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Archive for the ‘mental health and substance abuse’ Category

Social Host Liability for Underage Drinking Statutes

April 16, 2014 Comments off

Social Host Liability for Underage Drinking Statutes
Source: National Conference of State Legislatures

Enacted in 1984, the National Minimum Drinking Age Act set the minimum drinking age at 21. To comply with federal law, states prohibit persons under 21 years of age from purchasing or publicly possessing alcoholic beverages.

According to the 2012 National Survey on Drug Use and Health, about 9.3 million persons aged 12 to 20 (24.3 percent of this age group) reported drinking alcohol in the past month and an estimated 11.2 percent of persons aged 12 or older drove under the influence of alcohol at least once in the past year.

In an effort to combat underage drinking, state legislators have enacted laws that assign responsibility to adults who allow minors to drink alcohol at social gatherings. Thirty-one states allow social hosts to be civilly liable for injuries or damages caused by underage drinkers. Twenty-six states and the Virgin Islands have criminal penalties for adults who host or permit parties with underage drinking to occur in the adults’ homes or in premises under the adults’ control. These social host statutory provisions do not apply to licensed establishments such as restaurants, bars, and liquor stores, which are covered by dram shop laws.

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New Directions in Child Abuse and Neglect Research (2014)

April 16, 2014 Comments off

New Directions in Child Abuse and Neglect Research (2014)
Source: National Research Council

Each year, child protective services receive reports of child abuse and neglect involving six million children, and many more go unreported. The long-term human and fiscal consequences of child abuse and neglect are not relegated to the victims themselves — they also impact their families, future relationships, and society. In 1993, the National Research Council (NRC) issued the report, Understanding Child Abuse and Neglect, which provided an overview of the research on child abuse and neglect. New Directions in Child Abuse and Neglect Research updates the 1993 report and provides new recommendations to respond to this public health challenge. According to this report, while there has been great progress in child abuse and neglect research, a coordinated, national research infrastructure with high-level federal support needs to be established and implemented immediately.

New Directions in Child Abuse and Neglect Research recommends an actionable framework to guide and support future child abuse and neglect research. This report calls for a comprehensive, multidisciplinary approach to child abuse and neglect research that examines factors related to both children and adults across physical, mental, and behavioral health domains–including those in child welfare, economic support, criminal justice, education, and health care systems–and assesses the needs of a variety of subpopulations. It should also clarify the causal pathways related to child abuse and neglect and, more importantly, assess efforts to interrupt these pathways. New Directions in Child Abuse and Neglect Research identifies four areas to look to in developing a coordinated research enterprise: a national strategic plan, a national surveillance system, a new generation of researchers, and changes in the federal and state programmatic and policy response.

Mental Health Professionals’ Attitudes and Expectations About Adoption and Adopted Children

April 16, 2014 Comments off

Mental Health Professionals’ Attitudes and Expectations About Adoption and Adopted Children
Source: National Council for Adoption

Many researchers have documented heavy use of clinical services by adoptees, but little is known about how much training mental health professionals actually receive about adoption, or their beliefs about adoption and adopted people. It is important to understand mental health professionals’ expectations for their adopted clients.

Previous research has shown that teachers treat students differently if they have high expectations for those students. In other studies, some adoptive parents have told us it was necessary to educate their child’s counselor about issues related to adoption. We have therefore investigated adoption-related expectations and training on adoption issues among mental health professionals. In this article, we will review some of the most current published information about the adjustment of adopted children, and present our own findings regarding clinicians’ beliefs and expectations for their adopted clients.

Gender Differences in Primary Substance of Abuse across Age Groups

April 16, 2014 Comments off

Gender Differences in Primary Substance of Abuse across Age Groups
Source: Substance Abuse and Mental Health Services Administration

+ In 2011, about 609,000 of the 1.84 million admissions to substance abuse treatment were female (33.1 percent), and 1.23 million were male (66.9 percent)
+ Compared with their male counterparts, a larger proportion of female admissions aged 12 to 17 reported alcohol as their primary substance of abuse (21.7 vs. 10.5 percent)
+ Marijuana as the primary substance of abuse was less common among female than male admissions aged 12 to 17 (60.8 vs. 80.7 percent) and 18 to 24 (22.1 vs. 33.4 percent)
+ Within the 65 or older age group, the proportion of female admissions reporting primary abuse of prescription pain relievers (e.g., oxycodone) was nearly 3 times that of their male counterparts (7.2 vs. 2.8 percent)

Daytime sleepiness: associations with alcohol use and sleep duration in americans

April 15, 2014 Comments off

Daytime sleepiness: associations with alcohol use and sleep duration in americans
Source: Sleep Disorders

The aim of the current analysis was to investigate the relationship of daytime sleepiness with alcohol consumption and sleep duration using a population sample of adult Americans. Data was analyzed from adult respondents of the National Health and Nutritional Examination Survey (NHANES) 2007-2008 (N = 2919) using self-reported variables for sleepiness, sleep duration, and alcohol consumption (quantity and frequency of alcohol use). A heavy drinking episode was defined as the consumption of ≥5 standard alcoholic beverages in a day. Logistic regression models adjusted for sociodemographic variables and insomnia covariates were used to evaluate the relationship between daytime sleepiness and an interaction of alcohol consumption variables with sleep duration. The results showed that daytime sleepiness was reported by 15.07% of the subjects. In univariate analyses adjusted for covariates, an increased probability of daytime sleepiness was predicted by decreased log drinks per day [OR = 0.74 (95% CI, 0.58–0.95)], a decreased log drinking frequency [0.90 (95% CI, 0.83–0.98)], and lower sleep duration [OR = 0.75 (95% CI, 0.67–0.84)]. An interaction between decreased sleep duration and an increased log heavy drinking frequency predicted increased daytime sleepiness (P = 0.004). Thus, the effect of sleep duration should be considered when evaluating the relationship between daytime sleepiness and heavy drinking.

Excess Burden of Depression among HIV-Infected Persons Receiving Medical Care in the United States: Data from the Medical Monitoring Project and the Behavioral Risk Factor Surveillance System

April 14, 2014 Comments off

Excess Burden of Depression among HIV-Infected Persons Receiving Medical Care in the United States: Data from the Medical Monitoring Project and the Behavioral Risk Factor Surveillance System
Source: PLoS ONE

Background
With increased life expectancy for HIV-infected persons, there is concern regarding comorbid depression because of its common occurrence and association with behaviors that may facilitate HIV transmission. Our objectives were to estimate the prevalence of current depression among HIV-infected persons receiving care and assess the burden of major depression, relative to that in the general population.

Methods and Findings
We used data from the Medical Monitoring Project (MMP) and the Behavioral Risk Factors Surveillance System (BRFSS). The eight-item Patient Health Questionnaire was used to identify depression. To assess the burden of major depression among HIV-infected persons receiving care, we compared the prevalence of current major depression between the MMP and BRFSS populations using stratified analyses that simultaneously controlled for gender and, in turn, each of the potentially confounding demographic factors of age, race/ethnicity, education, and income. Each unadjusted comparison was summarized as a prevalence ratio (PR), and each of the adjusted comparisons was summarized as a standardized prevalence ratio (SPR). Among HIV-infected persons receiving care, the prevalence of a current episode of major depression and other depression, respectively, was 12.4% (95% CI: 11.2, 13.7) and 13.2% (95% CI: 12.0%, 14.4%). Overall, the PR comparing the prevalence of current major depression between HIV-infected persons receiving care and the general population was 3.1. When controlling for gender and each of the factors age, race/ethnicity, and education, the SPR (3.3, 3.0, and 2.9, respectively) was similar to the PR. However, when controlling for gender and annual household income, the SPR decreased to 1.5.

Conclusions
Depression remains a common comorbidity among HIV-infected persons. The overall excess burden among HIV-infected persons receiving care is about three-times that among the general population and is associated with differences in annual household income between the two populations. Relevant efforts are needed to reduce this burden.

The Treatment of Persons with Mental Illness in Prisons and Jails

April 14, 2014 Comments off

The Treatment of Persons with Mental Illness in Prisons and Jails
Source: Treatment Advocacy Center
From Executive Summary:

Prisons and jails have become America’s “new asylums”: The number of individuals with serious mental illness in prisons and jails now exceeds the number in state psychiatric hospitals tenfold. Most of the mentally ill individuals in prisons and jails would have been treated in state psychiatric hospitals in the years before the deinstitutionalization movement led to closing the hospitals, a trend that continues even today.

The treatment of mentally ill individuals in prisons and jails is critical, especially since such individuals are vulnerable and often abused while incarcerated. Untreated, their psychiatric illness often gets worse, and they leave prison or jail sicker than when they entered. Individuals in prison and jails have a right to receive medical care, and this right pertains to serious mental illness just as it pertains to tuberculosis, diabetes, or hypertension. This right to treatment has been affirmed by the US Supreme Court.

“The Treatment of Persons with Mental Illness in Prisons and Jails” is the first national survey of such treatment practices. It focuses on the problem of treating seriously mentally ill inmates who refuse treatment, usually because they lack awareness of their own illness and do not think they are sick. What are the treatment practices for these individuals in prisons and jails in each state? What are the consequences if such individuals are not treated?

To address these questions, an extensive survey of professionals in state and county corrections systems was undertaken. Sheriffs, jail administrators, and others who were interviewed for the survey expressed compassion for inmates with mental illness and frustration with the mental health system that is failing them. There were several other points of consensus among those interviewed:

  • Not only are the numbers of mentally ill in prisons and jails continuing to climb, the severity of inmates’ illnesses is on the rise as well.
  • Many inmates with mental illness need intensive treatment, and officials in the prisons and jails feel compelled to provide the hospital-level care these inmates need.
  • The root cause of the problem is the continuing closure of state psychiatric hospitals and the failure of mental health officials to provide appropriate aftercare for the released patients.

Is Violent Radicalisation Associated with Poverty, Migration, Poor Self-Reported Health and Common Mental Disorders?

April 14, 2014 Comments off

Is Violent Radicalisation Associated with Poverty, Migration, Poor Self-Reported Health and Common Mental Disorders?
Source: PLoS ONE

Background
Doctors, lawyers and criminal justice agencies need methods to assess vulnerability to violent radicalization. In synergy, public health interventions aim to prevent the emergence of risk behaviours as well as prevent and treat new illness events. This paper describes a new method of assessing vulnerability to violent radicalization, and then investigates the role of previously reported causes, including poor self-reported health, anxiety and depression, adverse life events, poverty, and migration and socio-political factors. The aim is to identify foci for preventive intervention.

Methods
A cross-sectional survey of a representative population sample of men and women aged 18–45, of Muslim heritage and recruited by quota sampling by age, gender, working status, in two English cities. The main outcomes include self-reported health, symptoms of anxiety and depression (common mental disorders), and vulnerability to violent radicalization assessed by sympathies for violent protest and terrorist acts.

Results
2.4% of people showed some sympathy for violent protest and terrorist acts. Sympathy was more likely to be articulated by the under 20s, those in full time education rather than employment, those born in the UK, those speaking English at home, and high earners (>£75,000 a year). People with poor self-reported health were less likely to show sympathies for violent protest and terrorism. Anxiety and depressive symptoms, adverse life events and socio-political attitudes showed no associations.

Conclusions
Sympathies for violent protest and terrorism were uncommon among men and women, aged 18–45, of Muslim heritage living in two English cities. Youth, wealth, and being in education rather than employment were risk factors.

Effect of Drinking on All-Cause Mortality in Women Compared with Men: A Meta-Analysis

April 11, 2014 Comments off

Effect of Drinking on All-Cause Mortality in Women Compared with Men: A Meta-Analysis
Source: Journal of Women’s Health

Background:
Alcoholic beverages are consumed by humans for a variety of dietary, recreational, and other reasons. It is uncertain whether the drinking effect on risk of all-cause mortality is different between women and men. We conducted a meta-analysis to evaluate the effect of drinking on the risk of all-cause mortality in women compared with men.

Methods:
We selected cohort studies with measures of relative risk (RR) and 95% confidence interval (CI) for all-cause mortality for drinkers versus nondrinkers by sex. Sex-specific RR and 95% CI were used to estimate the female-to-male ratio of RR (RRR) and 95% CI. Pooled estimates of RRR across studies were obtained by the fixed-effects model or the random-effects model (if heterogeneity was detected). Second-order fractional polynomials and random effects meta-regression models were used for modeling the dose-risk relationship.

Results:
Twenty-four studies were considered eligible. A total of 2,424,964 participants (male: 1,473,899; female: 951,065) were enrolled and 123,878 deaths (male: 76,362; female: 47,516) were observed. Compared with nondrinkers, the pooled female-to-male RRR for drinkers was 1.07 (95% CI: 1.02, 1.12). Subgroup analyses showed that the increased risk among female drinkers appeared to be consistent. J-shaped dose–response relationship was confirmed between alcohol and all-cause mortality in men and women, respectively. Moreover, the female-to-male RRR of all-cause mortality were 1.52 (95% CI: 1.01, 2.29), 1.95 (95% CI: 1.08, 3.49), and 2.36 (95% CI: 1.15, 4.88), respectively, for those who consumed 75, 90, and 100 g/day of alcohol.

Conclusions:
Females had an increased risk for all-cause mortality conferred by drinking compared with males, especially in heavy drinkers. The present study suggested that female drinkers, particularly heavy drinkers, should moderate or completely reduce their level of consumption to have a health benefit.

Current Issues in Mental Health in Canada

April 10, 2014 Comments off

Current Issues in Mental Health in Canada
Source: Library of Parliament

Mental health problems and mental illness exact a huge human, social and economic toll.

In Canada, roughly one in every five people will experience a mental illness in his or her lifetime. Individuals with mental health problems or mental illness may suffer from such consequences as stigmatization, discrimination, lost income, homelessness and substance abuse, among others. Left untreated, some mental health disorders may even lead to suicide.

The Library of Parliament recently published a series of papers on mental health in Canada and the involvement of the federal government in this area; this HillNote introduces the series and highlights some of the issues addressed in the papers.

NZ — Suicide Reporting

April 10, 2014 Comments off

Suicide Reporting
Source: Law Commission

The Report recommends that sections 71 to 73 of the Coroners Act 2006 that restrict the reporting of suicide be repealed and replaced by new provisions. Those provisions should only prohibit the reporting of the method of suicide and the fact that a death is a suicide. A person should be able to apply to the Chief Coroner for an exemption from those prohibitions. It also recommends that the Coroners Act requires the Minister of Health to prepare, in consultation with media and mental health experts, a new set of standards for reporting suicide, and to implement an ongoing programme to disseminate, promote, support and evaluate the implementation of those standards.

40% of Children Miss Out on the Parenting Needed to Succeed in Life

April 10, 2014 Comments off

40% of Children Miss Out on the Parenting Needed to Succeed in Life
Source> Sutton Trust

Four in ten babies don’t develop the strong emotional bonds – what psychologists call “secure attachment” – with their parents that are crucial to success later in life. Disadvantaged children are more likely to face educational and behavioural problems when they grow older as a result, new Sutton Trust research finds today.

The review of international studies of attachment, Baby Bonds, by Sophie Moullin (Princeton University), Professor Jane Waldfogel (Colombia University and the London School of Economics) and Dr Liz Washbrook (University of Bristol), finds infants aged under three who do not form strong bonds with their mother or father are more likely to suffer from aggression, defiance and hyperactivity when they get older.

CBO — Presentation on Raising the Excise Tax on Cigarettes: Effects on Health and the Federal Budget

April 9, 2014 Comments off

Presentation on Raising the Excise Tax on Cigarettes: Effects on Health and the Federal Budget
Source: Congressional Budget Office

Presentation by James Baumgardner, CBO’s Deputy Assistant Director for Health, Retirement, and Long-Term Analysis, to the 30th International Congress of Actuaries

Identifying Personality Disorders that are Security Risks: Field Test Results

April 9, 2014 Comments off

Identifying Personality Disorders that are Security Risks: Field Test Results (PDF)
Source: Defense Personnel Security Research Center

Accurate identification and assessment of employees with risky personality disorders is imperative for programs that involve access to nuclear materials, weapons, and biological select agents which depend on personnel maintaining mental health and reliable behavior. Certain risky personality disorders, however, are especially difficult to diagnose with routine assessment tools that rely on the subject’s self-report. To combat this issue, PERSEREC, in collaboration with Department of Energy, initiated a field test that examined whether an improved screening tool has utility for clinicians who routinely evaluate personnel in a high-risk program. Five clinicians used the Shedler-Westen Assessment Procedure (SWAP), along with its Dispositional Indicators of Risk Exposure (DIRE) subscale developed earlier, for a period of 4 months to evaluate 26 new candidates and current employees of concern. Debriefing interviews indicated that SWAP/DIRE was more effective than clinicians’ existing tools for establishing a positive rapport with the subject, assessing personality disorders, and making legally-defensible recommendations. Findings also include recommendations for using SWAP/DIRE methodology for identifying risky personnel.

New From the GAO

April 8, 2014 Comments off

New GAO Reports and Testimonies
Source: Government Accountability Office

Reports

1. Medicare: Second Year Update for CMS’s Durable Medical Equipment Competitive Bidding Program Round 1 Rebid. GAO-14-156, March 7.
http://www.gao.gov/products/GAO-14-156
Highlights - http://www.gao.gov/assets/670/661475.pdf

2. 2014 Annual Report: Additional Opportunities to Reduce Fragmentation, Overlap, and Duplication and Achieve Other Financial Benefits. GAO-14-343SP, April 8.
http://www.gao.gov/products/GAO-14-343SP
Podcast - http://www.gao.gov/multimedia/podcasts/662283

3. Aviation Safety: FAA Should Improve Usability of its Online Application System and Clarity of the Pilot’s Medical Form. GAO-14-330, April 8.
http://www.gao.gov/products/GAO-14-330
Highlights - http://www.gao.gov/assets/670/662388.pdf

4. Military Capabilities: Navy Should Reevaluate Its Plan to Decommission the USS Port Royal. GAO-14-336, April 8.
http://www.gao.gov/products/GAO-14-336
Highlights - http://www.gao.gov/assets/670/662377.pdf

5. Information Security: IRS Needs to Address Control Weaknesses That Place Financial and Taxpayer Data at Risk. GAO-14-405, April 8
http://www.gao.gov/products/GAO-14-405
Highlights - http://www.gao.gov/assets/670/662372.pdf
Podcast - http://www.gao.gov/multimedia/podcasts/662350

Testimonies

1. Paid Tax Return Preparers: In a Limited Study, Preparers Made Significant Errors, by James R. McTigue Jr., director, strategic issues, before the Senate Committee on Finance. GAO-14-467T, April 8.
http://www.gao.gov/products/GAO-14-467T
Highlights - http://www.gao.gov/assets/670/662357.pdf

2. Tobacco Products: FDA Spending and New Product Review Time Frames, by Marcia Crosse, director, health care, before the Subcommittee on Health, House Committee on Energy and Commerce. GAO-14-508T, April 8.
http://www.gao.gov/products/GAO-14-508T
Highlights - http://www.gao.gov/assets/670/662361.pdf

3. Government Efficiency and Effectiveness: Opportunities to Reduce Fragmentation, Overlap, and Duplication and Achieve Other Financial Benefits, by Gene L. Dodaro, Comptroller General of the United States, before the House Committee on Oversight and Government Reform. GAO-14-478T, April 8.
http://www.gao.gov/products/GAO-14-478T
Highlights - http://www.gao.gov/assets/670/662367.pdf

Big Five Personality Traits Reflected in Job Applicants’ Social Media Postings

April 8, 2014 Comments off

Big Five Personality Traits Reflected in Job Applicants’ Social Media Postings
Source: Cyberpsychology, Behavior, and Social Networking

Job applicants and incumbents often use social media for personal communications allowing for direct observation of their social communications “unfiltered” for employer consumption. As such, these data offer a glimpse of employees in settings free from the impression management pressures present during evaluations conducted for applicant screening and research purposes. This study investigated whether job applicants’ (N=175) personality characteristics are reflected in the content of their social media postings. Participant self-reported social media content related to (a) photos and text-based references to alcohol and drug use and (b) criticisms of superiors and peers (so-called “badmouthing” behavior) were compared to traditional personality assessments. Results indicated that extraverted candidates were prone to postings related to alcohol and drugs. Those low in agreeableness were particularly likely to engage in online badmouthing behaviors. Evidence concerning the relationships between conscientiousness and the outcomes of interest was mixed.

The Burden Attributable to Mental and Substance Use Disorders as Risk Factors for Suicide: Findings from the Global Burden of Disease Study 2010

April 8, 2014 Comments off

The Burden Attributable to Mental and Substance Use Disorders as Risk Factors for Suicide: Findings from the Global Burden of Disease Study 2010
Source: PLoS ONE

Background
The Global Burden of Disease Study 2010 (GBD 2010) identified mental and substance use disorders as the 5th leading contributor of burden in 2010, measured by disability adjusted life years (DALYs). This estimate was incomplete as it excluded burden resulting from the increased risk of suicide captured elsewhere in GBD 2010′s mutually exclusive list of diseases and injuries. Here, we estimate suicide DALYs attributable to mental and substance use disorders.

Methods
Relative-risk estimates of suicide due to mental and substance use disorders and the global prevalence of each disorder were used to estimate population attributable fractions. These were adjusted for global differences in the proportion of suicide due to mental and substance use disorders compared to other causes then multiplied by suicide DALYs reported in GBD 2010 to estimate attributable DALYs (with 95% uncertainty).

Results
Mental and substance use disorders were responsible for 22.5 million (14.8–29.8 million) of the 36.2 million (26.5–44.3 million) DALYs allocated to suicide in 2010. Depression was responsible for the largest proportion of suicide DALYs (46.1% (28.0%–60.8%)) and anorexia nervosa the lowest (0.2% (0.02%–0.5%)). DALYs occurred throughout the lifespan, with the largest proportion found in Eastern Europe and Asia, and males aged 20–30 years. The inclusion of attributable suicide DALYs would have increased the overall burden of mental and substance use disorders (assigned to them in GBD 2010 as a direct cause) from 7.4% (6.2%–8.6%) to 8.3% (7.1%–9.6%) of global DALYs, and would have changed the global ranking from 5th to 3rd leading cause of burden.

Conclusions
Capturing the suicide burden attributable to mental and substance use disorders allows for more accurate estimates of burden. More consideration needs to be given to interventions targeted to populations with, or at risk for, mental and substance use disorders as an effective strategy for suicide prevention.

CDC Grand Rounds: Global Tobacco Control

April 8, 2014 Comments off

CDC Grand Rounds: Global Tobacco Control
Source: Morbidity and Mortality Weekly Report (CDC)

During the 20th century, use of tobacco products contributed to the deaths of 100 million persons worldwide (1). In 2011, approximately 6 million additional deaths were linked to tobacco use, the world’s leading underlying cause of death, responsible for more deaths each year than human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), tuberculosis, and malaria combined (1). One third to one half of lifetime users die from tobacco products, and smokers die an average of 14 years earlier than nonsmokers (2,3). Manufactured cigarettes account for 96% of all tobacco sales worldwide. From 1880 to 2009, annual global consumption of cigarettes increased from an estimated 10 billion cigarettes to approximately 5.9 trillion cigarettes (Figure 1), with five countries accounting for 58% of the total consumption: China (38%), Russia (7%), the United States (5%), Indonesia (4%), and Japan (4%). Among the estimated 1 billion smokers worldwide, men outnumber women by four to one. In 14 countries, at least 50% of men smoke, whereas in more than half of these same countries, fewer than 10% of women smoke (4). If current trends persist, an estimated 500 million persons alive today will die from use of tobacco products. By 2030, tobacco use will result in the deaths of approximately 8 million persons worldwide each year (4). Yet, every death from tobacco products is preventable.

Psychological and Behavioral Changes during Confinement in a 520-Day Simulated Interplanetary Mission to Mars

April 7, 2014 Comments off

Psychological and Behavioral Changes during Confinement in a 520-Day Simulated Interplanetary Mission to Mars
Source: PLoS ONE

Behavioral health risks are among the most serious and difficult to mitigate risks of confinement in space craft during long-duration space exploration missions. We report on behavioral and psychological reactions of a multinational crew of 6 healthy males confined in a 550 m3 chamber for 520 days during the first Earth-based, high-fidelity simulated mission to Mars. Rest-activity of crewmembers was objectively measured throughout the mission with wrist-worn actigraphs. Once weekly throughout the mission crewmembers completed the Beck Depression Inventory-II (BDI-II), Profile of Moods State short form (POMS), conflict questionnaire, the Psychomotor Vigilance Test (PVT-B), and series of visual analogue scales on stress and fatigue. We observed substantial inter-individual differences in the behavioral responses of crewmembers to the prolonged mission confinement and isolation. The crewmember with the highest average POMS total mood disturbance score throughout the mission also reported symptoms of depression in 93% of mission weeks, which reached mild-to-moderate levels in >10% of mission weeks. Conflicts with mission control were reported five times more often than conflicts among crewmembers. Two crewmembers who had the highest ratings of stress and physical exhaustion accounted for 85% of the perceived conflicts. One of them developed a persistent sleep onset insomnia with ratings of poor sleep quality, which resulted in chronic partial sleep deprivation, elevated ratings of daytime tiredness, and frequent deficits in behavioral alertness. Sleep-wake timing was altered in two other crewmembers, beginning in the first few months of the mission and persisting throughout. Two crewmembers showed neither behavioral disturbances nor reports of psychological distress during the 17-month period of mission confinement. These results highlight the importance of identifying behavioral, psychological, and biological markers of characteristics that predispose prospective crewmembers to both effective and ineffective behavioral reactions during the confinement of prolonged spaceflight, to inform crew selection, training, and individualized countermeasures.

Notes from the Field: Calls to Poison Centers for Exposures to Electronic Cigarettes — United States, September 2010–February 2014

April 4, 2014 Comments off

Notes from the Field: Calls to Poison Centers for Exposures to Electronic Cigarettes — United States, September 2010–February 2014
Source: Morbidity and Mortality Weekly Report (CDC)

Electronic nicotine delivery devices such as electronic cigarettes (e-cigarettes) are battery-powered devices that deliver nicotine, flavorings (e.g., fruit, mint, and chocolate), and other chemicals via an inhaled aerosol. E-cigarettes that are marketed without a therapeutic claim by the product manufacturer are currently not regulated by the Food and Drug Administration (FDA) (1).* In many states, there are no restrictions on the sale of e-cigarettes to minors. Although e-cigarette use is increasing among U.S. adolescents and adults (2,3), its overall impact on public health remains unclear. One area of concern is the potential of e-cigarettes to cause acute nicotine toxicity (4). To assess the frequency of exposures to e-cigarettes and characterize the reported adverse health effects associated with e-cigarettes, CDC analyzed data on calls to U.S. poison centers (PCs) about human exposures to e-cigarettes (exposure calls) for the period September 2010 (when new, unique codes were added specifically for capturing e-cigarette calls) through February 2014. To provide a comparison to a conventional product with known toxicity, the number and characteristics of e-cigarette exposure calls were compared with those of conventional tobacco cigarette exposure calls.

An e-cigarette exposure call was defined as a call regarding an exposure to the e-cigarette device itself or to the nicotine liquid, which typically is contained in a cartridge that the user inserts into the e-cigarette. A cigarette exposure call was defined as a call regarding an exposure to tobacco cigarettes, but not cigarette butts. Calls involving multiple substance exposures (e.g., cigarettes and ethanol) were excluded. E-cigarette exposure calls were compared with cigarette exposure calls by proportion of calls from health-care facilities (versus residential and other non–health-care facilities), demographic characteristics, exposure routes, and report of adverse health effect. Statistical significance of differences (p<0.05) was assessed using chi-square tests.

During the study period, PCs reported 2,405 e-cigarette and 16,248 cigarette exposure calls from across the United States, the District of Columbia, and U.S. territories. E-cigarette exposure calls per month increased from one in September 2010 to 215 in February 2014 (Figure). Cigarette exposure calls ranged from 301 to 512 calls per month and were more frequent in summer months, a pattern also observed with total call volume to PCs involving all exposures (5).

E-cigarettes accounted for an increasing proportion of combined monthly e-cigarette and cigarette exposure calls, increasing from 0.3% in September 2010 to 41.7% in February 2014. A greater proportion of e-cigarette exposure calls came from health-care facilities than cigarette exposure calls (12.8% versus 5.9%) (p20 years (42.0%). E-cigarette exposures were more likely to be reported as inhalations (16.8% versus 2.0%), eye exposures (8.5% versus 0.1%), and skin exposures (5.9% versus 0.1%), and less likely to be reported as ingestions (68.9% versus 97.8%) compared with cigarette exposures (p<0.001).

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