Children and youth's perceptions of mental health-a scoping review of qualitative studies

BACKGROUND

Recent research indicates that understanding how children and youth perceive mental health, how it is manifests, and where the line between mental health issues and everyday challenges should be drawn, is complex and varied. Consequently, it is important to investigate how children and youth perceive and communicate about mental health. With this in mind, our goal is to synthesize the literature on how children and youth (ages 10-25) perceive and conceptualize mental health.

METHODS

We conducted a preliminary search to identify the keywords, employing a search strategy across electronic databases including Medline, Scopus, CINAHL, PsychInfo, Sociological abstracts and Google Scholar. The search encompassed the period from September 20, 2021, to September 30, 2021. This effort yielded 11 eligible studies. Our scoping review was conducted in accordance with the PRISMA-ScR Checklist.

RESULTS

As various aspects of uncertainty in understanding of mental health have emerged, the results indicate the importance of establishing a shared language concerning mental health. This is essential for clarifying the distinctions between everyday challenges and issues that require treatment.

CONCLUSION

We require a language that can direct children, parents, school personnel and professionals toward appropriate support and aid in formulating health interventions. Additionally, it holds significance to promote an understanding of the positive aspects of mental health. This emphasis should extend to the competence development of school personnel, enabling them to integrate insights about mental well-being into routine interactions with young individuals. This approach could empower children and youth to acquire the understanding that mental health is not a static condition but rather something that can be enhanced or, at the very least, maintained.

Relationship between Eczema and Self-reported Difficulties Keeping up with School Education: A Cross-sectional Study

Eczema is a common chronic disease that affects both children and adults, and may have an adverse impact on school performance, as it is characteristically pruritic, and hence may lead to poor concentration and inadequate sleep. The aim of this study was to elucidate the relationship between eczema and self-reported difficulties keeping up with school education. The study was based on cross-sectional questionnaire data collected in schools among all 9th graders (15-16 years old) within a Swedish county. Logistic regression analyses were used to assess the association between having eczema and self-reported difficulties keeping up with school education. A total of 2,620 pupils participated (50.1% female). An increased odds ratio (OR) of self-reported difficulties keeping up with school education was found in adolescents with eczema compared with those without eczema after adjustment for sex and  family residence (OR 2.13, 95% confidence interval (95% CI) 1.32-3.44), and with additional adjustment for sleeping problems, attention-deficit hyperactivity disorder, allergy, rhinitis, asthma, and alcohol consumption (adjusted OR 1.78, CI 1.05-3.00). Eczema may be a relevant risk factor for difficulty keeping up with school education in adolescents. However, studies that can assess temporality, based in different settings with objective reports of both eczema and self-reported difficulties at school, are needed to confirm these findings.

Exploring Potential Modifiers of the Association Between Neurodevelopmental Disorders and Risk of Bullying Exposure

This survey study examines data from the National Survey of Children’s Health to determine which sociodemographic factors might modify the association between neurodevelopmental disorders and being bullied.

The effect of robot interventions on sleep in adults: a systematic review and network meta-analysis

STUDY OBJECTIVES

Robotic pets or companion robots have demonstrated positive effects on several emotional and physiological factors in humans. Robots could constitute a complementary or alternative method to treat sleep problems, but individual studies on robots' effectiveness regarding sleep show mixed results. The aim of the current study was to compare the effects of robots, plush toys, and treatment as usual on sleep in adults.

METHODS

The current study is a systematic review and frequentist network meta-analysis of all randomized and cluster randomized controlled trials comparing the effects of robots, plush toys, and treatment as usual on total sleep time in adults.

RESULTS

Four studies were included in the analysis. Three studies were considered to have a high risk of bias, whereas one was rated with some concerns. The studies comprised 381 participants. These subjects were older adults, with or without dementia, living in nursing homes. The total sleep time was the only common sleep measure included in all four studies. The network meta-analysis showed no statistically significant differences between the three experimental groups.

CONCLUSIONS

The robot interventions were not found to have positive effects on total sleep time in older adults compared with plush toys or treatment as usual. Future studies should use robots especially made to target sleep, include a thorough screening of the participants, and exclude people with adequate sleep, select appropriate sleep measures, and report the results appropriately for future meta-analyses.

Flipped or traditional online teaching? Two different strategies to handle teaching in nursing education during the COVID-19 pandemic

OBJECTIVES

The aim of this study was to investigate differences in academic achievement between two groups of students who were taught the same course online within the nursing program but through two different teaching strategies and to examine the students' attitudes towards flipped classroom.

METHODS

Online lectures using Zoom was given to teach a course regarding the immune system and another course was taught the same subject in flipped classroom approach using video lectures followed by seminars. Academic achievement were compared between the groups, and perspectives on flipped classroom were investigated using a questionnaire.

RESULTS

The main findings were that participation in flipped classroom seminars had a positive effect on academic achievement (OR 2.3 (CI [1.001-5.1]), and that students preferred the flipped classroom approach over traditional lectures.

CONCLUSIONS

This study suggests that a student centered teaching strategy like flipped classroom is an effective way to increase the students' engagement and academic achievements.

Patient safety when receiving telephone advice in primary care – a Swedish qualitative interview study

Background

A lack of patient safety is a significant global public health challenge and is one of the leading causes of death and disability, entailing significant financial and economic costs. However, patient safety can be improved and patients can avoid being harmed if more knowledge could be gained about what it is that impacts patient safety. Patient safety when receiving telephone advice is an important issue given the increase in digitalization in healthcare services.

Aim

The aim of this study was to explore district nurses’ (“telenurses”) experiences and perceptions of patient safety when providing health advice over the phone.

Methods

Data collection was performed using semi-structured interviews and analyzed using qualitative content analysis. The participants (n = 12) were telnurses in primary care.

Results

The theme “Being able to make the right decision” was formed based on two categories: “Communication” and “Assessment”. Through effective communication with the right conditions to make an assessment, the correct decision can be made when a patient calls, and the district nurse feels that their telephone advice is safe for the patient.

Conclusions

Patient safety can be challenged when receiving telephone advice, particularly when they feel stressed due to organizational factors. There is a need to shift from the individual to the organization. Further, while computerized knowledge support generally results in safe decisions, there may also be problems. Hence, it is imperative to develop computerized knowledge support as a part of improved patient safety in telephone advice.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-021-00796-9.

Views on Adolescents' Mental Health in Sweden-A Qualitative Study among Different Professionals Working with Adolescents

Professionals who meet and work with adolescents hold important information and perspectives on adolescents' mental health that, in addition to the adolescents' voices, can shed light on complex issues. The aim was to explore professionals' views on what challenges they face and how they can strengthen today's adolescents' mental health. This study involves four group interviews, conducted in March and October of 2020, including professionals with different working backgrounds. Data were analyzed with a qualitative content analysis. Two categories emerged: navigating life arenas and support for mental health. The first category included the demanding aspects of school, the challenges of social media, and the professionals' thoughts on which pieces of mental health knowledge adolescents are lacking. The second category included what the professionals thought today's parents need to develop and do to best support their children. Moreover, self-critical views were expressed on which aspects the professionals could do better to improve adolescents' mental health. In conclusion, listening to professionals working with adolescents talk about adolescents' mental health gives important insights. According to the professionals, both adolescents and their parents need improved life skills, including a strengthened and empowered self-esteem as well as improved mental health literacy.

A Framework-Based Approach to Assessing Mental Health Impacts of the COVID-19 Pandemic on Children and Adolescents

The COVID-19 pandemic has yielded extensive impacts globally in the year of 2020. Although the mental health of children and adolescents may be particularly susceptible to stressors stemming from the pandemic and anti-contagion policies, most ongoing efforts are geared toward curbing the viral spread. In the current perspective, we have identified four domains of factors corresponding to an ecological framework that may directly or indirectly influence the mental health of children and adolescents during the pandemic. The evidence suggests that anti-contagion policies might trigger cascades that impact the mental health of children and their families through multiple different sectors that used to form a safety net for youths. Additionally, children with neuropsychiatric disorders could experience exacerbated symptoms during the pandemic. Furthermore, the risk of domestic violence has surged during the pandemic, which further compounds the imminent mental health crisis. A mental health pandemic could be inevitable if no proactive prevention strategies were in place. Therefore, we recommend understanding each individual mental health risk pathway via the ecological framework in order to develop integrative prevention and intervention strategies.

Compliance to Recommendations and Mental Health Consequences among Elderly in Sweden during the Initial Phase of the COVID-19 Pandemic-A Cross Sectional Online Survey

Background (1): In the wake of COVID-19, elderly people have been labelled a risk group. As the pandemic is a new crisis in Sweden, we have no knowledge on how this group perceives the information and recommendations being provided. Complying with these recommendations entails physical distancing and, for some, isolation at home. Methods (2): From 16 April to 15 May 2020, we conducted an online survey targeting people aged 70 and older in Sweden (n = 1854). Results (3): A vast majority of the participants find the information and recommendations clear and reliable. Half of the participants report staying at home all the time, and up to half report decreased mental health in terms of, e.g., feeling depressed, having sleeping problems and that isolation makes them feel bad. However, elderly people are not a homogenous group, and there are gender and demographic differences. (4) Conclusion: At this point, we do not know the full extent of the ongoing pandemic, either in terms of duration or in terms of losses. The Swedish model for action on COVID-19 has not included a lock down. However, elderly people seem to comply with recommendations and practice social distancing to a high degree. This might lead to decreased mental health and long-term effects.

Adolescents' perception of gender differences in bullying

Gender norms are normative societal expectations regarding the behaviors of girls and boys that can guide bullying behavior. As early adolescence is a time when peer relations become increasingly important, it is critical to understand the peer relationships of adolescents and what is considered gender non-confirming behavior. Therefore, the aim of this study is to analyze Swedish girls' and boys' perception of gender differences in bullying. Twenty-one Swedish adolescents (8 girls and 13 boys) took part in four focus group discussions separated by boys and girls. Data analysis was conducted using qualitative content analysis. "Expectations and needs to fit the norm" emerged as the main category as all categories emerging from the analysis related to boys' and girls' understandings of how expectations, strategies, expressions relating to bullying and the need to belong vary depending on gender. Further, girls and boys expressed admiration for each other's ways of coping with bullying indicating that also coping strategies are associated with expectations based on gender. For schools and adults to be better equipped to meet the needs of girls and boys and understand how these needs are expressed, adolescents voices regarding gender related bullying can be seen as helpful tools to develop strategies to work with gender norms and gender expectations. In light of the results of our study, schools may have work to do when it comes to the awareness of norms and attitudes and how they are expressed as these may be a foundation for bullying, among both staff and students.

Economic costs of antidepressant use: a population-based study in Sweden

BACKGROUND

Prescription of antidepressant drugs (ADs) has increased in recent decades, with rising costs for patients as well as for the health care system. There is sparse evidence of which factors explain the high economic costs and financial burden for the general population.

AIMS OF THE STUDY

The aim was to assess individual-level determinants of out-of-pocket and total health care costs of AD use in the Swedish general population.

METHODS

We randomly sampled 400,000 individuals aged 18+ from Statistics Sweden's population register from 2010 to 2013. Two-part regression models were used for our two primary outcome variables: (i) total health care costs for AD use per year and individual, and (ii) total out-of-pocket costs of AD use per year and individual.

RESULTS

Women, the unemployed, unmarried people and residents of big cities have both higher use of ADs and higher associated total health care and out-of-pocket costs. Today, ADs are relatively inexpensive and average cost differences among all groups are therefore minor. The elderly have higher use of ADs, but are more commonly low-volume users and do not have higher total health care or out-of-pocket costs.

DISCUSSION AND LIMITATIONS

Groups with relatively low socioeconomic status are at risk of higher costs for antidepressant use. However, given the Swedish system of drug subsidies, differences in financial burden for individuals are minor. The limitations of this study included that we lacked data on diagnosis and could therefore not categorize the reasons for AD consumption. Furthermore, our results may not be generalized to other countries with a lower AD prevalence then Sweden's, since our estimates are dependent on the point prevalence of antidepressant use in the population.

IMPLICATIONS FOR HEALTH CARE PROVISION AND USE

Groups with higher AD consumption and economic costs may suffer from more severe depression owing to more risk factors and less social support in their surroundings, and may be in greater need of additional treatment and support than other groups.

IMPLICATIONS FOR HEALTH POLICIES AND FURTHER RESEARCH

Our results offer insight at an aggregate level, and more information on the underlying causes of higher costs is needed to discern the policy implications.

Defining and measuring 'eczema control': an international qualitative study to explore the views of those living with and treating atopic eczema

Background

Atopic eczema (also known as eczema) is a chronic, inflammatory skin condition that often afflicts patients’ health and well‐being. The Harmonising Outcome Measures for Eczema (HOME) initiative recommends that ‘long‐term control of eczema’ is measured in all clinical trials 3 months or longer in duration. However, little has been published on what eczema control means to those living with or treating atopic eczema.

Objectives

To (i) develop understanding of what eczema control means to patients, carers and clinicians and (ii) explore the feasibility and acceptability of different ways of measuring eczema control in the long term.

Methods

Online focus groups explored patients/carers experiences in the UK, the United States, the Netherlands, France, Sweden and Japan, and an international online survey gathered views of clinicians. The framework method was used to analyse the focus groups, and thematic analysis was used to analyse survey data. All findings were integrated into a theoretical framework to create overarching themes that cut across these diverse groups.

Results

Eight focus groups with patients (16 years+) and eight groups with carers of children took place (N = 97). Sixty‐two people took part in the survey. Eczema control was described as a multifaceted construct involving changes in disease activity, the treatment and management of the condition and psychological, social and physical functioning. Patient/carer measurement allows personal accounts and frequent measurement, whilst clinician measurement was deemed less subjective. The burden on patients/carers and issues for analysing and interpreting data should be considered.

Conclusions

This study formed the basis of judging the content validity and feasibility of measurement instruments/methods to assess control of eczema in clinical trials. This online approach to an international qualitative study is an example of how core outcome set developers with limited resources can engage with multiple stakeholder groups on an international basis to inform consensus meeting discussions.

Cyber bullying among children with neurodevelopmental disorders: A systematic review

Children and young adults with neurodevelopmental disorders (ND) are at increased risk of bullying compared to typically developing peers. It is still unclear to what extent they are involved in cyber bullying. This systematic review aimed at studying the prevalence of cyber bullying as perpetrators, victims, or both ("bully-victims") among students with ND in a school setting and in need of special education. The Web of Science, Scopus, ERIC, PsycINFO, PubMED, and Cochrane databases were searched including a manual search of reference lists, until February 24, 2018. Eight studies conducted in Europe, North America, the Middle East, and Australia were included reporting a prevalence of cyber-victimization among students with ND of 0%-41%, a prevalence of cyber-perpetration of 0%-16.7%, and a prevalence of bully-victims of 6.7%. Three out of five studies using control groups showed that students with ND might be more involved in cyber bullying overall compared to typically developing students. Students in segregated school settings report slightly higher prevalence rates of cyber bullying compared to students with ND in inclusive school settings, especially among girls. When comparing prevalence rates among studies using the same definition, we found similar prevalence rates. There was a tendency towards students with ND being more involved in cyber bullying compared to typically developing students, but this needs to be confirmed in future studies that should include control groups with typically developing students as well as validated and standardized measurements of cyber bullying and ND diagnoses.

Association between childhood allergic diseases, educational attainment and occupational status in later life: systematic review protocol

INTRODUCTION

Childhood allergic diseases may prevent affected children from achieving their academic potential. Potential mechanisms include absence from school due to illness and medical appointments. Experience of symptoms in classes or leisure time, and stigma associated with visible signs and symptoms, including skin disease, requirements for medication during school time or the need for specific diets, may also contribute to reduced educational attainment. Studies have investigated the association between specific allergic diseases and educational attainment. The aim of this study is to systematically review the literature on allergic diseases, educational attainment and occupational status, and if possible, calculate meta-analytic summary estimates for the associations.

METHODS

Systematic electronic searches in Medline, EMBASE, Cochrane, Cumulative Index to Nursing & Allied Health Literature (CINAHL), PsycINFO and education Resources Information Center (ERIC); hand search in reference lists of included papers and conference reports; search for unpublished studies in clinical trial registers and the New York Academy of Medicine Grey Literature Report; data extraction; and study quality assessment (Newcastle-Ottawa Scale) will be performed.

ANALYSIS

Data will be summarised descriptively, and meta-analysis including meta-regression to explore sources of heterogeneities will be performed if possible.

ETHICS AND DISSEMINATION

Dissemination in a peer-reviewed, open-access, international scientific journal is planned.

PROSPERO REGISTRATION NUMBER

CRD42017058036.

Prevalence and risk factors of electronic cigarette use among adolescents: Data from four Swedish municipalities

Aims

To assess the prevalence rates and risk factors of electronic cigarette (e-cigarette) use, with special focus on e-cigarettes containing nicotine, among grade 9 students (aged 15–16 years) in four different municipalities in Sweden.

Methods

A cross-sectional sample of 665 adolescents was collected in April 2014. The data was analysed using binary logistic regression analysis.

Results

The results show that 26% of adolescents in this study have smoked e-cigarettes (have ever used), while 19% have smoked e-cigarettes with nicotine or do not know whether or not they contained nicotine. The strongest risk factor for ever having used e-cigarettes (any type or with nicotine) was smoking conventional cigarettes. Having tried cigarettes and having tried snus, as well as using or having used alcohol and having smoked a water pipe were also statistically significant risk factors for ever use of any type of e-cigarettes but not for use of e-cigarettes with nicotine. There was no gender difference.

Conclusions

Our result show that the use of e-cigarettes tends to cluster with the use of other substances, such as other tobacco products and alcohol. As a relatively large share of the participating adolescents, more than a fourth, had smoked e-cigarettes, this rather new phenomenon requires monitoring as a part of the tobacco control.

Effects on alcohol use of a Swedish school-based prevention program for early adolescents: a longitudinal study

BACKGROUND

The aim of the study was to address the lack of evaluations of school-based substance use prevention programs and to conduct a quasi-experimental evaluation of the alcohol use part of the Triad intervention.

METHODS

Eleven Swedish intervention schools (285 pupils) and three control schools (159 pupils) participated in the evaluation. Baseline measurements were conducted in 2011 before the alcohol part in the prevention program was implemented in the intervention schools (school year 6, ages 12-13). We estimated an Intention-To-Treat (ITT) Difference-in-Difference (DD) model to analyze the effectiveness of the intervention on subsequent alcohol use measured in grades 7, 8 and 9.

RESULTS

The main results show no effect on the likelihood of drinking alcohol or drinking to intoxication.

CONCLUSIONS

The lack of positive effects highlights the need for policy-makers and public health officials need to carefully consider and evaluate prevention programs in order to ensure that they are worthwhile from school, health, and societal perspectives.

Injury risks in schoolchildren with attention-deficit/hyperactivity or autism spectrum disorder: Results from two school-based health surveys of 6- to 17-year-old children in Sweden

INTRODUCTION

Injuries are one of the leading causes of death and disability among children in Sweden and attention-deficit/hyperactivity disorder (ADHD) has previously been associated with an increased risk of injury in pediatric populations elsewhere in the world. Current evidence regarding the possible link between autism spectrum disorder (ASD) and injury risk appears limited, even though some potentially risk-increasing symptoms overlap. The purpose of this study was thus to study the association between both ADHD and ASD concerning the risk of injury among Swedish schoolchildren.

METHODS

Two samples were used: a population-based register study containing data from 18,416 children ranging from the ages of 6-17years collected by school nurses during 2012/2014 (Survey A), and a national cross-sectional study of 3202 ninth-grade children (~15years old) collected from 92 schools in 2011 (Survey B). The data were analyzed using χ(2)-tests and log-binomial generalized linear models to obtain risk ratios (RR), comparing cases reportedly affected by ADHD or ASD to unaffected controls.

RESULTS

After adjusting for confounders, ADHD was associated with a 65% increased risk of injury (RR 1.65 [95% CI: 1.32-2.05] in Survey A, and a 57% increased risk of injury (RR 1.57 [95% CI: 1.27-1.95]) in Survey B. ASD was not significantly associated with any differences in injury risk (RR 0.81 [95% CI: 0.57-1.14]).

CONCLUSIONS

The results indicate that there is an elevated injury risk among Swedish schoolchildren with ADHD but not for children with ASD. Future studies should focus on causal mechanisms mediating the association between ADHD and injuries in order to facilitate injury prevention strategies.

PRACTICAL APPLICATIONS

Parents and teachers of schoolchildren with ADHD should be made aware of the elevated injury risks associated with the diagnosis. Safety experts and injury control professionals should consider the development of specialized prevention strategies in order to reduce these risks.

Associations between neurodevelopmental disorders and factors related to school, health, and social interaction in schoolchildren: Results from a Swedish population-based survey

BACKGROUND

Children and adolescents with autism spectrum disorder (ASD) or attention-deficit/hyperactivity disorder (ADHD) are more likely to be surrounded by different risk factors. In order to work preventively with decreasing ADHD and ASD symptoms, there is a need of more knowledge concerning risk factors.

OBJECTIVE

This study aimed to investigate school, health, lifestyle and social interactions association with autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) among schoolchildren aged 6-17 years.

METHODS

Data for 18,416 children and adolescents aged 6-17 years in the county of Värmland, Sweden, from the school year 2012/2013 and 2013/2014 were obtained from the Student Health Database, which includes information on health examinations by school nurses and self-reported information of mental and physical health, social relations, physical activity, and school conditions.

RESULTS

Of all participants, 2.4% reported only ADHD and 1.6% reported only ASD. The results confirmed that ADHD or ASD was significantly associated with worse school experiences, lower socioeconomic status, less physical activity, more substance use, weaker social network and more impairments than those without ADHD or ASD.

CONCLUSIONS

Knowledge of risk or protective factors during school years is needed to develop interventions to reduce symptoms of neurodevelopmental disorders in children and adolescents.

Dynamic loading, matrix maintenance and cell injection therapy of human intervertebral discs cultured in a bioreactor

Low back pain originating from intervertebral disc (IVD) degeneration affects the quality of life for millions of people, and it is a major contributor to global healthcare costs. Long-term culture of intact IVDs is necessary to develop ex vivo models of human IVD degeneration and repair, where the relationship between mechanobiology, disc matrix composition and metabolism can be better understood. A bioreactor was developed that facilitates culture of intact human IVDs in a controlled, dynamically loaded environment. Tissue integrity and cell viability was evaluated under 3 different loading conditions: low 0.1-0.3, medium 0.1-0.3 and high 0.1-1.2 MPa. Cell viability was maintained > 80 % throughout the disc at low and medium loads, whereas it dropped to approximately 70 % (NP) and 50 % (AF) under high loads. Although cell viability was affected at high loads, there was no evidence of sGAG loss, changes in newly synthesised collagen type II or chondroadherin fragmentation. Sulphated GAG content remained at a stable level of approximately 50 µg sGAG/mg tissue in all loading protocols. To evaluate the feasibility of tissue repair strategies with cell supplementation, human NP cells were transplanted into discs within a thermoreversible hyaluronan hydrogel. The discs were loaded under medium loads, and the injected cells remained largely localised to the NP region. This study demonstrates the feasibility of culturing human IVDs for 14 days under cyclic dynamic loading conditions. The system allows the determination a safe range-of-loading and presents a platform to evaluate cell therapies and help to elucidate the effect of load following cell-based therapies.

Physical Activity Is Associated with Attention Capacity in Adolescents

OBJECTIVE

To assess the relationships among physical activity, measured objectively, and attention capacity in European adolescents.

STUDY DESIGN

The study included 273 adolescents, aged 12.5-17.5 years, who participated in the Healthy Lifestyle in Europe by Nutrition in Adolescence Study. Participants wore a uniaxial accelerometer for 7 days to measure physical activity. The d2 Test of Attention was administered to assess attention capacity. Multivariate analyses were used to study the association of attention capacity with each measure of physical activity. Receiver operating characteristic analysis was performed to determine thresholds that best discriminate between low and good attention capacity.

RESULTS

After controlling for potential confounding variables (age, sex, body mass index, parental educational level, fat mass, aerobic fitness, and center), adolescents' attention capacity test performances were significantly and positively associated with longer time spent in moderate or moderate-to-vigorous physical activity (MVPA) in free-living conditions (P < .05). Receiver operating characteristic curve analyses revealed that the physical activity thresholds that best discriminated between low/good attention capacities were ≥41 min·day(-1) for moderate, ≥12 min·day(-1) for vigorous, and ≥58 min·day(-1) for MVPA.

CONCLUSION

These findings suggest that promoting MVPA may be have a beneficial effect on attention capacity, an important component of cognition, in adolescents.

The cost-effectiveness of the Olweus Bullying Prevention Program: Results from a modelling study

Exposure to bullying affects around 3-5 percent of adolescents in secondary school and is related to various mental health problems. Many different anti-bullying programmes are currently available, but economic evaluations are lacking. The aim of this study is to identify the cost effectiveness of the Olweus Bullying Prevention Program (OBPP). We constructed a decision-tree model for a Swedish secondary school, using a public payer perspective, and retrieved data on costs and effects from the published literature. Probabilistic sensitivity analysis to reflect the uncertainty in the model was conducted. The base-case analysis showed that using the OBPP to reduce the number of victims of bullying costs 131,250 Swedish kronor (€14,470) per victim spared. Compared to a relevant threshold of the societal value of bullying reduction, this indicates that the programme is cost-effective. Using a relevant willingness-to-pay threshold shows that the OBPP is a cost-effective intervention.

Acute mechanical injury of the human intervertebral disc: link to degeneration and pain

Excessive mechanical loading or acute trauma to intervertebral discs (IVDs) is thought to contribute to degeneration and pain. However, the exact mechanisms by which mechanical injury initiates and promotes degeneration remain unclear. This study investigates biochemical changes and extracellular matrix disruption in whole-organ human IVD cultures following acute mechanical injury. Isolated healthy human IVDs were rapidly compressed by 5% (non-injured) or 30% (injured) of disc height. 30% strain consistently cracked cartilage endplates, confirming disc trauma. Three days post-loading, conditioned media were assessed for proteoglycan content and released cytokines. Tissue extracts were assessed for proteoglycan content and for aggrecan integrity. Conditioned media were applied to PC12 cells to evaluate if factors inducing neurite growth were released. Compared to controls, IVD injury caused significant cell death. Injury also caused significantly reduced tissue proteoglycan content with a reciprocal increase of proteoglycan content in culture media. Increased aggrecan fragmentation was observed in injured tissue due to increased matrix metalloproteinase and aggrecanase activity. Injured-IVD conditioned media contained significantly elevated interleukin (IL)-5, IL-6, IL-7, IL-8, MCP-2, GROα, and MIG, and ELISA analysis showed significantly increased nerve growth factor levels compared to non-injured media. Injured-disc media caused significant neurite sprouting in PC12 cells compared to non-injured media. Acute mechanical injury of human IVDs ex vivo initiates release of factors and enzyme activity associated with degeneration and back pain. This work provides direct evidence linking acute trauma, inflammatory factors, neo-innervation and potential degeneration and discogenic pain in vivo.

Pregnancy motivations and contraceptive use: hers, his, or theirs?

CONTEXT

Studies increasingly consider the role of pregnancy motivations on contraceptive use. Few studies include measures of men's pregnancy motivations.

METHODS

We used baseline data (from a couples-intervention study) to examine the contribution of women's and men's pregnancy motivations and participation in decision making to contraceptive use by women in relatively stable relationships who were not trying to get pregnant. In addition to conducting multivariate analyses, we assessed agreement between a woman's perceptions of and her partner's reports of his pregnancy motivations.

RESULTS

We observed moderate agreement between men's pregnancy motivations and their partners' perceptions of those motivations. Levels of agreement about participation in decision making were somewhat lower. In bivariate analyses, effective contraceptive use was significantly associated with two measures of pregnancy motivation for men and women. In multivariate analyses, only women not wanting a child in 2 years (adjusted odds ratio [aOR], 1.73), women's (aOR, 1.80) and men's (aOR, 0.78) participation in decision making, women believing their partners favored contraceptive use (aOR, 2.01), relationships lasting 2 or more years (aOR, 1.98), and ethnicity/race (Latina aOR, 0.27; other race aOR , 0.45) were associated with effective contraceptive use.

CONCLUSION

Providers and those developing interventions must recognize that some women who are "not trying to get pregnant" have weak motivations to avoid pregnancy, and so should help women to clarify their motivations and seek support from their partners for contraceptive use. To understand the role of pregnancy motivations, future research may include both qualitative and longitudinal quantitative studies.