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      Psychotropic drug use as indicator of mental health in adolescents affected by a plexus injury at birth: A large population-based study in Sweden

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          Abstract

          Chronic handicap in early life may have a long-term impact on children’s psychosocial well-being. Here, we investigated whether Brachialis Plexus Birth Injury (BPBI)—an unpredictable injury at birth—is associated with worse mental health later on, as indicated by prescription and use of psychotropic drugs in adolescence. We explored further whether this association is different depending on socioeconomic characteristics of the child’s family, as well as sex. Of the 641 151 children born to native parents in Sweden 1987–1993 (alive and still living in Sweden at the end of 2008), identified in the Swedish Medical Birth Registry, 1587 had suffered a BPBI. Logistic regression analysis was performed to assess the impact of socioeconomic characteristics and associations with later psychosocial health. Results show that beyond the known increased risks for females as compared to males, BPBI, but also lower family income, further increased the risk of burdened mental health requiring psychotropic drug use in adolescence. The effects were additive. Thus, compared to unaffected peers, teenagers who suffered a BPBI at birth are at higher risk of suffering poor mental health during adolescence, independently of surgical intervention and its outcome. Girls growing up in families with lower socioeconomic status have this risk added to their already increased risk of poor mental health during adolescence.

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          Life course epidemiology.

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            Limitations of the odds ratio in gauging the performance of a diagnostic, prognostic, or screening marker.

            M. S. Pepe (2004)
            A marker strongly associated with outcome (or disease) is often assumed to be effective for classifying persons according to their current or future outcome. However, for this assumption to be true, the associated odds ratio must be of a magnitude rarely seen in epidemiologic studies. In this paper, an illustration of the relation between odds ratios and receiver operating characteristic curves shows, for example, that a marker with an odds ratio of as high as 3 is in fact a very poor classification tool. If a marker identifies 10% of controls as positive (false positives) and has an odds ratio of 3, then it will correctly identify only 25% of cases as positive (true positives). The authors illustrate that a single measure of association such as an odds ratio does not meaningfully describe a marker's ability to classify subjects. Appropriate statistical methods for assessing and reporting the classification power of a marker are described. In addition, the serious pitfalls of using more traditional methods based on parameters in logistic regression models are illustrated.
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              An integrative model of pediatric medical traumatic stress.

              To guide assessment and intervention for patients and families, a model for assessing and treating pediatric medical traumatic stress (PMTS) is presented that integrates the literature across pediatric conditions. A model with three general phases is outlined--I, peritrauma; II, early, ongoing, and evolving responses; and III, longer-term PMTS. Relevant literature for each is reviewed and discussed with respect to implications for intervention for patients and families. Commonalities across conditions, the range of normative responses to potentially traumatic events (PTEs), the importance of preexisting psychological well-being, developmental considerations, and a social ecological orientation are highlighted. Growing empirical support exists to guide the development of assessment and intervention related to PMTS for patients with pediatric illness and their parents. The need for interventions across the course of pediatric illness and injury that target patients, families, and/or healthcare teams is apparent. The model provides a basis for further development of evidence-based treatments.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: MethodologyRole: Writing – original draft
                Role: ConceptualizationRole: Data curationRole: Funding acquisitionRole: MethodologyRole: Writing – original draft
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                21 March 2018
                2018
                : 13
                : 3
                : e0193635
                Affiliations
                [1 ] Department of Psychology, Faculty of Social Sciences, Lund University, Lund, Sweden
                [2 ] Unit for Social Epidemiology, Department of Clinical Sciences (Malmö), Faculty of Medicine, Lund University, Malmö, Sweden
                [3 ] Department of Translational Medicine - Hand Surgery, Faculty of Medicine, Lund University, Lund, Sweden
                [4 ] Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
                Vanderbilt University, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0003-2758-5785
                Article
                PONE-D-17-00662
                10.1371/journal.pone.0193635
                5862449
                29561858
                21a26574-2c74-43a7-b0a6-f0cb987338e3
                © 2018 Psouni et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 6 January 2017
                : 15 February 2018
                Page count
                Figures: 3, Tables: 2, Pages: 16
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100004359, Vetenskapsrådet;
                Award ID: 2009-1273
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100009389, Stiftelsen Promobilia;
                Award ID: 2012
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/501100004359, Vetenskapsrådet;
                Award ID: 2013-2484
                Award Recipient :
                This research was partly funded by the Swedish Research Council (Psouni, 2009-1273) and (Merlo, 2013-2484) and the Promobilia foundation (Dahlin & Psouni 2012). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Mental Health and Psychiatry
                People and Places
                Population Groupings
                Age Groups
                Children
                People and Places
                Population Groupings
                Families
                Children
                Biology and Life Sciences
                Physiology
                Physiological Parameters
                Body Weight
                Birth Weight
                Medicine and Health Sciences
                Physiology
                Physiological Parameters
                Body Weight
                Birth Weight
                People and Places
                Population Groupings
                Age Groups
                Children
                Adolescents
                People and Places
                Population Groupings
                Families
                Children
                Adolescents
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Birth
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Birth
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Birth
                Labor and Delivery
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Birth
                Labor and Delivery
                People and places
                Geographical locations
                Europe
                European Union
                Sweden
                Medicine and Health Sciences
                Endocrinology
                Endocrine Disorders
                Diabetes Mellitus
                Medicine and Health Sciences
                Metabolic Disorders
                Diabetes Mellitus
                Custom metadata
                Public access to the data is restricted by the Swedish Authorities (Public Access to Information and Secrecy Act; http://www.government.se/information-material/2009/09/public-access-to-information-and-secrecy-act/) but data can be made available for researchers after a special review that includes approval of the research project by both an Ethics Committee and the authorities’ data safety committees. The National Board of Health and Welfare is a government agency under the Ministry of Health and Social Affairs. It is not their policy to provide individual level data to researchers abroad. Instead, they normally advise researchers in other countries to cooperate with Swedish colleagues, to whom they can provide data according to standard legal provisions and procedures. Requests for access to the data can be made to the National Board of Health and Welfare and Statistics Sweden ( http://www.socialstyrelsen.se/statistics; https://www.scb.se/en/services/guidance-for-researchers-and-universities/).

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