PATTERNS OF BINGE DRINKING, MARIJUANA USE, AND DEPRESSIVE SYMPTOMS FROM ADOLESCENCE TO YOUNG ADULTHOOD: TESTING THE SELF-MEDICATION AND STRESS MODELS

Understanding the relationships between substance use and depression could inform prevention and treatment efforts. Previous studies provide conflicting support for both depression leading to substance use—the Self-Medication Model—and substance use leading to depression—the Stress Model. Much of this prior literature focuses only on adolescence, examines only one direction, and/or fails to examine potential mediators or whether associations vary by biological sex. Using data from Waves I, III, and IV of the National Longitudinal Study of Adolescent to Adult Health, mixed effects models were used to test the relationships between depressive symptoms and frequency of alcohol use and marijuana use across development, and whether these associations were moderated by sex. Regression models were used to examine potential mediators and one moderator for both the Self-Medication and Stress Models. Adolescent depressive symptoms were significantly associated with a steeper predicted increase in marijuana use frequency across development. Further, persistent binge drinking or marijuana use across development were concurrently positively associated with the depressive symptom growth curve, and associations were stronger for females. Results also indicate the association between depressive symptoms and later binge drinking frequency may be mediated by sensation seeking and adherence to gender norms for males and females; adherence to gender norms also moderated this association for males. For females, the association between depressive symptoms and later marijuana use frequency may also be mediated by sensation seeking. These results inform how to target and integrate screenings for adolescent substance use and depressive symptoms, both newly covered under the Affordable Care Act. For example, if adolescents screen positive for high or increasing depressive symptoms, it seems they should also be screened for marijuana use. Binge drinking screening could be targeted towards adolescents with higher sensation seeking and depressive symptoms. The findings also indicate substance use and depression prevention and treatment programs should be integrated—as comorbidity is common—and tailored by sex—as the links between substance use and depression seem to differ by sex. Better yet, substance use and mental health programs for youth could challenge the gender norms that promote substance use and self-medication to begin with.Doctor of Philosoph

The Predictors of Youth Employment in Rural South Africa: The Poverty Alleviation Pilot Study

Objectives: Explore predictors of employment among 18-24 year olds in Mpumalanga, South Africa to inform intervention development. Method: The Poverty Alleviation Pilot collected quantitative data from 18-24 year olds randomly sampled from the Agincourt Health and Demographic Surveillance site in rural South Africa. Logistic regression models were estimated to identify demographic, qualification, and psychosocial predictors of youth employment. Results: Youth with working skills were significantly more likely to report employment and youth reporting greater life dissatisfaction also had slightly greater odds of employment. Having training was also significantly positively associated with employment, but for males only. Conclusions: To decrease youth unemployment, rural youth need access to training and entrepreneurship development programs and employers need incentives to hire youth.Master of Public Healt

A Novel Application of the Hydrostatic Test in Determining Live (Non)-Birth

It is important to determine whether a foetus had been born alive since various legal consequences follow upon such a determination. This article is concerned with the determination of live birth in terms of section 239 of the Criminal Procedure Act 51 of 1977 and live non-birth, the latter concept as transpired in the case of S v Mshumpa 2008 (1) SACR 126 (E). The medico- legal importance and risks of the hydrostatic test in determining live birth will be considered and its novel application in determining breathing before birth (live non-birth) for the purpose of criminal proceedings will also be discussed. Reference will be made to case law and legislation from the United Kingdom and selected states from the United States of America in order to show that section 239 of the Criminal Procedure Act 51 of 1977, which requires only that it be proved that a foetus had breathed in order to establish live birth, does not take into consideration the present medical opinion on the matter, or the legal developments with regard to infanticide and the determination of live birth in other jurisdictions

The employment environment for youth in rural South Africa: A mixed-methods study

South Africa has high youth unemployment. This paper examines the predictors of youth employment in rural Agincourt, Mpumalanga Province. A survey of 187 out-of-school 18–24 year olds found only 12% of women and 38% of men were currently employed. Men with skills/training were significantly more likely to report employment, mostly physical labour (aOR: 4.5; CI: 1.3, 15.3). In-depth interviews with 14 of the youth revealed women are perceived more suitable for formal employment, which is scarce informing why women were more likely to pursue further education and yet less likely to be employed. Ten key informants from local organisations highlighted numerous local youth employment resources while, in contrast, all youth in the sample said no resources were available, highlighting a need for the organisations to extend their services into rural areas. As these services are focused on entrepreneurship, programs to increase financial literacy and formal employment opportunities are also needed

Directions of the relationship between substance use and depressive symptoms from adolescence to young adulthood

Both substance use and depression are common in adolescence and often comorbid. Past research has produced conflicting results on whether there is a temporal relationship and if so, in which direction it operates and how it may vary by sex. The purpose of this paper is to explore the longitudinal, potentially bidirectional, relationships between high-frequency substance use and depressive symptoms from adolescence into young adulthood for males and females

Testing Longitudinal Relationships Between Binge Drinking, Marijuana Use, and Depressive Symptoms and Moderation by Sex

Both substance use and depression are common in adolescence and often comorbid. Past research has produced conflicting results on whether there is a temporal relationship and if so, in which direction it operates and how it may vary by sex. We examined the longitudinal associations between substance use frequency and depressive symptoms from adolescence into young adulthood, and whether the associations were moderated by sex

The FAIR Guiding Principles for scientific data management and stewardship

There is an urgent need to improve the infrastructure supporting the reuse of scholarly data. A diverse set of stakeholders—representing academia, industry, funding agencies, and scholarly publishers—have come together to design and jointly endorse a concise and measureable set of principles that we refer to as the FAIR Data Principles. The intent is that these may act as a guideline for those wishing to enhance the reusability of their data holdings. Distinct from peer initiatives that focus on the human scholar, the FAIR Principles put specific emphasis on enhancing the ability of machines to automatically find and use the data, in addition to supporting its reuse by individuals. This Comment is the first formal publication of the FAIR Principles, and includes the rationale behind them, and some exemplar implementations in the community

Efficacy and safety of baricitinib or ravulizumab in adult patients with severe COVID-19 (TACTIC-R): a randomised, parallel-arm, open-label, phase 4 trial

Background From early in the COVID-19 pandemic, evidence suggested a role for cytokine dysregulation and complement activation in severe disease. In the TACTIC-R trial, we evaluated the efficacy and safety of baricitinib, an inhibitor of Janus kinase 1 (JAK1) and JAK2, and ravulizumab, a monoclonal inhibitor of complement C5 activation, as an adjunct to standard of care for the treatment of adult patients hospitalised with COVID-19. Methods TACTIC-R was a phase 4, randomised, parallel-arm, open-label platform trial that was undertaken in the UK with urgent public health designation to assess the potential of repurposing immunosuppressants for the treatment of severe COVID-19, stratified by a risk score. Adult participants (aged ≥18 years) were enrolled from 22 hospitals across the UK. Patients with a risk score indicating a 40% risk of admission to an intensive care unit or death were randomly assigned 1:1:1 to standard of care alone, standard of care with baricitinib, or standard of care with ravulizumab. The composite primary outcome was the time from randomisation to incidence (up to and including day 14) of the first event of death, invasive mechanical ventilation, extracorporeal membrane oxygenation, cardiovascular organ support, or renal failure. The primary interim analysis was triggered when 125 patient datasets were available up to day 14 in each study group and we included in the analysis all participants who were randomly assigned. The trial was registered on ClinicalTrials.gov (NCT04390464). Findings Between May 8, 2020, and May 7, 2021, 417 participants were recruited and randomly assigned to standard of care alone (145 patients), baricitinib (137 patients), or ravulizumab (135 patients). Only 54 (39%) of 137 patients in the baricitinib group received the maximum 14-day course, whereas 132 (98%) of 135 patients in the ravulizumab group received the intended dose. The trial was stopped after the primary interim analysis on grounds of futility. The estimated hazard ratio (HR) for reaching the composite primary endpoint was 1·11 (95% CI 0·62–1·99) for patients on baricitinib compared with standard of care alone, and 1·53 (0·88–2·67) for ravulizumab compared with standard of care alone. 45 serious adverse events (21 deaths) were reported in the standard-of-care group, 57 (24 deaths) in the baricitinib group, and 60 (18 deaths) in the ravulizumab group. Interpretation Neither baricitinib nor ravulizumab, as administered in this study, was effective in reducing disease severity in patients selected for severe COVID-19. Safety was similar between treatments and standard of care. The short period of dosing with baricitinib might explain the discrepancy between our findings and those of other trials. The therapeutic potential of targeting complement C5 activation product C5a, rather than the cleavage of C5, warrants further evaluation

Developmental implications of prenatal opioid exposure among school-aged children: a mixed methods and community-initiated analysis

Abstract Background Growing research points to potential long-term developmental implications of prenatal opioid exposure for children. Yet, polysubstance use and adverse childhood experiences are raised as potential confounders. Further, there is a lack of data on school-age children and the children’s strengths. Methods Parents and caregivers of children with prenatal opioid exposure worked with the study team to design, collect, and descriptively analyze mixed method data. Data were collected through survey (n = 148) and two focus groups (n = 15) from a convenience sample in mostly West Virginia and Massachusetts. Results Nearly half of the children in the sample were diagnosed with multiple developmental delays, behavioral health conditions, and specific learning disorders. Roughly 85% of children have behavioral challenges. Associations between prenatal opioid exposure and negative developmental outcomes did not vary by type of opioid nor by polysubstance use, while controlling for adverse childhood experiences. Importantly, over 80% of families also reported their child’s strengths, including empathy, social magnetism, and their resilience. Conclusions The challenges for children born with prenatal opioid exposure may extend into school-age. The results are consistent with prior research on younger children, suggesting a need for best practices for caring for these children beyond the neonatal stage