Drug use among street children and adolescents: what helps?

The aim of this study was to investigate factors associated to frequent and heavy drug use among street children and adolescents aged 10 to 18 years. A sample of 2,807 street children and adolescents from the 27 Brazilian state capital cities was analyzed. A World Health Organization questionnaire for non-students was adapted for use in Brazil. Data analysis was performed using logistic regression and decision tree models. Factors inversely associated with frequent and heavy drug use were: being age nine to 11 years (OR = 0.1); school attendance (OR = 0.3); daily time (one to five hours) spent on the streets (OR = 0.3 and 0.4); not sleeping on the streets (OR = 0.4); being on the streets for less than one year (OR = 0.4); maintenance of some family bonds (OR = 0.5); presence on the streets of a family member (OR = 0.6); not suffering domestic violence (OR = 0.6); being female (OR = 0.8). All of these variables were significant at the p < 0.05 level. The findings suggest that being younger, having family bonds and engagement in school are important protective factors that affect drug use among this population and should be considered in the formulation of public policies.     

Is maternal age a risk factor for mental retardation among children?

The purpose of this study was to determine whether older or very young maternal age at delivery is associated with mental retardation in children. Ten-year-old children with mental retardation (an intelligence quotient of 70 or less) were identified in 1985-1987 from multiple sources in the metropolitan Atlanta, Georgia, area. These children were subdivided into two case groups according to whether they had concomitant developmental disabilities or birth defects affecting the central nervous system (codevelopmental retardation) or did not have such disabilities (isolated retardation). Control children were randomly chosen from the regular education files of the public school systems in the study area. Data on sociodemographic variables were gathered from birth certificates. Children of teenaged mothers were not at increased risk for either form of retardation and children of mothers aged > or =30 years were not at increased risk for isolated retardation, in comparison with children of mothers aged 20-29 years. A markedly elevated risk of codevelopmental retardation was seen among black children of mothers aged > or =30 years that was not attributable to Down syndrome. A modest increase in risk for codevelopmental retardation was observed among white children born to older mothers, but it was entirely due to Down syndrome.     

Health care access and use among low-income children: who fares best?

In this paper we assess how access to care and use of services among low-income children vary by insurance status. Although 40 percent of low-income children rely on private health insurance, little is known about how this coverage compares with Medicaid coverage in meeting their health care needs. We find that Medicaid and privately insured low-income children appear to have fairly comparable access but that Medicaid-covered children are more likely to receive services and to have more visits when they receive care. Expanding public coverage may not be sufficient to ensure that all low-income children have access to comprehensive and high-quality care. It may require improvements in preventive and dental care for children with private coverage, an area in which states have limited influence.     

Hormonal factors and risk of lung cancer among women?

BACKGROUND: Gender differences in the histological distribution of lung carcinoma and a possibly greater susceptibility of women than men to tobacco carcinogens, suggest a possible influence of sex-specific hormones. This study examines endocrine factors and risk of lung cancer among women by smoking status and histology. METHODS: We used data of a case-control study on lung cancer conducted from 1990 to 1996 in Germany, including 811 histologically confirmed female cases and 912 female population controls. Information on various menstrual and reproductive factors, use of oral contraceptives (OC), hormone replacement therapy (HRT), and smoking was gathered through personal interviews using a structured questionnaire. Odds ratios (OR) and 95% CI adjusted for age, region, smoking, and education were calculated via logistic regression. RESULTS: A reduction in lung cancer risk was observed with the use of OC (OR = 0.69; 95% CI: 0.51-0.92), but no trend in risk with increasing duration of use, age at first use, or calendar year of first use was present. A history of HRT was associated with a reduced risk (OR = 0.83; 95% CI: 0.64-1.09), particularly after long duration (>/=7 years) (OR = 0.59; 95% CI: 0.37-0.93). No clear association was found with regard to age at menarche, length of menstrual cycle, number of live-births, and age at menopause. Overall results did not differ much by histological cell subtype. The reduction in lung cancer risk associated with the use of exogenous hormones was primarily seen among smoking women. CONCLUSIONS: Our data provide evidence for a possible role of hormonal factors in the aetiology of lung cancer in women.     

How useful are sociodemographic characteristics in identifying children at risk of unintentional injury?

The social class gradient in childhood injury mortality is steep and increasing, so there is emphasis on targeting injury prevention on the basis of socioeconomic deprivation, to reduce inequalities in health. This paper examines the relationship between medically attended unintentional injury, sociodemographic characteristics and previous injury. This was a cohort study using the control group from a cluster randomised controlled trial of injury prevention in primary care. The cohort comprised children aged 3-12, months registered with participating practices, whose parents completed the baseline questionnaire (n = 771). 94% were followed for 25 months. Medically attended unintentional injury was ascertained from the primary and secondary care records. Logistic regression analysis examined the relationship between sociodemographic factors, previous injury and the occurrence of future medically attended injuries. Poisson regression examined the relationship between sociodemographic factors, previous injury and the number of future medically attended injuries. The response rate to the questionnaire was 75%. Residence in a deprived ward, lack of access to a car and male sex were associated with at least one medically attended injury. Residence in a deprived ward and young maternal age were associated with hospital admission. Residence in a deprived ward, male sex and non-ownership of a car were independently associated with number of unintentional injuries. Specificity exceeded sensitivity for all factors for medically attended injury and hospital admission. The positive predictive value was low for all factors, especially for hospital admissions. In conclusion, residence in a deprived ward was independently associated with any medically attended injury, with hospital admission and with number of injuries received. However, more than half of those children residing in a deprived ward did not have a medically attended injury and more than 90% did not have a hospital admission. 60% of children who had a medically attended injury and 40% who had a hospital admission do not live in a deprived ward. A combination of a population approach and targeted interventions will achieve the greatest health gain, and is unlikely to widen inequalities in health.     

Drug use and risk behaviour among regular ecstasy users: Does sexuality make a difference?

This study aimed to compare homo/bisexual men and women with their heterosexual counterparts who were regular ecstasy users, to consider whether patterns of drug use or risk differed across these groups. Respondents (n = 852 ecstasy users) were recruited via advertisements in entertainment street press, gay and lesbian newspapers, music and clothing stores and at university campuses. Interviewer contacts and 'snowball' sampling were also utilized. In total, 23% of females in the sample self-identified as lesbian or bisexual and 13% of males interviewed self-identified as homo/bisexual. Rates of use of 'newer' drugs on the dance scene--crystal methamphetamine and ketamine--were higher among homo/bisexual men and women. Self-reported risk behaviours such as unprotected sex and needle sharing (among those who had injected drugs) did not differ according to sexuality. However, homo/bisexual men and women were significantly more likely than heterosexual men and women to report a greater number of sexual partners and higher rates of injecting drug use. These findings suggest that among a group of people who were selected because they were regularly involved in the party drug market, initiatives designed to reduce harms related to injecting and sex risk may be needed for a greater proportion of homo/bisexual males and females who are involved in the dance/nightclub scene.     

Early retirement due to occupational injury: Who is at risk?

BACKGROUND: As the workforce is rapidly ageing, research on the consequences of occupational injuries in older workers is becoming more important. One adverse outcome unique to older workers, early retirement, has significant negative social and economic consequences for workers and employers. Although linked to poor worker health, the roles of workplace factors and occupational injury have not been well-defined. METHOD: Changes in retirement plans attributed to an occupational injury were studied in a population-based sample of 1,449 New Hampshire workers aged 相似文献   

Comparative effectiveness and personalized medicine: evolving together or apart?

Comparative effectiveness research and personalized medicine can at first appear to be at odds with each other. This research initially compares the overall benefits of one therapeutic approach with those of another for the majority of patients, while personalized medicine identifies the subsets of patients who could benefit based on personal characteristics such as genetics. But because comparative effectiveness research typically enrolls heterogeneous patient populations, it can uncover subpopulations that might benefit most from particular treatments. Thus, comparative effectiveness research can help discern the appropriate role of personalized medicine in improving health care outcomes and rationalizing costs.     

Bicycle helmet campaigns and head injuries among children. Does poverty matter?

OBJECTIVES: To assess the impact of a community based bicycle helmet programme aimed at children aged 5-12 years (about 140,000) from poor and well off municipalities. METHODS: A quasi-experimental design, including a control group, was used. Changes in the risk of bicycle related head injuries leading to hospitalisation were measured, using rates ratios. RESULTS: Reductions in bicycle related head injuries were registered in both categories of municipalities. Compared with the pre-programme period, the protective effect of the programme during the post-programme period was as significant among children from poor municipalities (RR= 0.45 95%CI 0.26 to 0.78) as among those from richer municipalities (RR=0.55 95%CI 0.41 to 0.75). CONCLUSION: Population based educational programmes may have a favourable impact on injury risks in poor areas despite lower adoption of protective behaviours.     

Neighbourhood deprivation and regional inequalities in self-reported health among Canadians: Are we equally at risk?

Individual-level data from the Canadian Community Health Survey was combined with area-level data from the 2001 Canada Census to explore the relationship between neighbourhood deprivation and regional inequalities in self-reported health (n=120,290). While neighbourhood deprivation was a significant predictor of fair/poor health in all geographic regions (OR=1.11; 95% CI: 1.08, 1.14), living on the Atlantic and Pacific coasts exacerbated the detrimental effects of neighbourhood deprivation on the perceived health of respondents (OR=1.21; 1.28). By failing to explore regional variations in risk, we could fail to identify areas where provincial policies may interact with neighbourhood factors to reinforce health inequalities amongst deprived communities.     

Treatment of overweight in children and adolescents: Does dieting increase the risk of eating disorders?

OBJECTIVE: Overweight is a serious health problem in children and adolescents. Some investigators fear that dieting, the principal method of reducing body weight, may precipitate eating disorders and related complications. This review examined the literature on the effects of dieting on eating behavior and psychological status in youth. METHOD: Electronic databases were searched for articles containing combinations of the following keywords: weight loss, dieting, treatment, overweight, obesity, anorexia, bulimia, binge eating, eating disorder, children, and adolescents. A manual search of reference lists also was conducted. RESULTS: Five relevant studies were found. Their findings suggest that a professionally administered weight loss poses minimal risks of precipitating eating disorders in overweight children and adolescents. Significant improvements in psychological status also were observed in several studies. DISCUSSION: Concerns about potential ill effects of dieting should not dissuade overweight youth from pursuing sensible methods of weight loss.     

What do children observe and learn from televised sports betting advertisements? A qualitative study among Australian children

Objective : To explore children's awareness of sports betting advertising and how this advertising may influence children's attitudes, product knowledge and desire to try sports betting. Methods : Semi‐structured qualitative interviews were conducted with 48 children (8–16 years) from Melbourne, Victoria. The interview schedule explored children's recall and interpretations of sports betting advertising, strategies within advertisements that may appeal to children, children's product knowledge and understanding of betting terminology, and factors that may encourage gambling. Interviews were transcribed and thematic analysis was conducted. Results : Children recalled in detail sports betting advertisements that they had seen, with humour the most engaging appeal strategy. They were also able to describe other specific appeal strategies and link these strategies to betting brands. Many children described how advertisements demonstrated how someone would place a bet, with some children recalling the detailed technical language associated with betting. Conclusions : Children had detailed recall of sports betting advertisements and an extensive knowledge of sports betting products and terminology. Implications for public health : To protect children from the potential harms associated with sports betting, governments should consider changing regulations and implementing evidence‐based education campaigns to counter the positive messages children receive from the sports betting industry.     

Can scientists and policy makers work together?

This paper addresses a fundamental question in evidence based policy making—can scientists and policy makers work together? It first provides a scenario outlining the different mentalities and imperatives of scientists and policy makers, and then discusses various issues and solutions relating to whether and how scientists and policy makers can work together. Scientists and policy makers have different goals, attitudes toward information, languages, perception of time, and career paths. Important issues affecting their working together include lack of mutual trust and respect, different views on the production and use of evidence, different accountabilities, and whether there should be a link between science and policy. The suggested solutions include providing new incentives to encourage scientists and policy makers to work together, using knowledge brokers (translational scientists), making organisational changes, defining research in a broader sense, re-defining the starting point for knowledge transfer, expanding the accountability horizon, and finally, acknowledging the complexity of policy making. It is hoped that further discussion and debate on the partnership idea, the need for incentives, recognising the incompatibility problems, the role of civil society, and other related themes will lead to new opportunities for further advancing evidence based policy and practice.     

Is spending more always wasteful? The appropriateness of care and outcomes among colorectal cancer patients

Increased area-level medical spending is not correlated with improved patient outcomes or quality, thereby supporting the case for spending reductions in high-spending regions. However, all additional spending need not be wasteful. Examining the care of patients with colorectal cancer, we show that high-spending regions are more likely than other regions to use recommended care but are also more likely to use discretionary and nonrecommended care, the latter of which has adverse outcomes for patients. Our results show that instead of cutting spending, policies designed to target services to patients most likely to benefit could increase the value of medical spending.