A Review of Telepsychiatry for Pediatric Patients in the Emergency Setting.

PURPOSE OF REVIEW: The purpose of this review is to summarize factors contributing to the current state of pediatric mental health access in ED settings and synthesize the existing literature on the use of telepsychiatry to extend access to care, with particular focus on feasibility and sustainability. RECENT FINDINGS: Children are presenting to emergency departments (EDs) with mental health concerns at an increasing rate, while ED capacity to treat psychiatric needs in children remains insufficient. This growing problem is compounded by decreased access to outpatient care and inpatient psychiatric beds, resulting in exorbitantly long waiting times, or "boarding," of children in crisis. Telepsychiatry has emerged as a strategy to decrease boarding of pediatric patients in ED settings by utilizing remote psychiatric professionals to provide consultation and assessment. Telepsychiatry in ED settings is an effective strategy to increase access to care and decrease length of stay for pediatric patients.

Laboratory Estimation of Occupational Exposures to Volatile Organic Compounds During Nail Polish Application.

In the United States, there are more than 120,000 nail salons in which workers could be potentially exposed to a number of volatile organic compounds (VOCs) used in various procedures. Measuring workers exposure in the field is time-consuming and could be very expensive. The purpose of this study was to estimate the VOC levels in the proximity of workers in nail salons through simulating the application process of some popular nail polishes in a laboratory chamber. The worst-case scenario was defined as a worker's exposure during nail polish application to one set of fingernails every 15 minutes for an 8-hour shift (total nail sets = 32). Nail polish was applied on paper plates in a flow-controlled test chamber. Air was sampled during the application of five different nail polishes for 8 hours using passive air samplers and the experiment was triplicated. Passive samplers were used for VOCs and formaldehyde. In this worst-case scenario setting, a total of 17 VOCs were detected, with eight that were found in all the samples. The mean concentration of butyl acetate (161-330 ppm, parts per million) and ethyl acetate (440 ppm) exceeded the threshold limit value (TLV) of 150 ppm and 400 ppm, respectively. Formaldehyde was analyzed separately and the mean concentrations exceeded the TLV of 0.10 ppm in all types of nail polish, ranging from 0.12 ppm to 0.22 ppm. Occupational safety and health professionals could use these data to increase awareness of workers' potential exposure to high levels of VOCs in nail salons and recommend practical measures to reduce potential exposures.

Risks of high-powered motorcycles among younger adults.

OBJECTIVES: We assessed whether policies designed to safeguard young motorcyclists would be effective given shifts in ownership toward high-powered motorcycles. METHODS: We investigated population-wide motor vehicle driver and motorcyclist casualties (excluding passengers) recorded in Britain between 2002 and 2009. To adjust for exposure and measure individual risk, we used the estimated number of trips of motorcyclists and drivers, which had been collected as part of a national travel survey. RESULTS: Motorcyclists were 76 times more likely to be killed than were drivers for every trip. Older motorcyclist age-strongly linked to experience, skill set, and riding behavior-did not abate the risks of high-powered motorcycles. Older motorcyclists made more trips on high-powered motorcycles. CONCLUSIONS: Tighter engine size restrictions would help reduce the use of high-powered motorcycles. Policymakers should introduce health warnings on the risks of high-powered motorcycles and the benefits of safety equipment.

Age-related decline in serum parathyroid hormone in maintenance hemodialysis patients is independent of inflammation and dietary nutrient intake.

BACKGROUND: There is a direct relationship between age and serum parathyroid hormone (iPTH) in the normal population, but several studies suggest this relationship is reversed in maintenance hemodialysis (MHD) patients. The pathophysiologic basis of this age-related decline in serum iPTH levels remains unclear, although others have proposed that it is related to low dietary phosphorus intakes. METHODS: We conducted a prospective, cross-sectional evaluation of the relationship between age and serum iPTH levels and factors affecting this relationship. All participating subjects were asked to complete a 3-day food diary. The charts were reviewed to obtain routinely measured laboratory values over the preceding 3 months, and serum was collected to measure markers of systemic inflammation. RESULTS: Ninety-two MHD patients (47 men; age, 51.3+/-14.9 [standard deviation] years; median dialysis vintage, 25.8 months) were studied. Age was inversely correlated with both serum phosphorus and iPTH; these relationships remained significant even when the data were adjusted for diabetic status, dialysis vintage, and dietary nutrient intake. However, there were no associations of age, serum phosphorus, or iPTH with dietary intakes of protein, calories, phosphorus, or calcium either on univariate or multivariate analyses. Markers of systemic inflammation (serum C-reactive protein, and alpha1 acid glycoprotein) did not correlate with age, serum phosphorus, and iPTH or dietary nutrient intake. On the other hand, serum albumin, which may reflect long-term effects of inflammation, did correlate inversely with age and positively with serum phosphorus. CONCLUSIONS: Our cross-sectional study confirms that there are age-related lower levels of both serum phosphorus and iPTH in MHD patients. The mechanisms regarding the inverse relationship between serum phosphorus and age are unclear, but may not be caused by low phosphorus intake or systemic inflammation. In elderly MHD patients, the reduced responsiveness of parathyroid glands may be related to age-dependent accumulation of uremic toxins.