Proliferation, differentiation and apoptosis in villous trophoblast at 13-41 weeks of gestation (including observations on annulate lamellae and nuclear pore complexes)

Ultrastructural, immunochemical, fluorescence and stereological studies were undertaken on human villous trophoblast from 13 weeks of gestation to term. The aim was to describe and quantify morphological changes during proliferation, differentiation and apoptosis in cytotrophoblast and syncytial regions of non-aggregated and aggregated nuclei. Numbers of trophoblast nuclei increased continuously from 13 weeks. In term placentae, intrasyncytial differentiation was characterized ultrastructurally by gradual decreases in nuclear size and packing density accompanied by nucleolar regression, and increasing heterochromatinization, envelope convolution and packing density of nuclear pore complexes. In densely packed areas, nuclear profiles resembled interlocking jigsaw pieces. Occasionally, these 'pre-apoptotic' nuclei were associated with annulate lamellae. Rarely, nuclear changes terminated in apoptosis with a characteristic pattern of condensed peripheral chromatin, a central island of euchromatin, no nucleoli and no discernible nuclear pores. Apoptotic nuclei were seen singly and within dense nuclear aggregations. Similar spatial patterns of nuclei and chromatin were seen in propidium iodide-stained sections at 13-41 weeks. Whilst the relative incidence of intensely fluorescent nuclei remained constant, absolute numbers increased linearly during gestation and correlated positively with the volume of syncytial knots. Nuclei labelled for DNA fragmentation occurred very infrequently and were also found in nuclear clusters as well as singly. We suggest that nuclear differentiation in syncytium has two phases: on entering syncytium, nuclei become committed to a long programmed pre-apoptotic phase which leads to a short apoptotic execution phase. We propose further that clustered nuclei (pre-apoptotic and apoptotic) in syncytial knots probably represent the extrusion component of normal continuous epithelial turnover.

Parent reported preschool attention deficit hyperactivity: measurement and validity

This is a two stage community study of 320 preschool children aged between two and a half to five years. An Attention Deficit Hyperactivity Scale (ADH-P) was constructed. A first stage sample was screened by asking parents to fill in the ADH-P and the Behaviour Check List (BCL) for behaviour problems; 116 children were included in the second stage. Reliability of the ADH-P was tested and found to be satisfactory. Its validity was also supported by teacher's report and clinical observation. Based on the parent report, the children were divided into four groups: pure hyperactive, pure behaviour problem, mixed and no problem groups. External correlates and psychopathology were examined among them. The mixed group had more symptoms, poor maternal mental health, high social adversities, poor prosocial behaviour and high help seeking. Whilst significant associations were also present between these correlates and pure behaviour problems, the situation was substantially worse when hyperactivity co-existed with behaviour problems.

The horizontal equity of health care in New Zealand

OBJECTIVE

Given that 'equal access for equal need' is a clearly articulated goal of the New Zealand public health system, this study is an attempt to determine if access to public health care services in New Zealand is, for people of equal health need, independent of income.

METHOD

Information on health status, income and health service utilisation for just over 6,000 New Zealanders was obtained from the national Household Health Survey 1992-93. Using standardised expenditure concentration curves and a concentration index, the distribution of health service use by individuals in different income groups, as a proxy for access, was illustrated and quantified.

RESULTS

The results suggest either appropriate or slightly excess use of services by the poor given their estimated health need. Due to analytical problems caused by data deficiencies, these results must be regarded as tentative.

CONCLUSION

For the period under study, no evidence was found to indicate significant access barriers to publicly funded health care for people on different incomes. This study has served to demonstrate one approach to measuring inequality and analysing the relationship between inequality and inequity. Given the reforms to the health sector since 1993, ongoing monitoring of equity of access to health care services is essential.

IMPLICATIONS

Given the income-related disparities in health that do exist, the public health community should endeavour to develop techniques to monitor the delivery of publicly funded health care to ensure that further inequity is not borne by the poor.

Is mental health in childhood a major predictor of smoking in adolescence?

AIMS

To test an extended version of Pomerleau's (1997) hypothesis that children with mental health problems are at higher risk of smoking in preadolescence and adolescence.

DESIGN

Information concerning mental health from 5 to 13 years, smoking at ages 11 and 15, and family disadvantage at age 7 was available for 773 children enrolled in a longitudinal study of children and adolescents.

PARTICIPANTS

Participants were enrolled into the Dunedin Multidisciplinary Health and Development Study, which is a longitudinal investigation of the health, development and behaviour of a large group of New Zealand children born between 1 April 1972 and 31 March 1973.

MEASUREMENTS

Assessment of mental health problems in childhood was based upon parent and teacher reports of behavioural and emotional problems. In pre-adolescence, mental health was assessed by self, parent and teacher report. Smoking was assessed by self-report.

FINDINGS

None of the potential risk factors of gender, childhood disadvantage or childhood mental health problems predicted onset of smoking in pre-adolescence. Daily smoking at age 15 was best predicted by smoking in preadolescence, being female and experiencing childhood disadvantage. Pre-adolescent mental health was only weakly predictive of later smoking and this association appeared to be confounded with background disadvantage.

CONCLUSIONS

We found little support for the extension of Pomerleau's (1997) hypothesis to childhood mental health. Our findings also run counter to recent suggestions for targeting smoking prevention at groups of children with mental health disorders.

Sun protection behaviours and the predictors of sunburn in young children

OBJECTIVE

To explore the use of sun protection behaviours and the experience of sunburn in a sample of parents and their children in New Zealand.

METHODOLOGY

Information was collected from 887 parents using postal questionnaires at the beginning of and during the summer.

RESULTS

Thirty per cent of the parents believed their child looked healthier with a suntan, and 40% intended to let their child get a suntan during the summer. Predictors of intention to tan included level of parental education, the child's age, the child's sensitivity to burning and experience of sunburn in the parent. At the end of the summer period, 29% of the children were reported as being sunburned. Predictors of sunburn in the child were the age of the child, experience of sunburn in the parent and use of sunscreen SPF15+ by the parent.

CONCLUSION

Despite intense media coverage of the dangers of overexposure to the sun, it is clear that a significant proportion of children are still getting sunburned.

Caregiving and well-being in a sample of women in midlife

A survey of 742 women in midlife found that 12% were involved in the care of another person with a chronic health disorder. Of note was the diversity of circumstances that led to the women becoming caregivers. Further, about a third of the carers were supporting more than one person. Carers did not differ on measures of depression or subjective health ratings from persons not involved in care. Burden scores were predicted by co-residence, low satisfaction with social support, and poorer health ratings on the part of the carers but not by the relationship between the person cared for and the carer.

Are young adults checking their skin for melanoma?

This study examined the prevalence and predictors of self screening for melanoma in a large sample of young New Zealanders. A self-report questionnaire was administered to a sample of 909, 21-year-olds to investigate if young adults check their skin for changes in lesions which could be melanoma, and to identify the factors which influence this behaviour and any subsequent help seeking. Fifty-three per cent reported checking their skin in the past year, with 20% noticing a change in a mole or freckle. Forty-five per cent of those who noticed a change sought medical advice. The most common reason for not seeking advice was cost. Women were more likely that men to have checked their skin, to have noticed a change and to have sought medical advice. In addition to gender, tendency to self check was also associated with knowledge of melanoma and perceived risk of melanoma. These results are discussed in light of the current debate regarding skin cancer screening. This study fills a gap in the literature regarding self screening for melanoma in young adults and identifies ways in which future prevention campaigns might be modified to address the concerns of this age group.

Children's understanding of sun protection behaviours: a comparative analysis

OBJECTIVE

To investigate awareness of sun protection behaviours in a sample of primary school children in New Zealand.

METHODOLOGY

Information was collected from 824 primary school children in New Zealand using a drawing and writing technique.

RESULTS

The data revealed a bias towards sunscreen as a method of sun protection compared with other methods such as clothing and the use of shade. Comparisons between results obtained from children resident in Australia and England indicated a greater awareness of sun protection methods amongst the children from Australia and New Zealand compared with those children living in England.

CONCLUSIONS

Children as young as 5 and 6 can describe the consequences of overexposure to the sun, and can illustrate methods of sun protection. Sunscreen is seen as the main method of sun protection.

Physical assault in New Zealand: the experience of 21 year old men and women in a community sample

AIM

To obtain epidemiological information on physical assault in a high risk group of New Zealanders.

METHOD

Rates of physical assault in the preceding twelve months were ascertained by interview in a cohort of 21 year old, Dunedin-born men (n = 482) and women (n = 462).

RESULTS

Forty-five percent of the men and one quarter of the women reported at least one physical assault, either completed, attempted or threatened. A small proportion of these received medical treatment. Most serious assaults were by a perpetrator who was thought to have been drinking alcohol. Most assaults on men were by strangers but partners carried out more assaults against women, especially those receiving medical treatment. One quarter of all assaults on women were by other women, compared to 15% of the assaults on men. Differences between patterns of assaults on women and on men are discussed.

CONCLUSION

It is important for doctors to be aware of the widespread occurrence of interpersonal violence in New Zealand and its underreporting.

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.

Level of education, age of bearing children and mental health of women

The present study examined the longitudinal relationship between women's mental health and both their level of education and age at which they had their first child. The women were divided into four groups depending on whether or not they had further education after leaving school and whether or not they had a baby before the age of 21. Longitudinal data collected over a 19-year period from this group of women suggested that psychological morbidity was relatively stable across this time span. Women who left school without proceeding to further education and those who became mothers before the age of 21 had higher psychological symptom scores than the other groups throughout this period. These two factors were associated with poorer mental health in an additive fashion. The women were also more likely to have separated from the father of their child and continued to be economically disadvantaged into mid-life.

Sunburn and sun protection among young children

OBJECTIVE

To examine the extent of sun exposure, sun protection and experience of sunburn among young New Zealand children on summer weekends.

METHODS

In a telephone survey of 1243 respondents, those with children in the household were asked about sun exposure and protection for the youngest child in the family. Information was obtained for 285 children aged from infancy to 10 years.

RESULTS

Over 90% of the children were reported to be outside on the preceding Saturday and/or Sunday; 7% of those outside experienced some degree of sunburn. The worst burning was on the face, head, neck or ears. On either day about half the children were wearing sunscreen and 60% were wearing a hat. Parental use of sun protection was the strongest predictor of sun protection among the children.

CONCLUSIONS

While reports of sun protection among young children were encouraging, many children in the community are still at high risk of sunburn. Efforts to promote sun protection as a family responsibility may reduce the experience of burning among the young.

Sun behaviour and perceptions of risk for melanoma among 21-year-old New Zealanders

This study investigated perceived risk of melanoma, sunscreen use and frequency of sunburn in a large sample of young New Zealanders. A self-report questionnaire was administered to a sample of 909 21-year-olds to survey their perception of how sun behaviours affect their risk of getting melanoma, how often they get sunburn, how often they use sunscreen and what factors would get them to use sunscreen more often. Knowledge of melanoma was high, but myths concerning 'safe tanning' persisted. Many young adults believed that sunbathing regularly using a sunscreen and obtaining a good base tan from gradual sun exposure decreased their risk of getting melanoma. They were unsure about the use of artificial sun beds and if their use would increase or decrease their risk. Males and females differed significantly on many aspects of their sun behaviour. Most used sunscreen only 'sometimes' and its use was linked to knowledge of melanoma and perceptions of risk. The best way to modify the sun behaviour of young adults is to target both their knowledge of melanoma risk factors and their perceptions of risk.

Psychometric properties of the Centre for Epidemiologic Studies Depression Scale (CES-D) in a sample of women in middle life

The Centre for Epidemiologic Studies Depression Scale (CES-D) was completed by 675 women taking part in a longitudinal investigation of health-related issues. The data were submitted to confirmatory factor analysis using LISREL 7 and a 4-factor model was found to fit the data moderately well. A second-order depression factor was also identified. The results provide support for the construct validity of the total and subscale scores from this measure. The scale was found to have good reliability. Evidence was found that scores on the subscale measuring somatic features of depression may be inflated in women who have experienced a chronic health problem in the past 12 months.

Inattentive and hyperactive behaviors and driving offenses in adolescence

OBJECTIVE

The associations between symptoms of attention-deficit hyperactivity disorder (ADHD), conduct disorder, anxiety, or depression and no disorder in relation to driving offenses were examined in 916 adolescents.

METHOD

Self-report and parent report were used to assess a birth cohort of New Zealand adolescents' mental health status at age 15 years. Adolescents who scored 1.5 SD above the mean on the DSM-III total ADHD symptom scale were identified as reporting significant ADHD symptomatology. Self-report data and official traffic conviction records were used to identify adolescents who had committed driving offenses between ages 15 and 18 years.

RESULTS

ADHD symptomatology and conduct disorder were strongly associated with driving offenses. ADHD symptomatology in females was significantly associated with driving offenses and more traffic crashes compared with other disorder or no disorder.

CONCLUSIONS

Adolescents with a history of ADHD and conduct problems are significantly more likely than their peers to commit traffic offenses. Research in ADHD and risky driving should include female adolescents, as those with attentional difficulties are at a high risk for being involved in traffic crashes than females who do not experience attentional difficulties.

A comparison of time trade-off and quality of life measures in patients with advanced cancer

Quality of life (QOL) measures are now accepted as indicators of efficacy in the palliative treatment of cancer. Utility measures may also provide valuable information in this area yet they have rarely been applied. To assess the concordance of QOL and utility scales, 93 patients with advanced, symptomatic cancer completed two QOL instruments, the Spitzer Quality of Life Index (QLI) and Spitzer Uniscale, and a time-trade off (TTO) question reflecting the utility of their health states. The scales were self-administered. All patients completed the QLI and Uniscale but only 37% of participants were prepared to trade time. The remainder comprised 39% who felt too well to trade time and 24% who did not wish to consider trading time at all. Those prepared to trade time had significantly worse scores on both QLI and Uniscale instruments than those who felt too well to trade. However the correlation between time traded and QLI and Uniscale scores was poor. We conclude that the TTO question used in this study, while not strongly related to QOL, provides a measure of the patient's attitude to their health state. This may explain why patients differ in their attitude to quantity vs. quality of life.

The (in)stability of adolescent fears

This study examined change in different types of fear in a longitudinal study of a birth cohort from age 13-15 yr. When viewed cross-sectionally there were few differences in the frequency and content of fears reported at these ages with the exception of an increase in social fears at age 15. When viewed longitudinally, however, few adolescents who reported fears at age 13 continued to report fears 2 yr later. Implications for developmental theories of fear and phobia are discussed.

Use of the new media for medical education

The use of an advanced communication network for education has been an integral part of practice at the Mayo Clinic since 1986. The network has been used for patient care, research coordination and administrative support, as well as for educational programming. In 1994, 2655 hours were broadcast by satellite. There were 42,292 participants, representing a total of 47,364 contact hours. Over half of this activity was educational. In using the satellite system, a number of background support systems have been found to be essential to effective communication. First, highly trained technical staff are required to support the communication system. Second, presenters require formal training in adapting audiovisual materials, such as slides and transparencies, to broadcast media. Third, as use of the system has grown, scheduling and prioritizing among the many users has become an increasingly time-consuming and challenging task.

The New Zealand Rugby Injury and Performance Project: alcohol use patterns within a cohort of rugby players

Although heavy drinking has traditionally been associated with rugby, the drinking patterns of New Zealand rugby players have not been examined. Three hundred and forty-eight rugby players (257 males and 91 females), completed the Alcohol Use Disorders Identification Test (AUDIT) at the beginning of the 1993 rugby season. The mean AUDIT scores were 11.2 (SD = 5.1) for the males and 8.7 (4.1) for the females: a cut-off of 8.0 has been recommended by the developers of the instrument for identifying alcohol use disorders. The consumption of large quantities of alcohol, and a high frequency of heavy drinking sessions were the norm for this group. Sixty-one per cent of males and 38% of females consumed six or more drinks in a session at least weekly: typically, men drank 10 or more drinks in a session and women 5-6 drinks. The patterns of drinking exhibited by the cohort give cause for concern regarding the health risks associated with such behaviour.

Personality traits are differentially linked to mental disorders: a multitrait-multidiagnosis study of an adolescent birth cohort

The authors assessed the relation between personality and mental disorder in a representative birth cohort of 897 men and women. Personality was assessed at age 18 with the Multidimensional Personality Questionnaire (MPQ; A. Tellegen, 1982), and 4 types of mental disorder (affective, anxiety, substance dependence, and conduct disorder) were assessed at ages 15, 18 and 21, using age-appropriate standardized diagnostic interviews. All disorder groups had MPQ profiles that were very different from those of controls. When comorbid cases were excluded, fewer significant differences between diagnosed cases and controls remained. Relations between personality and mental disorder were not affected by the measurement of disorder as continuous versus discrete, gender, or the age at which disorder was diagnosed. Relations between personality and mental disorders appear to be robust, and individual personality differences may be particularly relevant to understanding the most severe (comorbid) expressions of psychopathology.

Help-seeking for behavior problems by parents of preschool children: a community study

OBJECTIVE

To identify barriers to seeking help for preschool behavior problems and understand the pattern of service utilization.

METHOD

Altogether, 320 preschool children from eight preschool centers were studied using a two-stage design. After the initial screening, a more detailed assessment was carried out in the second stage involving semistructured interviews with parents and children. Parents also completed a service utilization questionnaire during the first stage and General Health Questionnaire, Family Assessment Device, and life events questions during the second stage.

RESULTS

Only 19% of those with preschool behavior disorder crossed all the filters in reaching for help. The most common perceived barriers to help-seeking were that problems would get better by themselves or that parents should be strong enough to handle them. The major blocks to help-seeking were at two levels, in parents recognizing the presence of a problem and in overcoming the perceived barriers by the parents. Parents sought help from the informal agencies more often than from the formal. Help was sought significantly less often by those who had parental separation, low income, or multiple adversities, all of which were known to be significantly associated with behavior disorder.

CONCLUSION

These findings indicate the need to educate and influence the parents' attitude to help-seeking, target those at risk to develop behavior disorder, and develop better consultation-liaison service with the informal agencies.

Adolescents' promotion of nonsmoking and smoking

Previous studies of the influence of friends on adolescent smoking have adopted the approach of asking adolescents about their friends. However, studies in which the friends were also approached have shown that adolescents' reports of friends behavior were not accurate (more closely resembled their own behavior). In order to gauge the level of active social influence among adolescents we asked 14-15 year old students what they did to influence others not to smoke or to smoke. Across two surveys, a quarter of the Form 4 students were promoting antismoking messages or activities and 3% were promoting smoking by encouraging or forcing friends, siblings and acquaintances to smoke. Relatively more positive beliefs about smoking identified those students who actively promoted smoking whereas some positive beliefs about the adverse effects of cigarette advertising tended to identify those who were actively antismoking. Use of this approach to examine the issue of social influence provided information about the antismoking activities which students conducted, and could be used to further examine which messages students do not believe or do not use. For example, students believed that smoking reduces fitness but did not promote this message to others, and the reasons for such disparity need to be investigated and should be addressed in the content of prevention programs.