Adolescent ecstasy use and depression: cause and effect, or two outcomes of home environment?

Background: This study assessed the association between adolescent ecstasy use and depressive symptoms in adolescence. Methods: The Belfast Youth Development Study surveyed a cohort annually from age 11 to 16 years. Gender, Strengths and Difficulties Questionnaire emotional subscale, living arrangements, parental affluence, parent and peer attachment, tobacco, alcohol, cannabis and ecstasy use were investigated as predictors of Short Mood and Feelings Questionnaire (SMFQ) outcome. Results: Of 5371 respondents, 301 (5.6%) had an SMFQ > 15, and 1620 (30.2) had missing data for SMFQ. Around 8% of the cohort had used ecstasy by the end of follow-up. Of the non-drug users, ∼2% showed symptoms of depression, compared with 6% of those who had used alcohol, 6% of cannabis users, 6% of ecstasy users and 7% of frequent ecstasy users. Without adjustment, ecstasy users showed around a 4-fold increased odds of depressive symptoms compared with non-drug users [odds ratio (OR) = 0.26; 95% confidence interval (CI) = 0.10, 0.68]. Further adjustment for living arrangements, peer and parental attachment attenuated the association to under a 3-fold increase (OR = 0.37; 95% CI = 0.15, 0.94). There were no differences by frequency of use. Conclusions: Ecstasy use during adolescence may be associated with poorer mental health; however, this association can be explained by the confounding social influence of family dynamics. These findings could be used to aid effective evidence-based drug policies, which concentrate criminal justice and public health resources on reducing harm.

Pain in care home residents with dementia: an exploration of frequency, prescribing and relatives' perspectives

Objectives: This study aims to determine pain frequency amongst care home residents with dementia, to investigate variables associated with pain, to explore analgesic use among residents and to seek residents' relatives' views on provision of care and management of pain by the care home. Methods: Structured face-to-face interviews were conducted with residents, nursing staff and relatives from nine dementia care homes in Northern Ireland, between May 2010 and March 2012. Demographic information was collected from participants, neuropsychiatric tests were used to assess residents' cognitive functioning, medication use was determined from care home records and residents' pain was assessed using a verbal descriptor scale. Relatives' views were sought on care provision and management of pain. Results: Forty-two residents, 16 nurses/care assistants and 35 relatives participated; the participation rate of residents was low (27.6%). Most residents were suffering moderate-severe dementia, and some residents (26.2%) were unable to provide a self-report of pain. A significantly higher proportion of relatives (57.1%) deemed residents to be experiencing pain at the time of the interview, compared with residents (23.8%, p = 0.005) and nurses/care assistants (42.9%, p = 0.035). Most residents (88.1%) were prescribed with analgesia; non-opioid analgesics were most commonly prescribed. High proportions of residents were prescribed with psychoactive medications. Antipsychotic drug use was associated with presence of pain (p = 0.046). Conclusions: This study has reinforced the challenge of assessing and managing pain in this resident population and highlighted issues to be addressed by long-term care providers and clinicians. Participation of people with dementia, and their families, in healthcare research needs to be improved.

Home Is Where the Self Is: Monodrama, Journey-Play Structure, and the Modernist Fairy Tale

The first decade of the twentieth century witnessed the creation of two of the most beloved works of children’s literature ever produced. L. Frank Baum’s 1900 novel The Wizard of Oz and Maurice Maeterlinck’s 1908 play each gave rise to many adaptations, including, well beloved film versions, and both have become a deeply ingrained part of the cultural memory and construction of childhood in both Europe and the United States. And while these works are deeply original in content and detail, the structure of these works harkens back to the form of the journey play (traceable, on some level, back to the medieval morality play Everyman), a form that had undergone a considerable revival in the second half of the nineteenth century in the work of writers such as Henrik Ibsen and August Strindberg. This article explores the structural and conceptual links between Baum and Maeterlinck’s children’s classics, Ibsen’s Norwegian folk play Peer Gynt, and August Strindberg’s Lucky Per’s Journey and The Road to Damascus, Part I. In these works, the protagonists, disenchanted with their homes or current situations, set out on an epic journey in which they come upon characters and situations that act as commentary upon their situations before the journey. Ultimately, the characters return to where they started, with the journey seeming to have been a dream or merely a pointless excursion. But in these journeys of self-discovery, the protagonist that emerges at the end has undergone a significant transformation, a process at the heart of all of these works.

Multimedia psycho-educational interventions to support patient self-care in degenerative conditions: a realist review

Objective: Multimedia interventions are increasingly used to deliver information in order to promote self-care among patients with degenerative conditions. We carried out a realist review of the literature to investigate how the characteristics of multimedia psychoeducational interventions combine with the contexts in which they are introduced to help or hinder their effectiveness in supporting self-care for patients with degenerative conditions.

Method: Electronic databases (Medline, Science Direct, PSYCHinfo, EBSCO, and Embase) were searched in order to identify papers containing information on multimedia psychoeducational interventions. Using a realist review approach, we reviewed all relevant studies to identify theories that explained how the interventions work.

Results: Ten papers were included in the review. All interventions sought to promote self-care behaviors among participants. We examined the development and content of the multimedia interventions and the impact of patient motivation and of the organizational context of implementation. We judged seven studies to be methodologically weak. All completed studies showed small effects in favor of the intervention.

Significance of Results: Multimedia interventions may provide high-quality information in an accessible format, with the potential to promote self-care among patients with degenerative conditions, if the patient perceives the information as important and develops confidence about self-care. The evidence base is weak, so that research is needed to investigate effective modes of delivery at different resource levels. We recommend that developers consider how an intervention will reduce uncertainty and increase confidence in self-care, as well as the impact of the context in which it will be employed.

Green Media: The Future of Wireless Multimedia Networks:Guest Editorial

By 2015, with the proliferation of wireless multimedia applications and services (e.g., mobile TV, video on demand, online video repositories, immersive video interaction, peer to peer video streaming, and interactive video gaming), and any-time anywhere communication, the number of smartphones and tablets will exceed 6.5 billion as the most common web access devices. Data volumes in wireless multimedia data-intensive applications and mobile web services are projected to increase by a factor of 10 every five years, associated with a 20 percent increase in energy consumption, 80 percent of which is multimedia traffic related. In turn, multimedia energy consumption is rising at 16 percent per year, doubling every six years. It is estimated that energy costs alone account for as much as half of the annual operating expenditure. This has prompted concerted efforts by major operators to drastically reduce carbon emissions by up to 50 percent over the next 10 years. Clearly, there is an urgent need for new disruptive paradigms of green media to bridge the gap between wireless technologies and multimedia applications.