Socio-Economic Status Differences in Patients' Desire for and Capacity to Obtain Information in the Clinical Encounter

As individual long-term doctor/patient relationships are increasingly replaced by more transient specialist and group practice contacts, there are likely to be growing doubts about the quality of overall care and communication. One aspect in particular of the quality of medical care involves the communication of information to patients (Donabedian 1980). Previous studies have pointed to a significant level of discontent with the amount and quality of information received by patients from their doctors (Cartright 1979; Boreham & Gibson 1978; Pendleton and Bochner 1980; Reid and McIlwaine 1980; Graham and Oakley 1981)

Sibling Influences on Adolescent Delinquent Behaviour: An Australian Longitudinal Study

This article examines sibling influences on adolescent delinquency at age 14, using data from an Australian longitudinal study of 374 same- and mixed-sex sibling pairs. Based on maternal and self-reports, a moderately strong association between siblings' delinquency is found. The relationship remains significant controlling for childhood aggression and family environment factors measured during childhood (age 5) and adolescence (age 14), using both standardized instruments and new scales. This effect varies according to the sex composition of the sibling pair and is stronger for males and those whose parents have been arrested. The need for increased attention to sibling influences by researchers and prevention practitioners is discussed

The Relative Contributions Of Parental And Sibling Substance Use To Adolescent Tobacco, Alcohol, And Other Drug Use

While research demonstrates that parental tobacco and alcohol use increases the likelihood of children's substance use, it is unclear whether or not sibling use has a greater, weaker, or similar effect. Based upon self-reported information from Australian adolescents, their siblings and parents, this investigation examines the association between siblings' tobacco and alcohol use. The relationship is consistent, moderately strong, and remains significant when controlling for a number of family-related factors, indicating that the shared environment cannot fully explain the extent of similarity in siblings' behaviors. In addition, sibling substance use has a greater effect on adolescent substance use than does smoking or drinking by parents. These findings indicate the need to include siblings and information regarding sibling relationships in prevention and intervention programs

The Prediction of Depression in the Postpartum Period

Eight thousand five hundred and fifty-six women enrolled in the Mater-University of Queensland Study of Pregnancy were surveyed to investigate the relationship between potential risk factors for depression and mood states in the postpartum period. Participants were followed from their first antenatal interview until 6 months postpartum. Level of depression was measured at the first interview using the Delusions Signs and Symptoms Inventory (DSSI) and again at 6 months postpartum. A second measure of depression, which was prototypical in nature and related to the maternity blues, was administered retrospectively to cover the 6 month period following parturition. the assessment of independent variables during pregnancy and/or the postpartum period included demographic data and several measures of: neonatal risk, stress and social adjustment. Having excluded from analysis, participants who were depressed at the initial interview a point prevalence for depression of 2.6% (measured by the DSSI) and a prevalence for severe and prolonged postpartum stress of 12.8% (using the prototype measure) was recorded. Data was analysed using categorical modelling techniques and multiple regression analysis. Linear models were constructed to predict, both, DSSI and prototype measures of depression. Predictor variables accounted for 17% of the variance in DSSI scores and only 7% in the prototype measure. Whilst stress and social support formed the core of both models, irrespective of the analysis used, neonatal risk variables were more strongly predictive of 'blues' related depression. Inconsistencies in results are discussed and the need to differentiate between postpartum depression and depression (unrelated to childbirth) occurring in the postpartum period is proposed. Implications for primary prevention are discussed

On the equivalence between hierarchical segmentations and ultrametric watersheds

We study hierarchical segmentation in the framework of edge-weighted graphs. We define ultrametric watersheds as topological watersheds null on the minima. We prove that there exists a bijection between the set of ultrametric watersheds and the set of hierarchical segmentations. We end this paper by showing how to use the proposed framework in practice in the example of constrained connectivity; in particular it allows to compute such a hierarchy following a classical watershed-based morphological scheme, which provides an efficient algorithm to compute the whole hierarchy.Comment: 19 pages, double-colum

Postnatal Depression - Myth and Reality: Maternal Depression Before and After the Birth of a Child

Background Much has been written about postnatal depression as a clinical condition. There is some evidence to suggest that a substantial proportion of women who give birth experience a depression in the postnatal period. This paper reports the results of a longitudinal study of the mental health of a large sample of women who were in the early stages of pregnancy at entry to the study. Methods Each participant was assessed for symptoms of depression at the first clinic visit (entry to the study), and reassessed at various intervals - at 3-5 days, at 6 months, and again at 5 years after the birth of the child - using the DSSI-D (Delusions-Symptoms-States Inventory). Results Retrospective recall questions indicate that shortly after the birth the majority of women experienced some depressed mood. Of those who experienced depressed mood, the data suggest that the symptoms were not severe, nor did these symptoms generally continue beyond a few weeks. The longitudinal data indicate that levels of depression in our sample are highest either at the firrst clinic visit or at the 5-year follow-up. Rates of depression at the 6-month follow-up are relatively low by comparison. Conclusion While most mothers experience periods of depressed mood after the birth of their baby, these periods are generally of short duration and of lesser intensity than a major depression. Mothers appear to experience increasing levels of symptoms of depression as their child grows up. Many of the "cases" of depression experienced at the 5-year follow-up represent a recurrence of a previous experience of depression

Unemployment and Reproductive Outcome: An Australian study

The Mater-University of Queensland Study involves the follow-up of 8556 pregnant women who were enrolled at their first clinic visit. This analysis compares four groups of women categorized according to their own and their partners' employment status. Group 1 comprised women unemployed, partners not unemployed. Group 2 comprised women not unemployed with unemployed partners. Group 3 comprised women and partners who were both unemployed. In group 4 neither partner was unemployed. Initial analysis showed that there was a significant association between birthweight and birthweight for gestational age, and unemployment as reported by mothers. After adjustment for lifestyle variables (principally smoking) there were no remaining statistically significant associations

Obstetrical Outcomes of Aboriginal Pregnancies at a Major Urban Hospital

While a number of previous papers have documented the poor general health of Australia's Aboriginal population, relatively few have considered the health of Aborigines living in Australia's urban centres. In this latter instance, Aborigines have access to conventional medical services and they live in a physical environment that does not differ greatly from that experienced by the lower-class white population. Of course, racial, familial and economic differences may continue to influence differentially the perceived accessibility of services to Aborigines and their non-Aboriginal neighbours. This paper compares the pregnancy outcomes of Aboriginal women and non-Aboriginal women living in a major urban centre in Australia. The data indicate that urban Aboriginal women have adverse pregnancy outcomes at one and a half o two times the rate experienced by the non-Aboriginal population. Much of the difference can be attributed to lifestyle variations in the groups being compared

Birthweight below the tenth percentile: the relative and attributable risks of maternal tobacco consumption and other factors.

Analysis of 7776 singleton births defined a cohort of babies with birthweight below the 10th percentile after adjusting for gestational age and sex. The relative risk of a baby being small for gestational age in respect to a number of factors, such as parental anthropometry, demographic factors, behavior patterns (tobacco, cannabis, alcohol, and caffeine consumption), maternal pathology, and fetal abnormality, was calculated. The highest relative risks are associated with severe antepartum hemorrhage, severe pre-eclampsia, and severe fetal abnormality. As these are relatively rare events, a more accurate calculation of overall risk to the population as opposed to the individual can be obtained by studying the percent attributable risk of each of the factors. This demonstrates that maternal tobacco consumption is the major environmental risk factor in our population

Social Class, Religion And Contraceptive Failure In A Sample Of Pregnant Women In Brisbane

The reproductive intent of women at the time of conception has been largely ignored in the social science and epidemiological literature. This is surprising in view of its likely relevance to a wide range of health and welfare issues. Despite the possible short and long term consequences of unplanned reproductive activity, it appears that we know a good deal more about the factors influencing decisions to acquire many consumer goods than we do about the factors influencing the decision to reproduce. The easy availability of contraception and a high level of literacy may contribute to an assumption that women have considerable control over their fertility. The received wisdom relating to reproductive intent suggests that most women are pregnant because they planned their pregnancy. In this study a large sample (4000) of pregnant women were asked about the beginning of their pregnancies. Women were specifically asked about the method of contraception they last used and whether their pregnancy was a consequence of a failure of contraception. Social, economic and religious variables were examined to assess the extent to which these were associated with differing rates of contraceptive failure