Youth Violence and Mental Health in Times of Uncertainty. Evidence from the Eastern Mediterranean Region

Itani T. Youth Violence and Mental Health in Times of Uncertainty. Evidence from the Eastern Mediterranean Region. Bielefeld: Universität Bielefeld; 2018

Gender moderates the association between polyvictimization and suicidal ideation among adolescents in the United Arab Emirates

Itani T, Fischer F, Krämer A. Gender moderates the association between polyvictimization and suicidal ideation among adolescents in the United Arab Emirates. International Journal of Adolescence and Youth. 2017;23(3):1-10.The evidence about the impact of polyvictimization on suicidal ideation among adolescents in the Eastern Mediterranean region is limited. The purpose of this study was to explore the association between polyvictimization and suicidal ideation while considering the potential moderating effect of gender on that association among Emirati adolescents. Secondary data (N = 2520) from the Global School-based Student Health Survey were analyzed. Gender was found to be a significant effect modifier of the association between polyvictimization and suicidal ideation. Based on gender-specific multivariable logistic regression models, victimized females had higher odds of reporting suicidal ideation than their male counterparts after adjusting for known confounders such as risk behavior and factors related to mental health, peer relations, and lack of parental understanding. The results of this study could guide public health officials in recognizing the magnitude of victimization on the mental health of adolescents especially in females

Varenicline Versus Nicotine Replacement Therapy for Long-Term Smoking Cessation:An Observational Study Using the Clinical Practice Research Datalink

Background Smoking is the leading avoidable cause of illness and premature mortality. The first-line treatments for smoking cessation are nicotine replacement therapy and varenicline. Meta-analyses of experimental studies have shown that participants allocated to the varenicline group were 1.57 times (95% confidence interval 1.29 to 1.91 times) as likely to be abstinent 6 months after treatment as those allocated to the nicotine replacement therapy group. However, there is limited evidence about the effectiveness of varenicline when prescribed in primary care. We investigated the effectiveness and rate of adverse events of these medicines in the general population. Objective To estimate the effect of prescribing varenicline on smoking cessation rates and health outcomes. Data sources Clinical Practice Research Datalink. Methods We conducted an observational cohort study using electronic medical records from the Clinical Practice Research Datalink. We extracted data on all patients who were prescribed varenicline or nicotine replacement therapy after 1 September 2006 who were aged ≥ 18 years. We investigated the effects of varenicline on smoking cessation, all-cause mortality and cause-specific mortality and hospitalisation for: (1) chronic lung disease, (2) lung cancer, (3) coronary heart disease, (4) pneumonia, (5) cerebrovascular disease, (6) diabetes, and (7) external causes; primary care diagnosis of myocardial infarction, chronic obstructive pulmonary disease, depression, or prescription for anxiety; weight in kg; general practitioner and hospital attendance. Our primary outcome was smoking cessation 2 years after the first prescription. We investigated the baseline differences between patients prescribed varenicline and patients prescribed nicotine replacement therapy. We report results using multivariable-adjusted, propensity score and instrumental variable regression. Finally, we developed methods to assess the relative bias of the different statistical methods we used. Results People prescribed varenicline were healthier at baseline than those prescribed nicotine replacement therapy in almost all characteristics, which highlighted the potential for residual confounding. Our instrumental variable analysis results found little evidence that patients prescribed varenicline had lower mortality 2 years after their first prescription (risk difference 0.67, 95% confidence interval –0.11 to 1.46) than those prescribed nicotine replacement therapy. They had similar rates of all-cause hospitalisation, incident primary care diagnoses of myocardial infarction and chronic obstructive pulmonary disease. People prescribed varenicline subsequently attended primary care less frequently. Patients prescribed varenicline were more likely (odds ratio 1.46, 95% confidence interval 1.42 to 1.50) to be abstinent 6 months after treatment than those prescribed nicotine replacement therapy when estimated using multivariable-adjusted for baseline covariates. Patients from more deprived areas were less likely to be prescribed varenicline. However, varenicline had similar effectiveness for these groups. Conclusion Patients prescribed varenicline in primary care were more likely to quit smoking than those prescribed nicotine replacement therapy, but there was little evidence that they had lower rates of mortality or morbidity in the 4 years following the first prescription. There was little evidence of heterogeneity in effectiveness across the population

Elevated lipoprotein(a) increases risk of subsequent major adverse cardiovascular events (MACE) and coronary revascularisation in incident ASCVD patients: a cohort study from the UK biobank

Background and aims: Elevated lipoprotein(a) [Lp(a)] is a genetic driver for atherosclerotic cardiovascular disease (ASCVD). We aimed to provide novel insights on the associated risk of elevated versus normal Lp(a) levels on major adverse cardiovascular events (MACE) in an incident ASCVD cohort. Methods: This was an observational cohort study of incident ASCVD patients. MACE counts and incidence rates (IRs) per 100-person-years were reported for patients with normal (<65 nmol/L) and elevated (>150 nmol/L) Lp(a) within the first year after incident ASCVD diagnosis and overall follow-up. Cox proportional hazard models quantified the risk of MACE associated with a 100 nmol/L increase in Lp(a). Results: The study cohort included 32,537 incident ASCVD patients; 5204 with elevated and 22,257 with normal Lp(a). Of those with elevated Lp(a), 41.2% had a subsequent MACE, versus 35.61% with normal Lp(a). Within the first year of follow-up, the IRs of composite MACE and coronary revascularisation were significantly higher (p < 0.001) in patients with elevated versus normal Lp(a) (IR difference 6.79 and 4.66). This trend was also observed in the overall follow-up (median 4.7 years). Using time to first subsequent MACE, a 100 nmol/L increase in Lp(a) was associated with an 8.0% increased risk of composite MACE, and 18.6% increased risk of coronary revascularisation during the overall follow-up period. Conclusions: The association of elevated Lp(a) with increased risk of subsequent MACE and coronary revascularisation, highlights a population who may benefit from earlier and more targeted intervention for cardiovascular risk including Lp(a), particularly within the first year after ASCVD diagnosis. Proactive Lp(a) testing as part of routine clinical practice can help to identify and better manage these higher-risk individuals

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine

[This corrects the article DOI: 10.1186/s13054-016-1208-6.]

Gender moderates the association between polyvictimization and suicidal ideation among adolescents in the United Arab Emirates

The evidence about the impact of polyvictimization on suicidal ideation among adolescents in the Eastern Mediterranean region is limited. The purpose of this study was to explore the association between polyvictimization and suicidal ideation while considering the potential moderating effect of gender on that association among Emirati adolescents. Secondary data (N = 2520) from the Global School-based Student Health Survey were analyzed. Gender was found to be a significant effect modifier of the association between polyvictimization and suicidal ideation. Based on gender-specific multivariable logistic regression models, victimized females had higher odds of reporting suicidal ideation than their male counterparts after adjusting for known confounders such as risk behavior and factors related to mental health, peer relations, and lack of parental understanding. The results of this study could guide public health officials in recognizing the magnitude of victimization on the mental health of adolescents especially in females

The lifetime prevalence of exposure to community violence among Lebanese university students: association with behavioural and mental health correlates

Itani T, Fischer F, Chu JJ. The lifetime prevalence of exposure to community violence among Lebanese university students: association with behavioural and mental health correlates. INTERNATIONAL JOURNAL OF ADOLESCENCE AND YOUTH. 2018;23(2):259-267.Studies that examine the exposure to community violence (CVE) among young adults in developing countries are limited. This study aimed at estimating the prevalence and types of CVE and its behavioural and mental health correlates among Lebanese university students. In this cross-sectional study, a total of 450 university students were sampled using proportionate sampling design. Overall, 70.3% of the sample reported witnessing violence and 49.1% violence victimization. The most common type of witnessing community violence was hearing gunfire, while the highest reported type of violence victimization was being threatened. After adjusting for potential socio-demographic confounders, alcohol binge drinking was the strongest correlate of CVE. Regarding mental health, psychological distress was significantly associated with both forms of CVE after accounting for relevant variables. The prevalence of CVE appears to be high among Lebanese young adults. Universities in Lebanon are encouraged to increase students' awareness about community violence