| 1. |
- Drake, TM, et al.
(författare)
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Surgical site infection after gastrointestinal surgery in children: an international, multicentre, prospective cohort study
- 2020
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Ingår i: BMJ global health. - : BMJ. - 2059-7908. ; 5:12
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Tidskriftsartikel (refereegranskat)abstract
- Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings.MethodsA multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI).ResultsOf 1159 children across 181 hospitals in 51 countries, 523 (45·1%) children were from high HDI, 397 (34·2%) from middle HDI and 239 (20·6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12·8% (51/397) in middle HDI and 24·7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI.ConclusionThe odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.
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| 2. |
- Maron, David J., et al.
(författare)
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Initial Invasive or Conservative Strategy for Stable Coronary Disease
- 2020
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Ingår i: New England Journal of Medicine. - 0028-4793 .- 1533-4406. ; 382:15, s. 1395-1407
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Tidskriftsartikel (refereegranskat)abstract
- Background: Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain.Methods: We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction.Results: Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, -1.8 percentage points; 95% CI, -4.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32).Conclusions: Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used. (Funded by the National Heart, Lung, and Blood Institute and others; ISCHEMIA ClinicalTrials.gov number, .) Patients with stable coronary disease were randomly assigned to an initial invasive strategy with angiography and revascularization if appropriate or to medical therapy alone. At 3.2 years, there was no significant difference between the groups with respect to the estimated rate of ischemic events. The findings were sensitive to the definition of myocardial infarction.
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| 3. |
- Camu, W., et al.
(författare)
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Repeated 5-day cycles of low dose aldesleukin in amyotrophic lateral sclerosis (IMODALS): A phase 2a randomised, double-blind, placebo-controlled trial
- 2020
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Ingår i: EBioMedicine. - : Elsevier BV. - 2352-3964. ; 59
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Tidskriftsartikel (refereegranskat)abstract
- Background: Low-dose interleukin-2 (ld-IL-2) enhances regulatory T-cell (Treg) function in auto-inflammatory conditions. Neuroinflammation being a pathogenic feature of amyotrophic lateral sclerosis (ALS), we evaluated the pharmacodynamics and safety of ld-IL-2 in ALS subjects. Methods: We performed a single centre, parallel three-arm, randomised, double-blind, placebo-controlled study. Eligibility criteria included age < 75 years, disease duration < 5 years, riluzole treatment > 3 months, and a slow vital capacity ≥ 70% of normal. Patients were randomised (1:1:1) to aldesleukin 2 MIU, 1 MIU, or placebo once daily for 5 days every 4 weeks for 3 cycles. Primary outcome was change from baseline in Treg percentage of CD4+ T cells (%Tregs) following a first cycle. Secondary laboratory outcomes included: %Treg and Treg number following repeated cycles, and plasma CCL2 and neurofilament light chain protein (NFL) concentrations as surrogate markers of efficacy. Safety outcomes included motor-function (ALSFRS-R), slow vital capacity (SVC), and adverse event reports. This trial is registered with ClinicalTrials.gov, NCT02059759. Findings: All randomised patients (12 per group), recruited from October 2015 to December 2015, were alive at the end of follow-up and included in the intent-to-treat (ITT) analysis. No drug-related serious adverse event was observed. Non-serious adverse events occurred more frequently with the 1 and 2 MIU IL-2 doses compared to placebo, including injection site reactions and flu-like symptoms. Primary outcome analysis showed a significant increase (p < 0·0001) in %Tregs in the 2 MIU and 1 MIU arms (mean [SD]: 2 MIU: +6·2% [2·2]; 1 MIU: +3·9% [1·2]) as compared to placebo (mean [SD]: -0·49% [1·3]). Effect sizes (ES) were large in treated groups: 2 MIU ES=3·7 (IC95%: 2·3–4·9) and 1 MIU ES=3·5 (IC95%: 2·1–4·6). Secondary outcomes showed a significant increase in %Tregs following repeated cycles (p < 0·0001) as compared to placebo, and a dose-dependent decrease in plasma CCL2 (p = 0·0049). There were no significant differences amongst the three groups on plasma NFL levels. Interpretation: Ld-IL-2 is well tolerated and immunologically effective in subjects with ALS. These results warrant further investigation into their eventual therapeutic impact on slowing ALS disease progression. Funding: : The French Health Ministry (PHRC-I-14-056), EU H2020 (grant #633413), and the Association pour la Recherche sur la SLA (ARSLA). © 2020 The Authors
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| 4. |
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| 5. |
- Di Giunta, Laura, et al.
(författare)
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Longitudinal associations between mothers' and fathers' anger/irritability expressiveness, harsh parenting, and adolescents' socioemotional functioning in nine countries.
- 2020
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Ingår i: Developmental Psychology. - : American Psychological Association (APA). - 0012-1649 .- 1939-0599. ; 56:3, s. 458-474
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Tidskriftsartikel (refereegranskat)abstract
- The present study examines parents' self-efficacy about anger regulation and irritability as predictors of harsh parenting and adolescent children's irritability (i.e., mediators), which in turn were examined as predictors of adolescents' externalizing and internalizing problems. Mothers, fathers, and adolescents (N = 1,298 families) from 12 cultural groups in 9 countries (China, Colombia, Italy, Jordan, Kenya, Philippines, Sweden, Thailand, and United States) were interviewed when children were about 13 years old and again 1 and 2 years later. Models were examined separately for mothers and fathers. Overall, cross-cultural similarities emerged in the associations of both mothers' and fathers' irritability, as well as of mothers' self-efficacy about anger regulation, with subsequent maternal harsh parenting and adolescent irritability, and in the associations of the latter variables with adolescents' internalizing and externalizing problems. The findings suggest that processes linking mothers' and fathers' emotion socialization and emotionality in diverse cultures to adolescent problem behaviors are somewhat similar.
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| 6. |
- Kapetanovic, Sabina, 1980-, et al.
(författare)
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Cross-Cultural Examination of Links between Parent-Adolescent Communication and Adolescent Psychological Problems in 12 Cultural Groups.
- 2020
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Ingår i: Journal of Youth and Adolescence. - : Springer Science and Business Media LLC. - 0047-2891 .- 1573-6601. ; 49:6, s. 1225-1244
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Tidskriftsartikel (refereegranskat)abstract
- Internalizing and externalizing problems increase during adolescence. However, these problems may be mitigated by adequate parenting, including effective parent-adolescent communication. The ways in which parent-driven (i.e., parent behavior control and solicitation) and adolescent-driven (i.e., disclosure and secrecy) communication efforts are linked to adolescent psychological problems universally and cross-culturally is a question that needs more empirical investigation. The current study used a sample of 1087 adolescents (M = 13.19 years, SD = 0.90, 50% girls) from 12 cultural groups in nine countries including China, Colombia, Italy, Jordan, Kenya, Philippines, Sweden, Thailand, and the United States to test the cultural moderation of links between parent solicitation, parent behavior control, adolescent disclosure, and adolescent secrecy with adolescent internalizing and externalizing problems. The results indicate that adolescent-driven communication, and secrecy in particular, is intertwined with adolescents' externalizing problems across all cultures, and intertwined with internalizing problems in specific cultural contexts. Moreover, parent-driven communication efforts were predicted by adolescent disclosure in all cultures. Overall, the findings suggest that adolescent-driven communication efforts, and adolescent secrecy in particular, are important predictors of adolescent psychological problems as well as facilitators of parent-adolescent communication.
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| 7. |
- Lansford, Jennifer E., et al.
(författare)
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Opportunities and peer support for aggression and delinquency during adolescence in nine countries.
- 2020
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Ingår i: New Directions for Child and Adolescent Development. - : Hindawi Limited. - 1520-3247 .- 1534-8687. ; 2020:172, s. 73-88
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Tidskriftsartikel (refereegranskat)abstract
- This study tested culture-general and culture-specific aspects of adolescent developmental processes by focusing on opportunities and peer support for aggressive and delinquent behavior, which could help account for cultural similarities and differences in problem behavior during adolescence. Adolescents from 12 cultural groups in 9 countries (China, Colombia, Italy, Jordan, Kenya, the Philippines, Sweden, Thailand, and the United States) provided data at ages 12, 14, and 15. Variance in opportunities and peer support for aggression and delinquency, as well as aggressive and delinquent behavior, was greater within than between cultures. Across cultural groups, opportunities and peer support for aggression and delinquency increased from early to mid-adolescence. Consistently across diverse cultural groups, opportunities and peer support for aggression and delinquency predicted subsequent aggressive and delinquent behavior, even after controlling for prior aggressive and delinquent behavior. The findings illustrate ways that international collaborative research can contribute to developmental science by embedding the study of development within cultural contexts.
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| 8. |
- Qviller, A. J., et al.
(författare)
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Direct observation of magnetic proximity effects in amorphous exchange-spring magnets by neutron reflectometry
- 2020
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Ingår i: Physical Review Materials. - 2475-9953. ; 4:10
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Tidskriftsartikel (refereegranskat)abstract
- In this paper, we report a direct observation of a magnetic proximity effect in an amorphous thin-film exchange-spring magnet by the use of neutron reflectometry. The exchange-spring magnet is a trilayer consisting of two ferromagnetic layers with high T-c separated by a ferromagnetic layer, which is engineered to have a significantly lower T-c than the embedding layers. This enables us to measure magnetization depth profiles at which the low-T-c material is in a ferromagnetic or paramagnetic state, while the embedding layers are ferromagnetic. A clear proximity effect is observed 7 K above the intrinsic T-c of the embedded layer, with a range extending 50 angstrom.
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| 9. |
- Rothenberg, W. Andrew, et al.
(författare)
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Cross-cultural effects of parent warmth and control on aggression and rule-breaking from ages 8 to 13.
- 2020
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Ingår i: Aggressive Behavior. - : Wiley. - 0096-140X .- 1098-2337. ; 46:4, s. 327-340
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Tidskriftsartikel (refereegranskat)abstract
- We investigated whether bidirectional associations between parental warmth and behavioral control and child aggression and rule-breaking behavior emerged in 12 cultural groups. Study participants included 1,298 children (M = 8.29 years, standard deviation [SD] = 0.66, 51% girls) from Shanghai, China (n = 121); Medellín, Colombia (n = 108); Naples (n = 100) and Rome (n = 103), Italy; Zarqa, Jordan (n = 114); Kisumu, Kenya (n = 100); Manila, Philippines (n = 120); Trollhättan/Vänersborg, Sweden (n = 101); Chiang Mai, Thailand (n = 120); and Durham, NC, United States (n = 111 White, n = 103 Black, n = 97 Latino) followed over 5 years (i.e., ages 8-13). Warmth and control were measured using the Parental Acceptance-Rejection/Control Questionnaire, child aggression and rule-breaking were measured using the Achenbach System of Empirically-Based Assessment. Multiple-group structural equation modeling was conducted. Associations between parent warmth and subsequent rule-breaking behavior were found to be more common across ontogeny and demonstrate greater variability across different cultures than associations between warmth and subsequent aggressive behavior. In contrast, the evocative effects of child aggressive behavior on subsequent parent warmth and behavioral control were more common, especially before age 10, than those of rule-breaking behavior. Considering the type of externalizing behavior, developmental time point, and cultural context is essential to understanding how parenting and child behavior reciprocally affect one another.
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| 10. |
- Rothenberg, W. Andrew, et al.
(författare)
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Effects of Parental Warmth and Behavioral Control on Adolescent Externalizing and Internalizing Trajectories Across Cultures
- 2020
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Ingår i: Journal of research on adolescence. - : Wiley. - 1050-8392 .- 1532-7795. ; 30:4, s. 835-855
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Tidskriftsartikel (refereegranskat)abstract
- We investigated the effects of parental warmth and behavioral control on externalizing and internalizing symptom trajectories from ages 8 to 14 in 1,298 adolescents from 12 cultural groups. We did not find that single universal trajectories characterized adolescent externalizing and internalizing symptoms across cultures, but instead found significant heterogeneity in starting points and rates of change in both externalizing and internalizing symptoms across cultures. Some similarities did emerge. Across many cultural groups, internalizing symptoms decreased from ages 8 to 10, and externalizing symptoms increased from ages 10 to 14. Parental warmth appears to function similarly in many cultures as a protective factor that prevents the onset and growth of adolescent externalizing and internalizing symptoms, whereas the effects of behavioral control vary from culture to culture. © 2020 Society for Research on Adolescence
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