The Status of Underage Drinking and Laws in Missouri

Underage drinking presents a serious public health problem in the United States with 10.7 million youth ages 12-20 reporting consumption of alcohol. Twenty-eight percent of youth ages 12-20 report using alcohol within the past 30 days. Additionally, underage youth consumed 19.7 percent of all alcohol in 1999, spending $22.5 billion on beer, wine, and liquor. Underage drinking contributes to a host of public health problems such as homicide, suicide, injury, drowning, burns, property crime, high risk sex, fetal alcohol syndrome, and alcohol poisoning. In addition to these concerns, research indicates early onset of alcohol use is a strong predictor of alcohol dependence later in life. Youth who begin drinking before age 15 are four times more likely to develop alcohol dependence and are two and a half times more likely to become abusers of alcohol than those who begin drinking at age 21. In Missouri, one out of four youth begins using alcohol before the age of 13

Factors associated with intracerebral hemorrhage after thrombolytic therapy for ischemic stroke pooled analysis of placebo data from the Stroke-Acute Ischemic NXY Treatment (SAINT) I and SAINT II trials

<p><b>Background and Purpose:</b> A number of factors have been associated with postthrombolysis intracerebral hemorrhage, but these have varied across studies.</p> <p><b>Methods:</b> We examined patients with acute ischemic stroke treated with intravenous tissue plasminogen activator within 3 hours of symptom onset who were enrolled in the placebo arms of 2 trials (Stroke-Acute Ischemic NXY Treatment [SAINT] I and II Trials) of a putative neuroprotectant. Early CT changes were graded using the Alberta Stroke Program Early CT Score (ASPECTS). Post–tissue plasminogen activator symptomatic intracerebral hemorrhage was defined as a worsening in National Institutes of Health Stroke Scale of ≥4 points within 36 hours with evidence of hemorrhage on follow-up neuroimaging. Good clinical outcome was defined as a modified Rankin scale of 0 to 2 at 90 days.</p> <p><b>Results:</b> Symptomatic intracerebral hemorrhage occurred in 5.6% of 965 patients treated with tissue plasminogen activator. In multivariable analysis, symptomatic intracerebral hemorrhage was increased with baseline antiplatelet use (single antiplatelet: OR, 2.04, 95% CI, 1.07 to 3.87, P=0.03; double antiplatelet: OR, 9.29, 3.28 to 26.32, P<0.001), higher National Institutes of Health Stroke Scale score (OR, 1.09 per point, 1.03 to 1.15, P=0.002), and CT changes defined by ASPECTS (ASPECTS 8 to 9: OR, 2.26, 0.63 to 8.10, P=0.21; ASPECTS ≤7: OR, 5.63, 1.66 to 19.10, P=0.006). Higher National Institutes of Health Stroke Scale was associated with decreased odds of good clinical outcome (OR, 0.82 per point, 0.79 to 0.85, P<0.001). There was no relationship between baseline antiplatelet use or CT changes and clinical outcome.</p> <p><b>Conclusions:</b> Along with higher National Institutes of Health Stroke Scale and extensive early CT changes, baseline antiplatelet use (particularly double antiplatelet therapy) was associated with an increased risk of post–tissue plasminogen activator symptomatic intracerebral hemorrhage. Of these factors, only National Institutes of Health Stroke Scale was associated with clinical outcome.</p&gt

A Quantitative Study of the Relationships between Activity Limitation and Participation Restriction among Older People with Vision Impairment and Comorbid Conditions

The purpose of the study was to investigate the prevalence and effects of vision impairment co-existing with other comorbid conditions. Utilizing the 2008 National Health Interview Survey, the most recent nationally representative data including expanded vision, health conditions, and activity questions, this study examined the effect of vision impairment co-existing with selected comorbid conditions among non-institutionalized older adults age ≥ 55 years. Specifically, this study compared 4 groups: (a) older adults with neither vison impairment nor comorbid conditions, (b) older adults with vision impairment only, (c) older adults with comorbid conditions only, and (d) older adults with both vision impairment and each of the comorbid conditions to examine the prevalence and effect of vision impairment and comorbid conditions on selected mobility and vision activity limitations, and participation restrictions. Using complex sample techniques to conduct frequency analyses and logistic regression procedures, this study compared these groups of older adults to document the likelihood of experiencing mobility and vision activity limitations, and participatory restrictions. These results suggest that older adults reporting vision impairments are a heterogeneous population, overwhelmingly use corrective lenses, and experience substantial mobility and vision activity limitations, and participatory restrictions; however, relatively few report using low vision aids or rehabilitation services. In addition, these results revealed, even when controlling for age, sex, race/ethnicity, marital status, region of residence, and health status, older adults with vision impairment and any of the selected comorbid conditions were statistically significantly more likely to report mobility and vision activity limitations, and participation restrictions. Moreover, when comparing older adults reporting vision impairment co-existing with comorbid conditions older adults reporting either vision impairment only or a comorbid condition only, the results suggest vision impairment had the largest statistically significant effect on the likelihood of mobility or vision activity limitations, or participatory restriction in 29 of the 44 logistic regression analyses. These findings are significant as vision impairment is framed as a public health concern, and can inform improvements in programs and services for older adults. Finally, these findings highlight the need for expanded research examining the effect of specific eye diseases and comorbid conditions among older adults

A Quantitative Study of the Relationships between Activity Limitation and Participation Restriction among Older People with Vision Impairment and Comorbid Conditions

The purpose of the study was to investigate the prevalence and effects of vision impairment co-existing with other comorbid conditions. Utilizing the 2008 National Health Interview Survey, the most recent nationally representative data including expanded vision, health conditions, and activity questions, this study examined the effect of vision impairment co-existing with selected comorbid conditions among non-institutionalized older adults age ≥ 55 years. Specifically, this study compared 4 groups: (a) older adults with neither vison impairment nor comorbid conditions, (b) older adults with vision impairment only, (c) older adults with comorbid conditions only, and (d) older adults with both vision impairment and each of the comorbid conditions to examine the prevalence and effect of vision impairment and comorbid conditions on selected mobility and vision activity limitations, and participation restrictions. Using complex sample techniques to conduct frequency analyses and logistic regression procedures, this study compared these groups of older adults to document the likelihood of experiencing mobility and vision activity limitations, and participatory restrictions. These results suggest that older adults reporting vision impairments are a heterogeneous population, overwhelmingly use corrective lenses, and experience substantial mobility and vision activity limitations, and participatory restrictions; however, relatively few report using low vision aids or rehabilitation services. In addition, these results revealed, even when controlling for age, sex, race/ethnicity, marital status, region of residence, and health status, older adults with vision impairment and any of the selected comorbid conditions were statistically significantly more likely to report mobility and vision activity limitations, and participation restrictions. Moreover, when comparing older adults reporting vision impairment co-existing with comorbid conditions older adults reporting either vision impairment only or a comorbid condition only, the results suggest vision impairment had the largest statistically significant effect on the likelihood of mobility or vision activity limitations, or participatory restriction in 29 of the 44 logistic regression analyses. These findings are significant as vision impairment is framed as a public health concern, and can inform improvements in programs and services for older adults. Finally, these findings highlight the need for expanded research examining the effect of specific eye diseases and comorbid conditions among older adults

THE RELATIONSHIP BETWEEN SELF-EFFICACY AND CLINICAL RISK FACTORS IN THE BYPASS ANGIOPLASTY REVASCULARIZATION INVESTIGATION 2 DIABETES (BARI 2D) STUDY

Objectives: Although prior research has shown that self-efficacy (SE), the belief that one has the ability to create change through behaviors, is associated with better clinical outcomes for Type 2 diabetes (DM) and coronary artery disease separately (CAD), little research has examined the role of SE in patients with both DM and CAD. The goal of this cross-sectional analysis was to describe the association between SE and glycosylated hemoglobin (HbA1c), systolic blood pressure (SBP), and low density lipids (LDL) in patients with comorbid CAD and DM. In addition, this analysis examined the demographic and clinical factors that are associated with SE in the management of DM and CAD.Methods: Bivariate and multivariate analyses were conducted with 1,447 patients in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) study who completed a self-efficacy assessment. Only patients recruited at U.S. sites were included in the analyses. The majority of the patients were White non-Hispanic, male, and had a post high school education. The average age at enrollment was 63 years. The models were adjusted for sex, age, race/ethnicity, and education.Results: Better HbA1c was positively associated with SE, even after adjusting for race/ethnicity, age, sex, and education. Better SBP was positively associated with SE, however this association was only marginally significant when adjusting for race/ethnicity, age, sex, and education. LDL was not associated with SE. Hispanic ethnicity, history of congestive heart failure, number of hypertension drugs, probable neuropathy, and insulin use were factors negatively associated with SE. A post high school education and history of cancer were positively associated with SE. Conclusions: Psychosocial factors, such as self-efficacy, are of public health significance because they play a considerable role in the management of diabetes and cardiovascular disease. Self-efficacy was positively associated with better cardiac and diabetic factors in the BARI 2D population. Literacy skills, cardiac history, number of medications, and neuropathy are several other factors doctors should take into consideration when assessing and building up patients' confidence in being able to manage their medical conditions

TGF-β1 modulates microglial phenotype and promotes recovery after intracerebral hemorrhage

Intracerebral hemorrhage (ICH) is a devastating form of stroke that results from the rupture of a blood vessel in the brain, leading to a mass of blood within the brain parenchyma. The injury causes a rapid inflammatory reaction that includes activation of the tissue-resident microglia and recruitment of blood-derived macrophages and other leukocytes. In this work, we investigated the specific responses of microglia following ICH with the aim of identifying pathways that may aid in recovery after brain injury. We used longitudinal transcriptional profiling of microglia in a murine model to determine the phenotype of microglia during the acute and resolution phases of ICH in vivo and found increases in TGF-β1 pathway activation during the resolution phase. We then confirmed that TGF-β1 treatment modulated inflammatory profiles of microglia in vitro. Moreover, TGF-β1 treatment following ICH decreased microglial Il6 gene expression in vivo and improved functional outcomes in the murine model. Finally, we observed that patients with early increases in plasma TGF-β1 concentrations had better outcomes 90 days after ICH, confirming the role of TGF-β1 in functional recovery from ICH. Taken together, our data show that TGF-β1 modulates microglia-mediated neuroinflammation after ICH and promotes functional recovery, suggesting that TGF-β1 may be a therapeutic target for acute brain injury

Tax loss carryovers in a competitive environment

The fact that incumbent firms can immediately deduct research and development (R&D) investments from taxable income is generally believed to give them a strategic advantage over new firms that cannot deduct the investment cost, but instead generate a net operating tax loss carryover. Using an analytical model, we show that this conventional wisdom need not hold in a competitive environment. We examine operating and investment decisions in a duopolistic industry in which an initial investment in R&D yields an immediate tax benefit for one firm, but creates a net operating loss carryover for the other firm. If both firms invest in R&D, the firm with the net operating loss carryover makes more aggressive capital investment decisions following successful R&D. This may deter the incumbent firm from investing in R&D despite the lower after‐tax costs of this investment. Changing the tax loss carryover rules would thus not only affects start‐up or loss firms, but would also affect the investment decisions of profitable firms in the same industry