Depressive Symptoms and Clinical Status During the Treatment of Adolescent Suicide Attempters (TASA) Study

ObjectiveTo examine the course of depression during the treatment of adolescents with depression who had recently attempted suicide.MethodAdolescents (N = 124), ages 12 to 18 years, with a 90-day history of suicide attempt, a current diagnosis of depressive disorder (96.0% had major depressive disorder), and a Children's Depression Rating Scale-Revised (CDRS-R) score of 36 or higher, entered a 6-month treatment with antidepressant medication, cognitive-behavioral therapy focused on suicide prevention, or their combination (Comb), at five academic sites. Treatment assignment could be either random or chosen by study participants. Intent-to-treat, mixed effects regression models of depression and other relevant ratings were estimated. Improvement and remission rates were computed with the last observation carried forward.ResultsMost patients (n = 104 or 84%) chose treatment assignment, and overall, three fourths (n = 93) received Comb. In Comb, CDRS-R declined from a baseline adjusted mean of 49.6 (SD 12.3) to 38.3 (8.0) at week 12 and to 27.0 (10.1) at week 24 (p < .0001), with a Clinical Global Impression -defined improvement rate of 58.0% at week 12 and 72.2% at week 24 and a remission (CDRS-R ≤28) rate of 32.5% at week 12 and 50.0% at week 24. The CDRS-R and the Scale for Suicidal Ideation scores were correlated at baseline (r= 0.43, p < .0001) and declined in parallel.ConclusionsWhen vigorously treated with a combination of medication and psychotherapy, adolescents with depression who have recently attempted suicide show rates of improvement and remission of depression that seem comparable to those observed in nonsuicidal adolescents with depression.     

A community based approach to bicycle helmet use counts.

OBJECTIVE: Bicycle helmet use has become an important measure of the effectiveness of bicycle safety programs and the effectiveness of helmet legislation. Accounts of analytical comparisons of observation site selection methods are scarce. This report addresses this gap by reporting the relative effectiveness and costs of two alternative approaches to the selection of observation sites for helmet use counts. METHODS: The community based (COBA) method of site selection entailed asking community informants to identify locations frequented by young bicycle riders. In the bicycle club/map (CLMA) method, site selections were based on recommendations from club members of sites at which cyclists were likely to be found and through examination of maps, keying on local features. These alternative site selection methods were compared in terms of their overall and cost effectiveness in locating youth riders. RESULTS: Despite fewer observer hours and fewer sites in a sparsely populated rural county, the COBA method yielded greater numbers of riding youth and from 1.9 to 4.6 times more youth riders per observer hour than did the CLMA method in two densely populated suburban counties. In addition, costs per youth rider observed associated with the COBA method were 2.9 to 7.0 times lower than those associated with the CLMA method. CONCLUSIONS: Community based site identification is both more efficient in locating youth riders and more cost effective.     

Low Energy Availability Interferes With Exercise-Associated Bone Effects in Female Long-Distance Triathletes as Detected by HR-pQCT

Female Athlete Triad, initially described as the association of disordered eating, amenorrhea and osteoporosis, was further redefined to focus on low energy availability (EA), which has a central role in development of hypoestrogenism and low bone mineral density (BMD). However, the contribution of each variable, that is, low EA and hypoestrogenism, for bone derangements is still an open question. To evaluate body composition and bone status in long-distance triathletes without hypoestrogenism, as compared to non-athletes, using DXA and HR-pQCT, and the influence of EA. Population comprised 23 triathletes who had completed at least one long-distance race in the previous year, and 17 non-athletic healthy controls. The athletes denied previous oligo-amenorrhea and had spontaneous regular menses or were on hormonal contraceptives. Control patients also had regular menses. Energy deficiency (low EA) was defined as energy intake below the recommended level for athletes, that is, 45 kcal/kg free fat mass/day. Only femoral neck BMD Z-score measured by DXA trended higher in athletes (p = 0.05), whereas high-resolution peripheral quantitative computed tomography detected significantly higher values of entire bone and trabecular bone area, cortical perimeter, trabecular vBMD and trabecular bone volume/tissue volume, and lower trabecular separation and trabecular inhomogeneity in athletes. No difference was found between athletes with spontaneous menses and those on hormone contraceptives in respect to all parameters. The effects of exercise on bone were not so pronounced in athletes with low EA, although they still had better bone parameters than controls. Stress fractures were reported by 4:12 athletes with low EA and by 2:11 athletes with adequate EA. Long-distance female triathletes without hypoestrogenism show higher values of cortical perimeter, bone area, volumetric density and trabecular microstructure, but low EA interferes with exercise-associated bone effects. These innovative findings reinforce the importance of adequate EA in female athletes to guarantee skeletal health.     

进一步推动我国儿童伤害预防控制工作

伤害是危害我国儿童健康的重要公共卫生问题。我国已开展了大量预防儿童伤害的实践和科学研究，儿童伤害疾病负担已有所减轻，但伤害仍是造成儿童死亡的第1位原因，预防儿童伤害应被列为促进儿童健康的优先工作领域。健全和完善以政府为主导、多部门合作的儿童伤害预防机制，开展系统、全面、科学的儿童伤害预防控制工作，是降低我国儿童伤害疾病负担的重要策略。建议依托《"健康中国2030"规划纲要》完善伤害预防相关政策法规，制定和颁布实施儿童伤害预防行动计划，深入开展预防儿童伤害的实践和科学研究，加强儿童伤害防控的队伍建设和人才培养，以达到减少儿童伤害，促进儿童健康的目的。     

气象因素与交通事故伤害关联性的系统评价

近年来, 气象因素对健康和伤害的影响受到越来越多的关注, 恶劣天气事件被认为可能是导致交通事故伤害发生的一项重要危险因素。大量的流行病学研究证据表明, 高温、降雨、降雪以及风速和能见度等气象因素与交通事故伤害的发生可能存在一定的联系。本文试图通过总结各种气象因素与交通事故伤害发生之间的关系, 归纳气象因素对交通事故伤害的影响, 系统评价气象因素与交通事故伤害之间的关联, 并对如何进一步开展相关研究进行了讨论。     

Pilot study of patron sound level exposure in loud restaurants,bars, and clubs in New York city

Visiting restaurants, bars, clubs, and lounges is a regular part of urban cultural life for residents and tourists alike; however, anecdotal reports and diner surveys suggest that sound levels are excessive and diners dislike them. High sound levels in these venues can contribute to both patron and employee overexposure, and young people may be particularly at risk. To supplement the paucity of literature and data on noise in urban venues, patron noise exposure was measured inside a sample of loud New York City restaurants, bars, clubs, and lounges. Sound level measurements were obtained in 59 venues. Field staff conducted one 20–162 minute visit per venue on a Thursday, Friday, or Saturday evening. The equivalent continuous sound pressure level on the A-scale (L_Aeq) was calculated for each visit. Median and mean L_Aeq among all venues sampled were both 92 decibels (dBA). Clubs and lounges had a higher mean L_Aeq than restaurants and bars (97 vs. 91 dBA, p < 0.05). A greater number of patrons was associated with a higher L_Aeq. Higher L_Aeq values were observed during later hours of the evening (9 PM and later). For 80% (N = 47) of the venues, the L_Aeq was above 85 dBA. In 49% (N = 29) of the venues, the visit exceeded the maximum allowable daily noise dose based on National Institute of Occupational Safety and Health (NIOSH) Recommended Exposure Limit (REL) of 85 dBA 8-hr Time-Weighted Average (TWA). Venues should assess indoor sound levels including employee exposure and aim to maintain sound levels that are within NIOSH guidelines.     

构建自我信心、动机和权威建议影响儿童安全座椅使用的分析模型

目的 建立自我信心、动机和权威建议影响儿童安全座椅使用的模型,并通过结构方程模型进行验证,为推动儿童安全座椅使用宣传倡导工作提供科学依据。方法 采用多阶段整群随机抽样方法,在上海市和深圳市调查9 112位拥有≥ 1辆私家轿车且有0~6岁儿童家庭的儿童监护人关于儿童安全座椅使用的情况,构建自我信心、动机和权威建议影响儿童安全座椅使用的模型,通过结构方程模型对理论模型进行验证和量化分析。结果 整体模型符合预期理论模型,且拟合情况较好,指标均达到标准。RMSEA=0.03,CFI=0.97。各路径标准化系数均有统计学意义（P<0.05）。权威建议和动机对自我信心的影响标准化系数分别为0.45和0.30,自我信心对儿童安全座椅使用的影响标准化系数为0.40。权威建议对动机的影响标准化系数为0.61。结论 在儿童安全座椅宣传倡导工作中应重视使用来源于专业权威、具备较好公信力和公益性的专家及机构组织的建议,应将儿童道路交通安全现况和安全座椅作用机制作为宣传重点之一。     

Long-term outcomes of major trauma patients with concussion

IntroductionConcussion may be sustained in the setting of injuries to multiple body regions and persistent effects of concussion may impact recovery. This project aimed to evaluate the association between concussion and 6-month and 12-month functional outcomes in survivors after major trauma.MethodsThis was a registry-based cohort study that included adult patients with major trauma who presented to hospital between 01 Jan 2008 and 31 Dec 2017 and survived to hospital discharge. We excluded patients presenting with a Glasgow Coma Scale score <13 and those diagnosed with other intracranial injuries. Additionally, from the non-concussed group, patients with fractured skull and/or face were excluded, with the assumption that such patients may have had undiagnosed concussion. A good recovery was considered for Glasgow Outcome Scale-Extended (GOS-E) scores of 7 or 8. In addition, we assessed for patient reported anxiety and/or depression measured using the 3-level EuroQol 5 dimensions questionnaire. A modified mixed effects Poisson models with random intercepts for participant was used to assess the association between concussion and outcome.ResultsThere were 28,161 eligible patients and 12,822 met inclusion criteria. Concussion was diagnosed in 1860 patients (14.5%; 95%CI: 13.9–15.1). There was no association between concussion and good recovery at 12 months (aRR 1.05 (95%CI: 0.99–1.11). There was no association between concussion and anxiety and/or depression at 12 months (aRR 1.03; 95%CI: 0.99–1.07).ConclusionsConcussion was sustained among 14.5% of included patients in the setting of major trauma but not associated with longer-term adverse outcomes using GOS-E. Concussed patients did not report differential rates of anxiety and/or depression.