Rates of Bile Acid Diarrhoea After Cholecystectomy: A Multicentre Audit.

INTRODUCTION: Bile acid diarrhoea (BAD) can occur due to disruption to the enterohepatic circulation, e.g. following cholecystectomy. Post-cholecystectomy diarrhoea has been reported in 2.1-57.2% of patients; however, this is not necessarily due to BAD. The aim of this study was to determine the rates of bile acid diarrhoea diagnosis after cholecystectomy and to consider investigation practices. METHODS: A retrospective analysis of electronic databases from five large centres detailing patients who underwent laparoscopic cholecystectomy between 2013 and 2017 was cross-referenced with a list of patients who underwent 75SeHCAT testing. A 7-day retention time of <15% was deemed to be positive. Patient demographics and time from surgery to investigation were collected and compared for significance (p < 0.05). RESULTS: A total of 9439 patients underwent a laparoscopic cholecystectomy between 1 January 2013 and 31 December 2017 in the five centres. In total, 202 patients (2.1%) underwent investigation for diarrhoea via 75SeHCAT, of which 64 patients (31.6%) had a 75SeHCAT test result of >15%, while 62.8% of those investigated were diagnosed with bile acid diarrhoea (BAD). In total, 133 (65.8%) patients also underwent endoscopy and 74 (36.6%) patients had a CT scan. Median time from surgery to 75SeHCAT test was 672 days (SD ± 482 days). DISCUSSION/CONCLUSION: Only a small proportion of patients, post-cholecystectomy, were investigated for diarrhoea with significant time delay to diagnosis. The true prevalence of BAD after cholecystectomy may be much higher, and clinicians need to have an increased awareness of this condition due to its amenability to treatment. 75SeHCAT is a useful tool for diagnosis of bile acid diarrhoea.

Partner Conflict and Support as Moderators of Alcohol Use on Alcohol Problems and Marital Satisfaction in Young Adult Marital Dyads.

BACKGROUND: This cross-sectional study used data from 483 young adult marital dyads to evaluate conflict-with-partner and support-from-partner as moderators of alcohol use on 2 outcomes: alcohol problems and marital satisfaction. A path analytic modeling approach was used to test stress-exacerbating and stress-buffering hypotheses, and to accommodate the interdependent nature of the dyadic data. METHODS: This cross-sectional sample was selected from an adolescent-to-young adult longitudinal study in which spouses were recruited into the study during a later young adult assessment when the sample was, on average, 32.5 years old. Individual interviews using computerized technology were conducted with participants. RESULTS: Findings for the outcome of alcohol problems indicated stress exacerbation in that higher conflict by each partner in interaction with higher alcohol use was associated with more alcohol problems for wives. Husbands' and wives' alcohol problems were lower when higher partner support buffered the association between alcohol use and alcohol problems. For the outcome of marital satisfaction, higher support-from-partner buffered the association between alcohol use and marital satisfaction. Finally, the combination of alcohol use and conflict-with-partner had more adverse implications for women's alcohol problems relative to men's alcohol problems. CONCLUSIONS: These findings highlight that interactions between interpersonal dimensions of romantic relationships and alcohol use by both partners contribute to our understanding of their associations with alcohol problems and marital satisfaction within the marital relationship. Furthermore, there was some sex specificity in that some interactions were more prominently associated with alcohol problems for wives than husbands.

Sex Differences in Peer Selection and Socialization for Alcohol Use from Adolescence to Young Adulthood and the Influence of Marital and Parental Status.

BACKGROUND: Peer selection and socialization influences for alcohol and other substance use have been a prominent area of research especially, though not exclusively, across adolescence. This study used 4-wave prospective data from 1,004 young adults to evaluate selection and socialization influences for young adults' alcohol use and friends' alcohol use from late adolescence to later young adulthood, and incorporated the time-varying predictors of marital and parental status. In addition, sex differences in peer selection and socialization processes were tested. METHODS: Participants were recruited from high schools, and assessments were based on self-reports initially collected in adolescence (at age 17.0 years) via paper-and-pencil surveys and in young adulthood at ages 23.8, 28.9, and 33.5 years via computer-based individual interviews (computer-assisted personal interview and audio computer-assisted self-interviewing). Initial sampling included a 76% participation rate, and the retention rate was 83%. Cross-lagged panel regression models were used to evaluate hypotheses about peer selection and socialization. RESULTS: Findings indicated that friend selection processes were stronger than socialization processes across adolescence to young adulthood. Adopting marital and (especially) parental roles was negatively associated with young adults' alcohol use and percentage of friends using alcohol, and the magnitude of these relationships was stronger and more consistent for females. CONCLUSIONS: These findings indicated that across the adolescence-to-young adulthood transition, peer selection processes were more influential than peer socialization. Marital and parental roles were associated with both lower young adult alcohol use and a lower percentage of friends using alcohol, with stronger role-related effects for females relative to males.

Parental Divorce and Family History of Alcohol Disorder: Associations with Young Adults' Alcohol Problems, Marijuana Use, and Interpersonal Relations.

BACKGROUND: This study used prospective data from 706 young adults to evaluate the impact of parental divorce and family history of alcoholism (FH+) on the outcomes of offspring alcohol problems, marijuana use, and interpersonal relationships with parents. METHODS: Assessments of parental divorce were based on parent reports, and young adult outcomes were collected from an offspring cohort (n = 706; X age = 33.25 years; females = 53%) via computer-based individual interviews (CAPI and ACASI). Family history of alcohol disorders for parents was based on assessments by mothers, fathers, and young adults. RESULTS: Parental divorce significantly predicted marijuana use but not alcohol problems. Maternal, but not paternal, alcoholism also significantly predicted marijuana use. Two-way interactions indicated that sex moderated several of the relationships. For example, among those with divorced parents, daughters reported higher levels of conflict with fathers than sons, and sons reported lower levels of maternal support than daughters. Paternal alcoholism was also associated with higher levels of alcohol problems among sons relative to daughters. There was also a significant 2-way interaction between divorce status and maternal alcoholism indicating that young adults who experienced both maternal alcoholism and parental divorce had the highest levels of marijuana use. CONCLUSIONS: These findings highlight the role that parental divorce and FH+ have on alcohol problems, marijuana use, and interpersonal relationships in young adulthood, and how sex may moderate some of these more nuanced relationships.

The Measurement of Adolescent Alcohol Problems via Item Response Theory and Their 15-Year Prospective Associations with Alcohol and Other Psychiatric Disorders.

BACKGROUND: A limited number of measures exist to assess alcohol problems during adolescence. Item response theory modeling was used to scale a measure of adolescent alcohol problems, including drinking and driving, and then related to alcohol and other psychiatric disorders that occurred over a 15-year period. METHODS: High school students (N = 832) completed the 13-item Alcohol Problems Index (API) at age 18 years as part of a long-term longitudinal study of predictors of alcohol use and alcohol disorders. Frequency of drinking and driving was also measured during adolescence. Lifetime psychiatric disorders, including alcohol disorders, were measured during young adulthood. Rasch modeling was used to scale the severity of alcohol problems, and the scaled total score was used to prospectively predict alcohol disorders. The area under the receiver operating characteristic (ROC) curve was also computed between the adolescent alcohol problems and alcohol and other psychiatric disorders across a 15-year period. RESULTS: The prevalence of alcohol disorders was 38.7% (for alcohol dependence, it was 27.7%). Rasch modeling indicated that the API assessed a range of severity of alcohol problems and that drinking and driving were among the less severe indicators. Age 18 API scores significantly correlated with an alcohol diagnosis (0.34), and ROC curve analysis indicated that for adolescent alcohol problem scores, the diagnostic accuracy (or area under the curve) for an alcohol diagnosis by age 33 was 0.70. CONCLUSIONS: Our findings supported the unidimensionality and reliability of the API, and statistically significant prospective prediction of young adult alcohol disorders. The measurement of alcohol problems during adolescence, in addition to drinking and driving, may be beneficial in understanding adverse consequences of drinking during adolescence as well as transitions in alcohol use and alcohol disorders across the lifespan.

Delayed-immediate breast reconstruction: An assessment of complications and outcomes in the context of anticipated post-mastectomy radiotherapy.

INTRODUCTION: The detrimental effects of post-mastectomy radiotherapy on breast reconstruction are well known. We report our experience with a delayed-immediate approach involving an initial subcutaneous implant with definitive reconstruction after adjuvant radiotherapy. METHODS: Patients were identified retrospectively from hospital, theatre and implant registry records. Details regarding demographics, cancer pathology, surgical data and oncological therapies were collected. Primary outcomes included complication rates of first-stage surgery and time to definitive reconstruction. RESULTS: A total of 115 patients underwent mastectomy and temporary subcutaneous implant (36 nipple sparing) between 2008 and 2019. Five were smokers with eleven having a body mass index > 30. The median age was 46 years (27-76 years) and tumour size 50 mm. Almost 95% underwent radiotherapy, 82% chemotherapy and 70% had axillary node clearance. Median mastectomy weight was 464 g (123-1300 g) with median temporary implant volume 375 cc (180-655 cc). Complications of first-stage surgery at three months included 5.2% implant loss (n = 6), 14.8% infection rate, 17.4% readmission rate and 10.4% returned to theatre. Reconstructive failure occurred in four cases (3.5%). A total of 76 patients completed definitive reconstruction, including 26 autologous, 21 latissimus dorsi with implant, and 28 implant-only reconstructions. The median time to reconstruction following the completion of radiotherapy was 12 months. This increased in those who had implant complications (28 vs. 15 months) or radiotherapy (16 vs. 10 months) versus those without. CONCLUSIONS: Delayed-immediate breast reconstruction using a temporary subcutaneous implant has been shown to be a safe, feasible and potentially beneficial method than simple mastectomy and delayed reconstruction with a complication rate comparable to that of immediate implant reconstruction.

A prospective study of mutual influence for substance use among young adult marital dyads.

The purpose of this 2-wave longitudinal study was to specify, test, and evaluate an actor-partner interdependence model (APIM) with young adult marital dyads to test husbands' and wives' mutual influences on each other's substance use. Prospective data were collected from young adults and their spouses at baseline and 5 years later. Data from 237 dyads were used to test spouses' interdependence on alcohol use, alcohol problems, and marijuana use with the APIMs. Marital partners had significant effects on each other's substance use, though the patterns were different contingent on the outcome referenced. Husbands' alcohol use significantly predicted wives' alcohol use and alcohol problems. Wives' alcohol use and marijuana use significantly predicted husbands' alcohol use, alcohol problems, and marijuana use. For these young adult dyads, partner influences were indicated for both spouses, but more pervasive influences were indicated from wives-to-husbands than the reverse. (PsycINFO Database Record

Adolescent precursors of young adult drinking motives.

INTRODUCTION: Numerous cross-sectional and shorter-term longitudinal studies have supported the role of drinking motives as potent proximal predictors of alcohol phenotypes (e.g., alcohol use, heavy episodic drinking). However, missing from this literature is a focus both on the stability of drinking motives across young adulthood and on adolescent precursors of drinking motives. METHODS: We investigated the adequacy of using a latent trait-state model (LTSM) to investigate three-wave data on social, enhancement, and coping motives for drinking with a community sample of young adults (N = 1004) at the mean ages of 23.8 years, 28.9 years, and 33.5 years. We further investigated adolescent (M age = 16.73 years) predictors of young adult drinking motives using data collected on the sample approximately seven years prior to the first young adult data collection. RESULTS: Findings indicated that all three drinking motives across young adulthood were modeled adequately via the LTSM, and that drinking motives manifested high stability (i.e., rank order) across individuals. Significant common (e.g., being male, alcohol-using peers, stressful life events, boredom susceptibility) and specific (e.g., depressive symptoms for coping motives; heavy episodic drinking for enhancement motives) adolescent precursors of young adult drinking motives were identified. CONCLUSIONS: Common and unique adolescent factors predicted trait-like drinking motives during young adulthood. These findings suggest the utility of intervening during the teen years to prevent or interrupt the development of cognitive motivations that encourage alcohol use for the purpose of affect regulation.

A comparison of electronic portal dosimetry verification methods for use in stereotactic radiotherapy.

Three methods of transit dosimetry using Electronic Portal Imaging Devices (EPIDs) were investigated for use in routine in-vivo dosimetry for cranial stereotactic radiosurgery and radiotherapy. The approaches examined were (a) A full Monte Carlo (MC) simulation of radiation transport through the linear accelerator and patient; (b) Calculation of the expected fluence by a treatment planning system (TPS); (c) Point doses calculated along the central axis compared to doses calculated using parameters acquired using the EPID. A dosimetric comparison of each of the three methods predicted doses at the imager plane to within ±5% and a gamma comparison for the MC and TPS based approaches showed good agreement for a range of dose and distance to agreement criteria. The MC technique was most time consuming, followed by the TPS calculation with the point dose calculation significantly quicker than the other methods.

Adolescent-to-young adulthood heavy drinking trajectories and their prospective predictors.

OBJECTIVE: The purpose of this study was to investigate longitudinal trajectories of heavy drinking for males and females from adolescence to young adulthood, across the age span of 16-25 years, and to identify prospective predictors of the trajectory groups identified. METHOD: This study used semiparametric group-based mixture modeling to derive adolescent to young adult longitudinal trajectories of heavy drinking separately for 760 participants (430 females and 330 males) who have been participating in a long-term prospective study of risk factors for the development of heavy drinking and alcohol disorders. RESULTS: Four trajectory groups were identified for males and five for females; the trajectories indicated both continuity and change in heavy drinking across time for the trajectory groups identified. Major common prospective predictors for the high and very high heavy drinking trajectory groups supported the influences of values and beliefs (e.g., religious commitment), stressful life events and substance use. Additional predictors for males included lower academic functioning and task orientation, and for females, more frequent sexual behavior and general deviance. CONCLUSIONS: In this predominantly white, middle-class sample, we identified groups of frequent, heavy drinking teens during the middle-adolescent years. Our findings suggest that the frequency of heavy drinking behavior will further increase for some teens into their young adult years. The potential adverse consequences of heavy drinking among adolescents and young adults suggests that multitargeted, gender-specific, early interventions with these high-risk teens is important.

A prospective study of stressful events, coping motives for drinking, and alcohol use among middle-aged adults.

OBJECTIVE: This prospective study investigated moderator variable models of the interrelationships among stressful events, coping motives for drinking, and current alcohol use on subsequent alcohol use across a 5-year window with middle-aged adults. METHOD: Data from women (n = 716; M(age) = 55.29 years at baseline) and men (n = 505; M(age) = 57.57 years at baseline) were used to examine theory-guided hypotheses that current levels of alcohol use would interact with stressful events and coping motives for drinking to predict higher levels of alcohol use across time. Analyses were conducted separately for men and women. RESULTS: After we controlled for several potentially important covariates (i.e., age, educational level, family income, and marital status), prospective regression analyses supported moderator effects for current alcohol use and stressful events as predictors of changes in alcohol use, and a somewhat weaker consistency of moderator effects for current alcohol use and coping motives for drinking as predictors of changes in alcohol use. For example, higher levels of baseline alcohol involvement in conjunction with higher levels of stress predicted higher levels of alcohol use and alcohol problems 5 years later. Similarly, higher levels of coping motives and higher levels of heavy episodic drinking predicted higher levels of heavy episodic drinking among women 5 years later. CONCLUSIONS: The findings were discussed from an alcohol-stress vulnerability model of affect regulation and a positive regulatory feedback loop perspective wherein conditional relationships among baseline alcohol use indicators, stressful events, and coping drinking motives predicted greater alcohol involvement, especially problematic use, across time.

A prospective study of alcohol use among middle-aged adults and marital partner influences on drinking.

OBJECTIVE: The purpose of this three-wave longitudinal study was twofold. First, prevalence data on alcohol characteristics (e.g., drinks per day, heavy episodic drinking [HED]) were provided for a community sample of middle-aged adults. Aggregate (or group) and individual levels of stability of these characteristics across a 10-year interval were a major focus. Second, an actor-partner interdependence model (APIM) was used to test husbands' and wives' mutual influences on each other's alcohol use. METHOD: Prospective data were collected from the middle-aged parents of a cohort study that originally targeted adolescents. Three measurement occasions occurred at baseline, 5 years later, and an additional 5 years later. Data from 597 men and 847 women were used to derive prevalence data on alcohol use, and 489 intact marital dyads were used to test spouses' interdependence on alcohol use and HED in the APIMs. RESULTS: The majority of men and women reported alcohol use at each measurement occasion, and the average number of drinks per day was highly similar across time, as was the percentage reporting HED. There was substantial stability at the individual level in the amount of alcohol consumed and HED between waves of measurement. Marital partners had significant but modest effects on each other's alcohol use. Wives had a somewhat greater influence on their husbands' drinking than vice versa. CONCLUSIONS: The majority of middle-aged adults consumed alcohol at a low to moderate level. However, there is heterogeneity in alcohol use patterns, and a significant minority reported at-risk levels of alcohol use and HED.

Recurrent depression, cardiovascular disease, and diabetes among middle-aged and older adult women.

BACKGROUND: The goal of this study was to investigate the concurrent and prospective relationships between a history of single and recurrent major depression disorder (MDD) and the medical conditions of cardiovascular disease (CVD) and diabetes using a community sample of middle- and older-aged women. METHODS: Data from women (n=557 at baseline; mean age=55.7 years) participating in a two-wave longitudinal study (5-year interval) were used to examine associations between single and recurrent MDD, assessed with a structured clinical interview, and three self-report indicators of CVD (heart attack or myocardial infarction, stroke, angina), major CVD risk markers (hypertension, high cholesterol), and diabetes. Analyses were conducted to evaluate hypotheses which proposed that recurrent depression would be significantly associated with the three medical outcomes, but not single episode MDD. RESULTS: After controlling for a range of important covariates (e.g., BMI, smoking, alcohol use), cross-sectional analyses indicated that recurrent MDD, but not single episode MDD, significantly predicted CVD risk and diabetes. Prospective analyses indicated that recurrent MDD, but not single episode MDD, increased the risk for CVD and diabetes. LIMITATIONS: The sample was a predominantly white, middle-class sample so generalizability of findings may be limited for minorities and men. Reliance on self-report data may have biased the findings. CONCLUSIONS: These findings suggest the benefits of measuring single versus recurrent MDD when investigating the risk of depression on chronic diseases. Findings also suggest the importance of identifying individuals suffering from recurrent MDD early in their lifespan with the goal of preventing future depressive episodes.

Intergenerational relations for drinking motives: invariant for same- and opposite-sex parent-child dyads?

OBJECTIVE: The purpose of this study was to investigate the similarity or dissimilarity of same-sex (e.g., mother-daughter) and opposite-sex (e.g., mother-son) associations for drinking motives across four pairings of parent-young adult child dyads. METHOD: Three waves of data spanning approximately 10 years in early to late young adulthood were used in conjunction with mother and father data to examine same-and cross-sex associations for drinking motives. Multiple group structural equation modeling was used to statistically model and evaluate these parent-young adult associations. RESULTS: Findings indicated strong same-sex intergenerational transmission patterns for mother-daughter dyads relative to father-daughter dyads. The strength of relationships for father-son dyads was also stronger and significantly different than those for father-daughter dyads. There were no statistically significant differences between sex-specific intergenerational patterns for mother-son and father-son dyads or for mother-daughter and mother-son dyads. Although there was some generality and some specificity in the sex-specific intergenerational transmission patterns of drinking motives, when statistically significant, the transmission pattern generalized across all three drinking motives (coping, social, and enhancement). CONCLUSIONS: Intergenerational factors contributing to alcohol phenotypes may not be limited to the modeling of alcohol use or the occurrence of alcohol disorders but may also include cognitive-motivational systems of affective regulation related to the use of alcohol. Future research would benefit by focusing on how biogenetic and socialization factors contribute to same- and opposite-sex intergenerational patterns and how to use this information to strengthen intervention programs.

Testing the specificity between social anxiety disorder and drinking motives.

This study tested the specificity of the relationship between social anxiety disorder (SAD) and coping drinking motives (versus enhancement drinking motives and social drinking motives) within the context of a range of potentially confounding variables measured during adolescence (e.g., quantity and frequency of alcohol use, coping drinking motives) and substantively important variables assessed during young adulthood (e.g., other anxiety disorders and major depressive disorder). A sample of high school sophomores and juniors (n=717) completed measures of substance use and risk factors during adolescence and were then prospectively followed-up in early- and middle-young adulthood, and psychiatric diagnoses and drinking motives (i.e., coping, enhancement, and social) were assessed each time. Findings indicated that SAD was specifically related to coping motives (measured during early-to-middle young adulthood) after controlling for the effects of a range of alcohol and mental health variables. In addition, adolescent variables predicted young adult drinking motives as did major depressive disorder and other anxiety disorders. These findings are discussed within a conceptual framework of the functional role (e.g., self-medication) that drinking motives, and especially coping drinking motives, may play in the etiology of alcohol problems and disorders. Implications for prevention and treatment interventions are discussed.

Early onset problem behaviors and alcohol, tobacco, and other substance use disorders in young adulthood.

OBJECTIVE: Ten early onset problem behaviors were used to prospectively predict alcohol, tobacco, cannabis, and cocaine disorders in young adulthood (mean age=28.6 yrs) for a U.S. community sample of 671 participants. METHOD: Data from a longitudinal study of participants who were recruited from high schools during adolescence and followed into young adulthood were used to evaluate prospective associations. The relationship between early onset problem behaviors, reported when participants were age 16 years, and psychiatric diagnoses assessed in young adulthood was tested. Structural equation models were used to evaluate both generality and specificity hypotheses regarding relationships between early onset problem behaviors and young adult disorders. RESULTS: Findings supported the specificity hypothesis in that "like" early onset problem behaviors significantly predicted "like" young adult outcomes (e.g., early cocaine use predicted cocaine disorders). Furthermore, eliminating such "like" predictors in regression equations resulted in a 36% reduction in the amount of variance accounted for by the equation. The generality hypothesis was also supported in that a larger number of early onset problem behaviors strengthened the prediction of young adult disorders beyond the "like" attribute, and a dose-response pattern indicated that additional early onset problem behaviors increased the probable occurrence of a young adult disorder. CONCLUSIONS: A comprehensive framework relating early onset problem behaviors to young adult substance disorders will require the integration of both generality and specificity hypotheses, and a developmental orientation focused on the unfolding of mediating and moderating processes. Early screening of multiple, rather than single, early onset problems is also discussed.

Predicting young adulthood smoking among adolescent smokers and nonsmokers.

OBJECTIVE: To examine predictors of smoking in young adulthood among (1) adolescent nonsmokers and (2) adolescent smokers. METHODS: Data were analyzed from a longitudinal study of adolescents to young adulthood in 1988-1998. RESULTS: Predictors of smoking in young adulthood among adolescent nonsmokers included less education, being unmarried in adulthood, lower family social support, non-smoking parents, and increased alcohol use over time. Predictors of smoking in young adulthood among adolescent smokers included lower family social support, more adolescent friends who used drugs, and slower decreases in depressive symptoms over time. CONCLUSIONS: Distinct factors predict smoking initiation versus maintenance among young adults.

Collecting longitudinal data through childhood, adolescence, and young adulthood: methodological challenges.

This article presents the proceedings of a workshop at the 2003 Research Society on Alcoholism meeting in Fort Lauderdale, Florida. The organizers and chairs were Vivian Faden and Nancy Day. The presentations were (1) Lessons Learned From the Lives Across Time Longitudinal Study, by Michael Windle and Rebecca Windle; (2) Methodological Issues in Longitudinal Surveys With Children and Adolescents, by Joel Grube; (3) The Pittsburgh ADHD Longitudinal Study: Methodological and Conceptual Challenges, by Brooke Molina, William Pelham, Elizabeth Gnagy, and Tracey Wilson; and (4) Lessons learned in Conducting Longitudinal Research on Alcohol Involvement: If Only I Had Known Before Hand! by Kristina Jackson and Kenneth Sher.