Family structure and posttraumatic stress reactions: a longitudinal study using multilevel analyses

<p>Abstract</p> <p>Background</p> <p>There is limited research on the relevance of family structures to the development and maintenance of posttraumatic stress following disasters. We longitudinally studied the effects of marital and parental statuses on posttraumatic stress reactions after the 2004 Southeast Asian tsunami and whether persons in the same households had more shared stress reactions than others.</p> <p>Method</p> <p>The study included a tourist population of 641 Norwegian adult citizens, many of them from families with children. We measured posttraumatic stress symptoms with the Impact of Event Scale-Revised at 6 months and 2 years post-disaster. Analyses included multilevel methods with mixed effects models.</p> <p>Results</p> <p>Results showed that neither marital nor parental status was significantly related to posttraumatic stress. At both assessments, adults living in the same household reported levels of posttraumatic stress that were more similar to one another than adults who were not living together. Between households, disaster experiences were closely related to the variance in posttraumatic stress symptom levels at both assessments. Within households, however, disaster experiences were less related to the variance in symptom level at 2 years than at 6 months.</p> <p>Conclusions</p> <p>These results indicate that adult household members may influence one another's posttraumatic stress reactions as well as their interpretations of the disaster experiences over time. Our findings suggest that multilevel methods may provide important information about family processes after disasters.</p

Population-level risks of alcohol consumption by amount, geography, age, sex, and year: a systematic analysis for the Global Burden of Disease Study 2020

Background The health risks associated with moderate alcohol consumption continue to be debated. Small amounts of alcohol might lower the risk of some health outcomes but increase the risk of others, suggesting that the overall risk depends, in part, on background disease rates, which vary by region, age, sex, and year. Methods For this analysis, we constructed burden-weighted dose–response relative risk curves across 22 health outcomes to estimate the theoretical minimum risk exposure level (TMREL) and non-drinker equivalence (NDE), the consumption level at which the health risk is equivalent to that of a non-drinker, using disease rates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020 for 21 regions, including 204 countries and territories, by 5-year age group, sex, and year for individuals aged 15–95 years and older from 1990 to 2020. Based on the NDE, we quantified the population consuming harmful amounts of alcohol. Findings The burden-weighted relative risk curves for alcohol use varied by region and age. Among individuals aged 15–39 years in 2020, the TMREL varied between 0 (95% uncertainty interval 0–0) and 0·603 (0·400–1·00) standard drinks per day, and the NDE varied between 0·002 (0–0) and 1·75 (0·698–4·30) standard drinks per day. Among individuals aged 40 years and older, the burden-weighted relative risk curve was J-shaped for all regions, with a 2020 TMREL that ranged from 0·114 (0–0·403) to 1·87 (0·500–3·30) standard drinks per day and an NDE that ranged between 0·193 (0–0·900) and 6·94 (3·40–8·30) standard drinks per day. Among individuals consuming harmful amounts of alcohol in 2020, 59·1% (54·3–65·4) were aged 15–39 years and 76·9% (73·0–81·3) were male. Interpretation There is strong evidence to support recommendations on alcohol consumption varying by age and location. Stronger interventions, particularly those tailored towards younger individuals, are needed to reduce the substantial global health loss attributable to alcohol. Funding Bill & Melinda Gates Foundation

Striking a balance between the visibility of landmarks and the demand for development: the case of Sri Jayawardanepura parliament surroundings

Landmarks’ which is one of the five elements those contribute to the city image, as first explained by Kevin Lynch, can be manipulated strategically to enhance the visual quality of urban environments. Landmarks are point references and their key physical characteristic is singularity which can be derived by maintaining background contrast. Urban Planners adopt various regulatory measures such as height restrictions and development control guidelines to maintain singularity of landmarks but they are mostly arbitrary and not methodologically derived. They are challenged in situations where the pressures for development is high and the real estate market conditions do not justify such controls. This paper presents a similar situation in Sri Jayawardanepura new capital city of Sri Lanka, where as a policy decision of the government, the prominence of the Parliament complex had to be preserved amidst enormous demand for developments. This paper presents a scientific methodology to handle this situation enabling physical developments to get to the optimum while maintaining the prominence of the Parliament complex. Visibility Analysis, which is an Isovist technique, based on the concept of the Imageability, was adopted to develop a methodology to propose the development types and the height controls in the vicinity of a landmark. Results indicated that such scientific approaches enable to liberate considerable extents of lands for development, which otherwise were restricted on arbitrary controls, as well as some new controls, without which the intended prominence of the landmark features wouldn’t have been preserved

Complications of cardiac implantable electronic device placement in public and private hospitals

Few safety data exist comparing clinical outcomes in Australian public and private hospitals. We hypothesised that differences could exist between public and private hospitals due to differences in acuity and patient-level co-morbidities.To report comparative complications of cardiac implantable electronic device placement in public and private hospitals.We conducted an observational cohort study of outcomes of patients aged >18 years from 2010-2015 undergoing a new permanent pacemaker (PPM), implantable cardioverter defibrillator (ICD) or cardiac resynchronisation therapy pacemaker or defibrillator (CRT-D/P) implant in NSW and Queensland public and private hospitals. The primary endpoint was major Cardiac Implantable Electronic Device (CIED) related complications occurring in-hospital or within 90 days of discharge. The independent effect of hospital sector was determined using multiple logistic regression, adjusting for covariates including age, sex, co-morbidities and procedural acuity.32,364 new CIED implants (PPM 23,845, ICD 5,361, and CRT-D/P 3,158) were included (49% in private hospitals). Overall, 8.0% of private hospital procedures and 9.6% public hospital procedures experienced at least one complication. After adjustment, the overall risk of CIED complications was similar in private and public hospitals (OR: 0.92, 95%CI: 0.84,1.00, P=0.06). In analysis of individual complications, adjusted all-cause in-hospital mortality was higher in private hospitals, (OR: 1.49, 95%CI: 1.03, 2.16, P=0.036) primarily driven by an excess mortality in acute cases. The adjusted risk of in hospital generator operation (OR: 0.53, 95%CI: 0.30, 0.94, P=0.03) and post-discharge infection (OR: 0.61, 95%CI: 0.46, 0.81,