Risky Patterns Research Articles

Социальные неравенства в здоровье: посредническая роль материальных лишений и психологических ресурсов

Многочисленные исследования свидетельствуют о социальном структурировании здоровья – оно заметно ухудшается по мере снижения социально-экономического статуса: уровня образования, доходов, профессионального положения. Основные теоретические подходы к объяснению таких неравенств связаны с материалистической, психосоциальной и поведенческой интерпретациями. В настоящем обзоре представлено современное состояние исследований, посвященных проверке этих подходов. Эмпирический анализ позволил установить, что менее удовлетворительное здоровье в нижних общественных слоях связано не только с повышенными поведенческими рисками (распространенностью курения и злоупотребления алкоголем), но и в значительной мере порождается неблагоприятными материальными условиями жизни представителей этих слоев. Психосоциальные объяснения также получили убедительные подтверждения в эмпирических исследованиях, посвященных изучению медиативных эффектов, связанных со стрессовыми воздействиями и психологическими ресурсами личности. В последнее время эти выводы ставятся под сомнение в связи с тем, что при учете совместного посреднического влияния материальных, психосоциальных и поведенческих факторов выраженность отдельных медиаций оказалась менее отчетливой: психосоциальные и поведенческие эффекты проявлялись не так явно, как при раздельном анализе, уступая по силе посредничеству материальных условий. Но и это заключение требует уточнения, учитывая, что медиативные эффекты могут зависеть от общественного макроконтекста. Не исключено, что материальные и психологические посредники окажутся менее выраженными в странах с сильной экономикой и социальными гарантиями, поскольку уязвимые слои могут рассчитывать в них на защиту со стороны государства и сохранять уверенность в собственных силах, с оптимизмом глядя в будущее. В менее развитых странах, не способных обеспечивать на высоком уровне социальные гарантии, посредником структурных неравенств будут служить не только материальная депривация, но и психологические ресурсы, которые люди с низким общественным положением утрачивают из-за тягот жизни.

Associations between affect and alcohol consumption in adults: an ecological momentary assessment study

ABSTRACT Background: Consuming alcohol for coping with negative affect (NA) or enhancing positive affect (PA) may lead to risky drinking patterns. Previous research has yielded mixed findings regarding these affective drinking associations. Objectives: To examine support for the self-medication and expectancy models of alcohol use in an adult community sample, by examining reciprocal associations between alcohol consumption and NA and PA within and between persons. Methods: During seven consecutive days, 162 adults from the community (109 female) reported their affective experiences and alcohol consumption, following a signal contingent ecological momentary assessment protocol on their smartphones. Results: Within-person daily NA preceding the first drinking event was associated with increased likelihood of same-day alcohol consumption. Within-person momentary NA was associated with a decrease in the amount of next-moment alcohol consumption. Within-person momentary PA was positively associated with likelihood of next-moment alcohol consumption. Between persons, levels of daily and momentary NA and PA were not associated with any index of alcohol consumption. The intercepts and slopes of NA were not significantly different before and after alcohol consumption. The intercept of PA was higher after alcohol consumption, whereas the slope of PA decreased after alcohol consumption. Conclusion: In the current sample affective drinking was a within-person process (i.e. persons were sensitive to their varying levels of affect). Some support was found for the self-medication and expectancy models. People may drink for coping with NA, but may also be at risk for developing affective drinking patterns in response to PA.

Menopausal Symptoms and Higher Risk Opioid Prescribing in a National Sample of Women Veterans with Chronic Pain.

The greatest increases in long-term opioid use and opioid-related overdose mortality in recent years have been among women in midlife. Common menopausal symptoms broadly affect health and health care utilization in midlife, but their contribution to chronic pain management during this period is unknown. To examine relationships between menopausal symptoms and long-term opioid prescription patterns among midlife women with chronic pain. Cross-sectional analysis of national Veterans Health Administration medical and pharmacy records (2014-2015). Women Veterans aged 45-64 with ≥ 1 outpatient visit and chronic pain diagnoses spanning ≥ 90days. Long-term opioids (prescribed oral opioids for ≥ 90days), high-dose long-term opioids (> 50mg average morphine equivalent daily dose), and long-term opioids co-prescribed with central nervous system depressants (benzodiazepine and non-benzodiazepine sedative-hypnotics, gabapentin/pregabalin, muscle relaxants). Multivariable logistic regression models were used to examine associations between outcomes and menopausal symptoms (menopausal symptom-related diagnoses (i.e., "symptomatic menopausal states") on ≥ 2 encounters and/or menopausal hormone therapy, adjusting for race, age, body mass index, and mental health and substance use disorder diagnoses. In this national sample of 104,984 midlife women Veterans with chronic pain (mean age 54.5, SD 5.4years), 17% had evidence of menopausal symptoms, 51% were prescribed long-term opioids, 13% were prescribed high-dose long-term opioids, and 35% were co-prescribed long-term opioids and central nervous system depressants. In multivariable analyses, women with menopausal symptoms had increased odds of long-term opioids (OR 1.21, 95% CI 1.18-1.26), high-dose long-term opioids (OR 1.08, 95% CI 1.02-1.13), and long-term opioids co-prescribed with central nervous system depressants (sedative-hypnotics OR 1.25, 95% CI 1.22-1.30; gabapentin/pregabalin OR 1.23, 95% CI 1.20-1.27; muscle relaxants OR 1.24, 95% CI 1.20-1.28). Among midlife women Veterans with chronic pain, evidence of menopausal symptoms was associated with potentially risky long-term opioid prescription patterns, independent of known risk factors.

Benzodiazepines and Z-Drugs - Analyses of Ambulatory Prescriptions from 2006 to 2015

The majority of medication-dependent persons uses sedatives and hypnotics for many years. In this study we describe trends of benzodiazepine and z-drug prescriptions over a 10-years period. Prescriptions from 2006 to 2015 (based on German statutory health insurances) from the North German Pharmacy Computing Centre (NARZ) were analysed for the Federal states Schleswig-Holstein, Hamburg, Lower Saxony and Bremen. Data were classified as appropriate (in accordance with the guideline) or inappropriate/risky prescription patterns. In a 10-years period 1.64 Million patients received benzodiazepine and/or z-drug prescriptions. Two thirds were women (65.3 %). More than half were 60 years or older. The percentage of patients with appropriate prescriptions (less than 2 months) increased from 51.7 % in 2006 to 60.2 % in 2015. The rate of inappropriate or risky prescription patterns which can be indicative of misuse or dependence dropped from 34.8 % in 2006 to 27.1 % in 2015. Over the past years the amount of inappropriate or risky benzodiazepine and z-drug prescriptions (which are not in accordance with the guideline) among patients with statutory health insurance is steadily decreasing. However, two fifths of the patients still received prescriptions for long-term intake or in higher doses. It remains unclear to what extent private prescriptions are used for inappropriate or long-term prescriptions of benzodiazepines and z-drugs.

Family income from birth through adolescence: Implications for positive youth development

This study took a life course approach to examine associations among family income from birth to age 15, and adolescent health and well-being. Utilizing latent growth mixture modeling, we identified four distinct family income trajectories based on changes in low-income status (family income ≤200% of the federal poverty line) over 15 years, which in turn related to their outcomes in adolescence. More specifically, youth living in a consistent state of higher income from birth to age 15 (Consistent Higher Income) reported better health and behavioral outcomes than youth in the Consistent Low Income, Increasing Income, or Decreasing Income groups. Furthermore, despite tending to have relatively high-income levels at the beginning of life, the Decreasing Income group showed several risky behavioral and health patterns, including more sexual risk-taking and high blood pressure. Results underscore the importance of studying changes in family income across childhood and adolescence.

Advanced visualizations to interpret prescription drug monitoring program information

ObjectivesPrescription drug monitoring programs (PDMPs) are state-based databases that contain information about controlled substance prescriptions dispensed by pharmacies. Many states now mandate PDMP use by prescribers, despite unclear effectiveness. We hypothesize that it is possible to improve the interpretability, and hence effectiveness, of PDMPs by enhancing them. MethodsThis was a real-time simulation of an enhanced PDMP. Fifty practicing physicians (25 primary care, 25 emergency medicine) were randomized to see three cases with a standard profile or an enhanced profile that included graphical representation of prescriptions and identified risky prescribing patterns. After a two-month washout period, participants were placed in the opposite group. ResultsPhysicians presented with the enhanced profile were more likely to correctly identify patients with multiple providers (97.0% vs. 85.8%, p = 0.002), overlapping opioid and benzodiazepine prescriptions (94.7% vs. 87.5%, p = 0.03), overlapping opioid prescriptions (89.5% vs. 70.8%, p < 0.01), high daily dosages of opioids (99.2% vs. 25.0%, p = 0.02), and traveling to distant pharmacies (79.7% vs. 2.5%, p < 0.01). There was no difference in interpretation time for the three cases (standard profile 657.3 s vs. enhanced profile 686.3 s, p = 0.31). ConclusionsA simulated PDMP with graphical displays and interpretation of findings was, for this cohort of emergency physicians and primary care physicians, associated with an increased ability to determine high-risk features on PDMP profiles.

High-Risk Lower-Extremity Biomechanics Evaluated in Simulated Soccer-Specific Virtual Environments.

Laboratory-based biomechanical analyses of sport-relevant movements such as landing and cutting have classically been used to quantify kinematic and kinetic factors in the context of injury risk, which are then used to inform targeted interventions designed to improve risky movement patterns during sport. However, the noncontextual nature of standard assessments presents challenges for assessing sport-relevant skill transfer. To examine injury-risk biomechanical differences exhibited by athletes during a jump-landing task performed as part of both a standard biomechanical assessment and a simulated, sport-specific virtual reality (VR)-based assessment. Observational study. Medical center laboratory. Twenty-two female adolescent soccer athletes (age = 16.0 [1.4]y, height = 165.6 [4.9]cm, and weight = 60.2 [11.4]kg). The landing performance was analyzed for a drop vertical jump task and a VR-based, soccer-specific corner-kick scenario in which the athletes were required to jump to head a virtual soccer ball and land. Hip, knee, and ankle joint kinematic differences in the frontal and sagittal planes. Athletes exhibited reduced hip and ankle flexion, hip abduction, and frontal plane ankle excursion during landing in realistic sport scenario compared with the standard drop vertical jump task. VR-based assessments can provide a sport-specific context in which to assess biomechanical deficits that predispose athletes for lower-extremity injury and offer a promising approach to better evaluate skill transfer to sport that can guide future injury prevention efforts.

Persistence of value-modulated attentional capture is associated with risky alcohol use

BackgroundThis study examined how risky patterns of alcohol use might be related to the persistence of learned attentional capture during reversal of stimulus–reward contingencies. MethodsParticipants were 122 healthy adults (mean age 21 years, 66% female) who completed an assessment including a visual search task to measure value-modulated attentional capture, with a reversal phase following a period of initial training. The assessment also included questions about alcohol use. ResultsOverall, attentional capture was greater for distractors associated with high reward than for those associated with low reward, replicating previous findings of value-modulated attentional capture. When stimulus–reward contingencies were reversed, a higher persistence of learned attentional capture was associated with risky patterns of alcohol use. ConclusionThis result highlights how value-modulated attentional capture may persist and is associated with risky alcohol use in a non-clinical sample. Future research (potentially with clinical samples of heavy drinkers) aimed towards understanding the mechanisms that drive these reversal deficits, and their relation to other compulsive behaviours, may provide important insights into the development and maintenance of addictive behaviours.

Decomposing social inequalities in alcohol consumption in Germany 1995-2015: an age-period-cohort analysis.

Background and aimsPrevious research indicates that compared with individuals with lower socio‐economic status (SES), individuals in higher SES groups are more often drinkers but those who drink report drinking smaller amounts more frequently. We aimed to decompose trends in self‐reported alcohol consumption in Germany into age, period and birth cohort effects and examine whether these effects varied by SES.DesignAge–period–cohort (APC) analysis using data from eight waves of the cross‐sectional German Epidemiological Survey of Substance Abuse (ESA) collected between 1995 and 2015.SettingGermany.ParticipantsThe analytical sample included n = 65 821 individuals aged 18–64 years reporting alcohol use within the last 30 days.MeasurementsAlcohol measures included drinking prevalence, alcohol volume and prevalence of episodic heavy drinking (EHD). Educational attainment was used as an indicator of SES. A series of generalized linear and logistic regression models, including both main and interaction effects of age, period and cohort with SES, were estimated.FindingsRegression models revealed significant interactions between APC effects and SES on two alcohol consumption measures. Higher SES was consistently associated with drinking prevalence across age (P &lt; 0.001), period (P = 0.016) and cohort (P = 0.016), and with volume of drinking in younger cohorts (P = 0.002) and 50+‐year‐olds (P = 0.001). Model results were inconclusive as to whether or not APC effects on EHD prevalence differed by SES.ConclusionsIn Germany, there are positive associations between socio‐economic status and alcohol consumption during the life‐course, over time and among birth cohorts. Three groups appear vulnerable to risky drinking: high socio‐economic status young birth cohorts who drink high average quantities, low socio‐economic status young birth cohorts who show a risky drinking pattern and high socio‐economic status adults in their 50s and older who increase their drinking volume beyond that age.

EFFECT OF STATIC ANATOMIC ALIGNMENT ON DYNAMIC LIMB VALGUS DURING SIDE-STEP CUTTING IN UNINJURED ADOLESCENT ATHLETES

BACKGROUND Dynamic limb valgus, combining hip adduction and internal rotation with knee abduction posture and moments, has been implicated in ACL injury. However, the contribution of static lower extremity alignment to dynamic limb valgus is unknown. This study assessed the relationships among lower extremity static alignment and dynamic kinematics and kinetics during side-step cutting in uninjured adolescent athletes. METHODS This prospective study included 88 limbs from 44 uninjured athletes aged 8-15 years (mean 12.3, SD 2.3; 19 (44%) female) who were evaluated during an anticipated 45° side-step cut. 3D lower extremity kinematics and kinetics from a custom 6 degree of freedom model were assessed while standing and during the loading phase of the cut from initial contact to peak knee flexion; 2-3 trials per limb were averaged for analysis. Femoral anteversion was measured for each limb with the participant lying prone. Relationships among static and dynamic measures were investigated using correlation and multiple linear regression. RESULTS In terms of static alignment, more static hip internal rotation and more static knee external rotation (tibia external relative to femur) were associated with more internal hip rotation and external knee rotation dynamically during cutting (r=0.34, p=0.001) (Table 1). Static hip adduction was also related to more external hip rotation and less hip flexion dynamically (p=0.24, p=0.02). More static knee abduction, external hip rotation and hip adduction were associated with higher average knee abduction angles during cutting (r=0.25, p=0.02). However, only static external knee rotation was associated with higher dynamic knee abduction moments (r=0.48, p&lt;0.0001) (Figure 1). During cutting, positive associations were observed between hip flexion, knee flexion, and hip internal rotation (r=0.24, p=0.03). Knee adduction angles were related to more hip flexion, internal hip rotation, and knee external rotation (r=0.25, p=0.02). Additionally, lower peak knee flexion was associated with higher peak ground reaction force and more external knee rotation (r=0.24, p=0.02). Both simple correlation and multiple regression analysis indicated that higher knee abduction moments were related dynamically to higher knee abduction angles, greater knee external rotation, higher hip abduction angles, and greater hip internal rotation (R2=0.72, p&lt;0.001). After considering dynamic metrics, no static measure remained significantly related to knee abduction moments. CONCLUSION/SIGNIFICANCE Static knee rotation was the only anatomic alignment measure associated with knee abduction moments during side-step cutting in uninjured adolescent athletes. Knee abduction moments were influenced more by dynamic posture than static alignment. As knee abduction moments have been implicated in ACL injury, this study supports the notion of dynamic limb valgus, specifically increased knee abduction and hip internal rotation, relating to ACL injury. Motion analysis can be used to identify these risky biomechanical patterns, and neuromuscular training can be used to correct them. Since knee abduction moments are primarily determined by dynamic posture, neuromuscular training can be used to reduce these moments and ACL injury risk. [Figure: see text][Table: see text]

PREVALENCE AND CHARACTERISTICS ASSOCIATED WITH ALCOHOL USE AND ALCOHOL RELATED PROBLEMS IN COMMUNITY DWELLING OLDER ADULTS

Objective: This study examine the prevalence, characteristics and associated factors of alcohol use and alcohol related problems among Belgian community dwelling older adults. Design: Retrospective cross-sectional study by extensive examination survey. Setting: The participants were questioned in their homes or in community centres. Participants: Overall, 1,366 adults ≥65 years participated in this study. Method: Information about self-reported alcohol use during the past year, Health Related Quality of Life (HRQL) and alcohol related problems was gathered with respectively the AUDIT, SF36 and MAST-G. Results: Of the total sample, 84.4% reported alcohol consumption. Using the NIAAA guidelines, the overall prevalence for at risk drinking was 26.6% and for binge drinking 14.8%, both risky alcohol patterns. Logistic regression analyses were performed on the drinking sample to determine the predictors associated with at risk drinking, binge drinking and hazardous drinking. Being male, a smoker of former smoker and living alone were associated with at risk drinking. Being male, being aged 65-74 years, being a smoker, reporting polypharmacy, MCS and having recent loss experience were associated with binge drinking. More than 25% of respondents were classified as hazardous drinking (score ≥5 on MAST-G). Associated factors with hazardous drinking were being male, having a family history of alcohol problems, PCS and MCS. Conclusions: The prevalence rates for at risk alcohol patterns and alcohol related problems were higher than in previous studies. As older adults are more vulnerable to the adverse consequences of alcohol use, awareness about alcohol use should be raised among older adults, as well as amongst health care givers and researchers.

Evaluation of food habits and physical activity in Galician students

Introduction: obesity causes millions of deaths each year. Its high prevalence in children and adolescents from southern European countries, including Spain, is associated with the new food preferences and decreased physical activity. Objective: to evaluate diet quality and physical activity in Galician schoolchildren in order to assess if modifying the current intervention strategies in lifestyles is required. Methods: in the present study, 662 students from the south of Galicia were studied (9-17 years). Body mass index (BMI) was calculated as adiposity indicator. The dietary pattern was evaluated through the Kidmed test and physical activity with PAQ-C. The sample was stratified by BMI according to Cole international standards. Data were analysed with the SPPS software. Results: fifty-six per cent of children are at high risk of overnutrition or need to improve their nutrition. The average adherence to the Mediterranean diet was low (7.64 ± 2.28), worsening with age and adiposity significantly. The average level of physical activity was moderate (3.02 ± 0.74) and it was lower in girls and adolescents; 58% showed a low-moderate level of physical activity. Quality diet was positively correlated with physical activity and negatively with BMI. Conclusions: Galician students showed a diet and physical activity risky pattern according to international/national recommendations. After several years of awareness campaigns and lifestyle interventions, improving their diet and increasing physical activity is still necessary.

Proposal of a normative table for body fat percentages of Brazilian young adults through bioimpedanciometry.

Identification of the body fat (BF) percentage allows health professionals to detect healthy or risky patterns in a population. However, no studies have elaborated BF cutoff points using the bioelectrical impedance method in young Brazilian adults. Thus, the objective of the present study was to elaborate normative tables for BF in Brazilian men and women (sedentary and physically active) between 18 and 39 years of age. A total of 3,111 adults (958 men and 2,153 women) were evaluated using bioimpedance measurements with the InBody 520 device. The data were distributed normally and divided into percentiles (P3, P10, P25, P50, P75, P90, and P97). The following values were observed: for men: P3=8.9%–12.5%; P10=12.6%–17.5%; P25=17.6%–25.3%; P50=25.4%–35.1%; P75=35.2%–43.0%; P90=43.1%–49.4% and P97=49.5%; for women: P3=18.7%–23.1%; P10=23.2%–28.7%; P25=28.8%–35.7%; P50=35.8%–42.9%; P75=43.0%–49.1%; P90=49.2%–52.1% and P97≥52.2%. These percentiles can be used to classify the adiposity of sedentary and physically active individuals evaluated by bioimpedanciometry.

Domestic Acquisition Experience and the Internationalization of Chinese Firms: The Role of Institutional Heterogeneity

ABSTRACTThe liability of foreignness increases firm risk of doing business abroad. However, it appears not to deter Chinese firms as evidenced by their risky internationalization pattern. This study is concerned with explaining this phenomenon. Drawing on organizational learning and institutional theories, I argue that institutional heterogeneity in China gives firms an opportunity to develop routines to overcome the liability of foreignness through acquisition experience gained outside of their home provinces. Further, I propose that coastal and inland firms draw different routines from their acquisition experiences. I test these arguments on panel data of listed Chinese firms, tracing their acquisition behavior from 2006 to 2015. My analyses suggest that acquisition experience outside of home province matters and that, in the case of inland firms, coastal acquisition experience facilitates subsequent internationalization. The present study contributes to the literature on the internationalization of Chinese firms. It highlights the value of context-specific measures for Chinese management research, sheds light on the functionality of institutional heterogeneity in China, and provides evidence to re-evaluate the riskiness of Chinese firms’ internationalization pattern.

Interrelationship of Opioid Dependence, Impaired Impulse Control, and Depressive Symptoms: An Open-Label Cross-Sectional Study of Patients in Maintenance Therapy

Objective: A growing number of studies indicate increased impulsivity in patients with opioid dependence (OD). However, few studies exclude concomitant drug use and consider depression as a comorbidity, both of which can bias results. Aim: We aimed to compare impulsivity in patients with OD enrolled in maintenance therapy (ICD code F11.22) and well-matched healthy controls taking psychopathological impairments into account. Furthermore, we compared the result to risky behavioral patterns in patients. Methods: This cross-sectional study included 50 patients with OD enrolled in either methadone or buprenorphine maintenance therapy and 50 healthy controls matched for gender, age, education, marital status, and premorbid intelligence. Abstinence from benzodiazepines, amphetamines, and cocaine was verified by urine analysis. We used the Barratt Impulsiveness Scale 11 (BIS-11), Beck’s Depression Inventory (BDI), the Symptom Checklist 90 Revised (SCL-90R), and the European version of the Addiction Severity Index (EuropASI). Results: Patients exhibited significantly worse impulse control than healthy individuals. We found no correlation between impulsiveness and reported risky behavior patterns but found a significant correlation between depressive symptoms and psychopathological impairment. Conclusions: Patients with OD showed a higher impulsivity than healthy individuals. Impulsivity could be a cause or a consequence of a substance use disorder; further research is warranted to explain this relationship. Impulsivity was associated with depression, an important confounder; future research needs to take this into account.

Explorative study on risky sexual behaviour in tradeswomen in denpasar city

Previous studies examined risky behaviour that cause women’s vulnerability in the market to transmission of Sexually Transmitted Infections (STIs). It was found that the leading factor the women’s vulnerability is sexual conduct with more than one partners. However, regarding a risky sexual behaviour pattern and prevention efforts to it, a study has not been carried out so far. The objective of this study was to investigate in-depth the risky sexual behaviour and the prevention of STIs in female traders. This study was designed using qualitative methods by conducting an in-depth interview with 20 women, including trade owners, trade assistants and trade workers who took turns in conducting trade activities, who ever had sexual intercourse with people aged 18-45 years in Denpasar. Purposive sampling was applied in choosing the respondents. After the data was collected, it was analysed thematically. The risky sexual behaviour perpetrated by most respondents is premarital sexual intercourse. Some of these perpetrators also have often had sexual intercourse switching pairs without using condoms. In the prevention of STIs, the respondents claimed that they should be loyal to their partners.

E-cigarettes, alcohol use, and mental health: Use and perceptions of e-cigarettes among college students, by alcohol use and mental health status

IntroductionElectronic cigarettes (e-cigarettes) are popular among college students, who display risky alcohol use patterns. However, little is known about patterns of co-use of e-cigarettes and alcohol. Further, relationships between e-cigarette use and mental illness among college students are unclear. MethodsCollege student participants (N = 631) at a northeastern U.S. university were invited via email to participate in a survey about e-cigarettes and alcohol use. Mental health was self-reported diagnosis of psychiatric (depression, bipolar disorder, schizophrenia, PTSD, anxiety disorder, personality disorder), and substance (alcohol and other drug) use disorders. Current use of e-cigarette, combustible cigarette, and other tobacco products were assessed via self-reported past 30-day use frequency. Alcohol consumption was assessed via number of self-reported standard alcoholic beverages consumed during a typical drinking episode. Participants also reported regarding co-use of alcohol, e-cigarettes and/or combustible cigarettes. Participants were categorized as non-drinkers, moderate drinkers or binge drinkers, and associations between e-cigarette use, drinking patterns and mental health diagnoses were examined. ResultsE-cigarette use was associated with drinking alcohol χ2 = 18.62, p < .001, and binge drinking (vs. moderate drinking) χ2 = 12.20, p < .001. Students who had tried e-cigarettes reported drinking more alcohol per episode (χ2 = 15.94, p < .001). E-cigarette use was more prevalent among those with psychiatric and substance use disorders χ2 = 11.65, p < .001. ConclusionsDrinking college students (especially binge drinkers) and those with mental illness may have heightened risks for e-cigarette use. More research is needed to elucidate relationships between risky alcohol and/or nicotine use and mental illness, and to guide appropriate prevention and intervention efforts for vulnerable college students.

Changes in biomechanical knee injury risk factors across two collegiate soccer seasons using the 11+ prevention program.

The 11+ injury prevention program effectively reduces injuries in high school-aged female soccer player, but the mechanism of the 11+ is unknown, particularly whether it impacts biomechanical risk factors associated with knee injuries. The purpose of this study was to report the changes in hip and knee biomechanics with use of the 11+ over two soccer seasons. Two collegiate women's soccer teams performed the 11+ for two soccer seasons. A control team was followed for one season. Athletes performed motion analysis of a drop vertical jump during preseason and postseason. Both groups had meaningful increases in peak knee abduction angle over the first season, and there were no meaningful changes in peak knee abduction moment over either season. The control group had bilateral decreases in knee flexion angle. The program did not seem to systematically impact biomechanical risk factors associated with knee injuries, with increases in peak knee abduction angle and no bilateral changes in frontal or transverse hip motion. The 11+ may have mitigated clinically meaningful decreases in knee flexion; however, as ACL injuries do not occur purely in the sagittal plane, it is unclear the impact of these changes. The results of this study indicate that the 11+ may require some modifications to impact landing biomechanics and potentially risky movement patterns, particularly when used in collegiate women over multiple seasons.

Hypertension and its associated factors among current drinkers in Malaysia: Results from the National Health and Morbidity Survey 2015

ABSTRACTObjectives: This study was carried out to determine the proportion of hypertension and its associated factors among current drinkers in Malaysia.Methodology: The data were obtained from the National Health and Morbidity Survey 2015, a cross-sectional population survey design with two-stage stratified random sampling method which involved Malaysian adults above 18 years. Data on alcohol consumption were obtained through a validated self-administered Alcohol Use Disorder Identification Test questionnaire. A complex sampling analysis and multiple logistic regression analysis were applied.Results: A total of 1065 adults (8.4%; 95% confidence interval: 7.4–9.5) were categorized as current drinkers. Among the current drinkers, 28.4% were identified as having a risky drinking pattern and a fourth (26.6%) of them had hypertension. The multivariable model shows that hypertension risk among current drinkers was significantly higher in male (adjusted odd ratio [AOR] 2.05), with increasing age (AOR 1.06), with risky drinking pattern (AOR 1.44), in current drinkers with diabetes (AOR 2.56) and in overweight (AOR 3.54).Conclusions: The proportion of current drinker having hypertension was alarming and become deleterious, especially among men, increase of age, risky drinker and those with other non-communicable disease co-morbidities. Preventive counselling for alcohol use among them should be integrated into primary care.

Prevalence and Pattern of Using Headphones and Its Relationship with Hearing Loss among Students

Background: Noise-induced hearing loss (NIHL) is one of the most important public health problems. There is scant information about NIHL, the prevalence and using patterns of headphones and music player devices in Iran. Objectives: This study aimed to assess the prevalence and using patterns of earphones and investigate the relationship between earphone use and hearing loss in a sample of students from Qazvin University of Medical Sciences (QUMS). Methods: In this cross-sectional study, 890 students were randomly selected using a proportional cluster sampling method in April and May 2015. The students completed a self-administered questionnaire assessing the pattern of their earphone use and hearing loss. Receiver operating characteristic (ROC) curve analysis was used to determine the cut-off point for the questionnaire. Results: The results suggested that 60.2% (95% confidence interval (CI): 56.9 - 66.4) of the students reported a history of hearing loss and hearing impairment and 86.4% (95% CI: 84.0 - 88.5) of the participants reported using an earphone in the past. Most of the participants listened to music on their cell phones (81.7%) and 89.6% of them used headphones for listening to music. The results indicated that 51.3% of those who used earphones used earbud-style earphones, 42.2% used supra-aural earphones, and 6.5% used headphones. Students who used earphones, those who used earphones more frequently during the week, and those who used earphones for more years had higher hearing loss scores compared to other students. Conclusions: Students have a risky pattern of using personal listening devices. The higher hearing loss score among headphone users requires further attention in order to implement interventions to increase students’ awareness and attitude towards the use of headphones.