BACKGROUND Childhood trauma and parental socialization have been postulated as environmental factors of at-risk mental state(ARMS).Parental socialization is the process through which parents shape children’s self-reg...BACKGROUND Childhood trauma and parental socialization have been postulated as environmental factors of at-risk mental state(ARMS).Parental socialization is the process through which parents shape children’s self-regulation by providing guidance and protection.Although the impact of trauma on ARMS has been theorized,its clinical implications have not yet been fully clarified in adolescence,nor have explanatory models of parenting styles been established.AIM To investigate the role of traumatic experiences in the appearance of ARMS in the general adolescent population,considering the influence of parental socialization.METHODS A cross-sectional study of 697 adolescents aged 11-15 years was conducted,during which several questionnaires assessing childhood trauma,psychotic symptoms,and parenting styles were administered.The sample was divided into control,low-risk,medium-risk,and high-risk groups.RESULTS Some 2.8%(n=19)of the adolescents presented ARMS and the presence of childhood trauma was associated with an increased risk of ARMS.Furthermore,the presence of abuse was greater in the high-risk and low-risk groups compared to controls.Regarding parental socialization,it was determined that a family socialization style based on greater affection–communication decreased the probability of ARMS.Finally,using PROCESS model 1(regressionbased path analysis that uses ordinary least squares regression),results suggested that low levels of affection and communication may mediate the relationship between childhood trauma and ARMS in adolescents.CONCLUSION These results highlight the importance of the early detection of trauma in preventing ARMS,without forgetting the importance of socialization styles.展开更多
BACKGROUND Esophageal variceal bleeding is a severe complication associated with liver cirrhosis and typically necessitates endoscopic hemostasis.The current standard treatment is endoscopic variceal ligation(EVL),and...BACKGROUND Esophageal variceal bleeding is a severe complication associated with liver cirrhosis and typically necessitates endoscopic hemostasis.The current standard treatment is endoscopic variceal ligation(EVL),and Western guidelines recom-mend antibiotic prophylaxis following hemostasis.However,given the impro-vements in prognosis for variceal bleeding due to advancements in the management of bleeding and treatments of liver cirrhosis and the global concerns regarding the emergence of multidrug-resistant bacteria,there is a need to reassess the use of routine antibiotic prophylaxis after hemostasis.AIM To evaluate the effectiveness of antibiotic prophylaxis in patients treated for EVL.METHODS We conducted a 13-year observational study using the Tokushukai medical database across 46 hospitals.Patients were divided into the prophylaxis group(received antibiotics on admission or the next day)and the non-prophylaxis group(did not receive antibiotics within one day of admission).The primary outcome was composed of 6-wk mortality,4-wk rebleeding,and 4-wk spontaneous bacterial peritonitis(SBP).The secondary outcomes were each individual result and in-hospital mortality.A logistic regression with inverse probability of treatment weighting was used.A subgroup analysis was conducted based on the Child-Pugh classification to determine its influence on the primary outcome measures,while sensitivity analyses for antibiotic type and duration were also performed.RESULTS Among 980 patients,790 were included(prophylaxis:232,non-prophylaxis:558).Most patients were males under the age of 65 years with a median Child-Pugh score of 8.The composite primary outcomes occurred in 11.2%of patients in the prophylaxis group and 9.5%in the non-prophylaxis group.No significant differences in outcomes were observed between the groups(adjusted odds ratio,1.11;95%confidence interval,0.61-1.99;P=0.74).Individual outcomes such as 6-wk mortality,4-wk rebleeding,4-wk onset of SBP,and in-hospital mortality were not significantly different between the groups.The primary outcome did not differ between the Child-Pugh subgroups.Similar results were observed in the sensitivity analyses.CONCLUSION No significant benefit to antibiotic prophylaxis for esophageal variceal bleeding treated with EVL was detected in this study.Global reassessment of routine antibiotic prophylaxis is imperative.展开更多
基金Supported by Universidad Cardenal Herrera-CEU,CEU Universities,No.GIR24/27。
文摘BACKGROUND Childhood trauma and parental socialization have been postulated as environmental factors of at-risk mental state(ARMS).Parental socialization is the process through which parents shape children’s self-regulation by providing guidance and protection.Although the impact of trauma on ARMS has been theorized,its clinical implications have not yet been fully clarified in adolescence,nor have explanatory models of parenting styles been established.AIM To investigate the role of traumatic experiences in the appearance of ARMS in the general adolescent population,considering the influence of parental socialization.METHODS A cross-sectional study of 697 adolescents aged 11-15 years was conducted,during which several questionnaires assessing childhood trauma,psychotic symptoms,and parenting styles were administered.The sample was divided into control,low-risk,medium-risk,and high-risk groups.RESULTS Some 2.8%(n=19)of the adolescents presented ARMS and the presence of childhood trauma was associated with an increased risk of ARMS.Furthermore,the presence of abuse was greater in the high-risk and low-risk groups compared to controls.Regarding parental socialization,it was determined that a family socialization style based on greater affection–communication decreased the probability of ARMS.Finally,using PROCESS model 1(regressionbased path analysis that uses ordinary least squares regression),results suggested that low levels of affection and communication may mediate the relationship between childhood trauma and ARMS in adolescents.CONCLUSION These results highlight the importance of the early detection of trauma in preventing ARMS,without forgetting the importance of socialization styles.
基金approved by the Institutional Review Board of the Future Medical Research Centre Ethical Committee(Approval No.TGE02100-02).
文摘BACKGROUND Esophageal variceal bleeding is a severe complication associated with liver cirrhosis and typically necessitates endoscopic hemostasis.The current standard treatment is endoscopic variceal ligation(EVL),and Western guidelines recom-mend antibiotic prophylaxis following hemostasis.However,given the impro-vements in prognosis for variceal bleeding due to advancements in the management of bleeding and treatments of liver cirrhosis and the global concerns regarding the emergence of multidrug-resistant bacteria,there is a need to reassess the use of routine antibiotic prophylaxis after hemostasis.AIM To evaluate the effectiveness of antibiotic prophylaxis in patients treated for EVL.METHODS We conducted a 13-year observational study using the Tokushukai medical database across 46 hospitals.Patients were divided into the prophylaxis group(received antibiotics on admission or the next day)and the non-prophylaxis group(did not receive antibiotics within one day of admission).The primary outcome was composed of 6-wk mortality,4-wk rebleeding,and 4-wk spontaneous bacterial peritonitis(SBP).The secondary outcomes were each individual result and in-hospital mortality.A logistic regression with inverse probability of treatment weighting was used.A subgroup analysis was conducted based on the Child-Pugh classification to determine its influence on the primary outcome measures,while sensitivity analyses for antibiotic type and duration were also performed.RESULTS Among 980 patients,790 were included(prophylaxis:232,non-prophylaxis:558).Most patients were males under the age of 65 years with a median Child-Pugh score of 8.The composite primary outcomes occurred in 11.2%of patients in the prophylaxis group and 9.5%in the non-prophylaxis group.No significant differences in outcomes were observed between the groups(adjusted odds ratio,1.11;95%confidence interval,0.61-1.99;P=0.74).Individual outcomes such as 6-wk mortality,4-wk rebleeding,4-wk onset of SBP,and in-hospital mortality were not significantly different between the groups.The primary outcome did not differ between the Child-Pugh subgroups.Similar results were observed in the sensitivity analyses.CONCLUSION No significant benefit to antibiotic prophylaxis for esophageal variceal bleeding treated with EVL was detected in this study.Global reassessment of routine antibiotic prophylaxis is imperative.
