Assessing the impact of an online dementia awareness initiative co-created with and for English, Arabic and Vietnamese speaking communities: A case study.

BACKGROUND: Awareness and understanding of dementia remain limited in ethnically diverse populations in multicultural societies due to culturally inappropriate and inaccessible information. OBJECTIVE: To establish the impact, helpers and hinderers of an online multilingual dementia awareness initiative co-created with and for English, Arabic and Vietnamese speaking people. DESIGN: A case study using mixed methods to assess the impact and implementation of an information session on dementia knowledge. SETTING AND PARTICIPANTS: The study was conducted with English, Arabic and Vietnamese speaking individuals in Canterbury-Bankstown, Australia. INTERVENTION STUDIED: A dementia alliance co-created an online multilingual dementia information session, which was delivered synchronously in English, Arabic and Vietnamese by trained facilitators. MAIN OUTCOME MEASURES: In-session group discussions, quizzes and a postsession survey assessed the impact on dementia knowledge. A postimplementation focus group explored the factors that helped and hindered the initiative. RESULTS: The online dementia information session successfully supported participants understanding of dementia causes, impacts and care strategies. The initiative was hindered by competing priorities and limited accessibility to target audiences, while it was helped by the support of an established organisation and feedback mechanisms. DISCUSSION: Ongoing dementia education and awareness-raising campaigns that are culturally sensitive are needed in communities to promote dementia literacy and help-seeking. CONCLUSIONS: An online multilingual dementia information session can be an effective way to improve dementia literacy and advocate for change in multicultural communities. PATIENT OR PUBLIC CONTRIBUTION: English, Arabic and Vietnamese speaking members of the Canterbury Bankstown Dementia Alliance participated in the co-creation and evaluation of this initiative.

Flanagan's condensed protocol for neurodegenerative diseases. Implementation in a clinical autopsy setting with partial supervision of a neuropathologist.

The Condensed Protocol (CP) was originally developed for the evaluation of Alzheimer's Disease (AD) and other neurodegenerative diseases as a workable alternative to the complex and costly established autopsy guidelines. The study objective is to examine the degree of implementation of the CP in the pathology department of a third level university hospital in a period of 5 years. Clinical autopsies performed between 2016 and 2021 on patients aged 65 years or over and did not require a specific neuropathological examination were reviewed. Histological screening and staging of neurodegenerative diseases was performed using the original immunohistochemical stains. Out of 255 autopsies, 204 met the inclusion criteria and 190 could be reviewed. The CP was applied to 99 cases; histological signs of neurodegenerative disease were observed in 92. Sampling errors were detected in 59 cases. Immunohistochemical studies were performed in 68 cases. The diseases identified were: 31 cases of AD (12 low grade; 19 intermediate), 18 amyloid angiopathy, 15 primary age-related tauopathy, 6 argyrophilic grain disease, 3 progressive supranuclear palsy, 1 Lewy body disease (of 22 cases), and 2 limbic-predominant age TDP43 encephalopathy (of 5 cases). In 30 out of 83 cases, there was more severe vascular pathology in complete sections of frontal cortex and lentiform nucleus. The CP allows reliable detection and staging of AD and related neurodegenerative diseases in clinical autopsies. However, supervision by a neuropathologist seems necessary for a fully successful implementation of the CP in a clinical hospital setting.

The ghost tumour revisited. Corticosteroids in primary central nervous system lymphoma: diagnostic, prognostic and therapeutic implications.

OBJECTIVE: The cytolytic effect of corticosteroids on primary central nervous system lymphoma (PCNSL) has established the clinical dogma of avoiding steroid therapy prior to surgery for diagnostic purposes. However, since steroids are very useful during the initial management of intracranial lesions with vasogenic oedema, it was our aim to determine whether they cause a drawback in the diagnosis and prognosis of PCNSL. METHODS: A retrospective cohort study of patients diagnosed with PCNSL between 2000 and 2020 in our tertiary neurosurgical centre. Data on steroid administration, surgery type and complications, haematopathological findings and prognostic factors were compiled. A second cohort was used as a control group to compare the ratio of non-diagnostic biopsies; this series comprised patients who underwent stereotactic brain biopsy for any reason between 2019 and 2020. RESULTS: Forty patients with PCNSL were included in the study, of which 28 (70%) had received steroids before surgery. The use of steroids was more prevalent in patients with poorer performance status at diagnosis. No relevant differences were found in the diagnostic accuracy regardless of steroid exposure (93% under steroids vs 100% without steroids) or type of surgery performed. Furthermore, steroid withdrawal did not seem to augment the diagnostic ratio. The notable diagnostic delay was not influenced by the use of steroids. CONCLUSIONS: Novel imaging and surgical techniques might obviate the need to withhold corticosteroids from patients suffering from PCNSL prior to biopsy. Moreover, when steroids have been given, tapering them and delaying the surgery might not be justified. This could hold relevant therapeutic implications in the early clinical stages.

Post-mortem neuropathologic examination of a 6-case series of CAR T-cell treated patients.

Introduction: Chimeric antigen receptor (CAR) T-cell therapy is a promising immunotherapy for the treatment of refractory hematopoietic malignancies. Adverse events are common, and neurotoxicity is one of the most important. However, the physiopathology is unknown and neuropathologic information is scarce. Materials and methods: Post-mortem examination of 6 brains from patients that underwent CAR T-cell therapy from 2017 to 2022. In all cases, polymerase chain reaction (PCR) in paraffin blocks for the detection of CAR T cells was performed. Results: Two patients died of hematologic progression, while the others died of cytokine release syndrome, lung infection, encephalomyelitis, and acute liver failure. Two out of 6 presented neurological symptoms, one with extracranial malignancy progression and the other with encephalomyelitis. The neuropathology of the latter showed severe perivascular and interstitial lymphocytic infiltration, predominantly CD8+, together with a diffuse interstitial histiocytic infiltration, affecting mainly the spinal cord, midbrain, and hippocampus, and a diffuse gliosis of basal ganglia, hippocampus, and brainstem. Microbiological studies were negative for neurotropic viruses, and PCR failed to detect CAR T -cells. Another case without detectable neurological signs showed cortical and subcortical gliosis due to acute hypoxic-ischemic damage. The remaining 4 cases only showed a mild patchy gliosis and microglial activation, and CAR T cells were detected by PCR only in one of them. Conclusions: In this series of patients that died after CAR T-cell therapy, we predominantly found non-specific or minimal neuropathological changes. CAR T-cell related toxicity may not be the only cause of neurological symptoms, and the autopsy could detect additional pathological findings.

Infant iron deficiency, iron supplementation, and psychosocial stress as predictors of neurocognitive development in Chilean adolescents.

Objective: The aim of the current study was to examine the unique and joint contributions of iron deficiency, iron supplementation, and psychosocial stress in infancy and stress in adolescence to neurocognitive functioning in adolescence.Methods: The current study (N = 796; Mage = 14.4y) involved a prospective cohort of low- and middle-socioeconomic status adolescents in Santiago, Chile. As infants, they had participated in an iron supplementation trial. Infant iron status was assessed at 12-18 months, and mothers answered questions about family psychosocial stress at 6-12 months and in adolescence (maternal depressive symptoms, home support for child development, stressful life events, father absence, socioeconomic status, and parental education). Neurocognitive functioning was assessed in adolescence using the Balloon Analogue Risk Task, Stockings of Cambridge, Trail Making Test, Purdue Pegboard Test, and Wisconsin Card Sorting Test.Results: Greater psychosocial stress in infancy predicted less risk-taking, poorer planning abilities and fluid cognition, and slower processing speed in adolescence. Iron deficiency anemia in infancy predicted less risk-taking. Greater adolescent psychosocial stress predicted difficulties in set-shifting. There were no interactions between infant psychosocial stress and iron deficiency predicting adolescent neurocognitive functioning.Conclusion: These results suggest that interventions to reduce infant psychosocial stress may be more likely to prevent multiple neurocognitive deficits in adolescence than interventions to reduce infant iron deficiency.

Antioxidant status in rabbit aqueous humor after instillation of ascorbyl laurate-based nanostructures.

BACKGROUND: The aim of this work was evaluate the antioxidant effect of ascorbyl laurate (ASC12) based nanostructures applied topically to the cornea of ocular normotensive and hypertensive rabbits. The ASC12 was chosen for its capacity to form liquid lyotropic crystal and keeps its free radical trapping power. METHODS: The hypertension model was performed in six rabbits and was obtained by the application of intracameral injections of alpha-chymotrypsin in the right eye. A single 50 ml dose of ascorbyl laurate coagel 2% w/v (COA-ASC12) was applied topically to the cornea of six normotensive and six hypertensive rabbits. The aqueous humor samples were obtained before and after instillation of COA-ASC12 at different times (2 h and 4 h). Antioxidant capacity was determined via the reduction reaction with iron and tripyridyltriazine (FRAP) and the total proteins were measured using the Bradford reagent. RESULTS: The kinetic antioxidant capacity in the aqueous humor of normotensive and hypertensive rabbits showed a maxim increment at 4 h instillation. Also, the antioxidant capacity in the aqueous humor of hypertensive rabbits was ten times lower than in normotensive rabbits. CONCLUSION: This type of nanostructures has the potential to significantly improve the topical formulation for the prophylaxis and treatment of several eye diseases.

Occurrence of Deoxynivalenol and Ochratoxin A in Beers and Wines Commercialized in Paraguay.

Alcoholic beverages can be contaminated with mycotoxins. Ochratoxin A (OTA) is the most frequently detected mycotoxinin wine and is produced by several species of Aspergillus. This mycotoxin is nephrotoxic and carcinogenic. In beer, the most commonly identified mycotoxin is deoxynivalenol (DON). Ingestion of food contaminated with DON has been associated with adverse gastrointestinal effects. Despite the harmful effects of mycotoxins on health, there are no regulations regarding their limits in alcoholic beverages in Paraguay. Here we determine the presence of OTA and DON in wine and beer, respectively. Four commercial brands of wine and twenty-nine brands of craft and industrial beerwere tested by the Agra quant ELISA method. One brand of wine was positive for OTA and seven brands of beer (one of them craft) were positive for DON. The values found for both toxins are below the recommended maximum intake proposed by international standards. Giving the high consumption of these products in the country, regulations and monitoring systems mustbe established to check the maximum levels of mycotoxins allowed in alcoholic beverages.

Marijuana use associated with worse verbal learning and delayed recall in a sample of young adults.

BACKGROUND: There is concern about the cognitive consequences of marijuana consumption. AIM: To assess the influence of current and past marijuana use and frequency on verbal learning and memory in a sample of adults aged 21 years old. MATERIAL AND METHODS: Marijuana use was assessed using a clinician administered interview in 654 participants (56% females), who reported frequency of use, age of first use and whether its use led to problems in their lives. The CogState International Shopping List was administered to assess learning and memory. RESULTS: Seventy percent reported ever using marijuana, 46% consuming during the past year and 27% during the past 30 days. The latter scored significantly lower on delayed recall. Current and frequent use were significantly associated with lower accuracy in verbal learning and memory. CONCLUSIONS: In this cohort of adults aged 21 years old, marijuana use was prevalent and related to worse verbal memory.

Marijuana use associated with worse verbal learning and delayed recall in a sample of young adults / El consumo de marihuana se asocia a una menor capacidad de aprendizaje verbal y memoria tardía en adultos jóvenes

ABSTRACT Background: There is concern about the cognitive consequences of marijuana consumption. Aim: To assess the influence of current and past marijuana use and frequency on verbal learning and memory in a sample of adults aged 21 years old. Material and Methods: Marijuana use was assessed using a clinician administered interview in 654 participants (56% females), who reported frequency of use, age of first use and whether its use led to problems in their lives. The CogState International Shopping List was administered to assess learning and memory. Results: Seventy percent reported ever using marijuana, 46% consuming during the past year and 27% during the past 30 days. The latter scored significantly lower on delayed recall. Current and frequent use were significantly associated with lower accuracy in verbal learning and memory. Conclusions: In this cohort of adults aged 21 years old, marijuana use was prevalent and related to worse verbal memory.

Antecedentes: Existe preocupación acerca de los efectos cognitivos del consumo de marihuana. Objetivo: Estudiar el efecto de consumo de marihuana presente o pasado en la capacidad de aprendizaje verbal y memoria en una muestra de adultos de 21 años. Material y Métodos: El consumo de marihuana fue evaluado mediante una entrevista médica en 654 adultos de 21 años (56% mujeres), quienes informaron acerca de la frecuencia de consumo, edad de comienzo y si el consumo les ha causado problemas en sus vidas. Se les administró el Cogstate International Shopping List para evaluar aprendizaje y memoria. Resultados: El 70% informó haber consumido marihuana alguna vez, 46% la usó durante el último año y el 27% en los últimos 30 días. Estos últimos tuvieron un menor puntaje en memoria tardía. El consumo actual y frecuente se asoció a una menor precisión en la capacidad de aprendizaje verbal y memoria. Conclusiones: En esta cohorte de adultos de 21 años, el consumo de marihuana fue prevalente y relacionado a una menor memoria verbal.

Associations Among Mothers' Depression, Emotional and Learning-Material Support to Their Child, and Children's Cognitive Functioning: A 16-Year Longitudinal Study.

This study examined the associations among maternal depression, mothers' emotional and material investment in their child, and children's cognitive functioning. Middle-class Chilean mothers and children (N = 875; 52% males) were studied when children were 1, 5, 10, and 16 years (1991-2007). Results indicated that highly depressed mothers provided less emotional and material support to their child across all ages, which related to children's lower IQ. Children with lower mental abilities at age 1 received less learning-material support at age 5, which led to mothers' higher depression at child age 10. Mothers' low support was more strongly linked to maternal depression as children got older. Findings elucidate the dynamic and enduring effects of depression on mothers' parenting and children's development.

Abordagem interdisciplinar do tratamento em paciente adulto com múltiplas perdas dentárias / Interdisciplinary treatment approach in adult patient with multiple tooth loss

Este relato de caso ilustra o tratamento interdisciplinar realizado em uma paciente adulta de 43 anos de idade, Classe II esquelética, perfil convexo, maloclusão Classe I de Angle com múltiplas perdas dentárias e extrusão dos molares superiores do lado direito com redução do espaço protético para reabilitação. O tratamento ortodôntico foi realizado para preparar os espaços desdentados para reabilitação com implantes dentários e próteses. Durante o nivelamento dos arcos dentários, mini-implantes foram posicionados entre o primeiro e o segundo molar superior, no lado direito, nas corticais vestibular e palatina, respectivamente, para auxiliar na intrusão desses dentes, aumentando o espaço protético mandibular. Na fase de finalização, implantes osseointegrados foram colocados para a reabilitação dos dentes ausentes. Após três anos e quatro meses de tratamento, os objetivos foram atingidos e o aparelho ortodôntico foi removido. A mecânica com mini-implantes ortodônticos favoreceu a intrusão dos molares superiores e a reabilitação bem-sucedida do caso, devolvendo a estética, a função dentária e mantendo os resultados estáveis após um ano e cinco meses de acompanhamento (AU)

This case report illustrates an interdisciplinary treatment approach performed in an adult female patient, 43-year-old, skeletal Class II, convex profile, Angle Class I malocclusion with multiple tooth loss and maxillary molars extrusion on the right side with reduction of the prosthetic space for rehabilitation. Orthodontic treatment was conducted in order to prepare the edentulous spaces for rehabilitation with dental implants and prostheses. During leveling of dental arches, mini-implants were placed between the first and second maxillary molars on the right side, in the buccal and palatal corticals, respectively, to aid intrusion of these teeth, increasing the mandibular prosthetic space. In the finalization phase, osseointegrated implants were placed for the rehabilitation of the missing teeth. After three years and four months of treatment, the goals were achieved, and the orthodontic appliance was removed. Mechanics with orthodontic mini-implants favored maxillary molars intrusion and successful rehabilitation of the case, returning aesthetics, dental function and maintaining stable results after one year and five months of follow-up (AU)

Infant Iron Deficiency and Iron Supplementation Predict Adolescent Internalizing, Externalizing, and Social Problems.

OBJECTIVE: To evaluate associations between iron supplementation and iron deficiency in infancy and internalizing, externalizing, and social problems in adolescence. STUDY DESIGN: The study is a follow-up of infants as adolescents from working-class communities around Santiago, Chile who participated in a preventive trial of iron supplementation at 6 months of age. Inclusionary criteria included birth weight ≥3.0 kg, healthy singleton term birth, vaginal delivery, and a stable caregiver. Iron status was assessed at 12 and 18 months of age. At 11-17 years of age, internalizing, externalizing, and social problems were reported by 1018 adolescents with the Youth Self Report and by parents with the Child Behavior Checklist. RESULTS: Adolescents who received iron supplementation in infancy had greater self-reported attention-deficit/hyperactivity disorder but lower parent-reported conduct disorder symptoms than those who did not (Ps < .05). Iron deficiency with or without anemia at 12 or 18 months of age predicted greater adolescent behavior problems compared with iron sufficiency: more adolescent-reported anxiety and social problems, and parent-reported social, post-traumatic stress disorder, attention-deficit/hyperactivity disorder, oppositional defiant, conduct, aggression, and rule breaking problems (Ps < .05). The threshold was iron deficiency with or without anemia for each of these outcomes. CONCLUSIONS: Iron deficiency with or without anemia in infancy was associated with increased internalizing, externalizing, and social problems in adolescence.

Tratamento da maloclusão Classe II, subdivisão, com a utilização unilateral do aparelho funcional fixo Forsus / Treatment of Class II malocclusion, sub-division, with a unilateral use of the Forsus fixed functional appliance

A Classe II subdivisão representa, aproximadamente, 50% das más oclusões de Classe II e os fatores que contribuem para essa relação assimétrica podem ser esqueléticos ou dentários. O objetivo deste artigo é descrever um caso clínico em que o tratamento ortodôntico foi realizado com utilização unilateral de aparelho funcional fixo em um paciente adulto que apresentava maloclusão Classe II subdivisão, desvio das linhas medianas superior e inferior e perda em idade precoce do primeiro molar inferior. Foi utilizado aparelho propulsor mandibular fixo (Forsus) unilateral para auxiliar na correção da relação dentária sagital do lado esquerdo e a correção da linha mediana inferior. A recuperação de espaço no local do primeiro molar inferior esquerdo foi realizada com mola aberta de aço inoxidável para a reabilitação com implante. Na maxila foi necessária a exodontia do primeiro pré-molar superior esquerdo para a correção da relação sagital e desvio da linha mediana superior com a retração dos dentes anteriores. Ao final do tratamento, concluiu-se que a extração do primeiro pré-molar superior esquerdo e o uso do aparelho funcional fixo unilateral foi uma abordagem previsível e adequada que favoreceu a correção da relação oclusal assimétrica em um paciente adulto.(AU)

Class II subdivision represents approximately 50% of Class II malocclusion and the factors that contribute to this asymmetric relationship may be skeletal or dental. The objective of this article was to describe a clinical case in which orthodontic treatment was performed with unilateral use of fixed functional appliance in an adult patient who presented Class II subdivision malocclusion, with maxillary and mandibular midline deviation and loss at the early age of the mandibular first molar. Unilateral fixed functional appliance (Forsus) was used to aid in the correction of the sagittal dental relationship of the left side and correction of the lower midline. The space recovery of the left mandibular first molar was performed with an open stainless steel spring for implant rehabilitation. In the maxilla, it was necessary to remove the maxillary left premolar to correct the sagittal relationship and upper midline deviation with the retraction of the anterior teeth. At the end of the treatment, it was concluded that the extraction of the maxillary left premolar and the use of the unilateral fixed functional appliance was a predictable and adequate approach that favored the correction of the asymmetric occlusion relationship in an adult patient. (AU)

Early Behavioral Risks of Childhood and Adolescent Daytime Urinary Incontinence and Nocturnal Enuresis.

OBJECTIVE: To investigate whether infant temperament and childhood internalizing, externalizing, and inattention symptoms increase the likelihood of daytime urinary incontinence or nocturnal enuresis at 10 years and adolescence (11.9-17.8 years). METHOD: Data were from a longitudinal cohort of 1119 healthy Chilean children. We assessed behavioral symptoms at infancy, 5 years, and 10 years and their relationship with subsequent daytime urinary incontinence and nocturnal enuresis. RESULTS: Daytime urinary incontinence and nocturnal enuresis occurred in, respectively, 3.3% and 11.4% at 10 years and 1.1% and 2.7% at adolescence. Difficult infant temperament was associated with increased odds of 10-year daytime urinary incontinence. Inattention at 5 years was associated with increased odds for nocturnal enuresis at 10 years and adolescence. Internalizing and externalizing symptoms at 5 years were associated with increased odds of 10-year daytime urinary incontinence and nocturnal enuresis. Internalizing and externalizing symptoms at 10 years were associated with adolescent nocturnal enuresis. CONCLUSION: Temperament and internal/externalizing symptoms may be risk factors for school-age and adolescent urinary incontinence.

Diagnóstico inmunológico de la Enfermedad de Chagas a partir de muestras colectadas en papel de filtro / Immunological diagnosis of Chagas disease from samples collected on filter paper

La Enfermedad de Chagas, es producida por el parásito Trypanosoma cruzi. Los métodos de diagnóstico inmunológico son los más utilizados, pero presentan problemas de reacciones cruzadas con Leishmaniasis y Rangeliosis, por lo cual la Organización Mundial de la Salud (OMS) sugiere la ejecución de tres pruebas inmunológicas diferentes. En Venezuela la disponibilidad de las tres pruebas sólo se encuentra en centros de investigación y en laboratorios de referencia. Debido a esto, las muestras deben ser transportadas bajo estrictas condiciones de conservación y aún así pueden llegar deterioradas. El uso del papel de filtro podría ser una alternativa para la recolección y transporte de las muestras. El objetivo del presente trabajo fue comparar los resultados de las técnicas de ELISA, HAI e IFI utilizando muestras de sangre colectadas en tubo y en papel de filtro. Las muestras se procesaron mediante las técnicas de Inmunoensayo Enzimático (ELISA), Hemaglutinación Indirecta (HAI) e Inmunofluorescencia Indirecta (IFI). Para las muestras de papel se hicieron eluciones de 1/50 a diferentes tiempos para ELISA e IFI, y de 1/25 para HAI. Se obtuvo una sensibilidad de 91% y una especificad de 100% en el diagnóstico de las muestras colectadas en papel de filtro a través de las tres técnicas inmunológicas. Al compararlo con los resultados de las muestras colectadas en tubo se encontró un índice de kappa 0,91 (P<0,001), lo que indica una alta concordancia entre las dos técnicas de recolección de muestras y la confiabilidad de los resultados.

Chagas disease is produced by the parasite Trypanosoma cruzi. Immunological diagnosis methods are the most used, but they present problems of cross reactions with Leishmaniasis and Rangeliosis. For this reason, the World-Health-Organization (WHO) suggests the use of three different immunological tests. In Venezuela, the three tests are only available in research centers and laboratories of reference. Consequently, many samples must be transported under strict conditions of conservation, and despite this, they may become spoiled before arriving at the mentioned centers. The use of the filter paper could be an alternative for the collection and transportation of the samples. The aim of the present work was to compare the results of ELISA, HAI and IFI techniques using blood samples collected in tubes and in filter paper. The samples collected in tubes and filter paper were processed by ELISA, HAI and IFI techniques. For the filter paper samples elutions of 1/50 were done at various times for ELISA and IFI, and of 1/25 for HAI. Was obtained a sensibility of 91 % and specificity of 100 % in the final diagnosis of the samples collected in filter paper using the three techniques before mentioned, finding a kappa index of 0.91 (P <0.001) in both types of samples, indicating a high concordance between the two sample collection techniques and thus the reliability of the results obtained by means of three immunological techniques.

Sexual intercourse among adolescents in Santiago, Chile: a study of individual and parenting factors.

OBJECTIVE: to examine a range of individual, parenting, and family factors associated with sexual intercourse among a community sample of youth and their families in Santiago, Chile. METHODS: Data were taken from the Santiago Longitudinal Study conducted in January 2008-November 2009. Participants were 766 youth (mean age = 14.03 years, 51% male) from municipalities of low- to mid-socioeconomic status. Variables included emotional and behavioral subscales from the Child Behavior Checklist's Youth Self Report, parental monitoring, family involvement, parental control and autonomy, relationship with each parent, and sexual activity. Bivariate and multivariate logistic regression models were used to examine the odds of sexual intercourse initiation. RESULTS: seventy (9.14%) youth reported having had sex in their lifetime; the average age of first sexual intercourse among this group was 13.5 years (Standard Deviation [SD] = 1.74) for males and 14.08 (SD = 1.40) for females. Having sex was inversely associated with withdrawn-depressed symptoms (Odds Ratio [OR] = 0.84, Confidence Interval [CI] = 0.72-0.97), but positively associated with somatic complaints (OR = 1.20, CI = 1.04-1.38) and rule breaking behavior (OR = 1.21, CI = 1.08-1.36), after adjusting for demographic and other individual and parenting variables. The majority (80%) of the youth who had had sex reported using protection at the time of last intercourse. CONCLUSIONS: findings highlight the role that mental health problems-some of them not commonly associated with onset of sexual activity-may play in a youth's decision to have sex. The potential protective effects of several parenting and family characteristics disappeared with youth age and youth behavioral problems.