Lawyers Must Follow Their Inner Compasses

This article reflects on the suicide of a Montana lawyer and offers some assumptions from Larry Krieger, a clinical law teacher and former litigator, on how lawyers can develop workable approaches to living and improving their professional lives

Assessment and Re-assessment of Psychiatirc Patients Boarded in the Emergnecy Department: The Impact of Compliance with Best Practice Standards on Patient Outcomes

Psychiatric patients have been “deinstitutionalized” over recent decades with their care shifting from the inpatient to outpatient setting. As a result of the closing of more than 13,500 in-patient psychiatric beds between 2005 and 2010, emergency departments (ED) across the nation have become both safe havens and holding areas for psychiatric patients seeking care in the ED. The boarding of psychiatric patients in the ED impacts the timeliness of care provide to psychiatric and non-psychiatric patients alike lengthening door to discharge time for all patients. The purpose of this study is to assess the nursing staff’s compliance with departmental standards for the assessment and re-assessment of psychiatric patients boarded in the ED and to assess the impact of compliance with the standards on patient outcomes. Using a retrospective randomized chart audit, this study examined nursing compliance with the established department standard for the assessment and re-assessment of Level 2 psychiatric and non-psychiatric patients presenting to the ED between May 1, 2013 and April 30, 2014. Descriptive statistics was used to analyze the data. The study revealed that there was no impact on the length of stay of the patient when compliance with standards for assessment and reassessment was met. The study revealed an unexpected finding in that patient who were not reassessed based on the standard had shorter lengths of stay

Using Kinship Navigators to Assess the Needs of Kinship Caregivers

Kinship care is a viable alternative to foster care for many children, however, the proper supports and services must be in place for the families. This article describes a kinship navigator program for children and kin caregivers involved in Child Protective Services in-home treatment cases. The program was piloted over a three-year period to assess and address the service needs of kinship caregivers. Using the Family Needs Scale as a measurement tool, the results of the evaluation are provided along with a discussion of the need to support caregivers to provide the best outcomes for children in kinship care

Alcohol Exposure Decreases CREB Binding Protein Expression and Histone Acetylation in the Developing Cerebellum

Fetal alcohol exposure affects 1 in 100 children making it the leading cause of mental retardation in the US. It has long been known that alcohol affects cerebellum development and function. However, the underlying molecular mechanism is unclear.We demonstrate that CREB binding protein (CBP) is widely expressed in granule and Purkinje neurons of the developing cerebellar cortex of naïve rats. We also show that exposure to ethanol during the 3(rd) trimester-equivalent of human pregnancy reduces CBP levels. CBP is a histone acetyltransferase, a component of the epigenetic mechanism controlling neuronal gene expression. We further demonstrate that the acetylation of both histone H3 and H4 is reduced in the cerebellum of ethanol-treated rats.These findings indicate that ethanol exposure decreases the expression and function of CBP in the developing cerebellum. This effect of ethanol may be responsible for the motor coordination deficits that characterize fetal alcohol spectrum disorders

Anterior insula stimulation suppresses appetitive behavior while inducing forebrain activation in alcohol-preferring rats

The anterior insular cortex plays a key role in the representation of interoceptive effects of drug and natural rewards and their integration with attention, executive function, and emotions, making it a potential target region for intervention to control appetitive behaviors. Here, we investigated the effects of chemogenetic stimulation or inhibition of the anterior insula on alcohol and sucrose consumption. Excitatory or inhibitory designer receptors (DREADDs) were expressed in the anterior insula of alcohol-preferring rats by means of adenovirus-mediated gene transfer. Rats had access to either alcohol or sucrose solution during intermittent sessions. To characterize the brain network recruited by chemogenetic insula stimulation we measured brain-wide activation patterns using pharmacological magnetic resonance imaging (phMRI) and c-Fos immunohistochemistry. Anterior insula stimulation by the excitatory Gq-DREADDs significantly attenuated both alcohol and sucrose consumption, whereas the inhibitory Gi-DREADDs had no effects. In contrast, anterior insula stimulation failed to alter locomotor activity or deprivation-induced water drinking. phMRI and c-Fos immunohistochemistry revealed downstream activation of the posterior insula and medial prefrontal cortex, as well as of the mediodorsal thalamus and amygdala. Our results show the critical role of the anterior insula in regulating reward-directed behavior and delineate an insula-centered functional network associated with the effects of insula stimulation. From a translational perspective, our data demonstrate the therapeutic potential of circuit-based interventions and suggest that potentiation of insula excitability with neuromodulatory methods, such as repetitive transcranial magnetic stimulation (rTMS), could be useful in the treatment of alcohol use disorders.Peer reviewe

Racial Disparities and Welfare Reform in Mississippi

This research is a part of a much larger study which has been conducted on the implementation of Temporary Assistance for Needy Families (TANF) and Welfare Reform in the state of Mississippi. The study on the implementation of TANF employs qualitative and quantitative approaches to data collection and analysis. One of the quantitative components of that study is a statewide survey of former and current TANF and Aid to Families with Dependent Children (AFDC) recipients which includes 1688 respondents. This number represents roughly 10 percent of the 15,000 families on welfare in the state of Mississippi (the most available data). The sample is overwhelmingly African-American and female and we posit that this is a realistic reflection of the current welfare population. As the survey was disaggregated by congressional districts, some patterns relative to access of supports emerged which reflected racial disparities. This pattern inspired researchers to look deeper and to analyze data from the five congressional districts and the state as a whole which most closely illustrated the issue of disparity

Preconception Care - Issues Paper

The evidence for the link between maternal risk factors (including smoking, obesity, alcohol use and maternal mental health) and perinatal morbidity and mortality rates among Australian women is clear. There is also a growing body of evidence that Indigenous women are significantly more likely than their non-Indigenous counterparts to be impacted by these risk factors. Risk factors originate from genetic, environmental and behavioural factors. In alignment with the Health and Social Policy Branch’s Strategic Plan, Healthy, Safe and Well, the purpose of this paper is to focus on those risk factors that have a behavioural element and can, therefore, be modified, or impacted by strategies to minimise associated harms. Smoking in pregnancy has been highlighted as the most significant preventable cause of morbidity and death among women and infants. The risk of smoking increases among Indigenous and other disadvantaged women. A combination of policy and social marketing interventions involving comprehensive bans on advertising and sponsorship, tobacco price increases, bans on smoking in work and public places, health warnings on packs, mass media, QUIT telephone coaching and monitoring by a physician have been found to be most effective. Trends in nutrition, physical activity and obesity suggest a need for greater awareness and education of women in their reproductive years, prior to conception. Given women who are overweight or obese at conception are at increased risk of excessive gestational weight gain, parenting education and the setting of weight management goals have had some traction in antenatal care, however, the success of such programs relies on regular attendance and health practitioner skill. Although targeted health promotion interventions have increased acceptance of the importance of a healthy diet and exercise, many health practitioners lack skills to manage the problem, and evidence of the efficacy of such interventions in achieving reductions in obesity at the population level is lacking. Aboriginal women are at increased risk of obesity and government support for culturally appropriate programs targeting lifestyle behaviours and supporting health eating and physical activity in local communities have the potential to impact positively. Alcohol consumption among young women and pregnant women in NSW represents a significant risk factor potentially impacting the unborn fetus. Whilst the proportion of women engaged in heavy drinking in pregnancy is low, the adverse outcomes (including FASD) of heavy gestational alcohol consumption and the lack of evidence around safe levels of consumption highlight the issue as a high public health priority. Mandatory labelling of alcohol products and training of health professionals have been proposed as best practice interventions, in combination with addressing issues of pricing and taxation and advocating abstinence from drinking during pregnancy. The estimated prevalence of harmful drinking in Indigenous populations is twice that of non-Indigenous populations and the normalisation of harmful consumption highlights the need to target Indigenous populations, Aboriginal Medical Services (AMS) and Aboriginal clinicians to give health practitioners the skills and resources needed to advocate for reduced alcohol consumption in pre-pregnancy. Key components of effective interventions targeting Aboriginal women and health practitioners in contact with women in preconception and pregnancy are interactive community-based education, culturally appropriate printed resources and ongoing community engagement. Maternal mental health issues are estimated to affect 10-15% of women in high income countries during the perinatal period. Policy frameworks in NSW reflect recognition of the need for greater awareness of maternal mental health and the requirement to integrate programs that provide support for women’s well-being in the antenatal and postnatal phase into policy, planning and delivery of health services. An evidence-based health home visiting program called Sustaining NSW Families, developed for the identification and treatment of women at risk of antenatal and postnatal depression, has been found to be effective as an early intervention tool. Factors impacting the health and well-being of Aboriginal people include spirituality, the relationship with family, land and culture and these factors are all intertwined. Programs targeting these women need to be culturally appropriate, driven by the community and run by a workforce who understands the psycho-social risks resulting from intergenerational trauma.Health and Social Policy Branch, NSW Ministry of Healt

Determination of a brief AUDIT screening questionnaire to identify women at risk of harmful and hazardous alcohol consumption in primary care settings

Abstract Background: Alcohol consumption in South Africa is a major contributing factor to the quadruple burden of disease. Additionally, South Africa has the highest rate of Foetal Alcohol Syndrome in the world. As effective interventions are available for hazardous and harmful drinking, screening for this behaviour in primary care can potentially contribute to improving health outcomes and reducing the cost to society. Existing validated screening questionnaires are available to identify those who drink at hazardous or harmful levels. However, no tools have been validated for women of childbearing age in South Africa. Any screening tools recommended for implementation should be as brief as possible with high sensitivity and specificity to justify the time spent on screening and minimise time spent on false positive results. Objectives: To identify the most appropriate existing abbreviated version of the Alcohol Use Disorder Identification Test (AUDIT) questionnaire for South African women aged 18-44 and determine whether adjustments are required for urban/rural residence or patterns of consumption (binge drinking vs non-binge drinking). Additionally, to determine whether a single question can be used to identify possible dependent drinking. Methods: An existing dataset was used for the analysis, collected by means of household surveys conducted in 2006 in rural areas of the Western Cape and urban areas in Gauteng, South Africa. The Western Cape sample was selected by stratified random sampling of farm workers and the Gauteng sample was selected by cluster random sampling. AUROC analysis was used to compare the abbreviated questionnaires (AUDIT-C, AUDIT-3, AUDIT-4, AUDIT-PC, AUDIT-QF), CAGE and single questions to results of the full AUDIT screening questionnaire as the gold standard. Data was stratified in relation to binge drinking and the analyses repeated to determine any effect of drinking patterns on the results. Results: AUDIT-4 and AUDIT-PC were the best performing brief questionnaires in both rural and urban settings. AUDIT-4 had AUCs of 97.52% and 96.87% in Western Cape and Gauteng respectively. AUDIT-PC had scores of 97.52% and 93.98% in Western Cape and Gauteng respectively. Stratification by drinking pattern did not substantially influence the results. The single question method of identification of possible dependent drinking is not supported by the results of this study, with AUCs of < 75%. Conclusion: AUDIT-4 appears to be the best brief questionnaire for the identification of hazardous and harmful drinking among women aged 18-44 in South Africa, with no adjustments required for urban/rural settings or drinking patterns