Bibliothek

Notizen: Aims. To test an extended version of Pomerleau's (1997) hypothesis that children with mental health problems are at higher risk of smoking in preadolescence and adolescence. Design. Information concerning mental health from 5 to 13 years, smoking at ages 11 and 15, and family disadvantage at age 7 was available for 773 children enrolled in a longitudinal study of children and adolescents. Participants. Participants were enrolled into the Dunedin Multidisciplinary Health and Development Study, which is a longitudinal investigation of the health, development and behaviour of a large group of New Zealand children born between 1 April 1972 and 31 March 1973. Measurements. Assessment of mental health problems in childhood was based upon parent and teacher reports of behavioural and emotional problems. In pre-adolescence, mental health was assessed by self, parent and teacher report. Smoking was assessed by self-report. Findings. None of the potential risk factors of gender, childhood disadvantage or childhood mental health problems predicted onset of smoking in pre-adolescence. Daily smoking at age 15 was best predicted by smoking in preadolescence, being female and experiencing childhood disadvantage. Pre-adolescent mental health was only weakly predictive of later smoking and this association appeared to be confounded with background disadvantage. Conclusions. We found little support for the extension of Pomerleau's (1997) hypothesis to childhood mental health. Our findings also run counter to recent suggestions for targeting smoking prevention at groups of children with mental health disorders.

Notizen: Background  Strong evidence exists for the efficacy of screening and brief intervention for reducing hazardous drinking. However, problems have been highlighted with respect to its implementation in health-care systems, not least of which is a reluctance of some doctors to discuss alcohol proactively with their patients.Aims  To determine the efficacy of a novel web-based screening and brief intervention (e-SBI) to reduce hazardous drinking.Design  A double-blind randomized controlled trial.Setting  A university student health service.Participants  A total of 167 students (17–26 years) were recruited in the reception area and completed a 3-minute web-based screen including the Alcohol Use Disorder Identifiation Test (AUDIT) questionnaire. Of these, 112 tested positive, and 104 (52 females) who consented to follow-up were included in the trial.Measurements  Drinking frequency, typical occasion quantity, total volume, heavy episode frequency (females 〉 80 g ethanol, males 〉 120 g ethanol), number of personal problems, an academic problems score.Intervention  Participants were randomized to 10–15 minutes of web-based assessment and personalized feedback on their drinking (intervention, n = 51) or to a leaflet-only control group (n = 53).Findings  Mean baseline AUDIT scores for control and intervention groups were  16.6  (SD = 6.0)  and  16.6  (SD = 5.7).  At  6  weeks,  participants  receiving e-SBI reported significantly lower total consumption (geometric mean ratio = 0.74; 95% confidence interval: 0.56–0.96), lower heavy episode frequency (0.63; 0.42–0.92) and fewer personal problems (0.70; 0.54–0.91). At 6 months personal problems remained lower (0.76; 0.60–0.97), although consumption did not differ significantly. At 6 months, academic problems were lower in the intervention group relative to controls (0.72; 0.51–1.02).Conclusions  e-SBI reduced hazardous drinking among university students, to an extent similar to that found for practitioner-delivered brief interventions in the general population. e-SBI offers promise as a strategy to reduce alcohol-related harm in a way that is non-intrusive, appealing to the target group, and capable of being incorporated into primary care. Research is required to replicate the findings, to determine the duration of intervention effects, and to investigate the mechanisms by which the intervention operates.

Notizen: Aims. To examine the longitudinal association between cannabis use and mental health. Design. Information concerning cannabis use and mental health from 15 to 21 years was available for a large sample of individuals as part of a longitudinal study from childhood to adulthood. Participants. Participants were enrolled in the Dunedin Multidisciplinary Health and Development Study, a research programme on the health, development and behaviour of a large group of New Zealanders born between 1 April 1972 and 31 March 1973. Measurements. Cannabis use and identification of mental disorder was based upon self-report as part of a general assessment of mental health using a standard diagnostic interview. Daily smoking and alcohol use at age 15 were assessed by self-report. Indices of family socio-economic status, family climate and parent - child interaction were formed using information gathered from parent report and behavioural observations over early childhood. Childhood behaviour problems were assessed by parent and teacher report. Attachment to parents was assessed in adolescence. Findings. Cross-sectional associations between cannabis use and mental disorder were significant at all three ages. Both outcome variables shared similar pathways of low socio-economic status and history of behaviour problems in childhood, and low parental attachment in adolescence. Mental disorder at age 15 led to a small but significantly elevated risk of cannabis use at age 18; by contrast, cannabis use at age 18 elevated the risk of mental disorder at age 21. The latter association reflected the extent to which cannabis dependence and other externalizing disorders at age 21 were predicted by earlier level of involvement with cannabis. Conclusions. The findings suggest that the primary causal direction leads from mental disorder to cannabis use among adolescents and the reverse in early adulthood. Both alcohol use and cigarette smoking had independent associations with later mental health disorder.

Notizen: Background:  Five sources of change modify trends in incidence of treated end-stage renal disease (ESRD): (i) demography; (ii) disease control, comprising prevention and treatment of progressive kidney disease; (iii) competing risks, which encompass dying from untreated uraemia or non-renal comorbidity; (iv) lead-time bias; and (v) classification bias. Thus, rising crude incidence of treated ESRD may conceal effective disease control when there has been demographic change, lessening competing risks, or the introduction of bias.Methods:  Age-specific incidences of treated ESRD in Australia were calculated from Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry data by indigenous/non-indigenous status (all causes) and by primary renal disease (non-indigenous only) for two successive decades, 1982–1991 and 1992–2001.Results:  We postulate that less competing risks explained much of the increase in treated ESRD in the elderly and Indigenous Australians. The increase in glomerulonephritic ESRD in non-indigenous Australians could be ascribed mainly to immigration from non-European countries. There was no significant change in incidence of treated ESRD in Indigenous or non-indigenous persons aged less than 25 years, in non-indigenous persons aged 25–64 years for ESRD caused by hereditary polycystic disease or hypertension, or in type 1 diabetics aged over 55 years. End-stage renal disease from analgesic nephropathy had declined. The increase in treated ESRD caused by type 2 diabetic nephropathy appeared to be multifactorial. Lead-time/length bias and less competing risks may have concealed a small favourable trend in other primary renal diseases.Conclusion:  Whether recent disease control measures have had an impact on incidence of treated ESRD is not yet certain, but seems more likely than implied by previous reports.

Notizen: Abstract Structural equation modelling was used with data from a longitudinal study of child development (N= 698) to examine relationships between early reading attainment and antisocial behaviour at ages 7 and 9 years and subsequent reading and delinquent behaviour in adolescence. While reading, analysed as a continuous variable, did not directly influence later delinquency, antisocial behaviour during the early school years was strongly predictive of delinquency at age 15 years. particularly for boys, and had a detrimental effect on reading. These findings were independent of social disadvantage, and were unchanged by adjusting reading scores for IQ. Reading disability at 9 years old, however, predicted conduct disorder at age l5 in boys.