Prenatal origins of suicide mortality: A prospective cohort study in the United States

Most suicide research focuses on acute precipitants and is conducted in high-risk populations. Yet, vulnerability to suicide is likely established years prior to its occurrence. In this study, we aimed to investigate the risk of suicide mortality conferred by prenatal sociodemographic and pregnancy-related factors. Offspring of participants (N = 49,853) of the Collaborative Perinatal Project, a U.S. population-based cohort of pregnancies enrolled between 1959 and 1966, were linked to the U.S. National Death Index to determine their vital status by the end 2016. We examined associations between sociodemographic factors during pregnancy, pregnancy complications, labor and delivery complications, and neonatal complications with suicide death coded according to ICD-9/10 criteria. By the end of 2016, 3,555 participants had died. Of these, 288 (214 males, 74 females) died by suicide (incidence rate = 15.6 per 100,000 person-years, 95% Confidence Interval [CI] = 13.9–17.5). In adjusted models, male sex (Hazard Ratio [HR] = 2.98, CI: 2.26–3.93), White race (HR = 2.14, CI = 1.63–2.83), low parental education (HR = 2.23, CI = 1.38–3.62), manual parental occupation (HR = 1.38, CI = 1.05–1.82), being a younger sibling (HR = 1.52, CI = 1.10–2.11), higher rates of pregnancy complications (HR = 2.36, CI = 1.08–5.16), and smoking during pregnancy (HR = 1,28, CI = 0.99–1.66) were independently associated with suicide risk, whereas birth and neonatal complications were not. Consistent with the developmental origins of psychiatric disorders, vulnerability to suicide mortality is established early in development. Both sociodemographic and pregnancy factors play a role in this risk, which underscores the importance of considering life course approaches to suicide prevention, possibly including provision of high-quality prenatal care, and alleviating the socioeconomic burdens of mothers and families.

Parental needs and nursing response following SUFE Surgery: An interpretive descriptive study

<p><b>The parental experience of caring for a child following the unexpected admission and surgery for a significant hip injury has largely been unexplored in the New Zealand (NZ) context. Slipped Upper Femoral Epiphysis (SUFE) is one of the most common orthopaedic hip disorders prevalent amongst children between the ages of nine to fifteen years. In New Zealand, Māori and Pacific children are the most vulnerable population at risk of this hip condition. Existing literature focuses on the demographic and epidemiological studies, including surgical treatment and management of SUFE; however, there is a dearth of research concerning SUFE that focuses on parents’ experiences in the postoperative, discharge and rehabilitative phases of care and the nurses’ experience of caring for these children and their families.</b></p> <p>This qualitative study was undertaken at a large public hospital in New Zealand and interpretive descriptive methodology was utilised to examine the experiences of parents and nurses in caring for a child following invasive SUFE repair. As Māori and Pacific Island populations are highly represented in the SUFE statistics, most of the parents used in this study are from these socio-cultural backgrounds. Through transcribed semi-structured interviews with parents of five children who underwent SUFE repair, and five paediatric nurses caring for children and their families in the hospital ward, this study offers two perspectives of the journey for these parents following such an injury, from the child’s hospitalisation to caring for these children once they are home. Following thematic analysis, these perspectives are presented and contrasted revealing, insights of the parents’ ongoing need for support, information and planning for care and nurses’ efforts to meet these needs. Implications of nursing practice and parental education include the need for improved information sharing and delivery to aid parents understanding of the SUFE condition and effective management of care during hospitalisation and at home following discharge. Recommendations are made to improve the parental experience to support their child’s recovery following SUFE surgery.</p> <p>Key Words:SUFE, Parents and caregivers, Māori and Pacific populations, Nurses</p>

Parental needs and nursing response following SUFE Surgery: An interpretive descriptive study

<p><b>The parental experience of caring for a child following the unexpected admission and surgery for a significant hip injury has largely been unexplored in the New Zealand (NZ) context. Slipped Upper Femoral Epiphysis (SUFE) is one of the most common orthopaedic hip disorders prevalent amongst children between the ages of nine to fifteen years. In New Zealand, Māori and Pacific children are the most vulnerable population at risk of this hip condition. Existing literature focuses on the demographic and epidemiological studies, including surgical treatment and management of SUFE; however, there is a dearth of research concerning SUFE that focuses on parents’ experiences in the postoperative, discharge and rehabilitative phases of care and the nurses’ experience of caring for these children and their families.</b></p> <p>This qualitative study was undertaken at a large public hospital in New Zealand and interpretive descriptive methodology was utilised to examine the experiences of parents and nurses in caring for a child following invasive SUFE repair. As Māori and Pacific Island populations are highly represented in the SUFE statistics, most of the parents used in this study are from these socio-cultural backgrounds. Through transcribed semi-structured interviews with parents of five children who underwent SUFE repair, and five paediatric nurses caring for children and their families in the hospital ward, this study offers two perspectives of the journey for these parents following such an injury, from the child’s hospitalisation to caring for these children once they are home. Following thematic analysis, these perspectives are presented and contrasted revealing, insights of the parents’ ongoing need for support, information and planning for care and nurses’ efforts to meet these needs. Implications of nursing practice and parental education include the need for improved information sharing and delivery to aid parents understanding of the SUFE condition and effective management of care during hospitalisation and at home following discharge. Recommendations are made to improve the parental experience to support their child’s recovery following SUFE surgery.</p> <p>Key Words:SUFE, Parents and caregivers, Māori and Pacific populations, Nurses</p>

Secondhand nicotine vaping at home and respiratory symptoms in young adults

RationaleDespite high prevalence of e-cigarette use (vaping), little is currently known regarding the health effects of secondhand nicotine vape exposure.ObjectiveTo investigate whether exposure to secondhand nicotine vape exposure is associated with adverse respiratory health symptoms among young adults.MethodWe investigated the effect of secondhand nicotine vape exposure on annually reported wheeze, bronchitic symptoms and shortness of breath in the prospective Southern California Children Health Study cohort. Data were collected from study participants (n=2097) with repeated annual surveys from 2014 (average age: 17.3 years) to 2019 (average age: 21.9). We used mixed effect logistic regression to evaluate the association between secondhand nicotine vape and respiratory symptoms after controlling for relevant confounders.ResultsPrevalence of secondhand nicotine vape increased from 11.7% to 15.6% during the study period in this population. Prevalence of wheeze, bronchitic symptoms and shortness of breath ranged from 12.3% to 14.9%, 19.4% to 26.0% and 16.5% to 18.1%, respectively, during the study period. Associations of secondhand nicotine vape exposure with bronchitic symptoms (OR 1.40, 95% CI 1.06 to 1.84) and shortness of breath (OR 1.53, 95% CI 1.06 to 2.21) were observed after controlling for vaping, active and passive exposure to tobacco or cannabis, and demographic characteristics (age, gender, race/ethnicity and parental education). Stronger associations were observed when analysis was restricted to participants who were neither smokers nor vapers. There were no associations with wheezing after adjustment for confounders.ConclusionSecondhand nicotine vape exposure was associated with increased risk of bronchitic symptoms and shortness of breath among young adults.

Parental education is associated with differential engagement of neural pathways during inhibitory control

Response inhibition and socioeconomic status (SES) are critical predictors of many important outcomes, including educational attainment and health. The current study extends our understanding of SES and cognition by examining brain activity associated with response inhibition, during the key developmental period of adolescence. Adolescent males (N = 81), aged 16–17, completed a response inhibition task while undergoing fMRI brain imaging and reported on their parents’ education, one component of socioeconomic status. A region of interest analysis showed that parental education was associated with brain activation differences in the classic response inhibition network (right inferior frontal gyrus + subthalamic nucleus + globus pallidus) despite the absence of consistent parental education-performance effects. Further, although activity in our main regions of interest was not associated with performance differences, several regions that were associated with better inhibitory performance (ventromedial prefrontal cortex, middle frontal gyrus, middle temporal gyrus, amygdala/hippocampus) also differed in their levels of activation according to parental education. Taken together, these results suggest that individuals from households with higher versus lower parental education engage key brain regions involved in response inhibition to differing degrees, though these differences may not translate into performance differences.

Frequency to Non-Compliance to Oral Iron Therapy in Pregnancy and Common Factors Leading to it

OBJECTIVES: The objective of this study was to determine frequency of non-compliance to oral iron therapy in pregnancy and common factors leading to it. METHODOLOGY: It was a cross-sectional study done in the Department of Obstetrics and Gynecology of Lady Willington Hospital Lahore, Pakistan. The duration of this study was six months i.e., 3rd October 2019 to 2nd March 2020. All antenatal patients between ages of 18 to 45 years presented in the obstetrics outdoors or admitted in the ward were included in this study. A total of 245 patients were included in this study by consecutive non-probability sampling. Patients with gynecological problems, patients dependent on others for their medication cost, patients with psychiatric illness or physical disability were excluded. Post stratification Chi-square test was applied keeping P-value ≤0.05 as significant RESULTS: Among 245 patients, mean age was 27±2.16 years. Iron supplement used by 245 patients was analyzed as 159 (65%) patients had used the iron supplement while 86 (35%) patients didn’t use iron supplements (P-value 0.001). Iron supplement used by 245 patients was analyzed and only 93 (38%) patients had used the iron supplement while 152 (62%) patients didn’t use iron supplements. CONCLUSION: The coverage of antenatal iron and folic acid supplements is very low in the surveyed districts of Pakistan due to lack of parental education and older aged women belonging to poor households.

The Emergence of 5-Year-Olds’ Behavioral Difficulties: Analyzing Risk and Protective Pathways in the United Kingdom and Germany

This study aimed to advance our understanding of 5-year-olds’ behavioral difficulties by modeling and testing both mediational protective and risk pathways simultaneously. Drawing on two national samples from different Western European countries—the United Kingdom (13,053) and Germany (2,022), the proposed model considered observed sensitive parental interactive behaviors and tested child vocabulary as protective pathways connecting parental education with children’s behavioral outcomes; the risk pathways focused on negative parental disciplinary practices linking (low) parental education, parental distress, and children’s difficult temperament to children’s behavioral difficulties. Further, the tested model controlled for families’ income as well as children’s sex and formal child care attendance. Children with comparatively higher educated parents experienced more sensitive interactive behavior, had more advanced vocabulary, and exhibited fewer behavioral difficulties. Children with a comparatively higher level of difficult temperament or with parents who suffered from distress tended to experience more negative disciplinary behavior and exhibited more behavioral difficulties. Additionally, children’s vocabulary skills served as a mechanism mediating the association between parental education and children’s behavioral difficulties. Overall, we found similar patterns of results across the United Kingdom and Germany with both protective and risk pathways contributing simultaneously to children’s behavioral development. The findings suggest that promoting parents’ sensitive interactive behaviors, favorable disciplinary practices, and child’s vocabulary skills have potential for preventing early behavioral difficulties.

Socioeconomic differences in psychiatric treatment before and after self-harm: an observational study of 4,280 adolescents and young adults

Background Individuals in higher socioeconomic positions tend to utilise more mental health care, especially specialist services, than those in lower positions. Whether these disparities in treatment exist among adolescents and young adults who self-harm is currently unknown. Methods The study is based on Finnish administrative register data on all individuals born 1986–1994. Adolescents and young adults with an episode of self-harm treated in specialised healthcare at ages 16–21 in 2002–2015 (n=4280, 64% female) were identified and followed 2 years before and after the episode. Probabilities of specialised psychiatric inpatient admissions and outpatient visits and purchases of psychotropic medication at different time points relative to self-harm were estimated using generalised estimation equations, multinomial models and cumulative averages. Socioeconomic differences were assessed based on parental education, controlling for income. Results An educational gradient in specialised treatment and prescription medication was observed, with the highest probabilities of treatment among the adolescents and young adults with the highest educated parents and lowest probabilities among those whose parents had basic education. These differences emerged mostly after self-harm. The probability to not receive any treatment, either in specialised healthcare or psychotropic medication, was highest among youth whose parents had a basic level of education (before self-harm 0.39, 95% CI 0.34–0.43, and after 0.29, 95% CI 0.25–0.33 after) and lowest among youth with higher tertiary educated parents (before self-harm: 0.22, 95% CI 0.18–0.26, and after 0.18, 95% CI 0.14–0.22). The largest differences were observed in inpatient care. Conclusions The results suggest that specialised psychiatric care and psychotropic medication use are common among youth who self-harm, but a considerable proportion have no prior or subsequent specialised treatment. The children of parents with lower levels of education are likely to benefit from additional support in initiating and adhering to treatment after an episode of self-harm. Further research on the mechanisms underlying the educational gradient in psychiatric treatment is needed.