Extracorporeal cardiopulmonary resuscitation (ECPR) is an emerging therapy for refractory cardiac arrest. The purpose of this study was to analyze and report characteristics and outcomes of adult ...patients treated with ECPR after out-of-hospital cardiac arrest (OHCA) in a large international registry.
The Extracorporeal Life Support Organization’s Extracorporeal Life Support Registry was queried for adult cardiac arrests with arrest location of “EMT Transport” or “Outside Hospital.”
From 2010–2016, 217 cases of ECPR following OHCA were reported in Europe (47%), Asia-Pacific (29%), and North America (24%). The median age was 52 years (IQR 45–62, range 18–87); 73% were male. The median duration of ECPR was 47h (IQR 17–94, range 0–711). Reported complications included hemorrhage (31.3%), limb complications (11.1%), circuit complications (8.8%), infection (7.4%), and seizures (5.5%). The rate of percutaneous coronary intervention (PCI) was higher in Europe (35.6%) and Asia-Pacific (25.8%) than North America (9.4%; p<0.01). Survival to hospital discharge was 27.6% (95% CI 22.1–34.0%), and male gender was independently associated with mortality (adjusted odds ratio 2.1 95% CI 1.1–4.2, p<0.05). Survival did not differ by region, race, age, or year. Brain death was reported in 16.6% 95% CI 12.2–22.1%; organ donation rate was not reported.
This international analysis of ECPR for refractory OHCA reveals a survival rate of 27.6%, demonstrates association of male gender with mortality, and highlights regional differences in PCI utilization. These results will help inform implementation and research of this potentially life-saving strategy for refractory OHCA.
The purpose of this study was to examine the cross-sectional and longitudinal associations among alcohol use disorder (AUD), stressful life events, and marital dissolution in a probability sample of ...adults.
The National Epidemiologic Survey on Alcohol and Related Conditions is a prospective, longitudinal study of a probability sample of 43,083 adults 18 years of age and older living in the United States. The interval between Wave 1 (W1) and Wave 2 (W2) was approximately 3 years. Cross-sectional analyses included 32,359 adults ages 18 and older who were ever married at W1, and longitudinal analyses included 17,192 adults who were currently married at W1 and who completed relevant W2 measures. Participants completed inhome surveys conducted with computer-assisted personal interviewing.
Rates of lifetime marital dissolution were significantly higher among those with lifetime AUD (48.3%) than in those with no lifetime AUD (30.1%). The incidence of marital dissolution from W1 to W2 was 15.5% for those with a past-12-month AUD at W1, compared to 4.8% among those with no AUD. Proportional hazards regression analyses showed that past-12-month AUD, tobacco use disorder, other substance use disorder, stressful life events, older age at marriage, being married more than once, and being married to an alcoholic at W1 predicted greater hazards of marital dissolution at W2. These associations were not moderated by gender.
AUD and stressful life events predict subsequent marital dissolution independently of other substance use disorders, mood and anxiety disorders, and personality disorders. Results were discussed within the framework of the Vulnerability-Stress-Adaptation model of marriage.
Abstract Purpose Very little research has examined the heterogeneity associated with the nonmedical use of prescription medications (NUPM) in nationally representative samples of adolescents. The ...main objectives of this study were to (1) identify motivational subtypes of past-year NUPM among high school seniors in the United States using a person-centered approach, and (2) examine the associations among motivational subtypes and characteristics of substance abuse (i.e., route of administration, co-ingestion, and subjective high). Methods Self-administered questionnaires as part of the Monitoring the Future study were completed by nationally representative samples of high school seniors (modal age, 18 years). The sample consisted of five cohorts (senior years of 2002–2006) made up of 12,431 high school seniors in total, of which 53% were women. Results Approximately 75% of past-year nonmedical users of prescription opioids, stimulants, and tranquilizers endorsed more than one motive. Latent class analysis indicated five motivational subtypes associated with nonmedical use of prescription opioids (experiment, relax, get high, pain relief, and affect regulation), four subtypes of prescription stimulants (weight loss/enhance energy, enhance energy/awake/high, experiment, and affect regulation), and five subtypes of prescription tranquilizers (experiment, get high, relax/sleep, relax, affect regulation). Recreational subtypes were positively associated with characteristics of substance abuse, whereas self-treatment subtypes were associated with medical use before nonmedical use. Conclusions Because multiple motives underlie NUPM, identifying subgroups of individuals who endorse combinations of motives, versus a single motive, will better inform intervention efforts to reduce nonmedical prescription medication use.
While ample research examines community violence as a serious public health problem that disproportionately affects minority adolescents, less attention focuses on adolescents' experiences of ...gender‐based harassment in poor, urban neighborhoods. Using data from 416 urban, low‐income Latino/a adolescents (53% female; Mage = 15.5), this study examined (a) the relations between community violence exposure (CVE), gender‐based harassment, and posttraumatic stress disorder (PTSD) symptoms and (b) the role of parent–child cohesion as a moderator of the relations between CVE/harassment and PTSD symptoms. Whereas both CVE and gender‐based harassment were associated with greater PTSD symptoms, the effect of gender‐based harassment on PTSD symptoms was far greater than the effect of community violence. Additionally, the association between gender‐based harassment and PTSD symptoms was exacerbated when parent–child cohesion was high, compared to when cohesion was low or average. Finally, Latino/a adolescents exposed to high levels of both CVE and gender‐based harassment had worse PTSD symptoms compared to those exposed primarily to gender‐based harassment, who in turn had worse PTSD symptoms than those exposed primarily to community violence. Findings highlight the importance of including adolescents' experiences with gender‐based harassment when studying community violence.
Highlights
Latino/a adolescents experience high rates of both community violence and gender‐based harassment.
Community violence exposure and gender‐based harassment were each associated with adolescents' posttraumatic stress disorder symptoms.
Community violence researchers should also assess gender‐based harassment to fully capture adolescents' experiences in dangerous neighborhoods.
Objectives. To explore the illicit use of specific prescription stimulants among college students and add to our understanding of reasons (motives) and routes of administration associated with ...illicit use of these drugs.
Methods. A random sample of 4580 college students self‐administered a Web‐based survey. The survey contained a variety of items pertaining to the illicit use of prescription stimulants. An extensive list of prescription stimulants was provided, and students were asked to select all the specific prescription stimulants that they had used illicitly. Items were also included to assess the motives and routes of administration associated with illicit use of prescription stimulants.
Results. Lifetime and past‐year prevalence rates for illicit use of prescription stimulants were 8.3% (382 students) and 5.9% (269 students), respectively. Approximately three fourths (75.8%) of the 269 past‐year illicit users of prescription stimulants reported using an amphetamine‐dextroamphetamine combination agent (e.g., Adderall) in the past year, and approximately one fourth (24.5%) reported using methylphenidate (e.g., Ritalin, Concerta, Metadate, Methylin). Past‐year illicit use of prescription stimulants was more than 3 times more likely among Caucasians (odds ratio OR 3.1, 95% confidence interval CI 1.5–6.6) and Hispanics (OR 3.8, 95% CI 1.6–9.3) compared with African‐Americans, and more than twice as likely among Caucasians (OR 2.1, 95% CI 1.3–3.4) and Hispanics (OR 2.6, 95% CI 1.4–5.1) compared with Asians. The most commonly reported motives for illicit use were to help with concentration (65.2%), help study (59.8%), and increase alertness (47.5%). Other motives included getting high (31.0%) and experimentation (29.9%). Nearly every illicit user (95.3%) reported oral administration, and 38.1% reported snorting prescription stimulants.
Conclusion. Illicit use of amphetamine‐dextroamphetamine is more prevalent than illicit use of methylphenidate formulations among college students.
Abstract This research examined 1) the prevalence of substance use behaviors in college students, 2) gender and academic level as moderators of the associations between mental health problems and ...substance use, and 3) mental health service use among those with co-occurring frequent binge drinking and mental health problems. As part of the Healthy Minds Study, a probability sample of 2843 college students completed an Internet survey on mental health problems, substance use behaviors, and utilization of mental health care. Response propensity weights were used to adjust for differences between respondents and non-respondents. Major depression, panic disorder, and generalized anxiety disorder were positively associated with cigarette smoking. Frequent binge drinking was negatively associated with major depression and positively associated with generalized anxiety disorder, and these associations were significantly stronger for males than females. Among students with co-occurring frequent binge drinking and mental health problems, 67% perceived a need for mental health services but only 38% received services in the previous year. There may be substantial unmet needs for treatment of mental health problems and substance use among college students.
The recent growth in diary and experience sampling research has increased research attention on how people change over time in natural settings. Often however, the measures in these studies were ...originally developed for studying between-person differences, and their sensitivity to within-person changes is usually unknown. Using a Generalizability Theory framework, the authors illustrate a procedure for developing reliable measures of change using a version of the Profile of Mood States (POMS; McNair, Lorr, & Droppleman, 1992) shortened for diary studies. Analyzing two data sets, one composed of 35 daily reports from 68 persons experiencing a stressful examination and another composed of daily reports from 164 persons over a typical 28-day period, we demonstrate that three-item measures of anxious mood, depressed mood, anger, fatigue, and vigor have appropriate reliability to detect within-person change processes.
Abstract Studies demonstrate associations between nonmedical use of prescription stimulants (NMUPS) and depressed mood; however, relevance of NMUPS route of administration and frequency of use have ...not been examined. We hypothesized frequent NMUPS and nonoral routes would be significantly associated with depressed mood. A Web survey was self-administered by a probability sample of 3,639 undergraduate students at a large U.S. university. The survey contained substance use (e.g., frequency, route of administration) and depressed mood measurement. Past-year prevalence of NMUPS was 6.0% ( n = 212). Approximately 50% of frequent or nonoral NMUPS reported depressed mood. Adjusted odds of depressed mood were over two times greater among frequent monthly NMUPS (adjusted odds ratio AOR = 2.3, 95% confidence interval CI = 1.01–5.15) and nonoral routes of administration (AOR = 2.2, 95% CI = 1.36–3.70), after controlling for other variables. Nonmedical users of prescription stimulants should be screened for depressed mood, especially those who report frequent and nonoral routes of administration.
Abstract Objectives This study examined trends in prescription drug abuse and dependence (sedatives, tranquilizers, opioids, and stimulants), co-occurrence with other substance use disorders and ...substance abuse treatment utilization among those with diagnoses of prescription drug abuse and dependence in two large, nationally representative, independent samples of adults in the United States in 1991–1992 and 2001–2002. Methods Two nationally representative cross-sectional samples of civilian non-institutionalized adults 18 years or older in the United States, of which 52% were women. Data were collected from structured diagnostic interviews using the NIAAA Alcohol Use Disorder and Associated Disabilities Interview Schedule: Diagnostic and Statistical Manual version IV (DSM-IV). National prevalence estimates were derived from the 1991–1992 National Longitudinal Alcohol Epidemiologic Survey ( n = 42,862) and the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions ( n = 43,093). Results The past-year prevalence of prescription sedative abuse, sedative dependence, opioid abuse, and opioid dependence increased from 1991–1992 to 2001–2002. The majority of individuals with past-year sedative (56.8%), tranquilizer (89.0%), stimulant (67.9%) and opioid (74.2%) use disorders also met DSM-IV criteria for an additional past-year substance use disorder. The co-occurrence of several forms of prescription drug use disorders and other substance use disorders increased from 1991–1992 to 2001–2002. A minority of individuals with past-year prescription drug abuse and approximately one-half of those with past-year prescription drug dependence utilized substance abuse treatment. Conclusions The findings reinforce the importance of continued national monitoring based on the increases in prescription drug abuse and dependence, high co-occurrence with other substance use disorders, and underutilization of substance abuse treatment services.
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