Mental illness hospitalizations of youth in Washington State

OBJECTIVE: To determine if mental health hospitalizations have increased among youth. DESIGN: A retrospective cross-sectional time trend study. The Washington State Comprehensive Hospital Abstract Reporting System data set was used to examine hospitalizations among youth (aged 5-19 years) from January 1, 1990, through December 31, 1999. The yearly rates of youth hospitalized for mental illness were calculated, as were the proportions of hospitalizations due to mental illness. Chi(2) tests of trend were computed to assess for significant change over time. Additional analyses examined trends in hospital days due to mental illness and repeated hospitalizations and compared mental illness with other major causes of child and adolescent hospitalization. RESULTS: The rate of school-aged children (aged 5-14 years) hospitalized for mental illness increased by 22% during the 1990s (P =.004). The proportion of hospitalizations due to mental illness in school-aged children increased from 7.8% in 1990 to 12.8% in 1999 (P<.001). Among adolescents (aged 15-19 years), no significant change occurred in the rate of mental illness hospitalizations, but the proportion of hospitalizations due to mental illness increased from 14.5% in 1990 to 21.5% in 1999 (P<.001). Although injuries were the leading cause of hospitalizations among youth in 1990, mental illness has since surpassed injuries as a cause for hospitalization. Mental illness accounted for one third of all hospital days for youth in 1999. CONCLUSIONS: Mental illness hospitalizations account for an increasing proportion of admissions and hospital days among children and adolescents in Washington State. During the past decade, mental illness has surpassed injury as a leading cause of hospitalization for Washington youth.     

High intensity focused ultrasound ablation of kidney guided by MRI

The effectiveness of magnetic resonance imaging (MRI) to monitor therapeutic protocols of high-intensity focused ultrasound (HIFU), in freshly excised pig kidney cortex is investigated. For high quality imaging, the pulse sequence fast spin echo (FSE) T1- and T2-weighted, and proton density were evaluated. For fast imaging, the pulse sequence T1-weighted fast spoiled gradient (FSPGR) was used. The main goal was to evaluate the MRI detection of large lesions (bigger than 1 cm x 1 cm x 1 cm) that is achieved by moving the transducer in a predetermined pattern. The contrast between lesion and kidney tissue is excellent with either T1-weighted or T2-weighted FSE. With T1-weighted FSE, the best contrast is observed for recovery time (TR) between 200 ms and 400 ms. With T2-weighted FSE best contrast can be achieved for echo time (TE) between 16 and 32 ms. T2-weighted FSE was proven as the best pulse sequence to detect cavitational activity. This advantage is attributed to the significant difference in signal intensity between air spaces and necrotic tissue. Air spaces appear brighter than thermal lesions. Therefore, for therapeutic protocols created using cavitational mode, T2-weighted FSE may be the optimum pulse sequence to use. The proton density pulse sequence does not provide any advantage over the T1- and T2-weighted pulse sequences. Using T1-weighted FSPGR, acquisition time as low as 5 s could be achieved. Good contrast and signal-to-noise ratio (SNR) are achieved with TR = 100 ms and flip angle between 75 to 90 degrees. The above techniques were very successful in detecting large lesion volumes.     

Mortality attributable to harmful drinking in the United States, 2000

OBJECTIVE: Although alcohol has been associated with death from a variety of causes, there are no recent data on the number of deaths in the United States attributable to harmful alcohol use. This study provides updated information on the number of deaths in the United States attributable to harmful drinking. METHOD: We used the etiologic-fraction method to calculate alcohol-related mortality by cause of death, using U.S. mortality data for 2000, the most recent year available. Prevalence of alcohol use was estimated from the Behavioral Risk Factor Survey and from the National Household Survey on Drug Abuse. Medium and high levels of regular drinking or heavy episodic drinking were defined as harmful drinking. RESULTS: An estimated 63,718 deaths were attributable to harmful drinking in the U.S. in 2000. Of these, an estimated 45,988 were in men and 17,730 in women, accounting for 4% of all deaths among men and 1.5% among women. Among men, 47.6% were due to medium and high levels of regular drinking, and 52.4% due to heavy episodic drinking, whereas among women these proportions were 54.2% and 45.8%. CONCLUSIONS: Harmful drinking accounts for a substantial number of deaths each year in the United States. Prevention of this underlying cause of mortality must be a public health priority.     

Tinker, tailor, soldier, patient: work attributes and depression disparities among young adults

Prior studies have consistently found the occurrence of depression to be higher among persons with lower socio-economic status (SES), but causal mechanisms for this relationship are often not well understood. For example, while depression has been shown to increase during spells of unemployment, little work has been done on job attributes that may be related to depression among employed people early in their careers. This study links the 1992 wave of the National Longitudinal Survey of Youth 1979 cohort-which included Depression symptom scores on the Center for Epidemiologic Studies Depression (CES-D) instrument-to the US Department of Labor's new occupational characteristics O*Net dataset. The resulting dataset includes information regarding depression, SES, and specific attributes of jobs held by the young adult respondents. Job attributes included measures of social status, interpersonal stressors, and physical conditions. Multivariate analysis revealed that for young men, higher job status is associated with lower CES-D scores. Higher scores on the opposition scale, which measures the extent to which employees are obliged to take a position opposed to others, is associated with higher CES-D scores. For young women, physically uncomfortable or dangerous jobs are associated with more depressive symptoms. Results are stratified by race/ethnicity. For Black men, unlike for White men or Latinos, job security is associated with fewer depressive symptoms; and for Latino men, but not for Black or White men, physically uncomfortable or dangerous jobs are associated with more depressive symptoms. For Black women, job status is associated with fewer depressive symptoms. We conclude that part of the SES-depression relationship may arise from the psychosocial aspects of jobs, which we have found to be significantly and meaningfully associated with depressive symptoms among employed young adults.     

Continuity of care is associated with well-coordinated care.

CONTEXT: The importance of continuity of care as a means to promote care coordination remains controversial. OBJECTIVE: To determine if there is an association between having an objective measure of continuity of care and parental perception that care is well coordinated. DESIGN: Cross-sectional study. SETTING AND POPULATION: Seven hundred fifty-nine patients presenting to a primary care clinic completed surveys that included 5 items from the Components of Primary Care Index (CPCI) that relate to care coordination. MAIN PREDICTOR VARIABLE: A continuity of care index (COC) that quantifies the degree of dispersion of care among providers. MAIN OUTCOME MEASURES: Likelihood of parents reporting high scores on the care coordination domain as well as each of the 5 individual CPCI items related to care coordination. RESULTS: Greater continuity of care was associated with higher scores on the CPCI care-coordination domain (P <.001). Continuity of care was also specifically associated with increased odds of agreeing with all 5 individual CPCI items, including reporting that their child's provider "always knows about care my child received in other places" (OR 3.97 [2.11-7.49]), "communicates with the other health care providers my child sees" (OR 2.98 [1.63-5.44]), "knows the results of my child's visits to other doctors" (OR 2.02 [1.08-3.80]), and "always follows up on a problem my child has had, either at the next visit or by phone" (OR 6.20 [2.88-13.35]) and wanting one provider to coordinate all of the health care that the child receives (OR 3.28 [1.48-7.27]). CONCLUSIONS: Greater continuity of primary care is associated with better care coordination as perceived by parents. Efforts to improve and maintain continuity may be justified.     

Disease-specific patterns of hospice and related healthcare use in an incidence cohort of seriously ill elderly patients

There appears to be significant heterogeneity across diseases in their patterns of health care use at the end of life. We use a new, nationally representative sample of patients diagnosed in 1993 with 13 serious diseases to demonstrate this variation in rates of inpatient, outpatient, and hospice utilization. The diseases are: cancer of the lung, colon, pancreas, urinary tract, liver or biliary tract, head or neck, or central nervous system, as well as leukemia or lymphoma, stroke, congestive heart failure, hip fracture, or myocardial infarction. We present disease-specific rates of: length of stay, interhospital transfer, outpatient visits in the year before and 3 years after diagnosis, death within 4 years, and gender-specific hospice use rates among decedents. Among decedents with noncancer diagnoses, rates of hospice use vary from 5.9% to 8.7%. Among decedents with cancer diagnoses, rates vary from 15.2% to 35.2%. For the cohort overall, 14.2% of male decedents and 12.4% of female decedents used hospice. Patterns of end-of-life care vary substantially according to diagnosis.