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Hasin D.,Health 123 | Hasin D.,Columbia University | Hasin D.,New York State Psychiatric Institute | Kilcoyne B.,Health 123
Current Opinion in Psychiatry | Year: 2012

Purpose of Review: The comorbidity between psychiatric and substance use disorders remains an important phenomenon to understand, and an active area of investigation. The purpose of this review is to highlight key 2011 issues and novel findings on psychiatric and substance disorders comorbidity from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a large national survey of the US general population. Recent Findings: Topics of active investigation included the internalizing/externalizing meta-structure of common mental disorders; the 10 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) personality disorders; the 3-year incidence and persistence of disorders; treatment of major depression; and many other topics not as easily categorized. Summary: Meta-structure may increasingly offer a parsimonious way of addressing comorbidity, although adding new disorders adds complexity and the value of etiologic analyses utilizing broad dimensions of psychopathology rather than individual disorders is not yet fully known. Expanding the range of personality disorders beyond antisocial personality disorder appears essential in understanding the incidence and persistence of substance use disorders. Substance use disorders have low rates of treatment relative to major depression, but increase the likelihood of depression treatment among comorbid cases, a phenomenon that needs to be understood. These comorbidity studies provide much novel information, and indicate many potentially fruitful directions for new research. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Jhu C.-Y.,National Yunlin University of Science and Technology | Wen C.-Y.,Health 123 | Shu C.-M.,National Yunlin University of Science and Technology | Shu C.-M.,Health 123
Applied Energy | Year: 2012

Thermal runaway hazards related to adiabatic runaway reactions in various 18650 Li-ion batteries were studied in an adiabatic calorimeter with vent sizing package 2 (VSP2). We selected two cathode types, LiCoO2 and Li(Ni1/3Co1/3Mn1/3)O2, and tested Li-ion batteries to determine the thermal runaway features. The charged 18650 Li-ion batteries were tested to evaluate the thermal hazard characteristics, such as the initial exothermic temperature (T0), self-heating rate (dT/dt), pressure rise rate (dP/dt), pressure-temperature profiles, maximum temperature (Tmax) and pressure (Pmax), which are measured by VSP2 with a customized stainless steel test can. The thermal reaction behaviors of the Li-ion battery packs were shown to be an important safety concern for energy storage systems for power supply applications. The thermal abuse trials of the adiabatic calorimetry methodology used to classify the self-reactive ratings of the various cathodes for Li-ion batteries provided the safety design considerations. © 2012 Elsevier Ltd.

Siegel R.L.,Health 123 | Sahar L.,Statistics and Evaluation Center | Portier K.M.,Statistics and Evaluation Center | Ward E.M.,Health 123 | Jemal A.,Health 123
CA Cancer Journal for Clinicians | Year: 2015

Knowledge of the cancer burden is important for informing and advocating cancer prevention and control. Mortality data are readily available for states and counties, but not for congressional districts, from which representatives are elected and which may be more influential in compelling legislation and policy. The authors calculated average annual cancer death rates during 2002 to 2011 for each of the 435 congressional districts using mortality data from the National Center for Health Statistics and population estimates from the US Census Bureau. Age-standardized death rates were mapped for all sites combined and separately for cancers of the lung and bronchus, colorectum, breast, and prostate by race/ethnicity and sex. Overall cancer death rates vary by almost 2-fold and are generally lowest in Mountain states and highest in Appalachia and areas of the South. The distribution is similar for lung and colorectal cancers, with the lowest rates consistently noted in districts in Utah. However, for breast and prostate cancers, while the highest rates are again scattered throughout the South, the geographic pattern is less clear and the lowest rates are in Hawaii and southern Texas and Florida. Within-state heterogeneity is limited, particularly for men, with the exceptions of Texas, Georgia, and Florida. Patterns also vary by race/ethnicity. For example, the highest prostate cancer death rates are in the West and north central United States among non-Hispanic whites, but in the deep South among African Americans. Hispanics have the lowest rates except for colorectal cancer in Wyoming, eastern Colorado, and northern New Mexico. These data can facilitate cancer control and stimulate conversation about the relationship between cancer and policies that influence access to health care and the prevalence of behavioral and environmental risk factors. CA Cancer J Clin 2015;65:339-344. © 2015 American Cancer Society. © 2015 American Cancer Society.

McFarlane G.J.,Health 123
Perspectives in Public Health | Year: 2010

If asked to describe the key public health challenges of our time many practitioners might well cite issues such as health inequalities, obesity, smoking and poverty. However, with the greatest of respect to those agendas, they are not, in my view, the greatest priority at present. If we cannot learn to live within sustainable limits and damage beyond repair the essential life support systems that we depend on, they will fail catastrophically with horrific consequences for humanity. All credible, reliable scientific evidence suggests that without profound and significant change that is exactly where we are headed. However, there is time, albeit short, to avoid the very worst consequences of runaway climate change. But to do so requires collective and urgent action now! Public health practitioners have potentially so much to offer towards this effort. We have many of the skills and experience so critically needed to advocate for change - both political and behavioural; we have the ability to design creative, effective, and dynamic interventions to assist and facilitate communities and individuals make the journey; and equally importantly we have huge opportunities to do so. However to do so effectively means that we need to look at the problem through a different lens and make climate change a top public health priority. We need to see beyond many of the institutional and cultural barriers that exist, albeit not through deliberate design, within our organisations which can cause us to be focused on very specific agendas and see the whole wood, rather than individual trees within it. Climate change is not just an "environmental" problem and a priority therefore specifically for that sector. It is already costing lives and is life threatening on a scale that far surpasses current public health concerns and priorities. Equally critically, tackling climate change would and will significantly contribute towards addressing health inequalities. To use two well worn public health cliché's, climate change is everyone's business. And it must be a case of prevention because there will be, in this instance, no cure! © 2010 Royal Society for Public Health.

Ramseier L.E.,University of Zürich | Janicki J.A.,Childrens Memorial Hospital | Weir S.,Health 123 | Narayanan U.G.,University of Toronto
Journal of Bone and Joint Surgery - Series A | Year: 2010

Background: The optimal management of femoral fractures in adolescents is controversial. This study was performed to compare the results and complications of four methods of fixation and to determine the factors related to those complications. Methods: We conducted a retrospective cohort study of 194 diaphyseal femoral fractures in 189 children and adolescents treated with elastic stable intramedullary nail fixation, external fixation, rigid intramedullary nail fixation, or plate fixation. After adjustment for age, weight, energy of the injury, polytrauma, fracture level and pattern, and extent of comminution, treatment outcomes were compared in terms of the length of the hospital stay, time to union, and complication rates, including loss of reduction requiring a reoperation, malunion, nonunion, refracture, infection, and the need for a reoperation other than routine hardware removal. Results: The mean age of the patients was 13.2 years, and their mean weight was 49.5 kg. There was a loss of reduction of two of 105 fractures treated with elastic nail fixation and ten of thirty-three treated with external fixation (p < 0.001). At the time of final follow-up, five patients (two treated with external fixation and one in each of the other groups) had ≥2.0 cm of shortening. Eight of the 104 patients (105 fractures) treated with elastic nail fixation underwent a reoperation (two each because of loss of reduction, refracture, the need for trimming or advancement of the nail, and delayed union or nonunion). Sixteen patients treated with external fixation required a reoperation (ten because of loss of reduction, one for replacement of a pin complicated by infection, one for débridement of the site of a deep infection, three because of refracture, and one for lengthening). One patient treated with a rigid intramedullary nail required débridement at the site of a deep infection, and one underwent removal of a prominent distal interlocking screw. One fracture treated with plate fixation required refixation following refractures. A multivariate analysis with adjustment for baseline differences showed external fixation to be associated with a 12.41-times (95% confidence interval = 2.26 to 68.31) greater risk of loss of reduction and/or malunion than elastic stable intramedullary nail fixation. Conclusions: External fixation was associated with the highest rate of complications in our series of adolescents treated for a femoral fracture. Although the other three methods yielded comparable outcomes, we cannot currently recommend one method of fixation for all adolescents with a femoral fracture. The choice of fixation will remain influenced by surgeon preference based on expertise and experience, patient and fracture characteristics, and patient and family preferences. Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence. Copyright © 2010 by The Journal of Bone and Joint Surgery, Incorporated.

Our objective was to evaluate a pharmacist-delivered comprehensive medication management (CMM) service provided to patients with psychiatric disorders. We conducted a retrospective review and analysis of medication-related data, and a return on investment cost analysis. The project consisted of 154 patients with psychiatric disorders who were referred to the CMM service by physicians, therapists, case managers, friends, or family, and were seen by the service between April 2011 and July 2013. CMM evaluates a patient's medications to ensure that they are appropriate, effective, safe, and convenient. Patients were seen by pharmacists trained in CMM and the treatment of mental illnesses, including one board-certified psychiatric pharmacist. All medications were reviewed including prescriptions, over-the-counter medications, and nutritional supplements. The patients' medication-related concerns, goals of treatment, vital signs, and laboratory studies were reviewed. Drug therapy problems such as adverse reactions, unnecessary medications, excessive doses, and poor medication adherence were identified, and written recommendations were mailed to patients and physicians within 1 week. Patients were offered follow-up in 4-6 weeks and were seen as many times as needed to resolve drug therapy problems. The 154 patients completed 256 CMM visits. A mean of 10.1 medical and psychiatric conditions and 13.7 medications/person were assessed. A mean of 5.6 drug therapy problems/patient were identified. A total net cost savings was estimated to be $90,484.00, with a mean savings of $586.55/patient. The cost of providing the service was estimated at $32,185.93. The return on investment was estimated to be 2.8; thus for every dollar spent on providing the service, $2.80 was estimated to be saved. Patients with mental illnesses may benefit from pharmacist-delivered CMM to help resolve drug therapy problems. Medication management may improve clinical outcomes and reduce costs. In addition, patients valued the opportunity to review their medications with a pharmacist. © 2014 Pharmacotherapy Publications, Inc.

Evans G.,Health 123 | Sutton E.L.,University of Washington
Medical Clinics of North America | Year: 2015

Oral contraception (OC) remains a popular noninvasive, readily reversible approach for pregnancy prevention and, largely off label, for control of acne, hirsutism, dysmenorrhea, irregular menstruation, menorrhagia, and other menstrual-related symptoms. Many OC formulations exist, with generics offering lower cost and comparable efficacy. Certain medical conditions, including hypertension, migraine, breast cancer, and risk of venous thromboembolism (VTE), present contraindications. Blood pressure measurement is the only physical examination or testing needed before prescription. Although no OC is clearly superior to others, OCs containing the second-generation progestin levonorgestrel have been associated with lower VTE risk than those containing other progestins. © 2015.

Wellock V.K.,Health 123
Midwifery | Year: 2010

Background: domestic abuse affects one in three women in the UK and can have long-term consequences for those concerned and their families. Guidelines suggest that all women should be asked about domestic abuse, and the Department of Health has suggested ways of supporting this issue. Health-care professionals could find themselves with a woman who cannot speak English, and may require the support of an interpreter. Current guidelines are not suitable for Black and minority-ethnic women, and midwives may not have enough cultural awareness to support these women. Aim: to interview bilingual women in the community to explore: (1) how domestic abuse is viewed in their culture; and (2) who should be questioning women about this sensitive issue. Method: a qualitative phenomenological study using semi-structured interviews with non-pregnant bilingual workers within the local community. Findings: women's lives were influenced by their in-laws and family, status, attitudes to marriage arrangements and gossiping in the community. All of these factors affected disclosure. Conclusions: health-care professionals must understand that women take serious measures to hide the fact that they are victims of abuse in order to preserve family honour. Divulging information to interpreters or relatives is a problem because of lack of confidentiality and gossiping in the community. © 2008 Elsevier Ltd. All rights reserved.

Health 123 | Date: 2014-10-31

A method that includes receiving information related to a wellness of a user from a plurality of data sources associated with the user, generating a wellness rating for the user, the generating of the wellness rating being based in part on the received information and based further in part on one or more weighting factors applied to the received information, and providing to the user an indication of the generated wellness rating and recommendations for improving the wellness of the user. At a time subsequent to the providing, receiving additional information related to the wellness of the user from at least one of the plurality of data sources associated with the user and generating, based at least in part on the receiving of the additional information, a modified wellness rating for the user.

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