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AIMS: There is substantial evidence showing an association between parental substance use and child substance use and/or mental health problems. Most research focuses upon maternal substance use, with the influence of paternal substance use often being overlooked. We aimed to investigate the differential effects of maternal and paternal substance use upon children aged 0-18 years. METHODS: We used systematic review methods to identify observational studies examining the association between either maternal or paternal substance use and child substance use and/or mental health problems. The odds ratio (OR) effect measure was used, for ease of computation. We used a random-effects model with the inverse variance method to meta-analyse the findings from eligible studies. RESULTS: We included 17 unique studies with a total of 47 374 child participants. Maternal and paternal substance use were both associated with increased odds of child any drug use [OR = 2.09; 95% confidence interval (CI) = 1.53, 2.86; n = 12 349 participants; three studies and OR = 2.86; 95% CI = 1.25, 6.54; n = 5692 participants; three studies, respectively], child alcohol problem use (OR = 2.16; 95% CI = 1.73, 2.71; n = 7339 participants; four studies and OR = 1.70; 95% CI = 1.36, 2.12; n = 14 219 participants; six studies), child externalizing problems (OR = 1.81; 95% CI = 1.01, 3.22; n = 1748 participants; three studies and OR = 1.60; 95% CI = 1.18, 2.17; n = 2508 participants; six studies) and child internalizing problems (OR = 1.60; 95% CI = 1.25, 2.06; n = 1748 participants; three studies and OR = 1.42; 95% CI = 1.12, 1.81; n = 2248 participants; five studies). Child any alcohol use was associated with maternal substance use only (OR = 2.26; 95% CI = 1.08, 4.70; n = 28 691 participants; five studies). CONCLUSIONS: Both maternal and paternal substance use are associated with child substance use and mental health problems.
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Trastornos Relacionados con Alcohol , Trastornos Relacionados con Sustancias , Masculino , Humanos , Niño , Padre , Trastornos Relacionados con Sustancias/epidemiología , PadresRESUMEN
BACKGROUND: Antidepressants are commonly prescribed. There are clear national guidelines in relation to treatment sequencing. This study examines trends and variation in antidepressant prescribing across English primary care. AIM: To examine trends and variation in antidepressant prescribing in England, with a focus on: monoamine oxidase inhibitors (MAOIs); paroxetine; and dosulepin and trimipramine. DESIGN & SETTIN: gRetrospective longitudinal study using national and practice-level data on antidepressant items prescribed per year (1998-2018) and per month (2010-2019). METHOD: Class- and drug-specific proportions were calculated at national and practice levels. Descriptive statistics were generated, percentile charts and maps were plotted, and logistic regression analysis was conducted. RESULTS: Antidepressant prescriptions more than tripled between 1998 and 2018, from 377 items per 1000 population to 1266 per 1000. MAOI prescribing fell substantially, from 0.7% of all antidepressant items in 1998 to 0.1% in 2018. There was marked variation between practices in past year prescribing of paroxetine (median practice proportion [MPP] = 1.7%, interdecile range [IDR] = 2.6%) and dosulepin (MPP = 0.7%, IDR = 1.8%), but less for trimipramine (MPP = 0%, IDR = 0.2%). CONCLUSION: Rapid growth and substantial variation in antidepressant prescribing behaviour was found between practices. The causes could be explored using mixed-methods research. Interventions to reduce prescribing of specific antidepressants, such as dosulepin, could include review prompts, alerts at the time of prescribing, and clinician feedback through tools like OpenPrescribing.net.
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PURPOSE OF THE STUDY: To examine the use of alcohol and other substances among medical and law students at a UK university. STUDY DESIGN: Anonymous cross-sectional questionnaire survey of first, second and final year medical and law students at a single UK university. RESULTS: 1242 of 1577 (78.8%) eligible students completed the questionnaire. Over half of first and second year medical students (first year 53.1%, second year 59.7%, final year 35.9%) had an Alcohol Use Disorders Identification Test (AUDIT) score suggestive of an alcohol use disorder (AUDIT≥8), compared with over two-thirds of first and second year law students (first year 67.2%, second year 69.5%, final year 47.3%). Approximately one-quarter of medical students (first year 26.4%, second year 28.4%, final year 23.7%) and over one-third of first and second year law students (first year 39.1%, second year 42.4%, final year 18.9%) reported other substance use within the past year. Over one-third of medical students (first year 34.4%, second year 35.6%, final year 46.3%) and approximately half or more of law students (first year 47.2%, second year 52.7%, final year 59.5%) had a Hospital Anxiety and Depression Scale anxiety score suggestive of a possible anxiety disorder. CONCLUSIONS: Study participants had high levels of substance misuse and anxiety. Some students' fitness to practice may be impaired as a result of their substance misuse or symptoms of psychological distress. Further efforts are needed to reduce substance misuse and to improve the mental well-being of students.
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Ansiedad/epidemiología , Abogados , Estrés Psicológico/epidemiología , Estudiantes de Medicina , Trastornos Relacionados con Sustancias , Adulto , Ansiedad/diagnóstico , Ansiedad/prevención & control , Estudios Transversales , Femenino , Humanos , Abogados/educación , Abogados/psicología , Abogados/estadística & datos numéricos , Masculino , Salud Mental/normas , Mejoramiento de la Calidad , Estrés Psicológico/diagnóstico , Estrés Psicológico/prevención & control , Estudiantes de Medicina/psicología , Estudiantes de Medicina/estadística & datos numéricos , Trastornos Relacionados con Sustancias/diagnóstico , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/prevención & control , Trastornos Relacionados con Sustancias/psicología , Encuestas y Cuestionarios , Reino Unido/epidemiología , Universidades/estadística & datos numéricosRESUMEN
We carried out an analysis of a serobehavioural study of men who have sex with men >19 years of age in Vancouver, Canada to examine HIV testing behaviour and use of risk reduction strategies by HIV risk category, as defined by routinely gathered clinical data. We restricted our analysis to those who self-identified as HIV-negative, completed a questionnaire, and provided a dried blood spot sample. Of 842 participants, 365 (43.3%) were categorised as lower-risk, 245 (29.1%) as medium-risk and 232 (27.6%) as higher-risk. The prevalence of undiagnosed HIV infection was low (lower 0.8%, medium 3.3%, higher 3.9%; p = 0.032). Participants differed by risk category in terms of having had an HIV test in the previous year (lower 46.5%, medium 54.6%, higher 67.0%; p < 0.001) and in their use of serosorting (lower 23.3%, medium 48.3%, higher 43.1%; p < 0.001) and only having sex with HIV-positive men if those men had low viral loads or were taking HIV medication (lower 5.1%, medium 4.8%, higher 10.9%; p = 0.021) as risk reduction strategies. These findings speak to the need to consider segmented health promotion services for men who have sex with men with differing risk profiles. Risk stratification could be used to determine who might benefit from tailored multiple health promotion interventions, including HIV pre-exposure prophylaxis.
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Infecciones por VIH/prevención & control , Homosexualidad Masculina/estadística & datos numéricos , Tamizaje Masivo/métodos , Conducta de Reducción del Riesgo , Asunción de Riesgos , Adulto , Canadá/epidemiología , Infecciones por VIH/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Riesgo , Encuestas y Cuestionarios , Sexo Inseguro/estadística & datos numéricosRESUMEN
OBJECTIVE: To assess growth of the middle/posterior cranial base during adolescence based on landmarks located on serial three-dimensional cone-beam computerized tomography (CBCT) images. MATERIALS AND METHODS: CBCT scans from 62 adolescents (11 to 17 years) at baseline and 12 months were used. Eleven landmarks in the cranial base were identified. Linear landmark distances were compared over the two time points using basic descriptive statistics. Shape analysis was carried out using R (R Foundation for Statistical Computing, Austria). Discrete curves were obtained and aligned via a Procrustes transformation and examined for group dimorphism and longitudinal change. RESULTS: Mean differences between linear distances in the cranial base were within 1mm, apart from the difference between the right and left auditory external meatuses, which was 2.25 mm. No statistically significant longitudinal differences in shape were found in relation to the peak growth period. CONCLUSION: Cranial base growth was minimal over the observation period. There were no differences in terms of the amount and pattern of growth. The cranial base is said to complete most of its growth by age 12, but this has only been verified through two-dimensional studies. Our findings using CBCT confirm this, and support the use of the cranial base as a stable anatomical reference structure for superimpositioning.
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Tomografía Computarizada de Haz Cónico/métodos , Base del Cráneo/crecimiento & desarrollo , Adolescente , Puntos Anatómicos de Referencia/diagnóstico por imagen , Puntos Anatómicos de Referencia/crecimiento & desarrollo , Cefalometría/métodos , Niño , Conducto Auditivo Externo/diagnóstico por imagen , Conducto Auditivo Externo/crecimiento & desarrollo , Femenino , Estudios de Seguimiento , Foramen Magno/diagnóstico por imagen , Foramen Magno/crecimiento & desarrollo , Humanos , Imagenología Tridimensional/métodos , Masculino , Órbita/diagnóstico por imagen , Órbita/crecimiento & desarrollo , Proyectos Piloto , Estudios Retrospectivos , Base del Cráneo/diagnóstico por imagenRESUMEN
OBJECTIVE: To systematically review published primary research on the development or validation of risk scores that require only self-reported or available clinical data to identify undiagnosed Type 2 Diabetes Mellitus (T2DM). METHODS: A systematic literature search of Medline and EMBASE was conducted until January 2011. Studies focusing on the development or validation of risk scores to identify undiagnosed T2DM were included. Risk scores to predict future risk of T2DM were excluded. RESULTS: Thirty-one studies were included; 17 developed a new risk score, 14 validated existing scores. Twenty-six studies were conducted in high-income countries. Age and measures of body mass/fat distribution were the most commonly used predictor variables. Studies developing new scores performed better than validation studies, with 11 reporting an AUC of >0.80 compared to one validation study. Fourteen validation studies reported sensitivities of <80%. The performance of scores did not differ by the number of variables included or the country setting. CONCLUSIONS: There is a proliferation of newly developed risk scores using similar variables, which sometimes perform poorly upon external validation. Future research should explore the recalibration, validation and applicability of existing scores to other settings, particularly in low/middle income countries, and on the utility of scores to improve diabetes-related outcomes.
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Diabetes Mellitus Tipo 2/diagnóstico , Tamizaje Masivo/métodos , Adiposidad , Factores de Edad , Índice de Masa Corporal , Diabetes Mellitus Tipo 2/epidemiología , Medicina Basada en la Evidencia , Humanos , Riesgo , AutoinformeRESUMEN
OBJECTIVES: Evaluate the effect of bone-anchored maxillary expander (BAME) treatment on palatal cortical bone in adolescent patients. STUDY DESIGN: Forty-two patients were assigned to two groups: treatment and control. CBCT scans were obtained for patients at baseline and 12 months later. Landmarks were placed between the second maxillary premolar and first maxillary molar following the palatal plate. Morphometric analysis of the palate was carried out. Individual differences in terms of the response to BAME treatment were assessed. RESULTS: Mean distance measurements between the six counterpart landmarks in BAME and control groups at T1 and T2 showed that the palatal perimeter increases after 12 months in the BAME group but not in the control group. There were very mild indentations in the area where the onplants were located in both groups. These indentations were not to be considered clinically significant. CONCLUSIONS: BAME treatment does not cause significant palatal bone resorption.
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Resorción Ósea/etiología , Métodos de Anclaje en Ortodoncia/efectos adversos , Métodos de Anclaje en Ortodoncia/instrumentación , Técnica de Expansión Palatina/instrumentación , Paladar Duro/patología , Adolescente , Resorción Ósea/diagnóstico por imagen , Tornillos Óseos , Niño , Tomografía Computarizada de Haz Cónico , Femenino , Humanos , Imagenología Tridimensional , Masculino , Variaciones Dependientes del Observador , Técnica de Expansión Palatina/efectos adversos , Paladar Duro/diagnóstico por imagen , Paladar Duro/cirugía , Sistemas de Información Radiológica , Estudios Retrospectivos , Estadísticas no ParamétricasRESUMEN
Assessments of skeletal maturation (ASM) are used by clinicians to optimize treatments for each patient. This study examines the interrelationship between and limitations of hand-wrist and cervical vertebrae maturation methods in adolescent patients. Radiographs (hand-wrist and lateral cephalometric) were obtained from patients (n=62, 11 to 17 years of age) at two-time periods (T1/T2) with time intervals of 9.75 to 16.50 months. Radiographs were scored using cervical vertebral maturation staging (CS) and Fishman's skeletal maturation indices (SMI). Functional data analysis was used to visually assess maturational changes of the cervical vertebrae. Both SMI and CS increased over the period of observation. Age was moderately correlated with SMI (0.707/0.651 at T1/T2) and mildly correlated with CS (0.431/0.314 at T1/T2). There was some evidence of gender variability in SMI. The correlations between SMI and CS were 0.513 and 0.372 at T1 and T2, respectively. Functional data analysis illustrated the difficulty in differentiating contiguous cervical stages. Discrepancies exist between both scoring methods. Further studies are needed to overcome the difficulties encountered with CS. Clinicians are advised to use ASM methods with caution in adolescent patients given the aforementioned discrepancies. Separate references for boys and girls are not required.