No abstract

No abstract

From the pre-teen to the mid-teen years, rates of alcohol use and misuse increase rapidly. Cross-sectional research shows that positive family emotional climate (low conflict, high closeness) is protective, and there is emerging evidence that these protective mechanisms are different for girls versus boys. Aims To explore gender differences in the longitudinal impact of family emotional climate on adolescent alcohol use and exposure to peer drinking networks. Design Three-wave two-level (individual, within-individual over time) ordinal logistic regression with alcohol use in the past year as the dependent measure and family variables lagged by one year. Setting Adolescents completed surveys during school hours. Participants 855 Australian students (modal age 10–11 years at baseline) participating in the International Youth Development Study (Victoria, Australia). Measurements These included emotional closeness to mother/father, family conflict, parent disapproval of alcohol use, and peer alcohol use. Findings For girls, the effect of emotional closeness to mothers on alcohol use was mediated by exposure to high-risk peer networks. Parent disapproval of alcohol use was protective for both genders, but this effect was larger for boys versus girls, and there was no evidence that peer use mediated this effect. Peer drinking networks showed stronger direct risk effects than family variables. Conclusions Family factors unidirectionally impact on growth in adolescent alcohol use and effects vary with child gender.

To determine 30-day case fatality and 1-year mortality after hospital admission, a cohort of incident hospitalized IS patients for the period 1997-2005 was constructed. This period was selected because good quality data were available for these years and include surrounding Background and Purpose-In Western Europe, mortality from ischemic stroke (IS) has declined over several decades. Agesex-specific IS mortality, IS incidence, 30-day case fatality, and 1-year mortality after hospital admission are essential for explaining recent trends in IS mortality in the new millennium. Methods-Data for all IS deaths in the Netherlands were grouped by year, sex, and age. A joinpoint regression was fitted to detect points in time at which significant changes in the trends occur. By linking nationwide registers, a cohort of patients first admitted for IS between 1997 and 2005 was constructed and age-sex-specific 30-day case fatality and 1-year mortality were computed. IS incidence (admitted IS patients and out-of-hospital IS deaths) was computed by age and sex. Mann-Kendall tests were used for trend evaluation. Results-IS mortality declined continuously between1980 and 2000 with an attenuation of decline in the 1990s in some of the age-sex groups. A remarkable decline in IS mortality after 2000 was observed in all age-sex groups, except for young men. An improved decline in 30-day case fatality and in 1-year mortality was also observed in almost all age-sex groups.In contrast, IS incidence remained stable between 1997 and 2005 or even increased slightly. Conclusions-The recent remarkable decline in IS mortality was not matched by a decline in the number of incident nonfatal IS events. This is worrying, because IS is already a leading cause of adult disability, claiming a heavy human and economic burden. Prevention of IS is therefore now of the greatest importance. IS IncidenceThe incidence of IS was defined as the sum of patients with first hospitalization for IS and patients who died from first IS before hospitalization.The number of patients with an incident hospitalization for IS between 1997 and 2007 was determined by constructing a cohort as was described above. The risk of IS does not depend on whether a unique combination of linking variables is present or not. Therefore we increased the observed number of IS in the constructed cohort using the age-sex-specific uniquity percentage (% of uniqueness ranges from 79.3% in age group 35-44 years to 99.8% in age group >95 years) allowing us to calculate an absolute number of first IS events in the Netherlands.To construct a cohort of patients who died from an incident IS before hospitalization, information from the cause of death register, the population registry, and hospital discharge registry were linked. All out-of-hospital deaths attributable to IS (ICD-10 code I63 and I64) between January 1, 1997 and December 31, 2005 were selected from the cause of death register. Information was subsequently collected on hospital admissions that may have occurred previously for the ...

The results point to the importance of monitoring and responding to comparatively minor shifts in the proportion of peers who use alcohol, particularly among very young adolescents.