Lessons learned from investigating patients' and physiotherapists' perspectives on the design of a telerehabilitation platform

PURPOSE

Home self-rehabilitation exercises for musculoskeletal conditions are a valuable complement to rehabilitation plans. Telerehabilitation systems using artificial intelligence can provide reliable solutions and empower patients by providing them with guidance and motivating them to engage in rehabilitation plans and activities. This study aims to understand the patient's and physiotherapist's perspective on the requirements of effective face-to-face physiotherapy sessions to inspire the design of a telerehabilitation platform to be used in home settings.

METHODS

The authors used an ethnography-informed approach through observation and semi-structured interviews with patients (n = 13) and physiotherapists (n = 10) in two outpatient rehabilitation clinics. The AEIOU framework was used to structure and analyse the observation. Thematic analysis was used to code and analyse the data collected from the observations and the interviews.

RESULTS

Patients' and physiotherapists' perspectives emphasise the need for exercise instruction clarity, evolution monitoring, and feedback. In the absence of the physiotherapist, in home settings, patients feel insecure and fear execution difficulties and limited exercise instructions, while physiotherapists struggle with controlling patients' home exercise performance. Telerehabilitation is seen as an opportunity to move further into home self-rehabilitation programs.

CONCLUSIONS

Besides home exercise monitoring and guidance, telerehabilitation platforms must allow personalization and effective communication between patients and physiotherapists.

The robot eyes don't have it. The presence of eyes on collaborative robots yields marginally higher user trust but lower performance

Eye gaze is a prominent feature of human social lives, but little is known on whether fitting eyes on machines makes humans trust them more. In this study we compared subjective and objective markers of human trust when collaborating with eyed and non-eyed robots of the same type. We used virtual reality scenes in which we manipulated distance and the presence of eyes on a robot's display during simple collaboration scenes. We found that while collaboration with eyed cobots resulted in slightly higher subjective trust ratings, the objective markers such as pupil size and task completion time indicated it was in fact less comfortable to collaborate with eyed robots. These findings are in line with recent suggestions that anthropomorphism may be actually a detrimental feature of collaborative robots. These findings also show the complex relationship between human objective and subjective markers of trust when collaborating with artificial agents.

Digital Practices by Citizens During the COVID-19 Pandemic: Findings From an International Multisite Study

BACKGROUND

The COVID-19 pandemic brought digital practices and engagement to the forefront of society, which were based on behavioral changes associated with adhering to different government mandates. Further behavioral changes included transitioning from working in the office to working from home, with the use of various social media and communication platforms to maintain a level of social connectedness, especially given that many people who were living in different types of communities, such as rural, urban, and city spaces, were socially isolated from friends, family members, and community groups. Although there is a growing body of research exploring how technology is being used by people, there is limited information and insight about the digital practices employed across different age cohorts living in different physical spaces and residing in different countries.

OBJECTIVE

This paper presents the findings from an international multisite study exploring the impact of social media and the internet on the health and well-being of individuals in different countries during the COVID-19 pandemic.

METHODS

Data were collected via a series of online surveys deployed between April 4, 2020, and September 30, 2021. The age of respondents varied from 18 years to over 60 years across the 3 regions of Europe, Asia, and North America. On exploring the associations of technology use, social connectedness, and sociodemographic factors with loneliness and well-being through bivariate and multivariate analyses, significant differences were observed.

RESULTS

The levels of loneliness were higher among respondents who used social media messengers or many social media apps than among those who did not use social media messengers or used ≤1 social media app. Additionally, the levels of loneliness were higher among respondents who were not members of an online community support group than among those who were members of an online community support group. Psychological well-being was significantly lower and loneliness was significantly higher among people living in small towns and rural areas than among those living in suburban and urban communities. Younger respondents (18-29 years old), single adults, unemployed individuals, and those with lower levels of education were more likely to experience loneliness.

CONCLUSIONS

From an international and interdisciplinary perspective, policymakers and stakeholders should extend and explore interventions targeting loneliness experienced by single young adults and further examine how this may vary across geographies. The study findings have implications across the fields of gerontechnology, health sciences, social sciences, media communication, computers, and information technology.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.3389/fsoc.2020.574811.

Developing a digital platform for community-led initiatives: from local agents′ needs to interface design

To identify how digital media are being used by community-led initiatives of the Centro Region of Portugal, and to identify the requirements that a digital platform for mediation between agents in the territory should have, two focus groups were conducted, involving six small-sized community-led initiatives and six larger-sized community-led initiatives. This article details the results of these focus groups, according to the following main categories: use of existing communication and mediation tools; the purpose of use of digital tools; type of experiences prompted by digital tools and attributes and features desired in a digital platform to support community-led initiatives. The results show differences between the use and needs of digital tools by small- and larger-sized initiatives and offer interesting insights to prototype an innovative digital solution, to enhance the actions of community-led initiatives. A reference framework for digital mediation strategies and a mobile app prototype were developed, based on these surveys. The article contributes with an analytical view about the development of digital solutions, which aim to strengthen the relationship among agents of local communities and promote mediation mechanisms among all stakeholders in territorial-based innovation.

An opinion mining methodology to analyse games for health

Despite the positive impact of games for health on players' health, users tend to stop playing them after a short period of time, leading benefits to fade. It is therefore important to understand how to sustain interest and, in this way, preserve the health benefits of games for health. This could be achieved by continuously reviewing user feedback after product launch and using this information to inform (re)design and better address user needs. With the growth of social media, user opinions became widely available in public forums. This abundance of information affords us the possibility of, through the application of natural language processing and sentiment analysis techniques, tapping into user opinions and automatically analysing and extracting knowledge from them. This paper introduces a methodology that analyses user comments posted on YouTube about the Just Dance game, to automatically extract information about Usability, User Experience (UX), and Perceived Health Impacts related to Quality of Life (H-QoL). In doing so, the methodology uses a pre-established vocabulary, based on the English lexicon and its semantic relations, to annotate the presence of 38 concepts (five of Usability, 18 of UX, and 15 of H-QoL) and to analyse sentiment. The results of the information extraction and processing are displayed on a dashboard that allows for the exploration and browsing of the results, which can be useful to better understand the opinions and impacts perceived by users and to inform the (re)design of games for health. The methodology proposed builds upon over 500,000 user comments collected from over 32,000 videos.

A Commentary on Blue Zones®: A Critical Review of Age-Friendly Environments in the 21st Century and Beyond

This paper explores the intersection of the World Health Organization’s (WHO) concepts of age-friendly communities and The Blue Zones^® checklists and how the potential of integrating the two frameworks for the development of a contemporary framework can address the current gaps in the literature as well as consider the inclusion of technology and environmental press. The commentary presented here sets out initial thoughts and explorations that have the potential to impact societies on a global scale and provides recommendations for a roadmap to consider new ways to think about the impact of health and wellbeing of older adults and their families. Additionally, this paper highlights both the strengths and the weaknesses of the aforementioned checklists and frameworks by examining the literature including the WHO age-friendly framework, the smart age-friendly ecosystem (SAfE) framework and the Blue Zones^® checklists. We argue that gaps exist in the current literature and take a critical approach as a way to be inclusive of technology and the environments in which older adults live. This commentary contributes to the fields of gerontology, gerontechnology, anthropology, and geography, because we are proposing a roadmap which sets out the need for future work which requires multi- and interdisciplinary research to be conducted for the respective checklists to evolve.

Genome Sequence Resource of 'Candidatus Liberibacter asiaticus' strain 9PA From Brazil

'Candidatus Liberibacter asiaticus', an unculturable α-proteobacterium, is associated with citrus huanglongbing (HLB), a devastating disease threatening citrus production in Brazil and worldwide. In this study, a draft whole-genome sequence of 'Ca. L. asiaticus' strain 9PA from a sweet orange (cultivar Pera) tree collected in São Paulo State, Brazil, is reported. The 9PA genome is 1,231,881 bp, including two prophages, with G+C content of 36.7%. This is the first report of a whole-genome sequence of 'Ca. L. asiaticus' from Brazil or South America. The 9PA genome sequence will enrich 'Ca. L. asiaticus' genome resources and facilitate HLB research and control in Brazil and the world.

COVID-19: Technology, Social Connections, Loneliness, and Leisure Activities: An International Study Protocol

Drawn from the stress process model, the pandemic has imposed substantial stress to individual economic and mental well-being and has brought unprecedented disruptions to social life. In light of social distancing measures, and in particular physical distancing because of lockdown policies, the use of digital technologies has been regarded as the alternative to maintain economic and social activities. This paper aims to describe the design and implementation of an online survey created as an urgent, international response to the COVID-19 pandemic. The online survey described here responds to the need of understanding the effects of the pandemic on social interactions/relations and to provide findings on the extent to which digital technology is being utilized by citizens across different communities and countries around the world. It also aims to analyze the association of use of digital technologies with psychological well-being and levels of loneliness. The data will be based on the ongoing survey (comprised of several existing and validated instruments on digital use, psychological well-being and loneliness), open for 3 months after roll out (ends September) across 11 countries (Austria, France, Germany, India, Malta, Portugal, Romania, Spain, Turkey, and UK). Participants include residents aged 18 years and older in the countries and snowball sampling is employed via social media platforms. We anticipate that the findings of the survey will provide useful and much needed information on the prevalence of use and intensities of digital technologies among different age groups, gender, socioeconomic groups in a comparative perspective. Moreover, we expect that the future analysis of the data collected will show that different types of digital technologies and intensities of use are associated with psychological well-being and loneliness. To conclude, these findings from the study are expected to bring in our understanding the role of digital technologies in affecting individual social and emotional connections during a crisis.

A Smart Health Platform for Measuring Health and Well-Being Improvement in People With Dementia and Their Informal Caregivers: Usability Study

Background

Dementia is a neurodegenerative chronic condition characterized by a progressive decline in a person’s memory, thinking, learning skills, and the ability to perform activities of daily living. Previous research has indicated that there are many types of technology interventions available in the literature that have shown promising results in improving disease progression, disease management, and the well-being of people with dementia (PwD) and their informal caregiver, thus facilitating dementia care and living. Technology-driven home care interventions, such as Connected Health (CH), could offer a convenient and low-cost alternative to traditional home care, providing an informal caregiver with the support they may need at home while caring for a PwD, improving their physical and mental well-being.

Objective

This study aimed (1) to create a multidimensional profile for evaluating the well-being progression of the PwD–informal caregiver dyad for a year during their use of a CH platform, designed for monitoring PwD and supporting their informal caregivers at home, and (2) to conduct a long-term follow-up using the proposed well-being profile at different time-interval evaluations.

Methods

The PwD–informal caregiver well-being profile was created based on the World Health Organization International Classification of Functioning considering the following outcomes: functional status, cognitive status, and quality of life for the PwD and mental well-being, sleeping quality, and burden for the informal caregiver. Over a year, comprehensive assessments of these outcomes were conducted every 3 months to evaluate the well-being of PwD–informal caregivers, using international and standardized validated questionnaires. Participants’ demographic information was analyzed using descriptive statistics and presented as means and SDs. A nonparametric Friedman test was used to analyze the outcome changes and the progression in the PwD-caregiver dyads and to determine if those changes were statistically significant.

Results

There were no significant changes in the well-being of PwD or their caregivers over the year of follow-up, with the majority of the PwD-caregiver dyads remaining stable. The only instances in which significant changes were observed were the functional status in the PwD and sleep quality in their caregivers. In each of these measures, post hoc pairwise comparisons did not indicate that the changes observed were related to the deployment of the CH platform.

Conclusions

The follow-up of this population of PwD and their informal caregivers has shown that disease progression and physical and mental well-being do not change significantly during the time, being a slow and gradual process. The well-being profile created to analyze the potential impact of the CH platform on the PwD–informal caregiver dyad well-being, once validated, could be used as a future tool to conduct the same analyses with other CH technologies for this population.

International Registered Report Identifier (IRRID)

RR2-10.2196/13280

Development of a Caregivers' Support Platform (Connected Health Sustaining Home Stay in Dementia): Protocol for a Longitudinal Observational Mixed Methods Study

Background

Dementia disease is a chronic condition that leads a person with dementia (PwD) into a state of progressive deterioration and a greater dependence in performing their activities of daily living (ADL). It is believed nowadays that PwDs and their informal caregivers can have a better life when provided with the appropriate services and support. Connected Health (CH) is a new technology-enabled model of chronic care delivery where the stakeholders are connected through a health portal, ensuring continuity and efficient flow of information. CH has demonstrated promising results regarding supporting informal home care and Aging in Place, and it has been increasingly considered by researchers and health care providers as a method for dementia home care management.

Objective

This study aims to describe the development and implementation protocol of a CH platform system to support informal caregivers of PwDs at home.

Methods

This is a longitudinal observational mixed methods study where quantitative and qualitative data will be combined for determining the utility of the CH platform for dementia home care. Dyads, consisting of a PwD and their informal caregiver living in the community, will be divided into 2 groups: the intervention group, which will receive the CH technology package at home, and the usual care group, which will not have any CH technology at all. Dyads will be followed up for 12 months during which they will continue with their traditional care plan, but in addition, the intervention group will receive the CH package for their use at home during 6 months (months 3 to 9 of the yearly follow-up). Further comprehensive assessments related to the caregiver’s and PwD’s emotional and physical well-being will be performed at the initial assessment and at 3, 6, 9, and 12 months using international and standardized validated questionnaires and semistructured individual interviews.

Results

This 3-year funded study (2016-2019) is currently in its implementation phase and is expected to finish by December 2019. We believe that CH can potentially change the PwD current care model, facilitating a proactive and preventive model, utilizing self-management–based strategies, and enhancing caregivers’ involvement in the management of health care at home for PwDs.

Conclusions

We foresee that our CH platform will provide knowledge and promote autonomy for the caregivers, which may empower them into greater control of the care for PwDs, and with it, improve the quality of life and well-being for the person they are caring for and for themselves through a physical and cognitive decline predictive model. We also believe that facilitating information sharing between all the PwDs’ care stakeholders may enable a stronger relationship between them, facilitate a more coordinated care plan, and increase the feelings of empowerment in the informal caregivers.

International Registered Report Identifier (IRRID)

DERR1-10.2196/13280

Design and development of a gait training system for Parkinson's disease

Background

Rhythmic Auditory Stimulation (RAS) is an effective technique to improve gait and reduce freezing episodes for Persons with Parkinson’s Disease (PwPD). The BeatHealth system, which comprises a mobile application, gait sensors, and a website, exploits the potential of the RAS technique. This paper describes the tools used for co-designing and evaluating the system and discusses the results and conclusions.

Methods

Personas, interviews, use cases, and ethnographic observations were used to define the functional requirements of the system. Low fidelity prototypes were created for iterative and incremental evaluation with end-users. Field trials were also performed with the final system. The process followed a user centered design methodology defined for this project with the aim of building a useful, usable, and easy-to-use system.

Results

Functional requirements of the system were produced as a result of the initial exploration phase. Building upon these, mock-ups for the BeatHealth system were created. The mobile application was iterated twice, with the second version of it achieving a rating of 75 when assessed by participants through the System Usability Scale (SUS). After another iteration field trials were performed and the mobile application was rated with an average 78.6 using SUS. Participants rated two website mock-ups, one for health professionals and another for end-users, as good except from minor issues related to visual design (e.g. font size), which were resolved in the final version.

Conclusion

The high ratings obtained in the evaluation of the BeatHealth system demonstrate the benefit of applying a user centered design methodology which involves stakeholders from the very beginning. Other important lessons were learned through the process of design and development of the system, such as the importance of motivational aspects, the techniques which work best, and the extra care that has to be taken when evaluating non-functional mock-ups with end users.

Antimicrobial activity of prodigiosin isolated from Serratia marcescens UFPEDA 398

Prodigiosin is an alkaloid and natural red pigment produced by Serratia marcescens. Prodigiosin has antimicrobial, antimalarial and antitumor properties and induces apoptosis in T and B lymphocytes. These properties have piqued the interest of researchers in the fields of medicine, pharmaceutics and different industries. The aim of the present study was to evaluate the antimicrobial activity of prodigiosin against pathogenic micro-organisms. The red pigments produced by S. marcescens exhibited absorption at 534 nm, Rf of 0.59 and molecular weight of 323 m/z. Antimicrobial activity was tested against oxacillin-resistant Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, Enterococcus faecalis, Streptococcus pyogenes, Acinetobacter sp. and oxacillin-resistant S. aureus. The standard antibiotics employed were ampicillin, chloramphenicol, gentamicin and oxacillin. The disc-diffusion tests demonstrated significant inhibition zones for S. aureus (35 ± 0.6), E. faecalis (22 ± 1.0) and S. pyogenes (14 ± 0.6). However, prodigiosin showed resistance to E. coli, P. aeruginosa and acinetobacter, where no significant formation of inhibitory halos were observed. We determined the inhibitory minimum concentrations and bactericidal for 20 strains of oxacillin-resistant S. aureus (ORSA). The pattern was the antibiotic oxacillin. The minimum inhibitory concentrations observed ranged from 1, 2 and 4.0 μg/mL, respectively, while the minimum bactericidal concentrations ranged from 2, 4, 8 and 16 μg/mL. The S. marcescens prodigiosin produced by showed bactericidal and bacteriostatic effect showing promising antimicrobial activity and suggesting future studies regarding its applicability in antibiotics therapies directed ORSA.

Identification of a novel subtype of feline immunodeficiency virus in a population of naturally infected felines in the Brazilian Federal District

The feline immunodeficiency virus (FIV) is a retrovirus that is found worldwide, and it can be assigned to six subtypes (A, B, C, D, E, and a putative subtype F) based on sequencing analysis of the env and gag genes. Subtypes A and B are the most common worldwide. In Brazil, several authors have isolated only subtype B, and its prevalence differs markedly among investigated populations. Blood samples from 200 domestic felines from the Federal District in Brazil were analyzed by PCR. Samples that tested positive for FIV were then cloned, sequenced, and analyzed phylogenetically and statistically. The results represent the first description of FIV infection in the Central Region of Brazil and suggest that only 2 % of felines in this region are positive for the virus. In addition, the analysis showed that one out of the four positive samples that we detected could not be assigned to any of the six classical subtypes. This sample was taken as a putative novel subtype of the FIV virus. The remaining three positive samples were assigned to subtype B, with differences existing among these samples.

Optimization of artificial neural network models through genetic algorithms for surface ozone concentration forecasting

INTRODUCTION

This study proposes three methodologies to define artificial neural network models through genetic algorithms (GAs) to predict the next-day hourly average surface ozone (O(3)) concentrations. GAs were applied to define the activation function in hidden layer and the number of hidden neurons.

METHODS

Two of the methodologies define threshold models, which assume that the behaviour of the dependent variable (O(3) concentrations) changes when it enters in a different regime (two and four regimes were considered in this study). The change from one regime to another depends on a specific value (threshold value) of an explanatory variable (threshold variable), which is also defined by GAs. The predictor variables were the hourly average concentrations of carbon monoxide (CO), nitrogen oxide, nitrogen dioxide (NO(2)), and O(3) (recorded in the previous day at an urban site with traffic influence) and also meteorological data (hourly averages of temperature, solar radiation, relative humidity and wind speed). The study was performed for the period from May to August 2004.

RESULTS AND DISCUSSION

Several models were achieved and only the best model of each methodology was analysed. In threshold models, the variables selected by GAs to define the O(3) regimes were temperature, CO and NO(2) concentrations, due to their importance in O(3) chemistry in an urban atmosphere.

CONCLUSION

In the prediction of O(3) concentrations, the threshold model that considers two regimes was the one that fitted the data most efficiently.

Dance! Don't Fall - preventing falls and promoting exercise at home

Falling is a serious danger to older adults that is usually only addressed after a person has fallen, when doctors administer clinical tests to determine the patient's risk of falling again. Having the technological capability of performing fall risk assessment tests with a smartphone, the authors set out to design a mobile application that would enable users to monitor their risk themselves and consequently prevent falls from occurring. The authors conducted a literature review and two observation sessions before beginning the iterative design process that resulted in the Dance! Don't Fall (DDF) game, a mobile application that enables users to both monitor their fall risk and actively reduce it through fun and easy exercise.

Monitoring of brain tissue oxygenation in surgery of middle cerebral artery incidental aneurysms

Introduction:

The management of incidental unruptured aneurysms remains a matter of controversy; middle-sized or large anterior circulation incidental aneurysms, in young or middle age patients, should be considered for treatment. Surgical clipping is an accepted treatment for middle cerebral artery unruptured aneurysms. Ischemic events can occur even in cases of incidental aneurysm surgery. Since regional cerebral blood flow can be compromised due to temporary arterial clipping or to incorrect placement of defi nitive clip, we performed intra-operative monitoring of brain tissue oxygen concentration (PtiO₂), to detect changes in brain oxygenation due to reduced blood fl ow, eventually leading to ischemia, during surgery of middle cerebral artery incidental aneurysms.

Methods:

PtiO₂ monitoring was performed during surgery of eight patients harboring incidental MCA aneurysms, using a polarographic microcatheter (Licox, GMS – Kiel, Germany), placed in the temporal lobe on the side of the lesion, from dural opening to dural closure.

Results:

Basal values varied between 2.3 and 27.3 mmHg; these values are lower than those previously described in the literature as “normal” for uninjured brain or in cases of subarachnoid hemorrhage. In all patients, a significant decrease in PtiO2 was found in every period of temporary clipping of MCA. Post-operative infarction in the territory of middle cerebral artery occurred in one patient and, in that case, there was a persistent minimum value of 0.6 mmHg, without recovery after the placement of the definitive clip. In another patient, an incorrect placement of the definitive clip could be predicted by a decrease in PtiO₂ value.

Conclusions:

PtiO₂ monitoring during aneurysm surgery shows brain tissue perfusion in real time and there is a correlation between any episode of reduced blood flow to the affected vascular territory during surgery and a decrease of PtiO2 values. Unexpected low basal values were obtained in “uninjured” brain, with no influence from subarachnoid hemorrhage. The values of risk for brain infarction during temporary arterial occlusion still need further studies, but an incomplete recovery or a persistent fall in PtiO₂ values after definitive clipping should be considered as an indication for verification of the position of the clip.

Parental help-seeking for behavioural and emotional problems in childhood and adolescence

Previous publications from the Dunedin Multidisciplinary Health and Development Research Unit have reported the prevalence of DSM-III disorders through its longitudinal examination of a New Zealand birth cohort. The present study describes the help-seeking practices of each sample member's parents for their child's behavioural or emotional problems exhibited in childhood (ages 5-11) or adolescence (ages 12-15). Increased help-seeking for boys was evident in childhood. However, this sex difference was not present at adolescence. There was a decline in the frequency with which medically oriented agencies were contacted between childhood and adolescence, and teachers were found to be the most frequently used source of assistance in adolescence. Although there was a strong association between help-seeking and mental health disorder, approximately half of those with disorder had parents who had not sought help for their child's problems. In addition, family characteristics of low SES, low family social support and poorer maternal mental health predicted help-seeking. The results are discussed in terms of service provision for these age groups, within the present restructuring of the public health system in New Zealand.

Pacific Islands Families Study: risk factors associated with otitis media with effusion among Pacific 2-year-old children

OBJECTIVE

This study examined the risk factors associated with middle ear disease in a cohort of Pacific 2-year-old children residing in New Zealand.

METHODS

The data were gathered as part of the Pacific Island Families: first 2 years of life (PIF) study in which 656 2-year-old were screened using tympanometry to identify children at risk for otitis media with effusion (OME) and other otological disorders.

RESULTS

Within this 2-year-old cohort of Pacific children, one set of factors significantly associated with OME was clustered around the respiratory and auditory health of the child over the past year. OME was more likely for children who were regularly suffering from fluid/pus discharge from ears (OR=2.10, 95% CI: 1.01-4.35), children with five or more coughs/colds in the last year (OR=1.90, 95% CI: 1.22-3.00), and children who frequently/constantly snored (OR=2.60, 95% CI: 1.09-6.23) to have OME. Those children who were treated at home for breathing problems were more that two times more likely to have OME (OR=2.61, 95% CI: 1.55-4.42). A second set of factors was clustered around environmental risks that exposed children to a large number of other children. Children who attended a day care centre for more than 20h were five times more likely (OR=5.21, 95% CI: 2.90-9.35) and those who regularly attended church (OR=2.78, 95% CI: 1.05-7.40) were almost three times more likely to have OME.

CONCLUSIONS

These findings portray a child compromised by persistent ear infections and general coughs and colds as being at increased risk of contracting OME. In line with international research these findings raise questions about the negative child health effects associated with the day care environment for young children.

Pacific Islands families study: the prevalence of chronic middle ear disease in 2-year-old Pacific children living in New Zealand

OBJECTIVE

The aim of this study was to determine the prevalence of chronic middle ear disease in 2-year-old Pacific children living in New Zealand.

METHODS

The data were gathered as part of the Pacific Islands Families: First Two Years of Life (PIF) Study in which 1001 two year olds were screened using tympanometry to identify children at risk for otitis media with effusion (OME) and other otological disorders. Those failing the screening tests were referred to Manukau Superclinic where they had a further tympanometry test, and if they failed this test, were followed up with a comprehensive otological examination by an otolaryngologist using otomicroscopy and pneumatic otoscopy.

RESULTS

Bilateral otitis media with effusion (OME) was the most common abnormality detected (N=102) with further cases of unilateral OME (N=8), and unilateral OME resolving (N=2). Other cases of OME were associated with acute otitis media (AOM), impacted wax (N=1), perforation (N=1), and mild retraction (N=2). Overall there were 118 children with unilateral or bilateral OME. AOM of any form was seen in nine cases. Retraction of the tympanic membrane was seen in 26 cases. The population prevalence among Pacific 2-year-old children was estimated as 25.4% for OME, 1.9% for AOM, and 26.9% for OME or AOM.

CONCLUSIONS

These findings reveal that over 25% of Pacific Island 2-year-old were affected by OME and recommend the consideration of national screening for OME and other otological disorders at this earlier age.

Molecular characterization of the first Aichi viruses isolated in Europe and in South America

The occurrence of Aichi virus, a picornavirus associated with acute gastroenteritis, has so far only been described in Asian countries. This study reports the first finding of Aichi virus in clinical specimens from Germany and Brazil. The nucleotide sequences of both a German and a Brazilian isolate were determined, analyzed, and compared to known Aichi sequences. The German strain turned out to be a member of genogroup A, while the Brazilian belonged to genogroup B. For a primary assessment of the epidemiological importance of Aichi virus in Germany, a panel of 485 German serum samples was screened for antibody to Aichi virus, and a seroprevalence of 76% was found.

Molecular characterization of human astroviruses isolated in Brazil, including the complete sequences of astrovirus genotypes 4 and 5

Human astroviruses (HAstV) are recognized as an important cause of gastroenteritis in young children worldwide. This study describes the molecular characteristics of astroviruses isolated in Brazil, using RT-PCR and molecular sequencing of segments of all three viral ORFs. Genetic analysis of a 348-nucleotide segment from ORF 2 demonstrated that the Brazilian isolates belong to HAstV genotypes 1 to 5 and 8. ORF 1b sequences displayed a high degree of nucleotide identity even between different genotypes, which disfavours HAstV genotyping in this region. ORF 1a sequence analysis classified all Brazilian samples as genogroup A. The complete sequences of HAstV genotype 4 (putative serotype 4) and genotype 5 (putative serotype 5) were determined for the first time.

Child-rearing antecedents of intergenerational relations in young adulthood: a prospective study

Data gathered from mothers on parenting and family climate when almost 1,000 children in the Dunedin, New Zealand, longitudinal study were 3, 5, 7, 9, 13, and 15 years of age were used to predict intergenerational relations between young adult children (age 26) and their middle-aged parents. Analyses focused on distinct developmental epochs revealed greater prediction from the middle-childhood and early-adolescent periods than from the early-childhood years: most indicated that more supportive family environments and child-rearing experiences in the family of origin forecasted more positive and less negative parent-child relationships (in terms of contact, closeness, conflict, reciprocal assistance) in young adulthood, though associations were modest in magnitude. Some evidence indicated that (modestly) deleterious effects on intergenerational relations of experiencing relatively unsupportive child-rearing environments in 1 but not 2 (of 3) developmental periods studied could be offset by relatively supportive family environments in the remaining developmental periods.

Child-rearing antecedents of intergenerational relations in young adulthood: a prospective study

Data gathered from mothers on parenting and family climate when almost 1,000 children in the Dunedin, New Zealand, longitudinal study were 3, 5, 7, 9, 13, and 15 years of age were used to predict intergenerational relations between young adult children (age 26) and their middle-aged parents. Analyses focused on distinct developmental epochs revealed greater prediction from the middle-childhood and early-adolescent periods than from the early-childhood years: most indicated that more supportive family environments and child-rearing experiences in the family of origin forecasted more positive and less negative parent-child relationships (in terms of contact, closeness, conflict, reciprocal assistance) in young adulthood, though associations were modest in magnitude. Some evidence indicated that (modestly) deleterious effects on intergenerational relations of experiencing relatively unsupportive child-rearing environments in 1 but not 2 (of 3) developmental periods studied could be offset by relatively supportive family environments in the remaining developmental periods.

The effect of academic self-concept on ADHD and antisocial behaviors in early adolescence

Using structural equation modeling techniques, we evaluated the effect of academic self-concept (ASC) on the development of attention-deficit/hyperactivity disorder (ADHD) and antisocial behaviors in early adolescence. Participants (n = 445) were recruited from the Dunedin Multidisciplinary Health and Development Research study. Eligibility was determined by the presence of complete data for the following variables at the specified time periods: reading at age 7, teacher reports of ADHD and antisocial behaviors at age 7, self-ratings of ASC at ages 9 and 11, and teacher reports of ADHD and antisocial behaviors at age 13. The results indicated that ASC is an important construct that directly contributes to the development of antisocial behaviors rather than to symptoms of ADHD. The results also indicated that children's early history of behavioral problems and academic performance contribute to the development of a more robust understanding of the impact of ASC on the development of disruptive behaviors in early adolescence.

Behaviour and developmental effects of otitis media with effusion into the teens

OBJECTIVE

To examine whether behavioural or cognitive sequelae of otitis media with effusion (OME) continue into late childhood and the early teens (11-18 years).

SETTING

Data from a large multipurpose birth cohort study: the Dunedin multidisciplinary health and development study.

PARTICIPANTS

Around 1000 children from the study. The main independent variable of interest was otological status of the child up to age 9.

MAIN OUTCOME MEASURES

Parent and teacher rated behaviour problems, including antisocial, neurotic, hyperactive, and inattentive behaviours, and tests of academic achievement including intelligence quotient (IQ), reading, and spelling were available in a high proportion of the cohort at ages 11 to 18 years.

RESULTS

After adjustments for covariates such as socioeconomic status, hyperactive and inattentive behaviour problems were evident as late as 15 years, and lower IQ associated with OME remained significant to 13 years. The largest effects were observed for deficits in reading ability between 11 and 18 years.

CONCLUSIONS

No previous study considering behaviour problems as an outcome has followed children long enough to determine whether some of the early sequelae of OME are still present in the early to late teens. Some developmental sequelae of OME, particularly deficits in reading ability, can persist into late childhood and the early teens.

Boys with reading disabilities and/or ADHD: distinctions in early childhood

We examined distinctions in the early childhood characteristics of boys with reading disabilities (RD) and/or attention-deficit/ hyperactivity disorder (ADHD). A four-group mixed design consisting of boys identified at age 11 with reading disabilities only (RD only; n = 46), reading disabilities and ADHD (RD/ADHD; n = 16), ADHD only (n = 20), and a comparison group (n = 281) was utilized. Differences on receptive and expressive language and temperament for ages 3 and 5 were investigated. Analyses indicated that the boys from the RD-only group performed worse on measures of receptive and expressive language. The results also indicated that boys from the RD/ADHD groups consistently performed worse on measures of receptive language and exhibited more behaviors indicative of an undercontrolled temperament. In summary, we suggest that reading disabilities and ADHD represent moderately unique disorders that frequently co-occur and are characterized by distinct developmental pathways.

Failure to overcome 'innate' fear: a developmental test of the non-associative model of fear acquisition

The non-associative, Darwinian theory of fear acquisition proposes that some individuals fail to overcome biologically-relevant fears (e.g. height) because they (1) do not have sufficient safe exposure to the relevant stimuli early in life or (2) are poor habituators who have difficulty 'learning not to fear'. These two hypotheses were tested in a longitudinal birth cohort study. Study 1 found evidence for reduced exposure to height stimuli in childhood for individuals with a fear of heights compared to study members without fear. Study 2 found evidence for higher levels of stress reactivity (a proxy for habituation) in childhood and adolescence among 18-year-old height phobics compared to study members with dental phobia and those with no fear. The results were discussed in relation to recent findings suggesting that some evolutionary-relevant fears may appear in the absence of traumatic 'learning' experiences. The merits of adding a fourth, non-associative pathway to Rachman's [Rachman, S. (1977)]. The conditioning theory of fear acquisition: a critical examination. Behaviour Research and Therapy, 15, 375-387) three pathways model of fear acquisition were briefly considered.

The effects of pre- and post-natal sunlight exposure on human growth: evidence from the Southern Hemisphere

Several recent studies have reported a causal association between stature and month of birth. Perinatal exposure to sunlight has been suggested as the principal factor underlying this relationship, although the mechanisms involved remain a matter of debate. The longitudinal design of the present study allowed us to directly test the influence of perinatal sunlight exposure (and other meteorological and behavioural factors) on body size at birth and at regular intervals up to age 26. The findings confirmed that pre-natal sunlight is one of the most significant determinants of height. However, the trimester of greatest influence differs depending on the age at which study members were measured.

Mental disorders and violence in a total birth cohort: results from the Dunedin Study

BACKGROUND

We report on mental disorders and violence for a birth cohort of young adults, regardless of their contact with the health or justice systems.

METHODS

We studied 961 young adults who constituted 94% of a total-city birth cohort in New Zealand, April 1, 1972, through March 31, 1973. Past-year prevalence of mental disorders was measured using standardized DSM-III-R interviews. Past-year violence was measured using self-reports of criminal offending and a search of official conviction records. We also tested whether substance use before the violent offense, adolescent excessive perceptions of threat, and a juvenile history of conduct disorder accounted for the link between mental disorders and violence.

RESULTS

Individuals meeting diagnostic criteria for alcohol dependence, marijuana dependence, and schizophrenia-spectrum disorder were 1.9 (95% confidence interval [CI], 1.0-3.5), 3.8 (95% CI, 2.2-6.8), and 2.5 (95% CI, 1.1-5.7) times, respectively, more likely than control subjects to be violent. Persons with at least 1 of these 3 disorders constituted one fifth of the sample, but they accounted for half of the sample's violent crimes (10% of violence risk was uniquely attributable to schizophrenia-spectrum disorder). Among alcohol-dependent individuals, violence was best explained by substance use before the offense; among marijuana-dependent individuals, by a juvenile history of conduct disorder; and among individuals with schizophrenia-spectrum disorder, by excessive perceptions of threat and a history of conduct disorder.

CONCLUSIONS

In the age group committing most violent incidents, individuals with mental disorders account for a considerable amount of violence in the community. Different mental disorders are linked to violence via different core explanations, suggesting multiple-targeted prevention strategies.

Water trauma and swimming experiences up to age 9 and fear of water at age 18: a longitudinal study

A small number of retrospective studies on the etiology of specific fears have obtained findings consistent with a biological (non-associative) explanation of fear acquisition. Unfortunately, reliance on imperfect memory to recall conditioning events which occurred many years earlier limits the conclusions that can be drawn from such data. The present investigation attempts to overcome this methodological shortcoming by examining the relationship between water trauma (i.e. conditioning) and water skills (e.g. swimming) before the age of 9 and the presence of water fear and phobia at age 18 in a longitudinal birth cohort. We found no evidence of a relationship between water confidence and water trauma up to the age of 9 and fear of water at age 18. Similar findings were obtained for water phobia at age 18 with the exception that study members who were less able to immerse themselves in water with confidence at age 9 were more likely to report water phobia at age 18. Associative and non-associative explanations of these findings were discussed.

Dental caries and changes in dental anxiety in late adolescence

Little is known about changes in dental anxiety with ageing and their association with changes in oral health. This study examined the relationship between changes in dental caries experience and dental anxiety from 15 to 18 years of age among adolescent participants in the Dunedin Multidisciplinary Health and Development Study. Dental anxiety was estimated using the Corah Dental Anxiety Scale (DAS), and individuals with a DAS score of 13+ were identified as being dentally anxious. Dental examinations were performed on 649 individuals at ages 15 and 18, and a DMFS score was computed for each. Caries prevalence among those who were dentally anxious at both 15 and 18 years was significantly higher than for those who were not at either age. Regression analysis revealed that dental anxiety predicted caries incidence between ages 15 and 18 years. Dental anxiety is likely to be a significant predictor of dental caries experience, and may be a risk factor for dental caries incidence.

Developmental antecedents of partner abuse: a prospective-longitudinal study

Prospective measures of risk factors for partner abuse were obtained from a large birth cohort in 4 domains: socioeconomic resources, family relations, educational achievements, and problem behaviors. Partner abuse outcomes were measured at age 21. Results showed that antecedents of abuse included risk factors from all 4 domains. Risk factors were similar for men and women. Some age 3 antecedents were significant, but the strongest correlations were from age 15. In multivariate analyses, the most consistent predictor was the presence of early problem behaviors. In a cross-validation tests, abuse was moderately predictable by the same antecedents, whether the outcome measure was self-report or reports from partners of sample members. Findings suggest that theories of partner abuse should account for developmental influences from multiple life domains and that primary prevention of partner abuse should begin in adolescence.

Developmental antecedents of partner abuse: a prospective-longitudinal study

Prospective measures of risk factors for partner abuse were obtained from a large birth cohort in 4 domains: socioeconomic resources, family relations, educational achievements, and problem behaviors. Partner abuse outcomes were measured at age 21. Results showed that antecedents of abuse included risk factors from all 4 domains. Risk factors were similar for men and women. Some age 3 antecedents were significant, but the strongest correlations were from age 15. In multivariate analyses, the most consistent predictor was the presence of early problem behaviors. In a cross-validation tests, abuse was moderately predictable by the same antecedents, whether the outcome measure was self-report or reports from partners of sample members. Findings suggest that theories of partner abuse should account for developmental influences from multiple life domains and that primary prevention of partner abuse should begin in adolescence.

The structure and stability of common mental disorders (DSM-III-R): a longitudinal-epidemiological study

The latent structure and stability of 10 common mental disorders were examined in a birth cohort at ages 18 and 21. A 2-factor model, in which some disorders were presumed to reflect internalizing problems and others were presumed to reflect externalizing problems, provided a more optimal fit to the data than either a 1- or a 4-factor model. To a significant extent, persons in the sample retained their relative positions on the latent factors across the 3-year period from age 18 to age 21. Results offer potential clarification of the meaning of comorbidity in psychopathology research by suggesting that comorbidity may results from common mental disorders being reliable, covariant indicators of stable, underlying "core psychopathological processes."

Comorbid mental disorders: implications for treatment and sample selection

Disorders from the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; American Psychiatric Association, 1987) were assessed in a birth cohort of 961 young adults. Comorbid cases exceeded single-disordered cases in chronic history of mental illness, use of treatments, physical health problems, functional interference in daily life, and impaired adaptation across domains such as work, education, health, and social-support networks. Single-disorder cases were also more impaired than nondisordered cases, but comorbid cases were the most severely impaired. Our findings suggest that (a) samples that underrepresent comorbidity (pure single-disorder cases or student samples) will underestimate effect sizes for relations between a disorder and its correlates, whereas samples that overrepresent comorbidity (clinical or adjudicated samples) will overestimate effect sizes, (b) comorbidity is accompanied by complications that challenge treatment planning, compliance, and coordination of service delivery, and (c) comorbidity is associated with physical, educational, and economic problems that make it a broad societal concern.

Adult physical health outcomes of adolescent girls with conduct disorder, depression, and anxiety

OBJECTIVE

To examine the young adult physical health outcomes of adolescent girls with behavior problems.

METHOD

Girls with conduct disorder, girls with depression, girls with anxiety, and healthy girls (N = 459) who had been evaluated at age 15 years were followed up at age 21, when general physical health, substance dependence, and reproductive health were assessed.

RESULTS

After control for potentially confounding variables including prior health, adolescent conduct disorder predicted more medical problems, poorer self-reported overall health, lower body mass index, alcohol and/or marijuana dependence, tobacco dependence, daily smoking, more lifetime sexual partners, sexually transmitted disease, and early pregnancy. Adolescent depression predicted only adult tobacco dependence and more medical problems; adolescent anxiety predicted more medical problems.

CONCLUSIONS

The robust link between female adolescent conduct disorder and poor physical health in adulthood suggests that intervention with girls who have conduct disorder may be a strategy for preventing subsequent health problems.

Dental fear with and without blood-injection fear: implications for dental health and clinical practice

The relation between dental, blood and injection fear and oral health was examined in 936 New Zealand 18-year-olds. Of the approximately ten percent (n = 96) of the sample who reported a dental fear, 1 in 10 also reported a fear of blood and 53% a co-morbid fear of injections. Study members with dental fear alone or co-morbid dental and blood or injection fear had significantly worse oral health (i.e. greater caries experience) than a no-fear comparison group or individuals with blood-injection fear only. Further, individuals with dental and blood or injection fear had a significantly higher level of recent tooth decay than individuals with dental fear alone. Time since last dental treatment also tended to be highest in this group. Implications for dental health and practice were discussed.

The structure and stability of common mental disorders (DSM-III-R): a longitudinal-epidemiological study

The latent structure and stability of 10 common mental disorders were examined in a birth cohort at ages 18 and 21. A 2-factor model, in which some disorders were presumed to reflect internalizing problems and others were presumed to reflect externalizing problems, provided a more optimal fit to the data than either a 1- or a 4-factor model. To a significant extent, persons in the sample retained their relative positions on the latent factors across the 3-year period from age 18 to age 21. Results offer potential clarification of the meaning of comorbidity in psychopathology research by suggesting that comorbidity may results from common mental disorders being reliable, covariant indicators of stable, underlying "core psychopathological processes."

Evidence for a non-associative model of the acquisition of a fear of heights

Theories that fear results from previous traumatic experience (i.e. conditioning theories) have enjoyed widespread support for over half a century. Recent research, however, has cast doubt on the validity of these models in some specific phobias. Two studies on the etiology of height phobia have obtained findings consistent with a non-associative, evolutionary explanation of fear acquisition (Menzies and Clarke, 1993a, Behaviour Research and Therapy, 31, 355-365; Menzies and Clarke, 1995a, Behaviour Research and Therapy, 33, 795-805). Unfortunately, the retrospective nature of these studies limits the conclusions that can be drawn from these data. Like all retrospective research, these studies depend on adult subjects imperfect ability to recall conditioning events that may have occurred many years earlier. The present investigation overcomes these methodological shortcomings by examining the relationship between putative conditioning events before the age of 9 yr and the presence of height fear at ages 11 and 18 yr in a large birth cohort studied longitudinally. To our knowledge this is the first study that has prospectively examined the relationship between relevant traumatic events early in life and the onset of height fear in late adolescence. No positive relationship was found between a history of falls resulting in injury (i.e. fracture, dislocation, intracranial injury or laceration) before the age of 9 and fear of heights at age 11 or 18. Interestingly, falls resulting in injury between the ages of 5 and 9 occurred more frequently in those without a fear of heights at 18 (P < 0.01)--a finding in the opposite direction to that predicted by conditioning theory but consistent with non-associative theories of fear acquisition. In general, the results provide strong support for non-associative models of fear and are difficult to reconcile with conditioning theories.

Assortative mating for antisocial behavior: developmental and methodological implications

Do people mate assortatively for antisocial behavior? If so, what are the implications for the development and persistence of antisocial behavior? We investigated assortative mating for antisocial behavior and its correlates in a sample of 360 couples from Dunedin, New Zealand. We found substantial assortative mating for self-reports of antisocial behavior per se and for self-reports of couple members' tendencies to associate with antisocial peers (0.54 on average). Perceptions about the likelihood of social sanctions for antisocial behavior (e.g., being caught by the authorities or losing the respect of one's family) showed moderate assortative mating (0.32 on average). However, assortative mating for personality traits related to antisocial behavior was low (0.15 on average). These findings suggest that, whereas assortative mating for many individual-difference variables (such as personality traits) is low, assortative mating for actual antisocial behaviors is substantial. We conclude that future family studies of antisocial behavior should endeavor to measure and understand the influence of assortative mating. In addition, we outline a testable behavior-genetic model for the development of antisocial behavior, in which genes and environments promoting or discouraging antisocial behavior become concentrated within families (due to assortative mating), giving rise to widely varying individual developmental trajectories that are, nevertheless, similar within families.

Comorbid mental disorders: implications for treatment and sample selection

Disorders from the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; American Psychiatric Association, 1987) were assessed in a birth cohort of 961 young adults. Comorbid cases exceeded single-disordered cases in chronic history of mental illness, use of treatments, physical health problems, functional interference in daily life, and impaired adaptation across domains such as work, education, health, and social-support networks. Single-disorder cases were also more impaired than nondisordered cases, but comorbid cases were the most severely impaired. Our findings suggest that (a) samples that underrepresent comorbidity (pure single-disorder cases or student samples) will underestimate effect sizes for relations between a disorder and its correlates, whereas samples that overrepresent comorbidity (clinical or adjudicated samples) will overestimate effect sizes, (b) comorbidity is accompanied by complications that challenge treatment planning, compliance, and coordination of service delivery, and (c) comorbidity is associated with physical, educational, and economic problems that make it a broad societal concern.

Development of depression from preadolescence to young adulthood: emerging gender differences in a 10-year longitudinal study

The authors investigated the emergence of gender differences in clinical depression and the overall development of depression from preadolescence to young adulthood among members of a complete birth cohort using a prospective longitudinal approach with structured diagnostic interviews administered 5 times over the course of 10 years. Small gender differences in depression (females greater than males) first began to emerge between the ages of 13 and 15. However, the greatest increase in this gender difference occurred between ages 15 and 18. Depression rates and accompanying gender differences for a university student subsample were no different than for a nonuniversity subsample. There was no gender difference for depression recurrence or for depression symptom severity. The peak increase in both overall rates of depression and new cases of depression occurred between the ages of 15 and 18. Results suggest that middle-to-late adolescence (ages 15-18) may be a critical time for studying vulnerability to depression because of the higher depression rates and the greater risk for depression onset and dramatic increase in gender differences in depression during this period.

Development of depression from preadolescence to young adulthood: emerging gender differences in a 10-year longitudinal study

The authors investigated the emergence of gender differences in clinical depression and the overall development of depression from preadolescence to young adulthood among members of a complete birth cohort using a prospective longitudinal approach with structured diagnostic interviews administered 5 times over the course of 10 years. Small gender differences in depression (females greater than males) first began to emerge between the ages of 13 and 15. However, the greatest increase in this gender difference occurred between ages 15 and 18. Depression rates and accompanying gender differences for a university student subsample were no different than for a nonuniversity subsample. There was no gender difference for depression recurrence or for depression symptom severity. The peak increase in both overall rates of depression and new cases of depression occurred between the ages of 15 and 18. Results suggest that middle-to-late adolescence (ages 15-18) may be a critical time for studying vulnerability to depression because of the higher depression rates and the greater risk for depression onset and dramatic increase in gender differences in depression during this period.

Comorbidity between abuse of an adult and DSM-III-R mental disorders: evidence from an epidemiological study

OBJECTIVE

The purpose of this study was to report the prevalence, risk, and implications of comorbidity between partner violence and psychiatric disorders.

METHOD

Data were obtained from a representative birth cohort of 941 young adults through use of the Conflict Tactics Scales and Diagnostic Interview Schedule.

RESULTS

Half of those involved in partner violence had a psychiatric disorder; one-third of those with a psychiatric disorder were involved in partner violence. Individuals involved in severe partner violence had elevated rates of a wide spectrum of disorders.

CONCLUSIONS

The findings support the importance of mental health clinicians screening for partner violence and treating victims and perpetrators before injury occurs.

Personality differences predict health-risk behaviors in young adulthood: evidence from a longitudinal study

In a longitudinal study of a birth cohort, the authors identified youth involved in each of 4 different health-risk behaviors at age 21: alcohol dependence, violent crime, unsafe sex, and dangerous driving habits. At age 18, the Multidimensional Personality Questionnaire (MPQ) was used to assess 10 distinct personality traits. At age 3, observational measures were used to classify children into distinct temperament groups. Results showed that a similar constellation of adolescent personality traits, with developmental origins in childhood, is linked to different health-risk behaviors at 21. Associations between the same personality traits and different health-risk behaviors were not an artifact of the same people engaging in different health-risk behaviors; rather, these associations implicated the same personality type in different but related behaviors. In planning campaigns, health professionals may need to design programs that appeal to the unique psychological makeup of persons most at risk for health-risk behaviors.

Personality differences predict health-risk behaviors in young adulthood: evidence from a longitudinal study

In a longitudinal study of a birth cohort, the authors identified youth involved in each of 4 different health-risk behaviors at age 21: alcohol dependence, violent crime, unsafe sex, and dangerous driving habits. At age 18, the Multidimensional Personality Questionnaire (MPQ) was used to assess 10 distinct personality traits. At age 3, observational measures were used to classify children into distinct temperament groups. Results showed that a similar constellation of adolescent personality traits, with developmental origins in childhood, is linked to different health-risk behaviors at 21. Associations between the same personality traits and different health-risk behaviors were not an artifact of the same people engaging in different health-risk behaviors; rather, these associations implicated the same personality type in different but related behaviors. In planning campaigns, health professionals may need to design programs that appeal to the unique psychological makeup of persons most at risk for health-risk behaviors.

Daylength during pregnancy and shyness in children: results from northern and southern hemispheres

An extreme degree of shyness in young children is a temperamental trait under modest genetic influence and characterized by distinct physiological profiles. Data from both the United States and New Zealand indicate that maternal exposure to short daylength during pregnancy, especially the midpoint of gestation, predicts an increased risk of subsequent shy behavior in children. Estimates of attributable risk indicate that approximately one-quarter of shyness prevalence can be linked to pregnancy during times of reduced daylength. This phenomenon might be mediated by changing concentrations of melatonin, serotonin, or other neurotransmitters or corticoids that are known to covary with seasonal variations in daylength.