Source: U.S. Department of Health and Human Services (Surgeon General)
From press release:
Today on World Suicide Prevention Day, the National Action Alliance for Suicide Prevention (Action Alliance) released an ambitious national strategy to reduce the number of deaths by suicide. The strategy was called for by Health and Human Services (HHS) Secretary Kathleen Sebelius and former Department of Defense Secretary Robert Gates when they launched the Action Alliance on Sept. 10, 2010. The 2012 National Strategy for Suicide Prevention, a report from the U.S. Surgeon General and the Action Alliance, details 13 goals and 60 objectives for reducing suicides over the next 10 years.
The Action Alliance, co-chaired by Gordon Smith, chief executive of the National Association of Broadcasters, and Army Secretary John McHugh, highlights four immediate priorities to reduce the number of suicides: integrating suicide prevention into health care policies; encouraging the transformation of health care systems to prevent suicide; changing the way the public talks about suicide and suicide prevention; and improving the quality of data on suicidal behaviors to develop increasingly effective prevention efforts.
The Obama Administration also announced a series of activities that will help prevent suicide:
- Secretary Sebelius announced $55.6 million in new grants for national, state, tribal, campus and community suicide prevention programs made possible under the Garrett Lee Smith Memorial Act and partially funded by the Prevention and Public Health Fund under the Affordable Care Act, the health care law enacted in 2010.
- The Department of Veterans Affairs (VA) launched, Stand by Them: Help a Veteran, a joint VA-Department of Defense (DoD) outreach campaign that includes a new public service announcement, Side by Side, designed to help prevent suicide among veterans and servicemembers and focuses on the important role family and community play in supporting Veterans in crisis. Throughout September and beyond, VA and DoD are urging community-based organizations, Veterans Service Organizations, health care providers, private companies and other government agencies to connect Veterans and Service members in need of assistance to the Veterans Crisis Line (1-800-273-8255, press 1). Additionally, as directed by President Obama’s Mental Health Executive Order issued August 31st, VA is also increasing the workforce of the Crisis Line by 50% and hiring 1,600 new mental health professionals.
Source: Substance Abuse and Mental Health Services Administration
The number of people aged 18 to 25 who used prescription drugs for non-medical purposes in the past month declined 14 percent — from 2.0 million in 2010 to 1.7 million in 2011 — the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) announced today, during the 23rd annual national observance of National Recovery Month. Non-medical use of prescription drugs among children aged 12 to 17 and adults aged 26 or older remained unchanged.
In addition, the 2011 National Survey on Drug Use and Health (NSDUH), a survey conducted annually by SAMHSA, showed that the rates of past month drinking, binge drinking and heavy drinking among underage people continued a decline from 2002. Past month alcohol use among 12 to 20 year olds declined from 28.8 percent in 2002 to 25.1 percent in 2011, while binge drinking (consuming 5 or more drinks on a single occasion on at least 1 day in the past 30 days) declined from 19.3 percent in 2002 to 15.8 percent in 2011, and heavy drinking declined from 6.2 percent in 2002 to 4.4 percent in 2011.
Overall, the use of illicit drugs among Americans aged 12 and older remained stable since the last survey in 2010. The NSDUH shows that 22.5 million Americans aged 12 or older were current (past month) illicit drug users — (8.7 percent of the population 12 and older in 2011 versus 8.9 percent in 2010).
Marijuana continues to be the most commonly used illicit drug. In 2011, 7.0 percent of Americans were current users of marijuana — up from 5.8 percent in 2007. Among youths aged 12 to 17, the rate of current marijuana use remained about the same from 2009 (7.4 percent) to 2011 (7.9 percent). Increases in the rate of current marijuana use occurred from 2007 to 2011 among adolescents (ages 12-17), young adults (ages 18 to 25), and adults (ages 26 or older). Additionally, the number of people aged 12 and older who used heroin in the past year rose from 373,000 in 2007 to 621,000 in 2010 and 620,000 in 2011.
Source: National Resource Center for Youth Development
This new guide —written specifically for youth in foster care with input from youth and professionals— looks at ways to handle powerful feelings and behaviors and make healthy choices. Understanding how psychotropic medication can help and what other options are available can be challenging. This guide can help you decide what’s best. Making Healthy Choices includes useful information, questions to ask, worksheets, and tips on:
- Recognizing you need help
- Knowing your rights about your health and who can help you make decisions
- Considering your options, including helpful approaches other than medication
- Making decisions about how best to stay healthy
- Maintaining treatment (taking medication safely and continuing or stopping treatment after leaving foster care)
Source: Preventing Chronic Disease (CDC)
Many policy measures to control the obesity epidemic assume that people consciously and rationally choose what and how much they eat and therefore focus on providing information and more access to healthier foods. In contrast, many regulations that do not assume people make rational choices have been successfully applied to control alcohol, a substance – like food – of which immoderate consumption leads to serious health problems. Alcohol-use control policies restrict where, when, and by whom alcohol can be purchased and used. Access, salience, and impulsive drinking behaviors are addressed with regulations including alcohol outlet density limits, constraints on retail displays of alcoholic beverages, and restrictions on drink "specials." We discuss 5 regulations that are effective in reducing drinking and why they may be promising if applied to the obesity epidemic.
Source: Institute of Medicine
From press release:
Outdated approaches to preventing and treating substance abuse, barriers to care, and other problems hinder the U.S. Defense Department’s ability to curb substance use disorders among military service members and their families, says a new report from the Institute of Medicine. Service members’ rising rate of prescription drug addiction and their difficulty in accessing adequate treatment for alcohol and drug-related disorders were among the concerns that prompted members of Congress to request this review.
About 20 percent of active duty personnel reported having engaged in heavy drinking in 2008, the latest year for which data are available, and binge drinking increased from 35 percent in 1998 to 47 percent in 2008. While rates of both illicit and prescription drug abuse are low, the rate of medication misuse is rising. Just 2 percent of active duty personnel reported misusing prescription drugs in 2002 compared with 11 percent in 2008. The armed forces’ programs and policies have not evolved to effectively address medication misuse and abuse, the committee noted.
To tackle these disorders better, DOD needs to lead from the top to ensure that all service branches take excess drinking and other substance use as seriously as they should, and that they consistently adhere to evidence-based strategies for prevention, screening, and treatment, the report says. Inconsistent use of evidence-based diagnostic and treatment strategies contributes to lower quality care. The department’s own Clinical Practice Guideline for Management of Substance Use Disorders is an excellent resource on effective approaches that is not being consistently followed, the committee said.
People often arrive in substance abuse treatment programs with multiple problems—including dependency on or addiction to both alcohol and drugs. National data from the Treatment Episode Data Set (TEDS) for 2009 show that 730,228 substance abuse treatment admissions (37.2 percent) reported abuse of alcohol and at least one other drug; 23.1 percent of all admissions reported the abuse of alcohol and one other drug, and 14.1 percent reported the abuse of alcohol and two other drugs.When alcohol is used with other drugs, it tends to be ingested in greater quantities than when used in their absence.2 Combining alcohol with other drugs is dangerous. For example, taking benzodiazepines concomitantly with alcohol increases the chances of benzodiazepine-involved death. It is important for treatment providers to identify patients who use alcohol with other drugs since that is an especially dangerous usage pattern.
Source: RAND Corporation
Discussions about reducing the harms associated with drug use and antidrug policies are often politicized, infused with questionable data, and unproductive. This paper provides a nonpartisan primer that should be of interest to those who are new to the field of drug policy, as well as those who have been working in the trenches. It begins with an overview of problems and policies related to illegal drugs in the United States, including the nonmedical use of prescription drugs. It then discusses the efficacy of U.S. drug policies and programs, including long-standing issues that deserve additional attention. Next, the paper lists the major funders of research and analysis in the area and describes their priorities. By highlighting the issues that receive most of the funding, this discussion identifies where gaps remain. Comparing these needs, old and new, to the current funding patterns suggests eight opportunities to improve understanding of drug problems and drug policies in the United States: (1) sponsor young scholars and strengthen the infrastructure of the field, (2) accelerate the diffusion of good ideas and reliable information to decisionmakers, (3) replicate and evaluate cutting-edge programs in an expedited fashion, (4) support nonpartisan research on marijuana policy, (5) investigate ways to reduce drug-related violence in Mexico and Central America, (6) improve understanding of the markets for diverted pharmaceuticals, (7) help build and sustain comprehensive community prevention efforts, and (8) develop more sensible sentencing policies that reduce the excessive levels of incarceration for drug offenses and address the extreme racial disparities. The document offers some specific suggestions for researchers and potential research funders in each of the eight areas.
Source: PLoS ONE
High levels of alcohol consumption and increases in heavy episodic drinking (binge drinking) are a growing public concern, due to their association with increased risk of personal and societal harm. Alcohol consumption has been shown to be sensitive to factors such as price and availability. The aim of this study was to explore the influence of glass shape on the rate of consumption of alcoholic and non-alcoholic beverages.
This was an experimental design with beverage (lager, soft drink), glass (straight, curved) and quantity (6 fl oz, 12 fl oz) as between-subjects factors. Social male and female alcohol consumers (n = 159) attended two experimental sessions, and were randomised to drink either lager or a soft drink from either a curved or straight-sided glass, and complete a computerised task identifying perceived midpoint of the two glasses (order counterbalanced). Ethical approval was granted by the Faculty of Science Research Ethics Committee at the University of Bristol. The primary outcome measures were total drinking time of an alcoholic or non-alcoholic beverage, and perceptual judgement of the half-way point of a straight and curved glass.
Participants were 60% slower to consume an alcoholic beverage from a straight glass compared to a curved glass. This effect was only observed for a full glass and not a half-full glass, and was not observed for a non-alcoholic beverage. Participants also misjudged the half-way point of a curved glass to a greater degree than that of a straight glass, and there was a trend towards a positive association between the degree of error and total drinking time.
Glass shape appears to influence the rate of drinking of alcoholic beverages. This may represent a modifiable target for public health interventions.
See: Stein, Tankard, Pint, Boot: Different beer glasses affect drinking speed (EveryONE blog)
Transgenerational transmission of trauma and resilience: a qualitative study with Brazilian offspring of Holocaust survivors
Source: BMC Psychiatry
Over the past five decades, clinicians and researchers have debated the impact of the Holocaust on the children of its survivors. The transgenerational transmission of trauma has been explored in more than 500 articles, which have failed to reach reliable conclusions that could be generalized. The psychiatric literature shows mixed findings regarding this subject: many clinical studies reported psychopathological findings related to transgenerational transmission of trauma and some empirical research has found no evidence of this phenomenon in offspring of Holocaust survivors.
This qualitative study aims to detect how the second generation perceives transgenerational transmission of their parents’ experiences in the Holocaust. In-depth individual interviews were conducted with fifteen offspring of Holocaust survivors and sought to analyze experiences, meanings and subjective processes of the participants. A Grounded Theory approach was employed, and constant comparative method was used for analysis of textual data.
The development of conceptual categories led to the emergence of distinct patterns of communication from parents to their descendants. The qualitative methodology also allowed systematization of the different ways in which offspring can deal with parental trauma, which determine the development of specific mechanisms of traumatic experience or resilience in the second generation.
The conceptual categories constructed by the Grounded Theory approach were used to present a possible model of the transgenerational transmission of trauma, showing that not only traumatic experiences, but also resilience patterns can be transmitted to and developed by the second generation. As in all qualitative studies, these conclusions cannot be generalized, but the findings can be tested in other contexts.
BACKGROUND AND OBJECTIVE: Many individuals with autism spectrum disorders (ASDs) are approaching adolescence and young adulthood; interventions to assist these individuals with vocational skills are not well understood. This study systematically reviewed evidence regarding vocational interventions for individuals with ASD between the ages of 13 and 30 years.
METHODS: The Medline, PsycINFO, and ERIC databases (1980–December 2011) and reference lists of included articles were searched. Two reviewers independently assessed each study against predetermined inclusion/exclusion criteria. Two reviewers independently extracted data regarding participant and intervention characteristics, assessment techniques, and outcomes, and assigned overall quality and strength of evidence ratings based on predetermined criteria.
RESULTS: Five studies were identified; all were of poor quality and all focused on on-the-job supports as the employment/vocational intervention. Short-term studies reported that supported employment was associated with improvements in quality of life (1 study), ASD symptoms (1 study), and cognitive functioning (1 study). Three studies reported that interventions increased rates of employment for young adults with ASD.
CONCLUSIONS: Few studies have been conducted to assess vocational interventions for adolescents and young adults with ASD. As such, there is very little evidence available for specific vocational treatment approaches as individuals transition to adulthood. All studies of vocational approaches were of poor quality, which may reflect the recent emergence of this area of research. Individual studies suggest that vocational programs may increase employment success for some; however, our ability to understand the overall benefit of supported employment programs is limited given the existing research.
Source: Agency for Healthcare Research and Quality
Few studies have been conducted to assess treatment approaches for adolescents and young adults with ASD, and as such there is very little evidence available for specific treatment approaches in this population; this is especially the case for evidence-based approaches to support the transition of youth with autism to adulthood. Of the small number of studies available, most were of poor quality, which may reflect the relative recency of the field. Five studies, primarily of medical interventions, had fair quality. Behavioral, educational, and adaptive/life skills studies were typically small and short term and suggested some potential improvements in social skills and functional behavior. Small studies suggested that vocational programs may increase employment success for some individuals. Few data are available to support the use of medical or allied health interventions in the adolescent and young adult population. The medical studies that have been conducted focused on the use of medications to address specific challenging behaviors, including irritability and aggression, for which effectiveness in this age group is largely unknown and inferred from studies including mostly younger children.
Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population
Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population
Source: Archives of Internal Medicine
Despite extensive data about physician burnout, to our knowledge, no national study has evaluated rates of burnout among US physicians, explored differences by specialty, or compared physicians with US workers in other fields.
We conducted a national study of burnout in a large sample of US physicians from all specialty disciplines using the American Medical Association Physician Masterfile and surveyed a probability-based sample of the general US population for comparison. Burnout was measured using validated instruments. Satisfaction with work-life balance was explored.
Of 27 276 physicians who received an invitation to participate, 7288 (26.7%) completed surveys. When assessed using the Maslach Burnout Inventory, 45.8% of physicians reported at least 1 symptom of burnout. Substantial differences in burnout were observed by specialty, with the highest rates among physicians at the front line of care access (family medicine, general internal medicine, and emergency medicine). Compared with a probability-based sample of 3442 working US adults, physicians were more likely to have symptoms of burnout (37.9% vs 27.8%) and to be dissatisfied with work-life balance (40.2% vs 23.2%) (P < .001 for both). Highest level of education completed also related to burnout in a pooled multivariate analysis adjusted for age, sex, relationship status, and hours worked per week. Compared with high school graduates, individuals with an MD or DO degree were at increased risk for burnout (odds ratio [OR], 1.36; P < .001), whereas individuals with a bachelor's degree (OR, 0.80; P = .048), master's degree (OR, 0.71; P = .01), or professional or doctoral degree other than an MD or DO degree (OR, 0.64; P = .04) were at lower risk for burnout.
Burnout is more common among physicians than among other US workers. Physicians in specialties at the front line of care access seem to be at greatest risk.
Tobacco Sales to Youth (PDF)
Tobacco use is the leading cause of death and disease in the United States, with 443,000 deaths annually attributed to smoking or exposure to secondhand smoke (CDC, 2008). Nearly all tobacco use begins during youth and young adulthood. In fact, among adults who have ever smoked daily, 88 percent report that they first smoked by the age of 18, with 99 percent reporting that they first smoked by the age of 26. Furthermore, more than one-third (36.7 percent) of adults who have ever smoked report trying their first cigarette by the age of 14 (USDHHS, 2012). These data suggest that if youth are prevented from smoking while they are young, they will be unlikely to begin smoking as adults.Tobacco use is also highly associated with the use of alcohol and illicit drugs. Specifically, over half (52.9 percent) of youths aged 12 to 17 who smoked cigarettes in the past month also used an illicit drug compared with 6.2 percent of youths who did not smoke cigarettes. Similarly, close to half (43.7 percent) of current cigarette users age 12 and over also report binge drinking in the past month, compared to 16.9 percent of current nonsmokers (SAMHSA, 2011).
Source: U.S. Department of Health and Human Services, Office of Inspector General
WHY WE DID THIS STUDY
During 2010, 206 community mental health centers (CMHC) received an estimated $218.6 million for providing partial hospitalization program (PHP) services to approximately 25,000 Medicare beneficiaries with mental disorders. Past OIG studies have found vulnerabilities in Medicare payments to CMHCs for PHPs. Additionally, in 2011, four CMHC owners and managers in Miami-Dade County, Florida, were convicted of fraudulently billing Medicare approximately $200 million for medically unnecessary PHP services from 2002 to 2010.
HOW WE DID THIS STUDY
We developed nine questionable billing characteristics based on past OIG work and input from CMS staff. We used 2009 and 2010 Medicare claims from CMS’s National Claims History File to identify CMHCs that had unusually high billing for at least one of nine OIG questionable billing characteristics in 2010 and the metropolitan areas where these CMHCs were located. We also determined whether the percentage of CMHCs with questionable billing varied according to whether States had licensure or certification requirements.
WHAT WE FOUND
In 2010, approximately half of CMHCs met or exceeded thresholds that indicated unusually high billing for at least one of nine questionable billing characteristics. Approximately one-third of these CMHCs had at least two of the characteristics. Additionally, approximately two-thirds of CMHCs with questionable billing were located in eight metropolitan areas. Finally, 90 percent of CMHCs with questionable billing were located in States that do not require CMHCs to be licensed or certified.
WHAT WE RECOMMEND
We recommend that CMS:
(1) Increase its monitoring of CMHCs’ Medicare billing and fraud prevention controls,
(2) Enforce the requirement that certifying physicians be listed on the PHP claims submitted by CMHCs,
(3) Finalize and implement the proposed conditions of participation for CMHCs, and
(4) Review and take appropriate action against CMHCs with questionable billing that we identified. CMS concurred with all four recommendations.
Practice-Based Interventions Addressing Concomitant Depression and Chronic Medical Conditions in the Primary Care Setting
Objectives: For adults with concomitant depression and chronic medical conditions seen in the primary care setting, to assess the effectiveness of practice-based interventions for improving mental health or medical outcomes.Data Sources: We searched MEDLINE ® , Embase, the Cochrane Library, CINAHL ® , and PsycINFO ® from inception to December 2011. We identified additional studies from reference lists and technical experts.Review Methods: Two people independently selected, extracted data from, and rated the quality of relevant trials and systematic reviews. We conducted quantitative analyses for outcomes when feasible and reported all results by medical condition when possible. Two reviewers graded the strength of evidence (SOE) using established criteria.Results: We included 24 published articles reporting data from 12 studies (9 randomized controlled trials and 3 preplanned subgroup analyses from a tenth trial). Sample sizes ranged from 55 to 1,001, and study duration ranged from 6 to 60 months. Eleven studies were conducted in the United States (1 in Puerto Rico) and 1 in Scotland. All studies characterized their respective intervention as a form of collaborative care compared with usual or enhanced usual care, and generally involved a care manager with physician supervision; we found no studies describing other types of practice-based interventions. Settings of care for included studies, although rarely characterized, included both open and closed systems. All studies specified depression as the targeted mental health condition. Medical conditions included arthritis, cancer, diabetes, heart disease, HIV, and one or more conditions. Our meta-analyses found that intervention recipients achieved greater improvement than controls in depression symptoms, response, remission, and depression-free days (moderate SOE); satisfaction with care (moderate SOE); and mental and physical quality of life (moderate SOE). Few data were available on outcomes for chronic medical conditions, except for diabetes; only one trial used a medical outcome as the primary outcome. Diabetic patients receiving collaborative care exhibited no difference in diabetes control as compared with control groups (change in HbA1c: weighted mean difference 0.13, 95% CI, -0.22 to 0.48 at 6 months; 0.24, 95% CI, -0.14 to 0.62 at 12 months; low SOE).Conclusions: Collaborative care interventions improved outcomes for depression and quality of life in primary care patients with multiple different medical conditions. Few data were available on medical outcomes, except for HbA1c in diabetes, which showed no difference between treatment and usual care. Future studies should be designed to target a broader range of medical conditions, or clusters of conditions, and should compare variations of practice-based interventions in head-to-head trials.
Previous work has suggested that the experience of psychological stress may influence physical attractiveness ideals, but most evidence in favour of this hypothesis remains archival. The objective of this study was to experimentally investigate the impact of stress on men’s judgements of female body size.
Men were randomly assigned to either an experimental group, in which they took part in a task that heightened stress (experimental group, n = 41) or in which they did not take part in such a task (control group, n = 40). Both groups rated the attractiveness of female bodies varying in size from emaciated to obese, completed a measure of appetite sensation, and had their body mass indices (BMIs) measured.
Between-groups analyses showed that the experimental group was matched with the control group in terms of mean age, BMI, and appetite sensation. Further analyses showed that men in the experimental group rated a significantly heavier female body size as maximally attractive than the control group. Men in the experimental group also rated heavier female bodies as more attractive and idealised a wider range of female figures than did the control group.
This study found that the experience of stress was associated with a preference among men for heavier female body sizes. These results indicate that human attractiveness judgements are sensitive to variations in local ecologies and reflect adaptive strategies for dealing with changing environmental conditions.
Source: BMC Psychiatry
Patients with autism spectrum disorders (ASDs) exhibit core autistic symptoms including social impairments from early childhood and mostly show secondary disabilities such as irritability and aggressive behavior based on core symptoms. However, there are still no radical treatments of social impairments in these patients. Oxytocin has been reported to play important roles in multiple social behaviors dependent on social recognition, and has been expected as one of the effective treatments of social impairments of patients with ASDs.
We present a case of a 16-year-old girl with autistic disorder who treated by long-term administration of oxytocin nasal spray. Her autistic symptoms were successfully treated by two month administration; the girl’s social interactions and social communication began to improve without adverse effects. Her irritability and aggressive behavior also improved dramatically with marked decreases in aberrant behavior checklist scores from 69 to 7.
This case is the first to illustrate long-term administration of oxytocin nasal spray in the targeted treatment of social impairments in a female with autistic disorder. This case suggests that long-term nasal oxytocin spray is promising and well-tolerated for treatment of social impairments of patients with ASDs.