The relationship between pain severity and alcohol use among school-aged children and adolescents : the moderating role of drinking motives

Objective. Evidence from adult samples suggests a co-occurrence between pain and alcohol abuse. However, studies in adolescents are scarce and results are inconsistent, with some studies observing heightened and others observing reduced alcohol consumption in adolescents suffering from pain. We hypothesized that in adolescents the association between pain and alcohol use will be moderated by drinking motives. Methods. Data from a large representative sample of Flemish school children and adolescents (N = 10,650, 50.8% boys, age range = 10-21 years, M-age = 514.33 years) were collected as part of the World Health Organization collaborative Health Behaviour in School-Aged Children (HBSC) survey. Pain severity was graded based on a pediatric pain classification system that accounts for both pain intensity and disability. Alcohol consumption was operationalized using two variables: frequency of drinking and drunkenness. The Drinking Motives Questionnaire-Revised was used to capture drinking motives; it assesses four motive categories (enhancement, coping, social, and conformity). Results. Findings indicated that higher pain severity was associated with greater frequency of alcohol use and drunkenness. However, drinking motives moderated this association. The positive association between pain severity and drinking frequency was stronger in case of high conformity motives. Likewise, the association between pain severity and drunkenness frequency was stronger at high levels of conformity motives and reached significance only at high levels of coping motives. Conclusions. Our findings suggest that specific drinking motives are linked to problematic alcohol use in adolescents with pain. Future studies using a longitudinal design are needed to draw conclusions about direction of effects

Effect of anti-interleukin drugs in patients with COVID-19 and signs of cytokine release syndrome (COV-AID): a factorial, randomised, controlled trial.

BACKGROUND: Infections with SARS-CoV-2 continue to cause significant morbidity and mortality. Interleukin (IL)-1 and IL-6 blockade have been proposed as therapeutic strategies in COVID-19, but study outcomes have been conflicting. We sought to study whether blockade of the IL-6 or IL-1 pathway shortened the time to clinical improvement in patients with COVID-19, hypoxic respiratory failure, and signs of systemic cytokine release syndrome. METHODS: We did a prospective, multicentre, open-label, randomised, controlled trial, in hospitalised patients with COVID-19, hypoxia, and signs of a cytokine release syndrome across 16 hospitals in Belgium. Eligible patients had a proven diagnosis of COVID-19 with symptoms between 6 and 16 days, a ratio of the partial pressure of oxygen to the fraction of inspired oxygen (PaO(2):FiO(2)) of less than 350 mm Hg on room air or less than 280 mm Hg on supplemental oxygen, and signs of a cytokine release syndrome in their serum (either a single ferritin measurement of more than 2000 μg/L and immediately requiring high flow oxygen or mechanical ventilation, or a ferritin concentration of more than 1000 μg/L, which had been increasing over the previous 24 h, or lymphopenia below 800/mL with two of the following criteria: an increasing ferritin concentration of more than 700 μg/L, an increasing lactate dehydrogenase concentration of more than 300 international units per L, an increasing C-reactive protein concentration of more than 70 mg/L, or an increasing D-dimers concentration of more than 1000 ng/mL). The COV-AID trial has a 2 × 2 factorial design to evaluate IL-1 blockade versus no IL-1 blockade and IL-6 blockade versus no IL-6 blockade. Patients were randomly assigned by means of permuted block randomisation with varying block size and stratification by centre. In a first randomisation, patients were assigned to receive subcutaneous anakinra once daily (100 mg) for 28 days or until discharge, or to receive no IL-1 blockade (1:2). In a second randomisation step, patients were allocated to receive a single dose of siltuximab (11 mg/kg) intravenously, or a single dose of tocilizumab (8 mg/kg) intravenously, or to receive no IL-6 blockade (1:1:1). The primary outcome was the time to clinical improvement, defined as time from randomisation to an increase of at least two points on a 6-category ordinal scale or to discharge from hospital alive. The primary and supportive efficacy endpoints were assessed in the intention-to-treat population. Safety was assessed in the safety population. This study is registered online with ClinicalTrials.gov (NCT04330638) and EudraCT (2020-001500-41) and is complete. FINDINGS: Between April 4, and Dec 6, 2020, 342 patients were randomly assigned to IL-1 blockade (n=112) or no IL-1 blockade (n=230) and simultaneously randomly assigned to IL-6 blockade (n=227; 114 for tocilizumab and 113 for siltuximab) or no IL-6 blockade (n=115). Most patients were male (265 [77%] of 342), median age was 65 years (IQR 54-73), and median Systematic Organ Failure Assessment (SOFA) score at randomisation was 3 (2-4). All 342 patients were included in the primary intention-to-treat analysis. The estimated median time to clinical improvement was 12 days (95% CI 10-16) in the IL-1 blockade group versus 12 days (10-15) in the no IL-1 blockade group (hazard ratio [HR] 0·94 [95% CI 0·73-1·21]). For the IL-6 blockade group, the estimated median time to clinical improvement was 11 days (95% CI 10-16) versus 12 days (11-16) in the no IL-6 blockade group (HR 1·00 [0·78-1·29]). 55 patients died during the study, but no evidence for differences in mortality between treatment groups was found. The incidence of serious adverse events and serious infections was similar across study groups. INTERPRETATION: Drugs targeting IL-1 or IL-6 did not shorten the time to clinical improvement in this sample of patients with COVID-19, hypoxic respiratory failure, low SOFA score, and low baseline mortality risk. FUNDING: Belgian Health Care Knowledge Center and VIB Grand Challenges program

Landschapsontwerp in Vlaanderen: landschap als narratief en integrerend medium in de ruimtelijke ontwerppraktijk

Vlaanderen kent een grote diversiteit aan landschappen met een extreme overlapping tussen platteland en stad en de ermee gepaard gaande multifunctionaliteit. Deze regio vormt daarom bij uitstek een boeiend laboratorium voor onderzoek, opleiding en praktijk in landschapsontwerp. Toch is landschapsontwerp hier opvallend minder geprofessionaliseerd of verankerd dan in vele andere Europese landen. De invloed ervan op het ruimtelijk beleid is klein en ook in een internationale context lijkt het Vlaamse landschapsontwerp zich maar moeizaam te kunnen positioneren. Dit boek schetst eerst in hoofdlijnen hoe de professionalisering en institutionalisering van het landschapsontwerp zich in Vlaanderen historisch heeft verdergezet. Daarna toont het aan dat verschillende interpretaties van landschap het hedendaagse ruimtelijk ontwerp van publieke ruimten bevruchten en hoe landschap hier als een narratief medium gebruik van maakt. Het verduidelijkt dat landschap - in overeenstemming met de holistische benadering in de Europese Landschapsconventie - een kneedbaar, multidimensionaal en integrerend concept is dat door ontwerpers wordt geïnterpreteerd vanuit de eigen perceptie en in functie van specifieke instrumenten of acties. Deze bevindingen leiden tot reflecties over de identiteit en de rol van landschapsontwerp in Vlaanderen en in internationale context. Het manuscript biedt binnen de literatuur rond ruimtelijk ontwerp in Vlaanderen belangrijke en vernieuwende inzichten. Door de multidisciplinaire benadering zal het landschapsarchitecten, architecten, ruimtelijk planners en stedenbouwkundigen aanspreken, maar ook aanverwante disciplines, zoals geografen, historici of biologen. Door zijn focus op het werkveld, de ontwerppraktijk en beleidsrepercussies bevat het insteken voor zowel praktiserende ontwerpers, onderzoekers, lesgevers als beleidsmedewerkers. Bovendien is het basislectuur rond landschapsontwerp voor studenten van diverse ontwerpopleidingen, zoals landschapsarchitectuur, architectuur, stedenbouw en ruimtelijke planning