Systematic Review of Electronic Cigarette Use (Vaping) and Mental Health Comorbidity Among Adolescents and Young Adults.

INTRODUCTION: The prevalence of electronic cigarette (EC) use has risen dramatically among adolescents and young adults (AYA, ages 12-26) over the past decade. Despite extensive established relationships between combustible cigarette use and mental health problems, the mental health comorbidities of EC use remain unclear. AIMS AND METHODS: To provide a systematic review of existing literature on mental health comorbidities of EC use among AYA. Database searches using search terms related to EC, AYA, and mental health identified 1168 unique articles, 87 of which prompted full-text screening. Multiple authors extracted data, applied the Effective Public Health Practice Project Quality Assessment Tool to evaluate the evidence, and synthesized findings. RESULTS: Forty articles met eligibility criteria (n = 24 predominantly adolescent and 16 predominantly young adult). Analyses yielded three main categories of focus: internalizing disorders (including depression, anxiety, suicidality, eating disorders, post-traumatic stress disorder), externalizing disorders (attention-deficit/hyperactivity disorder and conduct disorder), and transdiagnostic concepts (impulsivity and perceived stress). Significant methodological limitations were noted. CONCLUSIONS: Youth EC use is associated with greater mental health problems (compared with nonuse) across several domains, particularly among adolescents. Because many existing studies are cross-sectional, directionality remains uncertain. Well-designed longitudinal studies to investigate long-term mental health sequelae of EC use remain needed. IMPLICATIONS: Forty recent studies demonstrate a variety of mental health comorbidities with AYA EC use, particularly among adolescents. Mental health comorbidities of EC use generally parallel those of combustible cigarette use, with a few exceptions. Future EC prevention and treatment strategies may be enhanced by addressing mental health.

Are Women with a History of Low PAPP-A at Risk for Adverse Perinatal Outcomes in a Subsequent Pregnancy?

OBJECTIVE: To determine if patients with a history of low pregnancy-associated plasma protein A (PAPP-A) in an initial pregnancy are at higher risk for adverse obstetric outcomes in a subsequent pregnancy. STUDY DESIGN: This was a retrospective cohort study in patients who underwent first trimester screening for PAPP-A in two consecutive pregnancies. Two groups were examined: patients who had low PAPP-A in the first pregnancy followed by normal PAPP-A in the second pregnancy and patients who had recurrent low PAPP-A. Maternal and neonatal outcomes were compared between the groups, with the primary outcome being intrauterine growth restriction (IUGR) or preeclampsia. RESULTS: A total of 124 patients were included, representing 248 pregnancies. Ninety-two (74.2%) patients had normal PAPP-A in the second pregnancy, and 32 (12.9%) patients had recurrent low PAPP-A. Patients with recurrent low PAPP-A had a higher rate of IUGR or preeclampsia compared with patients with normal PAPP-A in the second pregnancy but this was not significantly different (12.5 vs. 10.9%, p = 0.51). There were no significant differences for all other outcomes. CONCLUSION: Among patients with a history of low PAPP-A, patients with normal PAPP-A in the subsequent pregnancy have a similar risk of adverse neonatal outcomes compared with patients with recurrent low PAPP-A.

Inpatient treatment for pathological gamblers in Germany: setting, utilization, and structure.

In Germany, there are two different approaches to inpatient treatment of pathological gambling (PG): Facilities focusing on addiction or on psychosomatic illness. However, little is known about how these differences influence utilization and structure of treatment. Therefore, in our study, we analyzed all known German gambling inpatient treatment centers concerning patients' sex, age and number of comorbid disorders and evaluated an expert assessment of the treatment system, access to treatment, and structure characteristics of inpatient treatment facilities. In 2011, 2,229 pathological gamblers were treated. This amounts to 1 % of all past-year pathological gamblers. 90 % of the patients were men, 93 % had at least one comorbid disorder. Access to treatment was mostly gained via psychosocial counseling centers, but was not readily available. Facilities with addiction departments treated less pathological gamblers per year (29.3 gamblers) than facilities with psychosomatic departments (53.3 gamblers) or with both departments (76.4 gamblers). Treatment duration was significantly longer in addiction departments treating PG as secondary diagnosis only, with a low rate of gamblers on all patients, or treating few gamblers. Some facilities specialized on PG and treated more gamblers, had a higher rate of gamblers on all patients, and offered specific treatment programs. The impact of this specialization on treatment outcome is still unclear. Although treatment numbers have risen steadily for the past years, only a small fraction of affected gamblers seek inpatient treatment. Therefore, awareness to the disease and access to treatment needs to be improved.

[It's not only the gamblers who need help - a pilot study on a family training programme]. / Nicht nur Spieler brauchen Hilfe - Ergebnisse einer Pilotstudie zum Angehörigenprojekt ETAPPE.

Relatives of problematic and pathological gamblers are seriously affected by the illness comparable to relatives of substance abusers. Therefore they might need support. Hence the psycho-educational training programme ETAPPE was developed and tested in an explorative pilot study in cooperation with counselling services. The participants got several questionnaires concerning amongst others: self-assessment of stress, psychological distress and taxing subjects. Results show that families of problematic and pathological gamblers are highly stressed. ETAPPE addresses the topics that are a burden for families. Taking into consideration the limitations, there are positive trends: Through this training, self-assessment of stress, psychological distress and actual situative perceived stress are reduced significantly. Chronic stress remains unchanged. A conclusive evaluation of the effectiveness of this manualized programme is still pending.