Objective To determine the use of pharmacologic analgesia during childbirth when antenatal hypnosis is added to standard care. Design Randomised controlled clinical trial, conducted from December 2005 to December 2010. Setting The largest tertiary referral centre for maternity care in South Australia. Population A cohort of 448 women at >34 weeks of gestation, with a singleton pregnancy and cephalic presentation, planning a vaginal birth. Exclusions were: the need for an interpreter; pre‐existing pain; psychiatric illness; younger than 18 years; and previous experience of hypnosis for childbirth. Methods All participants received usual care. The group of women termed H ypnosis + CD (hypnotherapist guided) were offered three antenatal live hypnosis sessions plus each session's corresponding audio CD for further practise, as well as a final fourth CD to listen to during labour. The group of women termed CD only (nurse administered) were played the same antenatal hypnosis CD s as group 1, but did not receive live hypnosis training. The control group participants were given no additional intervention or CD s. Main outcome measure Use of pharmacological analgesia during labour and childbirth. Results No difference in the use of pharmacological analgesia during labour and childbirth was found comparing hypnosis + CD with control (81.2 versus 76.2%; relative risk, RR 1.07; 95% confidence interval, 95% CI 0.95–1.20), or comparing CD only with control (76.9 versus 76.2%, RR 1.01, 95% CI 0.89–1.15). Conclusions Antenatal group hypnosis using the Hypnosis Antenatal Training for Childbirth ( HATC h) intervention in late pregnancy does not reduce the use of pharmacological analgesia during labour and childbirth.

Objective: Detection of muscle-bone-interaction in pediatric IBD patients over time.Methods: Bone parameters and muscle area were measured in 94 IBD patients (60 boys; 77 Crohn's disease, 17 ulcerative colitis; 26 newly diagnosed) by peripheral quantitative computed tomography (pQCT) at the forearm.First and latest measurements were considered.Results were expressed as sex and age specific z-scores from a healthy reference population.Results: At baseline, median age was 14.0 years (range 7 20), median disease duration 1.4 years (0 7).Time interval between measurements was 2.6 years (1 6).At baseline, patients showed reduced z-scores for height ( 0.73; 3.7 1.5), weight ( 1.05; 3.3 1.0), BMI ( 1.03; 3.6 1.2), trabecular density ( 0.61; 3.0 2.9), cortical cross sectional area (CSA) ( 0.53; 3.0 3.0) and muscle CSA ( 2.0; 4.1 2.3).Cortical density was increased (0.78; 3.6 2.8).Significant improvement over time occurred for height (0.2; 1.4 2.6), weight (0.24; 0.9 2.9), BMI (0.22; 1.9 2.9).Cortical density deteriorated ( 0.39; 4.9 4.50).Improvement of weight, BMI, total bone and muscle CSA occurred in newly diagnosed patients, but not after longer disease duration for weight (0.58 vs. 0.21), BMI (0.68 vs. 0.09), total CSA (0.24 vs. 0.10), and muscle CSA (0.55 vs. 0.17) respectively.Conclusion: Catch up of bone and muscle CSA occurs after initiation of treatment but stabilizes on a low level after longer disease duration.

OBJECTIVES:To investigate the interobserver variability of fetal middle cerebral artery (MCA) peak systolic velocity (PSV) Doppler measurements in a tertiary fetal medicine unit. METHODS:This was a prospective cohort study of pregnant women between 22 and 34 weeks of gestation who underwent fetal MCA-PSV Doppler velocimetry by a paired combination of operators. A set protocol was followed; ease of scanning was recorded and three quality assurance parameters were analyzed. The interobserver variability was determined. In addition, individual operator characteristics were determined by analyzing the variation of each operator relative to all his/her paired colleagues, and their quality assurance parameters. RESULTS:Two hundred and eighty-five women had completed paired fetal MCA-PSV Doppler measurements. Eighty-three (29%) of the ultrasound examinations requested were for suspected fetal anemia and 202 (71%) were for other obstetric indications. The interobserver variation was less than 10% in 78% of the paired MCA-PSV Doppler measurements whereas 99% had less than 15% variation. The intraclass correlation coefficient of each operator when compared with all his/her colleagues ranged from 0.82 to 0.95. The overall mean variability of the MCA-PSV recorded by a given operator, relative to all his/her paired colleagues, ranged from + 5.26% to - 6.47% in all but one operator whose value was + 13.5% (standard deviation factor, 1.13-1.22). Logistic regression analysis, using a 10% or greater variation in MCA-PSV as a binary outcome variable, showed a significant difference when inappropriate angle correction was detected (P < 0.001). CONCLUSIONS:Clinically acceptable interobserver variability was obtained in fetal MCA-PSV Doppler measurements. Inappropriate angle correction was found to be a significant predictive factor for increased interobserver variability. Analysis of mean variation identified operators who were outliers enabling quality assurance within the unit.

The authors compared service-use patterns and factors associated with service use for 279 boys and 119 girls who met the criteria for attention-deficit/hyperactivity disorder (ADHD), as defined in the Diagnostic and Statistical Manual of Mental Disorders—Fourth Edition ( DSM-IV).The participants had been identified from a nationally representative sample of Australian youth. Boys and girls with ADHD did not differ in their rates of service use, the types of services they attended (school/education or health-based services), the types of help they received, and the main problems for which they received help, with the exception that boys had higher rates of medication use. However, the factors associated with service use were not uniform across gender. For boys, problems with schoolwork or grades and number of ADHD symptoms were the main predictors of service use,whereas for girls the main predictor was the presence of depressive disorders.These findings suggest there are gender differences in the factors associated with service use among children with ADHD that are likely to have implications for assessment and treatment of the disorder.

Objectives: Low birthweight has been reported to be associated with lower IQ at school age. Further, some evidence suggests that the association extends across the range of normal birthweights. This study assessed the relationship of birthweight to cognitive development in the Port Pirie birth cohort.Methods: Of 723 singleton live births recruited into a prospective birth cohort study, 601, 548, 494 and 375 children were followed at ages 2, 4, 7 and 11–13 years, respectively. The children's developmental status was assessed using the Bayley Scales of Infant Development at age 2 years, the McCarthy Scales of Children's Abilities at age 4 years, and the revised Wechsler Intelligence Scale for Children at ages 7 and 11–13 years. The association between birthweight and cognitive function was assessed with multiple linear regression, adjusting for a wide range of possible confounders.Results: The mean birthweight was 3386 g (SD: 517). There was a statistically significant association between birthweight and cognitive performance at age 2 years (adjusted deficit: 0.97 points per 100 g lighter; 95% CI: 0.4–1.5), but the magnitude of this association gradually decreased and became statistically non‐significant at later childhood.Conclusions: The relationship between birthweight and cognitive development becomes progressively attenuated at increasing age. At older ages, socioenvironmental factors appear to play an increasingly important part in children's cognitive development.

OBJECTIVE:To examine gender differences among children meeting symptom criteria for DSM-IV attention-deficit/hyperactivity disorder (ADHD) identified in a nationally representative sample of Australian children.METHOD:From 2,404 children aged 6 to 13 years, 225 boys and 99 girls with ADHD symptoms were identified using the parent version of the Diagnostic Interview Schedule for Children and compared on parent reports of children's behavioral problems and impairment.RESULTS:When ADHD types were collapsed into a single group, boys and girls did not differ on core symptoms, comorbidity, and impairment with the exception that girls rated higher on somatic complaints and boys had poorer school functioning. However, gender patterns were found to vary across ADHD type on impairment measures of social problems, schoolwork difficulties, and self-esteem, with boys being generally rated as more impaired in the combined and hyperactive-impulsive groups but equally or less impaired in the inattentive group.CONCLUSIONS:The findings suggest the possibility of gender-specific risks associated with high levels of inattentive and hyperactive-impulsive symptoms indicating that ADHD subtype membership should be considered when conducting ADHD gender comparisons.

The aims of this study were to provide a population-based prevalence for congenital talipes equinovarus (CTEV), to conduct an epidemiological investigation into the risk factors for CTEV and describe associated features. The study used a retrospective case-control design of CTEV notified to the South Australian Birth Defects Register between 1986 and 1996 inclusive, linking characteristics of mother and baby from the perinatal data collection. The prevalence of isolated CTEV was 1.1/1000 total births (n = 231). Four factors were significantly associated with an increased risk of CTEV: maternal Aboriginal race (ORadj = 2.0; 95% CI 1.1, 3.6), male gender (ORadj = 2.4; 95% CI 1.8, 3.2), maternal anaemia (ORadj = 1.8; 95% CI 1.0, 2.9) and maternal hyperemesis (ORadj = 3.6; 95% CI 1.3, 9.8). The prevalence of CTEV associated with another birth defect or syndrome (n = 157) was 0.7/1000 total births. CTEV was associated with specific birth defects and also with oligohydramnios when another birth defect was present.

Lead is a confirmed neurotoxin, but questions remain about lead-associated intellectual deficits at blood lead levels < 10 μg/dL and whether lower exposures are, for a given change in exposure, associated with greater deficits. The objective of this study was to examine the association of intelligence test scores and blood lead concentration, especially for children who had maximal measured blood lead levels < 10 μg/dL. We examined data collected from 1,333 children who participated in seven international population-based longitudinal cohort studies, followed from birth or infancy until 5–10 years of age. The full-scale IQ score was the primary outcome measure. The geometric mean blood lead concentration of the children peaked at 17.8 μg/dL and declined to 9.4 μg/dL by 5–7 years of age; 244 (18%) children had a maximal blood lead concentration < 10 μg/dL, and 103 (8%) had a maximal blood lead concentration < 7.5 μg/dL. After adjustment for covariates, we found an inverse relationship between blood lead concentration and IQ score. Using a log-linear model, we found a 6.9 IQ point decrement [95% confidence interval (CI), 4.2–9.4] associated with an increase in concurrent blood lead levels from 2.4 to 30 μg/dL. The estimated IQ point decrements associated with an increase in blood lead from 2.4 to 10 μg/dL, 10 to 20 μg/dL, and 20 to 30 μg/dL were 3.9 (95% CI, 2.4–5.3), 1.9 (95% CI, 1.2–2.6), and 1.1 (95% CI, 0.7–1.5), respectively. For a given increase in blood lead, the lead-associated intellectual decrement for children with a maximal blood lead level < 7.5 μg/dL was significantly greater than that observed for those with a maximal blood lead level ≥7.5 μg/dL (p = 0.015). We conclude that environmental lead exposure in children who have maximal blood lead levels < 7.5 μg/dL is associated with intellectual deficits.

BACKGROUND Doctors develop the skills needed to interview parents and children in paediatric settings by practice and by receiving feedback during their medical training. Interviewed parents are ideally placed to provide evaluations of these skills. If parents, as consumers of health care services, are to be consulted, it is important to determine whether factors other than interview skills affect their evaluations. OBJECTIVES Our aim was to examine the relationship between maternal satisfaction ratings of student doctor interviews, and maternal and child characteristics. METHODS Sixty mothers of children attending the paediatric medical out-patient clinic at the Women's and Children's Hospital, South Australia were allocated randomly to rate one of four video-taped final year student doctor interviews (15 mothers per interview). The level of skills displayed by the student doctor differed in each interview. Maternal satisfaction was measured using the Medical Interview Satisfaction Scale (MISS) and the Interpersonal Skills Rating Scale (IPS), and interview ratings were compared for a number of maternal and child characteristics. RESULTS No significant associations were observed between maternal satisfaction ratings and any maternal or child characteristics other than lower satisfaction associated with previous experience of a real student doctor interview (P <0.01). The interview seen by mothers predicted 53% (MISS) and 65% (IPS) of the variance in maternal satisfaction ratings. After controlling for the interview type, the maternal and child characteristics studied predicted 17% additional variance in MISS scores and 7% in IPS scores. CONCLUSION The quality of the interview skills demonstrated was the principle determinant of maternal satisfaction ratings.

Objectives: The present study aims to describe the use of health services by children with asthma, and examine disease-specific, parental and sociodemographic variables associated with different levels of health-service utilization. Methods: Parents of 135 children attending an emergency room (ER) completed questionnaires measuring the children's asthma symptoms, and sociodemographic and psychological variables. Parents were contacted monthly for 6 months to document the number of planned and unplanned visits to hospital and community health-care services for asthma. Results: At least one further unplanned visit to the ER was made by 37% of children, while 62% made at least one unplanned visit to a general practitioner (GP). Fifty-five per cent made planned review visits to a GP, 30% to paediatricians and 5% to hospital clinics. After controlling for the level of asthma symptoms, parental anxiety and parental perceptions of children's vulnerability were associated with unplanned GP visits (P=0.05 and P=0.01, respectively); a planned review visit and the child being admitted to hospital for the index attack were associated with unplanned ER visits (P=0.05 and P=0.004, respectively). Conclusions: Children with asthma more frequently attend GP services than hospital services for both planned and unplanned asthma management. Different variables predict the unplanned use of GP and ER services. Understanding these differences is imperative if children and families are to make the most effective use of health services.

Background. It is widely accepted that the quality of doctor interviewing skills is an important determinant of health care outcomes. Two interviewing skills contributing significantly to optimal health outcomes are the clinical competence of the interviewer and the use of patient-centred techniques. However, the relative importance of these to health outcomes is unknown.Objective. The purpose of this study was to examine the relative effect on maternal recall and satisfaction of medical student clinical competence and use of patient-centred interview techniques.Methods. Sixty-nine mothers of children attending the Paediatric Medical Out-patient Clinic, Women's and Children's Hospital, South Australia agreed to participate in the study, with 60 successfully completing the study. They viewed two of four standardized 'medical student' interview videotapes in which the level of clinical competence and patient-centredness were varied independently. All other interview variables were controlled. Each mother rated the interviews by questionnaire (balanced incomplete block design, each interview rated by 30 mothers). Maternal satisfaction with the 'student' interview was measured using the Medical Interview Satisfaction Scale (MISS) and the Interpersonal Skills Rating Scale (IPS). Maternal recall of interview information was assessed by questionnaire, with maternal answers coded independently before analysis.Results. Significant, independent effects of clinical competence and patient-centredness were observed with both MISS (F = 42.1, P < 0.0001) and IPS (F = 49.3, P < 0.0001) scores. The effect of clinical competence was stronger than that of patient-centredness. Maternal recall for specific information was greater for some items following the more clinically competent interviews, but was lower for others. There was no association between maternal recall and the level of patient-centredness demonstrated by the 'student'.Conclusion. Clinical competence was a more significant determinant of maternal evaluations of medical student interviews and maternal recall of information than was patient-centredness. High levels of both patient-centredness and clinical competence were associated with the highest maternal satisfaction.

OBJECTIVE:To examine differences in health-related quality of life (HRQL) of children living in different socio-economic contexts in Australia.METHODS:Parental reports describing the HRQL and socio-economic status of a random national sample of 3,597 school-age children were obtained using the Child Health Questionnaire (CHQ) and a standardised socio-economic interview. Response rate was 70%.RESULTS:Children in families of higher income, whose parents had more years of schooling and were employed and children who lived in two-parent, original families had significantly higher HRQL across a range of domains assessed by the CHQ.CONCLUSION:Children from lower socio-economic backgrounds in Australia have a significantly more negative experience of health and wellness. Such differences may well increase unless deliberate political attention is given to addressing the widening differences in relative wealth in Australia.

Objective: To compare the health-related quality of life (HRQL) between children aged 6-17 years with one of three mental disorders (attention-deficit/hyperactivity disorder, major depressive disorder, or conduct disorder), a physical disorder, and those with none of these disorders. Method: Parent reports describing the HRQL, mental disorders, and physical disorders of a national sample of 3,597 children and adolescents in Australia, aged 6-17 years (response rate = 70%), were obtained by means of a structured diagnostic interview and questionnaires. Results: After controlling for age, gender, and family structure, children with mental disorders were reported to have a significantly worse HRQL in several domains than children with no disorder. In many areas they were reported to have a worse HRQL than children with physical disorders. Parents also reported that the problems of children with mental disorders interfered significantly with the daily lives of children, parents, and families. Conclusions: The findings are consistent with previous studies which have reported that adults with mental disorders have substantial impairment in their HRQL. The findings suggest that children with a mental disorder require help in many areas of their lives. Achieving this will require an integrated approach to health care delivery rather than the current distinction between physical and mental health services.