Meeting 24-hour movement guidelines: Their relationships with overweight and obesity among Chinese children with autism spectrum disorder

BackgroundCanada's and Australia's 24-hour movement guidelines for children and youth provide daily recommendations for physical activity (PA), screen time (ST), and sleep for optimal health. Previous studies have examined the associations between meeting these 24-hour movement guidelines and overweight and obesity among children without disabilities. Less is known about potential associations between the 24-hour movement behaviors and the weight status of children with disabilities.Therefore, the purpose of this study was to examine whether meeting movement behavior recommendations (i.e. ≥ 60 min of Moderate-to-vigorous activity [MVPA] per day, ≤ 2 h of recreational ST per day, and 9–11 h of sleep for those aged 5–13 years [or 8–10 h for children aged 14–17 years]), and combinations of these recommendations, are associated with overweight and obesity in Chinese children with ASD.MethodParticipants were 99 children with autism spectrum disorder (ASD) 7–17 years old recruited from one Chinese special school. MVPA and nightly sleep duration were measured using 24-hour wrist-worn accelerometer. ST was reported by parents by using reliable and valid items derived from the Health Behavior in School-aged Children (Chinese version). A series of binary logical regression analyses were performed for analysis.ResultsOnly 16.2% met all the three movement behavior recommendations. The proportions of children with ASD who met the recommendation for PA, ST, and sleep were 32.3%, 52.5%, and 65.7%, respectively. The children with ASD who met the MVPA (OR = 0.37, 95% CI: 0.15–0.94), MVPA + Sleep (OR = 0.27, 95% CI: 0.09–0.81), and all three 24-hour movement guidelines (OR = 0.14, 95% CI: 0.03–0.77), had significantly lower odds ratios for overweight/obesity than those who did not meet the respective recommendations.ConclusionsMeeting the MVPA, MVPA + Sleep, and all three of the guidelines was associated with lower odds ratios for overweight and obesity in children with ASD, and MVPA was the single most important activity for weight control among this population. Therefore, meeting the 24-hour movement guidelines, especially the MVPA guideline should be considered an effective intervention and can inform the design of strategies and policies for the prevention of overweight and obesity in children with ASD.     

The Canadian 24-Hour Movement Guidelines and Psychological Distress among Adolescents: Les Directives canadiennes en matière de mouvement sur 24 heures et la détresse psychologique chez les adolescents

Objective:The Canadian 24-Hour Movement Guidelines for Children and Youth recommend at least 60 minutes of physical activity per day, 2 hours or less of recreational screen time per day, and 9 to 11 hours of sleep per night for 5 to 13 years old and 8 to 10 hours per night for 14 to 17 years old. This study examined the association between meeting these guidelines and psychological distress among adolescents.Methods:The present cross-sectional sample included 6,364 students aged 11 to 20 years from the 2017 Ontario Student Drug Use and Health Survey. This provincially representative school-based survey is based on a 2-stage cluster design. A confirmatory factor analysis (CFA) was first conducted to confirm the factor structure of the K6, and structural equation modeling adjusted for age, sex, ethnoracial background, subjective socioeconomic status, and body mass index z-score was used to investigate the association between meeting the 24-Hour Movement Guidelines and K6 factors among adolescents.Results:The CFA demonstrated that a 2-factor model (representing anxiety and depressive symptoms) of the K6 fit the data well. The anxiety and depression items demonstrated a composite reliability (Cronbach’s α) of 0.86 and 0.83, respectively, indicating a high level of internal consistency. Compared to meeting none of the recommendations, meeting all 3 movement behavior recommendations was associated with lower anxiety (β = −0.076; P = 0.028) and depressive symptoms (β = −0.067; P = 0.028). Meeting the screen time + sleep duration recommendations had the strongest association with anxiety (β = −0.157; P < 0.001) and depressive symptoms (β = −0.139; P < 0.001), followed by meeting the sleep duration recommendation only for both anxiety (β = −0.135; P < 0.001) and depressive symptoms (β = −0.106; P < 0.001).Conclusions:Meeting the 24-Hour Movement Guidelines was associated with lower anxiety and depressive symptoms among adolescents, and these associations appear mainly driven by meeting the sleep duration recommendation.     

Muscle-Strengthening Exercise Links with Lower Odds for Depression in Adolescents

Purpose: Physical activity is a well-recognized protective factor against depression in adolescents. As a component of physical activity, muscle strengthening exercise (MSE) is also viewed as a correlate associated with lower risks of depression in adults. However, little is known about the association in adolescents. This study aimed to explore the association between MSE and depression in a sample of Chinese adolescents. Method: A self-reported questionnaire was used for data collection including variables of MSE, depression (assessed by Children’s Depression Inventory) and selected sociodemographic factors (e.g., sex, grade, height and weight [for body mass index]). Generalized Linear Models was utilized to estimate the association between MSE and depression. Results: Results showed a negative association between MSE and depression (Beta = –0.66; both MSE and depression were treated as continuous variables). When treating MSE (meeting or not meeting the recommendations) and depression as binary variables, odds ratio for depression in adolescents not meeting the MSE recommendation was significant higher (odd ratio = 1.50, 95%CI: 1.15–1.96) than those meeting the MSE recommendations. Conclusions: This study found that MSE may be a protective factor against MSE in adolescents. Future studies are encouraged to confirm or negate our study finding using improved study design.     

Association between Active School Travel and Depressive Symptoms among 51,702 Adolescents in 26 Low- and Middle-Income Countries

Little is known about the role of active school travel (AST) on mental health among adolescents. Thus, this study aimed to explore the AST-depression association among adolescents aged 12–15 years from 26 low- and middleincome countries (LMICs). Data from the Global School-based Student Health Survey were analyzed in 51,702 adolescents [mean (SD) age 13.8 (1.0) years; 49.3% boys). Both depressive symptoms and AST were assessed by a single question self-reported measure, respectively. Participants who reported having 5 days or above were considered as AST. Multivariable logistic regression analysis (accounting for sampling weights) was performed while controlling for gender, age, physical activity, sedentary behavior, and food insecurity, and a countrywide meta-analysis was undertaken. The prevalence of depressive symptoms and AST were 30.1% and 37.0%, respectively. Compared with those not having AST, adolescents with AST were less likely to have self-reported depressive symptoms (OR = 0.88, 95%CI: 0.85-0.93) regardless of gender. Countrywide meta-analysis demonstrated that having AST versus not having AST was associated with 12% lower odds for depressive symptoms (OR = 0.88; 95%CI: 0.82-0.94) but with a moderate between-country heterogeneity (I² = 59.0%). Based on large samples of adolescents from LMICs, it would be expected that AST may play a critical role in preventing adolescent depression worldwide. However, it is necessary to consider more country-specific factors when implementing AST-related mental health interventions. Future studies should adopt the solid study design to confirm or negate our research findings.     

Association between short sleep duration and metabolic syndrome in Chinese children and adolescents

BackgroundThe relationship between short sleep duration and metabolic syndrome (MetS) in children and adolescents has been inconsistent. This study aimed to examine the association between short sleep duration and MetS in Chinese children and adolescents.MethodsData were from a cross-sectional survey conducted in Jinan, China between September 2013 and November 2014. A total of 1008 children and adolescents aged 6–17 years were included. Sleep duration was self-reported by participants and categorized as normal or short (<9 h in children aged 6–12 years or <8 h in adolescents aged 13–17 years) according to the recommendations of the American Academy of Sleep Medicine. MetS was defined based on the modified criteria of the National Cholesterol Education Program Adult Treatment Panel III.ResultsAfter adjusted for sex, age, parental education levels, and midpoint of sleep, compared with normal sleep duration, short sleep duration was associated with increased odds of MetS (odds ratio [OR]: 1.79, 95% confidence interval [CI]: 1.09–2.95) and abdominal obesity (OR: 1.60, 95% CI: 1.14–2.25). In the subgroups stratified by age and sex, compared with normal sleep duration, short sleep duration was associated with increased odds of abdominal obesity (OR: 2.34, 95% CI: 1.07–5.13) in girls aged 6–12 years; short sleep duration was associated with increased odds of MetS (OR: 2.49, 95% CI: 1.06–5.84), abdominal obesity (OR: 2.30, 95% CI: 1.10–4.82), and high TG (OR: 2.63, 95% CI: 1.11–6.21) in boys aged 13–17 years.ConclusionsShort sleep duration associated with higher odds for MetS in Chinese children and adolescents. Interventions to improve sleep duration could help prevent and control MetS among children and adolescents.     

中国汉族人群PARK16基因多态性与帕金森病易患性的关联

目的 探讨PARK16基因单核苷酸多态性(SNP)与帕金森病(PD)易患性的关系,分析其SNP的基因型和等位基因频率及不同基因型的优势比(OR)和其临床特征.方法 采用病例-对照研究选择PD患者226例和362名健康对照,利用TaqMan荧光定量PCR方法检测中国汉族人群中PARKl6基因Rs947211和Rs823128基因多态性,并对不同基因型临床资料进行分析.结果 PARKl6基因的多态性位点Rs947211在PD组基因型频率为∶GG 34.1%(77/226)、AG 46.0%(104/226)、AA 19.9%(45/226),对照组分别为23.8%(86/362)、53.0%(192/362)、23.2%(84/362),2组基因型频率差异具有统计学意义(以野生型GG为参考,AG∶OR=0.57,95%CI 0.38～0.85,P=0.006;AA∶OR=0.55.95%CI,0.34～0.85,P=0.015).以PD组野生型GG为参照,暴露于A等位基因型(AA+AG)的OR=0.56,95%CI0.38～0.82,P=0.003.晚发型PD(LOPD)Rs947211的基因型频率与对照组比较差异亦有统计学意义(AG∶OR=0.46,95%C/0.27～0.78,P=0.004∶AA∶OR=0.35,95%C/0.18～0.68,P=0.002).PD组3种基因型在临床表现上差异没有统计学意义.Rs823128在PD组基因型频率分布与对照组差异无统计学意义(以野生型AA为参照,AG∶OR=1.12,95%CI0.75～1.68,P=0.568;GG∶OR=0.99,95%CI0.35～2.76,P=0.994).结论 中国汉族人群中PARK16基因与PD易患性相关.

Abstract：

Objective To investigate the association between PARK16 gene polymorphism and Parkinson's disease(PD)susceptibility in Chinese Han population.and to analyze its single-nucleotide polymorphism(SNP)genotypes,frequencies and odds ratios(OR)of different genotypes.Methods The association between two SNP loci in PARK16 gene(Rs947211,Rs823128)and PD susceptibility was investigated by TaqMan quantitative polymerase chain reaction(PCR)in 226 PD patients and 362 healthy controls.Allele and genotype frequencies were calculated by the Chi-square test,and the clinical data were also analyzed.Results Three genotypes of Rs947211(GG,AG and AA)account for 34.1%(77/226),46.0%(104/226),19.9%(45/226)in the PD group,and 23.8%(86/362),53.0%(192/362),23.2%(84/362)in the control group,respectively.There was significant difference between two groups (P<0.05).Setting the GG genotype as the reference,OR values of AG and AA genotype were 0.57(95%CI0.38-0.85,P=0.006)and 0.55(95%CI 0.34-0.85,P=0.015),while the OR value for exposure to the A allele(AA+AG)was 0.56(95%CI0.38-0.82,P=0.003).Genotypes of Iate-onset PD were also significantly different from the controls(OR valne of AG=0.46,95%CI 0.27-0.78,P=0.004:OR value of AA=0.35.95%CI 0.18-0.68,P=0.002).And there was no diffefence in clinical features among the 3 genotypes. The frequency of Rs823128, another locus, in PD group was not significantly different from the control group( AA genotype as the reference, OR value of AG was 1. 12, 95% CI 0. 75-1.68, P = 0.568; OR value of GG was 0.99, 95% CI 0.35-2.76, P = 0.994). Conclusion Polymorphism of PARK 16 locus Rs947211 is associated with PD patients in Chinese Han population.     

The efficacy and safety of lamotrigine for absence seizures in children and adolescents: A systematic review and meta-analysis

AimsThis systematic review and meta-analysis of randomized controlled trials (RCTs) systematically explored the effectiveness and safety of lamotrigine for absence seizures in children and adolescents.MethodsKeywords searches were conducted in Pubmed Embase Cochrane Central Register of Controlled Trials Wanfang CNKI from inception through March 2019. The RCTs comparing lamotrigine with other drugs and/or placebo for the treatment of absence seizures in children and adolescents were considered in this study. The study was conducted adhering to PRISMA guidelines.ResultsEight RCTs (n = 787) were included in our study. Among these studies, one study (N = 45 patients) used placebo as a control and seven studies (N = 742 patients) used positive drug controls. For effectiveness, there was significant difference between lamotrigine and valproate [OR = 0.42, 95%CI (0.28–0.63), I² = 0%] or ethosuximide [OR = 0.34, 95%CI (0.22–0.53), I² = 0%]. For adverse effects (AEs), there was no significant difference between lamotrigine and valproate [OR = 1.17, 95%CI (0.59, 2.32), I² = 0%] or ethosuximide [OR = 0.75, 95%CI (0.47, 1.19), I² = 92%], and the most common adverse effects of lamotrigine were Rash (7.88%), Fatigue (6.50%) and Headache (6.50%).ConclusionsAccording to current evidence, LTG is less effective than VPA and ESM, however, based on its relative safety, LTG might be reasonably tried as initial therapy in children and adolescents at risk of significant adverse effects from VPA and ESM, and future well-designed studies are needed to confirm our findings.     

Associations of Sport Participation with Depression and Anxiety among Chinese Minority Adolescents

This study aimed to explore associations of sport participation with anxiety and depressive symptoms among Chinese minority adolescents. A cross-sectional study was conducted among Chinese adolescents in Tibet. A convenience sample method was used to select participants. Finally, 1452 students completed the survey and 1421 (52.10% girls, Grades 4–9, 13.46 ± 1.41 years old) adolescents met the inclusion criteria of analysis. Sociodemographic variables, sport participation, depression and anxiety were evaluated by self-reported questionnaires. Among 1421 participants, 80% of adolescents lived in rural area and more than four fifths of participants had siblings. The parent’s education level of participants was mostly middle school and below. The prevalence of participating in sport more than 3 times per week was only 7%. More than one-third of adolescents reported they never engaged in sport and 36.5% of adolescents took part in sport 1–3 times per month. In comparison with participants who never engaging in sport participation, those who engaging in one to three time/month (OR = 0.71%, 95% CI: 0.54–0.93) and more than 3 times/week (OR = 0.50%, 95% CI: 0.32–0.79) were less likely to report severe depression symptoms. Compared with participants who never had sport participation, only those counterparts who engaged in sport more than 3 times/week had lower odds for severe anxiety (OR = 0.46%, 95% CI: 0.29–0.73). These results indicated that engaging in sport participation was negatively associated with depression and anxiety. There is an urgent need to improve the level of sport participation for Chinese minority adolescents, and to explore the mechanism of exercise under hypoxia on mental health.     

Last night's sleep in relation to academic achievement and neurocognitive testing performance in adolescents with and without ADHD

Objectives/backgroundObjectives were to (1) examine previous night's sleep in relation to next day performance on standardized academic achievement and neurocognitive assessments in adolescents, and (2) explore whether previous night's sleep is differentially associated with testing performance for adolescents with and without attention-deficit/hyperactivity disorder (ADHD).Participants/methodsParticipants were 300 adolescents (ages 12–14 years; 55% male). Approximately half (53.6%) were diagnosed with ADHD. Adolescents provided ratings of their previous night's sleep quality, sleep duration, and number of night wakings and were administered standardized tests of processing speed and working memory, as well as word reading, numerical operations, and math fluency academic achievement.ResultsIn analyses controlling for sex, race, medication use, time of testing, and ADHD group status, more night wakings the previous night were associated with significantly lower numerical operations and math fluency achievement scores and marginally lower working memory scores. Previous night's sleep was not associated with processing speed or reading achievement. ADHD status did not moderate sleep in relation to academic/neurocognitive performance. Participants reporting ≥2 night wakings the previous night had slightly over half a standard deviation lower scores on average compared to participants reporting 0 night wakings.ConclusionsThis preliminary study suggests that previous night's wakings are associated with poorer mathematics performance the next day, regardless of ADHD status. This may be due to the detrimental effect of interrupted and fragmented sleep on attention and executive control. These findings have implications for clinicians and educators when considering contextual factors that may impact academic and neurocognitive testing performance.     

A Cross-Sectional Analysis of Differences in Physical Activity Levels between Stroke Belt and Non-Stroke Belt US Adults

Background: The Stroke Belt is a region of the United States with elevated stroke incidence and prevalence of stroke risk factors. Physical inactivity is an important stroke risk factor, but little is known about whether current physical activity levels differ between Stroke Belt and non-Stroke Belt states. In this nationally representative study, we determined whether unadjusted and adjusted physical activity levels differ between the Stroke Belt region and the rest of the United States. Methods: Using 2017 Behavioral Risk Factor Surveillance System data, we conducted bivariate analyses to obtain unadjusted physical activity levels in Stroke Belt and non-Stroke Belt states. Logistic regressions that controlled for sociodemographic and stroke risk factors were created to estimate adjusted associations between Stroke Belt residence and physical activity. Results: A higher percentage of Stroke Belt residents were inactive (Stroke Belt: 35.3%, non-Stroke Belt: 29.4%) and failed to meet physical activity guidelines (Stroke Belt: 53.7%, non-Stroke Belt: 47.8%) compared to non-Stroke Belt residents. Stroke Belt residence was significantly associated with lower odds of meeting physical activity guidelines in a model that adjusted for sociodemographic factors only (odds ratio [OR]: 0.85, 95% confidence interval [CI]: 0.78-0.91) and one that adjusted for both sociodemographic and stroke risk factors (OR: 0.87, 95% CI: 0.81-0.93). Conclusions: The considerably lower physical activity levels and likelihood of meeting physical activity guidelines in Stroke Belt residents compared to their non-Stroke Belt counterparts demonstrates a need for clinician attention and public health interventions to increase regular physical activity as part of a stroke reduction strategy in this region.     

非心源性缺血性卒中近期再发危险因素分析

目的 探讨首发非心源性缺血性卒中且二级预防药物依从性好的患者近期再发的相关危险因素。      

卒中后睡眠障碍相关危险因素的Meta分析

【摘要】
目的 通过对卒中后睡眠障碍相关文献进行分析,分析卒中后睡眠障碍的常见危险因素。
方法 采用Meta分析方法,对符合条件的11篇有关卒中后睡眠障碍危险因素的文献进行定量分析,对每个危险因素进行异质性检验以及合并优势比（odds ratio,OR）和95％可信区间（confidence interval,CI）的计算。
结果 有5个因素与卒中后睡眠障碍有统计学意义,分别是：习惯性打鼾（OR 14.77,95％CI 5.52～39.53）、高血压（OR 1.3,95％CI 1.03～1.66）、糖尿病（OR 1.41,95％CI 1.08～1.84）、饮酒（OR 1.59,95％CI 1.19～2.12）、皮质型卒中（OR 1.31,95％CI 1.06～1.63）,合并结果稳定性较好。尚不能确定性别（OR 1.12,95％CI 0.96～1.31）、高血脂（OR 0.96,95％CI 0.7～1.33）、吸烟（OR 1.27,95％CI 0.73～2.20）、卒中史（OR 1.05,95％CI 0.74～1.49）与卒中后睡眠障碍有关。
结论 现有的证据表明高血压、糖尿病、饮酒、习惯性打鼾及皮质型卒中是卒中后睡眠障碍的危险因素。     

Association between short time in bed,health-risk behaviors and poor academic achievement among Norwegian adolescents

ObjectiveTo investigate the prevalence of short time in bed (<8 h/day) and to examine the association between time in bed, overweight/obesity, health-risk behaviors and academic achievement in adolescents.MethodsThis study included a sample of adolescents (n = 2432) aged 15–17 years in the southern part of Norway (participation rate, 98.7%). A self-report questionnaire was used to assess time in bed, body mass index, dietary habits, physical activity habits, sedentary behavior, smoking and snuffing habits, and academic achievement.ResultsA total of 32.3% of the students reported short time in bed (<8 h/day) on an average school night. Several health-risk behaviors were associated with short sleep duration, including not being physically active for ⩾60 min for ⩾5 days/week (adjusted odds ratio, 1.33; 95% confidence interval, 1.05–1.68); using television/computer >2 h/day (1.63; 1.23–2.17); being a current smoker (2.46; 1.80–3.35) or snuffer (2.11; 1.57–2.85); having an irregular meal pattern (1.33; 1.05–1.68); intake of sweets/candy ⩾4 times/week (0.51; 0.32–0.83); and poor academic achievement (1.62; 1.26–2.09). All odds ratios were adjusted for sex, age and parental education.ConclusionsIn Norwegian adolescents, short time in bed is associated with several health-risk behaviors and poor academic achievement.     

Cardiac autonomic dysfunction and functional outcome after ischaemic stroke

ischaemic stroke has been associated with an impairment of cardiac autonomic balance. The aim of this study was to assess the impact of cardiac autonomic derangement on functional outcome after a rehabilitation program in patients with recent ischaemic stroke. The study population included 85 consecutive first-ever stroke survivors (46 men and 39 women; mean age 60.0 ± 12.4 years), who underwent 24-h Holter monitoring before the beginning of a 60-day rehabilitation program. Time-domain measures of heart-rate variability (HRV) were considered in all cases. By the end of the rehabilitation program an unfavorable functional outcome with dependency (Barthel Index score of <75) was found in 44.7% of patients. Multivariate analysis demonstrated that age [odds ratio (OR) 1.09, 95% CI 1.04–1.19, P  = 0.002], stroke severity (OR 1.12, 95% CI 1.01–1.34, P  = 0.004), Barthel Index score (OR 0.92, 95% CI 0.87–0.98, P  = 0.01) and Rankin Scale score (OR 3.88, 95% CI 2.13–7.56, P  = 0.02) on admission, as well as lower values of the standard deviation of normal-to-normal R wave to R wave (RR) intervals (OR 9.67, 95% CI 2.58–18.67, P  = 0.006) were independent predictors of an unfavorable functional outcome. Assessment of HRV before a rehabilitation program may provide additional information on the probability of a functional recovery in stroke survivors.     

The associations between sleep situations and mental health among Chinese adolescents: A longitudinal study

ObjectiveFew studies are conducted to explore the longitudinal relationships between sleep situations and mental health among adolecents. This study aimed to explore the sleep situations (ie, sleep habits and sleep problems) among Chinese adolescents and the longitudinal associations between sleep situations and mental disorder symptoms (ie, depressive and anxiety symptoms).MethodsThis longitudinal study included 1957 high school students from ten schools in Guangzhou in January 2019, with 1836 students contributing valid data at a one-year follow-up (retention rate: 93.9%). Data of depressive and anxiety symptoms, sleep habits, and sleep problems were collected using a self-reported questionnaire.ResultsThe current study found that over half of the adolescents did not reach the recommended 8-h sleep-time on weekdays (63.3%). Short sleep duration, especially on weekdays, was significantly associated with subsequent depressive (AOR = 0.86, 95%CI: 0.80–0.92) and anxiety symptoms (AOR = 0.86, 95%CI: 0.77–0.96). In addition, longer weekday-weekend catch-up sleep and more sleep problems were risk factors of depressive and anxiety symptoms.ConclusionsThe health effects of insufficient sleep and suboptimal sleep quality on adolescents should not be neglected. Our longitudinal research showed that adolescents would demonstrate severer depressive and anxiety symptoms if lacking of a healthy sleeping practice. A regular sleep schedule and close attention to adolescents’ mental disorders are highly recommended.     

A pilot study on systemic thrombolysis followed by low molecular weight heparin in ischemic stroke

Low molecular weight heparin (LMWH) administered immediately after intravenous thrombolysis (IT) may reduce the risk of arterial re-occlusion. Its benefit, however, may not outweigh the risk of intracranial hemorrhage (ICH). We sought preliminary data regarding safety of this combined therapy in an open-label, non-randomized study. The patients received either a standard anticoagulation (AC) starting 24 h after IT (the standard AC group) or AC with 2850 IU of nadroparin, given every 12 h immediately after IT (the early AC group). Sixty patients received IT treatment: 25 in the standard AC group [mean age 66, median National Institutes of Health Stroke Scale (NIHSS) 13, 64% men] and 35 in the early AC group (mean age 68, median NIHSS 13, 69% men). Symptomatic ICH occurred in one patient (4%) in the standard AC group and three patients (8.6%) in the early AC group [odds ratio (OR) 1.8; 95%CI 0.2–12.8]. At 3 months, nine patients in the standard AC group (36%) and 16 patients in the early AC group (45.7%) achieved a modified Rankin scale 0 or 1 (OR 1.2; 95%CI 0.5–3.2). Our study suggests that treatment with LMWH could be associated with higher odds of ICH, although it may not necessarily lead to a worse outcome. This justifies larger clinical trials.     

Prevalence of substance use among moroccan adolescents and association with academic achievement

AIM: To investigate rates of drug and alcohol use and their association with academic performance in Moroccan youth.METHODS: An adapted version of the European School Project on Alcohol and Other Drugs survey was administered to 2139 10^th-12^th graders in 36 Moroccan public high schools. Two multiple logistic regressions were completed, one for male and one for female subjects. Grade average was used as a two-part outcome variable, and drug use was used as a four-level categorical independent variable. Parents’ education levels and socioeconomic status were included as covariates.RESULTS: Of the subjects, 181 girls (16%) and 390 boys (40%) reported ever having used alcohol, hashish, or psychotropic drugs. Girls who had used any of those substances in the past 30 d demonstrated an adjusted odds ratio (AOR) of 2.62 (95%CI: 1.31-5.22) of having average or below-average grades, and those with any lifetime use showed an AOR of 1.72 (95%CI: 1.07-2.77). Among the boys, use in the past 30 d was associated with an AOR of 2.08 (95%CI: 1.33-3.24) of average or below average grades, and use in the last 12 mo with an AOR of 1.74 (95%CI: 1.00-3.05). Any lifetime use among male and previous 12 mo use among female subjects were not significantly associated with academic achievement.CONCLUSION: Among Moroccan adolescents, drug use is substantially different between boys and girls. In both genders, lower academic achievement was associated with alcohol, hashish, or psychotropic drug use in the last 30 d.     

Diurnal Blood Pressure and Heart Rate Variability in Hypertensive Patients with Cerebral Small Vessel Disease: A Case-Control Study

BackgroundWhether autonomic dysfunction contributes to cerebral small vessel disease (CSVD) remains unclear. This study aimed to explore the relationship between CSVD and blood pressure variability (BPV) and heart rate variability (HRV).MethodsThis case-control study recruited 50 patients with CSVD and 50 non-CSVD hypertensive age- and gender-matched controls. All participants completed a 24-h ambulatory electrocardiogram recording and ambulatory BP monitoring (ABPM). Differences in HRV and BPV between the two groups were examined. BPV indices assessed by ABPM included mean systolic BP (SBP), mean diastolic BP (DBP), coefficient of variation and weighted standard deviation of SBP and DBP.ResultsCSVD patients had significant higher 24-h mean systolic BP (SBP), 24-h mean diastolic BP (DBP), daytime mean SBP, nocturnal mean SBP, and nocturnal mean DBP (P < .05 for all). CSVD patients had a significant lower nocturnal SBP fall rate compared with controls (median: 1.0 versus 6.2, respectively; P < .001) and were more likely to be non-dippers and reverse dippers. There were no differences in HRV variables between the two groups. Five logistic models were built to explore the correlations between BPV indices and CSVD. BPV indices were separately entered into the logistic regression models, together with hyperlipidemia, ischemic stroke history, current use of anti-hypertensive agents, and serum blood urea nitrogen. In models 1?3, 24-h mean SBP and nocturnal mean SBP and DBP were significantly correlated with CSVD (r² = 0.308?0.340). In model 4, the nocturnal SBP fall rate was negatively correlated with CSVD (odds ratio [OR] = 0.871, 95% confidence interval [CI] = 0.804?0.943; P = .001), with r² = 0.415 fitting the model. In model 5, the pattern of SBP dipping was significantly associated with CSVD, with non-dipper (OR = 8.389, 95%CI = 1.489?47.254; P = .016) and reverse dipper (OR = 27.008, 95%CI = 3.709?196.660; P = .001) having the highest risks of CSVD (r² = 0.413).ConclusionsLower nocturnal SBP fall rate is associated with CSVD. Non-dipper and reverse dipper hypertensive patients have a higher risk of CSVD.     

Associations of self-reported sleep disturbance and duration with academic failure in community-dwelling Swedish adolescents: Sleep and academic performance at school

ObjectiveTo examine associations of self-reported sleep disturbance and short sleep duration with the risk for academic failure.MethodsA cohort of ~40,000 adolescents (age range: 12–19 years) who were attending high school grades 7, 9, and 2nd year of upper secondary school in the Swedish Uppsala County were invited to participate in the Life and Health Young Survey (conducted between 2005 and 2011 in Uppsala County, Sweden). In addition to the question how many subjects they failed during the school year (outcome variable), subsamples of adolescents also answered questions related to subjective sleep disturbance (n = 20,026) and habitual sleep duration (n = 4736) (exposure variables). Binary logistic regression analysis was utilized to explore if self-reported sleep disturbances and habitual short sleep duration (defined as less than 7–8 h sleep per night) increase the relative risk to fail subjects during the school year (controlled for possible confounders, e.g. body-mass-index).ResultsAdolescents with self-reported sleep disturbances had an increased risk for academic failure (i.e., they failed at least one subject during the school year; OR: boys, 1.68; girls, 2.05, both P < 0.001), compared to adolescents without self-reported sleep disturbances. In addition, adolescents who reported short sleep duration on both working and weekend days were more likely to fail at least one subject at school than those who slept at least 7–8 h per night (OR: boys, 4.1; girls, 5.0, both P < 0.001).ConclusionOur findings indicate that reports of sleep disturbance and short sleep duration are linked to academic failure in adolescents. Based on our data, causality cannot be established.     

Effect of Sleep-Disordered Breathing During Rapid Eye Movement Sleep and Non-Rapid Eye Movement sleep on Acute Ischemic Stroke

ObjectivesSleep-disordered breathing adversely impacts stroke outcomes. We investigated whether sleep-disordered breathing during rapid eye movement sleep and non-rapid eye movement sleep differentially influenced stroke outcomes.Materials and MethodsAcute ischemic stroke patients who finished polysomnography within 14 days of stroke onset from April 2010 to August 2018 were reviewed. Patients were divided into four groups according to apnea-hypopnea index during rapid eye movement sleep and non-rapid eye movement sleep. The modified Rankin Scale was used to evaluate short-term outcome. During January and April 2019, another follow-up was performed for long-term outcomes, including stroke-specific quality-of-life scale, modified Rankin Scale, stroke recurrence and death.ResultsOf 140 patients reviewed, 109 were finally recruited. Although patients with sleep-disordered breathing during non-rapid eye movement sleep only and with sleep-disordered breathing during both rapid eye movement sleep and non-rapid eye movement sleep had higher apnea-hypopnea indices and more disrupted sleep structures, short-term and long-term outcomes did not significantly different between four groups. In Logistic regression analysis, apnea-hypopnea index (p = 0.013, OR 1.023, 95%CI 1.005–1.042) was found independently associated with short-term outcome. Rapid eye movement sleep latency (p = 0.045, OR 0.994, 95%CI 0.987–1.000) was found independently associated with quality of life. Apnea-hypopnea indices during rapid eye movement sleep or non-rapid eye movement sleep were not significantly associated with short-term or long-term outcomes.ConclusionsApnea-hypopnea index is an independent risk factor of short-term outcome of acute ischemic stroke while sleep-disordered breathing during rapid eye movement sleep and non-rapid eye movement sleep do not affect stroke outcomes differently.