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Campus Suicide Prevention: Knowledge, Facts, and Stigma in a College Student Sample

April 24, 2015 Comments off

Campus Suicide Prevention: Knowledge, Facts, and Stigma in a College Student Sample
Source: Sage Open

A public health approach to suicide prevention (SP) emphasizes using a comprehensive plan utilizing multiple strategies to address suicide in the community of interest. Universities using this approach are called to develop interventions to increase SP knowledge, reduce suicide risk factors, enhance protective factors, and examine their efforts scientifically to evaluate program effectiveness. The current study polled responding college students (N = 819) about their exposure to campus SP messaging materials, participation in SP activities, and whether they experienced having a person close to them attempt or die by suicide during the three years of a SP program funded by the Garrett Lee Smith Memorial Act (2004). Students were also queried about their perceived level of SP knowledge, knowledge of suicide facts, and the stigma associated with receiving treatment for suicidal thoughts and behaviors using the Suicide Prevention Exposure, Awareness, and Knowledge Survey (SPEAKS). Simultaneous multiple regression analyses were used to examine relationships between study variables. Results indicated that exposure to SP messaging materials predicted a higher level of self-perceived knowledge and a lower level of perceived stigma. Participating in SP activities and having someone close to you attempt or die by suicide predicted both a higher level of perceived knowledge and actual knowledge of suicide facts. Self-identifying as male predicted a higher level of stigma. Implications for campus SP programming are discussed.

Association of Improved Air Quality with Lung Development in Children

April 20, 2015 Comments off

Association of Improved Air Quality with Lung Development in Children
Source: New England Journal of Medicine

Background
Air-pollution levels have been trending downward progressively over the past several decades in southern California, as a result of the implementation of air quality–control policies. We assessed whether long-term reductions in pollution were associated with improvements in respiratory health among children.

Methods
As part of the Children’s Health Study, we measured lung function annually in 2120 children from three separate cohorts corresponding to three separate calendar periods: 1994–1998, 1997–2001, and 2007–2011. Mean ages of the children within each cohort were 11 years at the beginning of the period and 15 years at the end. Linear-regression models were used to examine the relationship between declining pollution levels over time and lung-function development from 11 to 15 years of age, measured as the increases in forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) during that period (referred to as 4-year growth in FEV1 and FVC).

Results
Over the 13 years spanned by the three cohorts, improvements in 4-year growth of both FEV1 and FVC were associated with declining levels of nitrogen dioxide (P<0.001 for FEV1 and FVC) and of particulate matter with an aerodynamic diameter of less than 2.5 μm (P= 0.008 for FEV1 and P<0.001 for FVC) and less than 10 μm (P<0.001 for FEV1 and FVC). These associations persisted after adjustment for several potential confounders. Significant improvements in lung-function development were observed in both boys and girls and in children with asthma and children without asthma. The proportions of children with clinically low FEV1 (defined as <80% of the predicted value) at 15 years of age declined significantly, from 7.9% to 6.3% to 3.6% across the three periods, as the air quality improved (P=0.001).

Conclusions
We found that long-term improvements in air quality were associated with statistically and clinically significant positive effects on lung-function growth in children. (Funded by the Health Effects Institute and others.)

Employee Assistance Programs in Private Health Plans: What Do They Offer?

April 19, 2015 Comments off

Employee Assistance Programs in Private Health Plans: What Do They Offer?
Source: Psychiatric Services

Employee assistance programs (EAPs) address issues affecting work performance and well-being. Studies show positive EAP outcomes, although methodological limitations necessitate additional research (1). Health plans are among the vendors selling EAPs to employers, but data on these EAPs are sparse. Data are from a 2010 survey of private health plans in 60 markets. A total of 389 market area–specific plans (89% response) reported on behavioral health services in 939 insurance products. The analysis included 200 products (from 72 plans) reporting EAPs.

Most products (57%) required that purchasers pay additional fees rather than including the EAP without charge in standard packages (Figure 1). Only 12% of products contracted with an EAP vendor outside the plan. Although 36% recommended that enrollees use the EAP before accessing behavioral health benefits, only 4% required this. Forty-five percent of products with EAPs covered clinical assessment. Nearly all covered in-person and telephone counseling. All products reporting per-year limits reported eight-session limits. Of products with per-problem limits, 78% had a five-session limit, and the remainder had a six-session limit.
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State Discretion Over Medicaid Coverage for Mental Health and Addiction Services

April 17, 2015 Comments off

State Discretion Over Medicaid Coverage for Mental Health and Addiction Services
Source: Psychiatric Services

Approximately one-third of adults who enroll in Medicaid because of a disability have a serious mental illness. Arguably, this population stands to benefit from insurance coverage that complies with the Mental Health Parity and Addiction Equity Act (MHPAEA). The MHPAEA and the Affordable Care Act (ACA) do not guarantee such coverage for this beneficiary group; however, they provide a variety of mechanisms by which states may provide parity-compliant coverage for mental health and substance use disorder treatment. This column explains key interactions between the MHPAEA, the ACA, and the Medicaid program that permit states to determine whether and how to provide parity-consistent coverage to beneficiaries with disabilities.

Racial and Ethnic Disparities in Breastfeeding

April 17, 2015 Comments off

Racial and Ethnic Disparities in Breastfeeding
Source: Breastfeeding Medicine

This article’s aim is to review the literature on racial and ethnic disparities in breastfeeding rates and practices, address barriers to breastfeeding among minority women, conduct a systematic review of breastfeeding interventions, and provide obstetrician-gynecologists with recommendations on how they can help increase rates among minority women. In order to do so, the literature of racial and ethnic disparities in breastfeeding rates and barriers among minority women was reviewed, and a systematic review of breastfeeding interventions among minority women on PubMed and MEDLINE was conducted. Racial and ethnic minority women continue to have lower breastfeeding rates than white women and are not close to meeting the Healthy People 2020 goals. Minority women report many barriers to breastfeeding. Major efforts are still needed to improve breastfeeding initiation and duration rates among minority women in the United States. Obstetrician-gynecologists have a unique opportunity to promote and support breastfeeding through their clinical practices and public policy, and their efforts can have a meaningful impact on the future health of the mother and child.

Long working hours and alcohol use: systematic review and meta-analysis of published studies and unpublished individual participant data

April 13, 2015 Comments off

Long working hours and alcohol use: systematic review and meta-analysis of published studies and unpublished individual participant data
Source: British Medical Journal

Objective
To quantify the association between long working hours and alcohol use.

Design
Systematic review and meta-analysis of published studies and unpublished individual participant data.

Data sources
A systematic search of PubMed and Embase databases in April 2014 for published studies, supplemented with manual searches. Unpublished individual participant data were obtained from 27 additional studies.

Review methods
The search strategy was designed to retrieve cross sectional and prospective studies of the association between long working hours and alcohol use. Summary estimates were obtained with random effects meta-analysis. Sources of heterogeneity were examined with meta-regression.

Results
Cross sectional analysis was based on 61 studies representing 333 693 participants from 14 countries. Prospective analysis was based on 20 studies representing 100 602 participants from nine countries. The pooled maximum adjusted odds ratio for the association between long working hours and alcohol use was 1.11 (95% confidence interval 1.05 to 1.18) in the cross sectional analysis of published and unpublished data. Odds ratio of new onset risky alcohol use was 1.12 (1.04 to 1.20) in the analysis of prospective published and unpublished data. In the 18 studies with individual participant data it was possible to assess the European Union Working Time Directive, which recommends an upper limit of 48 hours a week. Odds ratios of new onset risky alcohol use for those working 49-54 hours and ≥55 hours a week were 1.13 (1.02 to 1.26; adjusted difference in incidence 0.8 percentage points) and 1.12 (1.01 to 1.25; adjusted difference in incidence 0.7 percentage points), respectively, compared with working standard 35-40 hours (incidence of new onset risky alcohol use 6.2%). There was no difference in these associations between men and women or by age or socioeconomic groups, geographical regions, sample type (population based v occupational cohort), prevalence of risky alcohol use in the cohort, or sample attrition rate.

Conclusions
Individuals whose working hours exceed standard recommendations are more likely to increase their alcohol use to levels that pose a health risk.

Genetically Determined Height and Coronary Artery Disease

April 10, 2015 Comments off

Genetically Determined Height and Coronary Artery Disease
Source: New England Journal of Medicine

BACKGROUND
The nature and underlying mechanisms of an inverse association between adult height and the risk of coronary artery disease (CAD) are unclear.

METHODS
We used a genetic approach to investigate the association between height and CAD, using 180 height-associated genetic variants. We tested the association between a change in genetically determined height of 1 SD (6.5 cm) with the risk of CAD in 65,066 cases and 128,383 controls. Using individual-level genotype data from 18,249 persons, we also examined the risk of CAD associated with the presence of various numbers of height-associated alleles. To identify putative mechanisms, we analyzed whether genetically determined height was associated with known cardiovascular risk factors and performed a pathway analysis of the height-associated genes.

RESULTS
We observed a relative increase of 13.5% (95% confidence interval [CI], 5.4 to 22.1; P<0.001) in the risk of CAD per 1-SD decrease in genetically determined height. There was a graded relationship between the presence of an increased number of height-raising variants and a reduced risk of CAD (odds ratio for height quar-tile 4 versus quartile 1, 0.74; 95% CI, 0.68 to 0.84; P<0.001). Of the 12 risk factors that we studied, we observed significant associations only with levels of low-density lipoprotein cholesterol and triglycerides (accounting for approximately 30% of the association). We identified several overlapping pathways involving genes associated with both development and atherosclerosis.

CONCLUSIONS
There is a primary association between a genetically determined shorter height and an increased risk of CAD, a link that is partly explained by the association between shorter height and an adverse lipid profile. Shared biologic processes that determine achieved height and the development of atherosclerosis may explain some of the association. (Funded by the British Heart Foundation and others.)

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