Barriers and Facilitators to Behavioral Healthcare for Women Veterans: a Mixed-Methods Analysis of the Current Landscape

Women veterans have historically faced barriers to behavioral health treatment, particularly through the VA. In conjunction, there have been changes in behavioral healthcare delivery resulting from efforts to improve care for women veterans and the COVID-19 pandemic (e.g., widespread telehealth implementation). The current study draws on a quantitative and qualitative study centering current perspectives of women veterans in their choices to seek or not seek behavioral healthcare in VA and non-VA settings through interviewing 18 women recruited from a larger survey study on veteran behavioral health (n = 83 women, n = 882 men) on their experiences with behavioral health care access and satisfaction, including barriers and facilitators to seeking care. Quantitative findings are descriptively reported from the larger study, which outlined screening for behavioral health problems, behavioral health utilization, treatment modality preferences, and barriers/facilitators to care. While women in the survey sample screened for various behavioral health disorders, rates of treatment seeking remained relatively low. Women reported positive and negative experiences with telehealth and endorsed many barriers to treatment seeking in interviews not captured by survey findings, including lack of women-specific care (e.g., care for military sexual trauma, women-only groups), reports of stranger harassment at the VA, and lack of female providers. Women veterans continue to face barriers to behavioral healthcare; however, ongoing efforts to improve care access and quality, including the implementation of telehealth, show promise in reducing these obstacles. Continued efforts are needed to ensure diverse treatment modalities continue to reach women veterans as this population grows.

Order of Cannabis and Alcohol Use on Pregaming and Non-Pregaming Days among College Students

OBJECTIVE

Pregaming is common among college students and is associated with heavy drinking and negative alcohol-related consequences. The use of cannabis on pregaming days may exacerbate negative alcohol-related consequences, and the ordering of when cannabis is used on these days may buffer against or intensify these consequences. Considering the growing rates of simultaneous use of cannabis and alcohol among college students, it is necessary to examine the role of pregaming behaviors in the context of cannabis use and resulting effects on alcohol-related consequences.

METHOD

In the present study, college students (N=485) completed a baseline survey and 14 days of daily surveys, reporting on daily alcohol and cannabis use and alcohol-related negative consequences. Multilevel Structural Equation Models were fit to evaluate cannabis outcomes on pregaming versus non-pregaming drinking days and ordering effects on alcohol-related consequences controlling for number of drinks, age, and sex.

RESULTS

Across all drinking days, pregaming on that day as well as cannabis use during drinking on that day were associated with greater risk for alcohol-related consequences. On days that did not involve pregaming, use of cannabis before drinking was associated with greater risk for negative alcohol-related consequences, while cannabis use after drinking was associated with less risk for consequences. These effects were observed on non-pregaming days only and not on days with pregaming.

CONCLUSIONS

Findings have implications for brief interventions with students, as analyses suggested that both cannabis use and pregaming, independent of number of drinks consumed, are risky behaviors associated with alcohol-related consequences.

A Deeper Dive into Young Adults' Experiences with E-Cigarettes, E-Cigarette Cessation, and Transitioning to Cigarette Smoking

Introduction: E-cigarette use among young adults is prevalent, with some voicing their desire to quit using e-cigarettes but needing support to do so. Young adults who use e-cigarettes are at risk for progressing to smoking combustible cigarettes, placing them at risk for severe health consequences. Limited research exists describing young adults' lived experiences with using e-cigarettes, e-cigarette cessation, and progression to combustible cigarettes. Methods: Between July and August 2022, nine focus groups were conducted with 33 young adults who either (1) currently used e-cigarettes, (2) formerly used e-cigarettes, or (3) transitioned to cigarettes. Transcripts were coded and themes were identified independently by two research team members while a third researcher reviewed the coding and themes. Results: Participants described social influences, stress, and curiosity as primary reasons why they initiated e-cigarette use. The most reported negative experiences or consequences associated with e-cigarettes include the health effects, addiction, and financial costs. Participants who transitioned to cigarettes reported social influences, a desire to reduce or quit using e-cigarettes by replacing them with cigarettes, curiosity, and stress as the primary reasons for this progression to combustible cigarettes. Participants described barriers to quitting e-cigarettes, including social influences, withdrawal, and easy access to e-cigarettes, as well as facilitators of quitting, such as social support, change in environment, and finding healthier ways to manage stress. Conclusions: This qualitative work provides an in-depth look into factors that may be helpful in the development of prevention and intervention programs for both e-cigarette and combustible cigarette use in young individuals.

An Examination of Pregaming Behavior and Motives among Sexual and Gender Minority College Students

Introduction: Pregaming is a popular but high-risk drinking behavior common among college students. Although sexual and gender minority (SGM) college students are a vulnerable population with regards to hazardous alcohol use and alcohol consequences, there is currently limited research investigating the pregaming behavior of this group. The present study aimed to (1) examine mean level differences in pregaming behaviors and motives between SGM and non-SGM college students and (2) explore how SGM status was associated with pregaming behaviors and if SGM status moderated the association between motives and pregaming behaviors. Methods: The sample consisted of 485 college student drinkers in the US, with 19% (n = 93) identifying as SGM. All participants completed measures of past 30-day pregaming frequency and quantity (yielding a total pregaming drinks outcome) and drinking consequences experienced on pregaming days. Results: SGM participants consumed significantly fewer pregaming drinks than non-SGM participants, but did not significantly differ on alcohol-related consequences or drinking motives. The pregaming motive of intimate pursuit moderated the association between SGM status and total pregaming drinks, such that non-SGM participants with high intimate pursuit motives drank the heaviest. Conclusions: Our findings suggest that SGM students consume significantly fewer pregaming drinks than their non-SGM counterparts. However, they may be at a similar risk of experiencing pregaming consequences as non-SGM students. SGM students were less susceptible to the effect of intimate pursuit motives on pregaming drink consumption. This study offers support for past research regarding the effects of certain pregaming motives on pregaming drink consumption and consequences.

Bidirectional Associations Between Pain and Perceived Stress Among Veterans: Depressive Disorder as a Predisposing Factor

OBJECTIVE

Military veterans who were injured in combat very often report pain along with co-occurring perceived stress and preexisting depressive disorder. The systems model of pain is a theoretical model suggesting that pain and perceived stress are bidirectionally associated at the within-person level, and associations are heightened among those with depressive disorder. However, the systems model of pain has not been adequately tested. Testing the systems model of pain could illuminate salient treatment targets for combat-injured veterans with pain and co-occurring psychological problems.

METHODS

The present study empirically tests the systems model of pain among a sample of combat-injured veterans ( N = 902) surveyed five times during an 18-month period. We used a multigroup, autoregressive latent trajectory with structured residual statistical model to test the within-person associations between pain and perceived stress and determine whether associations differ between veterans with and without a positive screen for depressive disorder.

RESULTS

In line with the systems model of pain, pain and perceived stress were bidirectionally associated only among combat-injured veterans with depressive disorder. Among such veterans, perceived stress was positively associated with subsequent pain ( b = 0.12; 95% confidence interval = 0.06-0.17), and pain was positively associated with subsequent perceived stress ( b = 0.44; 95% CI = 0.11-0.77).

CONCLUSIONS

Our work highlights the interplay between pain and its psychological correlates among a particularly at-risk population. Clinicians addressing pain and perceived stress among combat-injured veterans should be prepared to identify and address depressive disorder.

Predictors of Housing Trajectories Among Young Adults Experiencing Homelessness in Los Angeles

Experiencing homelessness during young adulthood is associated with negative health outcomes and understanding housing trajectories of young adults experiencing homelessness may aid in the development of evidence-based public health programs designed to serve this at-risk age group. In the present study, the authors examined baseline predictors of 24-month trajectories of housing stability and unsheltered housing among a sample of 271 young adults aged 18 to 25 recruited from drop-in centers in Los Angeles. In multivariate models, the authors found that identifying as multi-racial/other and better friendship quality at baseline were associated with less steep increases in the likelihood of stable housing over time. Being employed at baseline was associated with a less steep decrease in the probability of being unsheltered over time, while illicit drug use days associated with a steeper decrease in the probability of being unsheltered over time. Continued research is needed to establish important factors determining young adults' long-term housing trajectories in the effort to promote greater access and engagement with housing services.

A latent profile analysis of social anxiety, depression, and pregaming motives among heavy-drinking college students

BACKGROUND

Pregaming is a high-risk drinking behavior that is associated with heavy drinking and negative alcohol-related consequences. College students may engage in pregaming for several reasons, including to enhance social experiences or cope with negative affect. Research shows that associations between drinking, social anxiety, and depression are multifaceted. However, our understanding of the complex associations of mental health symptoms with pregaming motives and behaviors remains limited.

METHODS

This study examined heterogeneity in how pregaming motives, social anxiety, and depression associate with past 30-day pregaming variables (quantity, frequency, and negative consequences). We used latent profile analysis (LPA) in a sample of heavy-drinking university students (N = 479).

RESULTS

LPA results indicated four profiles: mild/moderate social anxiety and depression symptoms, moderate motives (n = 285), minimal social anxiety and depression symptoms, low motives (n = 61), subclinical/elevated social anxiety and depression symptoms, high motives (n = 75), and clinically elevated social anxiety and depression symptoms, moderate motives (n = 58). The subclinical/elevated symptoms, high motives profile reported the highest pregaming frequency and consequences, including blackouts. Individuals in the clinically elevated symptoms, moderate motives profile reported more consequences than those in the minimal symptoms, low motives and mild/moderate symptoms, moderate motives profiles. Individuals in the minimal symptoms, low motives profile reported the fewest consequences.

CONCLUSIONS

Among these students, social anxiety and pregaming motives were associated with more frequent pregaming and social anxiety and depression were associated with greater negative consequences. Interventions that target pregaming-specific motives among students with mental health symptoms may be warranted to reduce this risky behavior and associated drinking-related harm.

A mobile-based pregaming drinking prevention intervention for college students: A pilot randomized controlled trial

OBJECTIVE

Pregaming is among the riskiest drinking behaviors in which college students engage, often leading to elevated blood alcohol levels and negative alcohol-related consequences. Yet, tailored interventions to reduce risk associated with pregaming are lacking. The present study was designed to develop and evaluate the efficacy of a brief, mobile-based intervention targeting heavy drinking during pregaming among college students, called Pregaming Awareness in College Environments (PACE).

METHOD

PACE was developed using two innovations to facilitate behavior change: (a) a mobile-based application to increase intervention accessibility and (b) personalized pregaming-specific intervention content delivered using a harm reduction approach with cognitive behavioral skills training. After development and β-testing, we employed a randomized clinical trial with 485 college students who reported pregaming at least once per week in the past month (Mage = 19.98; 52.2% from minoritized racial and/or ethnic groups; 65.6% female). Participants were randomly assigned to PACE (n = 242) or a control condition website (n = 243), which consisted of general information about the effects of alcohol. Analysis assessed intervention effects on pregaming drinking, global drinking, and alcohol-related consequences at 6 and 14 weeks postintervention.

RESULTS

Although participants in both conditions reduced drinking, small and significant intervention effects favoring PACE were found at 6-week follow-up for overall drinking days, pregaming days, and alcohol-related consequences.

CONCLUSIONS

Findings suggest the brief mobile PACE intervention has potential to address risky drinking, but more intensive pregaming-focused efforts may be necessary to achieve stronger and lasting effects among college students. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Informing the development of interventions for e-cigarette use and prevention of transition to cigarette smoking in young adults: A qualitative study

E-cigarette use in young individuals may increase risk for cigarette smoking initiation. Over half of young adults who use e-cigarettes voiced their desire to quit e-cigarettes. Mobile-based interventions may allow for an easy-to-use platform to engage young adults in cessation services and reduce risk for cigarette uptake. To inform development of such programs, this study sought to gather information about what young adults want to see included in e-cigarette cessation interventions that also target future smoking risk. Nine online focus groups (n = 33) were conducted in July and August 2022 with young adults who either (1) currently used e-cigarettes, (2) formerly used e-cigarettes, or (3) initiated nicotine use with e-cigarettes but subsequently smoked cigarettes (dual use). Two research team members independently coded the transcripts and identified themes. A third researcher independently reviewed the coding and thematic analysis. Participants believed that mobile-based interventions should include peer support, ways to track cessation progress, education about the harms of e-cigarettes, gamification, and incentivization. They also believed that to prevent future cigarette smoking, interventions need to include education about the harms of smoking, teach refusal skills for offers to smoke, and incorporate personal anecdotes from former smokers. To increase their readiness, motivation, and self-efficacy to quit, participants who continue to use e-cigarettes reported needing effective substitutions to replace e-cigarettes, barriers to hinder their access to e-cigarettes, and social support. Findings from this study may be useful to incorporate when developing interventions designed to reduce e-cigarette use and risk of progression to smoking for young adults.

Cigarette Smoking and Depression Among U.S. Veterans: Longitudinal Associations With Posttraumatic Stress Disorder

INTRODUCTION

Cigarette smoking and depression are associated with morbidity and mortality. Among veterans, approximately 22% are current smokers and 11%-15% have been diagnosed with depression. Although prior research suggests a strong association between smoking and depression among veterans, little research has examined trajectories of smoking and depressive symptoms and their correlates over time in this population.

AIMS AND METHODS

Using parallel process growth curve modeling, we examined the longitudinal relationship between smoking and depression and tested whether posttraumatic stress disorder (PTSD) symptoms predict smoking and depression trajectories over 18 months (February 2020-August 2021). Veterans were recruited for an online, longitudinal study and responded to surveys across five-time points (baseline N = 1230; retention = 79.3%-83.3% across waves).

RESULTS

Associations indicated that more frequent smoking at baseline was associated with steeper increases in depression symptom severity, and greater depression severity at baseline was associated with a less steep decrease in smoking frequency over time. PTSD was associated with less smoking at time 1 but more frequent smoking at times 3-5 as well as greater depression across all time points.

CONCLUSIONS

Findings provide support that the growth trajectories of smoking and depression are linked, and PTSD symptoms are associated with these trajectories among veterans. Addressing these factors simultaneously in veteran treatment centers or through tobacco cessation efforts may be beneficial.

IMPLICATIONS

This study offers strong evidence that the growth trajectories of smoking and depression are linked, and PTSD symptoms affect these trajectories among veterans, who represent a largely understudied population despite high rates of substance use and mental health problems. Results of this study strengthen the case for a more integrated treatment approach in which both smoking and mental health concerns are simultaneously addressed, which may yield more beneficial physical health and clinical outcomes for post-9/11 veterans.

Childhood adversity, combat experiences, and military sexual trauma: a test and extension of the stress sensitization hypothesis

BACKGROUND

U.S. veterans report high rates of traumatic experiences and mental health symptomology [e.g. posttraumatic stress disorder (PTSD)]. The stress sensitization hypothesis posits experiences of adversity sensitize individuals to stress reactions which can lead to greater psychiatric problems. We extend this hypothesis by exploring how multiple adversities such as early childhood adversity, combat-related trauma, and military sexual trauma related to heterogeneity in stress over time and, subsequently, greater risk for PTSD.

METHODS

1230 veterans were recruited for an observational, longitudinal study. Veterans responded to questionnaires on PTSD, stress, and traumatic experiences five times over an 18-month study period. We used latent transition analysis to understand how heterogeneity in adverse experiences is related to transition into stress trajectory classes. We also explored how transition patterns related to PTSD symptomology.

RESULTS

Across all models, we found support for stress sensitization. In general, combat trauma in combinations with other types of adverse experiences, namely early childhood adversity and military sexual trauma, imposed a greater probability of transitioning into higher risk stress profiles. We also showed differential effects of early childhood and military-specific adversity on PTSD symptomology.

CONCLUSION

The present study rigorously integrates both military-specific and early life adversity into analysis on stress sensitivity, and is the first to examine how sensitivity might affect trajectories of stress over time. Our study provides a nuanced, and specific, look at who is risk for sensitization to stress based on previous traumatic experiences as well as what transition patterns are associated with greater PTSD symptomology.

High Spirits? Exploring "Halloweekend" Alcohol and Cannabis Use Among Heavy-Drinking College Students

OBJECTIVE

Specific events are associated with heavier and riskier substance use behaviors among college students, including holidays like Halloween, which may include several days of themed parties/events ("Halloweekend"). The current study compared drinking, pregaming (i.e., fast-paced drinking before going out for the night), cannabis use, same-day alcohol and cannabis co-use, and negative alcohol-related consequences over Halloweekend compared with two adjacent non-Halloween weekends among a sample of heavy-drinking university students.

METHOD

Participants (N = 228; 65% female) provided 28 days of daily diary data. We used a three-level generalized linear mixed model (GLMM) approach estimating zero-inflated Conway-Maxwell Poisson regressions to assess the effect of weekend and specific weekend day on number of overall drinks, number of pregaming drinks, and negative alcohol-related consequences. Proportions tests assessed for differences in any cannabis use and daily co-use between Halloweekend and non-Halloween weekends.

RESULTS

Zero-inflated portions of the GLMMs indicated that general drinking, pregaming, and negative consequences were most prevalent on Halloweekend and Fridays and Saturdays. Count portions of the models indicated that general drinking quantity was highest during these periods, and participants experienced a greater number of negative consequences on Halloweekend compared with the weekend before; no differences were observed in the quantity of pregaming drinks consumed across weekends or days. No significant differences in cannabis use or co-use were observed between weekends.

CONCLUSIONS

Given risk associated with Halloweekend compared with weekends immediately before and after, interventions targeting alcohol use and pregaming on Halloweekend may be beneficial to reduce related harm for heavy-drinking students.

Associations between depression, stress, and e-cigarette use among OEF/OIF veterans

The COVID-19 pandemic has had profound mental and behavioral health implications for the general U.S. population. However, little is known regarding outcomes for U.S. veterans, who represent a population with high rates of depression, stress, and e-cigarette use. One month prior to the pandemic-related closures (February 2020), 1230 OEF/OIF veterans (ages 18-40) completed an online baseline survey. Six months later, participants completed a follow-up survey (83% retention rate). Hierarchical negative binomial regressions were used to examine the relationship between baseline depression and past 30-day e-cigarette use at follow-up and whether baseline stress moderated this relationship. Veterans who screened positive for depression or who endorsed higher stress levels reported greater e-cigarette use at follow-up. Stress also moderated the relationship between depression and e-cigarette use, such that regardless of stress levels, a positive depression screen was associated with greater rates of later e-cigarette use. However, for those with a negative depression screen, higher stress levels were associated with greater e-cigarette use relative to lower stress levels. Veterans with pre-pandemic depression and stress may be at highest risk for e-cigarette use. Ongoing assessment and treatment for depression and promoting stress management skills for veterans in e-cigarette use prevention and intervention programs may be valuable.

Preliminary development of the protective behavioral strategies for vaping scale

OBJECTIVE

Exploring factors that may mitigate the harms of e-cigarette use (i.e., vaping) among college students may provide insights for prevention/intervention efforts. Study aims were to develop and conduct initial psychometric analyses on the Protective Behavioral Strategies for Vaping (PBSV) scale to measure strategies that students use before, during, after, and instead of vaping to protect themselves from vaping-related harms.

METHODS

Students from one U.S. university (n = 277) completed an online survey and provided open-ended reports on things they do to avoid vaping and limit their use while vaping. Responses were used to generate an item pool of 52 strategies. Students from a second sample who vaped in the past year (n = 216) were administered these 52 items. A series of exploratory graph, unique variable, and exploratory factor analyses were used to develop and test the psychometric properties of the PBSV.

RESULTS

The finalized scale contained 39 items, which featured three subscales reflecting manner of use, avoiding use by creating obstacles, and committing to quitting and using supports to quit. The PBSV composite score and each subscale negatively associated with vaping frequency and dependence. Males endorsed significantly lower scores for manner of use than females.

CONCLUSIONS

This exploratory and preliminary examination of the PBSV scale's psychometric properties suggests that use of protective strategies for vaping may protect young people from more frequent use and greater dependence. More research with the PBSV scale is encouraged to determine its psychometric properties and potential practical utility as a clinical and assessment tool with young adults.

Development of a mobile mindfulness smartphone app for post-traumatic stress disorder and alcohol use problems for veterans: Beta test results and study protocol for a pilot randomized controlled trial

BACKGROUND

Post-traumatic stress disorder (PTSD) and alcohol use disorder (AUD) are highly prevalent, and co-occurring among post-9/11 veterans. Mobile health (mHealth) applications, specifically those focused on mindfulness-based techniques, may be an effective avenue to intervene with veterans who cannot or will not seek care at traditional in-person settings. Thus, to address areas of improvement in mHealth for veterans, we developed Mind Guide and prepared it for testing in a pilot randomized controlled trial (RCT) with veterans.

METHODS

We have completed phase 1 (treatment development) and Phase 2 (beta test) of our mobile mHealth app, Mind Guide. In this paper we describe the methods for Phase 1 as well as results for our beta test (n = 16; inclusion criteria included screen for PTSD, AUD, a post-9/11 veteran, and not currently receiving treatment) for Mind Guide as well as outline procedures for our pilot RCT of Mind Guide (Phase 3). The PTSD Checklist, self-reported alcohol use, the Perceived Stress Scale, Penn Alcohol Craving Scale, and the Emotion Regulation Questionnaire were used.

RESULTS

Results of our beta test of Mind Guide show promising past 30 day effects on PTSD (d = -1.12), frequency of alcohol use (d = -0.54), and alcohol problems (d = -0.44), and related mechanisms of craving (d = -0.53), perceived stress (d = -0.88), and emotion regulation (d = -1.22).

CONCLUSION

Our initial beta-test of Mind Guide shows promise for reducing PTSD and alcohol related problems among veterans. Recruitment is ongoing for our pilot RCT in which 200 veterans will be recruited and followed up for 3 months.

CLINICALTRIALS

gov Identifier: NCT04769986.

E-Cigarette Use: The Effects of Psychological Vulnerabilities, Perceptions, and Intentions to Use E-Cigarettes

Little research has examined the effects that psychological vulnerabilities (i.e., difficulty with emotion regulation, depressed mood, distress tolerance) have on the perceptions of e-cigarettes, intent to use e-cigarettes, and actual e-cigarette use. Data were collected via an online survey from 837 adults (55.6% male, Mage = 29.2, 71.7% Caucasian). The two path analytic models predicting lifetime and current use fit the data well. Difficulty with emotion regulation was positively associated with depressed mood and negatively associated with distress tolerance, while distress tolerance was negatively associated with depressed mood. Depressed mood was positively associated with perceived benefits of e-cigarette use, and perceived benefits was positively associated with intent to use. Perceived benefits and intent to use were significantly associated with both lifetime and current use. Findings enhance our understanding of the effects that mood and emotion-related factors have on perceptions of, intent to use, and actual use of e-cigarettes, which may have important implications for prevention and cessation.

Mental health treatment-seeking behaviors in medical students: A mixed-methods approach

Background

Healthcare professionals can experience problems regarding mental health and emotional well-being (e.g. burnout) at a higher degree compared to their non-physician counterparts. Fear of stigma is often a barrier to seeking treatment among physicians. However, there is a shortage of studies related to mental health and treatment seeking among trainees and medical students.

Objectives

This study sought to examine mental health in U.S. medical students, factors contributing to mental health symptoms, and obstacles to seeking treatment.

Design and Methods

This cross-sectional study was conducted through a confidential survey sent out in fall 2021, with 510 U.S. medical student participants. This survey included scales to assess depression (the Patient Health Questionnaire-8), anxiety (Generalized Anxiety Disorder-7), past year symptoms of hazardous drinking (Alcohol Use Disorder Identification Test), and past 30-day binge drinking days. The survey also included free-response questions about their reasons for seeking mental health care if they did (facilitators) and any barriers that kept them from seeking treatment.

Results

About one-quarter of participants met criteria for possible depressive (24%) or anxiety disorders (24%); 9% of the sample drank at hazardous drinking levels. Between 47% and 60% of those who screened positive for depression, anxiety, or hazardous drinking reported an unmet need for mental health services. Anxiety and depression were cited as the most common reasons to seek treatment; concerns about stigma from peers and professional retaliation were notable for being barriers to treatment.

Conclusion

Our sample of medical students reported notable prevalence of probable depression or anxiety disorder, while also reporting needing more support to improve their mental health. Despite this, barriers exist that may discourage medical students from seeking needed treatments. Findings from this study aim to encourage discussion and positive change in the healthcare community regarding perception and attitudes toward mental health and substance use treatment.

Changes in perceived stress during the COVID-19 pandemic among American veterans

American veterans are a population that suffer from both context specific stressors as well as many population-specific major-life events. The present exploratory study utilises a longitudinal cohort of 1230 U.S. veterans surveyed from February 2020 through February 2021. We sought to understand heterogeneity in perceived stress, using growth mixture modelling, over this time period, how COVID-specific factors such as negative reactions to the pandemic, loneliness, and employment disruptions influence perceived stress trajectories, and how veterans vary across distal outcomes including posttraumatic stress disorder (PTSD), pain, depression, sleep problems, physical health, and alcohol use disorder. Results revealed a 4-class solution: Stable High, Stable Low, Steady Increasing, and Steady Decreasing classes. In terms of COVID specific factors, negative reactions to COVID were consistently associated with perceived stress for those in the Stable High and Steady Increasing classes whereas loneliness was associated with stress trajectories for all emergent classes. Finally, in terms of our distal outcomes, results showed a relatively robust pattern with veterans in the Stable High or Steady Increasing classes reporting worse scores across all outcomes including PTSD, pain, sleep problems, physical health, depression, and alcohol use disorder. Understanding the interplay between existing vulnerabilities, ongoing stressors, and behavioural health outcomes among veterans is crucial for prevention and intervention efforts.

Mental health correlates of quitting cigarette smoking in youth experiencing homelessness

Smoking prevalence among youth experiencing homelessness (YEH) is three times higher than smoking prevalence among the general population. Many YEH who smoke are interested in quitting smoking, but also report smoking to cope with mental health symptoms. Research on factors that facilitate or impede successful smoking cessation among YEH is limited. This study examined mental health correlates (i.e., anxiety and depression symptoms) of quitting-related factors (i.e., quit attempts, perceived barriers to quitting) and whether smoking to cope moderates these relationships among this vulnerable population. The sample consisted of 77 YEH cigarette smokers between the ages of 18-25 who were interested in quitting. Participants completed a survey assessing various behavioral and cognitive factors related to tobacco use. Analyzing two separate models, hierarchical negative binomial and hierarchical linear regression were used to examine hypothesized correlates of the number of past year quit attempts and perceived barriers to quitting. Smoking to cope moderated the relationships of depression with past year quit attempts and perceived barriers to quitting. Those high in depression and smoking to cope had the fewest number of quit attempts and reported the greatest perceived barriers. Anxiety symptoms were not significantly associated with quit attempts or perceived barriers. Smoking cessation interventions that address using smoking to cope with mental health symptoms may be important for YEH with depression.

Substance Use, Financial Stress, Employment Disruptions, and Anxiety among Veterans during the COVID-19 Pandemic

The COVID-19 pandemic has resulted in financial, employment, and mental health challenges. In general, American veterans report high rates of substance use, which may be influenced by the COVID-19 pandemic. Those with pre-existing mental health problems, employment disruptions, or financial stress may be particularly vulnerable. We examined the relationships between pre-existing self-report screens for a probable anxiety disorder, COVID-19-related financial stress, employment disruption (e.g., lost job, reduced hours), and alcohol, cannabis, and cigarette use during the pandemic among 1230 veterans (M_age = 34.5; 89% male). Participants were recruited through various social media sites and completed an online survey 1 month prior to implementation of the nationwide physical distancing guidelines in the United States (February 2020). Six months later (August 2020), they completed a follow-up survey. Compared to veterans who screened negative for anxiety prior to the pandemic, veterans who screened positive reported consuming more drinks per week (b = 3.05), were more likely to use cannabis (OR = 6.53), and smoked more cigarettes (b = 2.06) during the first 6 months of the pandemic. Financial stress was positively associated with alcohol (b = 1.09) and cannabis use (OR = 1.90). Alcohol use was heaviest among veterans with a positive pre-existing anxiety screen and high financial stress. Moreover, veterans who experienced employment disruption due to the pandemic consumed less alcohol but were more likely to use cannabis during the pandemic. Veterans with pre-pandemic anxiety and pandemic-related financial stress may be using substances at higher rates and may benefit from intervention to mitigate negative substance use-related outcomes. Findings also enhance our understanding of veteran substance use behaviors following disruptions in employment due to the pandemic.

Trajectories and biopsychosocial predictors of daily acute pain in adolescents receiving treatment for pain: a daily diary study

Research regarding daily acute pain and its correlates has primarily been conducted with adolescents who have had major surgery or musculoskeletal pain, restraining efforts towards adapting interventions for adolescents with other sources of acute pain. We explored the trajectories and correlates of pain intensity. Adolescents with an opioid prescription to treat acute pain (N = 157) completed demographic questions, and the PROMIS pediatric depression and anxiety subscales. A 10-day daily diary assessed pain intensity, pain interference, sleep quality, and opioid use. Three trajectories of pain intensity emerged: (1) slow decreases in pain, (2) rapid decreases in pain, and (3) stable or slight increases in pain. Teens with stable pain demonstrated the greatest anxiety levels. Higher sleep quality predicted lower next day pain intensity and pain interference, when controlling for opioid use. Future research should employ intensive longitudinal methodology to further guide intervention development and prevent the transition to chronic pain.

Mental health symptoms among American veterans during the COVID-19 Pandemic

We examined the symptom trajectories of posttraumatic stress disorder (PTSD), depression, and anxiety among 1,230 American veterans assessed online one month prior to the COVID-19 outbreak in the United States (February 2020) through the next year (August 2020, November 2020, February 2021). Veterans slightly increased mental health symptoms over time and those with pre-pandemic alcohol and cannabis use disorders reported greater symptoms compared to those without. Women and racial/ethnic minority veterans reported greater symptoms pre-pandemic but less steep increases over time compared to men and white veterans. Findings point to the continued need for mental health care efforts with veterans.

Disposable E-Cigarette Use Prevalence, Correlates, and Associations with Previous Tobacco Product Use in Young Adults

INTRODUCTION

Novel, inexpensive disposable e-cigarettes widely sold in attractive flavors might be exempt from U.S. federal regulations. To inform regulatory and public health priorities, this study examined young adult disposable e-cigarette use uptake among existing tobacco users vs. non-users and possible use correlates that could be potential regulatory targets.

METHODS

Prospective cohort data were analyzed in 2021. Among baseline (2018-2019) never disposable e-cigarette users (n=1903; Mean[SD]:19.3[0.8] years-old), we tested prospective associations of baseline tobacco product use with follow-up (2020) disposable e-cigarette use initiation, followed by stratified analyses distinguishing baseline exclusive and dual e-cigarette/combustible tobacco use. Exploratory cross-sectional associations of tobacco-related correlates with vaping frequency among current disposable users (n=266) were tested.

RESULTS

Follow-up ever disposable e-cigarette use initiation was higher among baseline former (22.1%) and current (50.2%) vs. never (6.3%) rechargeable (non-disposable) e-cigarette users. In stratified analyses, follow-up disposable e-cigarette use initiation was 0% in baseline never-vaping exclusive current smokers, higher in baseline never-vaping former smokers vs. never users of any tobacco product (18.2% vs. 5.7%; adjusted odds ratio[AOR][95%CI]=3.9[2.1-7.5]), and higher among baseline current dual users vs. never-smoking exclusive current vapers (61.3% vs. 42.2%; AOR[95%CI]=3.0[1.5-6.0]). Among follow-up current disposable e-cigarette users (overall prevalence=10.9%), using ice-flavored (vs. fruit/sweet-flavored) e-cigarettes (adjusted rate ratio[95%CI]=1.5[1.0-2.1]) and vaping dependence symptoms (adjusted rate ratio[95%CI]=2.2[1.5-3.2]) were cross-sectionally associated with more past-month disposable e-cigarette use days.

CONCLUSIONS

Young adult disposable e-cigarette use was of appreciable prevalence, including among tobacco product never users and former smokers. Regulation of disposable e-cigarettes, including ice-flavored products, might benefit young adult health.

IMPLICATIONS

Sales of disposable e-cigarette products increased significantly in the United States from 2019 to 2020. These products contain high nicotine concentrations and various flavors that may appeal to young people. This study provides the first evidence that disposable e-cigarette use may be common among young adults, including among tobacco product never users and former smokers. Frequency of disposable e-cigarette use was positively associated with using ice-flavored e-cigarettes and vaping dependence. Regulatory policies and enforcement strategies addressing disposable e-cigarettes merit consideration in young adult health policy and prevention priorities.

Smoking, ADHD, and Problematic Video Game Use: A Structural Modeling Approach

Problematic video game use (PVGU), or addiction-like use of video games, is associated with physical and mental health problems and problems in social and occupational functioning. Possible correlates of PVGU include frequency of play, cigarette smoking, and attention deficit hyperactivity disorder (ADHD). The aim of the current study was to explore simultaneously the relationships among these variables as well as test whether two separate measures of PVGU measure the same construct, using a structural modeling approach. Secondary data analysis was conducted on 2,801 video game users (M_age = 22.43 years, standard deviation [SD]_age = 4.7; 93 percent male) who completed an online survey. The full model fit the data well: χ² (2) = 2.017, p > 0.05; root mean square error of approximation (RMSEA) = 0.002 (90% CI [0.000-0.038]); comparative fit index (CFI) = 1.000; standardized root mean square residual (SRMR) = 0.004; and all standardized residuals <|0.1|. All freely estimated paths were statistically significant. ADHD symptomatology, smoking behavior, and hours of video game use explained 41.8 percent of variance in PVGU. Tracking these variables may be useful for PVGU prevention and assessment. Young's Internet Addiction Scale, adapted for video game use, and the Problem Videogame Playing Scale both loaded strongly onto a PVGU factor, suggesting that they measure the same construct, that studies using either measure may be compared to each other, and that both measures may be used as a screener of PVGU.

Correction to: mouse mammary tumour virus (MMTV) and human breast cancer with neuroendocrine differentiation

[This corrects the article DOI: 10.1186/s13027-017-0135-8.].

Presence of mouse mammary tumour-like virus gene sequences may be associated with morphology of specific human breast cancer

BACKGROUND

Mouse mammary tumour virus (MMTV) has a proven role in breast carcinogenesis in wild mice and genetically susceptible in-bred mice. MMTV-like env gene sequences, which indicate the presence of a replication-competent MMTV-like virus, have been identified in some human breast cancers, but rarely in normal breast tissues. However, no evidence for a causal role of an MMTV-like virus in human breast cancer has emerged, although there are precedents for associations between specific histological characteristics of human cancers and the presence of oncogenic viruses.

AIM

To investigate the possibility of an association between breast cancer and MMTV-like viruses.

METHODS

Histological characteristics of invasive ductal human breast cancer specimens were compared with archival MMTV-associated mammary tumours from C3H experimental mice. The presence of MMTV-like env DNA sequences in the human breast cancer specimens was determined by polymerase chain reaction and confirmed by Southern hybridisation.

RESULTS

MMTV-like env gene sequences were identified in 22 of 59 (37.3%) human breast cancer specimens. Seventeen of 43 (39.5%) invasive ductal carcinoma breast cancer specimens and 4 of 16 (25%) ductal carcinoma in situ specimens had some histological characteristics, which were similar to MMTV-associated mouse mammary tumours. However, these similarities were not associated with the presence or absence of MMTV-like gene sequences in the human breast tumour specimens. A significant (p = 0.05) correlation was found between the grade of the human breast cancer and similarity to the mouse mammary tumours. The lower the grade, the greater the similarity.

CONCLUSION

Some human breast cancer specimens, in which MMTV-like env DNA sequences have been identified, were shown to have histological characteristics (morphology) similar to MMTV-associated mouse mammary tumours. These observations are compatible with, but not conclusive of, an association between the presence of MMTV-like env DNA sequences and some human breast cancers.

Hormone replacement therapy use dramatically increases breast oestrogen receptor expression in obese postmenopausal women

BACKGROUND

It is known that use of hormone replacement therapy (HRT) by postmenopausal women increases the risk of breast cancer.

METHOD

In this study, oestrogen receptor (ER)-alpha expression is examined using standard immunoperoxidase technique.

RESULTS

Normal breast samples of 11 Australian postmenopausal women have been included in the ER-alpha study; the result showed a strong correlation (r(2) = 0.80) between ER-alpha expression in normal breast epithelial cells and body mass index (BMI) in normal women who currently use HRT.

CONCLUSION

This finding confirms that the possibility of increased risk of breast cancer associated with increased ER-alpha expression in normal breast epithelial cells, in turn associated with high BMI and the use of HRT.

Cytochalasin B modulation of Caco-2 tight junction barrier: role of myosin light chain kinase

The intracellular mechanisms that mediate cytochalasin-induced increase in intestinal epithelial tight junction (TJ) permeability are unclear. In this study, we examined the involvement of myosin light chain kinase (MLCK) in this process, using the filter-grown Caco-2 intestinal epithelial monolayers. Cytochalasin B (Cyto B) (5 microg/ml) produced an increase in Caco-2 MLCK activity, which correlated with the increase in Caco-2 TJ permeability. The inhibition of Cyto B-induced MLCK activation prevented the increase in Caco-2 TJ permeability. Additionally, myosin-Mg(2+)-ATPase inhibitor and metabolic inhibitors (which inhibit MLCK induced actin-myosin contraction) also prevented the Cyto B-induced increase in Caco-2 TJ permeability. Cyto B caused a late-phase (15-30 min) aggregation of actin fragments into large actin clumps, which was also inhibited by MLCK inhibitors. Cyto B produced a morphological disturbance of the ZO-1 TJ proteins, visually correlating with the functional increase in Caco-2 TJ permeability. The MLCK and myosin-Mg(2+)-ATPase inhibitors prevented both the functional increase in TJ permeability and disruption of ZO-1 proteins. These findings suggested that Cyto B-induced increase in Caco-2 TJ permeability is regulated by MLCK activation.

Striatal glutamate antagonism induces contralateral neglect

To assess the role of striatal glutamatergic synapses in mediating sensorimotor orientation behavior, glutamate receptor antagonists were infused into the left striatum of awake rats and behavioral orientation to contralateral and ipsilateral stimuli were quantified. The AMPA-kainate antagonist, DNQX, and the NMDA antagonist, CPP, both induced a large asymmetry in responding, such that the rats oriented much less to stimuli presented contralateral to the antagonist infusions. Furthermore, intrastriatal glutamate antagonist infusions increased the occurrence of incorrect responses, or turning away from a contralaterally-presented stimulus. In a separate experiment, intrastriatal DNQX was shown to block kainic acid (KA)-induced Fos expression in the striatum, but not in adjacent cerebral cortex, suggesting that the diffusion of this drug is restricted to the striatum.

Alzheimer disease: improved visual interpretation of PET images by using three-dimensional stereotaxic surface projections

PURPOSE

To compare the diagnostic usefulness of three-dimensional (3D) stereotaxic surface projection (SSP) with that of standard transaxial display in brain positron emission tomography (PET) in Alzheimer disease (AD).

MATERIALS AND METHODS

Standard transaxial section display and 3D-SSP PET image sets obtained after administration of 2-deoxy-2-[fluorine-18]fluoro-D-glucose in 39 patients with probable AD (aged 53-82 years; 15 men, 24 women) and 40 subjects without AD (aged 21-78 years; 14 men, 26 women) were randomly interpreted. Receiver operating characteristic (ROC) analysis was performed.

RESULTS

Diagnostic performance was superior with 3D SSP (Az[section]=0.94,Az[3D SSP]=0.99[Az=area under the ROC curve];P=.043). With 3D SSP, diagnosis of AD was equally good in beginners and experts. The sensitivity and specificity in questionable or mild dementia were 94% and 99% with 3D SSP and 79% and 88% with standard transaxial display.

CONCLUSION

Accuracy of detecting AD was improved in PET with 3D SSP.

Serum nitrate levels in ulcerative colitis and Crohn's disease

BACKGROUND

Nitric oxide is an important mediator in inflammatory and autoimmune-mediated tissue destruction and may be of pathophysiologic importance in inflammatory bowel disease. We studied whether serum levels of nitrate, the stable end-product of nitric oxide, are increased in active Crohn's disease or ulcerative colitis, in comparison with quiescent disease and healthy controls. The setting was the gastroenterology unit of the Free University Hospital, Amsterdam.

METHODS

In 146 patients--75 with ulcerative colitis and 71 with Crohn's disease--and 33 controls serum nitrate was measured by the Griess reaction after enzymatic conversion of nitrate to nitrite with nitrate reductase.

RESULTS

Median serum nitrate concentrations did not differ statistically significantly between ulcerative colitis (median, 34.2 mumol/l; range, 15.6-229.4 mumol/l), Crohn's disease (median 32.3 mumol; range 13.2-143.2 mumol/l), and healthy controls (median, 28.7 mumol/l; range, 13.0-108.4 mumol/l). However, when active ulcerative colitis patients (median, 44 mumol/l; range, 29.1-229.4 mumol/l were compared with inactive ulcerative colitis patients (median, 31.2 mumol/l; range, 15.6-59.7 mumol/l), a significant difference in nitrate concentration was found (p < 0.0001). A significant positive correlation was found between serum nitrate levels in ulcerative colitis and erythrocyte sedimentation rate (ESR) (r = 0.30, p - 0.01), leucocyte count (r = 0.27, p = 0.02), and thrombocyte count (r = 0.24, p = 0.04). Comparing active Crohn's disease patients (median, 37.5 mumol/l; range, 13.2-143.2 mumol/l) with inactive Crohn's disease patients (median, 31.3 mumol/l; range, 14.5-92.3 mumol/l) also showed a significant difference in serum nitrate concentration (p < 0.009). Serum nitrate levels correlated with the ESR (r = 0.26, p = 0.028) and serum albumin (r = 0.38, p = 0.004) as well.

CONCLUSION

Nitric oxide production is increased in both active ulcerative colitis and Crohn's disease and may be implicated in the pathogenesis of inflammatory bowel disease.

Does additional treatment with fish oil mitigate the side effects of recombinant human erythropoietin in dialysis patients?

Since fish oil has been reported to reduce platelet aggregability, to reduce blood viscosity by increasing red blood cell deformability and to lower blood pressure, we studied the effect of dietary supplementation with fish oil on the occurrence of adverse effects in patients receiving recombinant human erythropoietin (rHuEPO). In a prospective, randomized, double blind cross-over design we studied the effect of daily ingestion of 3 g fish oil versus 3 g corn oil (placebo) for 5 months, with a wash-out period of 3 months in between. Thirty-two dialysis patients newly treated with rHuEPO participated. rHuEP0 was given using a low and slow dose regimen (25 U/kg twice weekly s.c.). Target Hct was 35%. Blood pressure, red blood cell deformability, plasma viscosity, fatty acid composition of plasma phospholipids, and fibrinogen levels were measured at 0, 5, 8 and 13 months. In both groups a stable target Hct (35%) was reached within 3 months. Blood pressure was not significantly different between the groups at any time point. In 4 patients (2 on fish oil and 2 on placebo) antihypertensives had to be increased to regulate blood pressure adequately, whereas shunt occlusion occurred in one patient on placebo. Despite a significant increase in the omega-3 fatty acid content of plasma phospholipids during ingestion of fish oil, no significant changes in red blood cell deformability were observed. Since hypertension and shunt occlusion occurred at rates comparable to those reported in the literature, long-term ingestion of fish oil does not appear to mitigate the side effects of low and slow dose rHuEPO.

Diagnosing intracranial vasculitis: the roles of MR and angiography

PURPOSE

To describe our experience with MR and angiography in diagnosing intracranial vasculitis and to test the hypothesis that MR can be used to screen for patients unlikely to have vasculitis.

METHODS

Ninety-two patients who had angiography with "exclude vasculitis" as the indication or who had angiography and a clinical diagnosis of vasculitis were identified. Angiograms of all 92 patients and the MRs of the 70 patients who had both studies were reviewed.

RESULTS

Eleven patients had intracranial vasculitis. Angiography showed characteristic changes in 8. MR, performed in 9 of 11 vasculitis cases, was significantly abnormal in all 9. Among 70 patients who had both studies, 19 had MR that was completely normal or showed only incidental findings. None of these 19 was diagnosed with vasculitis. The diagnostic yield of angiography performed to exclude vasculitis was only 6%.

CONCLUSIONS

Evaluation for intracranial vasculitis should include MR. A negative MR excludes intracranial vasculitis more definitively than does a negative angiogram and makes the likelihood of finding vasculitis with angiography negligible.

Prevalence and prediction of multiple organ system failure and mortality in acute pancreatitis

We studied the prevalence of multiple organ system failure (MOSF), the relations between age, pre-existing chronic conditions, local complications, systemic infection, organ system failure, and mortality in patients with acute pancreatitis. During the study period, 267 consecutive patients were admitted to a tertiary hospital with acute pancreatitis. Multivariate analyses were used to identify factors predictive of MOSF occurrence and mortality. Using a previously developed MOSF scoring system at our center, MOSF (> or = 2 organ systems) was found to occur in 63 (24%) of the patients. Cardiovascular, pulmonary, renal, and hepatic failure predominated. Advanced age (> 55 yr) and chronic disease were related to local complications and systemic infection (both, P < .001). Local complications and systemic infection occurred in 68% and 75% of patients, respectively. In multiple logistic regression, advanced age, chronic disease, local complications, and systemic infection independently contributed to the development of MOSF. Overall mortality was 19%. MOSF accounted for 96% of deaths; mortality increased from 1% to 79% in patients without and with MOSF, respectively. In multiple logistic regression, advanced age, chronic disease, local complications, failure of the cardiovascular, renal, hepatic, gastrointestinal, and neurological systems independently contributed to mortality prediction. Advanced age and prior chronic disease may reflect diminished physiological reserve and predispose to local complications, systemic infection, and MOSF. Although local complications and systemic infection are important predisposing factors for MOSF, a host-dependent response to unknown specific or nonspecific factors may have a role in the pathogenesis of the syndrome in 25% of patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Risk factors for multiple organ system failure and death in critically injured patients

BACKGROUND

This study was undertaken to evaluate the relative importance of factors related to the extent of multiple organ system failure (MOSF) and outcome in critical trauma.

METHODS

We performed a retrospective case series analysis of 206 consecutive patients with trauma admitted to a surgical intensive care unit during a 5-year period. Multivariate methods were used to select independent factors related to the MOSF score and subsequent death.

RESULTS

Multiple linear regression selected advancing age, prior chronic conditions, malnutrition, injury severity score (ISS), coma on admission, use of H2-receptor antagonists or antacids, number of blood transfusions, and intraabdominal infection as independent factors related to the MOSF score. Multiple logistic regression selected advancing age, chronic disease, ISS, and MOSF score as major predictors of death.

CONCLUSIONS

Advancing age, prior chronic disease, malnutrition, coma on admission, and use of H2-receptor antagonists or antacids may impair host defenses of the gastrointestinal tract and predispose to invasive infection, thereby aggravating the severity of existing MOSF. These findings, together with the predominance of Enterobacteriaceae in patients with infection, suggest that bacterial translocation may be important in the late MOSF septic state. Although infection, particularly intraabdominal infection, is a major risk factor for MOSF, a nonspecific host response to critical trauma, as expressed by the ISS and transfusion requirement, and intestinal endotoxin may contribute to the development of the syndrome.

Evaluation of severity in patients with acute pancreatitis

We compared the multiple organ system failure (MOSF) score, the Acute Physiologic and Chronic Health Evaluation (APACHE) II, and Ranson and Imrie scores for their predictive value in evaluating severity of acute pancreatitis. Of the 259 patients, 73 (28%) had severe disease. Fifty-two (20%) patients had organ system failure (OSF) on admission, and 59% of patients with severe disease had OSF. Shortly after admission, only MOSF and APACHE II scores were available, and in patients with severe disease, these predictions were correct in 64% and 60%, respectively. Forty-eight hours later, the MOSF score was the most sensitive, and correctly predicted outcome in 67% of patients, compared with about 60% for other scores. Of four scoring systems, only MOSF and APACHE II scores allowed repetitive assessment to monitor the course of the disease. MOSF score is organ-specific and may be better than APACHE II in reflecting disease activity. Our results suggest that the MOSF score is valuable in early identification and close monitoring of high risk patients and in deciding on therapy in these patients.

Acute renal failure in the medical intensive care unit: predisposing, complicating factors and outcome

The factors predisposing to and complicating acute renal failure (ARF) in the medical intensive care unit (ICU), and their relative influence on outcome during ARF are unclear. We retrospectively evaluated the relative importance of age, prior chronic disease (including chronic renal failure), sepsis and organ system failure, for development and outcome of ARF in the medical ICU. Of 487 consecutively admitted patients, 78 (16%) had ARF, in 63% treated with renal replacement therapy. Mortality was 63%. Independently from each other, advancing age, prior chronic disease, and cardiovascular and pulmonary failure directly related to the development of ARF, while neurological failure related inversely. Sepsis only contributed to ARF prediction from these variables if cardiopulmonary failure was excluded. Advancing age, cardiovascular failure before and after onset of ARF, pulmonary failure before ARF and use of renal replacement therapy were the major independent factors directly related to ARF mortality, while prior chronic renal failure related inversely and sepsis did not contribute. Hence, the outcome of ARF in a medical ICU is largely dependent on factors predisposing to ARF, even though the severity and complications of ARF may partly contribute. Our results may help in deciding on the prevention and therapy of ARF in a medical ICU.

Age, chronic disease, sepsis, organ system failure, and mortality in a medical intensive care unit

We retrospectively studied relations between age, pre-existing chronic disease, sepsis, organ system failure, and mortality in 487 patients from a medical ICU. Single organ system failure (SOSF) occurred in 136 (28%) and multiple (greater than or equal to 2) organ system failure (MOSF) in 187 (38%) patients. Cardiovascular and pulmonary failure predominated. Overall mortality was 27%. SOSF mortality was 16% and for MOSF 58%. Eighty-three percent of nonsurvivors had MOSF. Hence, MOSF is common and a major cause of death in critically ill medical patients. Advancing age and prior chronic disease may diminish physiologic reserve and predispose to sepsis and MOSF. Although sepsis is a major risk factor for MOSF, a nonspecific host response to critical illness may contribute to the syndrome in 35% of patients. Advancing age, chronic disease, and the number of failing organs, particularly failure of cardiovascular, pulmonary, renal, and neurologic systems, are major determinants of overall mortality, but sepsis is not an independent contributor.