Art on the skin, lifesaving within: Exploring the role of tattoo artists in suicide prevention.

Different populations experience suicide at different rates. Some studies have found an increased risk of suicide among individuals with tattoos. Studies indicate a higher prevalence of mental health disorders among individuals with one or more tattoos. These findings signal a need to explore suicide prevention in tattoo shops. The aim of this project is to determine the feasibility, acceptability, and interest of providing education on suicide prevention among tattoo artists. We conducted a cross-sectional survey with tattoo artists. Survey items assessed artists' experiences with clients expressing mental health issues or suicidal thoughts, their comfort level assisting clients, and general perceptions around suicide and stigma. Seventy-nine surveys were collected. Most artists reported that they have had at least one situation in which a client mentioned something that made them concerned about that client's mental health. Most respondents reported that a client has expressed suicidal thoughts to them at least once. Our study demonstrated that tattoo artists encounter clients who express mental health challenges as well as suicidal ideation, underscoring the potential role for tattoo artists in supporting individuals at risk for suicidal thoughts and behaviors.

Suicide Data in Trauma Centers: Implications of Imprecision.

BACKGROUND: Trauma registries exist to provide data for evaluating the quality of care of trauma patients. These data facilitate research and can be used for outreach, planning, and improvement in trauma patient outcomes. However, the accuracy of registry data related to suicide has not been well studied. OBJECTIVE: This study sought to evaluate the accuracy of current trauma registry coding practices related to labeling injury as a suicide attempt among patients presenting to a Level I trauma center after self-inflicted injury. METHODS: We conducted a single-center, retrospective cohort analysis of a Level I trauma center trauma registry on all patients with self-inflicted injuries from 2011 to 2021. Manual chart review was used to identify cases wherein patients' injuries were categorized as suicidal despite the absence of suicidal intent. RESULTS: During this 11-year period, 537 patients were identified as having presented to the trauma center for traumatic self-inflicted injuries. Manual chart review revealed that 16% of these patients were incorrectly categorized as having attempted suicide despite their self-inflicted injury lacking suicidal intent (e.g., accidents, nonsuicidal self-harm). CONCLUSION: We found that 16% of trauma registry patients were overcategorized as having attempted suicide. Trauma registry data are an important source of information for activities related to injury prevention in trauma centers. Imprecise coding of self-inflicted injury may lead to poorly targeted programs and interventions due to incorrectly represented injury causes and patterns in trauma patient populations, including suicide prevention.

Pharmacist and Student Knowledge and Perceptions of Herbal Supplements and Natural Products.

We aimed to collect parallel perspectives from pharmacists and pharmacy students on their use, knowledge, attitudes, and perceptions about herbal supplements/natural products. Two cross-sectional descriptive survey questionnaires-one focusing on pharmacists and the other focusing on pharmacy students-were administered from March to June 2021 via Qualtrics. The surveys were sent out to preceptor pharmacists and pharmacy students currently enrolled at a single U.S. school of pharmacy. The questionnaires were composed of five main sections, including (1) demographics; (2) attitudes/perceptions; (3) educational experience; (4) resource availability; and (5) objective knowledge of herbal supplements/natural products. Data analysis primarily utilized descriptive statistics with relevant comparisons across domains. A total of 73 pharmacists and 92 pharmacy students participated, with response rates of 8.8% and 19.3%, respectively. A total of 59.2% of pharmacists and 50% of pharmacy students stated they personally used herbal supplements/natural products. Most respondents (>95% for both groups) considered vitamins/minerals safe, although a lower percentage agreed on this for herbal supplements/natural products (60% and 79.3% for pharmacists and pharmacy students, respectively). Patient inquiries in the pharmacy setting were most seen for vitamin D, zinc, cannabidiol, and omega-3. A total of 34.2% of pharmacists reported having training in herbal supplements/natural products as a required part of their Pharm.D. training, and 89.1% of pharmacy students desired to learn more. The median score on the objective knowledge quiz was 50% for pharmacists and 45% for pharmacy students. Ultimately, herbal supplements/natural products are recognized by pharmacists/pharmacy students as a consistent and embedded part of pharmacy practice, although there is a need to enhance knowledge and skills in this area.

Disparities in disposition from trauma centers to inpatient psychiatric treatment in a national sample of patients with self-inflicted injury.

BACKGROUND: Surgery providers are integral to the treatment of patients with self-inflicted injuries. Patient disposition (eg, home, inpatient psychiatric treatment, rehabilitation) is important to long-term outcomes, but little is known about factors influencing disposition after discharge following traumatic self-inflicted injury. We tested whether patient or injury characteristics were associated with disposition after treatment for self-inflicted injury. METHODS: National Trauma Data Bank query for self-inflicted injuries from 2010 to 2018. RESULTS: There were 77,731 patients treated for self-inflicted injuries during the study period. Discharge home was the most common disposition (45%), and those without insurance were less likely to discharge to inpatient psychiatric treatment than those with insurance. Racial minority patients were less likely to discharge to inpatient psychiatric treatment (18.9%) than nonminority patients (23.8%, P < .001). Additionally, patients discharged to inpatient psychiatric treatment had significantly lower injury severity score (7.24 ± 7.5) than those who did not (8.69 ± 9.1, P < .001). CONCLUSION: Racial/ethnic minority patients and those without insurance were significantly less likely to discharge to an inpatient psychiatric facility after treatment at a trauma center for self-inflicted injury. Future research is needed to evaluate the internal factors (eg, trauma center practices) and external factors (eg, inpatient psychiatric facilities not accepting patients with wound care needs) driving disposition variability.

Blood volume responses in partially dehydrated subjects working in the cold.

The effects of high-salt diets, cold, and heavy exercise have been examined in 33 Marine Corps volunteers living and working in a cold chamber. Temperatures varied from -29 degrees C during working hours to -4 degrees C, simulating partly warmed shelters, at night. Dehydrated operational rations were eaten and fluid intakes were controlled. When quantities of water were consumed at or above the amounts determined in previous studies in this series to prevent symptoms of cold-induced dehydration with these diets, ie., 2.5-3.0 L/d with diets containing 24 g of NaCl/d or about 2.0 L/d with 8 g NaCl/d, blood volumes increased 5-10%, primarily as a result of plasma volume expansion. This finding apparently confirms the results of earlier workers who have noted plasma volume increases in subjects undergoing vigorous exercise training. In subjects receiving 0.5 L/d or more below recommended quantities of water, intravascular volume increases developed slowly and quite erratically during 5 d of exercise. Intravascular volume increases responded within 1-2 d when fluid levels became appropriate for either high- or low-salt intakes. Besides confirming recommendations concerning water needed with dehydrated diets under conditions of the experiment, the observation of intravascular fluid volume increases during exercise training--despite limiting fluid intakes--raises the question of whether there are any physiological advantages from this adaptive mechanism.

Biochemical and hematologic profiles of 1000 submariners.

Control biochemical and hematologic data were gathered for 1017 healthy submariners who ranged in age from 19.5 to 43.5 years. Means, standard deviation, and frequency distribution are presented for 24 whole blood and serum variables and, where appropriate, for 11 urinary variables. After statistical separation of the effects of aging and length of submarine service, it has been determined that the following correlations were significant in this sample: neutrophil and leucocyte levels, serum cholesterol, and both fasting and postprandial glucose correlated positively with age; serum alkaline phosphatase levels and age correlated negatively. Age-corrected positive correlations were demonstrable between length of submarine service and both serum cholesterol content and alkaline phosphatase activity; after a loading test, glucose levels showed a negative relationship to length of submarine service. Split-sample correlation analyses verified these significant correlations, with the exception of the apparent rise in alkaline phosphatase activity with increasing length of submarine duty.

Cardiovascular risk factors in submariners.

A sizeable group of biochemical, hematologic and physiologic variables that significantly affect the prognosis for diseases of aging, especially for coronary heart disease (CHD), were studied in 1017 submariners. Skinfold thickness in these subjects was determined to be higher than in most other groups of men of similar age; the total level of body fat was within the range of high normality. Serum cholesterol levels, cigarette smoking, relative weight, and blood pressure appeared to be the factors most directly responsible for the extent of cardiovascular risk in this group of submariners. Though submariners as a group do not apparently have appreciably higher levels of CHD risk than other American men, there was a significant tendency for total risk to increase with length of submarine service as well as with age. A similar age-independent increase in serum cholesterol correlating with length of submarine service was reported earlier. Split-sample analyses support the reliability of the age-corrected correlations of CHD risk with time of submarine service. Although no attempt was made to prove a direct relationship between alcohol consumption or coffee drinking and cardiovascular risk, there were strong correlations noted. These factors, combined with serum cholesterol levels, cigarette smoking, and relative weight, deserve consideration as potentially modifiable CHD risks.

Shallow habitat air dives I and II: human hematologic responses to compressed air saturation diving.

Two subjects each were exposed to pressure equivalents of 50 (SHAD I) and 60 (SHAD II) feet of sea water gauge (FSWG) for 30 and 28 d, respectively. Red blood cell (RBC) count, hemoglobin (Hb) content, and reticulocyte count of venous blood from divers were measured before, during, and after these exposures. RBC count of the divers decreased a maximum of 7.1% in the 50-ft dive and 10.7% in the 60-ft dive compared to surface control values. Hb content fell 7.7% and 11.1% in the 50- and 60-ft dives, respectively, when compared to nondiving subjects. Reticulocyte counts tended to increase late in the pressurization phase and during the recovery. The total month-long responses of Hgb in SHAD I, and RBC, Hgb, and reticulocyte count in SHAD II were significantly altered when compared to those of the surface control subjects. The changes in these factors were directly attributable to the month-long exposure to the total hyperbaric environment. The threshold for hematological effects of chronic exposure to compressed air would seem to lie between 50 and 60 FSWG.

Hematologic changes after two exposures to 6.7 ATA air at three-day intervals.

Hematologic parameters were studied in human subjects exposed to various diving regimens. A series of exposures in a dry chamber to a simulated depth of 188 ft of seawater gauge (fswg), 6.7 ATA, utilizing compressed air, were carried out according to standard Navy diving tables. The subjects were serially followed for a control period prior to diving and subsequently for up to 1 wk. Little significant change occurred except for alterations in some platelet factors. In another series of experiments, the single excursion was followed by a second dive to 188 fswg 3 days later, again with appropriate hematologic monitoring. A pronounced eosinopenia and increased clotting times were observed soon after reaching the surface. Platelet depletion associated with increased clumping and elevated megathrombocyte levels persisted long after the second excursion. A latent hemodilution also developed 3--5 after the second dive. These findings clearly demonstrate that repeated hyperbaric exposures produce additive effects and further suggest that no diving procedure is completely innocuous.

Biochemistry and hematology at decompression sickness: a case report.

A 24-year-old hospital corpsman, a volunteer in a series of dry chamber air dives to a simulated pressure equivalent to 188 FSWG (57.3 MSWG), developed left knee pain shortly after standard decompression. A tentative diagnosis of decompression sickness was made and recompression therapy was initiated with alleviation of pain occurring at 60 FSWG (18.3 MSWG). A U.S. Navy Treatment Table "5 (oxygen breathing) regimen was then selected and completed uneventfully. The subject had been undergoing biomedical evaluation for several days prior to diving; thus, a clinically diagnosed case of dysbarism with subsequent treatment was available for study. This individual was then monitored for a 10-d period. The acute phase of decompression sickness was characterized by a marked shortening of clotting time and a thrombocytopenia with accompanying increased platelet aggregates. The recovery phase was categorized by a variety of hematological and bio-chemical changes. Hemodilution, an elevated megathrombocyte index, and a tendency toward eosinopenia were evident for most of the 10-d observation period. Other persistent alterations detected during this period included a relative hyperglycemia, depressed urine Na+/K+, and increased ketosteroid excretion. These observations indicate that abatement of pain after treatment of dysbarism can be followed by the onset of a variety of biochemical and hematological changes. Moreover, complete recovery may require upwards of 10 d.