Prior research, mostly on adults, has shown that the causal link between the use of any specific drug and violence is weak. Using a longitudinal probability sample of adolescents in the United States, the National Longitudinal Study of Adolescent Health, we examined the effects of the use of six types of substances (cigarettes, alcohol, marijuana, inhalants, cocaine, and other illicit drugs) on the longitudinal change in adolescent violence (N = 13,568).Among adolescents, the order of initiation into drug use was fairly fixed, with alcohol and cigarettes being the first substances used, followed by marijuana. Nested regression models showed that, when all six substances were added to the baseline model, cigarettes and alcohol were the only significant predictors of change in the level of violence. Two measures of polydrug use, based on prevalence and on frequency, were then constructed across all six substances. At each level of polydrug use, using either measure, we found a consistent increase in the mean level of violence. Despite gender differences in the levels of violence, the same relation between polydrug use and violence was found within each gender. Controlling for the level of polydrug use, there were no consistent differences in the level of Time 2 violence between users and non-users of any specific substance. Employing a cross-lagged model, we were able to ascertain a clear direction of causation: violence did not lead to increased polydrug use, but polydrug use led to increased violence. We speculate that high levels of polydrug use reflect * Please send author correspondence to Sanford M. Dornbusch
Background There is a paucity of literature addressing COVID-19 case-fatality ratios (CFR) by zip code (ZC). We aim to analyze trends in COVID-19 CFR, population density, and socioeconomic status (SES) indicators (unemployment, median household income) to identify ZCs heavily burdened by COVID-19. Methods Cross-sectional study to investigate the US prevalence of COVD-19 fatalities by ZC and SES. CFRs were calculated from state/county Departments of Health. Inclusion criteria were counties that reported cases/deaths by ZC and a CFR≥2%. This study was reported in line with the STROCSS criteria. Results 609/1,853 ZCs, spanning 327 counties in 7 states had CFRs ≥2%. A significant positive correlation was found between the CFR and median household income (Pearson correlation:0.107; 95% CI [289.1,1937.9]; p < 0.001). No significant correlations exist between the CFR, and population/mi (Sen-Crowe et al., 2020) [2] or unemployment rate. Significant associations exist between the CFR and young males and elderly females without public insurance. CFR was inversely associated with persons aged <44 and individuals aged ≥65. The percentage of nursing homes (NHs) within cities residing within high CFR ZCs range from 8.7% to 67.6%. Conclusion Significant positive association was found between the CFR and median household income. Population/mi (Sen-Crowe et al., 2020) [2] and unemployment rates, did not correlate to CFR. NHs were heavily distributed in high CFR zip codes. We recommend the targeted vaccination of zip codes with a large proportion of long-term care facilities. Finally, we recommend for improved screening and safety guidelines for vulnerable populations (e.g nursing home residents) and established protocols for when there is evidence of substantial infectious spread.
IMPORTANCE Recent evidence suggests that select delayed replantation may not adversely affect digit survival; however, whether surgical timing (overnight or daytime) is associated with digit replantation outcomes is unknown. OBJECTIVE To assess whether digit survival, complication rate, and duration of surgery are associated with time of replantation.
BACKGROUND: Training for trauma procedures has been limited to infrequent courses with little data on longitudinal performance, and few address procedural and leadership skills with granular assessment. We implemented a novel training program that emphasized an assessment of trauma resuscitation and procedural skills. OBJECTIVE: This study aimed to determine whether this program could demonstrate improvement in both skill sets in surgical trainees over time. METHODS: This was a prospective, observational study at a Level I trauma center between November 2018 and May 2019. A procedural skill and simulation program was implemented to train and evaluate postgraduate year (PGY) 1–5 residents. All residents participated in an initial course on procedures such as tube thoracostomy and vascular access, followed by a final evaluation. Skills were assessed by the Likert scale (1–5, 5 noting mastery). PGY 3s and above were additionally evaluated on resuscitation. A paired t test was performed on repeat learners. RESULTS: A total of 40 residents participated in the structured procedural skills and simulation program. Following completion of the program, PGY-2 scores increased from a Mdn [interquartile range, IQR] 3.0 [2.5–4.0] to 4.5 [4.2–4.5]. The PGY-3 scores increased from a Mdn [IQR] 3.95 [3.7–4.6] to 4.8 [4.6–5.0]. Eighteen residents underwent repeat simulation training, with Mdn [IQR] score increases in PGY 2s (3.7 [2.5–4.0] to end score 4.47 [4.0–4.5], p = .03) and PGY 3s (3.95 [3.7–4.6] to end score 4.81 [4.68–5.0], p = .04). Specific procedural and leadership skills also increased over time.
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