Predictors of children's secondhand smoke exposure at home: a systematic review and narrative synthesis of the evidence

BACKGROUND: Children's exposure to secondhand smoke (SHS) has been causally linked to a number of childhood morbidities and mortalities. Over 50% of UK children whose parents are smokers are regularly exposed to SHS at home. No previous review has identified the factors associated with children's SHS exposure in the home. AIM: To identify by systematic review, the factors which are associated with children's SHS exposure in the home, determined by parent or child reports and/or biochemically validated measures including cotinine, carbon monoxide or home air particulate matter. METHODS: Electronic searches of MEDLINE, EMBASE, PsychINFO, CINAHL and Web of Knowledge to July 2014, and hand searches of reference lists from publications included in the review were conducted. FINDINGS: Forty one studies were included in the review. Parental smoking, low socioeconomic status and being less educated were all frequently and consistently found to be independently associated with children's SHS exposure in the home. Children whose parents held more negative attitudes towards SHS were less likely to be exposed. Associations were strongest for parental cigarette smoking status; compared to children of non-smokers, those whose mothers or both parents smoked were between two and 13 times more likely to be exposed to SHS. CONCLUSION: Multiple factors are associated with child SHS exposure in the home; the best way to reduce child SHS exposure in the home is for smoking parents to quit. If parents are unable or unwilling to stop smoking, they should instigate smoke-free homes. Interventions targeted towards the socially disadvantaged parents aiming to change attitudes to smoking in the presence of children and providing practical support to help parents smoke outside the home may be beneficial

Validation of the Beck Depression Inventory II in HIV-positive Patients

Objective: Research on depression among HIV-positive patients has been limited by the lack of a valid and reliable measure of depression. This project addresses this problem by exploring the internal consistency reliability and the concurrent and discriminant validity of the Beck Depression Inventory-II (BDI-II) using HIV-positive patients in Jamaica. Method: Patients from three HIV clinics in Jamaica (n = 191 patients; 61% female, 39% male, mean age 40.5 ± 10 years) were administered the BDI-II along with the Centre for Epidemiological Studies– Depression Scale (CES-D) and the Social Provisions Scale. Results: Overall, the BDI-II was found to have a high degree of reliability (α = 0.89). The scale also had good concurrent validity as evidenced by a high correlation with scores on the CES-D (r = 0.74) and acceptable discriminant validity as demonstrated through a moderate correlation with the Social Provisions Scale (r = -0.42). This pattern of scores suggests that the majority of the variance underlying the BDI-II assesses depression (55%) while a smaller degree of the variability (18%) measures a conceptually similar but distinct concept. Conclusion: The BDI-II is a sufficiently reliable and valid measure for assessing depression in HIVpositive patients. Key words: Depression, validation studies "Validación del Inventario de Depresión de Beck II en los Pacientes VIH-positivos" RESUMEN Objetivo: La investigación sobre la depresión entre los pacientes VIH-positivos ha estado limitada por la falta de una medida válida y confiable de la depresión. Este proyecto aborda este problema explorando la confiabilidad de la consistencia interna, así como la validez discrimínate y concurrente del Inventario de la Depresión de Beck II (BDI-II) usando pacientes VIH-positivos en Jamaica. Método: A los pacientes de tres clínicas de VIH en Jamaica (n = 191 pacientes; 61% hembras, 39% varones, edad promedio 40.5 ± 10 años) se les aplicó el BDI-II junto con la Escala de Depresión (CESD) y la Escala de Provisiones Sociales – Centro de Estudios Epidemiológicos. Resultados: En general, se halló que el BDI-II posee un alto grado de confiabilidad (α = 0.89). La escala poseía también una buena validez concurrente, como quedó evidenciado por la elevada correlación con las puntuaciones del CES-D (r =0.74), Igualmente, se constató que posee una validez discriminante aceptable como lo demuestran las correlaciones moderadas con la Escala de Provisiones Sociales (r = -0.42). Este patrón de puntuaciones sugiere que la mayor parte de la varianza que subyace en el BDI-II da la medida de la depresión (55%), en tanto que un grado menor de la variabilidad (18%) mide un concepto de naturaleza similar pero claramente definido. Conclusión: El BDI-II constituye una medida suficientemente confiable y válida para evaluar la depresión en pacientes VIH positivos. Palabras claves: depresión, estudios de validació

Patterns of Depressive Symptoms Among Patients with HIV-Infection

Objective: To identify the level of depressive symptoms among patients with HIV infection and to examine the reported patterns of depressive symptoms not confounded by the physical manifestations of HIV-infection. Method: A total of 191 patients with HIV infection (75 males (39%) and 116 females (61%), mean age 40.48 ± 10 years), from three HIV clinics were administered the Beck Depression Inventory – II as well as a demographic questionnaire as part of a larger study. Results: Moderate to severe depressive symptoms were reported by 17.3% of the HIV-infected patients with females reporting significantly higher levels of depressive symptoms than males. A principal components analysis identified three clusters of depressive symptoms: cognitive-affective, negative cognitions and somatic symptoms. The HIV-infected patients were found to display mainly cognitiveaffective symptoms of depression. Conclusion: HIV-infected patients, especially female patients, may be at an increased risk of experiencing high levels of depressive symptoms. It is recommended that HIV-infected patients be routinely screened for depression, particularly cognitive-affective symptoms of depression. Keywords: BDI-II Scores, depression, HIV, patterns of depressive symptoms "Patrones de Síntomas Depresivos entre Pacientes con Infección por VIH" RESUMEN Objetivo: Identificar el nivel de síntomas depresivos entre pacientes con infección por VIH y examinar los patrones reportados sobre los síntomas de depresión, no confundidos por las manifestaciones físicas de la infección por VIH. Método: A un total de 191 pacientes con infección por VIH (75 varones (39%) y 116 hembras (61%), con edad promedio 40.45 ± 10 años), de tres clínicas de VIH, se les aplicó el Inventario de Depresión de Beck II, así como una encuesta demográfica como parte de un estudio más grande. Resultados: Un 17.3% de los pacientes infectados por VIH, informaron síntomas depresivos de moderados a severos, reportando las hembras niveles de síntomas de depresión significativamente más altos que los varones. Un análisis de los componentes principales identificó tres grupos de síntomas depresivos: cognitivos afectivos, cogniciones negativas y síntomas somáticos. Se halló que los pacientes infectados por VIH presentaban principalmente síntomas afectivos cognitivos de depresión. Conclusión: Los pacientes infectados con VIH, especialmente las hembras, pueden hallarse en un mayor riesgo de experimentar niveles altos de síntomas depresivos. Se recomienda que los pacientes infectados con VIH sean sometidos de forma rutinaria a tamizajes de depresión, particularmente de los síntomas de depresión cognitivos afectivos. Palabras claves: Puntuaciones de BDI-I, depresión, VIH, patrones de síntomas depresivo