The Lancet
Volume 381, Issue 9862
Page 177
Last week, American people, health-care workers, and policy makers received shocking news. Despite spending more on health care per person than other high-income countries, Americans die sooner, are least likely to reach the age of 50 years, and have higher rates of disease or injury. When judged by health alone, Americans are less healthy from birth to 75 years of age than people in 16 other economically wealthy countries, and this health disadvantage has been getting worse for 30 years, especially among women.
In a report released on Jan 9 from the US National Research Council and Institute of Medicine, U.S. Health in International Perspective: Shorter Lives, Poorer Health, comprehensive mortality and morbidity data are presented, comparing the USA with affluent democratic countries including Australia, Canada, France, Italy, most of the Nordic countries, Spain, and the UK. Life expectancy is shorter at birth for American men than for men in any of the other 16 countries, and American women fare little better—Denmark is the only country that has a lower life expectancy for women at birth. In nine key areas of health, Americans fare least well, or are near the bottom of the tables. These areas are: infant mortality and low birthweight; injuries and homicides; teenage pregnancies and sexually transmitted infections; HIV/AIDS prevalence; drug-related deaths; obesity and diabetes; heart disease; chronic lung disease; and disability. This health disadvantage applies to those with health insurance, a college education, higher incomes, and healthy behaviours as well as to those without.
Some good news in the report is that those Americans who reach 75 years live longer than their peers in other countries, and that Americans have low death rates from stroke and cancer. Moreover, current smoking rates are low, which should lead to future health benefits, and household income is relatively high.
US health spending was US$2·7 trillion in 2011, which is $8700 for every person in the country, and represents 17·9% of the economy—far greater than any other economically advanced country. But spending on health care bears little relation to good health.
Why are Americans at a health disadvantage compared with those in other countries? The fragmented US health-care system, and, in particular, poor access to health care and to primary care, are partly to blame....
The entire story is here.
Monday, January 21, 2013
Sunday, January 20, 2013
Suspect in Killings Is Deemed Not Fit
By THE ASSOCIATED PRESS
Published: January 7, 2013
A judge ruled on Monday that a man accused of killing seven people at a small Christian college in Oakland is not mentally fit for trial.
Judge Carrie Panetta of Alameda County Superior Court temporarily suspended the case against One L. Goh after two psychiatric evaluations concluded that he had paranoid schizophrenia.
David Klaus, an Alameda County assistant public defender, said after Monday’s hearing that Mr. Goh’s condition causes him to have hallucinations and delusions and to distrust people, including those trying to help him. Mr. Goh’s lawyers have trouble talking to him, Mr. Klaus said.
The rest of the story is here.
Saturday, January 19, 2013
Prevalence, Correlates, and Treatment of Lifetime Suicidal Behavior Among Adolescents
Results From the National Comorbidity Survey
Matthew K. Nock, PhD; Jennifer Greif Green, PhD; Irving Hwang, MA; Katie A. McLaughlin, PhD; Nancy A. Sampson, BA; Alan M. Zaslavsky, PhD; Ronald C. Kessler, PhD
JAMA Psychiatry. 2013;():1-11. doi:10.1001/2013.jamapsychiatry.55.
ABSTRACT
Context
Although suicide is the third leading cause of death among US adolescents, little is known about the prevalence, correlates, or treatment of its immediate precursors, adolescent suicidal behaviors (ie, suicide ideation, plans, and attempts).
Objectives
To estimate the lifetime prevalence of suicidal behaviors among US adolescents and the associations of retrospectively reported, temporally primary DSM-IV disorders with the subsequent onset of suicidal behaviors.
Design
Dual-frame national sample of adolescents from the National Comorbidity Survey Replication Adolescent Supplement.
Setting
Face-to-face household interviews with adolescents and questionnaires for parents.
Participants
A total of 6483 adolescents 13 to 18 years of age and their parents.
Main Outcome Measures
Lifetime suicide ideation, plans, and attempts.
Results
The estimated lifetime prevalences of suicide ideation, plans, and attempts among the respondents are 12.1%, 4.0%, and 4.1%, respectively. The vast majority of adolescents with these behaviors meet lifetime criteria for at least one DSM-IV mental disorder assessed in the survey. Most temporally primary (based on retrospective age-of-onset reports) fear/anger, distress, disruptive behavior, and substance disorders significantly predict elevated odds of subsequent suicidal behaviors in bivariate models. The most consistently significant associations of these disorders are with suicide ideation, although a number of disorders are also predictors of plans and both planned and unplanned attempts among ideators. Most suicidal adolescents (>80%) receive some form of mental health treatment. In most cases (>55%), treatment starts prior to onset of suicidal behaviors but fails to prevent these behaviors from occurring.
Conclusions
Suicidal behaviors are common among US adolescents, with rates that approach those of adults. The vast majority of youth with suicidal behaviors have preexisting mental disorders. The disorders most powerfully predicting ideation, though, are different from those most powerfully predicting conditional transitions from ideation to plans and attempts. These differences suggest that distinct prediction and prevention strategies are needed for ideation, plans among ideators, planned attempts, and unplanned attempts.
The original research is here.
Matthew K. Nock, PhD; Jennifer Greif Green, PhD; Irving Hwang, MA; Katie A. McLaughlin, PhD; Nancy A. Sampson, BA; Alan M. Zaslavsky, PhD; Ronald C. Kessler, PhD
JAMA Psychiatry. 2013;():1-11. doi:10.1001/2013.jamapsychiatry.55.
ABSTRACT
Context
Although suicide is the third leading cause of death among US adolescents, little is known about the prevalence, correlates, or treatment of its immediate precursors, adolescent suicidal behaviors (ie, suicide ideation, plans, and attempts).
Objectives
To estimate the lifetime prevalence of suicidal behaviors among US adolescents and the associations of retrospectively reported, temporally primary DSM-IV disorders with the subsequent onset of suicidal behaviors.
Design
Dual-frame national sample of adolescents from the National Comorbidity Survey Replication Adolescent Supplement.
Setting
Face-to-face household interviews with adolescents and questionnaires for parents.
Participants
A total of 6483 adolescents 13 to 18 years of age and their parents.
Main Outcome Measures
Lifetime suicide ideation, plans, and attempts.
Results
The estimated lifetime prevalences of suicide ideation, plans, and attempts among the respondents are 12.1%, 4.0%, and 4.1%, respectively. The vast majority of adolescents with these behaviors meet lifetime criteria for at least one DSM-IV mental disorder assessed in the survey. Most temporally primary (based on retrospective age-of-onset reports) fear/anger, distress, disruptive behavior, and substance disorders significantly predict elevated odds of subsequent suicidal behaviors in bivariate models. The most consistently significant associations of these disorders are with suicide ideation, although a number of disorders are also predictors of plans and both planned and unplanned attempts among ideators. Most suicidal adolescents (>80%) receive some form of mental health treatment. In most cases (>55%), treatment starts prior to onset of suicidal behaviors but fails to prevent these behaviors from occurring.
Conclusions
Suicidal behaviors are common among US adolescents, with rates that approach those of adults. The vast majority of youth with suicidal behaviors have preexisting mental disorders. The disorders most powerfully predicting ideation, though, are different from those most powerfully predicting conditional transitions from ideation to plans and attempts. These differences suggest that distinct prediction and prevention strategies are needed for ideation, plans among ideators, planned attempts, and unplanned attempts.
The original research is here.
A Clinical Trial and Suicide Leave Many Questions: Part 4: The University of Minnesota’s Response
By Judy Stone | January 8, 2013
Scientific American
Demystifying drug development, clinical research, medicine, and the role ethics plays
In earlier posts, we’ve looked at issues of consent, investigator responsibilities, and conflicts of interest on the case of Dan Markingson’s suicide while participating in a clinical trial of anti-psychotics at the University of Minnesota. This time, we turn to the University’s response.
Not surprisingly, the University has claimed it has no responsibility for any wrongdoing—that in fact, no wrongdoing even occurred. But there are some inconsistencies in the story and unanswered questions. There is also concern over how the University has responded to criticism. We’ll examine these issues in this post.
Background regarding the University’s response
In response to the Minnesota Board of Social Work’s “corrective action” vs. Jeanne Kenney, the social worker/study coordinator who did most of the study assessments on Markingson, the UMN’s General Counsel Mark Rotenberg stated, “As we’ve stated previously, the Markingson case has been exhaustively reviewed by federal, state and academic bodies since 2004. The FDA, the Hennepin County District Court, the Minnesota Board of Medical Practice, the Minnesota Attorney General’s Office and the University’s Institutional Review Board have all reviewed the case. None found fault with the University. None found fault with any of our faculty. Most importantly, none found any causal link between the CAFE trial and the death of Mr. Markingson.”
Yet a number of UMN faculty have remaining concerns and have requested an independent investigation. Two years ago, eight faculty members in the Bioethics Department wrote Rotenberg, citing the University’s conflicts of interest in the matter. The UMN declines to reexamine the case, saying that they have been exonerated. In October 2012, Dr. Carl Elliott, Professor in the UMN Center for Bioethics, wrote Dr. Debra DeBruin, director of the Clinical Research Ethics Consultation Service for the UMN Clinical and Translational Science Institute, again requesting a review. This time Dr. Elliott expressed concern regarding human subjects protections in other trials conducted by the psychiatry department as well. As always, Dr. Elliott’s concerns were thoroughly documented. Once again, the University has turned away.
The entire story is here.
Thanks to Tom Fink for this story.
Military suicides hit record in 2012, outpace combat deaths
Reuters
Originally published January 14, 2013
The number of U.S. troops committing suicide set a record in 2012, exceeding the number of combat deaths, the Pentagon said on Monday.
The Pentagon said 349 active-duty troops killed themselves in 2012, up more than 15 percent from 2011 despite renewed efforts by the military to stem the suicide rate.
"This is an epidemic that cannot be ignored," said Senator Patty Murray, who championed legislation last year to improve suicide prevention efforts and mental health care for troops and veterans.
"As our newest generation of servicemembers and veterans face unprecedented challenges, today's news shows we must be doing more to ensure they are not slipping through the cracks."
The Army, as the largest service, counted the biggest number of suicides, with 182 soldiers killing themselves in 2012, according to preliminary figures. The Navy had 60 suicides, the Air Force had 59 and the Marines had 48.
The figures were first reported by the Associated Press.
The Pentagon pointed to steps to bolster suicide prevention efforts, including expanding a suicide prevention hotline. Still, Defense Secretary Leon Panetta last year acknowledged that the suicides were the most frustrating issue he had faced since taking over the Pentagon in 2011.
"Despite the increased efforts, the increased attention, the trends continue to move in a troubling and tragic direction," Panetta told at a joint Pentagon-Department of Veterans Affairs suicide prevention conference in June.
The entire story is here.
Originally published January 14, 2013
The number of U.S. troops committing suicide set a record in 2012, exceeding the number of combat deaths, the Pentagon said on Monday.
The Pentagon said 349 active-duty troops killed themselves in 2012, up more than 15 percent from 2011 despite renewed efforts by the military to stem the suicide rate.
"This is an epidemic that cannot be ignored," said Senator Patty Murray, who championed legislation last year to improve suicide prevention efforts and mental health care for troops and veterans.
"As our newest generation of servicemembers and veterans face unprecedented challenges, today's news shows we must be doing more to ensure they are not slipping through the cracks."
The Army, as the largest service, counted the biggest number of suicides, with 182 soldiers killing themselves in 2012, according to preliminary figures. The Navy had 60 suicides, the Air Force had 59 and the Marines had 48.
The figures were first reported by the Associated Press.
The Pentagon pointed to steps to bolster suicide prevention efforts, including expanding a suicide prevention hotline. Still, Defense Secretary Leon Panetta last year acknowledged that the suicides were the most frustrating issue he had faced since taking over the Pentagon in 2011.
"Despite the increased efforts, the increased attention, the trends continue to move in a troubling and tragic direction," Panetta told at a joint Pentagon-Department of Veterans Affairs suicide prevention conference in June.
The entire story is here.
Friday, January 18, 2013
U.S. high court won't review federal embryonic stem cell funds
By Terry Baynes
Reuters
Originally posted on January 7, 2013
The U.S. Supreme Court on Monday refused to review a challenge to federal funding of human embryonic stem cell research brought by two researchers who said the U.S. National Institutes of Health rules on such studies violate federal law.
The decision brings an end to a lawsuit that had threatened to hamper stem cell research after a district court judge blocked the taxpayer funding in 2010. But some observers expected the Supreme Court would decline the take the case after an appeals court ruled that the funding could continue.
U.S. law prohibits the NIH from funding the creation of human embryos for research or research in which human embryos are destroyed, but leaves room for debate over whether that includes work with human embryonic stem cells.
Opponents of such research, including many religious conservatives, have argued that it is unacceptable because it destroys human embryos.
Scientists hope to be able to use stem cells to find treatments for spinal cord injuries, cancer, diabetes and diseases such as Alzheimer's and Parkinson's.
The entire story is here.
Reuters
Originally posted on January 7, 2013
The U.S. Supreme Court on Monday refused to review a challenge to federal funding of human embryonic stem cell research brought by two researchers who said the U.S. National Institutes of Health rules on such studies violate federal law.
The decision brings an end to a lawsuit that had threatened to hamper stem cell research after a district court judge blocked the taxpayer funding in 2010. But some observers expected the Supreme Court would decline the take the case after an appeals court ruled that the funding could continue.
U.S. law prohibits the NIH from funding the creation of human embryos for research or research in which human embryos are destroyed, but leaves room for debate over whether that includes work with human embryonic stem cells.
Opponents of such research, including many religious conservatives, have argued that it is unacceptable because it destroys human embryos.
Scientists hope to be able to use stem cells to find treatments for spinal cord injuries, cancer, diabetes and diseases such as Alzheimer's and Parkinson's.
The entire story is here.
Thursday, January 17, 2013
'Protecting' Psychiatric Medical Records Puts Patients At Risk Of Hospitalization
Medical News Today
Originally published January 6, 2013
Medical centers that elect to keep psychiatric files private and separate from the rest of a person's medical record may be doing their patients a disservice, a Johns Hopkins study concludes.
In a survey of psychiatry departments at 18 of the top American hospitals as ranked by U.S. News & World Report's Best Hospitals in 2007, a Johns Hopkins team learned that fewer than half of the hospitals had all inpatient psychiatric records in their electronic medical record systems and that fewer than 25 percent gave non-psychiatrists full access to those records.
Strikingly, the researchers say, psychiatric patients were 40 percent less likely to be readmitted to the hospital within the first month after discharge in institutions that provided full access to those medical records.
"The big elephant in the room is the stigma," says Adam I. Kaplin, M.D., Ph.D., an assistant professor of psychiatry and behavioral sciences and neurology at the Johns Hopkins University School of Medicine and leader of the study published online in the International Journal of Medical Informatics. "But there are unintended consequences of trying to protect the medical records of psychiatric patients. When you protect psychiatric patients in this way, you're protecting them from getting better care. We're not helping anyone by not treating these diseases as we would other types of maladies. In fact, we're hurting our patients by not giving their medical doctors the full picture of their health."
The entire story is here.
Wednesday, January 16, 2013
Disclosure and Concealment of Sexual Orientation and the Mental Health of Non-Gay-Identified, Behaviorally Bisexual Men.
Eric W. Schrimshaw, Karolynn Siegel, Martin J. Downing, Jeffrey T. Parsons.
Disclosure and Concealment of Sexual Orientation and the Mental Health of Non-Gay-Identified, Behaviorally Bisexual Men. Journal of Consulting and Clinical Psychology, 2012;
DOI: 10.1037/a0031272
Objective:
Although bisexual men report lower levels of mental health relative to gay men, few studies have examined the factors that contribute to bisexual men's mental health. Bisexual men are less likely to disclose, and more likely to conceal (i.e., a desire to hide), their sexual orientation than gay men. Theory suggests that this may adversely impact their mental health. This report examined the factors associated with disclosure and with concealment of sexual orientation, the association of disclosure and concealment with mental health, and the potential mediators (i.e., internalized homophobia, social support) of this association with mental health.
Method:
An ethnically diverse sample of 203 non-gay-identified, behaviorally bisexual men who do not disclose their same-sex behavior to their female partners were recruited in New York City to complete a single set of self-report measures.
Results:
Concealment was associated with higher income, a heterosexual identification, living with a wife or girlfriend, more frequent sex with women, and less frequent sex with men. Greater concealment, but not disclosure to friends and family, was significantly associated with lower levels of mental health. Multiple mediation analyses revealed that both internalized homophobia and general emotional support significantly mediated the association between concealment and mental health.
Conclusions:
The findings demonstrate that concealment and disclosure are independent constructs among bisexual men. Further, they suggest that interventions addressing concerns about concealment, emotional support, and internalized homophobia may be more beneficial for increasing the mental health of bisexual men than those focused on promoting disclosure.
Disclosure and Concealment of Sexual Orientation and the Mental Health of Non-Gay-Identified, Behaviorally Bisexual Men. Journal of Consulting and Clinical Psychology, 2012;
DOI: 10.1037/a0031272
Objective:
Although bisexual men report lower levels of mental health relative to gay men, few studies have examined the factors that contribute to bisexual men's mental health. Bisexual men are less likely to disclose, and more likely to conceal (i.e., a desire to hide), their sexual orientation than gay men. Theory suggests that this may adversely impact their mental health. This report examined the factors associated with disclosure and with concealment of sexual orientation, the association of disclosure and concealment with mental health, and the potential mediators (i.e., internalized homophobia, social support) of this association with mental health.
Method:
An ethnically diverse sample of 203 non-gay-identified, behaviorally bisexual men who do not disclose their same-sex behavior to their female partners were recruited in New York City to complete a single set of self-report measures.
Results:
Concealment was associated with higher income, a heterosexual identification, living with a wife or girlfriend, more frequent sex with women, and less frequent sex with men. Greater concealment, but not disclosure to friends and family, was significantly associated with lower levels of mental health. Multiple mediation analyses revealed that both internalized homophobia and general emotional support significantly mediated the association between concealment and mental health.
Conclusions:
The findings demonstrate that concealment and disclosure are independent constructs among bisexual men. Further, they suggest that interventions addressing concerns about concealment, emotional support, and internalized homophobia may be more beneficial for increasing the mental health of bisexual men than those focused on promoting disclosure.
Tuesday, January 15, 2013
Guilt and Moral Character
Academic Minute
Inside Higher Ed
Originally published January 4, 2012
In today’s Academic Minute, Carnegie Mellon University's Taya Cohen analyzes why our moral nature may depend on our response to guilt. Cohen is an assistant professor of organizational behavior and theory in the Tepper School of Business at Carnegie Mellon. Find out more about her here.
In today’s Academic Minute, Carnegie Mellon University's Taya Cohen analyzes why our moral nature may depend on our response to guilt. Cohen is an assistant professor of organizational behavior and theory in the Tepper School of Business at Carnegie Mellon. Find out more about her here.
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