Mashhood Ahmed Sheikh

Several researchers have raised the concern that the cross-sectional association of retrospectively reported childhood adversity with self-reported onset of asthma and chronic bronchitis in adulthood may be confounded, as well as mediated by an individual's mental health. The aim of this study was to assess the effect of retrospectively reported childhood adversity on self-reported onset of asthma and chronic bronchitis in adulthood, independent of potential confounding and mediating variables (including respondent's mental health). We used data collected in 2007–2008 within the framework of the Tromsø Study (N = 12,981), a representative study of adult men and women in Norway. The associations of childhood adversity with asthma and chronic bronchitis were assessed with Poisson regression models. Relative risks (RR) and 95% confidence intervals (CI) were estimated with bias-corrected bootstrapping. Childhood adversity was associated with a 9% increased risk of asthma (RR = 1.09, 95% CI: 1.02, 1.16) and a 14% increased risk chronic bronchitis (RR = 1.14, 95% CI: 1.03, 1.26) in adulthood, independent of age, sex, parental history of psychiatric problems/asthma/dementia, education, smoking, social support, and respondent's mental health. Controlling for indicators of respondent's mental health reduced the strength of associations of childhood adversity with asthma and chronic bronchitis; however, the associations were still present in the same direction (p < .05). These findings suggest that the association of retrospectively reported childhood adversity with asthma and chronic bronchitis is independent of respondent's mental health. We recommend controlling for indicators of the respondent's mental health to assess an unbiased association of retrospectively measured childhood adversity with self-reported asthma and chronic bronchitis.

Objective: Many researchers view retrospective reports with skepticism. Indeed, the observed association between retrospectively-reported childhood disadvantage (CD) and morbidity in adulthood has been criticized as an artefactual correlation driven by the psychological state of the respondent at the time of reporting (current psychological state). The aim of this study was to assess the role of current psychological state in the association between childhood disadvantage and morbidity in adulthood. Methods: The present analysis used cross-sectional data collected in 2007-2008 within the framework of the Tromsø Study (N=10,765), a representative study of adult men and women in Norway. The association between CD and the physical health outcomes heart attack, angina pectoris, chronic bronchitis/emphysema/COPD, diabetes mellitus, hypothyroid/low metabolism, migraine, hypertension, and comorbidity (i.e., the sum of these physical health outcomes) was assessed with Poisson regression models. Relative risks (RR) and 95% confidence intervals (CI) were estimated. A wide range of indicators of respondents’ current psychological state were included in the models to assess the % attenuation in estimates. Results: CD was associated with an increased risk of heart attack, angina pectoris, chronic bronchitis/emphysema/COPD, diabetes mellitus, hypothyroid/low metabolism, migraine, hypertension, and comorbidity (p<0.05), independent of respondents’ current psychological state. A sizeable proportion (23-42%) of the association between CD and physical health outcomes was driven by recall bias or mediation via respondents’ current psychological state. Controlling for indicators of current psychological state reduced the strength of associations between CD and physical health outcomes; however, the independent associations remained in the same direction.

Objective: Physical inactivity is a major public health problem associated with an increased risk of several psychiatric and physical conditions. This study investigated the association between leisure time physical activity (PA) and incident use of prescription tranquilizers in a regionally representative and prospective cohort. Methods: A total of 4043 men and women (mean age: 61.3 years; 57% women) from the Tromsø Study were followed for six years. Leisure time PA was captured at baseline. Psychiatric morbidity was measured by use of prescription tranquilizers, captured at both baseline and follow-up. Leisure time PA at baseline was used as a predictor of subsequent (incident) use of prescription tranquilizers. We used multinomial regression models and Poisson regression models to estimate relative risk-ratios (RRRs), and relative risks (RRs), respectively, and their corresponding 95% confidence intervals (CIs). Results: In the fully-adjusted model, accounting for socio-demographic factors, parental history of psychopathology, years of education, smoking, respondent’s psychopathology at baseline, and occupational PA, a lower leisure time PA conferred a 41% increased risk of incident use of prescription tranquilizers at follow-up (RR= 1.41, 95% CI: 1.09, 1.83; p=0.010). Conclusions: These findings suggest that physical inactivity increases the risk of psychiatric morbidity (albeit, measured via use of prescription tranquilizers). Future regionally representative and longitudinal research is required to confirm/refute our findings and explore underlying mechanisms.

Background: The aim of this study was to assess the associations between child maltreatment (CM), psychopathological symptoms, and onset of diabetes mellitus, hypothyroidism (i.e., low metabolism), and chronic bronchitis/emphysema/COPD in adulthood.
Methods: The present analysis used data collected in 2007-2008 within the framework of the Tromsø Study, Norway (N=12,981). CM was measured with a single item, and self-reported information on psychopathological symptoms and physical health outcomes was used. The association between CM, psychopathological symptoms, and physical health outcomes was assessed with linear and Poisson regression models. Mediation was assessed with difference-in-coefficients methods.
Results: In the fully-adjusted models, CM was associated with higher levels of anxiety and depression, psychological distress, sleeping difficulty, insomnia, and use of sleeping pills or antidepressants in adulthood (p<0.05). Moreover, CM was associated with a more than two-folds increased risk of consultation with psychiatrist (p<0.001), a 26% increased risk of forgetfulness (p<0.001), a 15% increased risk of decline in memory (p<0.001), and a 96% increased risk of psychiatric problems (p<0.001) over the course of life. In the fully-adjusted models, CM was associated with a 27- 82% increased risk of physical health outcomes in adulthood (p<0.05). Indicators of psychopathological symptoms significantly (p<0.05) mediate the associations between CM and physical health outcomes.
Limitations: The design of this study is cross-sectional, and all measures are self-reported. Conclusion: The associations between retrospectively-reported CM and physical health outcomes in adulthood are partially driven by psychopathological symptoms in adulthood.

Objective
The aim of this study was to assess the mediating role of dissatisfaction with friendships in adulthood in the associations between psychological abuse in childhood, substance abuse distress in childhood, and incident psychiatric problems (IPPs) in adulthood over 13 years of follow-up.

Methods
We used data collected from 1994 to 2008 within the framework of the Tromsø Study (N = 9502), a representative, longitudinal, prospective cohort study. Poisson regression analysis was used to assess the associations between psychological abuse, substance abuse distress, dissatisfaction with friendships in adulthood, and IPPs in adulthood. Indirect effects and proportion mediated (%) were assessed with the difference-in-coefficients method.

Results
Psychological abuse (relative risk [RR] = 1.66, 95% confidence interval [CI]: 1.45–1.89) and substance abuse distress in childhood (RR = 1.38, 95% CI: 1.18–1.62) were associated with an increased risk of dissatisfaction with friendships in adulthood. Dissatisfaction with friendships in adulthood was associated with an increased risk of IPPs in adulthood (RR = 1.71, 95% CI: 1.33–2.20). Moreover, dissatisfaction with friendships in adulthood mediated 9.31% (95% CI: 4.25–14.57) of the association between psychological abuse in childhood and IPPs in adulthood, and 9.17% (95% CI: 4.35–16.33) of the association between substance abuse distress in childhood and IPPs in adulthood.

Conclusions
Dissatisfaction with friendships in adulthood mediates a minor proportion of the associations between psychological abuse, substance abuse distress, and IPPs in adulthood. Interventions aimed at decreasing dissatisfaction with friendships may dampen some of the effect of psychological abuse and substance abuse distress in childhood on IPPs in adulthood.

A number of cross-sectional studies have suggested that physical activity (PA) is negatively associated with psychological distress in adulthood. A paucity of regionally representative and longitudinal studies has considered this relationship. This study investigated the association between leisure time light and moderate-vigorous PA (MVPA) and psychological distress over 13 years in a regionally representative sample. A total of 4754 men (mean age: 47.2 years) and 5571 women from (mean age: 46.9 years) the Tromsø Study were followed for 13 years. Light PA and MVPA was captured at baseline and psychological distress was captured using the Hopkins Symptom Check List-10 scale. Ordinary least square and Poisson regression models were used, adjusting for multiple confounders to investigate the relationship between light PA/MVPA and psychological distress. In the fully-adjusted model, accounting sociodemographics, history of parental psychopathology, socioeconomic status, marital status, smoking, social support and risk factors, we found evidence that both light PA (β 0.11, 95% CI: 0.03, 0.19; p<0.01) and MVPA (β 0.19, 95% CI: 0.12, 0.26; p<0.001) confered protection against psychological distress at follow-up. Among men, a lower MVPA was associated with 14% (RR=1.14, 95% CI: 1.01, 1.28) increased risk of clinically significant psychological distress; while among women, the risk was 15% (RR=1.15, 95% CI: 1.06, 1.26; p<0.001). In this regionally representative cohort, our study suggests that both higher levels of light PA and MVPA confer protection against future psychological distress. However, a key limitation of this study is that psychological distress at baseline was not controlled-for.

Background: We assessed the mediating role of education in the association between childhood disadvantage and psychological distress in adulthood using longitudinal data collected in three waves, from 1994 to 2008, in the framework of the Tromsø Study (N = 4530), a cohort that is representative of men and women from Tromsø.
Methods: Education was measured at a mean age of 54.7 years, and psychological distress in adulthood was
measured at a mean age of 61.7 years. Ordinary least square regression analysis was used to assess the associations between childhood disadvantage, education, and psychological distress in adulthood. The indirect effects and the proportion (%) of indirect effects of childhood disadvantage (via education) on psychological distress in adulthood were assessed by mediation analysis.
Results: Childhood disadvantage was associated with lower education and higher psychological distress in
adulthood (p < 0.05). Lower education was associated with a higher psychological distress in adulthood (p <
0.05). A minor proportion (7.51%, p < 0.05) of the association between childhood disadvantage and psychological distress in adulthood was mediated by education.
Limitations: Childhood disadvantages were measured retrospectively.
Conclusion: The association between childhood disadvantage and psychological distress in adulthood is primarily independent of education.

A number of cross-sectional studies have consistently shown a correlation between childhood physical maltreatment, perceived social isolation and internalizing symptoms. Using a longitudinal, three-wave design, this study sought to assess the mediating role of perceived social isolation in adulthood in the association between childhood physical maltreatment and internalizing symptoms in adulthood. We used data collected from 1994 to 2008 within the framework of the Tromsø Study (N = 4530), a representative prospective cohort study of men and women. Perceived social isolation was measured at a mean age of 54.7 years, and internalizing symptoms were measured at a mean age of 61.7 years. The diference-in-coefcients method was used to assess the indirect efects and the proportion (%) of mediated efects. Childhood physical maltreatment was associated with an up to 68% [relative risk (RR) = 1.68, 95% confdence interval (CI): 1.33–2.13] higher risk of perceived social isolation in adulthood. Childhood physical maltreatment and perceived
social isolation in adulthood were associated with greater levels of internalizing symptoms in adulthood (p < 0.01). A dose response association was observed between childhood physical maltreatment and internalizing symptoms in adulthood (p < 0.001). Perceived social isolation in adulthood mediated up to 14.89% (p < 0.05) of the association between childhood
physical maltreatment and internalizing symptoms in adulthood. The results of this study indicate the need to take perceived social isolation into account when considering the impact of childhood physical maltreatment on internalizing symptoms.

Background: Previous studies that assessed the mediating role of social support in the association between
childhood adversity and psychological distress based their inferences on very small, selective samples, which
makes it impossible to generalise the findings to general population. The aim of this paper was to assess the
mediating role of quantity and quality of social support in adulthood in the association between childhood
adversity and psychological distress in adulthood.
Methods: The study has a three-wave design; the present analysis used longitudinal data collected from 1994 to
2008 within the framework of the Tromsø Study (N = 4530), a representative prospective cohort study of men
and women. Quantity and quality of social support were measured at a mean age of 54.7 years, and psychological
distress in adulthood was measured at a mean age of 61.7 years. Mediation analysis was used to assess the
indirect effect of childhood adversity (via quantity and quality of social support) on psychological distress in
adulthood.
Results: Childhood adversity was associated with deficits in quantity and quality of social support in adulthood
(p < 0.05). Childhood adversity and deficits in quantity and quality of social support were associated with
psychological distress in adulthood (p < 0.05). Quantity and quality of social support significantly (p < 0.05)
mediated the association between childhood adversity and psychological distress in adulthood.
Limitations: Childhood adversity was assessed retrospectively and social support was measured with two items.
Conclusion: Interventions aimed at reducing social isolation may alleviate the burden carried by survivors of
childhood adversity.

INTRODUCTION: Little evidence is available about the unique effect of different SES markers in childhood on subjective measures of health and life satisfaction in adulthood.

METHODS: The Tromsø Study is a prospective cohort study of the general population in the municipality of Tromsø. With more than 70,000 inhabitants, Tromsø is the largest city in Northern Norway. It is situated at 69˚ N, ∼400km north of the Arctic Circle. Between 1974 and 2007/8, six waves of the Tromsø Study have been conducted (referred to as Tromsø I-VI). The current research is based on data from the latest wave: 19,762 subjects were invited, and 12,984 (65.7%) attended – 6,054 men and 6,930 women, born between 1920–1977. The aim was to assess the unique effect of three indicators of childhood socio-economic status (CSES), childhood financial conditions, mothers' education and fathers' education on the EQ-5D health dimensions (mobility, self-care, usual activities, pain and discomfort, anxiety and depression), self-rated health, age-comparative self-rated health, and satisfaction with life. We observed interaction ( P < 0.05) between CSES indicators and the respondents education when regressed on subjective health measures therefore the data was analyzed with a counterfactual-based mediation analysis using Stata command Paramed as it allows exposure-mediator interaction. Logistic regression was used for the mediator (own education). Log-linear regression was used for the health and life satisfaction outcomes to estimate the natural direct effects (NDE), natural indirect effects (NIE) and marginal total effects (MTE) as risk ratios (RR). Statistically significant interaction (p < 0.05) was observed between the CSES exposures and gender, regressed on the health and wellbeing outcomes, therefore the analysis was conducted separately for men and women.

RESULTS: Independent of respondents education, childhood financial conditions was associated (NDE) with all EQ-5D dimensions, self-rated health, age-comparative self-rated health, and satisfaction with life. The RRs were not the same for men and women. Men had a higher risk of being unhealthy on the composite EQ-5D measure (RR: 1.22, CI 1.14–1.31), and the anxiety/depression dimension (RR: 1.88, CI 1.57–2.26), but women had a higher risk of being unhealthy on the dimensions self-care (RR: 1.91, CI 1.23–2.97), usual activities(RR: 1.68, CI 1.46–1.94), pain/discomfort(RR: 1.13, CI 1.07–1.21), as well as on SRH(RR: 1.46, CI 1.32–1.61). Childhood financial conditions had no statistically ( P > 0.05) significant NIE mediated by respondents' education, on any health measure. The magnitude of the estimate of NIE was 1.00, though not statistically significant ( P > 0.05). While almost all NDEs of parental education on health outcomes were not statistically significant ( P > 0.05), most of the NIEs of parental education were statistically significant ( P < 0.05). The exceptions were the increased risk (NDEs) of being unhealthy on the composite EQ-5D measure(RR: 1.10, CI 1.02–1.19), pain/discomfort(RR: 1.12, CI 1.03–1.22), and anxiety/depression(RR: 1.38, CI 1.13–1.69), from having low mothers' education among women.

CONCLUSIONS: Our results show that childhood financial conditions have a strong direct effect on later health and wellbeing, independent of respondents' education, while generally speaking parental education has an indirect effect on later health mediated by respondents' education. This indicates that effect of childhood financial conditions on later health and wellbeing is long-term and that there may be other pathways from childhood financial conditions to health, than respondents' education. However, the effect of parental education on later health is not independent of the respondents' education.

The life course perspective, the risky families model, and stress-and-coping models provide the rationale for assessing the role of smoking as a mediator in the association between childhood adversity and anxious and depressive symptomatology (ADS) in adulthood. However, no previous study has assessed the independent mediating role of smoking in the association between childhood adversity and ADS in adulthood. Moreover, the importance of mediator-response confounding variables has rarely been demonstrated empirically in social and psychiatric epidemiology. The aim of this paper was to (i) assess the mediating role of smoking in adulthood in the association between childhood adversity and ADS in adulthood, and (ii) assess the change in estimates due to different mediator-response confounding factors (education, alcohol intake, and social support). The present analysis used data collected from 1994 to 2008 within the framework of the Tromsø Study (N = 4,530), a representative prospective cohort study of men and women. Seven childhood adversities (low mother's education, low father's education, low financial conditions, exposure to passive smoke, psychological abuse, physical abuse, and substance abuse distress) were used to create a childhood adversity score. Smoking status was measured at a mean age of 54.7 years (Tromsø IV), and ADS in adulthood was measured at a mean age of 61.7 years (Tromsø V). Mediation analysis was used to assess the indirect effect and the proportion of mediated effect (%) of childhood adversity on ADS in adulthood via smoking in adulthood. The test-retest reliability of smoking was good (Kappa: 0.67, 95% CI: 0.63; 0.71) in this sample. Childhood adversity was associated with a 10% increased risk of smoking in adulthood (Relative risk: 1.10, 95% CI: 1.03; 1.18), and both childhood adversity and smoking in adulthood were associated with greater levels of ADS in adulthood (p < 0.001). Smoking in adulthood did not significantly mediate the association between childhood adversity and ADS in adulthood. However, when education was excluded as a mediator-response confounding variable, the indirect effect of childhood adversity on ADS in adulthood was statistically significant (p < 0.05). This study shows that a careful inclusion of potential confounding variables is important when assessing mediation.

Objectives:
The aim of this study was to (1) identify the influence of childhood socioeconomic status (CSES) on five chronic conditions: asthma, bronchitis, hypothyroid, migraine, and psychiatric disorders in later life; (2) determine the mediating role of childhood abuse (CA) in these associations, and (3) quantify recall bias due to respondent’s mental health in these associations.
Methods:
10,325 men and women from the Tromsø Study were followed for 13 years, and Poisson regression models were used.
Results:
Low CSES was associated with a 16–23% higher risk of chronic conditions, and CA was associated with a 16–58% higher risk of chronic conditions (p < 0.05). A minor proportion of the association between CSES and CA (3.98%, p < 0.05); CSES and chronic conditions (5.54–8.71%, p < 0.05); and CA and chronic conditions (9.51–19.52%, p < 0.05), were driven by recall bias due to the respondent’s mental health. CA mediated the association between CSES and chronic conditions (9.58–25.06%, p < 0.05).

Conclusions

Low CSES and CA are associated with higher risk of chronic conditions in later life. A minor proportion of these associations are driven by recall bias.

The mechanisms by which childhood socioeconomic status (CSES) affects adult mental health, general health, and well-being are not clear. Moreover, the analytical assumptions employed when assessing mediation in social and psychiatric epidemiology are rarely explained. The aim of this paper was to explain the intermediate confounding assumption, and to quantify differential recall bias in the association between CSES, childhood abuse, and mental health (SCL-10), general health (EQ-5D), and subjective well-being (SWLS). Furthermore, we assessed the mediating role of psychological and physical abuse in the association between CSES and mental health, general health, and well-being; and the influence of differential recall bias in the estimation of total effects, direct effects, and proportion of mediated effects. The assumptions employed when assessing mediation are explained with reference to a causal diagram. Poisson regression models (relative risk, RR and 99% CIs) were used to assess the association between CSES and psychological and physical abuse in childhood. Mediation analysis (difference method) was used to assess the indirect effect of CSES (through psychological and physical abuse in childhood) on mental health, general health, and well-being. Exposure (CSES) was measured at two time points. Mediation was assessed with both cross-sectional and longitudinal data. Psychological abuse and physical abuse mediated the association between CSES and adult mental health, general health, and well-being (6–16% among men and 7–14% among women, p < 0.001). The results suggest that up to 27% of the association between CSES and childhood abuse, 23% of the association between childhood abuse, and adult mental health, general health, and well-being, and 44% of the association between CSES and adult mental health, general health, and well-being is driven by differential recall bias. Assessing mediation with cross-sectional data (exposure, mediator, and outcome measured at the same time) showed that the total effects and direct effects were vastly overestimated (biased upwards). Consequently,

Background In recent decades, a great amount of research has investigated traumatic experiences in childhood and how it may relate to subsequent health and wellbeing. Aim/Purpose: To explore the association between traumatic experiences in childhood (psychological abuse, physical abuse, and distress in childhood) and health and wellbeing in adulthood.

Objective:
Self-reported information from questionnaires is frequently used in epidemiological studies, but few of these studies provide information on the reproducibility of individual items contained in the questionnaire. We studied the test–retest reliability of self-reported diabetes among 33,919 participants in Norwegian Women and Cancer Study.

Methods:
The test–retest reliability of self-reported type 1 and type 2 diabetes diagnoses was evaluated between three self-administered questionnaires (completed in 1991, 1998, and 2005 by Norwegian Women and Cancer participants) by kappa agreement. The time interval between the test–retest studies was ~7 and ~14 years. Sensitivity of the kappa agreement for type 1 and type 2 diabetes diagnoses was assessed. Subgroup analysis was performed to assess whether test–retest reliability varies with age, body mass index, physical activity, education, and smoking status.

Results:
The kappa agreement for both types of self-reported diabetes diagnoses combined was good (⩾0.65) for all three test–retest studies (1991–1998, 1991–2005, and 1998–2005). The kappa agreement for type 1 diabetes was good (⩾0.73) in the 1991–2005 and the 1998–2005 test–retest studies, and very good (0.83) in the 1991–1998 test–retest study. The kappa agreement for type 2 diabetes was moderate (0.57) in the 1991–2005 test–retest study and good (⩾0.66) in the 1991–1998 and 1998–2005 test–retest studies. The overall kappa agreement in the 1991–1998 test–retest study was stronger than in the 1991–2005 test–retest study and the 1998–2005 test–retest study. There was no clear pattern of inconsistency in the kappa agreements within different strata of age, BMI, physical activity, and smoking. The kappa agreement was strongest among the respondents with 17 or more years of education, while generally it was weaker among the least educated group.

Conclusion:
The test–retest reliability of the diabetes was acceptable and there was no clear pattern of inconsistency in the kappa agreement stratified by age, body mass index, physical activity, and smoking. The study suggests that self-reported diabetes diagnosis from middle-aged women enrolled in the Norwegian Women and Cancer Study is reliable.

This short paper presents the possibility of establishing a 'quality registry' for higher education in Pakistan. It presents a tentative list of variables for measuring the structural indicators, process indicators, and the results and outcomes of higher education. Further research, planning and discussion are needed to establish a central quality registry for higher education in Pakistan, as this article only highlights the possibility, and usage of it.