Effective Prevention of Adolescent Substance Abuse – Educational versus Deterrent Approaches

Substance abuse, especially among adolescents, has long been an important issue in society. In light of the adverse impact of substance abuse, scholars, educators, and policy-makers have proposed different approaches to prevent and reduce such abuse. This paper investigates the effectiveness of the two prominent approaches—educational and deterrent—in preventing and reducing adolescent substance abuse. The educational approach (e.g., school-based prevention programming) tends to be more comprehensive and better grounded in theories than the deterrent approach (e.g., drug testing). The educational approach not only targets multiple psychosocial factors contributing to substance abuse, but it is also supported by empirical studies showing that school-based prevention programming is effective in preventing substance abuse and has long-lasting positive influences on adolescent development. Practical implications of implementing school-based prevention programming are also discussed. L'abus d'alcool ou d'autres drogues, surtout chez les adolescents, constitue depuis longtemps une préoccupation importante de la société. À la lumière de l'impact défavorable de cet abus, les chercheurs, enseignants et décideurs ont proposé différentes approches pour le prévenir et le limiter. Cet article porte sur l'efficacité de deux approches importantes, l'une pédagogique, l'autre dissuasive, visant la prévention et la réduction de l'abus d'alcool ou d'autres drogues chez les adolescents. L'approche pédagogique (par ex. les programmes de prévention en milieu scolaire) est, de façon générale, plus globale et mieux fondée sur les théories que l'approche dissuasive (par ex. dépistage des drogues). Non seulement l'approche pédagogique cible-t-elle les divers facteurs psychosociaux qui contribuent à cet abus, elle est de plus appuyée par des études empiriques indiquant que les programmes de prévention en milieu scolaire sont des outils efficaces dans la prévention de l'abus d'alcool ou d'autres drogues et qu'ils ont un impact positif à long terme sur le développement des adolescents. Nous discutons des répercussions pratiques de la mise en œuvre des programmes de prévention en milieu scolaire

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Affective Profiles in a Massive Open Online Course and Their Relationship with Engagement

The importance of affects in learning has been firmly established in face-to-face learning environments, and now researchers are examining the roles of affects in online learning environments, including massive open online courses (MOOCs). The purpose of this research was to identify profiles of common achievement affects (i.e., relief, anxiety, boredom, and guilt) over the duration of one MOOC and examine the differences in academic engagement. Results from the latent profile analysis revealed unique affective profiles, and these profiles differed significantly in cognitive, behavioral, and social engagement in the MOOC. Our findings therefore highlight the importance of understanding affective profiles in MOOCs and address potential difficulties to engage these learners with a vast diversity in backgrounds

A Cross-Cultural Validation of the Learning-Related Boredom Scale (LRBS) With Canadian and Chinese College Students

This study evaluated the psychometric properties of the Learning-Related Boredom Scale (LRBS) from the Academic Emotions Questionnaire (AEQ; Pekrun, Goetz, & Perry, 2005; Pekrun, Goetz, Titz, & Perry, 2002) in a sample of 405 university students from Canada and China. Multigroup confirmatory factor analysis was used to test the factor structure and measurement invariance of the LRBS across cultural settings, after which the relationships between the LRBS, boredom frequency in class, intrinsic motivation, and self-efficacy for self-regulated learning (SESRL) were examined. Results showed evidence of reliability and measurement invariance of the LRBS, and the relationships between the LRBS, boredom frequency, and SESRL were similar across settings. The study thus provided evidence that learning-related boredom is a valid construct across culturally diverse school settings and supported the use of the LRBS in both Canadian and Chinese student populations. © 2013 SAGE Publications.Link_to_subscribed_fulltex

A motivation perspective on achievement appraisals, emotions, and performance in an online learning environment

Control-value theory (CVT) posits that cognitive appraisals and emotions govern motivation and learning in achievement settings. Within this framework, we used latent profile analysis to identify multifaceted motivation profiles involving academic control and value appraisals and achievement emotions (boredom, anxiety, enjoyment). Three motivation profiles were identified that comprised co-occurring appraisals and emotions at the start of a two-semester online university course: high control-enjoyment, low control-boredom, low value-boredom. These motivation profiles related to achievement perceptions and performance on six tests over the two-semester introductory psychology course. High control-enjoyment students reported greater success and expected better grades than low control-boredom and low value-boredom students, and outperformed low control-boredom students on all tests. These findings document the nature of adaptive (vs. maladaptive) CVT-related motivation profiles that predict academic attainment in an online course

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe

Measurement of charged particle spectra in minimum-bias events from proton-proton collisions at root s =13 TeV

Pseudorapidity, transverse momentum, and multiplicity distributions are measured in the pseudorapidity range vertical bar eta vertical bar 0.5 GeV in proton-proton collisions at a center-of-mass energy of root s = 13 TeV. Measurements are presented in three different event categories. The most inclusive of the categories corresponds to an inelastic pp data set, while the other two categories are exclusive subsets of the inelastic sample that are either enhanced or depleted in single diffractive dissociation events. The measurements are compared to predictions from Monte Carlo event generators used to describe high-energy hadronic interactions in collider and cosmic-ray physics.Peer reviewe