An observational study of adolescent health outcomes associated with school-based health service utilization: A causal analysis.

OBJECTIVE: Our aim is to examine the unbiased association between use of school-based health services (SBHS) and student health outcomes. DATA SOURCES: Data are from a nationally representative health and well-being survey of 8500 New Zealand high school students from 91 high schools. STUDY DESIGN: Student data were linked to the level of SBHS available to them: no SBHS, regular clinics from visiting health professionals, a health professional onsite, or a health team onsite. DATA COLLECTION/EXTRACTION METHODS: Causal analyses are used to compare utilization of SBHS and their association with student-reported health outcomes, including foregone health care, depressive symptoms, emotional and behavioral difficulties, suicide risk, substance use, and unsafe sexual behaviors. PRINCIPAL FINDINGS: Results from the multinomial propensity score-weighted regressions show that the use of SBHS was associated with poorer health outcomes, suggesting that selection bias was present due to unmeasured confounders. Instrumental variable analyses found that that students using team-based SBHS had a 4.7 percent (95% CI 0.5-8.9) probability of high levels of depressive symptoms compared to 14.2 percent (95% CI 11.5-16.8) among students not using team SBHS. For suicide attempt, students using team-based SBHS had a 2.0 percent (95% CI -0.3-4.2) probability of a suicide attempt in the previous 12 months compared to 5.6 percent (95% CI 2.6-8.5) among students not using team SBHS. CONCLUSIONS: These analyses suggest that team-based SBHS are associated with better mental health among students who attend them.

Characteristics of school-based health services associated with students' mental health.

Objective School-based health services (SBHS) have been shown to improve access to mental health services but the evidence of their effectiveness on students' mental health is lacking. Our objective was to examine associations between variation in the provision of SBHS and students' mental health. Methods A cross-sectional analysis of a nationally representative health and well-being survey of 8500 New Zealand high school students conducted in March-November 2012. Students' mental health is related to data on school health services obtained from clinic leaders and clinicians from 90 participating high schools. Results After adjustment for socio-demographic differences in students between schools, increasing levels of services were associated with progressively lower levels of student-reported depressive symptoms (p = 0.002), emotional and behavioural difficulties (p = 0.004) and suicidality (p = 0.008). Services with greater levels of nursing hours (p = 0.02) and those that performed routine, comprehensive psychosocial assessments (p = 0.01) were both associated with lower levels of student-reported depressive symptoms. Greater levels of nursing hours and doctor hours were associated with lower self-reported suicidality among students. Conclusions Although a causal association between school-based health services and students' mental health cannot be demonstrated, these findings support the benefit of such services and the need for a cluster randomized trial.

Quantification and clinical application of carboplatin in plasma ultrafiltrate.

Carboplatin is a chemotherapy drug used in a variety of cancers with the primary toxicity being exposure-dependant myelosuppression. We present the development and validation of a simple, robust inductively coupled plasma mass spectrometry (ICP-MS) method to measure carboplatin in plasma ultrafiltrate. Plasma ultrafiltrates samples were prepared using Amicon Ultra 30,000da cut-off filters and then diluted with ammonia EDTA before ICP-MS analysis. The assay was validated in the range 0.19-47.5mg/L carboplatin in ultrafiltrate. The assay was linear (r2>0.9999), accurate (<6% bias, 12% bias at LLOQ) and precise (intra- and inter-day precision of <3% coefficient of variation). No matrix effects were observed between plasma ultrafiltrate and aqueous platinum calibrators and recovery was complete. The assay was applied to 10 clinical samples from patients receiving carboplatin. Incurred sample reanalysis showed reproducible values over 3 analysis days (<6% CV). As plasma stability prior to ultrafiltration has been a major concern in previous clinical studies this was studied extensively at room temperature (22°C) over 24h. Carboplatin was found to be stable in both spiked plasma (n=3) and real patient samples (n=10) at room temperature for up to 8h before ultrafiltration. This makes routine measurement of carboplatin concentrations in clinical settings feasible.

Equation-free mechanistic ecosystem forecasting using empirical dynamic modeling.

It is well known that current equilibrium-based models fall short as predictive descriptions of natural ecosystems, and particularly of fisheries systems that exhibit nonlinear dynamics. For example, model parameters assumed to be fixed constants may actually vary in time, models may fit well to existing data but lack out-of-sample predictive skill, and key driving variables may be misidentified due to transient (mirage) correlations that are common in nonlinear systems. With these frailties, it is somewhat surprising that static equilibrium models continue to be widely used. Here, we examine empirical dynamic modeling (EDM) as an alternative to imposed model equations and that accommodates both nonequilibrium dynamics and nonlinearity. Using time series from nine stocks of sockeye salmon (Oncorhynchus nerka) from the Fraser River system in British Columbia, Canada, we perform, for the the first time to our knowledge, real-data comparison of contemporary fisheries models with equivalent EDM formulations that explicitly use spawning stock and environmental variables to forecast recruitment. We find that EDM models produce more accurate and precise forecasts, and unlike extensions of the classic Ricker spawner-recruit equation, they show significant improvements when environmental factors are included. Our analysis demonstrates the strategic utility of EDM for incorporating environmental influences into fisheries forecasts and, more generally, for providing insight into how environmental factors can operate in forecast models, thus paving the way for equation-free mechanistic forecasting to be applied in management contexts.

Family meals and the well-being of adolescents.

AIM: The current study describes the relationships between family meals and family connectedness, parental monitoring and parent-child communication and determines if frequent family meals are associated with better mental well-being and fewer risk-taking behaviours among adolescents. METHODS: Data were collected as part of Youth'07, a nationally representative survey of the health and well-being of secondary school students in New Zealand (n = 9107). RESULTS: Frequent family meals were positively associated with better indicators of family relationships (P < 0.001). Likewise, frequent family meals were significantly associated with higher well-being scores (P < 0.001), lower depression scores (P < 0.001) and fewer risk-taking behaviours (P < 0.001), even after controlling for age, sex, ethnicity, deprivation, family connectedness, parental monitoring and parental communication. CONCLUSIONS: Our findings suggest that family meals may provide a unique opportunity for building stronger families and young people. Creating environments where frequent family meals are normative, valued and feasible for families may result in benefits for young people that extend beyond good nutrition.

Family meals among New Zealand young people: relationships with eating behaviors and body mass index.

OBJECTIVE: To examine the relationship between family meals and nutrition behaviors of adolescents. DESIGN: Secondary analysis of Youth'07, a nationally representative survey. SETTING: Secondary schools in New Zealand. PARTICIPANTS: Randomly selected adolescents (aged 13-17 years, n = 9,107) completed a multimedia and anonymous survey about their health. VARIABLES MEASURED: Body mass index and eating behaviors. ANALYSIS: Multiple logistic regression equations were used to determine the associations between family meals and body size and dietary behaviors, controlling for demographic variables. RESULTS: Nearly 60% of young people shared a meal with their families 5 or more times in the previous week. Frequent family meals were associated with greater consumption of fruits and vegetables (P < .001), and breakfast (P < .001). Adolescents who frequently shared family meals were also more likely to report that what they ate in the past week was healthy than adolescents who did not (P < .001). There was no relationship between frequency of family meals and body mass index (P = .60). CONCLUSIONS AND IMPLICATIONS: Data from the current study suggest that family meals cannot be used as a single strategy for obesity prevention, but they may provide an important opportunity for young people to consume healthy food.

Do schools influence student risk-taking behaviors and emotional health symptoms?

PURPOSE: Many schools engage in health promotion, health interventions, and services aimed at improving the health and well-being outcomes for students. The purpose of this study was to examine the effects of schools on student health risk-taking behaviors and depressive symptoms. METHOD: A nationally representative sample (n = 9,056) of students from 96 secondary schools completed a health and well-being survey using Internet Tablets that included questions on school climate, health risk-taking behaviors, and mental health. Teachers (n = 2,901) and school administrators (n = 91) completed questionnaires on aspects of the school climate which included teacher well-being and burnout, the staff work environment, health and welfare services for students, and school organizational support for student health and well-being. Multilevel models were used to estimate school effects on the health risk-taking behaviors and depression symptoms among students. RESULTS: Schools where students reported a more positive school climate had fewer students with alcohol use problems, and fewer students engaging in violence and risky motor vehicle behaviors. Schools where teachers reported better health and welfare services for students had fewer students engaging in unsafe sexual health behaviors. Schools where teachers reported higher levels of well-being had fewer students reporting significant levels of depressive symptoms. CONCLUSIONS: More positive school climates and better school health and welfare services are associated with fewer health risk-taking behaviors among students. However, the overall school effects were modest, especially for cigarette use and suicidal behaviors.

Health and well-being of young people who attend secondary school in Aotearoa, New Zealand: what has changed from 2001 to 2007?

AIM: To describe the changes in the health and well-being of secondary school students from 2001 to 2007. METHODS: A total of 9107 secondary school students were randomly selected to participate in a comprehensive health and well-being survey using Internet tablets conducted in 2007. Comparisons are made with the first health and well-being survey conducted in 2001. RESULTS: Students from 2007 reported good relationships with their families, people in their schools and neighbourhoods. Compared with the 2001 survey, students surveyed in 2007 were more likely to report positive mental health, better nutritional habits and higher levels of physical activity, and were less likely to report using tobacco and marijuana than students in 2001. In addition, the proportion of students who reported significant depressive symptoms and suicidal behaviours had decreased since 2001. However, concerning proportions of students in 2007 reported: binge drinking, experience of physical and sexual abuse, and witnessing violence in their homes. CONCLUSION: While students' health and well-being have significantly improved from 2001 to 2007, there remain significant areas of concern.