62 research outputs found

    Maternal prenatal anxiety and depression and trajectories of cardiometabolic risk factors across childhood and adolescence: a prospective cohort study

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    Objectives: Quantifying long-term offspring cardiometabolic health risks associated with maternal prenatal anxiety and depression can guide cardiometabolic risk prevention. This study examines associations between maternal prenatal anxiety and depression, and offspring cardiometabolic risk from birth to 18 years.Design: This study uses data from the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort.Participants: Participants were 526-8,606 mother-offspring pairs from the ALSPAC cohort. Setting: British birth cohort set, Bristol, UK. Primary and secondary outcomes: Exposures were anxiety (Crown-Crisp Inventory score) and depression (Edinburgh Postnatal Depression Scale score) measured at 18 and 32 weeks gestation. Outcomes were trajectories of offspring body mass index; fat mass; lean mass; pulse rate; glucose, diastolic and systolic blood pressure; triglycerides, high-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol, and insulin from birth/early childhood to 18 years. Exposures were analysed categorically using clinically relevant, cut-offs and continuously to examine associations across the distribution of prenatal anxiety and depression.Results: We found no strong evidence of associations between maternal anxiety and depression, and offspring trajectories of cardiometabolic risk factors. Depression at 18 weeks was associated with higher SBP at age 18 (1.62 mmHg (95% CI, 0.17, 3.07). Anxiety at 18 weeks was also associated with higher DBP at 7 years in unadjusted analyses (0.70 mmHg (95% CI, 0.02, 1.38); this difference persisted at age 18 years (difference at 18 years; 0.89 mmHg (95% CI, 0.05, 1.73). No associations were observed for body mass index; fat mass; lean mass; pulse rate; glucose; triglycerides, high-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol, and insulin. Conclusions: This is the first examination of maternal prenatal anxiety and depression and trajectories of offspring cardiometabolic risk. Our findings suggest that prevention of maternal prenatal anxiety and depression may have limited impact on offspring cardiometabolic health across the first two decades of life

    Identification of genetic variants associated with Huntington's disease progression: a genome-wide association study

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    Background Huntington's disease is caused by a CAG repeat expansion in the huntingtin gene, HTT. Age at onset has been used as a quantitative phenotype in genetic analysis looking for Huntington's disease modifiers, but is hard to define and not always available. Therefore, we aimed to generate a novel measure of disease progression and to identify genetic markers associated with this progression measure. Methods We generated a progression score on the basis of principal component analysis of prospectively acquired longitudinal changes in motor, cognitive, and imaging measures in the 218 indivduals in the TRACK-HD cohort of Huntington's disease gene mutation carriers (data collected 2008–11). We generated a parallel progression score using data from 1773 previously genotyped participants from the European Huntington's Disease Network REGISTRY study of Huntington's disease mutation carriers (data collected 2003–13). We did a genome-wide association analyses in terms of progression for 216 TRACK-HD participants and 1773 REGISTRY participants, then a meta-analysis of these results was undertaken. Findings Longitudinal motor, cognitive, and imaging scores were correlated with each other in TRACK-HD participants, justifying use of a single, cross-domain measure of disease progression in both studies. The TRACK-HD and REGISTRY progression measures were correlated with each other (r=0·674), and with age at onset (TRACK-HD, r=0·315; REGISTRY, r=0·234). The meta-analysis of progression in TRACK-HD and REGISTRY gave a genome-wide significant signal (p=1·12 × 10−10) on chromosome 5 spanning three genes: MSH3, DHFR, and MTRNR2L2. The genes in this locus were associated with progression in TRACK-HD (MSH3 p=2·94 × 10−8 DHFR p=8·37 × 10−7 MTRNR2L2 p=2·15 × 10−9) and to a lesser extent in REGISTRY (MSH3 p=9·36 × 10−4 DHFR p=8·45 × 10−4 MTRNR2L2 p=1·20 × 10−3). The lead single nucleotide polymorphism (SNP) in TRACK-HD (rs557874766) was genome-wide significant in the meta-analysis (p=1·58 × 10−8), and encodes an aminoacid change (Pro67Ala) in MSH3. In TRACK-HD, each copy of the minor allele at this SNP was associated with a 0·4 units per year (95% CI 0·16–0·66) reduction in the rate of change of the Unified Huntington's Disease Rating Scale (UHDRS) Total Motor Score, and a reduction of 0·12 units per year (95% CI 0·06–0·18) in the rate of change of UHDRS Total Functional Capacity score. These associations remained significant after adjusting for age of onset. Interpretation The multidomain progression measure in TRACK-HD was associated with a functional variant that was genome-wide significant in our meta-analysis. The association in only 216 participants implies that the progression measure is a sensitive reflection of disease burden, that the effect size at this locus is large, or both. Knockout of Msh3 reduces somatic expansion in Huntington's disease mouse models, suggesting this mechanism as an area for future therapeutic investigation

    Immunization practices in physicians' offices on the avalon peninsula of Newfoundland

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    The immunization needs in Newfoundland and Labrador are currently met through a mixed delivery system. Immunization is performed through the Regional Health and Community Services offices, approximately 60% and private practice physicians, approximately 40%. This study assessed immunization practices in private physicians' offices with a focus on storage, handling and documentation compared with National Advisory Committee on Immunization (NACI) Guidelines. One of the key aspects of storage and handling is the maintenance of the cold chain. The cold chain is the process of maintaining vaccine at the optimum temperature from the time it is manufactured until it is administered. Since the inception of the cold chain concept, methods to assess and promote proper vaccine storage and handling have been developed. -- This study has a quasi-experimental, pre and post intervention design. The study group consisted of solo and group private practice physicians who provide childhood immunizations in urban and rural practices on the Avalon Peninsula in the Province of Newfoundland and Labrador. Starting in March 1998, the researcher contacted 37 offices representing 89 physicians to participate in the study. -- The study consisted of an office visit during which information was collected concerning the practice for handling vaccine. This information was collected through a questionnaire, observation of the storage area and documentation of the refrigerator temperature. The intervention included the provision and discussion of National and Provincial guidelines for storage and handling of vaccine. A second visit six to eight months later assessed change in practice post intervention. -- Of the 37 available offices, 27 (73%) participated in the study representing 89 physicians; all offices visited met at least 18 of the 24 guidelines. Vaccine was stored in the body of a refrigerator in 95% of the participating offices, 37% of the offices had a thermometer in the refrigerator, and less than 20% used thermal transport bags. Documenting the refrigerator temperature on a regular basis was only done in one office. Post intervention visits indicated little change In practice. This study has collected baseline data about physicians' practices and has given some data as to what is effective in encouraging physicians to maintain the cold chain

    Epistemological beliefs and practice in a preschool setting

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    Thesis (M.Ed.)--University of Melbourne, Dept. of Education, 2004The aim of this case study was to determine whether the level of espoused epistemological beliefs of a qualified teacher and unqualified assistant were implicit in each Teacher's individual practice. The study was undertaken in a privately operated preschool in Victoria. Two participants were chosen on their identified preference to work and be recognized by co-workers, parents and children, as a team of two teachers working side by side. For this reason, the participants were referred to as Teacher A and Teacher B. Data were collected using five different methods of inquiry: preliminary interview; audio transcripts during planning and preparation sessions; copy of the written teaching plan; video recordings of Teacher interactions; and video stimulated debriefings. These methods set out to investigate: the epistemological beliefs of each Teacher; what beliefs held by each Teacher about knowledge, learning, child development and teaching practices were similar or dissimilar; the levels of epistemological development in each Teacher's espoused beliefs; the consistency between each Teacher's espoused beliefs with their individual practice; and whether each Teacher's level of epistemological development was implicit in their individual practice. The research indicates that Teacher A and Teacher B generally held varying beliefs about the nature of knowledge, learning, child development, and teaching practice. Despite dissimilarities, the comparison of each Teacher's espoused beliefs with Belenky et al's (1986) Women's Ways of Knowing Model revealed each had the same level of espoused epistemological development, which was subjective knowledge. Comparisons between Teacher A and Teacher B's espoused beliefs with individual practice revealed that each Teacher's beliefs were predominantly inconsistent with their practice. The results also revealed inconsistencies between practice and particular recollections by each Teacher. Although the comparative analyses of each Teacher's beliefs and practice revealed inconsistencies, the comparative analyses of each Teacher's espoused epistemological development with each Teacher's practice revealed Teacher A and Teacher B's espoused epistemological development were implicit in their individual practice
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