Peter Jacoby

Telethon Kids Institute, West Perth, Western Australia, Australia

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Publications (134)425.92 Total impact

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    ABSTRACT: Rett syndrome is a pervasive neurodevelopmental disorder associated with a pathogenic mutation on the MECP2 gene. Impaired movement is a fundamental component and the Rett Syndrome Gross Motor Scale was developed to measure gross motor abilities in this population. The current study investigated the validity and reliability of the Rett Syndrome Gross Motor Scale. Video data showing gross motor abilities supplemented with parent report data was collected for 255 girls and women registered with the Australian Rett Syndrome Database, and the factor structure and relationships between motor scores, age and genotype were investigated. Clinical assessment scores for 38 girls and women with Rett syndrome who attended the Danish Center for Rett Syndrome were used to assess consistency of measurement. Principal components analysis enabled the calculation of three factor scores: Sitting, Standing and Walking, and Challenge. Motor scores were poorer with increasing age and those with the p.Arg133Cys, p.Arg294* or p.Arg306Cys mutation achieved higher scores than those with a large deletion. The repeatability of clinical assessment was excellent (intraclass correlation coefficient for total score 0.99, 95% CI 0.93-0.98). The standard error of measurement for the total score was 2 points and we would be 95% confident that a change 4 points in the 45-point scale would be greater than within-subject measurement error. The Rett Syndrome Gross Motor Scale could be an appropriate measure of gross motor skills in clinical practice and clinical trials.
    Preview · Article · Jan 2016 · PLoS ONE
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    ABSTRACT: Influenza is associated with significant morbidity and mortality in children receiving therapy for cancer, yet recommendation for, and uptake of the seasonal vaccine remains poor. One hundred children undergoing treatment for cancer were vaccinated with the trivalent inactivated influenza vaccine according to national guidelines in 2010 and 2011. Influenza-specific hemagglutinin inhibition antibody titers were performed on blood samples taken prior to each vaccination and 4 weeks following the final vaccination. A nasopharyngeal aspirate for influenza was performed on all children who developed an influenza-like illness. Following vaccination, seroprotection and seroconversion rates were 55 and 43% for H3N2, 61 and 43% for H1N1, and 41 and 33% for B strain, respectively. Overall, there was a significant geometric mean fold increase to H3N2 (GMFI 4.56, 95% CI 3.19-6.52, P < 0.01) and H1N1 (GMFI 4.44, 95% CI 3.19-6.19, P < 0.01) strains. Seroconversion was significantly more likely in children with solid compared with hematological malignancies and in children <10 years of age who received a two-dose schedule compared to one. Influenza infection occurred in 2% of the vaccinated study population, compared with 6.8% in unvaccinated controls, providing an adjusted estimated vaccine effectiveness of 72% (95% CI -26-94%). There were no serious adverse events and a low reactogenicity rate of 3%. The trivalent inactivated influenza vaccine is safe, immunogenic, provides clinical protection and should be administered annually to immunosuppressed children receiving treatment for cancer. All children <10 years of age should receive a two-dose schedule.
    No preview · Article · Dec 2015 · Cancer Medicine
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    ABSTRACT: Study design: Population-based longitudinal observational study. Objectives: To describe the prevalence of scoliosis in Rett syndrome, structural characteristics and progression, taking into account the influences of age, genotype and ambulatory status. Summary of background data: Scoliosis is the most common orthopaedic comorbidity in Rett syndrome yet very little is known about its natural history and influencing factors such as age, genotype and ambulatory status. Methods: The infrastructure of the Australian Rett Syndrome Database was used to identify all cases with confirmed Rett syndrome in Australia and collect data on genotype and walking status. We identified radiological records and described the Cobb angle of each curve. Time to event analysis was used to estimate the median age of onset of scoliosis and the log rank test to compare by mutation type. Latent class group analysis was used to identify groups for the trajectory of walking status over time and a multilevel linear model used to assess trajectories of scoliosis development by mutation type and walking status. We used a logistic regression model to estimate the probability of developing a scoliosis with a Cobb angle >60° at 16 years in relation to Cobb angle and walking status at 10 years of age. Results: The median age of scoliosis onset was 11 years with earliest onset in those with a p.Arg255 mutation or large deletion. Scoliosis was progressive for all mutation types except for those with the p.Arg306Cys mutation. Scoliosis progression was reduced when there was capacity to walk independently or with assistance. Cobb angle and walking ability at age 10 can be reliably used to identify those who will develop a very severe scoliosis by age 16. Conclusions: These data on prognosis of scoliosis inform clinical decision-making about the likelihood of progression to very severe scoliosis and the need for surgical management. Level of evidence: 4.
    No preview · Article · Dec 2015 · Spine
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    ABSTRACT: Background: Acute haematogenous osteomyelitis is a bacterial infection of bone, which occurs most frequently in children. Outcomes are excellent for the majority of children, but a minority develop complicated osteomyelitis. Predicting which children will develop complicated osteomyelitis remains a challenge, particularly in developed countries where most patients are discharged home after a relatively short period in hospital. Methods: We conducted a 5 year retrospective case note review of all children aged 3 months to 16 years admitted with a diagnosis of acute haematogenous osteomyelitis. We compared standardised clinical and laboratory parameters in those who developed simple and complicated osteomyelitis. Results: Of the 299 children who met inclusion, 241 (80.6%) had simple and 58 (19.4%) had complicated osteomyelitis. The major predictors of complicated disease were older age, a temperature greater than 38.5[degrees]C and a higher C-reactive protein at admission. Conclusions: A risk prediction model, utilising information available shortly after hospitalisation, allows early identification of children at greatest risk of developing complicated osteomyelitis. Copyright
    No preview · Article · Dec 2015 · The Pediatric Infectious Disease Journal
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    ABSTRACT: Background: Data demonstrating the effectiveness of inactivated trivalent influenza vaccine (TIV) for children at increased risk of severe disease are limited. Our objective was to determine the effectiveness of TIV in children with risk factors for severe disease and to compare vaccine uptake, parental attitudes and prescriber recommendations in children with and without risk factors for severe disease. Methods: Children aged 6-59 months presenting for emergency care (2008-2014) with an influenza-like illness were eligible. Influenza PCR/culture were performed on nasopharyngeal samples. Vaccination status was confirmed via the national register and/or vaccine providers. The test-negative design was used to estimate vaccine effectiveness (VE). Risk factors, parental attitudes and prescriber recommendations were assessed by parental questionnaire. Results: 2723 children were recruited. Risk factors for severe disease included comorbid medical conditions (11.6%), preterm birth (13.0%) and indigeneity (5.0%). Influenza was identified in 546 (20.1%) participants. Overall VE (2008, 2010-2014) was 70.0% (95%CI: 47.7,82.9); VE for children with medical comorbidities, children born preterm, and children <2 years were 82.5% (14.6,96.4), 79.2% (10.9,95.1) and 84.7% (49.6,95.3) respectively. Following adverse events in 2010, the number of children fully vaccinated with TIV declined significantly. This included children with and without risk factors for severe disease. Attitudes were similar in parents of children with and without risk factors for severe disease. Conclusions: VE for TIV in young children with and without risk factors for severe disease was ≥70%. Despite this, participation in the preschool influenza vaccination program remains low with parents and prescribers unconvinced of the benefits and safety of TIV.
    No preview · Article · Dec 2015 · The Pediatric Infectious Disease Journal
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    ABSTRACT: Background Orofacial clefts are a group of frequently observed congenital malformations often requiring multiple hospital admissions over the lifespan of affected individuals. The aim of this study was to describe the total-population hospital admissions with principal diagnosis of cleft lip and/or palate in Australia over a 10 year period. Methods Data for admissions to hospitals were obtained from the Australian Institute of Health and Welfare National Hospital Morbidity Database (July 2000 to June 2010). The outcome variable was a hospital separation with the principal diagnosis of cleft palate, cleft lip or cleft lip and palate (ICD-10-AM diagnosis codes Q35-Q37 respectively). Trends in rates of admission and length of stay by age, gender and cleft type were investigated. Results A total of 11, 618 admissions were identified; cleft palate (4,454; 0.22 per 10,000 people per year), cleft lip (2,251; 0.11) and cleft lip and palate (4,913; 0.25). Admission age ranged from birth to 79 years with males more frequently admitted. Most admissions occurred prior to adolescence in cleft palate and cleft lip and through to late teens in cleft lip and palate, declining for all groups after 25 years. Conclusions This study identified population level trends in hospital separations for orofacial cleft diagnosis in Australia.
    Preview · Article · Dec 2015 · BMC Oral Health
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    ABSTRACT: The evidence regarding older parental age and incidence of mood disorder symptoms in offspring is limited, and that which exists is mixed. We sought to clarify these relationships by using data from the Western Australian Pregnancy Cohort (Raine) Study. The Raine Study provided comprehensive data from 2,900 pregnancies, resulting in 2,868 live born children. A total of 1,220 participants completed the short form of the Depression Anxiety Stress Scale (DASS-21) at the 20-year cohort follow-up. We used negative binomial regression analyses with log link and with adjustment for known perinatal risk factors to examine the extent to which maternal and paternal age at childbirth predicted continuous DASS-21 index scores. In the final multivariate models, a maternal age of 30-34 years was associated with significant increases in stress DASS-21 scores in female offspring relative to female offspring of 25- to 29-year-old mothers. A maternal age of 35 years and over was associated with increased scores on all DASS-21 scales in female offspring. Our results indicate that older maternal age is associated with depression, anxiety, and stress symptoms in young adult females. Further research into the mechanisms underpinning this relationship is needed. (PsycINFO Database Record
    No preview · Article · Nov 2015 · Journal of Abnormal Psychology
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    ABSTRACT: Background: There is increasing evidence demonstrating influenza vaccine effectiveness (VE) in the prevention of influenza in children, including the very young. Data demonstrating the effectiveness against severe disease, including hospitalisation, are limited. We aimed to determine the VE of the southern hemisphere trivalent inactivated influenza vaccine (TIV) in preventing laboratory-confirmed influenza-associated hospitalisation in children. Patients and methods: Laboratory records were used to identify children with confirmed influenza hospitalised (i.e., cases) during a 5 year period (2008, 2010-2013) at the only tertiary paediatric facility in Western Australia. Cases and time, age and ward matched controls were retrospectively reviewed to determine risk factors, vaccination status and outcome. Adjusted odds ratios and VE estimates were derived using conditional logistic regression models. Results: Three hundred and eighty five cases were identified (Influenza A, 64.9%; Influenza B: 35.1%). Influenza-like illness and pneumonia were the most frequent presentation (74.5% and 23.9%, respectively). The median length of stay was 2 days (Interquartile range 1-4 days). Twenty children (5.2%) required admission to the intensive care unit. Vaccine uptake in cases and controls was low (4.9% and 8.5%, respectively). Three hundred and six case-control pairs were included in the VE analysis, of which 19 pairs were informative with discrepant vaccination status. VE (fully vaccinated vs. unvaccinated) was estimated to be 62.3% (95% CI: -6.6%, 86.7%). Conclusion: In this study, the point estimate for the effectiveness of TIV in preventing influenza-associated hospitalisation in children was similar to that reported for emergency or outpatient attended, laboratory-confirmed influenza, yet confidence intervals were wide. Vaccine uptake remains low. Studies, enroling larger numbers of children, ideally with higher vaccine uptake, are needed to provide additional evidence on TIV protection against influenza hospitalisation in children.
    No preview · Article · Nov 2015 · Vaccine
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    ABSTRACT: Numerous studies have observed that a proportion of infants later diagnosed with autism spectrum disorder (ASD) experience accelerated head growth during the first years of life. An emerging methodology for examining the developmental trajectory prior to a diagnosis of ASD is to investigate siblings of affected individuals. The current study is the first prospective investigation of fetal growth in siblings of children with ASD. Two groups of pregnant women were recruited as part of the PRegnancy Investigation of Siblings and Mothers of children with autism cohort in Perth, Western Australia. The "high risk" group (n = 23) comprised pregnant women who have an existing child with a diagnosis of ASD and the "low risk" group (n = 36) comprised pregnant mothers who have an existing child who has developed typically. Prenatal ultrasounds were procured at multiple time-points throughout the second- and third-trimesters, enabling an examination of growth trajectories. Growth measurements were then compared for the high- and low-risk fetuses. Mixed linear regression models identified no significant differences between the high- and low-risk fetuses in the rate of prenatal head and body growth throughout the second- and third-trimester (all P-values >0.05). Similarly, there were no significant differences observed when comparing high and low risk groups on a ratio of head circumference relative to body size (β = -0.019, P = 0.75). Future studies may consider looking beyond the macro architecture of the prenatal brain and examine the growth of brain subregions that have been implicated in the presentation of ASD symptoms. Autism Res 2015. © 2015 International Society for Autism Research, Wiley Periodicals, Inc. © 2015 International Society for Autism Research, Wiley Periodicals, Inc.
    Full-text · Article · Jul 2015 · Autism Research
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    ABSTRACT: The caesarean delivery rate in the developed world has been increasing. It is not well understood how caesarean delivery rates have changed by gestational age at birth in Western Australia, particularly in relation to the introduction of the early-term delivery guidelines in Australia in 2006. Data from the Western Australian Midwives Notification System were used to identify 193 136 singletons born to primiparous women at 34-42 weeks' gestation during 1995-2010. Caesarean delivery rates were calculated by gestational age group (34-36 weeks, 37-38 weeks, and 39-42 weeks) and stratified into pre-labour and in-labour caesarean delivery. The average annual per cent change (AAPC) for the caesarean delivery rates was calculated using joinpoint regression. Log-binomial regression was used to estimate the risk of having a caesarean delivery while adjusting for maternal and antenatal factors. Caesarean delivery rates rose steadily from 1995 to 2005 (AAPC = 5.9%, [95% confidence interval (CI) 4.9, 6.9]), but stabilised since then (AAPC = 0.9%, [95% CI -1.9, 3.8]). The rate of in-labour caesarean deliveries rose consistently from 1995 to 2010 across all gestational age groups. The pre-labour caesarean delivery rate rise was most dominant at 37-38 weeks' gestation from 1995 to 2005 (AAPC = 6.8%, [95% CI 5.4, 8.2]), but declined during 2006-10 (AAPC = -4.5, [95% CI -6.7, -2.3]), while at the same time the rate at 39-42 weeks rose slightly. The rise in pre-labour caesarean deliveries during 1995-2005 occurred predominantly at 37-38 weeks' gestation, but declined again from 2006 to 2010. This suggests that the recently developed Australian early-term delivery guidelines may have had some success in reducing early-term deliveries in Western Australia. © 2015 John Wiley & Sons Ltd.
    Full-text · Article · Jul 2015 · Paediatric and Perinatal Epidemiology
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    Leon Lor · Kylie Hill · Peter Jacoby · Helen Leonard · Jenny Downs
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    ABSTRACT: The aim of this study was to investigate the validity of using a Bouchard activity record (BAR) in individuals with Rett syndrome to measure physical activity, as compared with pragmatic criterion standard measures of walking status and step counts recorded using the StepWatch activity monitor (SAM). During the waking hours of 1 day, 43 females (mean age 21y, SD 9y) wore a SAM whilst a proxy completed a modified BAR. Responses to the BAR were compared among participants, who were grouped according to walking status, using the Mann-Whitney two-sample rank-sum test. Relationships were sought between BAR responses and step counts using linear regression. According to the proxy-reported BAR responses, those who needed assistance with walking spent more time sitting (median [interquartile range] 9h 15min [8h 8min-10h 30min] vs 6h 15min [4h 15min-8h 30min]; p<0.001) and less time standing (1h [38min-1h 30min] vs 2h 15min [45min-3h 45min]; p=0.04) than those who could walk independently. In those who could walk independently, time classified as 'uptime' (standing and walking) using the BAR was associated with increased step count (r(2) =0.58; p<0.001). These data support the validity of proxy-reported BAR responses. In those who could walk independently, uptime, classified using the BAR, could be used to estimate daily step count. This tool offers an inexpensive method for clinicians to gain insights into physical activity levels in individuals with Rett syndrome. © 2015 Mac Keith Press.
    Full-text · Article · Jun 2015 · Developmental Medicine & Child Neurology
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    ABSTRACT: People with intellectual disabilities are at a higher risk for experiencing behavioral, emotional, and psychiatric problems in comparison with the general population. People with Down syndrome have been reported as experiencing fewer behavioral problems than others with intellectual disability, although still at a greater level than the non-intellectually disabled population, except for depression and Alzheimer disease. The aim of this study was to describe the trajectories of subscales of behavior, including depressive symptoms, communication disturbance, anxiety, disruptiveness, and social relating abilities, for young adults with Down syndrome. Families of young adults with Down syndrome living in Perth, Western Australia, participated in a questionnaire study over 8 years, 2004 (n = 255), 2009 (n = 191), and 2011 (n = 188). Questionnaires collected information about young person characteristics and family functioning. The parent-completed Developmental Behavior Checklist-Adult (DBC-A) and Developmental Behavior Checklist-Primary Carer Version (DBC-P) were used to measure emotional and behavioral problems. These measures include the following subscales: disruptive, communication and anxiety disturbances, self-absorbed, antisocial, depressive, and social relating. DBC score declined from 2004 to 2011 reflecting an improvement in behavior in the self-absorbed (coeff −0.011, 95% confidence interval (CI) −0.031, −0.008), anxiety (coef −0.009 95%CI −0.129, −0.006), communication disturbances (coeff −0.008, 95% CI −0.012, −0.005) and disruptive/antisocial behavior (coeff −0.013, 95% CI −0.016, −0.009) subscales. Subscales for depressive symptoms and social relating problems decreased less (coeff −0.003, 95% CI −0.007, −0.0001) (coeff −0.003 95% CI −0.007, 0.001). Young people who were lower functioning were reported as exhibiting significantly more behavioral problems across every subscale when compared with those who were higher functioning. Behavior of young adults with Down syndrome improves over time but depressive symptoms and social relating behavior problems persist into adulthood. It is possible that those with persistent depressive symptoms are at a high risk for developing depressive illness in adulthood. Identifying young people with Down syndrome who are at risk for developing depression in adult life has implications for prevention and early treatment.
    No preview · Article · May 2015 · Medicine

  • No preview · Article · May 2015 · Physiotherapy
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    ABSTRACT: Mothers of a child with autism spectrum disorder have more psychiatric disorders after the birth of their child. This might be because they have more psychiatric disorders before the birth, or the increase could be related to the burden of caring for their child. We aimed to calculate the incidence of a psychiatric diagnosis in women with no psychiatric history after the birth of their eldest child with autism spectrum disorder compared to women with no child with autism spectrum disorder or intellectual disability and no psychiatric history. By linking datasets from Western Australian population-based registries, we calculated the incidence of a psychiatric disorder in mothers of children with autism spectrum disorder and compared to mothers of children with no autism spectrum disorder or intellectual disability. Negative binomial regression using STATA 13 was used for all analyses. Apart from alcohol and substance abuse, mothers of children with autism spectrum disorder had higher incidences of all categories of psychiatric disorders than other mothers. The increase of psychiatric disorders in mothers of children with autism spectrum disorder and no psychiatric history compared to similar mothers with no child with autism spectrum disorder or intellectual disability might be due to a pre-existing genetic disposition coupled with an environmental trigger provided by the challenges of raising their children with autism spectrum disorder. In addition, the increased burden borne by the mothers of children with autism spectrum disorder might result in a higher incidence of psychiatric disorders in mothers who are not genetically disposed. © The Author(s) 2015.
    No preview · Article · Feb 2015 · Autism
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    ABSTRACT: Mothers of children with intellectual disability or autism spectrum disorder (ASD) have poorer health than other mothers. Yet no research has explored whether this poorer health is reflected in mortality rates or whether certain causes of death are more likely. We aimed to calculate the hazard ratios for death and for the primary causes of death in mothers of children with intellectual disability or ASD compared to other mothers. The study population comprised all mothers of live-born children in Western Australia from 1983-2005. We accessed state-wide databases which enabled us to link socio-demographic details, birth dates, diagnoses of intellectual disability or ASD in the children and dates and causes of death for all mothers who had died prior to 2011. Using Cox Regression with death by any cause and death by each of the three primary causes as the event of interest, we calculated hazard ratios for death for mothers of children intellectual disability or ASD compared to other mothers. During the study period, mothers of children with intellectual disability or ASD had more than twice the risk of death. Mothers of children with intellectual disability were 40% more likely to die of cancer; 150% more likely to die of cardiovascular disease and nearly 200% more likely to die from misadventure than other mothers. Due to small numbers, only hazard ratios for cancer were calculated for mothers of children with ASD. These mothers were about 50% more likely to die from cancer than other mothers. Possible causes and implications of our results are discussed. Similar studies, pooling data from registries elsewhere, would improve our understanding of factors increasing the mortality of mothers of children with intellectual disability or ASD. This would allow the implementation of informed services and interventions to improve these mothers' longevity.
    Full-text · Article · Dec 2014 · PLoS ONE
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    ABSTRACT: Background: Rett syndrome is a pervasive neurological disorder with impaired gait as one criterion. This study investigated the capacity of three accelerometer-type devices to measure walking activity in Rett syndrome. Methods: Twenty-six participants (mean 18 years, SD 8) wore an Actigraph, ActivPAL and StepWatch Activity Monitor (SAM) during a video-taped session of activities. Agreement was determined between step-counts derived from each accelerometer and observation. Repeatability of SAM-derived step counts was determined using pairs of one-minute epochs during which the same participant was observed to walk with the same cadence. Results: The mean difference (limit of agreement) for the Actigraph, ActivPAL and SAM were -41 (SD 33), -16 (SD 21) and -1 (SD 16) steps/min, respectively. Agreement was influenced by a device/cadence interaction (p < 0.001) with greater under-recording at higher cadences. For SAM data, repeatability of step-count pairs was excellent (intraclass correlation coefficient 0.91, 95% CI 0.79-0.96). The standard error of measurement was 6 steps/min and we would be 95% confident that a change ≥17 steps/min would be greater than within-subject measurement error. Conclusions: The capacity of the SAM to measure physical activity in Rett syndrome allows focus on participation-based activities in clinical practice and clinical trials. Implications for Rehabilitation Many girls and women with Rett syndrome are able to walk on their own or with assistance but with altered movement patterns. Validated measures of physical activity, such as step counts, have potential to monitor function during daily life. Compared with other forms of accelerometer-type devices, such as ActiGraph and ActivPAL, the StepWatch Activity Monitor (SAM) measured step counts with good accuracy and repeatability. The capacity of the SAM to measure physical activity in Rett syndrome allows focus on participation-based activities in clinical practice and clinical trials.
    No preview · Article · Dec 2014 · Disability and Rehabilitation
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    ABSTRACT: This study aimed to examine the relationship between advanced parental age and behavioural outcomes in offspring in a longitudinal cohort of children in Western Australia. The Western Australian Pregnancy Cohort (Raine) is a prospective study of 2900 pregnancies. Offspring were followed up at ages 2, 5, 8, 10, 14, and 17 years, and 1754 adolescents were available for follow-up at 17 years. The Child Behaviour Checklist was used to measure child behaviour, including internalising (e.g. anxious/withdrawn) and externalising (e.g. aggressive/destructive) behaviours. There was a significant linear relationship between maternal age and total internalising and externalising behaviour outcomes, but not paternal age. Increasing maternal age was associated with decreasing risk for problem behaviours in offspring. In the categorical models, young maternal age (20-24 years) was associated with significantly increased risk for problem behaviours in offspring relative to offspring of parents in the reference group (25-29 years), and a paternal age of 35-39 years was associated with decreased risk for total behaviour morbidity in offspring. This study showed no evidence that late fatherhood is associated with adverse behavioural outcomes in offspring. Increasing maternal age was found to be a protective factor for child behaviour morbidity. © 2014 John Wiley & Sons Ltd.
    No preview · Article · Dec 2014 · Paediatric and Perinatal Epidemiology
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    ABSTRACT: The time interval between pregnancies is a modifiable risk factor of adverse birth outcomes, including preterm birth, small for gestational age (SGA), and low birth weight. Variations in birth outcomes might be explained by risk factors that vary greatly among women but tend to persist between pregnancies (eg, genetics, lifestyle, or social conditions). Among women who have had 3 births, each mother can be her own control for risk factors that affect outcomes. This retrospective cohort study was performed to examine the effect of interpregnancy interval after adjusting for maternal factors by using within-mother analyses. The association between interpregnancy interval and the incidence of preterm birth, SGA, and low birth weight among the second and third births was determined using data from a population-wide database. Among 84,151 mothers, 40,441 all had their first 3 births as live singletons during 1980 to 2010. Outcome variables were preterm birth (<37 weeks), SGA, and low birth weight (<2500 g). Interpregnancy intervals (in months) were 0 to 5, 6 to 11, 12 to 17, 18 to 23 (reference category), 24 to 59, 60 to 119, and 120 or longer. A maternally matched design was used to model the odds of preterm birth, SGA, and low birth weight as a function of interpregnancy interval. Conditional logistic regression was used to measure this association for an individual woman, which allowed inferences based only on within-mother effects. Confounding factors that can vary between births and affect interpregnancy interval were maternal age, parity, birth year, ethnicity, socioeconomic status, and outcome of the previous birth. The terms matched and unmatched referred to the within-mother design based on conditional and unconditional logistic regression, respectively. Among the 40,441 pairs of second and third births, matched by mother, the mean incidence rates for preterm birth, SGA, and low birth weight for second births were 5.3%, 7.4%, and 3.5%, respectively. For third births, the rates were 5.8%, 6.3%, and 3.6%, respectively. Unconditional logistic regression suggested a strong effect of short interpregnancy interval on the incidence of preterm birth and low birth weight but not SGA, after adjustment for confounders. Among interpregnancy intervals of less than 18 to 23 months, the highest odds ratios (ORs) for preterm birth (adjusted OR [aOR], 1.41; 95% confidence interval [CI], 1.31–1.51) and low birth weight (aOR, 1.26; 95% CI, 1.15–1.37) were for intervals of 0 to 5 months. The incidence of SGA birth was similar across 0 to 23 months, with ORs ranging from 0.98 to 1.03. Among interpregnancy intervals of more than 18 to 23 months, the highest OR of preterm birth (aOR, 1.35; 95% CI, 1.26–1.45) was 60 to 119 months; the highest ORs of low birth weight (aOR, 1.67; 95% CI, 1.42–1.97) and SGA (aOR, 1.98; 95% CI, 1.74–2.24) were for intervals of more than 119 months. In the matched model, among intervals of less than 18 to 23 months, the highest ORs of preterm birth (aOR, 1.07; 95% CI, 0.86–1.34) and low birth weight (aOR, 1.03; 95% CI, 0.79–1.34) were for 0 to 5 months. The OR for SGA was estimated at 1.08 for all 3 categories of interpregnancy intervals of less than 18 months. For preterm birth at intervals of more than 23 months, ORs ranged from 1.01 (0.86–1.18) for 24 to 59 months to 0.88 (0.54–1.46) for more than 119 months. For intervals of more than 23 months, ORs for low birth weight ranged from 1.07 (0.88–1.30) for 24 to 59 months to 1.58 (0.82–3.06) for more than 119 months. Odds ratios for SGA ranged from 1.11 (0.96–1.28) for 24 to 59 months to 1.72 (1.04–2.85) for intervals of more than 119 months. These results do not support the concept of a causal effect of short interpregnancy interval on adverse birth outcomes. However, short interpregnancy interval remains a strong predictor of the risk for adverse birth outcomes, but correlated maternal risk factors must be considered. Clinicians should treat a short interpregnancy interval as a possible risk of adverse birth outcomes but remain aware of other maternal risk factors.
    No preview · Article · Dec 2014 · Obstetrical and Gynecological Survey
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    ABSTRACT: Rett syndrome is one of many severe neurodevelopmental disorders with feeding difficulties. In this study, associations between feeding difficulties, age, MECP2 genotype, and utilization of gastrostomy were investigated. Weight change and family satisfaction following gastrostomy were explored. Data from the longitudinal Australian Rett Syndrome Database whose parents provided data in the 2011 family questionnaire (n = 229) were interrogated. We used logistic regression to model relationships between feeding difficulties, age group, and genotype. Content analysis was used to analyze data on satisfaction following gastrostomy. In those who had never had gastrostomy and who fed orally (n = 166/229), parents of girls <7 years were more concerned about food intake compared with their adult peers (odds ratio [OR] 4.26; 95% confidence interval [CI] 1.29, 14.10). Those with a p.Arg168∗ mutation were often perceived as eating poorly with nearly a 6-fold increased odds of choking compared to the p.Arg133Cys mutation (OR 5.88; 95% CI 1.27, 27.24). Coughing, choking, or gagging during meals was associated with increased likelihood of later gastrostomy. Sixty-six females (28.8%) had a gastrostomy, and in those, large MECP2 deletions and p.Arg168∗ mutations were common. Weight-for-age z-scores increased by 0.86 (95% CI 0.41, 1.31) approximately 2 years after surgery. Families were satisfied with gastrostomy and felt less anxious about the care of their child. Mutation type provided some explanation for feeding difficulties. Gastrostomy assisted the management of feeding difficulties and poor weight gain, and was acceptable to families. Our findings are likely applicable to the broader community of children with severe disability.
    Full-text · Article · Dec 2014 · Medicine
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    ABSTRACT: Mothers of a child with intellectual disability (ID) have more psychiatric disorders after the birth of their child than other mothers. However, it is unclear if this is because they have more psychiatric disorders before the birth or if the increase is related to the burden of caring for the child. We aimed to calculate the rate of new psychiatric disorders in mothers after the birth of their eldest child with ID born between 1983 and 2005 and to compare these with rates in women with a child with no ID or autism spectrum disorder (ASD) born during the same period. By linking data from Western Australian population-based registries, we selected women with no psychiatric history who survived the birth of their live-born child (N = 277,559) and compared rates of psychiatric disorders for women with a child with ID and women without a child with or ASD. Negative binomial regression with STATA 12 was used for all analyses. Mothers of children with mild-moderate ID of unknown cause had around two to three and a half times the rate of psychiatric disorders of mothers of children without ID or ASD. Mothers of children with Down syndrome and no pre-existing psychiatric disorder showed resilience and had no impairments in their mental health. Interventions and services are needed for mothers of other children with ID to improve their mental health. Further research is implicated to explore the mental health of mothers of children with ID and a pre-existing psychiatric disorder. Copyright © 2014 Elsevier Ltd. All rights reserved.
    Full-text · Article · Nov 2014 · Journal of Psychiatric Research

Publication Stats

2k Citations
425.92 Total Impact Points

Institutions

  • 2010-2016
    • Telethon Kids Institute
      West Perth, Western Australia, Australia
  • 2005-2015
    • University of Western Australia
      • Centre for Health Services Research
      Perth City, Western Australia, Australia
  • 2014
    • Western Australia Health
      Perth City, Western Australia, Australia
  • 2013
    • Edith Cowan University
      • School of Exercise and Health Sciences
      Joondalup, Western Australia, Australia