BACKGROUND:The association among gallbladder disease, cholecystectomy, and pancreatic cancer is unclear. Moreover, time interval between gallbladder disease or cholecystectomy and pancreatic cancer diagnosis is not considered in most previous studies. AIM:To quantify the association among gallbladder disease, cholecystectomy, and pancreatic cancer, considering time since first diagnosis of gallbladder disease or cholecystectomy. METHODS:We used data from nine case-control studies within the Pancreatic Cancer Case-Control Consortium, including 5760 cases of adenocarcinoma of the exocrine pancreas and 8437 controls. We estimated pooled odds ratios and the corresponding 95% confidence intervals by estimating study-specific odds ratios through multivariable unconditional logistic regression models, and then pooling the obtained estimates using fixed-effects models. RESULTS:Compared with patients with no history of gallbladder disease, the pooled odds ratio of pancreatic cancer was 1.69 (95% confidence interval, 1.51-1.88) for patients reporting a history of gallbladder disease. The odds ratio was 4.90 (95% confidence interval, 3.45-6.97) for gallbladder disease diagnosed <2 years before pancreatic cancer diagnosis and 1.11 (95% confidence interval, 0.96-1.29) when ≥2 years elapsed. The pooled odds ratio was 1.64 (95% confidence interval, 1.43-1.89) for patients who underwent cholecystectomy, as compared to those without cholecystectomy. The odds ratio was 7.00 (95% confidence interval, 4.13-11.86) for a surgery <2 years before pancreatic cancer diagnosis and 1.28 (95% confidence interval, 1.08-1.53) for a surgery ≥2 years before. CONCLUSIONS:There appears to be no long-term effect of gallbladder disease on pancreatic cancer risk, and at most a modest one for cholecystectomy. The strong short-term association can be explained by diagnostic bias and reverse causation.

Objective: To explore the experiences, expectations, and motivations of parents/caregivers of children with otitis media who were booked to undergo tympanostomy tube insertion. Method: A cross-sectional cohort study was conducted using semistructured interviews with 39 parents. Interviews were conducted via telephone and analyzed for key themes. Results: Three themes emerged that incorporated a range of subthemes: (1) the impact of the child’s underlying condition on the family, (2) the cues and prompts that influenced parents to seek intervention, and (3) the parents’ expectations of the health-care system. The child’s otitis media disrupted the day-to-day functioning of the family and the child’s well-being, but despite this, the families found ways to adapt and cope. Parents were influenced by their friends, family, and medical practitioners when making treatment decisions and had differing expectations of the health-care system. Conclusion: Parents need support during their child’s illness to help with pressures placed on the family and also in making health-care decisions for their child. Clinicians should consider these issues when discussing treatment options with parents.

Aims: Gestational diabetes (GDM) and Type 2 diabetes pose tremendous health and economic burdens as worldwide incidence increases. Primary care-based systematic diabetes screening and prevention programs could be effective in women with previous GDM. GooD4Mum aimed to determine whether a Quality Improvement Collaborative (QIC) would improve postpartum diabetes screening and prevention planning in women with previous GDM in general practice. Methods: Fifteen general practices within victoria (Australia) participated in a 12-month QIC, consisting of baseline and four quarterly audits, guideline-led workshops and Plan-Do-Study-Act feedback cycles after each audit. The primary outcome measures were the proportion of women on local GDM registers completing a diabetes screening test and a diabetes prevention planning consultation within the previous 15 months. Results: Diabetes screening increased with rates more than doubled from 26% to 61% and postpartum screening increased from 43%-60%. Diabetes prevention planning consultations did not show the same level of increase (0%-10%). The recording of body mass index improved overall (51%-69%) but the number of women with normal body mass index did not. Conclusions: GooD4Mum supported increased diabetes screening and the monitoring of high risk women with previous GDM in general practice. (C) 2018 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

This study examined the long-term associations between childhood lead exposure, childhood trauma and adult substance use, and subclinical psychotic experiences (SPEs) in the Port Pirie Cohort Study. Adult participants were initially 402 (175 males, 227 females) 25–29 year-olds followed up from the Port Pirie Cohort Study that commenced in 1979 (55.6% of the original cohort). Multiple linear regression analyses were conducted on a sub-sample of 158 participants for which adequate data was available. Variables examined as correlates of positive, negative and depressive SPEs included socioeconomic status at birth, cumulative blood lead level at age 7, maternal mental health, family functioning and cognitive ability at age 11-13, and adverse childhood experiences, alcohol use and cannabis use assessed during adulthood. Cumulative blood lead levels at age 7 were bi-variately associated with the frequency of positive SPEs in adulthood; however this relationship was not significant when other variables were accounted for. Adverse childhood experiences and substance use (cannabis use in particular) were significant correlates of SPEs in adulthood.

Abstract Objective The number of years of education an individual completes is related to their future morbidity and mortality. There are obvious drivers for educational attainment such as childhood intellect, parental intelligence and education attainment, as well as socioeconomic status; and associations may be age‐dependent. We investigated associations between intelligence across childhood (collected at two, four, seven and between eleven and thirteen years) and educational attainment (total years) by the late 20s in the Port Pirie Cohort Study, taking into account maternal intelligence, parental schooling and occupational prestige. Method There were 388 individuals from the population‐based longitudinal Port Pirie Cohort Study (South Australia) who provided educational attainment data in the 2008‐9 data collection wave. A Structural Equation Model was employed to test associations between educational attainment and childhood cognitive/IQ measures, taking into account parental factors of IQ, schooling and socioeconomic status. Results The vast majority of variables displayed significant simple correlations with each other in expected directions, e.g. child cognitive/IQ measures with maternal IQ. In the full structural equation model, paternal schooling and child intelligence at seven years were the only variables significantly related to educational attainment by the late 20s; maternal intelligence was strongly associated with early life but not adolescent intelligence. Conclusions These findings highlight the complex inter‐generational transmission of social advantages, and substantiate the independent effects of education and intelligence on later morbidly and mortality.

Objectives We aimed to evaluate the relation between menstrual and reproductive factors, exogenous hormones, and risk of pancreatic cancer (PC). Methods Eleven case–control studies within the International Pancreatic Cancer Case–control Consortium took part in the present study, including in total 2838 case and 4748 control women. Pooled estimates of odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated using a 2-step logistic regression model and adjusting for relevant covariates. Results An inverse OR was observed in women who reported having had hysterectomy (ORyesvs.no, 0.78; 95% CI, 0.67–0.91), remaining significant in postmenopausal women and never-smoking women, adjusted for potential PC confounders. A mutually adjusted model with the joint effect for hormone replacement therapy (HRT) and hysterectomy showed significant inverse associations with PC in women who reported having had hysterectomy with HRT use (OR, 0.64; 95% CI, 0.48–0.84). Conclusions Our large pooled analysis suggests that women who have had a hysterectomy may have reduced risk of PC. However, we cannot rule out that the reduced risk could be due to factors or indications for having had a hysterectomy. Further investigation of risk according to HRT use and reason for hysterectomy may be necessary.

Objective: We explored relationships between children's cognitive abilities measured with the Wechsler Intelligence Scale for Children-Fourth Edition and blood lead levels. Methods: Participants were 127 children (mean age = 7.9 years, standard deviation = 0.6) from Australian cities, Port Pirie, and Broken Hill, with low-level blood lead concentrations (mean = 4.8 microgram/decilitre, standard deviation = 3.3, range = 1.0-19.3). Potential covariates (demographic, parental, familial, psychosocial, pre-and post-natal factors) were controlled statistically. Results: Unadjusted analyses found moderate, continuous, and statistically significant inverse, non-linear associations between blood lead level and three of the four cognitive indices that combine to deliver Full Scale IQ. In addition to blood lead level, variables that consistently explained most variance in cognitive performance were breastfeeding up to 6 months and stressful life events reported within the family for the past 12 months. In multiple regression analyses, after controlling for these, blood lead level remained a significant predictor of cognitive outcomes. Conclusion: These results support the hypothesis that blood lead levels below 10 micrograms/decilitre may still have a detrimental impact on children's cognitive abilities, supporting recent concern that there is no safe level of paediatric lead exposure.

OBJECTIVES:We aimed to evaluate the relation between menstrual and reproductive factors, exogenous hormones, and risk of pancreatic cancer (PC). METHODS:Eleven case-control studies within the International Pancreatic Cancer Case-control Consortium took part in the present study, including in total 2838 case and 4748 control women. Pooled estimates of odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated using a 2-step logistic regression model and adjusting for relevant covariates. RESULTS:An inverse OR was observed in women who reported having had hysterectomy (ORyesvs.no, 0.78; 95% CI, 0.67-0.91), remaining significant in postmenopausal women and never-smoking women, adjusted for potential PC confounders. A mutually adjusted model with the joint effect for hormone replacement therapy (HRT) and hysterectomy showed significant inverse associations with PC in women who reported having had hysterectomy with HRT use (OR, 0.64; 95% CI, 0.48-0.84). CONCLUSIONS:Our large pooled analysis suggests that women who have had a hysterectomy may have reduced risk of PC. However, we cannot rule out that the reduced risk could be due to factors or indications for having had a hysterectomy. Further investigation of risk according to HRT use and reason for hysterectomy may be necessary.

Although refugee adolescents and children are recognised as a health risk population, few studies have explored their Health-related Quality of Life (HRQOL). The present study investigated 1) the sociodemographic predictors of HRQOL such as ethnicity, trauma exposure, and length of residency in Australia in a multiethnic paediatric population with refugee experiences and 2) the relationship between mental healthcare utilisation and HRQOL. Method: Participants were 458 adolescents and children, aged 4 - 17 years, living in South Australia. Parents provided data across the sample and adolescents also completed questionnaires. Overall HRQOL and its composite functional dimensions were assessed using the Paediatric Quality of Life (PedsQL) instrument. Questions from the Child and Adolescent Component of the Australian National Survey of Mental Health and Wellbeing were used to assess service utilisation. Results: Migration region/ethnicity predicted better HRQOL as well as physical, emotional and psychosocial functioning for both children and adolescents. African youths indicated higher HRQOL than those from the former Yugoslavia and the Middle East/South Asia respectively. Pre-migration trauma exposure was associated with lower HRQOL; and longer stay in Australia was related to lower emotional functioning in children. There was a negative association between healthcare service utilisation and PedsQL scores, with participants accessing services demonstrating lower HRQOL. Conclusion: Using more rigorous methods, future research is needed to investigate additional sociodemographic predictors of HRQOL, and protective/risk factors that impact on HRQOL of young refugees.

This study compared the latency of pattern reversal visual evoked potentials (VEP) of 36-month old children exposed to opioid pharmacotherapy in utero to that of a group of non-exposed children. Pregnant women were enrolled as part of an open-label non-randomised flexible dosing longitudinal study. Participants were 21 children whose mothers were treated with buprenorphine- (n=11) or methadone-pharmacotherapy (n=10) during pregnancy, and 15 children not exposed to opioids in pregnancy. One-way between groups analyses of variance (ANOVA) were conducted to test the statistical significance of differences between the mean latencies of the peak response to two different sized checkerboard patterns (48' and 69' of retinal arc). Standard multiple regression analyses were conducted to determine whether there was a significant relationship between group status and VEP latencies after adjusting for the effect of covariates. VEP latencies ranged from 98 to 112 milliseconds (ms) for checks of 48' arc, and from 95 to 113ms for checks of 69' arc. Latencies were comparable across groups. After adjusting for covariates children prenatally exposed to methadone or buprenorphine did not differ significantly from non-opioid exposed children in their responses to either check size. Nor were there any significant differences in VEP latencies between children prenatally exposed to methadone and children prenatally exposed to buprenorphine. Head circumference (HC) was significantly associated with P100 latencies for both check sizes. Data from this controlled, non-randomised study suggest that neither buprenorphine nor methadone appear to have any long-term effects on visual maturity assessed at 36months of age.

BACKGROUND:Type 2 diabetes mellitus has been associated with an excess risk of pancreatic cancer, but the magnitude of the risk and the time-risk relationship are unclear, and there is limited information on the role of antidiabetic medications.PATIENTS AND METHODS:We analyzed individual-level data from 15 case-control studies within the Pancreatic Cancer Case-Control Consortium, including 8305 cases and 13 987 controls. Pooled odds ratios (ORs) were estimated from multiple logistic regression models, adjusted for relevant covariates.RESULTS:Overall, 1155 (15%) cases and 1087 (8%) controls reported a diagnosis of diabetes 2 or more years before cancer diagnosis (or interview, for controls), corresponding to an OR of 1.90 (95% confidence interval, CI, 1.72-2.09). Consistent risk estimates were observed across strata of selected covariates, including body mass index and tobacco smoking. Pancreatic cancer risk decreased with duration of diabetes, but a significant excess risk was still evident 20 or more years after diabetes diagnosis (OR 1.30, 95% CI 1.03-1.63). Among diabetics, long duration of oral antidiabetic use was associated with a decreased pancreatic cancer risk (OR 0.31, 95% CI 0.14-0.69, for ≥15 years). Conversely, insulin use was associated with a pancreatic cancer risk in the short term (OR 5.60, 95% CI 3.75-8.35, for <5 years), but not for longer duration of use (OR 0.95, 95% CI 0.53-1.70, for ≥15 years).CONCLUSION:This study provides the most definitive quantification to date of an excess risk of pancreatic cancer among diabetics. It also shows that a 30% excess risk persists for more than two decades after diabetes diagnosis, thus supporting a causal role of diabetes in pancreatic cancer. Oral antidiabetics may decrease the risk of pancreatic cancer, whereas insulin showed an inconsistent duration-risk relationship.

This 1-year prospective study aimed to examine associations between children''s preschool emotional and behavioral problems and their kindergarten classroom engagement, and to identify any gender differences in this association. In preschool, parents and teachers completed questionnaires assessing aspects of children''s ((n == 575)) emotional and behavioral problems. Teachers rated children''s engagement levels 1 year later in kindergarten. Compared with girls, boys showed higher levels of preschool hyperactivity/inattention and conduct problems, and lower kindergarten engagement. Regression analyses revealed that boys'' higher hyperactivity/inattention levels almost completely accounted for their engagement disadvantage. However, the lack of interactions suggested that emotional/behavioral problems were related to engagement similarly for boys and girls. Preschool emotional and behavioral problems appear to be important correlates of kindergarten engagement and may be worthwhile targets for early intervention. Though girls and boys may benefit similarly from interventions, boys are disadvantaged from preschool onward and may benefit from greater support.

Background: Despite much discussion regarding the clinical relevance of glycemic variation (GV), little discourse has addressed the properties of the data set from which it is derived. We aimed to assess the minimum duration of data required using continuous glucose monitoring (CGM) that most closely approximates to a gold standard 90-day measure. Methods: Data from 20 children and adolescents with type 1 diabetes were examined. All participants had CGM data sets of 90 days duration, from which standard deviation (SD), coefficient of variation (CV), mean amplitude of glycemic action (MAGE), and continuous overlapping net glycemic action (CONGA1-8) were calculated for the overall period and then investigational periods of 2, 4, 6, 12, 18, 24, and 30 days. The percentage difference between each measure and the overall measure per time period was assessed. Results: As the duration of the CGM data set increased, the percentage error continued to decrease, giving a metric approximating more closely toward the overall measure. Median SD and CV differed from the overall measure by <10% at 12 days duration. The frequency of interruptions to the CGM trace rendered MAGE and CONGA unreliable, hence SD and CV were reported. Conclusions: We suggest that data sets used to infer GV should be of a minimum duration of 12 days. MAGE and CONGA exhibit poor performance in the setting of frequent trace interruption.

Passive reporting of adverse events following immunization (AEFI) by consumers or healthcare professionals is the primary mechanism for post-marketing surveillance of vaccine safety. Although recent initiatives have promoted consumer reporting, there is a lack of research concerning consumer reporters. Computer assisted telephone interviews (CATI) were conducted in 2011 of a cross-sectional, random, general population sample of 191 South Australian parents who stated that their children had previously experienced an AEFI. We compared awareness of surveillance, vaccine safety opinions, and demographics of parents reporting an AEFI to either healthcare professionals or surveillance authorities with those who did not report their children's AEFI. Multivariate regression analyses measured: the association between reporting and safety views; and demographic predictors of reporting an AEFI. Reporting an AEFI to a healthcare professional or a surveillance authority was not significantly associated with awareness of a surveillance system. AEFI reporters, when compared with non-reporters, were more likely to be Australian-born (OR = 4.58, [1.64, 12.78], P = 0.004); were associated with the perception that a serious reaction was more likely to occur at their children's last immunization (OR = 2.54 [95% CI 1.22, 5.30], P = 0.013); and were less accepting of the risk of febrile convulsion, (OR = 3.59 [95% CI 1.50, 8.57], P = 0.004).Although reporting an AEFI was not associated with awareness of surveillance or most socio-demographics, the results suggest some difference in safety opinions. Further studies are required to ascertain if these differences pre-date the occurrence of an AEFI or are a consequence of the AEFI and how consumers can contribute further to vaccine safety surveillance.

Several prospective cohort studies have demonstrated that childhood lead levels show small but statistically significant adjusted associations with subsequent development in later childhood and adolescence. The Port Pine Cohort study is one of the few prospective cohort studies to follow participants into adulthood. This paper reviews all childhood and adulthood findings of the Port Pine Cohort study to date.Cohort members (initially, 723 infants born in/around the lead-smelting town of Port Pine) showed a wide range of childhood blood lead levels, which peaked around 2 years old (M = 21.3 mu g/dL, SD = 1.2). At all childhood assessments, postnatal lead levels particularly those reflecting cumulative exposure showed small significant associations with outcomes including cognitive development, IQ and mental health problems. While associations were substantially attenuated after adjusting for several childhood covariates, many remained statistically significant. Furthermore, average childhood blood lead showed small significant associations with some adult mental health problems for females, including anxiety problems and phobia, though associations only approached significance following covariate adjustment. Overall, there did not appear to be any age of greatest vulnerability or threshold of effect, and at all ages, females appeared more susceptible to lead-associated deficits.Together, these findings suggest that the associations between early childhood lead exposure and subsequent developmental outcomes may persist. However, as the magnitude of these effects was small, they are not discernible at the individual level, posing more of a population health concern. It appears that the combination of multiple early childhood factors best predicts later development. As such, minimising lead exposure in combination with improving other important early childhood factors such as parent child interactions may be the best way to improve developmental outcomes. (C) 2014 Elsevier Inc. All rights reserved.

Age-specific paediatric reference intervals are used in interpretation of laboratory results. However, interpretation may be problematic when a child just crosses an age bracket and the difference between the original and the subsequent age-specific reference interval is large. Moreover, details about the physiological changes with age may be masked. For the 12 months ending 30 September 2013, results of 16 common clinical biochemistry tests of ambulatory paediatric patients aged 0-19, requested by primary care physicians, were retrospectively collected in a large pathology service, and used to construct smoothed centile charts using a penalised maximum likelihood method. From the developed centile charts, the concentrations of sodium, bicarbonate, creatinine, urate, total protein, and albumin all increased with increasing age of the children. In contrast, the concentrations of potassium, chloride, anion gap, calcium, phosphate and lactate dehydrogenase decreased with increasing age of the children. Changes in the concentrations of urea, alkaline phosphatase, glucose, and total cholesterol varied by age. Generally, the boys and girls shared similar trend patterns until 10-15 years of age, when variations in the age of onset of puberty and development caused the trends of some biochemical measures to differ. The paediatric biochemistry centile charts are intuitive tools to use. They complement age-specific reference intervals in the tracking, interpretation and discussion of laboratory results. They also enhance the understanding of underlying physiological changes in biochemistry in children.

Background Caesarean section rates in A ustralia rose over the period 1999–2009, as did maternal age at first birth. The contribution of the rise of maternal age to the rise in caesarean sections remains unclear. Aims To estimate the effect of increasing maternal age on the incidence of emergency caesarean section or instrumental delivery in term singleton first births in S outh A ustralia. Methods We undertook a population‐based study of 117 981 term singleton first births, which followed labour during the period 1991–2009, using data from the S outh A ustralian P erinatal S tatistics C ollection. The main outcome measures were deliveries other than spontaneous vaginal births ( SVB ) (emergency caesarean section or instrumental birth) and emergency caesarean section alone. Logistic regression analysis was performed. Results Increasing maternal age at first birth was found to be associated with delivery other than SVB and emergency caesarean section. The adjusted odds of delivery other than SVB increased multiplicatively by approximately 1.49 (95% CI , 1.47–1.51) per five‐year rise in maternal age, and the odds of emergency caesarean section increased multiplicatively by approximately 1.39 (95% CI , 1.37–1.42) per five‐year rise. Although there are likely to be many reasons for the effect, increases in maternal age at first birth made a contribution in up to 75% of the observed increase in delivery other than SVB from 44.0% to 49.6% over the study period. Conclusions Rising maternal age at first birth appeared to contribute to a large proportion of the increase in deliveries other than SVB in South Australia.

Objective: To assess the screening accuracy of information obtained from parents of 4–5-year-old children for the purpose of identifying the children who have teacher-reported mental health problems when they are aged 6–7 years. Method: The study used data from the Longitudinal Study of Australian Children (LSAC) obtained when children were aged 4–5 years and 6–7 years. The level of children’s mental health problems was assessed using the Strengths and Difficulties Questionnaire (SDQ) completed by parents when children were aged 4–5 years and by teachers when children were aged 6–7 years ( n=2163). When children were aged 4–5 years, parenting skills were assessed using three questionnaires developed for the parent-completed LSAC questionnaire and maternal mental health was assessed using the Kessler Psychological Distress Scale (K6). Results: When the level of parent-reported childhood mental health problems at 4–5 years old was used to identify children with teacher-reported mental health problems (i.e. a score in the “abnormal” range of the teacher-reported SDQ Total Difficulties Scale) when the children were aged 6–7 years, sensitivity was 26.8%, positive predictive value was 22.8%, and specificity was 92.9%. The addition of further information about the characteristics of children and their parents made only a small improvement to screening accuracy. Conclusions: Targeted interventions for preschool children may have the potential to play an important role in reducing the prevalence of mental health problems during the early school years. However, current capacity to accurately identify preschoolers who will experience teacher-reported mental health problems during the early school years is limited.