Publications by authors named "Michael P Dunne"

88 Publications

Intergenerational effects of violence on women's perinatal wellbeing and infant health outcomes: evidence from a birth cohort study in Central Vietnam.

BMC Pregnancy Childbirth 2021 Sep 23;21(1):648. Epub 2021 Sep 23.

Institute for Community Health Research, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam.

Background: Girls exposed to violence have a high risk of being victimized as adults and are more likely than non-abused women to have children who are treated violently. This intergenerational transmission may be especially serious when women suffer violence during pregnancy and early motherhood, as it impairs maternal wellbeing and infant health and development. This study examined the intergenerational effects of being exposed to childhood maltreatment (CM) and prenatal intimate partner violence (p-IPV) on perinatal mental distress and birth outcomes in central Vietnam.

Methods: A birth cohort study in Hue City, Vietnam was conducted with 150 women in the third trimester of pregnancy (Wave 1) and 3 months after childbirth (Wave 2). Using multivariable logistic regression models, augmented inverse-probability-weighted estimators and structural equation modelling (SEM), we analyzed a theoretical model by evaluating adjusted risk differences and pathways between CM, p-IPV and subsequent perinatal adversity and indicators of infant health problems.

Results: One in two pregnant women experienced at least one form of CM (55.03%) and one in ten pregnant women experienced both CM and p-IPV (10.67%). Mothers who experienced p-IPV or witnessed IPV as a child were approximately twice as likely to experience poor mental health during pregnancy [ARR 1.94, 95% CI (1.20-3.15)]. Infants had a two-fold higher risk of adverse birth outcomes (low birth weight, preterm birth, admission to neonatal intensive care) [ARR 2.45 95% CI (1.42, 4.25)] if their mothers experienced any form of p-IPV, with greater risk if their mothers were exposed to both CM and p-IPV [ARR 3.45 95% CI (1.40, 8.53)]. Notably, significant pathways to p-IPV were found via adverse childhood experience (ACE) events (β = 0.13), neighborhood disorder (β = 0.14) and partner support (β = - 1.3).

Conclusion: These results emphasize the detrimental and prolonged nature of the effect of violence during childhood and pregnancy. Exposure to childhood maltreatment and violence during pregnancy increases the risk of maternal mental health difficulties and adverse birth outcomes. Antenatal care systems need to be responsive to women's previous experiences of violence and maternal mental health. The significant protective role of partner support and social support should also be considered when designing tailored interventions to address violence during pregnancy.
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http://dx.doi.org/10.1186/s12884-021-04097-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8461881PMC
September 2021

The impact of maternal adverse childhood experiences and prenatal depressive symptoms on foetal attachment: Preliminary evidence from expectant mothers across eight middle-income countries.

J Affect Disord 2021 Sep 4;295:612-619. Epub 2021 Sep 4.

Psychology Department, The University of Edinburgh, Edinburgh, United Kingdom.

Background: Mothers from middle-income countries (MIC) are estimated to have higher rates of adverse childhood experiences (ACEs) and depression during pregnancy compared to mothers from high income countries. Prenatal depression can adversely impact on a mother's feelings towards her foetus and thus may be partially responsible for intergenerational transmission of risk associated with maternal ACEs. However, the extent to which prenatal depressive symptoms mediate the association between maternal ACEs and foetal attachment is unknown.

Methods: Data on foetal attachment, ACEs, and prenatal depression came from mothers in their third trimester of pregnancy (n = 1,185) located across eight MICs, participating in the prospective birth cohort Evidence for Better Lives Study - Foundational Research (EBLS-FR). Data were from the baseline measurement.

Results: Full-sample path mediation analyses, adjusting for relevant covariates, suggested a full mediating effect of prenatal depression. However, at the individual-country level, both positive and negative effects of ACEs on foetal attachment were observed after the inclusion of depressive symptoms as a mediator, suggesting cultural and geographical factors may influence a mother's empathic development after ACE exposure.

Limitations: As no follow-up measurements of depressive symptoms or postnatal attachment were included in the analyses, the findings cannot be extrapolated to the postnatal period and beyond. Further, causality cannot be inferred as the study was observational.

Conclusions: The findings reinforce the importance of screening for prenatal depression during antenatal care in MICs. Addressing prenatal depression within maternal health care may support foetal attachment and contribute to reducing the intergenerational transmission of disadvantage.
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http://dx.doi.org/10.1016/j.jad.2021.08.066DOI Listing
September 2021

"Under great anxiety": Pregnancy experiences of Vietnamese women with physical disabilities seen through an intersectional lens.

Soc Sci Med 2021 09 15;284:114231. Epub 2021 Jul 15.

Institute for Community Health Research, Hue University, Hue, 47000, Viet Nam; Australian Centre for Health Law Research, Faculty of Business and Law, Queensland University of Technology, Brisbane, 4059, Australia.

Background: There is scant research on pregnancy experiences of women with physical disabilities in low and middle-income countries. This qualitative study used an intersectional lens to explore pregnancy experiences of women with physical disabilities in northern Vietnam. Specifically, socio-cultural, economic, and environmental influences were analysed, drawing upon their lived experiences.

Methods: Two in-depth interviews were conducted at different time-points in 2018 with women with physical disabilities who had given birth in the previous three years. Twenty-nine women participated in the first interview and 27 in the follow-up interview. The interviews were thematically analysed.

Results: The women were happy and excited when discovering their pregnancy but they also experienced anxiety, fear, and distress. Their ambivalence related to concerns around having a child with disabilities, their capability to carry a pregnancy, and their mothering abilities. Negative community views of disability were internalised by the women. These socio-culturally constructed beliefs led to lack of confidence in their pregnancy journey. This was exacerbated by inaccessible environments that contributed to increased risk of falls, and women who used wheelchairs experienced particular difficulties. Other powerful influences included poverty, lost income, and costs associated with pregnancy. Single mothers with disabilities experienced additional stigma and discrimination as Vietnamese society judged their pregnancies as socially unacceptable.

Conclusion: This study contributes to knowledge and understanding about women with physical disabilities, specifically how the intersection of gender, disability, socio-economic, and marital status shaped their pregnancy experiences in Vietnam. Multiple challenges were encountered by the women in their pregnancy journey, including negative community views, inaccessible environments, and poverty. The findings highlight the necessity for Vietnamese women with physical disabilities to be actively engaged in talking about their experiences to ensure maternal and child health providers become more sensitive to their pregnancy and motherhood needs.
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http://dx.doi.org/10.1016/j.socscimed.2021.114231DOI Listing
September 2021

The association between elder abuse and childhood adversity: A study of older adults in Malaysia.

PLoS One 2021 22;16(7):e0254717. Epub 2021 Jul 22.

Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.

Objectives: Childhood adversity has been linked with later victimization of young and middle-aged adults, but few studies have shown persistence of this effect among elders, especially outside of North America. This research examined the association between adverse childhood experiences (ACEs) and elder abuse among older adults aged 60 years and over in Malaysia.

Design: Cross sectional data were collected via face-to-face interview from June to August 2019.

Setting: Eight government community health clinics in Kuala Pilah, a district in Negeri Sembilan state approximately 100km from Malaysian capital city Kuala Lumpur.

Participants: Older adults aged 60 years and above (N = 1984; Mean age 69.2, range 60-93 years) attending all eight government health clinics in the district were recruited for a face-to-face interview about health and well-being.

Measurement: The Adverse Childhood Experience International Questionnaire (ACE-IQ) and the Revised Conflict Tactics Scale (CTS) were utilized to estimate childhood adversity and elder abuse respectively.

Results: Multiple logistic regression analysis revealed a significant relationship between the number of cumulative ACEs and elder abuse. Compared to older adults with no self-reported adversity, those reporting three ACEs (OR 2.67, 95% CI 1.84,3.87) or four or more ACEs (OR 1.7, 95% CI 1.16, 2.48) had higher risk of any elder abuse occurrence since age 60 years. The effect was most prominent for financial and psychological elder abuse. The associations persisted in multivariate logistic regression models after adjusting for sociodemographic and health factors.

Conclusion: Early life adversities were significantly associated with victimization of older adults. Social and emotional support to address elder abuse should recognize that, for some men and women, there is a possibility that vulnerability to maltreatment persisted throughout their life course.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0254717PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8297753PMC
July 2021

Improvement in the Cognitive Aspects of Cultural Competence after Short-Term Overseas Study Programs.

Int J Environ Res Public Health 2021 07 2;18(13). Epub 2021 Jul 2.

Faculty of Health, School of Psychology and Counseling, Queensland University of Technology, Brisbane 4059, Australia.

Universities are providing short-term overseas study programs for healthcare students to increase their cultural competence (i.e., capacity to work effectively in cross-cultural situations). However, there is limited empirical research evaluating the effects of these programs using well-controlled research designs. In the present research study, undergraduate healthcare students in an Australian university were selected as participants. Group 1 ( = 32) participated in a short-term overseas study program in Asia (i.e., China, Vietnam, Singapore, and Taiwan), whereas Group 2 ( = 46) stayed in Australia to continue their university education as usual. All participants completed a self-developed demographic questionnaire, Cultural Intelligence Scale, and Multicultural Personality Questionnaire. Cultural competence was surveyed pre- and post-short-term overseas programs. After controlling for prior overseas experiences and the open-mindedness trait, an ANCOVA indicated that Group 1 had a significantly higher scores than Group 2 in cultural knowledge ( < 0.05), but not in cultural awareness, attitude, or skills. It is suggested that short-term overseas study programs may increase healthcare students' cultural knowledge, a component of competence, and that more needs to be accomplished to improve other areas of cultural competence.
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http://dx.doi.org/10.3390/ijerph18137102DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8297341PMC
July 2021

Psychosocial Interventions for Amphetamine Type Stimulant Use Disorder: An Overview of Systematic Reviews.

Front Psychiatry 2021 17;12:512076. Epub 2021 Jun 17.

Faculty of Health, School of Public Health and Social Work, Queensland University of Technology (QUT), Brisbane, QLD, Australia.

Amphetamine-type stimulants (ATS) use is a global concern due to increased usage and the harm to physical, mental, and social well-being. The objective of this overview of systematic reviews is to summarise trial results of psychosocial interventions and describe their efficacy and safety. We searched seven bibliographic databases to November 2020 for systematic reviews examining ATS misuse treatment by psychosocial interventions. Given the apparent incompleteness of the included reviews, we undertook a supplemental meta-analysis of all eligible primary studies. We included 11 systematic reviews of moderate to high quality and 39 primary studies which assessed the outcomes of psychosocial interventions on people who use ATS. The key findings include: (1) There were conflicting results about the effectiveness of psychosocial interventions among reviews, which may confuse decision-makers in selecting treatment. (2) In the supplemental meta-analysis, relative to usual care (only counselling or self-help materials), membership of a psychological intervention group was associated with an important reduction in drug usage [risk ratio (RR) 0.80, 95% CI: 0.75 to 0.85]. Patients in psychological interventions used injectables substantially less [odds ratio (OR) 0.35, 95% CI: 0.24 to 0.49]. The risk of unsafe sex in the psychosocial intervention group was lower than in the control group (RR 0.49, 95% CI: 0.34 to 0.71). The combination of therapies reduced 1.51 day using drugs in the preceding 30 days (95% CI: -2.36 to -0.67) compared to cognitive behavioural therapy intervention alone. (3) Compared to usual care, cognitive behavioural therapy was less likely to be retained at follow-up (RR 0.89, 95% CI: 0.82 to 0.97; high-quality evidence). However, the additional of contingency management strategy can make an important improvement upon retention (RR 1.42, 95%CI: 1.25 to 1.62). Integrated models are more effective than a single-treatment strategy. Comprehensive and sustained psychosocial interventions can help to reduce use of ATS and other drugs, risk behaviours and mental disorders, and significantly improve treatment adherence.
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http://dx.doi.org/10.3389/fpsyt.2021.512076DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8245759PMC
June 2021

Assessing evidence for seasonality of hospital admissions for schizophrenia in Queensland, Australia: a time series observational study.

Int J Biometeorol 2021 Jun 10. Epub 2021 Jun 10.

School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, Queensland, 4059, Australia.

Most evidence on seasonal admission patterns for schizophrenia derives from the Northern Hemisphere with results from the Southern Hemisphere less documented. This study examines seasonal patterns in hospital admissions due to schizophrenia in Queensland, Australia, a large area that has a range of different climatic features. Daily hospital admissions data for people with the primary diagnosis of schizophrenia were collected from Queensland Health Department for the period from January 1996 to December 2015. A generalised linear regression model with Quasi-Poisson distribution was used to assess seasonal admission patterns across different climatic regions. The evidence for seasonality was also explored in subgroups that had different socio-demographic characteristics or history of prior hospitalisation for psychiatric disorders. Overall, a significant winter pattern (RR 1.05, 95%CI 1.01-1.13) was found with a peak in August (RR 1.08, 95%CI 1.03-1.17) in temperate Southeast Queensland. However, the hot humid North and Far North Queensland showed a peak in October (RR 1.10, 95%CI 1.02-1.22). Males (RR 1.11, 95%CI 1.07-1.14), people aged 40-59 years old (RR 1.10, 95%CI 1.05-1.15) and those who had never married (RR 1.09, 95%CI 1.06-1.12), were Australian by birth (RR 1.07, 95%CI 1.04-1.10) or were unemployed (RR 1.13, 95%CI 1.09-1.18) had significantly higher risk for hospital admissions, particularly during the winter months. The seasonal admission pattern for schizophrenia did not change significantly according to admission status and history of outpatient or community psychiatric treatment. The study found some evidence for seasonality of hospital admissions for schizophrenia that differed from northern tropical to southern temperate regions of Queensland.
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http://dx.doi.org/10.1007/s00484-021-02160-7DOI Listing
June 2021

How much can our universities do in the development of cultural intelligence? A cross-sectional study among health care students.

Nurse Educ Today 2021 Aug 14;103:104956. Epub 2021 May 14.

School of Psychology and Counseling, Faculty of Health, Queensland University of Technology, Australia.

Background: Cultural intelligence reflects the competence to adapt to new cultural settings. Universities offer students various opportunities to gain cultural learning and develop cultural intelligence. However, there has been little empirical research to compare the effects of cultural learning and other related psycho-social factors in this process.

Objective: This study explores the importance of cultural learning and identifies the unique contribution of cultural education in universities to health care students' cultural intelligence.

Design: Cross-sectional survey study.

Methods: 271 health care students completed a survey measuring social desirability, demographics, personality, prior cultural exposure, previous cultural learning and cultural intelligence.

Results: Hierarchical regressions showed that cultural learning could affect cultural intelligence and its three components (i.e., metacognition, cognition, motivation, and behaviour) under the control for related psycho-social factors. However, its effect on the behavioral component was not significant. Considering the different types of cultural learning, overseas study experiences were more related to cultural intelligence, compared to in-class cultural learning.

Conclusion: Cultural learning, especially overseas study experiences, plays a significant role in the development of health care students' cultural intelligence.
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http://dx.doi.org/10.1016/j.nedt.2021.104956DOI Listing
August 2021

Factor structure and internal consistency of the ISPCAN Child Abuse Screening Tool Parent Version (ICAST-P) in a cross-country pooled data set in nine Balkan countries.

Child Abuse Negl 2021 May 13;115:105007. Epub 2021 Mar 13.

Institute of Child Health, Athens, Greece. Electronic address:

Objective: Researchers are increasingly using parental report measures in population-based surveys of violence against children. No research thus far has examined the factor structure of the International Society for the Prevention of Child Abuse and Neglect (ISPCAN) Child Abuse Screening Tool Parent Version (ICAST-P), a non-commercialized measure for prevalence studies.

Methods: This paper uses secondary data from the Balkan Epidemiological Study on Child Abuse and Neglect (BECAN) which included 25,202 primary caregivers of school-going children in three grades (aged 11, 13 and 16). Primary caregivers completed the ICAST-P 2010-2011, which measures children's exposure to physical and psychological violence and neglect by caregivers and sexual violence by any perpetrator. Confirmatory factor analysis (CFA) was used to assess the reliability and the factor structure of the ICAST-P for a four-dimensional model and a bifactor model, with one general factor and four group factors representing the specific components of each set of items. Measurement invariance could not be tested.

Results: Lifetime prevalence for physical violence was 66.7 %, for psychological violence 66.6 %, for sexual violence 3.1 % and for neglect 9.1 %. CFA showed adequate fit for the hypothesized four-dimensional model, however, improved fit was shown for a bifactor model with abuse as the general factor. Internal consistency was good for physical and psychological violence, but not neglect and sexual violence. Hierarchical omega showed good internal consistency for the general factor.

Conclusions: Parents report that their children experience high levels of violence. The factor structure of the ICAST-P is best captured using a bifactor modelling approach.
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http://dx.doi.org/10.1016/j.chiabu.2021.105007DOI Listing
May 2021

Preventive behavior of Vietnamese people in response to the COVID-19 pandemic.

PLoS One 2020 9;15(9):e0238830. Epub 2020 Sep 9.

Institute for Community Health Research, University of Medicine and Pharmacy, Hue University, Hue, Vietnam.

We sought to evaluate the adherence of Vietnamese adults to Coronavirus Disease 2019 (COVID-19) preventive measures, and gain insight into the effects of the epidemic on the daily lives of Vietnamese people. An online questionnaire was administered from March 31 to April 6, 2020. The questionnaire assessed personal preventive behavior (such as physical distancing, wearing a face mask, cough etiquette, regular handwashing and using an alcohol hand sanitizer, body temperature check, and disinfecting mobile phones) and community preventive behavior (such as avoiding meetings, large gatherings, going to the market, avoiding travel in a vehicle/bus with more than 10 persons, and not traveling outside of the local area during the lockdown). A total adherence score was calculated by summing the scores of the 9 personal and the 11 community prevention questions. In total, 2175 respondents completed the questionnaire; mean age: 31.4 ± 10.7; (range: 18-69); 66.9% were women; 54.2% were health professionals and 22.8% were medical students. The mean adherence scores for personal and community preventive measures were 7.23 ± 1.63 (range 1-9) and 9.57 ± 1.12 (range 1-11), respectively. Perceived adaptation of the community to lockdown (Beta (β) = 2.64, 95% Confidence Interval (CI) 1.25-4.03), fears/worries concerning one's health (β = 2.87, 95% CI 0.04-5.70), residing in large cities (β = 19.40, 95% CI 13.78-25.03), access to official COVID-19 information sources (β = 16.45, 95% CI 6.82-26.08), and working in healthcare/medical students (β = 22.53, 95% CI 16.00-29.07) were associated with a higher adherence score to anti-COVID instructions. In conclusion, this study confirmed a high degree of adherence to personal and community preventive behavior among Vietnamese people. Our findings are consistent with the epidemiology of COVID-19 in Vietnam, where there have been few infections and no recorded deaths up to the first week of July 2020.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0238830PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7480837PMC
September 2020

Childhood adversity and death of young adults in an affluent society.

Lancet 2020 08;396(10249):449-451

School of Social and Political Sciences, University of Edinburgh, Edinburgh, UK; Faculty of Health Sciences, North-West University, Vanderbijlpark, South Africa.

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http://dx.doi.org/10.1016/S0140-6736(20)30899-0DOI Listing
August 2020

Measuring violence against children: The adequacy of the International Society for the Prevention of Child Abuse and Neglect (ISPCAN) child abuse screening tool - Child version in 9 Balkan countries.

Child Abuse Negl 2020 10 31;108:104636. Epub 2020 Jul 31.

Centre for Development and Environment(ZEU), Justus-Liebig-University, Giessen, Germany; Department of Psychosomatic Medicine, Johann Gutenberg University Mainz, Germany. Electronic address:

Objective: Violence against children is a global public health concern. Researchers are increasingly using self-report measures of physical, psychological, and sexual violence and neglect for population-based surveys. The current gold-standard measure, the 45-item ISPCAN Child Abuse Screening Tool has been used across the world. This study assesses its adequacy for measuring abuse across countries.

Methods: Multiple group confirmatory factor analyses were used to assess the configural, metric and scalar invariance of the measure across nine Balkan countries. Data were collected using a three-stage stratified random sampling frame of 42,194 school-attending children in three grades (aged 11,13 and 16 years) from schools in Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Greece, North Macedonia, Romania, Serbia, and Turkey. Children completed the ICAST-C, which measures children's exposure to physical, psychological, and sexual violence, neglect and witnessing household violence in the past year and across the lifespan.

Results: The analyses show partial scalar invariance for the ICAST-C constructs children's exposure to physical and psychological violence, neglect and witnessing household violence across the nine countries and partial scalar invariance for the constructs of children's exposure to physical, psychological and sexual violence, neglect and witnessing household violence across eight countries (Turkey did not measure sexual violence).

Conclusions: The ICAST-C can be used to validly compare levels of physical, psychological, and sexual violence, neglect and witnessing violence in school-aged children across countries. It can also be used to validly compare the relations between these forms of violence and their covariates, predictors, and outcomes across countries.
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http://dx.doi.org/10.1016/j.chiabu.2020.104636DOI Listing
October 2020

"Nothing suitable for us": experiences of women with physical disabilities in accessing maternal healthcare services in Northern Vietnam.

Disabil Rehabil 2020 Jun 11:1-9. Epub 2020 Jun 11.

Faculty of Health, School of Public Health and Social Work, Queensland University of Technology (QUT), Brisbane, Australia.

This article explores how maternal healthcare access was experienced by women with physical disabilities in Northern Vietnam. A qualitative methodology with an interpretive phenomenological design was used. In-depth interviews were conducted with women with physical disabilities who had given birth in the previous three years. Twenty-nine women participated in a first in-depth interview, and 27 women completed follow-up interviews. Physical access audits were also conducted at 14 facilities providing maternal healthcare services. Data were thematically analyzed. The women said they highly valued antenatal care but rarely attended postnatal check-ups. Their decisions around service uptake were influenced by attitudinal barriers from staff, particularly failure to recognize that women with physical disabilities had a right to motherhood and quality maternal healthcare. Specialized information on pregnancy and childbirth for women with physical disabilities was limited. Long waiting times, confusing referral systems, and financial hardship were also significant problems in accessing maternal healthcare. Many healthcare facilities were not disability friendly. Women with physical disabilities in Northern Vietnam encountered multiple challenges when accessing maternal healthcare services. Many Vietnamese healthcare services are ill-equipped to provide disability-inclusive and responsive maternal healthcare because of inadequate structural design, attitudinal barriers, limited appropriate information, and financial burden. There should be increased attention paid to mainstreaming the needs of women with physical disabilities into maternal healthcare services in Vietnam.Implications for rehabilitationThere is a need for strong and sustained advocacy from all related staff, including rehabilitation workers, to improve the quality of healthcare for pregnant women with physical disabilities in Vietnam.Disability training should be integrated into mainstream in-service courses for maternal healthcare providers and curricula for medical, midwifery and nursing students.A resource package that provides women with physical disabilities with reliable and comprehensive information on disability and pregnancy, childbirth and maternal healthcare should be developed and disseminated.Professional protocols and infrastructure for maternal healthcare for women with physical disabilities should be more sensitive and responsive to their needs and rights.
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http://dx.doi.org/10.1080/09638288.2020.1773548DOI Listing
June 2020

Seasonality and schizophrenia: a comprehensive overview of the seasonal pattern of hospital admissions and potential drivers.

Int J Biometeorol 2020 Aug 13;64(8):1423-1432. Epub 2020 Apr 13.

Queensland Centre for Mental Health Research, The Park Centre for Mental Health Treatment, Research and Education, Brisbane, Queensland, 4076, Australia.

Schizophrenia is a severe neuropsychiatric disorder with heterogeneous aetiology mostly affecting younger people and causing immense disability. Seasonal patterns may be observed in schizophrenia hospital admissions with possible association with changing climatic parameters and socio-demographic characteristics. This study critically reviewed studies that have assessed seasonal variations of hospital admissions for schizophrenia and/or explored an association with climate parameters and/or other potential factors. Following PRISMA guidelines, a systematic literature search was conducted using electronic databases (e.g. MEDLINE, Science Direct, PsycINFO, Pub Med) from inception to February 29, 2020. Thirty five papers were identified, of which only six (17.1%) examined evidence for a seasonal pattern or monthly excess of hospital admissions and the remaining twenty nine (82.9%) assessed climatic and socio-demographic attributes relating to the seasonal pattern or increased hospitalisation for schizophrenia. While most studies reported a summer peak in hospital admission rates, other studies reported a winter peak. Most of the evidence indicated that higher temperatures (> 28 °C) were positively correlated with schizophrenia admission rates. The individual effects of other climatic parameters (e.g. relative humidity, rainfall, atmospheric pressure, sunlight) were less frequently assessed. Males, people of 21-60 years old, and those married were more vulnerable to climatic variability specifically to higher temperatures. Further studies using large sample sizes, analysis of a wide range of interacting environmental variables and sophisticated statistical approaches are needed to better understand the underlying mechanisms involved. This will also provide more reliable statistical evidence that will help in the prevention and better management of cases.
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http://dx.doi.org/10.1007/s00484-020-01910-3DOI Listing
August 2020

What Research Questions Should the Next Generation of Birth Cohort Studies Address? An International Delphi Study of Experts.

Acad Pediatr 2021 Jan-Feb;21(1):43-52. Epub 2020 Apr 6.

Department of Psychology, The University of Edinburgh (RH Brown and AL Murray), Edinburgh, United Kingdom.

Objective: Birth cohort studies (BCS) have generated a wealth of invaluable basic scientific and policy-relevant information on a wide range of issues in child health and development. This study sought to explore what research questions are currently a priority for the next generation of BCS using a 3-round Delphi survey of interdisciplinary experts.

Methods: Twenty-four (Round I, N = 17; Round II, N = 21; Round III, N = 18) experts across a wide range of fields (eg, psychology, public health, and maternal/child health) agreed to participate. In Round I, the expert panel was invited to freely respond to the question, "what are the key scientific questions future birth cohort studies should address?" Content analysis of answers was used to identify 47 questions for rating on perceived importance by the panel in Round II and consensus-achieving questions were identified. Questions that did not reach consensus in Round II were posed again for expert re-rating in Round III.

Results: Twenty six of 47 questions reached consensus in Round II, with an additional 6 reaching consensus in Round III. Consensus-achieving questions rated highly on importance spanned a number of topics, including environmental effects on child development, intergenerational transmission of disadvantage, and designing BCS to inform intervention strategies.

Conclusion: Investigating the effects of family/environmental factors and social disadvantage on a child's development should be prioritized in designing future BCS. The panel also recommended that future BCS are designed to inform intervention strategies.
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http://dx.doi.org/10.1016/j.acap.2020.03.011DOI Listing
July 2021

Improving measurement of child abuse and neglect: A systematic review and analysis of national prevalence studies.

PLoS One 2020 28;15(1):e0227884. Epub 2020 Jan 28.

Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.

Objectives: Child maltreatment through physical abuse, sexual abuse, emotional abuse, neglect, and exposure to domestic violence, causes substantial adverse health, educational and behavioural consequences through the lifespan. The generation of reliable data on the prevalence and characteristics of child maltreatment in nationwide populations is essential to plan and evaluate public health interventions to reduce maltreatment. Measurement of child maltreatment must overcome numerous methodological challenges. Little is known to date about the extent, nature and methodological quality of these national studies. This study aimed to systematically review the most comprehensive national studies of the prevalence of child maltreatment, and critically appraise their methodologies to help inform the design of future studies.

Methods: Guided by PRISMA and following a published protocol, we searched 22 databases from inception to 31 May 2019 to identify nationwide studies of the prevalence of either all five or at least four forms of child maltreatment. We conducted a formal quality assessment and critical analysis of study design.

Results: This review identified 30 national prevalence studies of all five or at least four forms of child maltreatment, in 22 countries. While sound approaches are available for different settings, methodologies varied widely in nature and robustness. Some instruments are more reliable and obtain more detailed and useful information about the characteristics of the maltreatment, including its nature, frequency, and the relationship between the child and the person who inflicted the maltreatment. Almost all studies had limitations, especially in the level of detail captured about maltreatment, and the adequacy of constructs of maltreatment types.

Conclusions: Countries must invest in rigorous national studies of the prevalence of child maltreatment. Studies should use a sound instrument containing appropriate maltreatment constructs, and obtain nuanced information about its nature.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0227884PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6986759PMC
April 2020

Stimulant expectancy questionnaire for men who have sex with men: A measure of substance-related beliefs.

Health Promot J Austr 2020 Apr 3;31(2):309-319. Epub 2019 Jul 3.

School of Psychology & Counselling, Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Ipswich, QLD, Australia.

Issue Addressed: Stimulant use has been identified as a key risk factor for sexual behaviours leading to HIV transmission. Substance-related expectancies are associated with substance use and postsubstance use thoughts, feelings and behaviours. Expectancies held by specific cultural subgroups have rarely been investigated, particularly regarding a range of commonly used stimulants.

Method: The Stimulant Expectancy Questionnaire for Men who have Sex with Men (SEQ-MSM) was initially generated through consumer panel and interviews regarding the most commonly used stimulants among MSM in Australia (methamphetamine, amphetamines and ecstasy), with initial administration among 98 MSM to facilitate item reduction. A community sample of 427 MSM was used to validate the SEQ-MSM, with exploratory factor analysis (EFA; n = 202) and confirmatory factor analysis (CFA; n = 225).

Results: EFA revealed three distinct substance reinforcement domains ('Enhanced sexual experience', 'Sexual communication and negotiation' and 'Cognitive impairment'). The scale was associated with stimulant consumption patterns (including greater expectancies regarding sexual enhancement among methamphetamine users), and the factor structure, comprising a final form of the MSM-SEQ, was confirmed through CFA.

Conclusions: The SEQ-MSM represents a reliable measure of outcome expectancies related to the range of commonly used stimulants among Australian MSM. Development of applied validation studies with the SEQ-MSM is a key next step in advancing health promotion, clinical interventions and research efforts to reduce harm (eg, HIV transmission) associated with stimulant use (particularly methamphetamine) among MSM. SO WHAT?: Objectives: This research maps expectancies specific among gay and men who have sex with men (MSM), and relationships between expectancies and stimulant use patterns and behaviours postuse - including sexual activity (eg, condomless anal sex).
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http://dx.doi.org/10.1002/hpja.271DOI Listing
April 2020

The evolution of domestic violence prevention and control in Vietnam from 2003 to 2018: a case study of policy development and implementation within the health system.

Int J Ment Health Syst 2019 8;13:41. Epub 2019 Jun 8.

2School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia.

Background: Internationally, mental health and social care systems face significant challenges when implementing policy to prevent and respond to domestic violence (DV). This paper reviews the policy process pertaining to the national law on domestic violence prevention and control (DVPC) within the health system in Vietnam from 2003 to 2018, and critically examines the policy-making process and content, the involvement of key actors and the barriers to implementation within the health system.

Methods: 63 policy documents, 36 key informant interviews and 4 focus group discussions were conducted in Hanoi city, Bac Giang and Hai Duong provinces. The policy triangle framework was used to analyse the development and implementation process of the Law on DVPC.

Results: The Vietnamese government developed the law on DVPC in response to the Millennium Development Goals reporting requirements. The development was a top-down process directed by state bodies, but it was the first time that international agencies and civil society groups had been involved in the health policy development process. The major themes that emerged in the analysis include: policy content, policymaking and implementation processes, the nature of actors' involvement, contexts, and mechanisms for policy implementation. Policy implementation was slow and delayed due to implementation being optional, decentralization, socio-cultural factors related especially to sensitivity, insufficient budgets, and insufficient cooperation between various actors within the health system and other related DV support systems.

Conclusion: The initial development process for DVPC Law in Vietnam was pressured by external and internal demands, but the subsequent implementation within the health system experienced protracted delays. It is recommended that the policy be revised to emphasise a rights-based approach. Implementation would be more effective if monitoring and evaluation mechanisms are improved, the quality of training for health workers is enhanced, and cooperation between the health sector and related actors in the community is required and becomes routine in daily work.
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http://dx.doi.org/10.1186/s13033-019-0295-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6555957PMC
June 2019

The evolution of domestic violence prevention and control in Vietnam from 2003 to 2018: a case study of policy development and implementation within the health system.

Int J Ment Health Syst 2019 8;13:41. Epub 2019 Jun 8.

2School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia.

Background: Internationally, mental health and social care systems face significant challenges when implementing policy to prevent and respond to domestic violence (DV). This paper reviews the policy process pertaining to the national law on domestic violence prevention and control (DVPC) within the health system in Vietnam from 2003 to 2018, and critically examines the policy-making process and content, the involvement of key actors and the barriers to implementation within the health system.

Methods: 63 policy documents, 36 key informant interviews and 4 focus group discussions were conducted in Hanoi city, Bac Giang and Hai Duong provinces. The policy triangle framework was used to analyse the development and implementation process of the Law on DVPC.

Results: The Vietnamese government developed the law on DVPC in response to the Millennium Development Goals reporting requirements. The development was a top-down process directed by state bodies, but it was the first time that international agencies and civil society groups had been involved in the health policy development process. The major themes that emerged in the analysis include: policy content, policymaking and implementation processes, the nature of actors' involvement, contexts, and mechanisms for policy implementation. Policy implementation was slow and delayed due to implementation being optional, decentralization, socio-cultural factors related especially to sensitivity, insufficient budgets, and insufficient cooperation between various actors within the health system and other related DV support systems.

Conclusion: The initial development process for DVPC Law in Vietnam was pressured by external and internal demands, but the subsequent implementation within the health system experienced protracted delays. It is recommended that the policy be revised to emphasise a rights-based approach. Implementation would be more effective if monitoring and evaluation mechanisms are improved, the quality of training for health workers is enhanced, and cooperation between the health sector and related actors in the community is required and becomes routine in daily work.
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http://dx.doi.org/10.1186/s13033-019-0295-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6555957PMC
June 2019

Short - term effects of temperature on hospital admissions for acute myocardial infarction: A comparison between two neighboring climate zones in Vietnam.

Environ Res 2019 08 25;175:167-177. Epub 2019 Apr 25.

Institute for Community Health Research, University of Medicine and Pharmacy, Hue University, Hue City, Viet Nam; School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia.

Background: Vietnam is one of the countries most affected by climate change, but few studies have focused on the population health effects of climate variation. Extreme heatwaves and cold spells might exacerbate underlying chronic conditions and precipitate hospitalization or early death. This study examined the short-term effects of ambient temperature extremes on hospital admissions (HAs) due to acute myocardial infarction (AMI) between different climate zones in the Central Coast region of Vietnam.

Methods: Information from medical records of all 3328 cases of AMI HAs (with hospital records cross-checked by clinicians) was collected from three hospitals in the South-Central Coast region (tropical savanna climate) and North-Central Coast region (tropical monsoon climate) for the period 2008-2015. Meteorological data were obtained from the National Hydro-Meteorological and Environment Network Centre. We used distributed lag non-linear models to assess the association between daily average temperature and AMI HAs, accounting for long-term trend and other meteorological variables.

Results: We found a negative and significant association between AMI HAs and temperature in the North-Central Coast region while conversely there was a positive and significant association in the South-Central Coast region. In the North-Central Coast region, the risk of AMI HAs increased by 11% (Relative risk (RR): 1.11, 95% CI: 0.91-1.35, p > 0.05) at moderately low temperatures (10th percentile of temperature range - 18.5 °C) and increased by 25% (RR: 1.25, 95% CI: 1.02-1.55, p < 0.05) at extremely low temperatures (5th percentile of temperature range - 16.8 °C). In the South-Central Coast region, the risk of AMI HAs increased by 18% (RR: 1.18, 95% CI: 0.95-1.47, p > 0.05) and 36% (RR: 1.36, 95% CI: 1.06-1.73, p < 0.05) at moderately high temperatures (90 percentile of temperature range -29.5 °C) and extreme high temperatures (95th percentile of temperature range - 29.9 °C), respectively.

Conclusions: Risk of AMI is associated with extremely high and extremely low temperature in Vietnam and the risk varies in relation to the local regional climate. Public health preparedness and multi-level interventions should attempt to reduce people's exposure in periods of disadvantageous temperatures.
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http://dx.doi.org/10.1016/j.envres.2019.04.023DOI Listing
August 2019

Trauma Exposure and Mental Health Problems Among Adults in Central Vietnam: A Randomized Cross-Sectional Survey.

Front Psychiatry 2019 22;10:31. Epub 2019 Feb 22.

School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia.

There is relatively little evidence about the psychological and social impacts of trauma exposure in the general population in East Asian countries. Vietnam has a long history of war and poverty, is prone to natural disasters and has high mortality related to traffic accidents. The mental health systems may be inadequate to cope with the resultant trauma. This research examines the lifetime prevalence of single and multiple traumas and the association between trauma exposure and depression, anxiety and post-traumatic stress disorder (PTSD) among a randomly selected sample of the adult population in Thua Thien-Hue province in central Vietnam. Six hundred and eight Vietnamese adults aged 18 years or older participated in the survey. The main tools in the face-to-face interview included the Life Event Checklist (LEC) to measure trauma exposure, the Hospital Anxiety and Depression Scale (HADS) and the PTSD Checklist for DSM-IV (PCL-IV). Hierarchical multiple logistic regression was used to examine associations between trauma exposure and mental health. Forty seven percent of the participants experienced at least one traumatic event in their lifetime and about half of these people were exposed to multiple traumas. The prevalence of depression, anxiety, and PTSD symptoms among the total sample was 12.7, 15.5, and 6.9%, respectively. Prevalence of PTSD among those reporting trauma exposure was 14.8%. Exposure to a higher number of trauma types was associated with increased risk of having depression, anxiety, and PTSD symptoms. Interpersonal traumas were strongly associated with symptoms of all three mental disorders while non-interpersonal traumas were only associated with depressive symptoms. Our findings indicate high burden of lifetime trauma and mental ill health in the adult population of central Vietnam and show a cumulative effect of multiple traumas on symptoms of the three mental disorders. Interpersonal trauma appears to have a more harmful effect on mental health than non-interpersonal trauma. Efforts to improve mental health in Vietnam should focus on reducing risk of preventable interpersonal trauma in every stage of life, and more broadly, ensure greater availability of trauma-sensitive mental health programs and services.
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http://dx.doi.org/10.3389/fpsyt.2019.00031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6395446PMC
February 2019

Future of Public Health Training: What Are the Challenges? What Might the Solutions Look Like?

Asia Pac J Public Health 2018 Nov 16:1010539518810555. Epub 2018 Nov 16.

1 Queensland University of Technology, Brisbane, Queensland, Australia.

The Asia-Pacific region has rapidly changing health needs. This reshaping of health priorities is directly affecting current and future public health education. This brief review focuses on foundational public health skills including epidemiology, biostatistics, and health informatics. Epidemiological skills, in particular, are essential for policymakers and practitioners to identify the emergence of problems and to inform priority setting of public health efforts. Training needs to move beyond didactic, passive learning methods in class settings to approaches that engage and challenge students and academics in active, flexible learning and realistic problem-solving. We provide an overview of future trends in public health training in the Asia-Pacific region and illustrate the diversity of online training resources globally that can enrich staff and student skills and complement our active, class-based teaching.
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http://dx.doi.org/10.1177/1010539518810555DOI Listing
November 2018

Which eHealth interventions are most effective for smoking cessation? A systematic review.

Patient Prefer Adherence 2018 8;12:2065-2084. Epub 2018 Oct 8.

School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia,

Purpose: To synthesize evidence of the effects and potential effect modifiers of different electronic health (eHealth) interventions to help people quit smoking.

Methods: Four databases (MEDLINE, PsycINFO, Embase, and The Cochrane Library) were searched in March 2017 using terms that included "smoking cessation", "eHealth/mHealth" and "electronic technology" to find relevant studies. Meta-analysis and meta-regression analyses were performed using Mantel-Haenszel test for fixed-effect risk ratio (RR) and restricted maximum-likelihood technique, respectively. Protocol Registration Number: CRD42017072560.

Results: The review included 108 studies and 110,372 participants. Compared to nonactive control groups (eg, usual care), smoking cessation interventions using web-based and mobile health (mHealth) platform resulted in significantly greater smoking abstinence, RR 2.03 (95% CI 1.7-2.03), and RR 1.71 (95% CI 1.35-2.16), respectively. Similarly, smoking cessation trials using tailored text messages (RR 1.80, 95% CI 1.54-2.10) and web-based information and conjunctive nicotine replacement therapy (RR 1.29, 95% CI 1.17-1.43) may also increase cessation. In contrast, little or no benefit for smoking abstinence was found for computer-assisted interventions (RR 1.31, 95% CI 1.11-1.53). The magnitude of effect sizes from mHealth smoking cessation interventions was likely to be greater if the trial was conducted in the USA or Europe and when the intervention included individually tailored text messages. In contrast, high frequency of texts (daily) was less effective than weekly texts.

Conclusions: There was consistent evidence that web-based and mHealth smoking cessation interventions may increase abstinence moderately. Methodologic quality of trials and the intervention characteristics (tailored vs untailored) are critical effect modifiers among eHealth smoking cessation interventions, especially for web-based and text messaging trials. Future smoking cessation intervention should take advantages of web-based and mHealth engagement to improve prolonged abstinence.
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http://dx.doi.org/10.2147/PPA.S169397DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6188156PMC
October 2018

Family-Based Social Health Insurance for Informal Workers in Vietnam: Willingness to Pay and Its Determinants.

Asia Pac J Public Health 2018 09 15;30(6):512-520. Epub 2018 Sep 15.

2 Queensland University of Technology, Brisbane, Queensland, Australia.

The study aimed to assess willingness to pay for family-based social health insurance and its determining factors among informal workers in Vietnam. A double-bounded dichotomous choice approach was used to elicit the willingness to pay of 391 heads of uninsured households. The study indicates that 48.8% of 391 uninsured households were willing to pay for family-based health insurance. The households were willing to pay about 921.9 thousand Vietnamese dongs per household per year (US$42). The factors that significantly affected willingness to pay were household income, number of uninsured members in a household, and sickness of the household head. The study suggests that a feasible premium for family-based health insurance supported by government subsidy, along with attention to the quality improvements of health services, could be an effective means to increase coverage among the informal sector workers.
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http://dx.doi.org/10.1177/1010539518799785DOI Listing
September 2018

Adverse Childhood Experiences, Mental Health, and Risk Behaviors Among Men in the Solomon Islands.

Asia Pac J Public Health 2018 09 22;30(6):582-591. Epub 2018 Aug 22.

3 Solomon Islands National University, Honiara, Solomon Islands.

Compared with many parts of the world, there has been little research in Pacific Island nations into the effects of adverse childhood experiences (ACEs) on adult health. This is a significant gap for local evidence-based child protection. We describe findings from a survey of 400 men aged 18 to 70 years recruited from randomly sampled households in Honiara city, Solomon Islands. Most men reported multiple adversities during childhood (80.7% 3 or more; 46% 5 or more), such as exposure to community and domestic violence, bullying, physical maltreatment, and sexual abuse. Men with multiple ACEs had significantly lower well-being and more psychological distress, recent stressful life events, and health risk behaviors. This study reports the first observation that betel quid chewing increased as a function of multiple ACEs. In comparison with recent East Asian studies, the Solomon Islands data suggest that the collective geographic category of "Asia-Pacific" masks significant intraregional differences in childhood adversities.
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http://dx.doi.org/10.1177/1010539518792911DOI Listing
September 2018

Adaptation and psychometric properties of the ISPCAN Child Abuse Screening Tool for use in trials (ICAST-Trial) among South African adolescents and their primary caregivers.

Child Abuse Negl 2018 08 31;82:45-58. Epub 2018 May 31.

School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia. Electronic address:

Child abuse prevention research has been hampered by a lack of validated multi-dimensional non-proprietary instruments, sensitive enough to measure change in abuse victimization or behavior. This study aimed to adapt the ICAST child abuse self-report measure (parent and child) for use in intervention studies and to investigate the psychometric properties of this substantially modified tool in a South African sample. First, cross-cultural and sensitivity adaptation of the original ICAST tools resulted in two preliminary measures (ICAST-Trial adolescents: 27 items, ICAST-Trial caregivers: 19 items). Second, ICAST-Trial data from a cluster randomized trial of a parenting intervention for families with adolescents (N = 1104, 552 caregiver-adolescent dyads) was analyzed. Confirmatory factor analysis established the hypothesized 6-factor (adolescents) and 4-factor (caregivers) structure. Removal of two items for adolescents and five for caregivers resulted in adequate model fit. Concurrent criterion validity analysis confirmed hypothesized relationships between child abuse and adolescent and caregiver mental health, adolescent behavior, discipline techniques and caregiver childhood abuse history. The resulting ICAST-Trial measures have 25 (adolescent) and 14 (caregiver) items respectively and measure physical, emotional and contact sexual abuse, neglect (both versions), and witnessing intimate partner violence and sexual harassment (adolescent version). The study established that both tools are sensitive to measuring change over time in response to a parenting intervention. The ICAST-Trial should have utility for evaluating the effectiveness of child abuse prevention efforts in similar socioeconomic contexts. Further research is needed to replicate these findings and examine cultural appropriateness, barriers for disclosure, and willingness to engage in child abuse research.
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http://dx.doi.org/10.1016/j.chiabu.2018.05.022DOI Listing
August 2018

OMGene: mutual improvement of gene models through optimisation of evolutionary conservation.

BMC Genomics 2018 Apr 27;19(1):307. Epub 2018 Apr 27.

Department of Plant Sciences, University of Oxford, South Parks Road, Oxford, OX1 3RB, UK.

Background: The accurate determination of the genomic coordinates for a given gene - its gene model - is of vital importance to the utility of its annotation, and the accuracy of bioinformatic analyses derived from it. Currently-available methods of computational gene prediction, while on the whole successful, frequently disagree on the model for a given predicted gene, with some or all of the variant gene models often failing to match the biologically observed structure. Many prediction methods can be bolstered by using experimental data such as RNA-seq. However, these resources are not always available, and rarely give a comprehensive portrait of an organism's transcriptome due to temporal and tissue-specific expression profiles.

Results: Orthology between genes provides evolutionary evidence to guide the construction of gene models. OMGene (Optimise My Gene) aims to improve gene model accuracy in the absence of experimental data by optimising the consistency of multiple sequence alignments of orthologous genes from multiple species. Using RNA-seq data sets from plants, mammals, and fungi, considering intron/exon junction representation and exon coverage, and assessing the intra-orthogroup consistency of subcellular localisation predictions, we demonstrate the utility of OMGene for improving gene models in annotated genomes.

Conclusions: We show that significant improvements in the accuracy of gene model annotations can be made, both in established and in de novo annotated genomes, by leveraging information from multiple species.
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http://dx.doi.org/10.1186/s12864-018-4704-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5923031PMC
April 2018

Childhood Sexual Violence in Indonesia: A Systematic Review.

Trauma Violence Abuse 2020 04 8;21(2):284-299. Epub 2018 Apr 8.

Queensland University of Technology, Queensland, Brisbane, Australia.

There has been relatively little research into the prevalence of childhood sexual violence (CSV) as well as the risk and protective factors for CSV in low- and middle-income countries including Indonesia. Systematic searches conducted in English and Bahasa Indonesia in this review identified 594 records published between 2006 and 2016 in peer-reviewed journals and other literature including 299 Indonesian records. Fifteen studies, including nine prevalence studies, met the quality appraisal criteria developed for this review. The review found that CSV research is scarce: Only one study included nationally representative prevalence estimates. Varying definitions for CSV, survey methods, and sample characteristics limited the generalizability of the data. The available evidence points to significant risk of sexual violence affecting both girls and boys across many geographical and institutional settings. Married adolescent girls are vulnerable to sexual violence by partners in their homes. Children in schools are vulnerable to CSV by peers and adults. Victims seldom disclose incidents and rarely seek support. In addition, early childhood experiences of trauma were strongly associated with later perpetration of sexual violence and revictimization. Limited information is available about protective factors. This review synthesizes evidence about what is currently known about CSV in Indonesia and identifies the strengths and weaknesses of the existing research. A more robust evidence base regarding CSV is required to better inform policy and justify investment into prevention programs.
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http://dx.doi.org/10.1177/1524838018767932DOI Listing
April 2020

The Importance of Contextual Factors in Carrying Out Childhood Violence Surveys: a Case Study from Indonesia.

Child Indic Res 2018 17;11(2):405-421. Epub 2017 Feb 17.

3School of Public Health and Social Work, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, QLD 4059 Australia.

Nationally representative research into violence against children is necessary to understand the scale and complexity of such violence and to evaluate prevention efforts. To date, however, most countries do not have adequate data. In 2013, the government of Indonesia conducted a national Violence Against Children Survey (VACS). This was a cross-sectional household survey of male and female 13-to-24- year-olds designed to estimate physical, emotional, and sexual violence prevalence. The target was to interview at least 2580 individuals; but response rates were much lower than anticipated (females = 66.6%; males = 56.1%). Insufficient data was available across several variables and there were unexpected anomalies in obtained data. We conducted a retrospective analysis of the survey to understand impediments and to advise future national efforts in Indonesia and other low-to-middle-income contexts. Survey managers and implementers ( = 22) were interviewed online and in person. We also carried out secondary analysis of the child survey data to identify factors possibly associated with (non-)response and assessed field notes from interviewers. Culturally inappropriate timing of data-collection (during Ramadan) may have had a negative impact on household responsiveness and the availability of children at home. Face-toface interviews in households were considered to impede participation and disclosure. Survey field staff and managers expressed the need for deeper training and a more comprehensive pilot. Recommendations to improve privacy and anonymity include the use of self-administered questionnaires and school-based rather than at-home surveys. These and other findings from this case study may be useful in planning future surveys in Indonesia and similar social and cultural contexts.
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http://dx.doi.org/10.1007/s12187-017-9457-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5838122PMC
February 2017

The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis.

Lancet Public Health 2017 08 31;2(8):e356-e366. Epub 2017 Jul 31.

School of Public Health and Social Work, Queensland University of Technology, Queensland, Australia.

Background: A growing body of research identifies the harmful effects that adverse childhood experiences (ACEs; occurring during childhood or adolescence; eg, child maltreatment or exposure to domestic violence) have on health throughout life. Studies have quantified such effects for individual ACEs. However, ACEs frequently co-occur and no synthesis of findings from studies measuring the effect of multiple ACE types has been done.

Methods: In this systematic review and meta-analysis, we searched five electronic databases for cross-sectional, case-control, or cohort studies published up to May 6, 2016, reporting risks of health outcomes, consisting of substance use, sexual health, mental health, weight and physical exercise, violence, and physical health status and conditions, associated with multiple ACEs. We selected articles that presented risk estimates for individuals with at least four ACEs compared with those with none for outcomes with sufficient data for meta-analysis (at least four populations). Included studies also focused on adults aged at least 18 years with a sample size of at least 100. We excluded studies based on high-risk or clinical populations. We extracted data from published reports. We calculated pooled odds ratios (ORs) using a random-effects model.

Findings: Of 11 621 references identified by the search, 37 included studies provided risk estimates for 23 outcomes, with a total of 253 719 participants. Individuals with at least four ACEs were at increased risk of all health outcomes compared with individuals with no ACEs. Associations were weak or modest for physical inactivity, overweight or obesity, and diabetes (ORs of less than two); moderate for smoking, heavy alcohol use, poor self-rated health, cancer, heart disease, and respiratory disease (ORs of two to three), strong for sexual risk taking, mental ill health, and problematic alcohol use (ORs of more than three to six), and strongest for problematic drug use and interpersonal and self-directed violence (ORs of more than seven). We identified considerable heterogeneity (I of >75%) between estimates for almost half of the outcomes.

Interpretation: To have multiple ACEs is a major risk factor for many health conditions. The outcomes most strongly associated with multiple ACEs represent ACE risks for the next generation (eg, violence, mental illness, and substance use). To sustain improvements in public health requires a shift in focus to include prevention of ACEs, resilience building, and ACE-informed service provision. The Sustainable Development Goals provide a global platform to reduce ACEs and their life-course effect on health.

Funding: Public Health Wales.
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http://dx.doi.org/10.1016/S2468-2667(17)30118-4DOI Listing
August 2017
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