Association between locus of control in childhood and psychotic symptoms in early adolescence: results from a large birth cohort

INTRODUCTION. Specific attributional styles have been demonstrated in individuals with psychotic disorders and are implicated in the development of psychotic symptoms. We aimed to examine the association between locus of control (LOC) assessed in childhood and psychotic symptoms reported in early adolescence. METHODS. We used a prospective longitudinal design using data from a large birth cohort (the Avon Longitudinal Study of Parents and Children, ALPSAC). 6455 subjects completed a semistructured clinical interview assessing 12 individual psychotic symptoms at a mean age of 12.9 years. A measure of LOC was previously collected in the cohort at the age of 8. RESULTS. Children who reported an externalised LOC at age 8 were at increased risk of reporting both broadly defined (OR 1.77, 95% CI 1.49 to 2.08) and narrowly defined (OR 2.06, 95% CI 1.58 to 2.67) psychotic symptoms at age 13 years. These associations were only slightly attenuated after adjustment for potential confounders. The associations were similar for broadly defined specific paranoid symptoms but weaker for narrowly defined specific paranoid symptoms. CONCLUSIONS. An externalised LOC appears to be associated with later reporting of psychotic symptoms in early adolescence. Further investigation of the role of attributional styles, such as LOC, in increasing the risk for psychotic disorders, is warranted.     

Surveillance of mother-to-child transmission prevention programmes at immunization clinics: the case for universal screening

BACKGROUND: Surveillance programmes for prevention of mother-to-child transmission of HIV (PMTCT) fail to quantify numbers of infant HIV infections averted, often because of poor postnatal follow-up. Additionally, infected infants are often not identified early and only gain access to comprehensive HIV care and treatment late in their disease. METHODS: Anonymous, unlinked, HIV prevalence testing was conducted on dried blood spot (DBS) samples from all infants attending 6 week immunization clinics at seven primary health care clinics offering PMTCT. Samples were tested for HIV antibodies (indicating maternal HIV infection) and those determined to be from HIV-exposed infants were tested for HIV RNA by polymerase chain reaction. Infant and child mortality rates were determined using birth histories. RESULTS: Samples were collected from 2489 infants aged 4-8 weeks. HIV antibodies were identified in 931 infants [37.4%; 95% confidence interval (CI), 35.4-39.4], of whom 188 were HIV RNA positive. The estimated vertical transmission rate (VTR) was 20.2% (95% CI, 17.8-23.1%); 7.5% of all infants at this age were infected. Amongst mothers who reported that they had taken single-dose nevirapine for PMTCT, VTR was 15.0%. Amongst women who reported being HIV uninfected but whose infants had HIV antibodies, VTR was 30.5%. Infant mortality rates in KwaZulu Natal increased from 28/1000 live births in 1990-1994 to 92/1000 in 2000-2004. CONCLUSIONS: Anonymous HIV prevalence screening of all infants at immunization clinics is feasible to monitor the impact of PMTCT programmes on peripartum infection; linked screening could identify infected children early for referral into care and treatment programmes.     

Prevalence of traumatic brain injury among children, adolescents and young adults: prospective evidence from a birth cohort

Background: Little is known about the incidence and prevalence of traumatic brain injury (TBI), particularly for infants, children and young adults.

Primary objective: The purpose of this study was to provide an accurate estimate of the incidence and prevalence of TBIs for individuals between 0-25 years of age.

Method and procedures: A birth cohort of 1265 individuals was used, for which information regarding TBI events, both hospitalized and non-hospitalized, had been recorded.

Main outcomes and results: The average incidence for this age group ranged from 1.10-2.36 per 100 per year, with an overall prevalence of ∼30%. The most common source of injury was falls for individuals 0-14 years of age and contact sports and motor vehicle accidents for 15-25 year olds. Approximately one third of the individuals who experienced a TBI went on to have one or more additional injuries.

Conclusions: The incidence rates reported here are much higher than those previously found. It is clear that TBIs constitute a major health issue and therefore it is important to have accurate information to enable planning for primary healthcare services and to inform prevention programmes.     

A Comprehensive Overview of Vision Screening Programmes across 46 Countries

Purpose:To describe and compare vision screening programmes and identify variance in number and type of tests used, timing of screening, personnel involved, monitoring and funding to be used as data for optimising, disinvesting or implementing future screening programmes.Methods:A questionnaire consisting of nine domains: demography & epidemiology, administration & general background, existing screening, coverage & attendance, tests, follow-up & diagnosis, treatment, cost & benefit and adverse effects was completed by Country Representatives (CRs) recruited from 47 countries.Results:The questionnaire was sufficiently completed for 46 Countries: 42 European countries, China, India, Malawi and Rwanda. Variation of provision was found in; age of screening (0–17 years), tests included (23), types of visual acuity (VA) test used (35 different optotypes), personnel (13), number of screens per child (median 5, range 1–32), and times VA tested (median 3, range 1–30). Infant screening is offered in all countries, whereas childhood vision screening is offered at least once in all countries, but not all regions of each country. All 46 countries provide vision screening between the ages of 3–7 years. Data on screening outcomes for quality assurance was not available from most countries; complete evaluation data was available in 2% of countries, partial data from 43%.Conclusion:Vision screening is highly variable. Some form of VA testing is being undertaken during childhood. Data collection and sharing should be improved to facilitate comparison and to be able to optimise vision screening programmes between regions and countries.