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Biomedical subjects

Dieter Wolke

Publications and source records attributed to Dieter Wolke.

13 recordsLinked to original sources

Pushing the boundaries of viability: the economic impact of extreme preterm birth.

BACKGROUND: Previous assessments of the economic impact of preterm birth focussed on short term health service costs across the broad spectrum of prematurity. OBJECTIVE: To estimate the societal costs of extreme preterm birth during the sixth year after birth. METHODS: Unit costs were applied to estimates of health, social and broader resource use made by 241 children born at 20 through 25 completed weeks of gestation in the United Kingdom and Republic of Ireland and a comparison group of 160 children born at full term. Societal costs per child during the sixth year after birth were estimated and subjected to a rigorous sensitivity analysis. The effects of gestational age at birth on annual societal costs were analysed, first in a simple linear regression and then in a multiple linear regression. RESULTS: Mean societal costs over the 12 month period were 9541 pounds sterling (standard deviation 11,678 pounds sterling) for the extreme preterm group and 3883 pounds sterling (1098 pounds sterling) for the term group, generating a mean cost difference of 5658 pounds sterling (bootstrap 95% confidence interval: 4203 pounds sterling, 7256 pounds sterling) that was statistically significant (P<0.001). After adjustment for clinical and sociodemographic covariates, sex-specific extreme preterm birth was a strong predictor of high societal costs. CONCLUSION: The results of this study should facilitate the effective planning of services and may be used to inform the development of future economic evaluations of interventions aimed at preventing extreme preterm birth or alleviating its effects.

Cohort Studies↗

Stability in cognition across early childhood. A developmental cascade.

Children confront the formidable task of assimilating information in the environment and accommodating their cognitive structures to that information. Developmental science is concerned equally with two distinctive features of these processes: children's group mean level of performance through time and the standing of individual children through time. Prevailing opinion since the inception of the mental-measurement movement has been that individual development is unstable-that individual children change unpredictably in their abilities. We report results of a large-scale controlled, multivariate, prospective, microgenetic, 4-year longitudinal study that reveals a statistically significant cascade of species-typical cognitive abilities from infancy to childhood. Infancy is a recognizable starting point of life; we find that to a small but significant degree, infancy also represents a setting point in the life of the individual.

Child↗

Neurologic and developmental disability at six years of age after extremely preterm birth.

BACKGROUND: Birth before 26 weeks of gestation is associated with a high prevalence of neurologic and developmental disabilities in the infant during the first two years of life. METHODS: We studied at the time of early school age children who had been born at 25 or fewer completed weeks of gestation in the United Kingdom and Ireland in 1995. Each child had been evaluated at 30 months of age. The children underwent standardized cognitive and neurologic assessments at six years of age. Disability was defined as severe (indicating dependence on caregivers), moderate, or mild according to predetermined criteria. RESULTS: Of 308 surviving children, 241 (78 percent) were assessed at a median age of six years and four months; 160 classmates delivered at full term served as a comparison group. Although the use of test reference norms showed that cognitive impairment (defined as results more than 2 SD below the mean) was present in 21 percent of the children born extremely preterm (as compared with 1 percent in the standardized data), this value rose to 41 percent when the results were compared with those for their classmates. The rates of severe, moderate, and mild disability were 22 percent, 24 percent, and 34 percent, respectively; disabling cerebral palsy was present in 30 children (12 percent). Among children with severe disability at 30 months of age, 86 percent still had moderate-to-severe disability at 6 years of age. In contrast, other disabilities at the age of 30 months were poorly predictive of developmental problems at 6 years of age. CONCLUSIONS: Among extremely preterm children, cognitive and neurologic impairment is common at school age. A comparison with their classroom peers indicates a level of impairment that is greater than is recognized with the use of standardized norms.

Case-Control Studies↗

Domestic violence risk during and after pregnancy: findings from a British longitudinal study.

OBJECTIVE: The objectives of this study were to examine the rates of domestic violence reported during and after pregnancy and to assess the importance of family adversity. DESIGN: Prospective longitudinal cohort study. SETTING: Bristol Avon, Southwest England. POPULATION: Seven thousand five hundred and ninety-one pregnant women with due dates between 1.4.91 and 31.12.92. METHODS: Questionnaires administered at 18 weeks of gestation and 8 weeks, 8 months, 21 months and 33 months postpartum. MAIN OUTCOME MEASURES: The experience of emotional or physical cruelty by an intimate partner at each time point. RESULTS: Fewer women reported domestic violence victimization during pregnancy than they did postpartum (18 weeks of gestation: 1% physical cruelty, 4.8% emotional cruelty, 5.1% any victimization; 33 months postpartum: 2.9% physical, 10.8% emotional, 11% any victimization). Women who reported being victimized during pregnancy also reported significantly higher levels of social adversity during pregnancy. The number of social adversities reported during pregnancy also predicted postpartum victimization. Women who reported only one adversity during pregnancy were 2.73 (95% CI, 2.16-3.45) times more likely to report physical victimization at 33 months postpartum. Women who reported 5 adversities during pregnancy were 14.69 (95% CI, 7.35-29.37) times more likely to report such victimization at 33 months postpartum. For emotional cruelty, women who reported only one adversity during pregnancy were 2.10 (95% CI 1.80-2.46) times more likely to report emotional victimization at 33 months postpartum and 6.10 (95% CI 3.51-10.59) times more likely to report such victimization when five or more adversities were present during pregnancy. CONCLUSIONS: Levels of social adversity reported in pregnancy are important predictors of concurrent and future victimization. Screening for social adversity factors could help identify women at high risk for future domestic violence.

Adolescent↗

Common visual defects and peer victimization in children.

PURPOSE: To investigate whether wearing glasses, having manifest strabismus, or having a history of wearing an eye patch predisposes preadolescent children to being victimized more frequently at school and whether the impact may be different on boys than on girls. METHODS: Data were examined on 6536 children from the Avon Longitudinal Study of Parents and Children (ALSPAC) based in the United Kingdom. At 7.5 years, the children undertook a detailed eye examination by orthoptists, including a cover test and visual acuity assessment. At 8.5 years, trained psychologists assessed the children's bullying involvement as either victim or perpetrator for overt and relational bullying, in a standard interview. RESULTS: Children currently wearing glasses or with a history of wearing eye patches were 35% to 37% more likely to be victims of physical or verbal bullying, even after adjustment for social class and maternal education. No interactions were found between sex and visual problems in the prediction of bullying. CONCLUSIONS: For those children who require glasses, opticians should be aware of the risks of bullying, and strategies should be developed and discussed that help reduce their vulnerability.

Aggression↗

Negative self-schemas and the onset of depression in women: longitudinal study.

BACKGROUND: Beck's cognitive theory of depression has received little empirical support. AIMS: To test whether those with negative self-schemas were at risk of onset of depression. METHOD: Data were collected by postal questionnaire from 12,003 women recruited during early pregnancy; questionnaires included measures of depressive symptoms and negative self-schemas. Regular questionnaires were sent during pregnancy and following childbirth. RESULTS: Of 8540 women not depressed when recruited, 8.6% (95% CI 8.0-9.2) became depressed 14 weeks later. Those in the highest tertile for negative self-schema score were more likely to become depressed than those in the lowest tertile (odds ratio 3.04, 95% CI 2.48-3.73). The association remained after adjustment for baseline depressive symptoms and previous depression (OR 1.6, 95% CI 1.27-2.02) and was of similar magnitude for onset 3 years later. CONCLUSIONS: Holding a negative self-schema is an independent risk factor for the onset of depression in women. This finding supports a key element of Beck's cognitive theory. Understanding more about how negative self-schemas arise should help inform preventive policies.

Adolescent↗

Validation of a parent report measure of cognitive development in very preterm infants.

Parental report may provide an inexpensive alternative to standardized assessments of children's development. We have adapted and validated a parental questionnaire on cognitive development for use with very preterm infants. Sixty-four 2-year-olds (28 males, 36 females) born less than 30 weeks' gestation (median 28.5 weeks, range 23 to 31 weeks), median birthweight 980g (range 500 to 1905g) were assessed using the Mental Development Index (MDI) of the Bayley Scales of Infant Development-II and the parental questionnaire. Significant correlations between parent report and MDI scores (r=0.54-0.68, p<0.001) indicated good concurrent validity. Diagnostic use of the parent report for predicting an MDI score of less than 70 was assessed by using receiver operating characteristic (ROC) curves. The optimal cut off produced equal sensitivity and specificity (81%), indicating good discriminatory power in diagnosing developmental delay. Test-retest reliability was demonstrated and accuracy of parent reporting was not affected by sociodemographic factors. Our questionnaire provides a valid outcome measure for use in randomized trials or large population surveys.

Child Development↗

Bullied by siblings: association with peer victimisation and behaviour problems in Israeli lower secondary school children.

BACKGROUND: The association of bullying victimisation by siblings with a) involvement in bullying at school and b) behaviour problems among lower secondary school children in Israel was investigated. METHOD: Self-report questionnaires of sibling victimisation, peer bullying experiences and behaviour problems were completed by 921 pupils aged 12-15 (mean age 13.7 years). RESULTS: Of the sample, 16.2% were directly bullied by their siblings at home and 11.9% were direct victims of bullying by peers at school every week. More than half of victims of bullying by siblings (50.7%) were also involved in bullying behaviour at school compared to only 12.4% of those not victimised by siblings, indicating a strong link between intrafamilial and extrafamilial peer relationships. Children with poor sibling and peer relationships were at a highly increased risk for behaviour problems. Ethnic (Israeli Jewish vs. Arab) and sex differences were small compared to the effects of sibling relationship on behaviour problems. CONCLUSION: Intervention strategies directed at reducing bullying in school should take into account pupils' experiences of victimisation by siblings at home.

Adolescent↗

Sex 'n' drugs 'n' rock 'n' roll: the meaning and social consequences of pubertal timing.

This is a brief review of the normal changes in adolescent behaviour and the interplay between biology and social factors that occur at and around puberty, in an attempt to explain when this transition may become problematic The onset of puberty is a biological marker for an individual's transition from a non-reproductive to a reproductive state. Adolescence is a normal developmental transition associated with clearly visible physical changes, reorganization and pruning of neuronal circuits in the brain and the occurrence of new behaviours and interests. It is a time when new life tasks (orientation towards peers of the other sex, romantic and sexual involvement and mastering an educational career) need to be mastered. Parent-child conflict increases and becomes more intense as the adolescent struggles for more independence while still requiring support. These normal changes can become problematic if biological and social expectations diverge e.g. entering puberty very early or very late. While early pubertal onset in boys is likely to have beneficial effects, in girls precocious pubertal timing may have a negative impact on body-image, affect (or emotional well-being) and sex-role expectations. Other individual biological predispositions and genetic endowment may interact with social factors (e.g. peers, parenting style, neighbourhood) making adolescence either an adaptive or a challenging transition. There is a lack of sufficiently large longitudinal studies that have been able to study this interaction between genetics, biology and social environment on adolescent development. The Avon Longitudinal Study of Parents and Children (ALSPAC) cohort provides a unique opportunity to investigate the impact of pubertal timing on social behaviour. Planned assessments and concepts are outlined.

Adolescent↗

School-age outcomes in children who were extremely low birth weight from four international population-based cohorts.

OBJECTIVE: The aim of this study was to determine whether learning and school problems in extremely low birth weight (ELBW) and reference children differ between cohorts in different countries. METHODS: Participants were 4 international population-based cohorts of ELBW survivors who were 500 to 1000 g birth weight from New Jersey, central-west Ontario, Bavaria, and Holland (n = 532) and were followed longitudinally from birth. Psychometric data were collected independently and prospectively and included at least 1 measure of cognitive status and 1 measure of achievement administered to the children between the ages of 8 and 11 years. Adjustments were made for comparison of all measures based on reference norms within each country. Information on special educational assistance and grade repetition was obtained from the parents. RESULTS: The overall follow-up rate was 84% (range: 74%-90%; n = 436). The proportion of children who performed within the normal range (> or =85) were as follows: IQ between 44% and 62%; reading between 46% and 81%; arithmetic between 31% and 76%; and spelling between 39% and 65%. Children from New Jersey had the lowest rates of cognitive and achievement deficits, and Bavarian children did less well in achievement scores relative to their peers and other cohorts. Despite these differences, more than half of all cohorts required special educational assistance and/or repeated a grade. CONCLUSIONS: School difficulties were found to be a serious sequelae of ELBW in all 4 countries, an observation that has social and economic implications.

Child↗

A randomised controlled trial of maternal satisfaction with the routine examination of the newborn baby at three months post birth.

OBJECTIVE: to determine whether any differences in maternal satisfaction with the examination of a newborn baby between midwives and junior paediatricians are maintained over a three-month period. DESIGN, SETTING AND PARTICIPANTS: randomised controlled trial. Eight hundred and twenty-six mother and baby pairs in a district general hospital in South East England were randomised to a junior paediatrician or a midwife for the routine examination. Four hundred and eighty-six mothers completed a maternal satisfaction questionnaire on day-one and again three-months later. Maternal satisfaction with the examination was analysed in relation to randomised group, process and background variables. FINDINGS: high satisfaction with the examination was reported by most mothers (day-one: 82%; three-months: 79%). At day-one, mothers whose babies were examined by a midwife were more satisfied with the examination (crude odds ratio (OR) for the lowest tertile of satisfaction 0.49, 95% CI 0.32-0.73). However, after controlling for provision of health education during the examination (e.g. discussing feeding, sleeping and skin care) and continuity of care provided, maternal satisfaction was no longer related to status of examiner (adjusted OR 0.83, 95% CI 0.52-1.33). Three months later, there was no significant difference in maternal satisfaction with midwife and junior paediatrician examinations of the newborn baby (crude OR 0.89, 95% CI 0.58-1.37). Discussion of health-care issues by the examiner during the examination was significantly related to increased satisfaction even at three-months. Three month ratings of low satisfaction with the examination were most strongly predicted by current maternal depressive mood, even when other factors were adjusted for (adjusted OR 2.58, 95% CI 1.19-5.59). KEY CONCLUSIONS: from the mother's perspective, the quality of midwife examination is at least as satisfactory as that of junior paediatricians and this perception is maintained over a three-month period. Satisfaction can be significantly enhanced if the examiner provides information on behavioural and health-care issues. The examination of the newborn baby provides an important window of opportunity for sharing information on newborn behaviour and care issues.

Continuity of Patient Care↗

Persistent infant crying and hyperactivity problems in middle childhood.

OBJECTIVE: To investigate whether persistent infant crying is associated with an increased risk for externalizing behavior problems in childhood. METHODS: Sixty-four infants who were referred for persistent crying in infancy (PC; mean age: 3.8 +/- 1.3 months) were reassessed at 8 to 10 years of age and compared with 64 classroom controls (CC). The major outcome measure was pervasive hyperactivity or conduct problems defined as parent, child, and teacher ratings that across informants were within the borderline/clinical range according to the Strengths and Difficulties Questionnaire (SDQ). Ratings of other behavior problems, parent ratings of temperament, and teacher assessment of academic achievement were also obtained. RESULTS: Ten (18.9%) of 53 PC had pervasive hyperactivity problems (child, parent, and teacher reported) compared with 1 (18.9%) of 62 CC (odds ratio: 14.19 [1.75-114.96]). Parents (29 [45.3%] of 64 vs 11 [17.2%] of 64; 4.00 [1.77-9.01]) and children (30 [46.9%] of 64 vs 17 [26.6%] of 64; 2.44 [1.16-5.12]) but not the teachers reported more conduct problems. Parents of PC rated the temperament of their children to be more negative in emotionality (PC mean: 3.0 +/- 1.0; CC: 2.4 +/- 1.0; effect size: 0.6) and difficult-demanding (PC mean: 5.2 +/- 1.3; CC: 6.3 +/- 0.9; effect size: 1.0). Academic achievement was reported by teachers to be significantly lower for PC than CC, in particular for those children with pervasive hyperactivity problems. CONCLUSIONS: Infants who are referred for PC problems and associated sleeping or feeding problems are at increased risk for hyperactivity problems and academic difficulties in childhood.

Achievement↗