Risk and protective factors for marijuana use and problems with use in a national sample of female Ecuadorian secondary school students.

This study investigated risk and protective factors for marijuana use and problems with use in Ecuadorian girls in an attempt to inform this growing problem. Female secondary school students (N = 16,310; M = 15.02, SD = 1.73 years) who completed the 2016 national survey of drug use participated. The likelihood of lifetime marijuana use, reported by 7.3% of the sample, was predicted by older age, greater perceived access to marijuana and affiliation with tobacco- and marijuana-using peers; aspects of parental monitoring and perceived physical safety in and around school were negatively related to the probability of use. Among girls reporting any marijuana use, age, frequency of past year use, ease of access and affiliation with marijuana-using peers was positively associated with marijuana use problems. These data support the roles of both parents and communities in reducing marijuana use among Ecuadorian girls and highlight the important role of peer influence.

Impact of Noninvasive Follicular Thyroid Neoplasm With Papillary-Like Nuclear Features on Revised Bethesda System Malignancy Rates at a Single Institution.

BACKGROUND: The Bethesda System for Reporting Thyroid Cytopathology (BSRTC) standardizes thyroid cytopathology reporting in six tier diagnostic categories. In recent years, noninvasive encapsulated follicular variant of papillary thyroid carcinoma was reclassified as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). This study examines the impact of NIFTP on the BSRTC risk of malignancy (ROM). METHODS: This was a retrospective review of prospectively collected data from 565 patients who underwent fine needle aspiration and thyroidectomy at a single institution. ROM for each Bethesda category was analyzed and calculated with NIFTP classified as a malignant and nonmalignant lesion. Absolute and relative differences between ROM were compared. RESULTS: Of 565 patients, 19 were Bethesda I, 159 were Bethesda II, 178 were Bethesda III, 46 were Bethesda IV, 42 were Bethesda V, and 121 were Bethesda VI. ROM differences with NIFTP classified as malignant versus nonmalignant for each class were as follows: Bethesda I, no change; Bethesda II, 18%-14%; Bethesda III, 55%-48%; Bethesda IV, 50%-35%; Bethesda V, 93%-91%; and Bethesda VI, 99%-98%. Absolute ROM differences for each category were as follows: Bethesda I, 0%; Bethesda II, 4%; Bethesda III, 7%; Bethesda IV, 15%; Bethesda V, 2%; and Bethesda VI, 1%. CONCLUSIONS: A decreasing trend in absolute and relative ROM was seen in Bethesda II, III, and IV categories; however, exclusion of NIFTP as a malignant lesion did not significantly alter the ROM of BSRTC categories. Surgeons should assess their respective institution's experiences with NIFTP and the BSRTC.

Home Safety Fall and Accident Risk Among Prematurely Aging, Formerly Homeless Adults.

OBJECTIVE: Homelessness prematurely ages people. A large subgroup of formerly homeless adults between ages 40 and 64 yr have health conditions similar to or worse than people categorized as elderly. Little is known about the impact of this group's chronic health conditions on their ability to safely function in supportive housing. METHOD: Home safety visits were carried out with 25 formerly homeless adults, ages 40-64 yr, now residing in supportive housing. RESULTS: Participants had physical, cognitive, and mental health problems that significantly interfered with their ability to perform daily life skills, safely function in an apartment, and manage chronic health conditions. Home safety hazards included cluttered walking paths, the presence of steps, and the lack of grab bars and nonskid flooring. CONCLUSION: The homeless population would benefit from aging specialists, such as occupational therapists, who could help people to maintain and function more safely in their homes. Without such services, this population may be at risk for home safety events leading to hospitalization and mortality.

Risk and protective factors for heroin use in a nationally representative sample of Ecuadorian youth.

INTRODUCTION: Recent reports from a variety of sources indicate that heroin use among Ecuadorian adolescents is on the rise. In order to design effective prevention and intervention programs, research is needed that quantifies use and assesses risk and protective factors associated with use. METHODS: This study analyzed the National Survey of Drug Use, a nationally representative survey of 50,145 adolescents (49.6% female; M age = 14.92 years, SD = 1.74) conducted in Ecuador in 2015. RESULTS: Overall, 2.3% of the sample reported lifetime heroin use. Logistic regression analysis revealed that higher lifetime heroin use was associated with lifetime use of alcohol (Adj OR = .71 CI[.58, .86]), marijuana (Adj OR = 3.79 CI[3.17, 4.52]), and hard drugs (Adj OR = 16.33 CI[13.89, 19.21]), as well as with greater perceived access to heroin (Adj OR = 2.13 CI[1.93, 2.36]) and repeating more school grades (Adj OR = 1.66 CI[1.37, 2.01]). Higher levels of parental involvement (Adj OR = .95 CI[.91, .99]) were associated with a reduced risk of use. Risk and protective factors operated similarly across age and gender. CONCLUSION: These data suggest that targeting substance use early in adolescence, focusing on school engagement, enhancing parenting skills, and improving family climate may be important approaches to curbing heroin use among Ecuadorian teens. The relative absence of age and gender differences in patterns of risk and protection suggest that a universal prevention approach versus a targeted approach may be most effective.