A Multifaceted Intervention to Improve the Quality of Care of Children in District Hospitals in Kenya: A Cost-Effectiveness Analysis

A cost-effective analysis conducted by Edwine Barasa and colleagues estimates that a complex intervention aimed at improving quality of pediatric care would be affordable and cost-effective in Kenya

The Adelaide polka /

In bound volumes: Copyright Deposits 1820-186

The relationship between depression and chronotype: A longitudinal assessment during childhood and adolescence

Background/Objective During adolescence, chronotype shifts towards “eveningness.” “Eveningness” is related to negative physical and mental health outcomes. Little is known about what influences the shift in chronotype beyond pubertal status. The current study examined the influence of earlier depression predicting later individual differences in adolescent chronotype, accounting for pubertal status, and the prospective prediction of later increases in depression from earlier chronotype. Methods Youth (age M=12.06, SD=2.35; 56.5% girls) from the community completed repeated assessments of depression, including both self-reports (14 assessments) and diagnostic interviews (8 assessments), over a 48-month period. At the 36-month time-point, participants completed chronotype and pubertal development measures. Regression and ANOVA analyses examined: (1) the influence of earlier depression levels (baseline to 36-months) upon chronotype, and (2) chronotype (at 36 months) upon later depression (48 months). Results Youth with higher earlier depression symptoms (β=-.347, p<.001) and history of depression diagnosis (β=-.13, p=.045) showed a greater eveningness preference controlling for pubertal status, age and gender. Further, depression diagnosis history interacted with pubertal status to predict chronotype: (F(1,243)=4.171, p=.045) such that the influence of depression on chronotype was greatest among postpubertal youth (t=3.271, p=.002). Chronotype (greater eveningness preference) predicted prospective increases in depression symptoms (β=-.16, p=.03) and onset of depressive episode (b=-.085, OR=.92, p=.03) one year later. Conclusion Depression, experienced earlier in life, predicts greater preference for eveningness, especially among postpubertal youth. In turn, later depression is predicted by evening preference. These findings suggest the reciprocal interplay between mood and biological rhythms, especially depression and chronotype, during adolescence

Massachusetts quick step /

In bound volumes: Copyright Deposits 1820-186

The Adelaide polka /

In bound volumes: Copyright Deposits 1820-186