Bubbles in the Box: Recurrent Pneumothorax From Bronchopleural Fistula in Rheumatoid Arthritis.

When considering rheumatoid arthritis (RA)-associated pulmonary diseases, interstitial lung disease and pleural disease are the most common RA-associated pulmonary manifestations while spontaneous pneumothorax and bronchopleural fistula (BPF) are among the extremely rare ones. To the best of our knowledge, all the previous reports of RA-associated BPFs were attributed to peripherally located pulmonary nodules that necrotized, burst into the pleural cavity, and eventually lead to the fistula formation. However, we hereby present the first case of BPF in an RA patient that formed in the absence of any underlying rheumatic pulmonary nodules. Additionally, our patient was on chronic methotrexate therapy, and there are no data in the literature that suggest methotrexate-induced parenchymal lung disease can predispose to BPF formation. Our report is the first to introduce a probe to further investigate this association.

Planning Ahead: Using the Theory of Planned Behavior to Predict Older Adults' Intentions to Use Hospice if Faced With Terminal Illness.

Hospice is underutilized in the United States, and many patients enroll for short periods of times. The purpose of this cross-sectional study was to identify significant predictors of intentions to use hospice in community-dwelling older adults. The Theory of Planned Behavior informed the selection of predictors. Data were collected from 146 White older adults ( M age = 69.5; 69% females). Multiple linear regression analyses showed that higher hospice knowledge, normative beliefs that support hospice utilization, higher perceived control to use hospice, and preferences for end-of-life care that favor comfort and quality of life over living as long as possible were significant predictors of intentions to use hospice. In spite of being a sample of mostly highly educated older adults, almost half did not know about funding for hospice. These results provide better understanding of where to focus interventions to educate older adults about hospice, ideally in advance of a crisis.

Impact of Trauma-Certified Registered Nurse Anesthetists Team on Intra-Operative Resuscitation and Postoperative Outcomes of Trauma Patients.

A Trauma Certified Registered Nurse Anesthetists Team (TCT) was created and trained to provide trauma-focused anesthesia and resuscitation. The purpose of this study was to examine patient outcomes after implementation of TCT. We conducted retrospective analyses of trauma patients managed with surgical intervention from March to December 2015. During the first five months, patients managed before the development of TCT were grouped No-TCT, patients managed after were grouped TCT. To assess outcomes, we used hospital and intensive care unit length of stay, ventilator days, and a validated 10-point intraoperative Apgar score (IOAS). IOAS is calculated using the estimated blood loss, lowest heart rate, and lowest mean arterial pressure during surgery. Higher IOAS are associated with significantly decreased complications and mortality after surgery. We used t test and nonparametric tests for analyses. Fifty two patients were included (mean age 39 years, 75% male; 46.2% managed with TCT). Patients in the No-TCT group had significantly lower use of vasopressors (0.019), lower mean IOAS (P = 0.02), and spent more days on ventilator (P = 0.005) than patients in the TCT. These results suggest that trauma centers should take into consideration implementation of TCT to improve intraoperative and overall outcomes.

Longitudinal Examination of Aggression and Study Skills From Middle to High School: Implications for Dropout Prevention.

BACKGROUND: High school completion provides health and economic benefits. The purpose of this study is to describe dropout rates based on longitudinal trajectories of aggression and study skills using teacher ratings. METHODS: The sample consisted of 620 randomly selected sixth graders. Every year from Grade 6 to 12, a teacher completed a nationally normed behavioral rating scale. We used latent class mixture modeling to identify the trajectories. RESULTS: Participants followed 3 trajectories of aggression (Low, Medium Desisting, and High Desisting) and 5 trajectories of study skills (Low, Average-Low, Decreasing, Increasing, and High). Over three-quarters of the sample were in stable trajectories of study skills over time. Most students in the High Desisting Aggression group were in the Low Study Skills group, and all students in the High Study Skills group were in the Low Aggression group. The overall dropout rate was 17%, but varied dramatically across combined aggression and study skills groups, ranging from 2% to 50%. CONCLUSIONS: The results highlight the importance of early prevention that combines academic enhancement and behavioral management for reducing school dropout.

Low and Increasing Trajectories of Perpetration of Physical Dating Violence: 7-Year Associations with Suicidal Ideation, Weapons, and Substance Use.

Understanding the interrelation among problem behaviors and their change over time is fundamental for prevention research. The Healthy Teens Longitudinal Study followed a cohort of adolescents from Grades 6-12. Prior research identified two distinct trajectories of perpetration of physical dating violence: Low and Increasing. The purpose of this study was to examine whether adolescents in these two trajectories differed longitudinally on other problem behaviors: (1) suicidal ideation and attempts, (2) weapon-carrying and threats with a weapon, and (3) substance use, particularly alcohol and marijuana. The sample consisted of 588 randomly-selected students (52% males; 49% White, 36% Black, 12% Latino). Students completed a self-reported, computer-based survey each spring from Grades 6-12. To examine significant differences by perpetration of physical dating violence trajectory, we used Chi-square test and generalized estimating equations modeling. Across most grades, significantly more students in Increasing than in the Low trajectory reported suicidal ideation and attempts, carried a weapon, and threatened someone with a weapon. Adolescents in the Increasing trajectory also had higher trajectories of alcohol use, being drunk, and marijuana use than those in the Low trajectory. All differences were already significant in Grade 6. The difference in the rate of change between groups was not significant. This longitudinal study highlights that problem behaviors-physical dating violence, suicidal ideation and attempts, weapon carrying and threats, marijuana and alcohol use-cluster together as early as sixth grade and the clustering persists over time. The combination of these behaviors poses a great public health concern and highlight the need for early interventions.

Cigarette Smoking Trajectories From Sixth to Twelfth Grade: Associated Substance Use and High School Dropout.

INTRODUCTION: The purpose of this longitudinal study was to identify distinct trajectories of cigarette smoking from sixth to twelfth grade and to characterize these trajectories by use of other drugs and high school dropout. METHODS: The diverse sample for this analysis consisted of a cohort of 611 students from Northeast Georgia who participated in the Healthy Teens Longitudinal Study (2003-2009). Students completed seven yearly assessments from sixth through twelfth grade. We used semi-parametric, group-based modeling to identify groups of students whose smoking behavior followed a similar progression over time. RESULTS: Current smoking (past 30 day) increased from 6.9% among sixth graders to 28.8% among twelfth graders. Four developmental trajectories of cigarette smoking were identified: Abstainers/Sporadic Users (71.5% of the sample), Late Starters (11.3%), Experimenters (9.0%), and Continuous Users (8.2%). The Abstainer/Sporadic User trajectory was composed of two distinct groups: those who never reported any tobacco use (True Abstainers) and those who reported sporadic, low-level use (Sporadic Users). The True Abstainers reported significantly less use of alcohol and other drugs and lower dropout rates than students in all other trajectories, and Sporadic Users had worse outcomes than True Abstainers. Experimenters and Continuous Users reported the highest drug use. Over one-third of Late Starters (35.8%) and almost half of Continuous Users (44.4%) dropped out of high school. CONCLUSIONS: Cigarette smoking was associated with behavioral and academic problems. Results support early and continuous interventions to reduce use of tobacco and other drugs and prevent high school dropout.

Gender differences in trajectories of relational aggression perpetration and victimization from middle to high school.

Relational aggression refers to harming others through damaging or manipulating peer relationships. In a cohort of students surveyed annually from middle to high school, this study identified groups of adolescents who followed distinct trajectories of perpetration and of victimization of relational aggression, compared the proportion of boys and girls in each trajectory, and examined the overlap between perpetration and victimization trajectories. The sample consisted of 620 randomly selected sixth graders. Students completed yearly surveys from Grade 6-12. We used group-based trajectory modeling to identify the trajectories. Adolescents followed three developmental trajectories of perpetration and three similar trajectories of victimization: Low (lowest aggression), Moderate, and High Declining (high in middle school, with a steep decline in high school). All trajectories declined from Grade 6-12. The largest groups were the Low perpetration (55%) and Low victimization (48%). Relational aggression trajectories differed by gender: more boys reported perpetration, and more girls reported victimization. For perpetration, slightly more boys than girls were classified in the two trajectories of higher aggression. For victimization, significantly fewer girls than boys were classified in the Low trajectory, and significantly more girls than boys were classified in the Moderate trajectory. There was substantial overlap of the perpetration and victimization trajectories. These findings highlight the importance of implementing programs to reduce relational aggression for boys and for girls.

Marijuana Use from Middle to High School: Co-occurring Problem Behaviors, Teacher-Rated Academic Skills and Sixth-Grade Predictors.

Rising marijuana use and its lowered perceived risk among adolescents highlight the importance of examining patterns of marijuana use over time. This study identified trajectories of marijuana use among adolescents followed from middle through high school, characterized these by co-occurring problem behaviors and teacher-rated academic skills (study skills, attention problems, and learning problems), and tested sixth-grade predictors of trajectory membership. The sample consisted of a randomly-selected cohort of 619 students assessed annually from sixth to twelfth grade. Using group-based modeling, we identified four trajectories of marijuana use: Abstainer (65.6%), Sporadic (13.9%), Experimental (11.5%), and Increasing (9.0%). Compared to Abstainers, students in the Sporadic, Experimental and Increasing trajectories reported significantly more co-occurring problem behaviors of alcohol use, cigarette smoking, and physical aggression. Sporadic and Experimental users reported significantly less smoking and physical aggression, but not alcohol use, than Increasing users. Teachers consistently rated Abstainers as having better study skills and less attention and learning problems than the three marijuana use groups. Compared to Abstainers, the odds of dropping out of high school was at least 2.7 times higher for students in the marijuana use trajectories. Dropout rates did not vary significantly between marijuana use groups. In sixth grade, being male, cigarette smoking, physical aggression and attention problems increased the odds of being in the marijuana use trajectories. Multiple indicators--student self-reports, teacher ratings and high school dropout records--showed that marijuana was not an isolated or benign event in the life of adolescents but part of an overall problem behavior syndrome.

Longitudinal association of suicidal ideation and physical dating violence among high school students.

Two salient problems in adolescent development are dating violence and suicidal ideation. Theory and empirical research have supported their association in primarily cross-sectional studies. The purpose of this study is to examine the longitudinal association between physical dating violence and suicidal ideation (thoughts or plans) in a cohort of students evaluated annually from Grades 9 to 12. The sample consisted of 556 random-selected students (50.2 % males; 47.5 % White, 37.8 % Black, 11.2 % Latino) who reported dating at least once during the four assessments. Self-reported frequency of suicidal ideation, dating, and physical dating violence perpetration and victimization were assessed each spring from ninth to twelfth grade. We used generalized estimating equations modeling to predict the effects of sex, race, school grade, and physical dating perpetration and victimization on suicidal ideation. Cumulatively, one-fourth of the sample reported suicidal ideation at least once by the end of Grade 12, and approximately half reported physical dating violence. Female gender (OR = 1.7, p = 0.02), physical dating perpetration (OR = 1.54, p = 0.048), physical dating victimization (OR = 2.03, p < 0.001), and being in grades 9-11 versus 12 in high school (OR = 1.83, p = 0.004) were significant predictors of suicidal ideation. Race was not a significant predictor among adolescents in this sample. This longitudinal study highlights the detrimental emotional effect of physical dating violence perpetration and victimization among high school students. It is important that suicide prevention programs incorporate physical dating violence education and prevention strategies starting early in high school.

Trajectories of physical dating violence from middle to high school: association with relationship quality and acceptability of aggression.

Although research on dating violence is growing, little is known about the distinct developmental trajectories of dating violence during adolescence. The current study identifies trajectories of physical dating violence victimization and perpetration that boys and girls follow from sixth to twelfth grade, examines the overlap of these trajectories, and characterizes them by perceptions of a caring dating relationship and acceptability of dating aggression. The sample consisted of randomly selected sixth graders from nine schools in Northeast Georgia (n = 588; 52 % boys; 49 % White, 36 % African American, 12 % Latino) who completed yearly surveys from Grades 6-12. We used latent class mixture modeling to identify the trajectories and generalized estimating equations models to examine the acceptability of dating aggression by dating violence trajectories. Participants followed two trajectories of dating violence victimization (boys: low and high; girls: low and increasing) and two of perpetration (boys and girls: low and increasing). When examining the joint trajectories of victimization and perpetration, a similar proportion of boys (62 %) and girls (65 %) were in the low victimization and low perpetration group and reported the lowest acceptance of dating aggression. The same proportion of boys and girls (27 %) were in the high/increasing victimization and perpetration group, and reported the highest acceptance of dating aggression. However, acceptance of dating aggression decreased from Grade 6-12 for all groups, even for those whose trajectory of dating violence increased. Victimization and perpetration were associated with reporting a less caring dating relationship. Results highlight the importance of focusing prevention efforts early for adolescents who follow this increasing probability of physical dating violence.

Psychological dating violence perpetration and victimization: trajectories from middle to high school.

Despite evidence documenting the negative consequences, psychological dating violence occurs frequently in adolescent dating relationships. No information exists on the trajectories that adolescents follow and their association to nonphysical peer violence. The sample comprised 624 randomly selected 6th graders. In yearly surveys from 6th through 12th grade, 550 of the 624 students reported dating at least twice during the 3 months prior to completing the survey. These students responded to questions about frequency of engagement in psychological dating violence perpetration and victimization. We used Proc TRAJ to identify developmental trajectories of behavior over time and generalized estimating equation models to examine the associations of the trajectories and peer aggression. Adolescents followed three distinct developmental trajectories related to psychological dating violence victimization and perpetration: low, increasing, and high. Based on the joint probabilities of victimization and perpetration, we identified four predominant groups: low victimization/low perpetration (LVLP; 36%), increasing victimization/increasing perpetration (40%), high victimization/high perpetration (HVHP; 15%), and increasing victimization/low perpetration (IVLP; 7%). The LVLP had significantly more boys and White students; the HVHP group had an even gender distribution and more African-American students. For all groups, peer aggression decreased from Grade 6 to 12; students in the HVHP group reported the highest peer aggression, and students in the LVLP reported the lowest peer aggression. Findings suggest a strong, reciprocal relationship in the developmental trajectories of adolescents who experience and perpetrate psychological dating violence. Those highly engaged in these behaviors were also more likely to be violent toward peers.

Understanding dementia prevalence among centenarians.

The goals of this article are to (a) establish the concurrent and clinical validity of the Global Deterioration scale in assessing cognitive functions and stages of dementia among centenarians, (b) identify the prevalence of all-cause dementia in representative samples of centenarians, and (c) demonstrate how variations in sample demographic characteristics could significantly affect estimates of dementia prevalence. A quarter of the 244 centenarians in a population-based sample had no objective evidence of memory deficits. Another quarter showed signs of transient confusion, and about half showed classical behavioral signs of dementia with about 15% in each of Global Deterioration scale stages 4-6 and about 5% in the most severe stage 7. Variations in age, gender, race, residence status, and education of the study sample as well as criteria used for dementia rating were found to affect prevalence.

Predicting successful aging in a population-based sample of georgia centenarians.

Used a population-based sample (Georgia Centenarian Study, GCS), to determine proportions of centenarians reaching 100 years as (1) survivors (43%) of chronic diseases first experienced between 0-80 years of age, (2) delayers (36%) with chronic diseases first experienced between 80-98 years of age, or (3) escapers (17%) with chronic diseases only at 98 years of age or older. Diseases fall into two morbidity profiles of 11 chronic diseases; one including cardiovascular disease, cancer, anemia, and osteoporosis, and another including dementia. Centenarians at risk for cancer in their lifetime tended to be escapers (73%), while those at risk for cardiovascular disease tended to be survivors (24%), delayers (39%), or escapers (32%). Approximately half (43%) of the centenarians did not experience dementia. Psychiatric disorders were positively associated with dementia, but prevalence of depression, anxiety, and psychoses did not differ significantly between centenarians and an octogenarian control group. However, centenarians were higher on the Geriatric Depression Scale (GDS) than octogenarians. Consistent with our model of developmental adaptation in aging, distal life events contribute to predicting survivorship outcome in which health status as survivor, delayer, or escaper appears as adaptation variables late in life.

A cross-cultural comparison of hospice development in Japan, South Korea, and Taiwan.

By 2050, one out of four people in Eastern Asia will be aged 65 and above. Thus, preparing to care for an older population is imperative. Addressing quality care for elders includes consideration of palliative and end-of-life care. A comparative study of the development of hospice and palliative care services in Japan, South Korea, and Taiwan, is presented, based on an extensive literature review. Both commonalities and differences were found. This article provides information on the origins and administration of hospice services in these three cases, as well as the degree of government involvement. Cultural and religious aspects are also considered, and obstacles to the spread of hospice services are discussed. This review compares experiences with hospice services and identifies factors that influence people's perceptions and adoption of hospice. Stronger financial support for hospice and palliative care through the government and insurance programs would help increase the availability and use of services. Also, the need for continuing education of healthcare providers, patients, families, and the community is urgent. However, promotion of understanding of better pain management and the worth of hospice and palliative care must be conducted in ways that are sensitive to the cultural values and traditions in Japan, South Korea, and Taiwan. Only when hospice and palliative care can be viewed as an admirable choice for one's loved ones, overcoming issues of truth telling, filial piety, worries about how one is judged, and religious considerations, will it become more widely accepted.

Discussions by elders and adult children about end-of-life preparation and preferences.

INTRODUCTION: In the United States, 73% of deaths occur among people aged 65 years or older. Although most would prefer to die at home after a short illness, most actually die in institutions after prolonged declines. Despite this discrepancy, elders and their adult children often do not discuss end-of-life preferences. Use of advance directives has not been widespread, and people often avoid the subject until a crisis. This project focused on informal family communication about end-of-life preparation and preferences, about which little is known. METHODS: In May 2006, we conducted in-depth exploratory interviews with 15 older adults about their end-of-life preparation and preferences and with 15 younger adults about their parents' end-of-life preparation and preferences. The interview included an item rating the depth of discussion. RESULTS: Participants in both groups were primarily female and white. Mean age of older adults was 78.6 years (range, 70-88 years). Mean age of younger adults was 53.1 years (range, 42-63 years); mean age of their parents was 82.6 years (range, 68-99 years). Nine older adults reported discussing end-of-life preparation and preferences with their adult children; six had barely discussed the topic at all. Ten younger adults reported having talked with their parents about end-of-life preparation and preferences; five had not discussed it. Barriers to discussions about end-of-life preparation and preferences were fear of death, trust in others to make decisions, family dynamics, and uncertainty about preferences. Facilitators for discussion were acceptance of the reality of death, prior experience with death, religion or spirituality, and a desire to help the family. Successful strategies included casually approaching the topic and writing down end-of-life preparation and preferences. CONCLUSION: Knowing the obstacles to and facilitators for discussion can help health care and public health professionals target approaches to encouraging elders and their families to discuss end-of-life preparation and preferences before a crisis.