Hospitals with aggressive treatment styles have mixed results

Hospitals with aggressive treatment styles, also known as high hospital care intensity (HCI), had lower rates of patients dying from a major complication (failure to rescue) but longer hospitalizations, writes Kyle H. Sheetz, M.D., M.S., of the Center for Healthcare Outcomes and Policy, Ann Arbor, Mich., and colleagues.

The intensity of medical care varies around the country. Intensity is synonymous with an aggressive treatment style and it has been implicated in rising health care costs, especially during the end-of-life period. Inpatient surgery also is a cost burden. The authors analyzed national Medicare data to examine increased HCI and outcomes after major surgery.

The data identified 706,520 patients at 2,544 hospitals who underwent 1 of 7 major cardiovascular, orthopedic or general surgical operations. The Dartmouth Atlas provides metrics of health care intensity for Medicare beneficiaries in their last two years of life.

Patients who had surgery at high HCI vs. low HCI hospitals had increased major complication rates. However, patients who had surgery at high HCI hospitals were 5 percent less likely to die of a major complication (failure to rescue) than at a low HCI facility. However, patients treated at high-HCI hospitals had longer hospitalizations, more inpatient deaths and lower hospice use during the final two years of life.

“Hospital care intensity has an independent influence on established quality metrics for surgical care, although its ability to improve quality through direct augmentation appears limited.”

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JAMA Surgery. Published online October 1, 2014. doi:10.1001/jamasurg.2014.552

An author made conflict of interest disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Posted in Health Care: Costs, Health Care: Hospitals, Health Care: Medical Errors | Leave a comment

Hypertension risk rises closer to major roadways

PROVIDENCE, R.I. [Brown University] — A new study in the Journal of the American Heart Association reports a significant association between living near a major roadway and the risk of high blood pressure.

The Brown University-led analysis of data from 5,400 post-menopausal women in the San Diego metropolitan area found that women who lived within 100 meters of a highway or major arterial road had a 22-percent greater risk of hypertension than women who lived at least 1,000 meters away. In a range of intermediate distances, hypertension risk rose with proximity to the roadways.

Put in epidemiological terms, a 58-year-old woman in the study who lived close to a major road had the blood pressure risk of a 60-year-old woman who lived far from one. The elevated risks reported in the study statistically account for a wide range of confounding cardiovascular risk factors including age, demographics, health, and lifestyle and even local fast food availability.

Hypertension is an underlying factor for some cardiovascular diseases. For that reason, the increased likelihood of hypertension reported in the new study may help explain prior findings of associations between proximity to major roadways and cardiovascular diseases such as stroke. A few studies, mostly in Europe, have also tested the association between roadway proximity and hypertension, but results have been mixed.

“I think in the United States this study does tip the scale in favor of being concerned about the urban environment and how we develop our cities and our transportation systems,” said study corresponding author Gregory Wellenius, assistant professor of epidemiology in the Brown University School of Public Health. “There are a lot of new developments going up right near highways. One has to start thinking about what are the associated health effects with that.”

Assessing the association

The study data comes from the Women’s Health Initiative, a study funded by the National Heart Lung and Blood Institute that enrolled tens of thousands of participants in the mid 1990s including more than 5,600 in San Diego County. The study gathered data on a wide variety of personal health and demographic measures, including where participating women lived, their blood pressure and other key attributes.

Wellenius, lead author and graduate student Kipruto Kirwa, and their co-authors took this dataset and used mapping software to measure the distance from each woman’s home to a major roadway. They also consulted a database to determine each neighborhood’s abundance of supermarkets and fast-food restaurants to determine who lived in a so-called “food desert” where unhealthy food options were relatively many and healthier ones relatively few.

They then looked at the association between the prevalence of high blood pressure and distance from the highway (in ranges of less than or exactly 100 meters, between 100 and 200 meters, 200 to 1,000 meters and more than 1,000 meters).

In three levels of analysis, the researchers controlled for more and more possible confounding factors. In all, they controlled for age, ethnicity, smoking status, education, household income, cholesterol, body-mass index, diabetes history, physical activity level, and local food quality.

After all that, they found the odds of hypertension were 1.22 to 1 for those living closest, 1.13 to 1 for those between 100 and 200 meters, and 1.05 to 1 for those between 200 and 1000 meters from a major roadway. These odds are indexed such that 1 represents the prevalence risk of those living more than 1,000 meters from a major roadway.

Wellenius acknowledged that because the study only measured who had hypertension and where they lived at one moment in time, it does not necessarily show a causal link. The study also does not shed light on what specifically about proximity to the road could cause hypertension. It could be airborne pollutants or noise or both — or something else. But prior studies have shown specific physiological effects from pollution and noise that could have direct causal relevance to cardiovascular disease.

Wellenius cautioned that hypertension, even when treated, still carries an elevated risk of cardiovascular disease. The best policy, he said, is therefore prevention.

“The public health message is that we need to take into consideration the health of the population when planning neighborhoods, when planning transportation systems, and when deciding where new highways are going to go, and how we might be able to mitigate traffic or its effects,” Wellenius said.

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In addition to Kirwa and Wellenius, other authors are Melissa Eliot, Yi Wang, and Dr. Charles Eaton of Brown; Marc Adams of Arizona State University; and Cindy Morgan, Jacqueline Kerr, Gregory Norman, and Dr. Matthew Allison of the University of California–San Diego.

Grants from the National Institute of Environmental Health Sciences (R01-ES020871 and R00-ES015774), from the National Cancer Institute (R21-CA127777), and the National Institutes of Health (NO1-WH-3-2120) and Brown University funded the study.

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Posted in Environmental Health: Urban, Hypertension | Leave a comment

Worry, Jealousy, Moodiness Linked to Higher Risk of Alzheimer’s in Women

Newswise — MINNEAPOLIS – Women who are anxious, jealous, or moody and distressed in middle age may be at a higher risk of developing Alzheimer’s disease later in life, according to a nearly 40-year-long study published in the October 1, 2014, online issue of Neurology®, the medical journal of the American Academy of Neurology.

“Most Alzheimer’s research has been devoted to factors such as education, heart and blood risk factors, head trauma, family history and genetics,” said study author Lena Johannsson, PhD, of the University of Gothenburg in Gothenburg, Sweden. “Personality may influence the individual’s risk for dementia through its effect on behavior, lifestyle or reactions to stress.”

For the study, 800 women with an average age of 46 were followed for 38 years and given personality tests that looked at their level of neuroticism and extraversion or introversion, along with memory tests. Of those, 19 percent developed dementia.

Neuroticism involves being easily distressed and personality traits such as worrying, jealousy or moodiness. People who are neurotic are more likely to express anger, guilt, envy, anxiety or depression. Introversion is described as shyness and reserve and extraversion is associated with being outgoing.

The women were also asked if they had experienced any period of stress that lasted one month or longer in their work, health, or family situation. Stress referred to feelings of irritability, tension, nervousness, fear, anxiety or sleep disturbances. Responses were categorized as zero to five, with zero representing never experiencing any period of stress, to five, experiencing constant stress during the last five years. Women who chose responses from 3 and 5 were considered to have distress.

The study found that women who scored highest on the tests for neuroticism had double the risk of developing dementia compared to those who scored lowest on the tests. However, the link depended on long-standing stress.

Being either withdrawn or outgoing did not appear to raise dementia risk alone, however, women who were both easily distressed and withdrawn had the highest risk of Alzheimer’s disease in the study. A total of 16 of the 63 women, or 25 percent, who were easily distressed and withdrawn developed Alzheimer’s disease, compared to eight out of the 64 people, or 13 percent, of those who were not easily distressed and were outgoing.

The study was supported by the Swedish Medical Research Council, the Swedish Council for Working Life and Social Research, the Swedish Research Council for Health, Working Life and Welfare, the Alzheimer’s Association, the Bank of Sweden Tercentenary Foundation, Swedish Brain Power, Söderström – Königska Nursing Home Foundation, Gamla Tjänarinnor Foundation, Shopkeeper Hjalmar Svensson’s Research Foundation, Professor Bror Gadelius Memorial Foundation the Dementia Foundation, Fredrik and Ingrid Thurings Foundation and the University of Gothenburg.

Posted in Alzheimer's, Human Behavior: Jealousy | Leave a comment

Treatment of substance abuse can lessen risk of future violence in mentally ill

BUFFALO, N.Y. — If a person is dually diagnosed with a severe mental illness and a substance abuse problem, are improvements in their mental health or in their substance abuse most likely to reduce the risk of future violence?

Although some may believe that improving symptoms of mental illness is more likely to lessen the risk for future episodes of violence, a new study from the University at Buffalo Research Institute on Addictions (RIA) suggests that reducing substance abuse has a greater influence in reducing violent acts by patients with severe mental illness.

“We were surprised to find that the severity of the patient’s psychiatric symptoms was not the primary factor in predicting later aggression,” says Clara Bradizza, senior research scientist at RIA and co-author of the study. “Rather, the patient’s substance abuse was the factor most closely associated with future aggression.”

A downloadable photo of Bradizza is available here: http://www.buffalo.edu/news/releases/2014/09/059.html.

Although the vast majority of people with mental illness do not engage in violent acts, the risk of violence is greater among the severely mentally ill than among the general population, and the connection between severe mental illness, substance abuse and aggression is a significant concern for community safety, treatment programs and public policy.

“Our findings suggest that treatment attendance is very important for these individuals and treatment programs should include interventions that are likely to decrease substance abuse, as this may provide the additional benefit of reducing the risk of later aggression among dual-diagnosis patients,” Bradizza says. “This not only improves the lives of affected individuals and their families, but also provides a safer environment for society as a whole.”

The study, funded by a grant from the National Institute on Alcohol Abuse and Alcoholism, followed nearly 300 patients over a six-month period following admission to an outpatient dual-diagnosis treatment program that provided both substance abuse and mental illness treatment.

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The results appear in the current online edition of the Journal of Substance Abuse Treatment. The study’s co-authors are Yue Zhuo, PhD, of St. John’s University and Stephen A. Maisto, PhD, of Syracuse University.

RIA is a research center of the University at Buffalo (UB) and a national leader in the study of alcohol and substance abuse issues. RIA’s research programs, most of which have multiple-year funding, are supported by federal, state and private foundation grants. Located on UB’s Downtown Campus, RIA is a member of the Buffalo Niagara Medical Campus and a key contributor to UB’s reputation for research excellence. To learn more, visit buffalo.edu/ria.

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Mean girl bullying behaviors: new research

COLUMBIA, Mo. – Relational aggression, or “mean girl” bullying, is a popular subject in news and entertainment media. This nonphysical form of aggression generally used among adolescent girls includes gossiping, rumor spreading, exclusion and rejection. As media coverage has illustrated, relational aggression can lead to tragic and sometimes fatal outcomes. Despite these alarming concerns, little has been done to prevent and eliminate these negative behaviors. Now, University of Missouri researchers have developed and tested an intervention that effectively decreases relational aggression among teen girls.

“Good outcomes can happen when priorities are set by schools and families to prevent and eliminate relational aggression,” said co-author Connie Brooks, an assistant professor in the Department of Health Psychology in the School of Health Professions and in the Thompson Center for Autism and Neurodevelopmental Disorders. “This study was an attempt to address this social problem in a meaningful way by testing an intervention to reduce relational aggression among teen girls.”

The intervention, Growing Interpersonal Relationships through Learning and Systemic Supports (GIRLSS), developed by MU researchers, is a 10-week, group counseling, caregiver training and caregiver phone consultation intervention for relationally aggressive middle school girls and their families. Students, ranging in age from 12 to 15, participated in one 70-minute session per week that included interactive discussions, media-based examples, role-playing, journaling and weekly goal setting. At the end of the intervention, school counselors and teachers reported a decrease in relationally aggressive behaviors among the girls.

Caregivers of students participated in separate workshops and biweekly phone consultations during which they learned new communication, monitoring and supervision strategies in addition to appropriate disciplinary responses.

“It takes a village to raise relationally healthy children,” said Melissa Maras, co-author and assistant professor in the Department of Educational, School and Counseling Psychology in the MU College of Education. “This study represents a first step in helping school personnel meet the intervention needs of a diverse group of relationally aggressive girls.”

According to Brooks, relational aggression is a complicated issue with many variables, including schools, families and individuals. She says parents and teachers should be aware of relational aggression so they don’t unknowingly contribute to the negative behaviors.

In order for the intervention to expand to more schools, MU researchers hope to improve and further evaluate GRILSS based on feedback from the participants.

The study’s lead author, Joni Williams Splett, completed this research at MU while she was a doctoral student. Splett is now a postdoctoral research fellow at the University of South Carolina. The research, “GIRLSS: A Randomized, Plot Study of a Multisystemic, School-Based Intervention to Reduce Relational Aggression,” was published in the Journal of Child and Family Studies.

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Tinnitus: First ever mutli-disciplinary, evidence-based clinical practice guideline to improve the diagnosis and management

ALEXANDRIA, VA — The American Academy of Otolaryngology—Head and Neck Surgery Foundation has released the first ever mutli-disciplinary, evidence-based clinical practice guideline to improve the diagnosis and management of tinnitus, the perception of sound—often ringing—without an external sound source. The guideline was published today in the journal Otolaryngology–Head and Neck Surgery.

“Tinnitus affects 10-15% of adults in the United States. It is the most common service-related disability among our military veterans. Yet despite its prevalence and effect on quality of life, prior to this there weren’t any evidence-based guidelines about managing tinnitus,” said Sujana S. Chandrasekhar, MD, a co-author of the guideline.

One of the strongest recommendations in the guideline is that clinicians differentiate between bothersome tinnitus and nonbothersome tinnitus. “About 20% of adults who experience tinnitus require clinical intervention, the rest are experiencing nonbothersome tinnitus,” explained Dr. Chandrasekhar.

The guideline, developed by a panel including representatives for otolaryngologists, geriatricians, primary care physicians, nurses, psychiatrists, behavioral neuroscientists, neurologists, radiologists, audiologists, psychoacousticians, and tinnitus patients, gives healthcare providers a framework for care and support in mitigating the personal and social impact that tinnitus can have. The guideline’s recommendations are made by experienced clinicians and methodologists, according to the best scientific evidence.

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The guideline authors are: David E. Tunkel, MD; Carol A. Bauer, MD; Gordon H. Sun, MD, MS; Richard M. Rosenfeld, MD, MPH; Sujana S. Chandrasekhar, MD; Eugene R. Cunningham Jr, MS; Sanford M. Archer, MD; Brian W. Blakley, MD, PhD; John M. Carter, MD; Evelyn C. Granieri, MD, MPH, MSEd; James A. Henry, PhD; Deena Hollingsworth, RN, MSN, FNP; Fawad A. Khan, MD; Scott Mitchell, JD, CPA; Ashkan Monfared, MD; Craig W. Newman, PhD; Folashade S. Omole, MD; C. Douglas Phillips, MD; Shannon K. Robinson, MD; Malcolm B. Taw, MD; Richard S. Tyler, PhD; Richard W. Waguespack, MD, and Elizabeth J. Whamond.

The guideline can be found at http://www.entnet.org.

About the AAO-HNS/F

The American Academy of Otolaryngology—Head and Neck Surgery, one of the oldest medical associations in the nation, represents about 12,000 physicians and allied health professionals who specialize in the diagnosis and treatment of disorders of the ears, nose, throat, and related structures of the head and neck. The Academy serves its members by facilitating the advancement of the science and art of medicine related to otolaryngology and by representing the specialty in governmental and socioeconomic issues. The AAO-HNS Foundation works to advance the art, science, and ethical practice of otolaryngology-head and neck surgery through education, research, and lifelong learning. The organization’s vision: “Empowering otolaryngologist-head and neck surgeons to deliver the best patient care.”

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Olfactory dysfunction may be a signal of mortality for older adults

For older adults, being unable to identify scents may be a predictor of mortality within five years, according to a study published October 1, 2014, in the journal PLOS ONE by Jayant Pinto from The University of Chicago and colleagues.

The study was part of the National Social Life, Health and Aging Project (NSHAP), the first in-home study of social relationships and health in a large, nationally representative sample of men and women ages 57 to 85. Researchers first surveyed 3,000 participants in 2005-06, assessing their ability to identify five distinct common odors, one at a time, from a set of four choices. The five odors, in order of increasing difficulty, were peppermint, fish, orange, rose and leather. In the second survey, during 2010-11, the team confirmed which participants were still living. During that five-year gap, 430 (12.5%) of the original 3005 study subjects had died; 2,565 were still alive.

Thirty-nine percent of study subjects who failed the first smelling test died before the second survey, compared to 19 percent of those with moderate smell loss and just 10 percent of those with a healthy sense of smell. For those already at high risk, lacking a sense of smell more than doubled the probability of death. When the researchers adjusted for demographic variables such as age, gender, socioeconomic status (as measured by education or assets), overall health, and race—those with greater smell loss when first tested were substantially more likely to have died five years later. Precisely how smell loss contributes to mortality is unclear, but olfactory dysfunction was better at predicting mortality than a diagnosis of heart failure, cancer or lung disease. Only severe liver damage was a more powerful predictor of death.

“We think loss of the sense of smell is like the canary in the coal mine,” said the study’s lead author Jayant M. Pinto, MD, associate professor of surgery at the University of Chicago. “It doesn’t directly cause death, but it’s a harbinger, an early warning system, that something has already gone badly wrong, that damage has been done. Our findings could provide a useful clinical test, a quick and inexpensive way to identify patients most at risk.”

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Use this URL to access to the freely available paper: http://dx.plos.org/10.1371/journal.pone.0107541

Citation: Pinto JM, Wroblewski KE, Kern DW, Schumm LP, McClintock MK (2014) Olfactory Dysfunction Predicts 5-Year Mortality in Older Adults. PLoS ONE 9(9):e107541. doi:10.1371/journal.pone.0107541

Funding: The National Institutes of Health, including the National Institute on Aging, the Office of Women’s Health Research, the Office of AIDS Research, and the Office of Behavioral and Social Sciences Research (AG021487, AG033903-01, and AG030481). Support was also provided by the National Institute on Aging (AG029795, AG036762, and T32000243), the McHugh Otolaryngology Research Fund, the American Geriatrics Society, The Center on the Demography and Economics of Aging, a Mellon Foundation Social Sciences Dissertation-Year Fellowship, and the Institute of Translational Medicine at The University of Chicago (KL2RR025000 and UL1RR024999). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests: The authors have declared that no competing interests exist.

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Exercise walking, fine tuned

Newswise — New research suggests the adage that encourages people to keep their “eyes on the prize” may be on target when it comes to exercise. When walking, staying focused on a specific target ahead can make the distance to it appear shorter and help people walk there faster, psychology researchers have found. Their study, which compares this technique to walking while looking around the environment naturally, offers a new strategy to improve the quality of exercise.

“People are less interested in exercise if physical activity seems daunting, which can happen when distances to be walked appear quite long,” explains New York University’s Emily Balcetis, an assistant professor in the Department of Psychology and one of the study’s co-authors. “These findings indicate that narrowly focusing visual attention on a specific target, like a building a few blocks ahead, rather than looking around your surroundings, makes that distance appear shorter, helps you walk faster, and also makes exercising seem easier.”

The study, which appears in the journal Motivation and Emotion, focused on “attentional narrowing,” which affects perceptions of space. The researchers, who also included Shana Cole, an NYU doctoral student at the time of the study and now an assistant professor in the School of Arts and Sciences at Rutgers University, and Matthew Riccio, an undergraduate at NYU’s College of Arts and Science, hypothesized that narrowing attention on a finish line would lead it to appear closer, increase walking speed, and reduce feelings of physical exertion.

Related research previously conducted in Balcetis’ lab and published last year found that people who are overweight see distances as farther than those who are average weight, especially when they are not very motivated to exercise.

“People are gaining weight at alarming rates,” Balcetis says. “More than 1.4 billion adults and 40 million kids under the age of five are overweight or obese worldwide. And in America, obesity rates have almost tripled in the last 30 years. Attentional narrowing might help people exercise more effectively because it makes physical activity look easier.”

The new research found that attentional narrowing acts as an intervention, changing perceptions of distance, so that all people can see the distances in ways that fit people see it.

In the Motivation and Emotion paper, the researchers conducted two experiments.

In the first, the study’s subjects—66 adults visiting a New York City park in the summer—stood 12 feet away from an open cooler, which contained cold beverages and ice. The experimenter explained to participants that they would estimate the distance to the cooler.

One set of subjects was randomly assigned to a narrowed attention condition in which they imagined that a spotlight was shining only on the cooler. They learned that to be effective at estimating distance, they should direct and focus their attention on the cooler and avoid looking around the environment. The second set of subjects was assigned to the natural attention condition and was instructed to allow their attention to move naturally and in whatever way they found to be most helpful for estimating distance.

Subjects who focused their attention only on the cooler perceived the cooler as closer than did those in the natural attention group.

In a second experiment, the researchers used this intervention to change perceptions of distance and improve the quality of exercise. Here, 73 participants walked 20 feet in a gymnasium while wearing ankle weights that added 15 percent to their body weight, thus making the task more challenging than unfettered walking.

As in the first experiment, one set of participants received the narrowed attention instructions (they were asked to focus on a traffic cone marking a finish line) and the other set received the natural attention condition (they were told to glance at the cone as well as look at their surroundings). Each group then completed the walking test while being timed by the experimenters.

The results confirmed the researchers’ hypothesis that attentional narrowing changed perceptions of distance, speed of walking, and perceived effort.

Those in the narrowed attention group perceived the cones to be 28 percent closer than did those in the natural condition group. In addition, those in the narrowed attention group walked 23 percent faster than did those in the natural attention group. Finally, those in the narrowed attention group reported that the walk required less physical exertion than did those in the natural condition group—a finding that may serve as an incentive to exercise.

“Physical activity is an important component of a healthy lifestyle,” Cole remarks. “Interventions that train people to keep their ‘eyes on the prize’ may play an important role in health and fitness. When goals appear within reach, and when people move faster and experience exercise as easier, they may be especially motivated to continue exercising.

“Given the alarming obesity epidemic in America, strategies that encourage or improve exercise may be particularly important for aiding the nationwide effort to combat obesity and promote healthier living.”

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Dog waste contaminates our waterways

Americans love their dogs, but they don’t always love to pick up after them. And that’s a problem. Dog feces left on the ground wash into waterways, sometimes carrying bacteria — including antibiotic-resistant strains — that can make people sick. Now scientists have developed a new genetic test to figure out how much dogs are contributing to this health concern, according to a report in the ACS journal Environmental Science & Technology.

Orin C. Shanks, Hyatt C. Green and colleagues explain that our waterways are susceptible to many sources of fecal contamination, including sewage leaks and droppings from farm animals and wildlife. Contamination from dog feces is a concern because it can harbor antibiotic-resistant strains of E. coli and other bacteria and parasites that can infect humans — and there are nearly 70 million domesticated dogs in the U.S.

Scientists have had few tools to determine the extent to which waste from dogs is adding to the pathogens in rivers, lakes and beachfront surf. Current methods look for certain genes from gut bacteria that end up in dog feces. However, this is not foolproof — the microbiota of humans and the canine pets they live with often overlap, making the analysis complicated. So Shanks’ team set out to create a more specific test.

The researchers developed a new genetic testing method to specifically detect canine fecal contamination in water. They identified 11 genetic markers that were common among most of the dog samples but missing from the human ones. To determine whether their method would work for real-world monitoring, they sampled storm water from a rain garden where people often walk their dogs. The technique successfully detected some of the same markers they had identified as evidence for canine waste.

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The American Chemical Society is a nonprofit organization chartered by the U.S. Congress. With more than 161,000 members, ACS is the world’s largest scientific society and a global leader in providing access to chemistry-related research through its multiple databases, peer-reviewed journals and scientific conferences. Its main offices are in Washington, D.C., and Columbus, Ohio.

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Posted in Animals: Dogs, Environmental Health: Groundwater, Environmental Health: Water | Leave a comment

Drug addicts or the mentally ill; which group is perceived more negatively?

People are significantly more likely to have negative attitudes toward those suffering from drug addiction than those with mental illness, and don’t support insurance, housing, and employment policies that benefit those dependent on drugs, new Johns Hopkins Bloomberg School of Public Health research suggests.

A report on the findings, which appears in the October issue of the journal Psychiatric Services, suggests that society seems not to know whether to regard substance abuse as a treatable medical condition akin to diabetes or heart disease, or as a personal failing to be overcome.

“While drug addiction and mental illness are both chronic, treatable health conditions, the American public is more likely to think of addiction as a moral failing than a medical condition,” says study leader Colleen L. Barry, PhD, MPP, an associate professor in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health. “In recent years, it has become more socially acceptable to talk publicly about one’s struggles with mental illness. But with addiction, the feeling is that the addict is a bad or weak person, especially because much drug use is illegal.”

Between Oct. 30 and Dec. 2, 2013, Barry and her colleagues surveyed a nationally representative sample of 709 participants about their attitudes toward either mental illness or drug addition. The questions centered on stigma, discrimination, treatment and public policy.

Not only did they find that respondents had significantly more negative opinions about those with drug addiction than those with mental illness, the researchers found much higher levels of public opposition to policies that might help drug addicts in their recovery.

Only 22 percent of respondents said they would be willing to work closely on a job with a person with drug addiction compared to 62 percent who said they would be willing to work with someone with mental illness. Sixty-four percent said that employers should be able to deny employment to people with a drug addiction compared to 25 percent with a mental illness. Forty-three percent were opposed to giving individuals addicted to drugs equivalent health insurance benefits to the public at-large, while only 21 percent were opposed to giving the same benefits to those with mental illness.

Respondents agreed on one question: Roughly three in 10 believe that recovery from either mental illness or drug addiction is impossible.

The researchers say that the stories of drug addiction portrayed in the media are often of street drug users in bad economic conditions rather than of those in the suburbs who have become addicted to prescription painkillers after struggling with chronic pain. Drug addicts who fail treatment are seen as “falling off the wagon,” as opposed to people grappling with a chronic health condition that is hard to bring under control, they say. Missing, they say, are inspiring stories of people who, with effective treatment, are able to overcome addiction and live drug-free for many years.

Barry says once it would have been taboo for people to casually discuss the antidepressants they are taking, which is often the norm today. That kind of frank talk can do wonders in shaping public opinion, she says.

“The more shame associated with drug addiction, the less likely we as a community will be in a position to change attitudes and get people the help they need,” says another study author, Beth McGinty, PhD, MS, an assistant professor in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health. “If you can educate the public that these are treatable conditions, we will see higher levels of support for policy changes that benefit people with mental illness and drug addiction.”

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“Stigma, Discrimination, Treatment Effectiveness, and Policy: Public Views About Drug Addiction and Mental Illness,” was written by Colleen L. Barry, PhD, MPP; Emma E. McGinty, PHD, MS; Bernice A. Pescosolido, PhD; and Howard H. Goldman, MD, PhD.

The study was supported by grants from AIG Inc.; the National Institutes of Health’s National Institute on Drug Abuse (R01 DA026414); the NIH’s National Institute of Mental Health (1R01MH093414-01A1); the National Science Foundation and the College of Arts and Sciences, Indiana University.

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Posted in Drug Addiction, Human Behavior: Perception, Mental Health | Leave a comment

The psychology behind Costco’s free samples

There’s no brand that’s as strongly associated with free samples as Costco.

People have been known to tour the sample tables at Costco stores for a free lunch, acquired piecemeal.

There are even personal-finance and food bloggers who’ve encouraged the practice.

Costco knows that sampling, if done right, can convince people that its stores are fun places to be. (Penn Jillette, of the magic act Penn & Teller, has on more than one occasion taken a woman on a date at a Costco warehouse.)

“When we compare it to other in-store mediums … in-store product demonstration has the highest [sales] lift,” says Giovanni DeMeo of the product-demonstration company Interactions, a department of which handles Costco’s samples.

That department is Club Demonstration Services, and it—not Costco—staffs the sample tables.

While DeMeo insists that the short-term spike in sales isn’t the only effect of product sampling that matters—it’s great for making customers loyal to stores and brands over longer periods of time—the figures are impressive.

In the past year, Interactions’ beer samples at many national retailers on average boosted sales by 71 percent, and its samples of frozen pizza increased sales by 600 percent.

(These figures are in line with the few others that are publicly available.)

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Posted in Human Behavior: Loyalty, Marketing, Nutrition: Marketing | Leave a comment

How one small fire can snarl the entire air travel ecosystem

Air traffic nationwide has been snarled since a fire erupted in the basement telecommunications room of an air traffic control center outside Chicago early Friday.

Things won’t get better anytime soon, and you can blame an air traffic control system that hasn’t changed in any meaningful way since the 1950s.

The problem started with a fire that authorities said was part of a suicide plot by an FAA contractor.

Beyond canceling thousands of flights over the weekend and raising troubling questions about the security of these facilities, the incident calls into question the efficacy of an air traffic system that manages 87,000 flights daily and won’t fully recover for another two weeks.

First, a quick lesson on air traffic control.

In the course of a flight, an aircraft is guided by a series of air traffic controllers, each handling a specific portion of the flight.

Take-off is run by the airport control tower.

Once a plane reaches 3,000 feet or so, it’s passed off to one of 160 terminal radar control facilities (TRACON) nationwide that monitor airspace up to about 10,000 feet.

Beyond that, aircraft are managed by one of 22 air route traffic control centers (ARTCC).

These centers ensure aircraft are properly spaced and following their flight plans, tracking them using a national network of more than 400 ground-based radars.

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When anger takes hold

I had just sat down to look over my calendar and plan my day when the phone rang.

It was my contractor. Several of his workers were at my apartment ready to finish some work, but the building management company refused to let them in.

This news made me furious.

We have been renovating our small apartment, and it’s painfully over budget and six months overdue.

During that time, the building management company’s mismanagement has cost me a tremendous amount of money and made an already difficult process even more agonizing.

Now they were needlessly delaying the project again, this time over a senseless bureaucratic triviality.

My contractor told me he would keep the workers there for an hour, at which point he would need to send them elsewhere and we would lose another day of work.

Too angry and agitated to stay still, I got up and began pacing around the room.

Over time, it will be useful to consider what I could have done to avoid this situation.

What role did I play in the dysfunction of my relationship with the building manager?

But that’s not what I want to explore here because that’s not what I was facing in the moment.

The real issue I had as I prepared to call the building manager was: What do I do with all my anger?

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Posted in Human Behavior: Angst | Leave a comment