Paediatrics (RCH) - Research Publications

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    Avoiding conflict: What do adolescents with disordered eating say about their mothers in music therapy?
    McFerran, K ; Baker, F ; Kildea, C ; Patton, G ; Sawyer, S (SAGE Publications, 2008-06-01)
    Music therapy is an integral part of the inpatient treatment programme for young women with disordered eating at the Royal Children's Hospital in Melbourne. As part of ongoing clinical audit activities, an investigation was undertaken to analyse retrospectively the lyrics of young women who had participated in the music therapy programme. The¬¬¬¬¬¬ purpose was to monitor and improve local clinical practice and clarify the specific contribution of music therapy to the diagnosis of anorexia nervosa. Results highlighted the role of mothers in the experiences of the young participants, with references to this relationship exceeding those to any other relationships. These findings are discussed in conjunction with an abandoned study where parental consent was not forthcoming for participation in a group music therapy research project. This article promotes a continuing awareness of the importance of the mother-daughter relationship in the treatment of eating disorders.
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    The Multimedia activity recall for children and adolescents (MARCA): development and evaluation
    Ridley, K ; Olds, TS ; Hill, A (BMC, 2006)
    BACKGROUND: Self-report recall questionnaires are commonly used to measure physical activity, energy expenditure and time use in children and adolescents. However, self-report questionnaires show low to moderate validity, mainly due to inaccuracies in recalling activity in terms of duration and intensity. Aside from recall errors, inaccuracies in estimating energy expenditure from self-report questionnaires are compounded by a lack of data on the energy cost of everyday activities in children and adolescents. This article describes the development of the Multimedia Activity Recall for Children and Adolescents (MARCA), a computer-delivered use-of-time instrument designed to address both the limitations of self-report recall questionnaires in children, and the lack of energy cost data in children. METHODS: The test-retest reliability of the MARCA was assessed using a sample of 32 children (aged 11.8 +/- 0.7 y) who undertook the MARCA twice within 24-h. Criterion validity was assessed by comparing self-reports with accelerometer counts collected on a sample of 66 children (aged 11.6 +/- 0.8 y). Content and construct validity were assessed by establishing whether data collected using the MARCA on 1429 children (aged 11.9 +/- 0.8 y) exhibited relationships and trends in children's physical activity consistent with established findings from a number of previous research studies. RESULTS: Test-retest reliability was high with intra-class coefficients ranging from 0.88 to 0.94. The MARCA demonstrated criterion validity comparable to other self-report instruments with Spearman coefficients ranging from rho = 0.36 to 0.45, and provided evidence of good content and construct validity. CONCLUSION: The MARCA is a valid and reliable self-report questionnaire, capable of a wide variety of flexible use-of-time analyses related to both physical activity and sedentary behaviour, and offers advantages over existing pen-and-paper questionnaires.
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    How should activity guidelines for young people be operationalised?
    Olds, T ; Ridley, K ; Wake, M ; Hesketh, K ; Waters, E ; Patton, G ; Williams, J (BMC, 2007-09-21)
    BACKGROUND: If guidelines regarding recommended activity levels for young people are to be meaningful and comparable, it should be clear how they are operationalised. It is usually open to interpretation whether young people are required to meet activity and screen time targets (1) all days of the week, (2) on most days of the week, (3) on average across all days, or (4) whether compliance should be understood as the probability that a randomly selected young person meets the guidelines on a randomly selected day. This paper studies this question using data drawn from the Australian Health of Young Victorians study. METHODS: The subjects for this study were 885 13-19 year olds who recalled four days of activities using a computerised use-of-time instrument, the Multimedia Activity Recall for Children and Adolescents (MARCA). Daily minutes of moderate-to-vigorous physical activity (MVPA) and screen time were calculated. The prevalence of compliance to Australian guidelines (> or = 60 min/day of MVPA and < or = 120 min/day of screen time outside of school hours) was calculated using the four methods. RESULTS: The four methods resulted in significantly different prevalence estimates for compliance to the MVPA guideline (20-68%), screen guideline (12-42%) and both guidelines (2-26%). Furthermore, different individuals were identified as compliant by the different methods. CONCLUSION: Clarification of how compliance to guidelines should be operationalised would assist in comparisons between studies, and in consistency in determining correlates of compliance.
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    Prevention and Mental Health Promotion in Adolescents: the evidence
    PATTON, GC ; OLSSON, CA ; TOUMBOUROU, JW ; ROWLING, L ; MARTIN, G ; WALKER, L (McGraw Hill Australia, 2002)
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    Family risk factors for cannabis use: a population-based survey of Australian secondary school students
    Olsson, CA ; Coffey, C ; Toumbourou, JW ; Bond, L ; Thomas, L ; Patton, G (CARFAX PUBLISHING, 2003-06)
    The objective of this study was to investigate relationships between adolescent cannabis use and indices of parent - child attachment, family functioning and parent attitudes to drugs and delinquency. A total of 2848 year 9 and 2363 year 11 students participated in the Victorian Adolescent Health and Well-Being Survey (1999). The study was a school-based random sample of 535 metropolitan and rural, government and non-government secondary schools throughout Victoria, Australia. Cannabis use was defined as 'any' and 'weekly' use in the last 30 days. Multivariate logistic regression was used to identify independent associations between cannabis use and parent - child attachment, family functioning and parent attitudes to drugs and delinquency. Cannabis use in year 9 was associated with permissive parent attitudes to drugs and delinquency (any use: adjusted odds ratio (OR) = 8.1; weekly use: adjusted OR = 7.6), and was particularly sensitive to small changes in the quality of the parent - child relationship with risk increasing threefold for those describing their attachment as 'good' compared with 'very good' (any use: adjusted OR = 2.8, weekly use adjusted OR = 2.9). A similar, but more moderate pattern association was evident in year 11. After adjusting for other family and background factors, poor family functioning showed minimal association with level of cannabis use at both year levels. Results suggest that intervention efforts might sensibly target strengthening parent - children relationships and promoting less permissive parent attitudes to drug use.
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    Nicotine dependence in a prospective population-based study of adolescents: the protective role of a functional tyrosine hydroxylase polymorphism
    Anney, RJL ; Olsson, CA ; Lotfi-Miri, M ; Patton, GC ; Williamson, R (LIPPINCOTT WILLIAMS & WILKINS, 2004-02)
    Dopamine is a key neurotransmitter of the mesolimbic reward pathway in the human brain, and tyrosine hydroxylase (TH) is the rate-limiting enzyme in dopamine biosynthesis. Consequently, the gene encoding TH is a strong candidate for involvement in the genetic component of addiction. The importance of this gene in nicotine dependence is supported by many studies showing a link between nicotine administration and TH expression. A functional tetranucleotide repeat polymorphism within intron 1 of the TH gene (HUMTH01-VNTR) has been shown to modify tobacco use in two independent Caucasian samples from the USA and Australia. Using information drawn from an eight-wave Australian population-based longitudinal study of adolescent health, we tested the effect of the HUMTH01-VNTR on nicotine dependence. Comparisons were made between dependent smokers and non-dependent smokers. These data provide further support for a protective association between the K4 allele and dependent smoking (odds ratio 0.54, 95% confidence interval 0.28-1.0). No associations were observed at any of three other common TH polymorphisms (rs6356, rs6357 and HUMTH01-PstI). Including these data, three independent studies, two of which use identical phenotypes, have now identified a protective relationship between the K4 allele of the functional HUMTH01-VNTR polymorphism and high-level smoking.
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    COMT Val158Met and 5HTTLPR functional loci interact to predict persistence of anxiety across adolescence:: results from the Victorian Adolescent Health Cohort Study
    Olsson, CA ; Byrnes, GB ; Anney, RJL ; Collins, V ; Hemphill, SA ; Williamson, R ; Patton, GC (BLACKWELL PUBLISHING, 2007-10)
    We investigated whether a composite genetic factor, based on the combined actions of catechol-O-methyltransferase (COMT) (Val(158)Met) and serotonin transporter (5HTTLPR) (Long-Short) functional loci, has a greater capacity to predict persistence of anxiety across adolescence than either locus in isolation. Analyses were performed on DNA collected from 962 young Australians participating in an eight-wave longitudinal study of mental health and well-being (Victorian Adolescent Health Cohort Study). When the effects of each locus were examined separately, small dose-response reductions in the odds of reporting persisting generalized (free-floating) anxiety across adolescence were observed for the COMT Met(158) [odds ratio (OR) = 0.85, 95% confidence interval (CI) = 0.76-0.95, P = 0.004] and 5HTTLPR Short alleles (OR = 0.88, CI = 0.79-0.99, P = 0.033). There was no evidence for a dose-response interaction effect between loci. However, there was a double-recessive interaction effect in which the odds of reporting persisting generalized anxiety were more than twofold reduced (OR = 0.45, CI = 0.29-0.70, P < 0.001) among carriers homozygous for both the COMT Met(158) and the 5HTTLPR Short alleles (Met(158)Met + Short-Short) compared with the remaining cohort. The double-recessive effect remained after multivariate adjustment for a range of psychosocial predictors of anxiety. Exploratory stratified analyses suggested that genetic protection may be more pronounced under conditions of high stress (insecure attachments and sexual abuse), although strata differences did not reach statistical significance. By describing the interaction between genetic loci, it may be possible to describe composite genetic factors that have a more substantial impact on psychosocial development than individual loci alone, and in doing so, enhance understanding of the contribution of constitutional processes in mental health outcomes.
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    Variation in the gene coding for the M5 Muscarinic receptor (CHRM5) influences cigarette dose but is not associated with dependence to drugs of addiction:: evidence from a prospective population based cohort study of young adults
    Anney, RJ ; Lotfi-Miri, M ; Olsson, CA ; Reid, SC ; Hemphill, SA ; Patton, GC (BMC, 2007-07-03)
    BACKGROUND: The mesolimbic structures of the brain are important in the anticipation and perception of reward. Moreover, many drugs of addiction elicit their response in these structures. The M5 muscarinic receptor (M5R) is expressed in dopamine-containing neurones of the substantia nigra pars compacta and ventral tegmental area, and regulates the release of mesolimbic dopamine. Mice lacking M5R show a substantial reduction in both reward and withdrawal responses to morphine and cocaine. The CHRM5, the gene that codes for the M5R, is a strong biological candidate for a role in human addiction. We screened the coding and core promoter sequences of CHRM5 using denaturing high performance liquid chromatography to identify common polymorphisms. Additional polymorphisms within the coding and core promoter regions that were identified through dbSNP were validated in the test population. We investigated whether these polymorphisms influence substance dependence and dose in a cohort of 1947 young Australians. RESULTS: Analysis was performed on 815 participants of European ancestry who were interviewed at wave 8 of the cohort study and provided DNA. We observed a 26.8% increase in cigarette consumption in carriers of the rs7162140 T-allele, equating to 20.1 cigarettes per week (p=0.01). Carriers of the rs7162140 T-allele were also found to have nearly a 3-fold increased risk of developing cannabis dependence (OR=2.9 (95%CI 1.1-7.4); p=0.03). CONCLUSION: Our data suggest that variation within the CHRM5 locus may play an important role in tobacco and cannabis but not alcohol addiction in European ancestry populations. This is the first study to show an association between CHRM5 and substance use in humans. These data support the further investigation of this gene as a risk factor in substance use and dependence.
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    Predicting Female Depression Across Puberty: A Two-Nation Longitudinal Study
    Patton, GC ; Olsson, C ; Bond, L ; Toumbourou, JW ; Carlin, JB ; Hemphill, SA ; Catalano, RF (ELSEVIER SCIENCE INC, 2008-12)
    OBJECTIVE: To prospectively examine the relation between pubertal stage and the onset and course of depressive symptoms. METHOD: The design was a three-wave longitudinal study of health and social development using statewide community samples in Washington, United States, and Victoria, Australia. Approximately 5,769 students initially ages 10 to 15 years were assessed for depressive symptoms with the Short Mood and Feelings Questionnaire. Pubertal status was assessed using a self-report version of the Pubertal Development Scale. RESULTS: Advancing pubertal stage carried higher risks for depressive symptoms in female subjects in all of the three study waves. The pubertal rise in female depressive symptoms was due to both higher risk for incident cases and an even greater effect on risks for persistence of depressive symptoms. Report of poor emotional control 12 months earlier carried a twofold higher risk for incident depressive symptoms and largely explained the pubertal rise in female incident cases. High family conflict and severity of bullying also predicted persistence of depressive symptoms. Preexisting depressive symptoms were not associated with later increases in the rate of pubertal transition. CONCLUSIONS: Advancing pubertal stage carries risks for both the onset and persistence of depressive symptoms in females. Social adversity around puberty predicts the persistence of symptoms but does not account for a pubertal rise in female depression. A report of poor emotional control may be a useful marker of girls at risk for depressive symptoms and as a target for preventive intervention.
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    Avoiding Conflict
    McFerran, K ; Baker, F ; Kildea, C ; Patton, G ; Sawyer, SM (SAGE Publications, 2008-06)
    Music therapy is an integral part of the inpatient treatment programme for young women with disordered eating at the Royal Children's Hospital in Melbourne. As part of ongoing clinical audit activities, an investigation was undertaken to analyse retrospectively the lyrics of young women who had participated in the music therapy programme. The purpose was to monitor and improve local clinical practice and clarify the specific contribution of music therapy to the diagnosis of anorexia nervosa. Results highlighted the role of mothers in the experiences of the young participants, with references to this relationship exceeding those to any other relationships. These findings are discussed in conjunction with an abandoned study where parental consent was not forthcoming for participation in a group music therapy research project. This article promotes a continuing awareness of the importance of the mother-daughter relationship in the treatment of eating disorders.