Implementing Universal Suicide Risk Screening in a Pediatric Hospital.

BACKGROUND: Health care providers are in a prime position to identify teens at risk for suicide, yet many do not. The research team developed and implemented a hospitalwide program to identify teens at elevated risk for suicide and connect them with services. METHODS: Screening was implemented at both locations of a pediatric hospital, including two emergency departments, three urgent care clinics, and ambulatory clinics. Patients aged 12 years and older presenting for care were screened for suicide risk using the Ask Suicide-Screening Questions (ASQ) in most settings, while the Columbia-Suicide Severity Rating Scale (C-SSRS) was used in mental health areas. A social worker responded to positive screens to complete a more thorough assessment and determine next steps. Social workers also completed outreach to patients in the weeks following a positive screen. Implementation began with pilot locations and expanded after refinements were made. Stakeholders provided screening recommendations, and education was provided prior to implementation. The cost of implementation was calculated based on the time screening required from nursing and social work. RESULTS: Review of the program focused on implementation fidelity, quality improvement, and trends among screening results. During the first year of screening, 138,598 screens were completed, and 6.8% of screens were positive for elevated risk. The annualized cost of the program was estimated to be $887,708.65 for personnel directly involved in screening and following up on positive screens. CONCLUSION: Early involvement of stakeholders and hospital leaders and a robust response plan were essential to successful implementation of this suicide-screening program.

A comparison of subjective and objective measures of physical exertion.

Better methods are needed to improve validity and reliability of physical activity (PA) assessment instruments. The purpose of this study was to compare individual's Borg's Rate of Perceived Exertion (RPE) scores to GT1M ActiGraph accelerometer output, with the aim to better understand estimates of perceived exertion for exercise prescription. Adults were recruited (n = 117) from Utah, with 43.1% males (n = 50), and most (53.1%) self-reporting regular exercise. Participants performed three indoor laps of increasing intensity, ranging from walking to running, and immediately completed a RPE form. A subsample was mailed the same RPE survey 6-8 weeks later to compare differences from their initial responses. Individual accelerometer data was compared to RPE levels from validated metabolic equivalents (METs). There were significant differences between the RPE ratings and the accelerometer output overall for gender (χ(2) = 10.9, P = 0.004), and exercise status (χ(2) = 15.5, P < 0.001). The odds of underestimating RPE for an exerciser were 3.67 times greater than a non-exerciser (95% CI = 1.48, 9.11). The subsample also underestimated RPE after the time lapse (Z = -2.324, P = 0.020). Overall, the RPE proved to be a useful tool for most individuals and could be used in individualised exercise prescription, although women may overestimate, and regular exercisers may underestimate exertion.

Development, implementation, and evaluation of a computerized self-administered diet history questionnaire for use in studies of American Indian and Alaskan native people.

Collection of dietary intake in epidemiologic studies involves using methods that are comprehensive yet appropriate for the population being studied. Here we describe a diet history questionnaire (DHQ) that was developed using an audio self-administered computer-assisted interview technique. The DHQ was developed for use in a cohort of American Indians and Alaskan Natives with tribal input and area-specific modules to incorporate local food availability. The DHQ includes 54 main food group questions, specific food items within the main food group, and food preparation and general eating practice questions. The questionnaire was programmed to be self-administered using a computer with a touch screen. The average time for the first 6,604 participants to complete the questionnaire was 36 minutes. Almost 100% of participants had complete DHQ data and the average number of food items selected was 70. The methods developed for collection of dietary data appear to be appropriate for the targeted population and may have usefulness for other populations where collecting dietary data in a self-administered format is desirable.

Antioxidants, carotenoids, and risk of rectal cancer.

Numerous properties suggest that antioxidants and carotenoids may be valuable chemopreventive agents. A population-based case-control study of 952 rectal cancer cases and 1,205 controls from Northern California and Utah was conducted between September 1997 and February 2002. Detailed diet history, medical history, and lifestyle factors interviews were conducted. Dietary antioxidants were not associated with rectal cancer risk in men. For women, relative to the highest level of intake, low intake of dietary lycopene (odds ratio (OR) = 1.7, 95% confidence interval (CI): 1.0, 2.8) or vitamin E (OR = 2.2, 95% CI: 1.1, 4.3) was associated with an increased risk of rectal cancer. Alpha-, beta-, and gamma-tocopherol were associated with an approximate twofold increased risk of rectal cancer in women. Associations were stronger for women aged > or = 60 years for vitamin E and tocopherols (alpha-tocopherol OR = 3.6, 95% CI: 1.4, 9.4; gamma-tocopherol OR = 5.3, 95% CI: 2.1, 13.2; delta-tocopherol OR = 1.9, 95% CI: 0.9, 4.0), except for beta-tocopherol, for which risk increased twofold for all women. Associations differed by estrogen status for beta-carotene, lycopene, and vitamin E. These results suggest that vitamin E and lycopene may modestly reduce the risk of rectal cancer in women.

Energy balance and rectal cancer: an evaluation of energy intake, energy expenditure, and body mass index.

Lack of energy balance, or greater energy intake than expenditure as indicated by a large body mass index (BMI), has been associated with colon cancer, although less is known about its association with rectal cancer. In this study, we examined the association between BMI, energy intake, and energy expenditure and their combined effect on rectal cancer risk. A population-based case-control study was conducted in Utah and Northern California. Incident cases (n = 952) of rectal cancer and population-based controls (n = 1205) were interviewed between 1997 and 2002 to obtain detailed information on body size, dietary intake, and physical activity patterns. BMI (kg/m(2)) was not associated with rectal cancer in either men or women. Participation in vigorous leisure-time physical activity over the past 20 yr was associated with a significant 40% reduction in rectal cancer risk. Energy intake was associated significantly with increased risk of rectal cancer, especially among people whose diagnosis was prior to age 60 yr (odds ratio [OR] = 3.9; 95% confidence interval [CI] = 1.7-9.1 for men; OR = 2.8; 95% CI = 1.1-7.2 for women). There was a significant interaction between energy intake and energy expenditure, although not between BMI and either energy intake or energy expenditure. These data suggest that large BMI, an indicator of lack of energy balance, is not an important component of the etiology of rectal cancer. However, both physical activity and energy intake were significantly associated with rectal cancer risk. These data suggest that energy expenditure and energy intake alter rectal cancer risk through mechanisms other than energy balance.

A five-year evaluation of reports of overdose with indinavir sulfate.

PURPOSE: To describe the adverse event profile for indinavir sulfate overdose. METHODS: Analysis of indinavir overdose reports in Merck & Co., Inc.'s safety database through the first 5 years following US licensure of indinavir. Reports were classified as acute (single high dose in excess of 2400 mg), chronic (multiple extra doses, not exceeding 2400 mg per dose), single extra dose (not exceeding 2400 mg) and dose not reported. RESULTS: Seventy-nine reports of indinavir overdose were reviewed (15 acute, 43 chronic, 13 single extra dose and 8 dose not reported). A total of 52/79 (66%) reports were associated with adverse events. For acute overdose reports with adverse events, indinavir doses ranged from 2.8 g to 48 g (median 6 g; mean 13 g); for acute overdose reports without adverse events, indinavir doses ranged from 4 g to 80 g (median 56 g; mean 45 g). Adverse events following acute and chronic exposures were similar; the most commonly reported adverse events included nausea, vomiting, abdominal pain and nephrolithiasis. Of the 52 patients with adverse events, 39 recovered, 6 had not recovered at the time of reporting and no information regarding outcome was provided in 7 reports. CONCLUSIONS: Overdose with indinavir was associated with adverse events in the majority of reports. These were most commonly gastrointestinal and renal events, and were generally consistent with the known safety profile of indinavir. The majority of patients recovered.