Temporal association between childhood depressive symptoms and alcohol problem use in early adolescence : findings from a large longitudinal population-based study

My thesis addresses the nature of the longitudinal relationship between depressive symptoms at age 10 years and alcohol problem use at age 14 years. Using data from 4220 participants in the Avon Longitudinal Study of Parents and Children (ALSPAC), a large population-based UK birth cohort, I examined the impact of relevant covariates on the relationship between these two behaviours and evidence of gender differences; testing furthermore for the moderating effects of peers' influences in this relationship. Childhood depressive symptoms were associated with increased risk of alcohol problem use in early adolescence for girls (O. R. 1.14, p-value = 0.016) but not boys. Covariates describing particularly the family and social environment influenced this association for girls. This association becomes smaller when these covariates were taken into account. Having a strong bond with alcohol-drinking peers interacted with depressive symptoms to increase risk of alcohol problem use in 14 year old girls (O. R. 1.18, p-value = 0.029). These findings provide support to a Family Interactional theoretical model and corroborate the growing evidence that family-related interventions to reduce alcohol use are particularly effective for girls. Future policy will have to consider that girls who experience high levels of depressive symptoms may be at particular risk of alcohol problem use if they affiliate with a peer group exerting strong pressure to drink.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Temporal association between childhood depressive symptoms and alcohol problem use in early adolescence: findings from a large longitudinal population-based study

My thesis addresses the nature of the longitudinal relationship between depressive symptoms at age 10 years and alcohol problem use at age 14 years. Using data from 4220 participants in the Avon Longitudinal Study of Parents and Children (ALSPAC), a large population-based UK birth cohort, I examined the impact of relevant covariates on the relationship between these two behaviours and evidence of gender differences; testing furthermore for the moderating effects of peers' influences in this relationship. Childhood depressive symptoms were associated with increased risk of alcohol problem use in early adolescence for girls (O. R. 1.14, p-value = 0.016) but not boys. Covariates describing particularly the family and social environment influenced this association for girls. This association becomes smaller when these covariates were taken into account. Having a strong bond with alcohol-drinking peers interacted with depressive symptoms to increase risk of alcohol problem use in 14 year old girls (O. R. 1.18, p-value = 0.029). These findings provide support to a Family Interactional theoretical model and corroborate the growing evidence that family-related interventions to reduce alcohol use are particularly effective for girls. Future policy will have to consider that girls who experience high levels of depressive symptoms may be at particular risk of alcohol problem use if they affiliate with a peer group exerting strong pressure to drink

Problemas metodológicos en la evaluación de un programa de rehabilitación.

El presente trabajo intenta hacer una reflexión sobre los problemas metodológicos que se encuentran en la evaluación de programas o servicios de rehabilitación psiquiátrica. Se analizan los principios de la evaluación de la calidad de los servicios brindados a los pacientes crónicos, así como las dificultades metodológicas en la búsqueda de criterios y estándares

Problemas metodológicos en la evaluación de un programa de rehabilitación.

El presente trabajo intenta hacer una reflexión sobre los problemas metodológicos que se encuentran en la evaluación de programas o servicios de rehabilitación psiquiátrica. Se analizan los principios de la evaluación de la calidad de los servicios brindados a los pacientes crónicos, así como las dificultades metodológicas en la búsqueda de criterios y estándares

Endoscopic evacuation of massive intraventricular hemorrhages reduces shunt dependency: a meta-analysis

Intraventricular hemorrhage (IVH) is characterized by severe prognosis. The amount of intraventricular blood is the most important, disease-specific, prognostic factor, as acute complications are strictly dependent on clot formation. Although external ventricular drain (EVD) placement is the standard treatment, in the past 15 years neuroendoscopic (NE) evacuation of IVH has been advocated, but available comparative data are limited. A systematic review of the literature was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included articles compare the treatment of primary and secondary IVH with NE and EVD. The meta-analysis was performed in terms of shunt dependency. Cochran's Q-test and I2 statistics were used to assess heterogeneity in the studies. No heterogeneity was considered for p greater than 0.05 and I2 less than 20%. A random-effect model was used, with restricted maximum likelihood to estimate the heterogeneity variance. After screening 744 articles, 5 were included in the meta-analysis. A total of 303 patients presenting with primary or pure (50 patients) and secondary (253 patients) IVH, undergoing either NE (151) or EVD (152), were included in the metanalysis. The risk of ventriculoperitoneal (VP) shunt was higher in the EVD group (relative risk: 1.93, 95% confidence interval: 1.28-2.92, p  = 0.0094). The risk of VP shunt was higher in the EVD group, but the overall outcome remains poor for patients with IVH, with a moderate-to-high disability. Large randomized controlled trials are needed to evaluate more deeper both advantages and effects on the outcome of NE over EVD

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05-1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4-7 days or >= 8 days of 1.25 (1.04-1.48), p = 0.015 and 1.31 (1.11-1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care