Association between childhood cognitive skills & adult suicidal behavior: A systematic review and meta-analysis.

BACKGROUND: It is unclear whether cognitive skill deficits during childhood carry risk for suicide attempt or mortality later in adulthood at the population level. We conducted a systematic review and meta-analysis of population-based studies examining the association between childhood cognitive skills and adult suicidal behavior, namely attempt and mortality. METHOD: We systematically searched databases for articles then extracted study characteristics and estimates on the association between childhood cognitive skills (i.e., IQ or school performance at age ≤ 18 years) and later suicide attempt and mortality. Random-effect meta-analysis was used to quantify this association across all studies with available data. RESULTS: Twenty-three studies met the inclusion criteria and suggest an association between lower childhood cognitive skills and increased risk of suicidal behavior. Meta-analysis of the adjusted estimates from 11 studies (N = 2,830,191) found the association to be small but statistically significant. Heterogeneity was significant but moderate, and results were unlikely to be influenced by publication bias. In subgroup analyses, associations were significant only for males. No difference in effect size was found between suicide attempt and suicide mortality. LIMITATIONS: Cognitive skills were measured with different cognitive subtests. Heterogeneity in the age of cognitive skills assessment. Meta-regression and subgroup analyses were based on a relatively low number of studies. CONCLUSIONS: Individuals with lower cognitive skills in childhood have a greater risk of suicidal behavior in adulthood, especially males. Although the association was small, interventions improving cognitive skills may yield large effects on suicide prevention at the population level if the association is causal.

Biomimetic photo-actuation: sensing, control and actuation in sun-tracking plants.

Although the actuation mechanisms that drive plant movement have been investigated from a biomimetic perspective, few studies have looked at the wider sensing and control systems that regulate this motion. This paper examines photo-actuation-actuation induced by, and controlled with light-through a review of the sun-tracking functions of the Cornish Mallow. The sun-tracking movement of the Cornish Mallow leaf results from an extraordinarily complex-yet extremely elegant-process of signal perception, generation, filtering and control. Inspired by this process, a concept for a simplified biomimetic analogue of this leaf is proposed: a multifunctional structure employing chemical sensing, signal transmission, and control of composite hydrogel actuators. We present this multifunctional structure, and show that the success of the concept will require improved selection of materials and structural design. This device has application in the solar-tracking of photovoltaic panels for increased energy yield. More broadly it is envisaged that the concept of chemical sensing and control can be expanded beyond photo-actuation to many other stimuli, resulting in new classes of robust solid-state devices.

Effect of different bowel preparations on residual fluid at CT colonography.

The effect of different bowel preparations on residual fluid during computed tomographic (CT) colonography was evaluated. Forty-two patients received either a polyethylene glycol electrolyte solution preparation or a phospho-soda preparation the day prior to CT colonography. The amount of residual fluid was calculated for each patient. On average, a phospho-soda preparation provided significantly less residual fluid than a polyethylene glycol electrolyte solution preparation.

Usefulness of CT colonography in patients with incomplete colonoscopy.

OBJECTIVE: Our objective was to investigate the use of CT colonography in patients who have undergone incomplete colonoscopy. CONCLUSION: CT colonography is effective in evaluating portions of the colon not seen during colonoscopy and may have an adjunctive role.

Increasing PAs' awareness and understanding of self-help groups. An educational model.

A model for inclusion of information about self-help groups into a PA training program is provided based on the results of a study of 26 PA students enrolled in a patient-counseling class. Interactions with self-help groups yield more positive beliefs and greater intentions to collaborate with self-help groups than training programs that do not address self-help groups. The experiential component is also useful for increasing understanding of appropriate roles for professionals interacting with self-help groups.

Trends in the US prevalence of drug-using parturient women and drug-affected newborns, 1979 through 1990.

OBJECTIVES: There has been a lack of reliable national data on the number of pregnant women using drugs and the number of newborns affected by such use. The major reasons for this lack have been inadequate sampling and data collection procedures and the lack of a risk assessment perspective in analysis. This paper corrects for these inadequacies. METHODS: Data from 1979 through 1990 from the National Hospital Discharge Survey, an annual survey by the National Center for Health Statistics, were analyzed. RESULTS: Between 1979 and 1990 there was a 576% increase in the rate of discharges of drug-using parturient women in the United States and a 456% increase in the rate of discharges of drug-affected newborns. After adjustment for underreporting, a "best estimate" of the number of discharges from 1988 through 1990 was about 88,000 per year for drug-using parturient women and about 48,000 per year for drug-affected newborns. CONCLUSIONS: Although the data support the occurrence of a national epidemic of drug use among pregnant women during the 1980s, the size and severity of this epidemic have been overstated.

Foscarnet treatment of cytomegalovirus gastrointestinal infections in acquired immunodeficiency syndrome patients who have failed ganciclovir induction.

This compassionate-use study examined the efficacy of foscarnet in patients with AIDS and cytomegalovirus (CMV) gastrointestinal disease who had failed ganciclovir induction. Nineteen male homosexuals with AIDS and biopsy-proven CMV gastrointestinal disease who had twice failed standard ganciclovir induction (defined as progression of clinical CMV disease) were studied. Foscarnet 60 mg/kg every 8 h was administered intravenously for 14 days, then maintenance was utilized at 90 or 120 mg/kg every day with 1 L normal saline daily. Endpoints included endoscopic appearance, blinded histopathologic analysis of biopsies for CMV inclusions, and changes in symptoms by 50% from baseline. Patients were evaluated before and 2-3 wk after foscarnet. Histopathologic improvement was seen in 67%, whereas 74% improved clinically after a median duration of 7.5 days (1-12). Among the nine with esophageal disease, six patients (68%) had a clinical response and six of eight (75%) had a pathologic response. Among the 10 with colonic disease, eight patients (80%) had a clinical response and six (60%) had a pathologic response. Reversible elevations in creatinine were seen in two of 17 (12%). Three patients with esophageal disease developed strictures late in therapy requiring dilation. Median survival after foscarnet induction was 5.0 months. Foscarnet appears to induce remission of CMV gastrointestinal disease in 67% of patients when ganciclovir induction has failed. Reversible nephrotoxicity occurred in 12%. Strictures may be a late complication of CMV esophagitis.

Trends in diagnosed drug problems among newborns: United States, 1979-1987.

Between 1979 and 1987, there was an estimated 361% increase in the number of drug-affected newborns discharged from the 6000 non-federal, short-stay hospitals in the United States. Per 10,000 newborns, the rate increased 339%, mostly occurring after 1983. The estimated number of drug affected newborns in 1987 was about 13,000 (95% confidence interval: 10,000-15,000). Recognizing that underreporting could have occurred, multiplicative correction factors derived from the literature were employed to produce 'adjusted' estimates. While somewhat arbitrary, the number of drug-affected newborns, adjusted for underreporting, was about 38,000 (95% confidence interval: 30,000-45,000). Both adjusted and unadjusted estimates of the numbers of newborns identified as drug-affected by the present study is much smaller than most of the estimates reported in the literature. Possible reasons for this finding are discussed.

Using postcards to increase patient provided information on medication use.

Many elderly persons take medications that their physicians do not know about. The reasons include multiple prescribers, errors in prescriber records, and lack of patient-to-physician communication on medication use. This study assessed the use of mailed cues (postcards) to prompt elderly patients to bring all medications to physician office visits. Four family physician offices were studied; every other current elderly patient received a postcard reminder several days before an appointment. Of those receiving cards, 72% brought in medicines, compared to 8% of the controls.

Determinants of total family charges for health care: United States, 1980.

This report addresses a question of importance for policymakers: "What are the determinants of the total charges for health care that U.S. families face?" Policymakers' concerns about this question have two main grounds. First, U.S. health care costs are large and growing rapidly. They now exceed 11 percent of the gross national product, and the answer to the question can shed some light on their troubling growth. Second, total family charges for health care reflect the quantity of health care received by families, and it is important to know whether the determinants of total charges are principally the need for health care, or involve other factors less related to need. In this report, the determinants of total charges and their importance are identified principally through multiple regression analysis. Total charges are defined as the full amount charged for all types of health care for all family members regardless of whether these amounts are paid out of pocket, paid by insurance (or public health care coverage programs), or go unpaid. The data used are from the family data files of the 1980 National Medical Care Utilization and Expenditure Survey (NMCUES). This report presents data on the approximately 5,000 multiple-person families interviewed in this year-long longitudinal survey. The report provides a separate analysis for each of three socioeconomic family populations that have consistently been of interest to policymakers. These are (1) older families (defined for this report as all U.S. multiple-person families with a member 65 years of age or over); (2) younger, lower income families (all U.S. multiple-person families below 200 percent of the poverty level in 1980 and with all members under 65 years of age); and (3) younger, better off families (all U.S. multiple-person families at 200 percent of the poverty level or higher in 1980 and with all members under 65). Multiple regression analysis was used to investigate the effect on total family charges of family demographic and sociocultural characteristics, family illnesses, special health events (such as births, deaths, and hospitalizations of family members), general family health status, family income, family health insurance characteristics, and family geographic and urbanization characteristics. Regressions were run separately for each of the three socio-economic family populations, with total family charges as the dependent variable and approximately 45 variables measuring these family characteristics as independent variables. Because of the large number of independent variables involved, a multiple-step regression process (described in appendix I) was used.(ABSTRACT TRUNCATED AT 400 WORDS)

Determinants of financially burdensome family health expenses: United States, 1980.

This report focuses on two questions of current interest to policymakers. First, "What percent of U.S. families experience financially burdensome health expenses?" and, second, "What are the determinants of financially burdensome health expenses among U.S. families?" The first question is addressed by examining how the distribution in the United States of families with financially burdensome health expenses is affected by six different possible measures of financial burden. The second question is addressed by using multiple regression techniques on one of the measures selected as a preferred measure. The data used are from the family data files of the 1980 National Medical Care Utilization and Expenditure Survey (NMCUES). This report presents data on approximately 5,000 multiple-person families interviewed in this longitudinal survey. It provides a separate analysis for each of three socioeconomic family populations that have consistently been of interest to policymakers. These are (1) older families (defined for this report as all U.S. multiple-person families with a member 65 years of age or over); (2) younger, lower-income families (defined as all U.S. multiple-person families below 200 percent of the poverty level in 1980 and with all members under 65 years of age); and (3) younger, better-off families (defined as all U.S. multiple-person families at 200 percent of the poverty level or higher in 1980 and with all members under 65 years of age). Two general conceptual approaches have been used in the literature to assess financially burdensome health expenses. The first approach measures financial burden by the size of a family's health bill in dollars. The second approach focuses on a family's ability to pay its health bill, and it measures financial burden as a ratio of health expenses to family income. There is no agreement on which of the two approaches is preferable and also no agreement on which of several operational measures in each category is the most appropriate. In order to shed light on this controversy, this report compares six potentially useful operational measures of financially burdensome health expenses. Three are dollar measures and three are ratio measures. The three dollar measures are (1) total charges for health care (irrespective of who pays the bill or whether or not the bill is paid), (2) out-of-pocket expenses for health care services (family-paid premiums for health insurance are not included), and (3) total out-of-pocket expenses for health (the previous measure plus out-of-pocket premiums).(ABSTRACT TRUNCATED AT 400 WORDS)

Total family expenditures for health care: United States, 1980.

Information on total family expenditures for health care in 1980 is presented in this report. Total expenditures are the total amounts billed (either actual or imputed) to families whether these amounts are paid out-of-pocket by the family, paid by private health insurance or a public health care coverage program, or remain unpaid. The data discussed here were gathered in the national household sample of the National Medical Care Utilization and Expenditure Survey (NMCUES). In this sample, information was collected on health problems, health care received, expenditures for care, health insurance, and related topics throughout calendar year 1980 from approximately 6,800 families in the civilian noninstitutionalized population of the United States. The survey excluded all individuals who were in institutions or in the military. This report also entirely excludes families with military heads, even if they had some civilian members. For this report, a family was initially defined as (1) two or more persons living together who were related by either blood, marriage, adoption, or a formal foster care relationship or (2) a single person living outside such relationships. Because data on these families were collected across an entire year, the important concept of "longitudinal family" was developed. This concept was necessary to deal with the fact that the composition of a family could change over time and that families could come into existence and go out of existence over time. As the data are based on this dynamic concept of families, all measures of expenditures for care are calculated in annual rates. Family data are important for understanding the health care system because decisions to seek and use health care are usually family decisions, health care is usually paid for out of family resources, and family distributions for health-related variables differ from the distributions found for individuals. This report deals with total expenditures for health care as reported by a sample of consumers of health care. These types of data are limited by the knowledge the respondent has as to the amount of the total bill. For various reasons, which are discussed in detail in the text, the respondent often doesn't know the amount of the total bill. Therefore, the statistics in this report should be regarded as having more limitations than the statistics in two previous family reports: "Family Use of Health Care: United States, 1980" (Dicker and Sunshine, 1987) and "Family Out-of-Pocket Expenditures for Health Care: United States, 1980" (Sunshine and Dicker, 1987).

Family out-of-pocket expenditures for health care: United States, 1980.

Information on out-of-pocket health care expenditures for families in 1980 is presented in this report. The data discussed here were gathered through the national household sample of the National Medical Care Utilization and Expenditure Survey (NMCUES). Information for the year 1980 was collected on health problems, health care received, expenditures for care, health insurance, and related topics from approximately 6,800 families in the U.S. civilian, noninstitutionalized population. All individuals who are in institutions or in the military are excluded from this analysis as are all families with military heads of family, even if they have civilian members. For this report, a family was initially defined as: two or more persons living together who were related either by blood, marriage, adoption, or a formal foster care relationship; or as a single person living outside such relationships. Because these data were collected throughout an entire year, the important concept of "longitudinal family" was developed. This concept was necessary to deal with the fact that the composition of a family could change over time, and that families could come into existence and go out of existence over time. As the data are based on this dynamic concept of families, all measures of health care expenditures are calculated in terms of annual rates. Family data are important for understanding the health care system because decisions to seek and use health care are usually family decisions, health care is usually paid for out of family resources, and family distributions for health-related variables differ from the distributions found for individuals.

Family use of health care: United States, 1980.

Information on families' use of health care in 1980 is presented in this report. The data discussed here were gathered in the national household sample of the National Medical Care Utilization and Expenditure Survey. In this sample, information was collected on health problems, health care received, expenditures for care, health insurance, and related topics throughout calendar year 1980 from approximately 6,800 families in the U.S. civilian noninstitutionalized population. (The report entirely excludes families with military heads, even if they have civilian members.) For this report, a family was initially defined as (1) two or more persons living together who were related by either blood, marriage, adoption, or a formal foster care relationship or (2) a single person living outside such relationships. But because these data were collected across an entire year, the important concept of "longitudinal family" was developed. This concept was necessary to deal with the fact that the composition of a family could change over time and that families could come into existence and go out of existence over time. As the data are based on this dynamic concept of families, all measures of the use of health services are calculated in annual rates. Family data are important for understanding the health care system because decisions to seek and use health care are usually family decisions, health care is usually paid for out of family resources, and family distributions for health-related variables differ from the distributions found for individuals. Data on both multiple-person families (families that averaged 1.5 persons or more during the year) and one-person families (families that averaged less than 1.5 persons during the year) are presented in this report. Only findings for multiple-person families, however, are addressed in this section. It is multiple-person families that are usually referred to in discussions of families by both the general public and professional social scientists.