131 resultados para Cohort study
Resumo:
OBJECTIVE—To assess change in health-related quality of life (HRQOL) in children with diabetes over 2 years and determine its relationship to change in metabolic control.
RESEARCH DESIGN AND METHODS—In 1998, parents of children aged 5–18 years attending a tertiary diabetes clinic reported their child’s HRQOL using the Child Health Questionnaire PF-50. Those aged 12–18 years also self-reported their HRQOL using the analogous Child Health Questionnaire CF-80. HbA1c levels were recorded. In 2000, identical measures were collected for those who were aged ≤18 years and still attending the clinic.
RESULTS—Of 117 eligible subjects, 83 (71%) participated. Parents reported no significant difference in children’s HRQOL at baseline and follow-up. However, adolescents reported significant improvements on the Family Activities (P < 0.001), Bodily Pain (P = 0.04), and General Health Perceptions (P = 0.001) scales and worsening on the Behavior (P = 0.04) scale. HbA1c at baseline and follow-up were strongly correlated (r = 0.57). HbA1c increased significantly (mean 7.8% in 1998 vs. 8.5% in 2000; P < 0.001), with lower baseline HbA1c strongly predicting an increase in HbA1c over the 2 years (r2 = 0.25, P < 0.001). Lower parent-reported Physical Summary and adolescent-reported Physical Functioning scores at baseline also predicted increasing HbA1c. Poorer parent-reported Psychosocial Summary scores were related to higher HbA1c at both times but did not predict change in HbA1c.
CONCLUSIONS—Changes in parent and adolescent reports of HRQOL differ. Better physical functioning may protect against deteriorating HbA1c, at least in the medium term. While the HRQOL of children with diabetes does not appear to deteriorate over time, we should not be complacent, as it is consistently poorer than that of their healthy peers.
Resumo:
Purpose: To describe longitudinal changes in leisure-time sedentary behavior among girls, during early to mid-adolescence. Methods: A 2.5-year prospective cohort study, comprising 5 data collections, 6 months apart, between 2000 and 2002. Girls aged 12–15 years (n = 200) from 8 high schools located in Sydney, Australia, self-reported the usual time spent each week in a comprehensive range of sedentary behaviors. Results: Retention rate for the study was 82%. Girls aged 12.8 years spent approximately 45% of their discretionary time in sedentary behavior, which increased to 63% at age 14.9 years. Watching TV, videos, and playing video games (small screen recreation; SSR) was the most popular sedentary pastime, accounting for 33% of time spent in sedentariness, followed by homework and reading (25%). Sedentary behavior increased 1.4 and 3.3 hours on week and weekend days, respectively. On weekdays, increased time was spent on hobbies (27 min/day) and on weekend days, increased time was spent sitting around talking with friends (60 min/day), computer use (37 min/day), and television viewing (34 min/day). Conclusions: Among girls, the transition between early and mid-adolescence was accompanied by a significant increase in leisure-time sedentary behavior. Interventions to reduce sedentariness among adolescent girls are best to focus on weekend behaviors. Studies seeking to examine the association between inactivity and the development of chronic health problems need to examine a diverse range of activities that comprehensively measure sedentariness. This information will provide a better understanding of inactivity patterns among adolescent girls.
Resumo:
Issue addressed: To assess the effectiveness of a walking program in a psychiatric in-patient unit. Method: In-patients at a private psychiatric unit were offered the opportunity to participate in a daily morning 40 minute walk led by an activity supervisor. After discharge, outcomes for patients who had regularly participated in the walking group (n=35) and patients who had not participated (n=49) were compared for length of stay during their period of admission and Clinical Global Impression - Severity (CGI-S) and Depression Anxiety Stress Scales (DASS) scores measured at admission and discharge. This was a retrospective analysis of data collected routinely. Results: There were no significant differences between the two cohorts on most primary outcome measures, including length of stay, DASS scores at admission and at discharge and CGI-S scores at admission. Patients who had not participated in the walking group had a significantly lower score on a single measure, the CGI-S, than patients who had participated (p=0.001). Conclusions: This study showed no evidence that in-patients benefited from participating in the physical activity program. However, this must be interpreted within the confines of a number of study limitations and, as such, the findings can neither support nor refute the effectiveness of physical activities.
Resumo:
Background
While much cross-sectional data is available, there have been few longitudinal investigations of patterns of electronic media use in children. Further, the possibility of a bi-directional relationship between electronic media use and body mass index in children has not been considered. This study aimed to describe longitudinal patterns of television viewing and electronic game/computer use, and investigate relationships with body mass index (BMI).
Methods
This prospective cohort study was conducted in elementary schools in Victoria, Australia. 1278 children aged 5–10 years at baseline and 8–13 years at follow-up had their BMI calculated, from measured height and weight, and transformed to z-scores based on US 2000 growth data. Weight status (non-overweight, overweight and obese) was based on international BMI cut-off points. Weekly television viewing and electronic game/computer use were reported by parents, these were summed to generate total weekly screen time. Children were classified as meeting electronic media use guidelines if their total screen time was ≤14 hrs/wk.
Results
Electronic media use increased over the course of the study; 40% met guidelines at baseline but only 18% three years later. Television viewing and electronic game/computer use tracked moderately and total screen time was positively associated with adiposity cross-sectionally. While weaker relationships with adiposity were observed longitudinally, baseline z-BMI and weight status were positively associated with follow-up screen time and baseline screen time was positively associated with z-BMI and weight status at follow-up. Children who did not meet guidelines at baseline had significantly higher z-BMI and were more likely to be classified as overweight/obese at follow-up.
Conclusion
Electronic media use in Australian elementary school children is high, increases with age and tracks over time. There appears to be a bi-directional association suggesting that interventions targeting reductions in either screen time or adiposity may have a positive effect on both screen time and adiposity.
Resumo:
Objective: To investigate the prevalence and incidence of overweight and obesity, the frequency of overweight resolution and the influence of parental adiposity during middle childhood.
Design: As part of a prospective cohort study, height and weight were measured in 1997 and 2000/2001. Children were classified as non-overweight, overweight or obese based on standard international definitions. Body mass index (BMI) was transformed into age- and gender-specific Z-scores employing the LMS method and 2000 growth chart data of the Centers for Disease Control and Prevention. Parents self-reported height and weight, and were classified as underweight, healthy weight, overweight or obese based on World Health Organization definitions.
Setting: Primary schools in Victoria, Australia.
Subjects: In total, 1438 children aged 5–10 years at baseline.
Results: The prevalence of overweight and obesity increased between baseline (15.0 and 4.3%, respectively) and follow-up (19.7 and 4.8%, respectively; P < 0.001 for increase in overweight and obesity combined). There were 140 incident cases of overweight (9.7% of the cohort) and 24 of obesity (1.7% of the cohort); only 3.8% of the cohort (19.8% of overweight/obese children) resolved to a healthy weight. The stability of child adiposity as measured by BMI category (84.8% remained in the same category) and BMI Z-score (r = 0.84; mean change = −0.05) was extremely high. Mean change in BMI Z-score decreased with age (linear trend β = 0.03, 95% confidence interval 0.01–0.05). The influence of parental adiposity largely disappeared when children's baseline BMI was adjusted for.
Conclusions: During middle childhood, the incidence of overweight/obesity exceeds the proportion of children resolving to non-overweight. However, for most children adiposity remains stable, and stability appears to increase with age. Prevention strategies targeting children in early childhood are required.
Resumo:
Purpose: Most women with early-stage breast cancer believe that psychosocial factors are an important influence over whether their cancer will recur. Studies of the issue have produced conflicting results.
Patients and Methods: A population-based sample of 708 Australian women diagnosed before age 60 years with nonmetastatic breast cancer was observed for a median of 8.2 years. Depression and anxiety, coping style, and social support were assessed at a median of 11 months after diagnosis. Hazard ratios for distant disease-free survival (DDFS) and overall survival (OS) associated with psychosocial factors were estimated separately using Cox proportional hazards survival models, with and without adjustment for known prognostic factors.
Results: Distant recurrence occurred in 209 (33%) of 638 assessable patients, and 170 (24%) of 708 patients died during the follow-up period. There were no statistically significant associations between any of the measured psychosocial factors and DDFS or OS from the adjusted analyses. From unadjusted analyses, associations between greater anxious preoccupation and poorer DDFS and OS were observed (P = .02). These associations were no longer evident after adjustment for established prognostic factors; greater anxious preoccupation was associated with younger age at diagnosis (P = .03), higher tumor grade (P = .02), and greater number of involved axillary nodes (P = .008).
Conclusion: The findings do not support the measured psychosocial factors being an important influence on breast cancer outcomes. Interventions for adverse psychosocial factors are warranted to improve quality of life but should not be expected to improve survival.
Resumo:
Background
The purpose of this paper was to evaluate the long-term impact of a childhood motor skill intervention on adolescent motor skills and physical activity.
Methods
In 2006, we undertook a follow-up of motor skill proficiency (catch, kick, throw, vertical jump, side gallop) and physical activity in adolescents who had participated in a one-year primary school intervention Move It Groove It (MIGI) in 2000. Logistic regression models were analysed for each skill to determine whether the probability of children in the intervention group achieving mastery or near mastery was either maintained or had increased in subsequent years, relative to controls. In these models the main predictor variable was intervention status, with adjustment for gender, grade, and skill level in 2000. A general linear model, controlling for gender and grade, examined whether former intervention students spent more time in moderate-to-vigorous physical activity at follow-up than control students.
Results
Half (52%, n = 481) of the 928 MIGI participants were located in 28 schools, with 276 (57%) assessed. 52% were female, 58% in Grade 10, 40% in Grade 11 and 54% were former intervention students. At follow-up, intervention students had improved their catch ability relative to controls and were five times more likely to be able to catch: ORcatch = 5.51, CI (1.95 – 15.55), but had lost their advantage in the throw and kick: ORthrow = .43, CI (.23 – .82), ORkick = .39, CI (.20 – .78). For the other skills, intervention students appeared to maintain their advantage: ORjump = 1.14, CI (.56 – 2.34), ORgallop = 1.24, CI (.55 – 2.79). Intervention students were no more active at follow-up.
Conclusion
Six years after the 12-month MIGI intervention, whilst intervention students had increased their advantage relative to controls in one skill, and appeared to maintain their advantage in two, they lost their advantage in two skills and were no more active than controls at follow up. More longitudinal research is needed to explore whether gains in motor skill proficiency in children can be sustained and to determine the intervention characteristics that translate to subsequent physical activity.
Resumo:
Objective: The aim of this study was to assess the major dietary patterns of two age cohorts of women, to determine to the extent to which the dietary patterns differ between the cohorts and to assess whether they vary according to sociodemographic and behavioural characteristics and patterns of nutrient intake.
Method: Dietary intake was assessed using an 80-item food frequency questionnaire for women aged 50–55 years (n=10 150; ‘middle age’) in 2001 and aged 25–30 years (n=7371; ‘young’) in 2003, from the Australian Longitudinal Study on Women's Health. Factor analysis using principal component extraction was used to identify dietary patterns, and a pattern score was calculated from the consumption of the food items identified with each dietary pattern. Associations between the dietary pattern scores and sociodemographic and behavioural characteristics and nutrient intakes were investigated using regression analysis.
Results: Six dietary patterns were identified and were labelled: cooked vegetables; fruit; Mediterranean-style; processed meat, meat and takeaway; reduced fat dairy; and high-fat and sugar foods. Regression analysis revealed that healthier dietary patterns were significantly associated with other favourable health-related behaviours, higher socioeconomic status and living in urban areas (P-values <0.05).
Conclusions: In spite of differences in the level of consumption of individual food items, the similarity in dietary patterns across two generations of women suggests that policies and interventions to improve diet should focus on social and economic factors and general health-related behaviour rather than different age groups.
Resumo:
This study examines associations between parental feeding restriction at baseline and child body mass index (BMI) z-score at 3-year follow-up. Parents of 204 5–6-year-old and 188 10–12-year-old children completed the Child Feeding Questionnaire at baseline (2002/3). In 2002/3 and 2005/6, children's BMI z-score was calculated from measured height and weight. Analyses were stratified by age-group. The association of follow-up zBMI and baseline feeding restriction score was explored using (i) linear regression with adjustment for baseline zBMI and (ii) with further adjustments for baseline maternal BMI, maternal education level and child sex. Baseline restriction was associated with follow-up zBMI at 3 years in 5–6-year-old children and was largely unchanged when adjusting for child sex, maternal BMI and education. Restriction was not associated with follow-up zBMI in 10–12-year-old children. This longitudinal study adds important depth to our understanding of associations between restrictive feeding and change in zBMI, suggesting that restriction of energy-dense foods and drinks may be protective of unhealthy weight gain in younger children but may have no effect among older children. These findings support a reconsideration of the notion that restriction is likely to result in increased child weight.
Resumo:
Objective To determine if use of paracetamol in early life is an independent risk factor for childhood asthma.
Design Prospective birth cohort study.
Setting Melbourne Atopy Cohort Study.
Participants 620 children with a family history of allergic disease, with paracetamol use prospectively documented
on 18 occasions from birth to 2 years of age, followed until age 7 years.
Main outcome measures The primary outcome was childhood asthma, ascertained by questionnaire at 6 and 7 years. Secondary outcomes were infantile wheeze, allergic rhinitis, eczema, and skin prick test positivity.
Results Paracetamol had been used in 51% (295/575) of children by 12 weeks of age and in 97% (556/575) by 2 years. Between 6 and 7 years, 80% (495/620) were followed up; 30% (148) had current asthma. Increasing frequency of paracetamol use was weakly associated with increased risk of childhood asthma (crude odds ratio 1.18, 95% confidence interval 1.00 to 1.39, per doubling of days of use). However, after adjustment for frequency of respiratory infections, this association essentially disappeared (odds ratio 1.08, 0.91 to 1.29). Paracetamol use for non-respiratory causes was not associated with asthma (crude odds ratio 0.95, 0.81 to 1.12).
Conclusions In children with a family history of allergic diseases, no association was found between early paracetamol use and risk of subsequent allergic disease after adjustment for respiratory infections or when paracetamol use was restricted to non-respiratory tract infections. These findings suggest that early paracetamol use does not increase the risk of asthma.
Resumo:
Background: Dental caries (decay) is the most prevalent disease of childhood. It is often left untreated and can impact negatively on general health, and physical, developmental, social and learning outcomes. Similar to other health issues, the greatest burden of dental caries is seen in those of low socio-economic position. In addition, a number of diet-related risk factors for dental caries are shared risk factors for the development of childhood obesity. These include high and frequent consumption of refined carbohydrates (predominately sugars), and soft drinks and other sweetened beverages, and low intake of (fluoridated) water. The prevalence of childhood obesity is also at a concerning level in most countries and there is an opportunity to determine interventions for addressing both of these largely preventable conditions through sustainable and equitable solutions. This study aims to prospectively examine the impact of drink choices on child obesity risk and oral health status.
Methods/Design: This is a two-stage study using a mixed methods research approach. The first stage involves qualitative interviews of a sub-sample of recruited parents to develop an understanding of the processes involved in drink choice, and inform the development of the Discrete Choice Experiment analysis and the measurement instruments to be used in the second stage. The second stage involves the establishment of a prospective birth cohort of 500 children from disadvantaged communities in rural and regional Victoria, Australia (with and without water fluoridation). This longitudinal design allows measurement of changes in the child’s diet over time, exposure to fluoride sources including water, dental caries progression, and the risk of childhood obesity.
Discussion: This research will provide a unique contribution to integrated health, education and social policy and program directions, by providing clearer policy relevant evidence on strategies to counter social and environmental factors which predispose infants and children to poor health, wellbeing and social outcomes; and evidence-based strategies to promote health and prevent disease through the adoption of healthier lifestyles and diet. Further, given the absence of evidence on the processes and effectiveness of contemporary policy implementation, such as community water fluoridation in rural and regional communities it’s approach and findings will be extremely
informative.
