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Objectives To estimate the prevalence in Australia of each type of child maltreatment; to identify gender- and age group-related differences in prevalence. Design, setting Cross-sectional national survey; mobile telephone interviews using random digit dialling (computer-generated), Australia, 9 April – 11 October 2021. Retrospective self-report data using validated questionnaire (Juvenile Victimisation Questionnaire-R2 Adapted Version (Australian Child Maltreatment Study). Participants People aged 16 years or more. The target sample size was 8500 respondents: 3500 people aged 16–24 years and 1000 respondents each from five further age groups (25–34, 35–44, 45–54, 55–64, 65 years or more). Main outcome measures Proportions of respondents reporting physical abuse, sexual abuse, emotional abuse, neglect, and exposure to domestic violence to age 18 years, assessed with the Juvenile Victimization Questionnaire-R2 Adapted Version (Australian Child Maltreatment Study), overall and by gender and age group, and weighted to reflect characteristics of the Australian population aged 16 years or more in 2016. Results Complete survey data were available for 8503 eligible participants (14% response rate). Physical abuse was reported by 32.0% of respondents (95% confidence interval [CI], 30.7–33.3%), sexual abuse by 28.5% (95% CI, 27.3–29.8%), emotional abuse by 30.9% (95% CI, 29.7–32.2%), neglect by 8.9% (95% CI, 8.1–9.7%), and exposure to domestic violence by 39.6% (95% CI, 38.3–40.9%). The proportions of respondents who reported sexual abuse, emotional abuse, or neglect were each statistically significantly larger for women than men. The reported prevalence of physical abuse by respondents aged 16–24 years was lower than for those aged 25–34 years, and that of sexual abuse was lower than for those aged 35–44 years, suggesting recent declines in the prevalence of these maltreatment types. Conclusions Child maltreatment is common in Australia, and larger proportions of women than men report having experienced sexual abuse, emotional abuse, and neglect during childhood. As physical and sexual abuse may have declined recently, public health policy and practice may have positive effects, justifying continued monitoring and prevention activities.

Objectives To examine associations between child maltreatment and health service use, both overall, by type and by the number of types of maltreatment reported. Design, setting Cross-sectional, retrospective survey using the Juvenile Victimization Questionnaire-R2: Adapted Version (Australian Child Maltreatment Study); computer-assisted mobile telephone interviews using random digit dialling, Australia, 9 April – 11 October 2021. Participants Australians aged 16 years or more. The target sample size was 8500 respondents: 3500 people aged 16–24 years and 1000 respondents each from the five age groups (25–34, 35–44, 45–54, 55–64, 65 years or more). Main outcome measures Self-reported health service use during the past twelve months: hospital admissions, length of stay, and reasons for admission; and numbers of consultations with health care professionals, overall and by type. Associations between maltreatment and health service use are reported as odds ratios adjusted for age group, gender, socio-economic status, financial hardship (childhood and current), and geographic remoteness. Results A total of 8503 participants completed the survey. Respondents who had experienced child maltreatment were significantly more likely than those who had not to report a hospital admission during the preceding twelve months (adjusted odds ratio [aOR], 1.39; 95% confidence interval [CI], 1.16–1.66), particularly admission with a mental disorder (aOR, 2.4; 95% CI, 1.03–5.6). The likelihood of six or more visits to general practitioners (aOR, 2.37; 95% CI, 1.87–3.02) or of a consultation with a mental health nurse (aOR, 2.67; 95% CI, 1.75–4.06), psychologist (aOR, 2.40; 95% CI, 2.00–2.88), or psychiatrist (aOR, 3.02; 95% CI, 2.25–4.04) were each higher for people who reported maltreatment during childhood. People who reported three or more maltreatment types were generally most likely to report greater health service use. Conclusions Child maltreatment has a major impact on health service use. Early, targeted interventions are vital, not only for supporting children directly, but also for their longer term wellbeing and reducing their health system use throughout life.

Objectives To describe the aims, design, methodology, and respondent sample representativeness of the Australian Child Maltreatment Study (ACMS). Design, setting Cross-sectional, retrospective survey; computer-assisted mobile telephone interviewing using random digit dialling (computer-generated), Australia, 9 April – 11 October 2021. Participants People aged 16 years or more. The target sample size was 8500 respondents: 3500 people aged 16–24 years and 1000 respondents each from five further age groups (25–34, 35–44, 45–54, 55–64, 65 years or more). Main outcome measures Primary outcomes: Emotional abuse, neglect, physical abuse, sexual abuse, exposure to domestic violence during childhood, assessed with the Juvenile Victimization Questionnaire-R2 Adapted Version (Australian Child Maltreatment Study). Secondary outcomes: selected mental disorder diagnoses (Mini International Neuropsychiatric Interview, MINI), selected physical health conditions, health risk behaviours, health service use. Results The demographic characteristics of the ACMS sample were similar to those of the Australian population in 2016 with respect to gender, Indigenous status, region and remoteness category of residence, and marital status, but larger proportions of participants were born in Australia, lived in areas of higher socio-economic status, had tertiary qualifications, and had income greater than $1250 per week. Population weights were derived to adjust for these differences. Associations between the number of calls required to recruit participants and maltreatment rates and health outcomes were not statistically significant. Conclusions The ACMS provides the first reliable estimates of the prevalence of each type of child maltreatment in Australia. These estimates, and those of associated mental health and health risk behaviours reported in this supplement can inform policy and practice initiatives for reducing the prevalence of child maltreatment and its consequences. Our benchmark study also provides baseline data for repeated waves of the ACMS that will assess the effectiveness of these initiatives.

Objective To estimate associations between all five types of child maltreatment (emotional abuse, neglect, physical abuse, sexual abuse, and exposure to domestic violence) and health risk behaviours and conditions. Design, setting, participants Nationally representative survey of Australian residents aged 16 years and older conducted by computer-assisted telephone interviewing. Main outcome measures Associations between child maltreatment and the following health risk behaviours and conditions: current smoker, binge drinking (at least weekly in past 12 months), cannabis dependence (according to the Cannabis Severity of Dependence Scale), obesity (based on body mass index), self-harm in past 12 months, and suicide attempt in past 12 months. Results A total of 8503 participants completed the survey. All five types of child maltreatment were associated with increased rates of all of the health risk behaviours and conditions that we considered. The strongest associations were in the youngest age group (16–24-year-olds). Sexual abuse and emotional abuse were associated with the highest odds of health risk behaviours and conditions. Cannabis dependence, self-harm and suicide attempts were most strongly associated with child maltreatment. Experiencing more than one type of child maltreatment was associated with higher rates of health risk behaviours and conditions than experiencing one type of child maltreatment. Conclusions Child maltreatment is associated with substantially increased rates of health risk behaviours and conditions. Prevention and intervention efforts should be informed by trauma histories, and holistic psychosocial care should be incorporated into programs focusing on behaviour change.

Objectives To determine the prevalence in Australia of multi-type child maltreatment, defined as two or more maltreatment types (physical abuse, sexual abuse, emotional abuse, neglect, or exposure to domestic violence) and to examine its nature, family risk factors, and gender and age cohort differences. Design Retrospective cross-sectional survey using a validated questionnaire. Setting and participants Mobile phone random digit-dial sample of the Australian population aged 16 years and older. Main outcome measures National estimates of multi-type child maltreatment up to age 18 years using the Juvenile Victimisation Questionnaire-R2: Adapted Version (Australian Child Maltreatment Study). Results Of 8503 participants, 62.2% (95% CI, 60.9–63.6%) experienced one or more types of child maltreatment. Prevalence of single-type maltreatment was 22.8% (95% CI, 21.7–24.0%), whereas 39.4% (95% CI, 38.1–40.7%) of participants reported multi-type maltreatment and 3.5% (95% CI, 3.0–4.0%) reported all five types. Multi-type maltreatment was more common for gender diverse participants (66.1% [95% CI, 53.7–78.7%]) and women (43.2% [95% CI, 41.3–45.1%]) than for men (34.9% [95% CI, 33.0–36.7%]). Multi-type maltreatment prevalence was highest for those aged 25–44 years. Family-related adverse childhood experiences — especially mental illness and alcohol or substance misuse — increased risk. Exposure to domestic violence was the maltreatment type most often present in multi-type maltreatment patterns. Conclusions Multi-type child maltreatment is prevalent in Australia and more common in women and gender diverse individuals. Child protection services, health practitioners, and prevention and intervention services must assess and manage multi-type maltreatment in children and address its health consequences across the lifespan. Public health policy should consider prevention services or strategies that target multi-type child maltreatment.

Objectives To examine the associations between experiences of child maltreatment and mental disorders in the Australian population. Design Population-representative survey conducted by computer-assisted telephone interviewing. Setting, participants Australian residents aged 16 years and older. Main outcome measures Mental disorder diagnoses of lifetime major depressive disorder, current alcohol use disorder (mild, moderate and severe), current generalised anxiety disorder and current post-traumatic stress disorder. Results More than one in three Australians (3606/8503 surveyed participants; 38.0%; 95% CI, 36.7–39.3%) met the diagnostic criteria for a mental disorder. The prevalence of mental disorders in non-maltreated participants was 21.6% (95% CI, 19.9–23.3%; n = 851). This increased to 36.2% (95% CI, 33.5–38.9%; n = 764) for those who experienced a single type of maltreatment and 54.8% (95% CI, 52.6–56.9%; n = 1991) for participants who experienced multi-type maltreatment. Compared with non-maltreated Australians, maltreated participants had about three times the odds of any mental disorder (odds ratio [OR], 2.82; 95% CI, 2.47–3.22), generalised anxiety disorder (OR, 3.14; 95% CI, 2.48–3.97), major depressive disorder (OR, 3.19; 95% CI, 2.68–3.80) and severe alcohol use disorder (OR, 2.62; 95% CI, 1.83–3.76), and almost five times the odds of post-traumatic stress disorder (OR, 4.60; 95% CI, 3.00–7.07). Associations between experiences of child maltreatment and mental disorders were strongest for sexual abuse, emotional abuse and multi-type maltreatment. The strength of the associations did not differ by gender. Adjustment for childhood and current financial hardship and for current socio-economic status did not significantly attenuate the associations. Conclusions Mental disorders are significantly more likely to occur in individuals who experience child maltreatment, particularly multi-type maltreatment. Prevention of child maltreatment provides an opportunity to substantially reduce the prevalence of mental illness and improve the health of the Australian population.

Maximising the yield of recombinantly expressed proteins is a critical part of any protein engineering pipeline. In most cases, the expression of a given protein can be tuned by adjusting its DNA coding sequence, however finding coding sequences that optimise expression is a nontrivial task. The 3-dimensional structure of mRNA is known to strongly influence the expression levels of proteins, due to its effect on the efficiency of ribosome attachment. While correlations between mRNA structure and expression are well established, no model to date has succeeded in effectively utilising this information to accurately predict expression levels. Here we present ExpressUrself, a model designed to capture spatial characteristics of the sequence surrounding the start codon of an mRNA transcript, and intended to be used for optimising protein expression. The model is trained and tested on a large data set of variant DNA sequences and is able to predict the expression of previously unseen transcripts to a high degree of accuracy.

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.

This study aims to explore the effects of intimate partner violence during pregnancy (p-IPV) on postpartum depression among women in central Vietnam. p-IPV was defined among 150 women aged 18 years and older in the third trimester of their pregnancy. Baseline data was collected between February and May 2019, and then those women were followed up to 3-5 months after childbirth to assess depression using the Patient Health Questionnaire-9 (PHQ-9). Data collection was completed in September 2019. Relative risk was estimated to identify the effect of p-IPV on maternal postpartum depression. Twenty-one women reported IPV during pregnancy. In the follow-up assessment, 8 of 21 mothers exposed to p-IPV and 23 of 127 mothers not exposed to p-IPV developed postpartum depression. p-IPV including emotional and physical violence were increased the risk of postpartum depression. The findings support evidence that p-IPV increases the risk of postpartum depression among women in central Vietnam.

Objective: To develop a job satisfaction instrument (questionnaire) to assess the satisfaction of preventive medicine workers in Vietnam.Method: Project was conducted in three phases. First, a comp...

Objectives Adverse childhood experiences (ACEs) are events stressful, traumatic, and related to the development of a wide range of health conditions throughout the person's lifespan. This study explored the relationship between ACEs and health conditions among older adults in Bhutan. Study design Cross-sectional survey. Methods Older adults aged 60–101 years (n = 337) completed a face-to-face interview in a convenient community setting in the four major towns of Bhutan. Measurements included the modified World Health Organization Adverse Childhood Experiences International Questionnaire and the checklist of chronic health conditions. Results Commonest ACEs reported by the sample were related to the contribution of physical labour in childhood (n = 284 [84.3%]) and witnessing of community violence (n = 185 [54.9%]). Assuming an adult role while still a child highly co-occur with other forms of ACEs. Compared to 0–2 ACEs, participants with ≥7 ACEs had the higher odds of reporting lung disease (odds ratio [OR] = 2.15, 95% confidence interval [CI]: 1.03–4.49), visual impairment (OR = 2.38, 95%CI: 1.16–4.85), insomnia (OR = 2.35, 95%CI: 1.11–4.98), and memory decline (OR = 2.30, 95%CI: 1.10–4.78) by twofold and high blood pressure by threefold (OR = 3.21, 95%CI: 1.39–7.38). Overall, the odds of self-rated poor health conditions among those ≥7 ACEs compared to 0–2 ACEs was high by almost twofold (OR = 1.97; 95%CI: 1.04–3.73). Conclusions The influence of ACEs on health conditions persisted into late adulthood, and older people in Bhutan have had a complex variety of chronic health conditions implicating greater demand on the free healthcare system in Bhutan. ACEs prevention is critical to promote better health for a country like Bhutan, where the healthcare services are provided free of cost to its citizens.

Objectives: To examine the cost-effectiveness of three mutually exclusive reproductive health interventions (named level A, B and C) implemented in Chi Linh for adolescents.Methods: This research i...

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).

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.

The increasing integration between protein engineering and machine learning has led to many interesting results. A problem still to solve is to evaluate the likelihood that a sequence will fold into a target structure. This problem can be also viewed as sequence prediction from a known structure.In the current work, we propose improvements in the recent architecture of Geometric Vector Perceptrons [1] in order to optimize the sampling of sequences from a known backbone structure. The proposed model differs from the original in that there is: (i) no updating in the vectorial embedding, only in the scalar one, (ii) only one layer of decoding. The first aspect improves the accuracy of the model and reduces the use of memory, the second allows for training of the model with several tasks without incurring data leakage.We treat the trained classifier as an Energy-Based Model and sample sequences by sampling amino acids in a non-autoreggresive manner in the empty positions of the sequence using energy-guided criteria and followed by random mutation optimization. We improve the median identity of samples from 40.2% to 44.7%.An additional question worth investigating is whether sampled and original sequences fold into similar structures independent of their identity. We chose proteins in our test set whose sampled sequences show low identity (under 30%) but for which our model predicted favorable energies. We used AlphaFold [2, 3] and observed that the predicted structures for sampled sequences highly resemble the predicted structures for original sequences, with an average TM-score of 0.84.

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.

Background This study evaluated the psychometric properties of three self-reported scales including WHO Well-Being Index (WHO-5), Patient Health Questionnaire-9 items (PHQ-9), and Perceived Stress Scale (PSS) for determining the severity of antenatal depression and suicide risk. Methods Extracted from a multi-site birth cohort study in eight countries, we test the reliability and validity of tri-scales among 148 women in the third trimester and 3-months after childbirth in Vietnam. Results Reliability testing achieved good internal consistency for the set of scales (Alpha = 0.75–0.81). The multitrait-multimethods matrix and SEM model indicated a good fit [Chi-square (230) = 337.5, p Conclusions This present study suggested adequate validity and reliability of the WHO-5, PHQ9 and PSS to measure antenatal depression and suicide risk in Vietnam. Key messages Further studies might consider to use one or a set of scales to understand multiple domains of mental disorder as it is simple to administer and acceptable duration for completion in the community.

Background 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 three 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). Conclusions 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. Key messages Mothers with violent and adverse family backgrounds have twice the risk of poor mental health during pregnancy, and their infants have twice the risk of adverse birth outcomes. Social support during pregnancy may have a buffering effect by reducing the long-term impact of childhood traumatic events.

Aims This paper explores the number and characterization of latent classes of adverse childhood experiences across the Evidence for Better Lives Study cohort and investigates how the various typologies link to prenatal substance use (i.e., smoking, alcohol, and illicit drugs) and poor infant outcomes (i.e., infant prematurity and low birth weight). Participants and setting A total of 1,189 mother-infant dyads residing in eight diverse low- and middle-income countries (LMICs) were recruited. Methods Latent class analysis using the Bolck, Croon, and Hagenaars (BCH) 3-step method with auxiliary multilevel logistic regressions with distal outcomes were performed. Results The LCA identified three high-risk classes and one low-risk class, namely: (1) highly maltreated (7%, n = 89), (2) emotionally and physically abused with intra-familial violence exposure (13%, n = 152), (3), emotionally abused (40%, n = 474), and (4) low household dysfunction and abuse (40%, n = 474). Overall, across all latent classes, there were low probabilities of prenatal substance use and poor infant outcomes. However, pairwise comparisons between classes indicate that class 1 and 3 had higher probabilities of prenatal illicit drug use compared to class 4. Additionally, class 2 had higher probability of low birth weight compared to the three remaining classes. Conclusion The results further our understanding of the dynamic and multifaceted nature of ACEs. More research grounded on LMICs is warranted with more attention to various parameters of risk exposure (i.e., severity, duration, chronicity).

Despite the detrimental effects and life-course health consequences of violence exposure, relatively few studies have adequate capacity to investigate the evolution of violence from childhood to motherhood.This study aims to examine the cyclical nature of childhood abuse and prenatal inter-partner violent victimization (p-IPV) and its adverse impact on childbirth trauma and exclusive breastfeeding (EBF) practice in Vietnam.Using a prospective birth cohort, 150 pregnant women were recruited in the third trimester of pregnancy in Hue city in central Vietnam (Wave 1-Baseline) and re-interviewed approximately three months after delivery (Wave 2-Follow-up). The direct and indirect effects of violent victimization on subsequent childbirth experience (measured by Birth Memories and Recall Questionnaire) and EBF practice were estimated by using augmented-inverse-probability-weighted models, sensitivity analysis, and structural equation model.Detrimental and prolonged effects of the inter-generational cycle of violence transverse childhood to motherhood. Women who experienced either childhood abuse or p-IPV violence were more likely to experience negative emotional childbirth memories [ARR 1.21, 95 % CI (1.04, 1.39)]. Evidence also suggested that not continuing to exclusively breastfeed at 3 months post-partum was strongly associated with prenatal depression, young age, and perceived low social status during pregnancy. Perceived strong connectedness among extended family members and social networks (i.e. nexus among family, friends, and neighborhood) provided a buffering effect by preventing EBF termination.This research provides insights into the protective role of social connectedness in improving breastfeeding practice. It is vital to establish wholistic antenatal care and social service system to offer specialized support and response for victims of violence and mitigate the long-term sequelae of traumatic events.

Toxins are widely produced by different organisms to disrupt the physiology of other organisms, and support their own existence. Their study is useful to understand protein evolution, environmental adaptation and survival competition. In-silico predictions of toxic proteins can support empirical frameworks, and help in the safety measurements needed for various industrial related processes. Some in-silico methods are slow, hard to implement or lack taxa representation in their training datasets. Here we present a deep learning model to classify protein toxins, through the use of Convolutional Neural Networks (ConvTOX). ConvTOX is able to accurately identify toxic proteins across the domains of life, with accuracies over 80% for animal and plant toxins, and over 50% for bacterial toxins. Moreover, ConvTOX is able to generalize the identification of differences among toxin types, such as neurotoxins and myotoxins, and to accurately identify structural similarities between different protein toxins. ConvTOX overcomes limitations from previous models by being able to predict toxin proteins from across all domains of life, and by not being limited to only short toxin peptides. Limitations are still clear in terms of lower accuracies for specific phylogenetic groups (such as bacterial toxins), but still this works presents itself as a one step forward for the universal use, classification and study of toxic proteins.

IntroductionChild maltreatment (physical abuse, sexual abuse, emotional abuse, neglect and exposure to domestic violence) is widely understood to be associated with multiple mental health disorders, physical health problems and health risk behaviours throughout life. However, Australia lacks fundamental evidence about the prevalence and characteristics of child maltreatment, its associations with mental disorders and physical health, and the associated burden of disease. These evidence gaps impede the development of public health strategies to better prevent and respond to child maltreatment. The aims of this research are to generate the first comprehensive population-based national data on the prevalence of child maltreatment in Australia, identify associations with mental disorders and physical health conditions and other adverse consequences, estimate attributable burden of disease and indicate targeted areas for future optimal public health prevention strategies.Methods and analysisThe Australian Child Maltreatment Study (ACMS) is a nationwide, cross-sectional study of Australia’s population aged 16 years and over. A survey of approximately 10 000 Australians will capture retrospective self-reported data on the experience in childhood of all five types of maltreatment (physical abuse, sexual abuse, emotional abuse, neglect and exposure to domestic violence). A customised, multimodule survey instrument has been designed to obtain information including: the prevalence and characteristics of these experiences; diagnostic screening of common mental health disorders; physical health; health risk behaviours and health service utilisation. The survey will be administered in March–November 2021 to a random sample of the nationwide population, recruited through mobile phone numbers. Participants will be surveyed using computer-assisted telephone interviews, conducted by trained interviewers from the Social Research Centre, an agency with extensive experience in studies of health and adversity. Rigorous protocols protect the safety of both participants and interviewers, and comply with all ethical and legal requirements. Analysis will include descriptive statistics reporting the prevalence of individual and multitype child maltreatment, multiple logistic and linear regression analyses to determine associations with mental disorders and physical health problems. We will calculate the population attributable fractions of these putative outcomes to enable an estimation of the disease burden attributable to child maltreatment.Ethics and disseminationThe study has been approved by the Queensland University of Technology Human Research Ethics Committee (#1900000477, 16 August 2019). Results will be published to the scientific community in peer-reviewed journals, scientific meetings and through targeted networks. Findings and recommendations will be shared with government policymakers and community and organisational stakeholders through diverse engagement activities, a dedicated Advisory Board and a systematic knowledge translation strategy. Results will be communicated to the public through an organised media strategy and the ACMS website.

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.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.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 (90Risk 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.

This article reports on the outcomes of a comprehensive review of qualitative research using the Joanna Briggs Institute (JBI) guidelines to guide a systematic approach addressing women with physical disabilities (WWPD)’s access to and utilization of maternal health care services in low and middle-income countries. The article specifically examines existing literature on the experiences and challenges facing WWPD in accessing and utilization of these services during pregnancy, childbirth and the post-natal period. Fifteen studies that met inclusion criteria were identified. Findings from the review highlight that pregnancy and motherhood are meaningful for WWPD in both individual and socio-cultural ways. Multiple challenges facing WWPD were identified, including low self-esteem and confidence, negative responses and lack of family support, problematic experiences of transport, health and other social systems for maternal healthcare of WWPD, and social unacceptance and discrimination from the community. Addressing barriers in accessing healthcare services was perceived as an individual responsibility of WWPD and their families, rather than perceptions that society had a responsibility to act. The reproductive rights of WWPD, particularly expression of sexuality and the right to motherhood needs to be conceptualized beyond individual responsibility. Society needs to eliminate attitudinal and environmental barriers to ensure WWPD can choose to be mothers without threat of discrimination or negative social consequences.

Introduction Intimate partner violence (IPV) is common worldwide and associated with maternal mental disorders and adverse child health outcomes. Research in this field in Vietnam is still nascent, although some substantial studies have emerged in recent years. The objective of this review was to estimate the prevalence of IPV during pregnancy in Vietnam and examine its impact upon women and children at an early age. Methods We searched seven bibliographic databases (from 1970 to 2018), browsed grey literature sources, and consulted experts. Two review authors independently extracted data and assessed risk of bias with using the Newcastle – Ottawa Quality Assessment Tool for non-randomized studies. A meta-analysis was conducted using the Mantel-Haenszel fixed-effect approach to estimate pooled effect (odds ratio) of Prenatal IPV (P-IPV) on maternal Common Mental Disorder (CMD). Results The selection process produced eight eligible studies of 4598 participants. Six studies were pooled. The estimated proportions of IPV during pregnancy ranged from 5.9% to 32.5% depending on the form of IPV. P-IPV is strongly associated with greater risk of both mental disorders and adverse birth outcomes (preterm labor and low-birth-weight). The meta-analysis revealed that women exposed to P-IPV have a 4-fold increased risk for prenatal CMD compared to non-abused peers (OR = 3.69, 95% CI (2.51–5.42), I2 = 36%). Women exposed to physical P-IPV had five-fold increased odds of premature labour, OR = 5.5, 95% CI (2.1–14.1) and almost six-fold increased odds of having low-birth-weight neonates, OR = 5.7, 95% CI (2.2–14.9). Discussion To improve mother and child well-being in Vietnam, multifaceted health policies should include routine screening for IPV and mental disorders in the antenatal care system. Taken together, the evidence supports calls for national programs in Vietnam to eliminate gender inequality and promote awareness of the serious harms caused by IPV.

Prenatal intimate partner violence (P-IPV) can have significant adverse impacts on both mother and fetus. Existing P-IPV interventions focus on the safety of the mother and on reducing revictimization; yet expanding these to address the adverse impact on the fetus has considerable potential for preventing long-term negative developmental outcomes. In this review, we draw together evidence on major pathways linking exposure to P-IPV and child outcomes, arguing that these pathways represent potential targets to improve P-IPV intervention efforts. Using a narrative review of 112 articles, we discuss candidate pathways linking P-IPV to child outcomes, as well as their implications for intervention. Articles were identified via key word searches of social science and medical databases and by inspection of reference lists of the most relevant articles, including recent reviews and meta-analyses. Articles were included if they addressed issues relevant to understanding the effects of P-IPV on child outcomes via six core pathways: maternal stress and mental illness, maternal–fetal attachment, maternal substance use, maternal nutritional intake, maternal antenatal health-care utilization, and infection. We also included articles relevant for linking these pathways to P-IPV interventions. We conclude that developing comprehensive P-IPV interventions that target immediate risk to the mother as well as long-term child outcomes via the candidate mediating pathways identified have significant potential to help reduce the global burden of P-IPV.

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.

Measures that produce valid and reliable antenatal depressive symptom scores in low resource country contexts are important for research efforts to better understand risk factors, outcomes, and effective interventions in these contexts. Establishing the psychometric comparability of scores across countries also facilitates cross-country analysis of similarities and differences across contexts. To date, however, very few studies have evaluated the psychometric properties and comparability of widely used antenatal depressive symptom measures across diverse cultural, political and social contexts. To address this gap, we used data from the Evidence for Better Lives Study – Foundational Research (EBLS-FR) to examine the reliability, validity, and cross-country invariance of the 9-item version of the Patient Health Questionnaire (PHQ-9) in antenatal samples across eight low- and middle-income countries (LMICs). We found that the PHQ-9 scores had good internal consistency and construct validity across all eight countries. However, in measurement invariance analyses, only partial metric invariance held and only across four of the countries. Further, there were some notable between-site contrasts in the nomological networks of PHQ-9 scores. Our results suggest that the PHQ-9 yields reliable scores when administered in antenatal populations; however, the meaning of the scores varies by country. Thus, interpretation of PHQ scores should consider local meanings of depression to ensure that local conceptualisations and manifestations of antenatal depressive symptoms are adequately reflected.

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.

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.

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.

Funder: Consuelo Zobel Alger Foundation, Inc., Funder: British Academy; FundRef: http://dx.doi.org/10.13039/501100000286, Funder: Cambridge Humanities Research Grants Scheme, Funder: University of Cambridge GCRF Quality Research, Funder: Jacobs Foundation; FundRef: http://dx.doi.org/10.13039/501100003986, Funder: Wolfson discretionary research, Introduction: Violence against children is a health, human rights and social problem affecting approximately half of the world’s children. Its effects begin at prenatal stages with long-lasting impacts on later health and well-being. The Evidence for Better Lives Study (EBLS) aims to produce high-quality longitudinal data from cities in eight low- and middle-income countries—Ghana, Jamaica, Pakistan, the Philippines, Romania, South Africa, Sri Lanka and Vietnam—to support effective intervention to reduce violence against children. EBLS-Foundational Research (EBLS-FR) tests critical aspects of the planned EBLS, including participant recruitment and retention, data collection and analysis. Alongside epidemiological estimates of levels and predictors of exposure to violence and adversity during pregnancy, we plan to explore mechanisms that may link exposure to violence to mothers’ biological stress markers and subjective well-being. Methods and analyses: EBLS-FR is a short longitudinal study with a sample of 1200 pregnant women. Data are collected during the last trimester of pregnancy and 2 to 6 months after birth. The questionnaire for participating women has been translated into nine languages. Measures obtained from mothers will include, among others, mental and physical health, attitudes to corporal punishment, adverse childhood experiences, prenatal intimate partner violence, substance use and social/community support. Hair and dry blood spot samples are collected from the pregnant women to measure stress markers. To explore research participation among fathers, EBLS-FR is recruiting 300 fathers in the Philippines and Sri Lanka. Ethics and dissemination: The study received ethical approvals at all recruiting sites and universities in the project. Results will be disseminated through journal publications, conferences and seminar presentations involving local communities, health services and other stakeholders. Findings from this work will help to adjust the subsequent stages of the EBLS project.

Background Pregnant women with physical disabilities are more likely to have caesarean sections than are women without disabilities. For some women with disabilities, caesarean birth may not be clinically necessary, as they may lack autonomy in decision-making to a greater extent than is the case for other pregnant women. Objective To explore the relative influence of health staff, family, friends, and the women themselves on key decisions about childbirth of women with physical disabilities in northern Vietnam. Research design/setting A qualitative approach using a phenomenological design was employed. Fifty-six in-depth interviews were conducted with women with physical disabilities who had given birth in the previous three years in two northern provinces in Vietnam (Hanoi and Thaibinh). Twenty-nine women participated in a first interview and 27 completed follow-up interviews several months later. Additionally, semi-structured interviews were conducted with 12 maternal healthcare providers. Interviews were transcribed and thematically analysed. Results Twenty-eight of the 29 participants underwent caesarean sections. Two themes were identified: (1) The women reported that caesarean section was mandated by attending doctors “because of their disability”. Consistently, the healthcare providers said caesarean section is essential for women with physical disabilities; and (2) The women said that their parents and peers supported caesarean birth. Very few women indicated that they could influence this decision, even though one-third said their personal preference was for vaginal birth. Conclusions Many women with physical disabilities are not given the opportunity to exercise informed choices around childbirth options. Women in Vietnam who live with physical disabilities should be empowered to make informed decisions about childbirth. It is recommended that professional guidelines and training are revised to properly engage women with physical disabilities in joint decision-making for the birth of their children.

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 (e.g., 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 prioritised in designing future BCS. The panel also recommended that future BCS are designed to inform intervention strategies.