpret the messages women receive during their first antenatal care visit, relating to alcohol consumption. METHODS: Participants were 12 females who had attended an initial antenatal care visit within the previous two years. They participated in semi-structured interviews about their experiences of the health messages they recalled receiving during their first antenatal care visit, with emphasis on messages relating to alcohol consumption. FINDINGS: Data were analysed using Interpretative Phenomenological Analysis which identified two superordinate themes: (1) Messages Received About Alcohol Consumption, and (2) Ways of Interpreting Messages Relating to Alcohol Consumption. Messages received by participants about alcohol consumption were generally consistent with national guidelines, stating that there is no safe level during pregnancy. Women interpreted these messages, however, within a broader, personal and socio-cultural context. This leads to women's choices about alcohol consumption being informed by their individual understanding of risk. To facilitate open discussions about sensitive topics such as alcohol consumption, participants expressed a preference for antenatal support that is tailored to their individual needs. CONCLUSION: Strategies to prevent fetal alcohol spectrum disorder need to include messages encouraging women to abstain during pregnancy, whilst at the same time, providing the type of individualised antenatal care that best enables this to be accomplished.

Protocol for the Yapatjarrathati project: a mixed-method implementation trial of a tiered assessment process for identifying fetal alcohol spectrum disorders in a remote Australian community.

BACKGROUND: Fetal alcohol spectrum disorder (FASD) is a highly prevalent neurodevelopmental disorder associated with prenatal alcohol exposure. Early identification can improve functioning for individuals and reduce costs to society. Gold standard methods of diagnosing FASD rely on specialists to deliver intensive, multidisciplinary assessments. While comprehensive, prevalence rates highlight that this assessment model cannot meet demand, nor is it feasible in remote areas where specialist services are lacking. This project aims to expand the capabilities of remote practitioners in north Queensland, Australia, where 23-94% of the community identify as First Nations people. Integrating cultural protocols with the implementation science theories of Knowledge-To-Action, Experience-Based Co-Design, and RE-AIM, remote practitioners with varying levels of experience will be trained in a co-designed, culturally appropriate, tiered neurodevelopmental assessment process that considers FASD as a potential outcome. This innovative assessment process can be shared between primary and tertiary health care settings, improving access to services for children and families. This project aims to demonstrate that neurodevelopmental assessments can be integrated seamlessly with established community practices and sustained through evidence-based workforce development strategies. METHODS: The Yapatjarrathati project (named by the local First Nations community and meaning 'to get well') is a mixed-method implementation trial of a tiered assessment process for identifying FASD within a remote Australian community. In collaboration with the community, we co-designed: (a) a culturally sensitive, tiered, neurodevelopmental assessment process for identifying FASD, and (b) training materials that up-skill remote practitioners with varying levels of expertise. Qualitative interviews for primary, secondary and end users will be undertaken to evaluate the implementation strategies. RE-AIM will be used to evaluate the reach, effectiveness, adoption, implementation and maintenance of the assessment and training process. DISCUSSION: Co-designed with the local community, integrated with cultural protocols, and based on implementation science theories, the assessment and training process from this project will have the potential to be scaled-up across other remote locations and trialed in urban settings. The Yapatjarrathati project is an important step towards increasing the availability of neurodevelopmental services across Australia and empowering remote practitioners to contribute to the FASD assessment process.

Effect of maternal smoking in pregnancy and childhood on child and adolescent sleep outcomes to 21 years: a birth cohort study.

BACKGROUND: The effects of prenatal maternal smoking have been studied extensively, however little research has examined the effects of prenatal exposure to maternal smoking on offspring sleep, particularly over several developmental periods. We examined the effects of prenatal maternal smoking and postnatal smoking from birth to 14 years, on offspring sleep at 6 months, 5, 14 and 21 years. METHODS: This was a prospective, community-based birth cohort study involving 7223 women who delivered a singleton child in Brisbane, Australia between 1981 and 1983. Women were recruited at the first antenatal visit. Offspring sleep problems were reported by mothers at 6 months, 5 and 14 years, and by youth at 14 and 21 years. 3738 mothers prospectively reported their smoking status from pregnancy to 14 years postpartum. Youth snoring was reported by mothers at 14 years and by youth at 21 years. Multinomial logistic regression analyses were performed. RESULTS AND DISCUSSION: Prenatal maternal smoking was independently associated with an increased risk of offspring adolescent parasomnias including walking and talking in sleep and nightmares, and an increased likelihood of being in the highest quintile for maternal and youth reported sleep problems at 14 years. Maternal postnatal smoking was associated with increased likelihood of offspring snoring at 14 years. CONCLUSIONS: Exposure to maternal prenatal smoking has different effects on offspring sleep compared to exposure to postnatal smoking. Prenatal smoking exposure may be associated with changes in neurodevelopment whereas postnatal smoking is more likely to affect the respiratory system. These findings highlight the long lasting and potentially serious clinical effects of exposure to pre and postnatal maternal smoking on offspring, the mechanisms by which warrant further investigation.

Physiological self-regulation and mindfulness in children with a diagnosis of fetal alcohol spectrum disorder.

OBJECTIVE: To explore the differences in baseline respiratory sinus arrhythmia (RSA) between children with fetal alcohol spectrum disorder (FASD) and typically developing children (TDC) and to investigate whether children with FASD have the capacity to engage in a brief mindfulness exercise. METHODS: Participants were 14 children with FASD and 20 TDC. RSA was measured at baseline, during, and following a mindfulness exercise. A mindfulness compliance checklist was completed to ascertain if children could follow the task instructions. RESULTS: Both groups obtained high scores on the mindfulness compliance checklist. There was a trend for children with FASD to have lower baseline RSA compared to TDC. Children in both groups demonstrated an increase in RSA during the mindfulness task. CONCLUSIONS: Children with FASD could engage in a mindfulness task, and both groups showed an increase in RSA. Further research is needed to establish whether prolonged mindfulness practice could be beneficial.

Preventing surgical site infections: Facilitators and barriers to nurses' adherence to clinical practice guidelines-A qualitative study.

AIMS: To identify the facilitators of and barriers to nurses' adherence to evidence-based wound care clinical practice guidelines (CPGs) in preventing surgical site infections (SSIs) in an Australian tertiary hospital. BACKGROUND: Current research suggests that up to 50% of nurses are unaware of the evidence-based recommendations to prevent SSIs and that adherence to evidence-based CPGs is suboptimal. However, little is known regarding the facilitators and barriers to adherence to evidence-based CPGs. DESIGN: A qualitative study incorporating ethnographic data collection techniques. METHODS: Data collection included semi-structured individual interviews and focus groups (N = 20), and examination of existing hospital policy and procedure documents. Thematic analysis using inductive and deductive approaches was conducted. This manuscript adheres to the COnsolidated criteria for REporting Qualitative research (COREQ) guidelines. FINDINGS: Data analysis revealed four themes: adhering to aseptic technique, knowledge and information seeking, documenting wound care and educating and involving patients in wound care. Facilitators and barriers within each theme were identified. Facilitators included participants' active information-seeking behaviour, a clear understanding of the importance of aseptic technique, and patient participation in wound care. Barriers included participants' knowledge and skills deficits regarding application of aseptic technique principles in practice, the availability of the hospital's wound care procedure document, suboptimal wound care documentation and the timing of patient education. CONCLUSIONS: There is a need to develop interventions to improve nurses' adherence to recommended CPGs including following aseptic technique principles, hand hygiene, documentation and patient education. Hospital procedure documents that outline wound care need to reflect current recommended CPGs. RELEVANCE TO CLINICAL PRACTICE: Adhering to evidence-based CPGs has been found to be effective in reducing and preventing SSIs. Our study provides an in-depth understanding of the barriers and facilitators to nurses' adherence to recommended CPGs. The findings may inform future practice improvements in wound care.

Effects of caffeine on sleep quality and daytime functioning.

Caffeine (particularly in the form of coffee) is one of the most widely consumed stimulants in the world, with 90% of American adults consuming caffeine-infused beverages almost daily. While there is substantial evidence that caffeine enhances performance, caffeine withdrawal leads to deficits at both the individual (eg, cognitive, emotional, and behavioral processes) and societal (eg, increases in work accidents) level. Scholars for some time have considered that the supposed psychoactive benefits of caffeine may be the result of the mere reversal of deleterious effects of caffeine withdrawal, rather than a net benefit of caffeine ingestion. In this integrative review, we examine evidence illuminating the relationship between caffeine consumption and subsequent quality and quantity of nighttime rest. Secondly, we consider evidence as to whether performance deficits caused by sleep deprivation linked to caffeine can be reversed by caffeine consumption during the subsequent daytime period. Finally, we consider how these two stages can be reconciled in a single model that enables calculation of the net caffeine effect on daytime functioning. The literature highlights a range of positive impacts of caffeine consumption on both physical and cognitive functioning. There are also a number of factors that complicate any conclusions that can be drawn regarding the potential of caffeine to improve performance. Most critically, performance improvements the next day may simply be a result of the reversal of caffeine withdrawal. Animal studies and well-controlled human studies involving high habitual and low habitual users tend to confirm a "net benefit" for caffeine use. Further research, particularly with (necessarily rare) caffeine-naive populations, is required to elucidate the complexities of the relationship between caffeine, sleep, and daytime functioning. However, the convenience of accessing caffeine compared to ensuring adequate restorative sleep means that caffeine has applied advantages that are likely to see its use as a performance "enhancing" substance persist.

The Influence of University Students' Stress Mindsets on Health and Performance Outcomes.

Background: Emerging evidence indicates that holding particular stress mindsets has favorable implications for peoples' health and performance under stress. Purpose: The aim of the current study was to examine the processes by which implicit and explicit stress mindsets relate to health- and performance-related outcomes. Specifically, we propose a stress beliefs model in which somatic responses to stress and coping behaviors mediate the effect of stress mindsets on outcomes. Methods: Undergraduate university students (N = 218, n = 144 females) aged 17- 25 years completed measures of stress mindset, physical and psychological wellbeing, perceived stress, perceived somatic responses to stress, proactive behaviors under stress, and an implicit association test assessing an implicit stress mindset. At the end of the semester, students' academic performance was collected from university records. Results: Path analysis indicated significant indirect effects of stress mindset on psychological wellbeing and perceived stress through proactive coping behaviors and perceived somatic symptoms. Stress mindset directly predicted perceived stress and physical wellbeing, and physical wellbeing and academic performance were predicted by stress mindset through perceived somatic symptoms. Implicit stress mindset did not predict proactive behavior as anticipated. Conclusions: Current findings indicate that behaviors with the goal of proactively meeting demands under stress and perceived somatic symptoms are important mediators of the effect of stress mindset on health- and performance-related outcomes. The findings from this study provide formative data that can inform the development of future interventions aiming to encourage more adaptive responses to stress.

Applying the Integrated Behavior Change Model to Understanding Physical Activity Among Older Adults: A Qualitative Study.

We explored older adults' experiences of physical activity (PA) and related decision-making processes underlying PA. Twenty Australians (Mage = 73.8 years) participated in semistructured interviews. Data were analyzed using thematic analysis, and identified themes were matched deductively within motivational, volitional, and implicit processes of the integrated behavior change model for PA. Motivational influences such as participants' time orientation toward health and perceptions of what PA should be like were frequently featured in participants' narratives. Volitional processes were also identified, with participants reporting different ways of coping with competing priorities. Physical surroundings and habitual PA were the identified themes within implicit processes. Together, these findings contribute to a better understanding of subjective experiences of older adults regarding PA. They also add to a more contextual understanding of multiple decision-making processes underpinning older adults' PA engagement. Identified concepts may be used in future research and PA interventions targeting older adults.

Feasibility study of a family-focused intervention to improve outcomes for children with FASD.

BACKGROUND: Growing evidence shows that children with fetal alcohol spectrum disorder (FASD) can benefit from interventions, and specifically interventions focused on improving self-regulation. However, novel ways of improving outcomes for children with FASD need further investigation so that programs target not only the individual child but also the family context, which includes the parent-child relationship. AIMS: The current study aimed to evaluate the feasibility of an adapted version of the Parents under Pressure (PuP) program that addresses self-regulatory processes, through improving the parent-child relationship and the use of mindfulness-based strategies for both children and parents. METHODS: This was a mixed methods study. Feasibility was examined by evaluating recruitment, data collection/outcome measures, and intervention procedures. The study used a phenomenological approach to obtain qualitative information from caregivers and a single-case experimental design to evaluate the preliminary participant responses to the intervention. RESULTS: Two out of three families completed treatment. The recruitment and intervention procedures were found to be suitable for and acceptable to the families involved. Some concerns were identified regarding the outcome measures that would need to be addressed in future research. Quantitative and qualitative outcomes were positive. CONCLUSIONS AND IMPLICATIONS: The results provide preliminary support for the feasibility of an adapted version of the PuP program. Thus, offering a potential multi-component option, that aims to improve self-regulatory skills for children with FASD, through focusing on improving the parent-child relationship and incorporating mindfulness-based techniques for both parents and children.

Profile of children diagnosed with a fetal alcohol spectrum disorder: A retrospective chart review.

INTRODUCTION AND AIMS: Fetal alcohol spectrum disorder (FASD) is a significant public health concern, and growing recognition in Australia led to the establishment of a specialist service for young children. The aim of the current study was to report on the diagnostic profile of a group of children who attended the service, to document the extent to which there were comorbid diagnoses and to provide information on the neurocognitive functioning of the children. DESIGN AND METHODS: This study was a retrospective chart review conducted by the diagnostic service. A pre-formulated tool to extract the diagnostic data from the client files was designed, a chart review was performed, and the required data was extracted. FASD diagnoses were made using the 4-Digit Diagnostic Code. RESULTS: Thirty-one families participated, and the majority of children were diagnosed with static encephalopathy (alcohol exposed) or neurobehavioral disorder (alcohol exposed) (11 children each; 36%). Only one child was diagnosed with fetal alcohol syndrome (alcohol exposed), and five children were diagnosed with partial fetal alcohol syndrome (alcohol exposed). Twenty-six children (84%) had a comorbid diagnosis, with 19 (61%) having a comorbid diagnosis of attention deficit hyperactivity disorder. While the majority of children were not found to display growth deficiency or significant facial features, 18 children (58%) had significant central nervous system dysfunction. DISCUSSION AND CONCLUSIONS: The current study demonstrates that with the relevant training and expertise, assessment and diagnosis of FASD can be embedded within the existing health services available in Australia. [Reid N, Shelton D,Warner J, O'Callaghan F, Dawe S. Profile of children diagnosed with a fetal alcohol spectrum disorder: A retrospective chart review. Drug Alcohol Rev 2017;00:000-000].

Illness Perceptions of Cystic Fibrosis: A Comparison of Young Adults with CF and Same-Aged Peers.

In the last two decades, the life expectancy for individuals with Cystic Fibrosis (CF) has increased significantly. The limited research examining the psychosocial experiences of young adults with CF indicates that other young adults lack awareness and understanding of CF. Using the Illness Perception Questionnaire, perceptions of CF were examined in individuals with CF aged 16 to 25 and two groups of same-aged peers: those who did, or did not, know someone with CF. ANOVA with pairwise comparisons revealed that individuals with CF perceived significantly fewer physical symptoms of illness and fewer emotional and practical consequences of CF than both groups of peers. Individuals with CF also perceived significantly more personal control and greater understanding of CF than peers without experience of CF. Implications for enhancing opportunities for social engagement and for the provision of social support for young people with CF are identified.

A longitudinal investigation of older adults' physical activity: Testing an integrated dual-process model.

OBJECTIVE: To assess the effects of conscious and non-conscious processes for prediction of older adults' physical activity (PA), we tested a dual-process model that integrated motivational (behavioural intention) and volitional (action planning and coping planning) processes with non-conscious, automatic processes (habit). METHOD: Participants (N = 215) comprised community-dwelling older adults (M = 73.8 years). A longitudinal design was adopted to investigate direct and indirect effects of intentions, habit strength (Time 1), and action planning and coping planning (Time 2) on PA behaviour (Time 3). Structural equation modelling was used to evaluate the model. RESULTS: The model provided a good fit to the data, accounting for 44% of the variance in PA behaviour at Time 3. PA was predicted by intentions, action planning, and habit strength, with action planning mediating the intention-behaviour relationship. An effect of sex was also found where males used fewer planning strategies and engaged in more PA than females. CONCLUSIONS: By investigating an integration of conscious and non-conscious processes, this study provides a novel understanding of older adults' PA. Interventions aiming to promote PA behaviour of older adults should target the combination of psychological processes.

Systematic Review of Fetal Alcohol Spectrum Disorder Interventions Across the Life Span.

BACKGROUND: Individuals with fetal alcohol spectrum disorders (FASDs) can experience profound impairments and long-term adverse outcomes. This systematic review adopts a life span perspective providing an extensive analysis of the available literature. METHODS: Studies were identified from PsycInfo, PubMed, Scopus, Web of Knowledge, CINAHL, ERIC, The Cochrane Central Register of Controlled Trials, and gray literature. Two reviewers independently screened the title and abstract of each reference, and the methodological rigor of the included studies was assessed using the Effective Public Health Project assessment tool. RESULTS: Thirty-two studies met the inclusion criteria, of which the vast majority targeted early to middle childhood. Two studies focused on early intervention in the postnatal period, and 6 studies aimed to improve attention and/or self-regulation in childhood. Three of these provided promising evidence on improving self-regulatory difficulties for children with FASDs. Nine studies focused on improving specific areas of dysfunction. Six studies addressed social skills; 3 of these used an adaptation of a well-validated social skills program. Three studies provided promising initial evidence that parents and caregivers could benefit from support with child behavior and a further 4 studies provided education and advocacy for parents/caregivers, teachers, or child welfare workers. The final 2 studies were aimed at supporting parents who were themselves affected by prenatal alcohol exposure. CONCLUSIONS: There is growing evidence for interventions that improve outcomes for early to middle childhood. However, a lack of research exists outside of this developmental period. This lack of research is concerning given the potential positive impact of early intervention, for individuals and, financially, for governments. In addition, the lack of interventions for adolescents and adults further highlights the widening developmental gap and the potential influence of secondary disabilities for this at-risk population.

Early adversity and health outcomes in young adulthood: the role of ongoing stress.

OBJECTIVE: The current study examined the prospective effects of exposure to stressful conditions in early childhood on physical health in young adulthood, and explored continuing exposure to stressors, as well as depression, in adolescence as possible mechanisms of this relationship. METHOD: A prospective longitudinal design was used to examine 705 mother-child pairs from a community-based sample, followed from offspring birth through age 20 years. Mothers provided contemporaneous assessments of early adverse conditions from offspring birth through age 5. Offspring responses to the UCLA Life Stress Interview, Structured Clinical Interview for DSM Disorders, Physical Functioning subscale of the SF-36 Health Survey, and questions about the presence of chronic disease were used to assess youth stress at age 15, depression from ages 15-20, and physical health at age 20. RESULTS: Early adversity conferred risk for elevated levels of social and nonsocial stress at youth age 15, as well as depression between ages 15 and 20. Social and nonsocial stress, in turn, had effects on physical health at age 20, directly and indirectly via depression. CONCLUSION: Findings suggest that early adverse conditions have lasting implications for physical health, and that continued exposure to increased levels of both social and nonsocial stress in adolescence, as well as the presence of depression, might be important mechanisms by which early adversity impacts later physical health.

Recovering from traumatic occupational hand injury following surgery: a biopsychosocial perspective.

PURPOSE: Significant differences occur in the return-to-work (RTW) period amongst workers with an acute traumatic occupational hand injury. This study aimed to develop and test a comprehensive multivariate conceptual biopsychosocial model to predict RTW outcome. METHOD: Patients presenting with an occupational hand injury were interviewed 7-10 days after their injury (N = 192) and again at 4 weeks after their injury (n = 150). Potential determinants from biomedical, work-related, demographic and psychosocial categories were studied simultaneously. RESULTS: A small sub-set of workers with an acute traumatic hand injury experienced chronic disability beyond 12 weeks. Analyzing the relationship between predictor variables and work absence resulted in the identification of the most important determinants of recovery. During the acute stages of recovery, injury severity, pain, self-efficacy, and living alone were the most important determinants of delayed RTW outcome. At 4 weeks post-injury, locus of control, injury severity, negative affect and living alone were the most important predictors of delayed RTW. CONCLUSION: A number of prognostic variables were identified that influenced RTW outcome, which offer new and unique contributions to the field. Injury severity was not the most important determinant of RTW outcome; neither were factors identified in previous hand injury research, such as attribution of blame, significant predictors. Factors not examined in previous research, such as negative affect, were more important determinants of delayed RTW.

Continuity and discontinuity of trouble sleeping behaviors from early childhood to young adulthood in a large Australian community-based-birth cohort study.

OBJECTIVE: To examine the continuity and discontinuity of trouble sleeping behaviors (TSB) from childhood to adolescence and young adulthood in a community-based prospective birth cohort study. METHODS: The original study comprised 7223 mother-offspring pairs who were followed prospectively at pregnancy, 6 months, 5, 14 and 21 years post-delivery. Participant numbers differ by follow-up stages. There were 3184 offspring for whom we have consistently collected information on TSB retrospectively at 2-4 years, and prospectively at 14 and 21 years of age. RESULTS: These comprised maternal-reported offspring TSB at 2-4 years and 14 years, and offspring-reported trouble sleeping at 14 and 21 years. One in two children had persistent trouble sleeping from 2-4 to 14 years and two-thirds from 14 to 21 years. In the adjusted analysis, compared with 2-4-years-old children with no trouble sleeping, those who experienced trouble sleeping were 1.20 (95% CI: 1.00, 1.44) times more likely to have trouble sleeping at 21 years. Similarly, adolescents who experienced trouble sleeping were 1.94 (95% CI: 1.66, 2.27) times more likely to experience trouble sleeping at 21 years. CONCLUSIONS: There is a continuity of TSB from early childhood through adolescence and young adulthood, although the persistence of TSB is strongest from adolescence to young adulthood. Interventions improving sleep in young children may prevent longer term difficulties in adolescents and young adults.