Longitudinal associations between adult-supervised drinking during adolescence and alcohol misuse from ages 25-31 years: A comparison of Australia and the United States.

Prior studies suggest that adult supervised drinking in adolescence predicts greater adolescent alcohol misuse. Long-term follow up data examining how adult supervised drinking during adolescence relates to alcohol misuse in adulthood are lacking. Longitudinal data from the International Youth Development Study tested associations between adult supervised drinking during adolescence (ages 13-16; 2002-2004) and adult alcohol misuse (ages 25-31; 2014, 2018, 2020). Cross-nationally matched samples were compared in Washington State, USA (n = 961) and Victoria, Australia (n = 1,957; total N = 2,918, 55 % female, 83 % White), where adult-supervised adolescent alcohol use was more common. Multilevel analyses adjusted for state, sex, adolescent drinking, parent education, family management, family history of substance use problems, and parent alcohol-related norms. Adult supervised drinking in adolescence (at dinner or parties, on holidays) predicted more adult alcohol misuse (mean Alcohol Use Disorders Identification Test score; b[SE] 0.07[0.03]; p = 0.004) and higher rates of alcohol-impaired driving (Odds Ratio [OR] 1.501, p = 0.034) and riding with an alcohol-impaired driver (OR 1.669, p = 0.005), but not the use of strategies to moderate alcohol intake (e.g., counting drinks). Better family management (monitoring, clear rules) in adolescence predicted less adult alcohol misuse. Associations were similar in the two states. Reducing the frequency of adult supervised drinking and improving family management practices in adolescence may help to decrease alcohol misuse well into adulthood. Findings support the widespread implementation of substance use prevention and family management training programs.

Pancreatic metastasis of mesenchymal chondrosarcoma: a surgical case report and review of literature.

Introduction: Mesenchymal chondrosarcoma (MC) is a rapidly progressive sarcoma that predominantly impacts the bones. Making up only 3% of chondrosarcomas, about one-third of these tumours develop in extra-skeletal sites. Case presentation: The authors present a clinical case of a 42-year-old patient who was diagnosed with MC 8 years ago, now admitted to the hospital with a palpable epigastric mass. Clinical and laboratory examinations showed consistent results for MC tumours, with metastasis to the body and tail of the pancreas and invasion of the splenic vein. Surgical resection and systemic screening were performed to ensure that there were no lesions elsewhere. Regular follow-up has found no localized lesions or complications after 15 months. Clinical discussion: Metastatic extra-skeletal mesenchymal chondrosarcoma of the pancreas is exceptionally rare. To our current understanding, only 14 such cases have been documented in medical literature. The symptoms of pancreatic metastasis are diverse and the radiographic features of metastatic mesenchymal chondrosarcoma are not typically distinct. Conclusions: Although MC tumours do not frequently occur in sites other than the axial system, a tumour presenting later in a patient with a history of MC should be reviewed to confirm the diagnosis of metastatic MC. Treatment can vary between surgery, radiation therapy and systemic therapy.

Long-term Effects of the Raising Healthy Children Intervention on Family Functioning in Adulthood: A Nonrandomized Controlled Trial.

Some universal prevention programs, such as Raising Healthy Children (RHC), have shown persisting and wide-ranging benefits in adulthood, long after the intervention has ended. Recent studies suggest that benefits may continue into the next generation as well. This study examines whether the RHC intervention, delivered in childhood, may promote healthy family functioning among participants who now have families of their own. Participants were drawn from the Seattle Social Development Project (SSDP), a nonrandomized controlled trial of the RHC intervention prospectively following youths from 18 elementary schools in Seattle, Washington from 1985 to 2014. Participants who became parents were enrolled in an intergenerational study, along with their oldest biological child and an additional caregiver who shared responsibility for raising the child. Ten waves of data were collected between 2002 and 2018. The present analysis includes 298 SSDP parents, 258 caregivers who identified as a parent or partner of SSDP parent ("co-parent"), and 231 offspring. The SSDP parent sample was composed of 41.6% male, 21.1% Asian or Pacific Islander, 24.2% Black or African American, 6.4% Native American, and 48.3% white individuals. No significant intervention effects were found on adult romantic relationship quality; offspring bonding to co-parent; or co-parent past-month use of cannabis, cigarettes, or binge drinking. Findings highlight the continued need to understand how the benefits of theory-guided universal preventive interventions are sustained across the life course and how they may or may not shape family functioning for those who go on to have families and children of their own.ClinicalTrials.gov Identifier: NCT04075019.

Testing Cross-Generational Effects of the Raising Healthy Children Intervention on Young Adult Offspring of Intervention Participants.

This study tested whether effects of a preventive intervention delivered in elementary school showed benefits for the young adult offspring of intervention recipients over 20 years later. The Raising Healthy Children (RHC) intervention, trialed in 18 public schools in Seattle, Washington, from 1980-1986 (grades 1-6), sought to build strong bonds to family and school to promote school success and avoidance of substance use and illegal behavior. Four intervention groups were constituted: full, late, parent training only, and control. Participants were followed through 2014 (age 39 years). Those who became parents were enrolled in an intergenerational study along with their oldest offspring (10 assessments between 2002 and 2018). This study includes young adult offspring (ages 18-25 years; n = 169; 52% female; 4% Asian, 25% Black, 40% multiracial, 4% Native American, 2% Native Hawaiian/Pacific Islander, 25% White, and 14% Hispanic/Latinx) of participants in the original RHC trial. Offspring outcome measures included high school noncompletion, financial functioning, alcohol misuse, cannabis misuse, cigarette use, criminal behavior, internalizing behavior, social skills, and social bonding. A global test across all young adult outcome measures showed that offspring of parents who received the full RHC intervention reported better overall functioning compared to offspring of control group parents. Analyses of individual outcomes showed that offspring of full intervention group parents reported better financial functioning than offspring of control group parents. Findings show the potential of universal preventive interventions to provide long-term benefits that reach into the next generation. ClinicalTrials.gov Identifier: NCT04075019; retrospectively registered in 2019.

The association between cannabis use and risk of non-medical pain reliever misuse onset among young adults in a legal cannabis context.

BACKGROUND: Little is known about the prospective relationship between cannabis use and pain reliever misuse. This study examined associations of non-medical and medical cannabis use with onset of non-medical pain reliever misuse among young adults in Washington State (WA), where non-medical cannabis is legal. METHODS: Data were from a cohort-sequential study of adults 18-25 residing in WA. Four annual surveys were used from cohorts recruited in 2014, 2015, and 2016. Participants who had not reported non-medical pain reliever misuse at baseline were included in discrete time survival analyses (N = 4,236). Odds ratios (ORs) were estimated for new onset of non-medical pain reliever misuse in any given follow-up year over the course of three years according to baseline non-medical and medical cannabis use. RESULTS: When included separately in models, non-medical and medical cannabis use at baseline were associated with increased risk of non-medical pain reliever misuse adjusting for demographic characteristics as well as past year cigarette use and alcohol use (non-medical OR = 5.27; 95 % CI: 3.28, 8.48; medical OR = 2.21; 95 % CI: 1.39, 3.52). Including both forms of use in the model, associations of non-medical and medical cannabis use with non-medical pain reliever misuse onset remained (non-medical OR = 4.64; 95 % CI: 2.88, 7.49; medical OR = 1.65; 95 % CI: 1.04, 2.62). CONCLUSIONS: Despite claims that cannabis use may reduce opioid use and related harms, findings suggest that cannabis use, including medical use, may not be protective, but instead may increase risk for non-medical pain reliever misuse.

Health of Young Adults Experiencing Social Marginalization and Vulnerability: A Cross-National Longitudinal Study.

People who experience social marginalization and vulnerability have uniquely complex health needs and are at risk of poor health outcomes. Regression analyses using longitudinal data from a cross-national, population-based sample of young adults participating in the International Youth Development Study, tested associations between social marginalization and vulnerabilities and physical health, mental health, and substance use outcomes. Participants from Victoria, Australia, and Washington State in the US were surveyed at ages 25 (2014) and 29 years (2018; N = 1944; 46.7% male). A history of adverse childhood experiences (ACEs), LGBT identity, financial insecurity, and justice system involvement at age 25 predicted poor health outcomes at age 28, including lower perceived health status, risk for chronic illness, depression and anxiety symptoms, and diagnosed mental health/substance use disorders. Tests of model equivalence across states showed that a history of ACEs was more strongly related to health status and serious injury at age 28 and justice system involvement at age 25 was more strongly related to age 28 serious injury in Victoria than in Washington State. Findings strengthen the case for future population-based research identifying life-course interventions and state policies for reducing poor health and improving health equity among members of socially marginalized groups.

Associations of Cumulative and Point-in-Time Neighborhood Poverty and Walkability with Body Mass from Age 30 to 39.

Few studies examining the effects of neighborhood exposures have accounted for longitudinal residential history. This study examined associations of body mass index (BMI, kg/m2) with neighborhood-level walkability and poverty, both assessed concurrently and cumulatively in the years leading up to BMI assessment. Participants (N = 808) were from a cohort study of individuals originally recruited from public schools in Seattle, Washington, in fifth grade in 1985. Height and weight for BMI were obtained at four assessments at ages: 30 (in 2005), 33, 35, and 39. Participants also completed residential timelines listing each address where they lived from ages 28 to 39, creating a continuous record of addresses and moves. Neighborhood-level walkability and poverty were based on census block groups of each address. Generalized estimating equation models estimated associations of standardized neighborhood variables, both at point-in-time concurrently with assessment of BMI and cumulatively up to the time of BMI assessment. Mean BMI across observations was 28.8 (SD = 7.1). After adjusting for covariates, cumulative walkability was associated with lower BMI (b = - 0.28; 95% CI: - 0.55, - 0.02), and cumulative neighborhood poverty was associated with higher BMI (b = 0.35; 95% CI: 0.09, 0.60). When examining point-in-time concurrent walkability and poverty with BMI, adjusted associations were close to the null and non-significant. This study provides evidence for a significant role of cumulative exposure to neighborhood built and socioeconomic environments predicting BMI. It underscores the relative strength and importance of cumulative assessments to capture neighborhood exposure not captured through point-in-time assessments.

Trends and Disparities in the Use of Telehealth Among Injured Workers During the COVID-19 Pandemic.

OBJECTIVE: To describe telehealth trends within a population-based workers' compensation system during the COVID-19 pandemic, and to assess telehealth utilization by sociodemographic characteristics. METHODS: This cross-sectional study used Washington State workers' compensation claims and medical billing data from January 2019 to October 2020. RESULTS: Telehealth use averaged 1.2% of medical bills pre-pandemic, peaked in April 2020 at 8.8%, and leveled off to around 3.6% from July to October 2020. Telehealth utilization differed significantly by age, sex, number of dependents, injury, industry, and receipt of interpreter services. Workers residing in counties with higher population, lower poverty rates, and greater Internet access had higher telehealth usage. CONCLUSIONS: There were dramatic shifts in telehealth; usage differed by sociodemographic characteristics. Further studies evaluating disparities in tele-health access among injured workers are needed.

Neonatal Antiepileptic Medication Treatment Patterns: A Decade of Change.

OBJECTIVE: This study aims to describe the frequency and characteristics of anticonvulsant medication treatments initiated in the neonatal period. STUDY DESIGN: We analyzed a cohort of neonates with a seizure diagnosis who were discharged from institutions in the Pediatric Health Information System between 2007 and 2016. Adjusted risk ratios and 95% confidence intervals for characteristics associated with neonatal (≤ 28 days postnatal) anticonvulsant initiation were calculated via modified Poisson regression. RESULTS: A total of 6,245 infants from 47 institutions were included. There was a decrease in both phenobarbital initiation within the neonatal period (96.9 to 91.3%, p = 0.015) and continuation at discharge (90.6 to 68.6%, p <0.001). Levetiracetam (7.9 to 39.6%, p < 0.001) initiation within the neonatal period and continuation at discharge (9.4 to 49.8%, p < 0.001) increased. Neonates born at ≥ 37 weeks' gestation and those diagnosed with intraventricular hemorrhage, ischemic/thrombotic stroke, other hemorrhagic stroke, and hypoxic ischemic encephalopathy (HIE) had a higher probability of anticonvulsant administration. The most prevalent diagnosis was HIE (n = 2,223, 44.4%). CONCLUSION: Phenobarbital remains the most widely used neonatal seizure treatment. Levetiracetam is increasingly used as a second line therapy. Increasing levetiracetam use indicates a need for additional study to determine its effectiveness in reducing seizure burden and improving long-term outcomes.

Moving Toward Physical Activity Targets by Walking to Transit: National Household Transportation Survey, 2001-2017.

INTRODUCTION: Public transportation systems can help people engage in physical activity. This study assesses sociodemographic correlates and trends in the daily time spent walking to and from transit in the U.S. from 2001 to 2017. METHODS: This cross-sectional study used data from the 2001, 2009, and 2017 National Household Transportation Survey. Data were analyzed in 2019 to assess the daily level of physical activity attained solely by walking to and from transit. Regression models were used to examine predictors of daily transit‒associated walking. RESULTS: Compared with the full National Household Transportation Survey sample, transit users who walked to and from transit tended to be younger, from households earning <$25,000 per year, in areas with rail infrastructure, and did not have a household-owned car. Transit walkers spent a median of 20 minutes per day (95% CI=18.5, 21.5) walking to and from transit in 2017, compared with a median of 19 minutes (95% CI=17.5, 20.5) in 2001. Among transit walkers, daily transit-associated physical activity was 27% higher for those residing in areas with rail infrastructure (adjusted coefficient=1.27, 95% CI=1.11, 1.46) and 34% higher for those from households earning <$25,000 per year than those earning >$99,999 per year (adjusted coefficient=1.34, 95% CI=1.15, 1.56). CONCLUSIONS: As documented in a growing literature, most public transit trips include at least some walking; thus, efforts to encourage transit use are favorable to public health. Continued monitoring by transportation surveys is important as new forms of mobility and changing demographics may impact future transit use and associated physical activity.

Early prediction of spontaneous Patent Ductus Arteriosus (PDA) closure and PDA-associated outcomes: a prospective cohort investigation.

BACKGROUND: Patent ductus arteriosus (PDA), the most commonly diagnosed cardiovascular condition in preterm infants, is associated with increased mortality and harmful long-term outcomes (chronic lung disease, neurodevelopmental delay). Although pharmacologic and/or interventional treatments to close PDA likely benefit some infants, widespread routine treatment of all preterm infants with PDA may not improve outcomes. Most PDAs close spontaneously by 44-weeks postmenstrual age; treatment is increasingly controversial, varying markedly between institutions and providers. Because treatment detriments may outweigh benefits, especially in infants destined for early, spontaneous PDA closure, the relevant unanswered clinical question is not whether to treat all preterm infants with PDA, but whom to treat (and when). Clinicians cannot currently predict in the first month which infants are at highest risk for persistent PDA, nor which combination of clinical risk factors, echocardiographic measurements, and biomarkers best predict PDA-associated harm. METHODS: Prospective cohort of untreated infants with PDA (n=450) will be used to predict spontaneous ductal closure timing. Clinical measures, serum (brain natriuretic peptide, N-terminal pro-brain natriuretic peptide) and urine (neutrophil gelatinase-associated lipocalin, heart-type fatty acid-binding protein) biomarkers, and echocardiographic variables collected during each of first 4 postnatal weeks will be analyzed to identify those associated with long-term impairment. Myocardial deformation imaging and tissue Doppler imaging, innovative echocardiographic techniques, will facilitate quantitative evaluation of myocardial performance. Aim1 will estimate probability of spontaneous PDA closure and predict timing of ductal closure using echocardiographic, biomarker, and clinical predictors. Aim2 will specify which echocardiographic predictors and biomarkers are associated with mortality and respiratory illness severity at 36-weeks postmenstrual age. Aim3 will identify which echocardiographic predictors and biomarkers are associated with 22 to 26-month neurodevelopmental delay. Models will be validated in a separate cohort of infants (n=225) enrolled subsequent to primary study cohort. DISCUSSION: The current study will make significant contributions to scientific knowledge and effective PDA management. Study results will reduce unnecessary and harmful overtreatment of infants with a high probability of early spontaneous PDA closure and facilitate development of outcomes-focused trials to examine effectiveness of PDA closure in "high-risk" infants most likely to receive benefit. TRIAL REGISTRATION: ClinicalTrials.gov NCT03782610. Registered 20 December 2018.

Nonmedical use of over-the-counter medications is significantly associated with nonmedical use of prescription drugs among university students.

OBJECTIVE: To examine the association between nonmedical use of over-the-counter medications (NMUOTC) and nonmedical use of prescription drugs (NMUPD). PARTICIPANTS: University students surveyed on NMUOTC and NMUPD between August and December 2011 (N = 939). METHODS: Cross-sectional data analysis of online survey. RESULTS: The majority of respondents were women, undergraduate, Caucasian, and not affiliated with Greek life. NMUPD and NMUOTC were reported by 21.4% and 11.2% of students, respectively. NMUOTC was significantly associated with NMUPD in unadjusted analyses and after adjustment for gender, age, race/ethnicity, and Greek membership (odds ratio: 3.37, 95% confidence interval: 2.17, 5.23). Secondary analyses showed a relationship between over-the-counter (OTC) cough medication misuse and NMUPD, OTC stimulant misuse and prescription stimulant misuse, and OTC sleep aid misuse with prescription depressant misuse. CONCLUSIONS: Results suggest the importance of both measuring the prevalence of OTC misuse and incorporating its misuse into assessments of polydrug use in the university population.

Transient effects of transfusion and feeding advances (volumetric and caloric) on necrotizing enterocolitis development: A case-crossover study.

OBJECTIVE: To evaluate the short-term effects of feed fortification, feed volume increase, and PRBC transfusion on the odds of developing NEC. STUDY DESIGN: Case-crossover study of neonatal intensive care infants born at ≤ 32 weeks' gestation who were admitted to 5 central Ohio intensive care units from January 2012-July 2016 and developed NEC Bell Stage ≥2. Each patient served as their own control, with exposure during the 48-hour period just prior to NEC onset (hazard period) being compared to a preceding 48-hour control period, thus eliminating confounding by patient factors fixed between both intervals. NEC onset was determined by chart review as the earliest occurrence of one of the following within 24 hours of confirmatory x-ray: (1) antibiotic initiation, (2) enteral feeding cessation, (3) physician first notified of abdominal concerns, or (4) abdominal x-ray ordered. Conditional logistic regression compared exposures to feed volume increase, fortification, and PRBC transfusion during the 48-hour period prior to NEC onset to those during a preceding 48-hour control period. Analyses were stratified by gestational age and anemia (defined: hemoglobin ≤ 9.3 g/dL within 7 days of NEC onset). RESULTS: We included 63 infants with confirmed NEC. Acute exposure to fortification (odds ratio [OR]: 1.67, 95% confidence interval [CI]: 0.61, 4.59), feed volume increase (OR: 0.63, 95% CI: 0.28, 1.38), and PRBC transfusion (OR: 1.80, 95% CI: 0.60, 5.37) was not associated with the onset of NEC. Gestational age and anemia did not significantly modify the associations. Sensitivity testing substituting 24- and 72-hour hazard and control periods produced similar results. CONCLUSION: Using a case-crossover design, we did not detect an association between NEC development and feed fortification, feed volume increase, or PRBC transfusion within 48-hours prior to NEC-onset. Replication in a larger set of cases is needed.