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We previously reported a >50% increase in mean plasma eicosapentaenoic acid levels in a general medicine clinic population after supplementation with alpha-linolenic acid. In the current analysis, we evaluate the variability of changes in eicosapentaenoic acid levels among individuals supplemented with alpha-linolenic acid and evaluated the impact of baseline plasma fatty acids levels on changes in eicosapentaenoic acid levels in these individuals. Changes in eicosapentaenoic acid levels among individuals supplemented with alpha-linolenic acid ranged from a 55% decrease to a 967% increase. Baseline plasma fatty acids had no statistically significant effect on changes in eicosapentaenoic levels acid after alpha-linolenic acid supplementation. Changes in eicosapentaenoic acid levels varied considerably in a general internal medicine clinic population supplemented with alpha-linolenic acid. Factors that may impact changes in plasma eicosapentaenoic acid levels after alpha-linolenic acid supplementation warrant further study. [ABSTRACT FROM AUTHOR]

BACKGROUND: Transient paroxysmal alterations of consciousness or behavior are common sequelae of moderate and severe traumatic brain injury (TBI). Clinicians caring for patients with such episodes often diagnose them as epileptic seizures, a frequent and well-studied complication of TBI. As it is difficult to confirm this diagnosis, antiepileptic drugs are often used empirically. However, as such therapy is frequently ineffective, we studied the usefulness of prolonged video electroencephalogram (VEEG) monitoring in the clinical management of paroxysmal behaviors in TBI survivors. METHODS: Records of patients referred evaluation in an epilepsy monitoring unit for management of medically intractable epilepsy were retrospectively reviewed. Patients with a documented history of moderate-to-severe brain injury preceding the onset of epilepsy were identified. These patients were studied by simultaneous videotape and scalp electroencephalographic recordings, and the majority also underwent magnetic resonance imaging and neuropsychologic studies. RESULTS: Of the 1858 consecutive admissions over a 66-month period, 127 (7%) fulfilled enrollment criteria. VEEG monitoring was conducted for an average of 4.6 days. Monitoring was successful in establishing a diagnosis in 82% of the cases referred: 62% had focal seizures, 6% had generalized seizures, and 33% had psychogenic nonepileptic seizures. Of those with temporal lobe epilepsy, 53% had mesial temporal sclerosis, as shown by magnetic resonance imaging. CONCLUSIONS: VEEG is a useful procedure in the evaluation of TBI survivors with spells. The yield of diagnoses that may alter treatment is substantial. Additionally, mesial temporal sclerosis is associated with TBI. Given the variety of seizure types found in survivors of moderate-to-severe TBI, obtaining specific diagnosis of seizure type by VEEG monitoring impacts treatment options. [ABSTRACT FROM AUTHOR]

The aim of the present study was to utilize a strain gauge, which enabled the force applied to produce firmly attached crimpable hooks to rectangular stainless steel archwires, to be measured. In vitro testing of two hooks, American Orthodontic (AO) and TP Orthodontic (TP), and two dimensions of stainless steel archwire, 0.019 x 0.025 and 0.018 x 0.025-inch, was carried out using an Instron Universal Testing machine. The results demonstrate that there was a significant difference in the behaviour of the two types of crimpable hooks, with almost twice the force needed to dislodge the TP hooks compared with the AO hooks (11.7 and 6.22 N, respectively). When using TP hooks attached to either 0.019 x 0.025 or 0.018 x 0.025-inch stainless steel wires, the archwire size makes little difference to the force required to produce movement. The clinical significance of these findings is discussed. [ABSTRACT FROM AUTHOR]

Adverse childhood experiences (ACEs) are potentially traumatic but preventable experiences that occur before the ages of 18, including child abuse, witnessing violence, and parental substance use. ACEs have been linked with increased risk for substance use, along with a variety of other negative health outcomes. However, there is limited evidence of community-level strategies that link ACEs and substance to increase awareness of prevention efforts. This article reports on a $2.9 million program to promote health equity and inform narratives for the prevention of ACEs and substance use within three Midwestern communities. Program partners sought to create new transformational narratives that linked ACEs and substance use, while underscoring the importance of addressing social determinants of health (SDOH) that lead to disparities in ACEs and substance use. A mixed-methods evaluation design included document review, in-depth interviews with program staff (N = 8) and community liaisons (N = 2), and site reports from program staff (N = 8) and their community partners (N = 17). Analyses showed that successful implementation efforts had early leadership buy-in and support, set clear and manageable expectations at the outset of implementation, and developed strong relationships with organizations that engage in health equity work. Training and technical assistance were critical to helping community partners build trust, recognize each other's perspectives, broaden and reframe their world view, and better understand narrative efforts for the primary prevention of ACEs and substance use., (© 2024 Society for Community Research and Action. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.)

There is increasing scientific evidence linking substance use, childhood adversity, and social determinants of health. However, little research has considered the evaluation of community-level strategies to reduce substance use by increasing awareness and implementation of evidence-based strategies for preventing adverse childhood experiences (ACEs). This article lays out the conceptual framework for a $2.9 million demonstration project designed to raise awareness of the impact of ACEs on substance use, including primary prevention strategies. Communities used transformational narrative change-with an emphasis on the voices of those most impacted by ACEs and substance use-to highlight the importance of addressing social determinants of health along with primary prevention strategies. The conceptual background highlighted in this article informed media, public health, and local efforts in the three accompanying articles and invited commentary. These findings may help inform future efforts to promote community-level strategies and strengthen the evidence-base for transformational narrative change efforts., (Published 2024. This article is a U.S. Government work and is in the public domain in the USA.)

Suicide is a leading cause of death in the United States, particularly among adolescents. In recent years, suicidal ideation, attempts, and fatalities have increased. Systems maps can effectively represent complex issues such as suicide, thus providing decision-support tools for policymakers to identify and evaluate interventions. While network science has served to examine systems maps in fields such as obesity, there is limited research at the intersection of suicidology and network science. In this paper, we apply network science to a large causal map of adverse childhood experiences (ACEs) and suicide to address this gap. The National Center for Injury Prevention and Control (NCIPC) within the Centers for Disease Control and Prevention recently created a causal map that encapsulates ACEs and adolescent suicide in 361 concept nodes and 946 directed relationships. In this study, we examine this map and three similar models through three related questions: (Q1) how do existing network-based models of suicide differ in terms of node- and network-level characteristics? (Q2) Using the NCIPC model as a unifying framework, how do current suicide intervention strategies align with prevailing theories of suicide? (Q3) How can the use of network science on the NCIPC model guide suicide interventions?, Competing Interests: Competing interests. None.

Transgender and gender diverse (TGD) youth experience significant risk for negative health outcomes, yet few studies exist that address TGD youth's experiences of health care. This paper explores the equitable access and utilization of health care in a sample of TGD youth of diverse gender and racial/ethnic identities. Data for this analysis are from the TGD subsample (n = 1415) of the 2018 Survey of Today's Adolescent Relationships and Transitions (START) Project. We assessed five health care experiences: being insured, having a current health care provider, being out to one's provider, believing your provider was knowledgeable about transgender issues, and barriers to accessing care due to gender identity/expression. We examined the proportion of TGD youth who reported each of these outcomes and within-group differences by gender identity and race/ethnicity using descriptive statistics, logistic regression, and predicted probabilities. When differences were examined by gender identity, barriers to equitable care were consistently more present among transgender females than youth of other gender identities. There were few significant differences by race/ethnicity; however, dual referent models demonstrated barriers to equitable care were particularly evident among Black and Hispanic transgender women. We discuss these findings through the lens of intersectionality and highlight the importance of research and intervention work focused on reducing barriers to equitable care for TGD youth., (© 2023. Society for Prevention Research.)

Using family systems theory, this longitudinal study of middle school youth examined the effects of abuse, family conflict, and sibling aggression on sexual harassment perpetration (N = 1563; M age 11.2, 51% boys; 39% Hispanic, 29% Black, and 19% White). Boys reported more sexual harassment than girls; perpetration increased for both. The association between a hostile home environment and sexual harassment perpetration was moderated by school experiences. School belonging buffered effects of hostile home environment on baseline sexual harassment perpetration for boys who experienced abuse and White adolescents with high sibling aggression. Academic grades moderated change in perpetration over time, but effects differed by sex and race. It is important to understand how early violence exposures relate to sexual violence perpetration during early adolescence., (© 2022 Society for Research on Adolescence.)

Community violence, including homicides involving firearms, is a significant public health concern. From 2019 to 2020, firearm-related homicides increased by 39% for youths and young adults aged 10-24 years, and rates of suicide by firearm increased by approximately 15% among the same age group. Findings from the nationally representative 2021 Youth Risk Behavior Survey were used to analyze disparities and correlates of witnessing community violence and gun carrying among a nationally representative sample of high school students. Chi-square tests and logistic regression accounting for the complex sampling of the survey were used to assess demographic differences by student sex, race and ethnicity, age, and sexual identity in ever witnessing community violence, gun carrying in the past 12 months, and their associations with substance use and suicide risk. Measures of substance use included current binge drinking and marijuana use and lifetime prescription opioid misuse and illicit drug use. Suicide risk included seriously considered attempting suicide and attempted suicide in the past 12 months. Overall, approximately 20% of students witnessed community violence and 3.5% of students carried a gun. American Indian or Alaska Native, Black, and Hispanic students were more likely to witness community violence and to report carrying a gun than their White peers. Males were more likely to witness community violence and carry a gun than females. Lesbian, gay, or bisexual students were more likely to witness community violence than their heterosexual peers. Also, witnessing community violence consistently was associated with increased odds of gun carrying, substance use, and suicide risk for both males and females and when comparing Black, White, and Hispanic students. These findings highlight the importance of comprehensive violence prevention strategies that incorporate health equity to mitigate the effects of violence exposure on substance use and suicide risk among youths., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Background: Suicide is currently the second leading cause of death among adolescents ages 10-14, and third leading cause of death among adolescents ages 15-19 in the United States (U.S). Although we have numerous U.S. based surveillance systems and survey data sources, the coverage offered by these data with regard to the complexity of youth suicide had yet to be examined. The recent release of a comprehensive systems map for adolescent suicide provides an opportunity to contrast the content of surveillance systems and surveys with the mechanisms listed in the map., Objective: To inform existing data collection efforts and advance future research on the risk and protective factors relevant to adolescent suicide., Methods: We examined data from U.S. based surveillance systems and nationally-representative surveys that included (1) observations for an adolescent population and (2) questions or indicators in the data that identified suicidal ideation or suicide attempt. Using thematic analysis, we evaluated the codebooks and data dictionaries for each source to match questions or indicators to suicide-related risk and protective factors identified through a recently published suicide systems map. We used descriptive analysis to summarize where data were available or missing and categorized data gaps by social-ecological level., Results: Approximately 1-of-5 of the suicide-related risk and protective factors identified in the systems map had no supporting data, in any of the considered data sources. All sources cover less than half the factors, except the Adolescent Brain Cognitive Development Study (ABCD), which covers nearly 70% of factors., Conclusions: Examining gaps in suicide research can help focus future data collection efforts in suicide prevention. Our analysis precisely identified where data is missing and also revealed that missing data affects some aspects of suicide research (e.g., distal factors at the community and societal level) more than others (e.g., proximal factors about individual characteristics). In sum, our analysis highlights limitations in current suicide-related data availability and provides new opportunities to identify and expand current data collection efforts., (© 2023. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Introduction: Sexual minority youth are disproportionately exposed to school violence compared with their heterosexual peers. It is unknown whether the associations between school absence and exposure to school violence vary by sexual identity., Methods: In 2021, data were combined from the 2015, 2017, and 2019 national Youth Risk Behavior Surveys to produce nationally representative samples of U.S. high-school students who identified as gay/lesbian (n=1,061), identified as bisexual (n=3,210), were not sure of their sexual identity (n=1,696), or identified as heterosexual (n=35,819). Associations were examined between 3 school violence exposures (being threatened/injured with a weapon at school, being bullied at school, and being in a physical fight at school) and school absence due to safety concerns. In each sample, multivariable logistic regression models were used to calculate adjusted prevalence ratios adjusted for sex, race/ethnicity, grade, current substance use, being offered/sold drugs at school, feeling sad/hopeless, and suicidal thoughts. Adjusted prevalence ratios were considered statistically significant if 95% CIs did not include 1.0., Results: Exposure to school violence and school absence due to safety concerns were more prevalent among sexual minority students than among heterosexual students. Associations between exposure to school violence and school absence due to safety concerns were similar across sexual identity groups. For example, school absence was associated with being threatened/injured with a weapon at school among gay/lesbian (adjusted prevalence ratio=3.00), bisexual (adjusted prevalence ratio=3.66), those not sure (adjusted prevalence ratio=4.56), and heterosexual (adjusted prevalence ratio=3.75) students., Conclusions: Associations between school absenteeism and school violence exist in each sexual identity group. Therefore, programs providing safe and supportive school environments may result in reduced absenteeism among all students., (Published by Elsevier Inc.)

Purpose: Transgender and gender expansive (TGE) youth experience elevated risk for substance use and other health inequities compared to cisgender peers. The purpose of this study was to examine associations between protective environments-perceived community tolerance, perceived family support, and housing stability-and recent binge drinking, lifetime high-risk substance use (HRSU; cocaine, methamphetamines, and/or heroin), and self-rated health in a sample of TGE youth. Methods: This secondary analysis of 1567 TGE youth aged 13-24 years draws from the Centers for Disease Control and Prevention's 2018 web-based Survey of Today's Adolescent Relationships and Transitions , which used a nonprobabilistic recruiting strategy via social media. Logistic regression was used to test the associations between protective environments and substance use and health outcomes. Results: Overall, 28.1% of participants reported that people who lived near them were tolerant of transgender people, 32.8% reported that their family was at least somewhat supportive of their TGE identity, and 77.0% were stably housed. In the logistic regression models, community tolerance and housing stability were associated with lower odds of self-rated poor health. Housing stability was associated with lower odds of recent binge drinking and lifetime HRSU. Conclusion: Perceived community tolerance and housing stability were associated with several health outcomes among TGE youth in this study. Protective factors, including safe, stable, nurturing relationships and environments, are critical to youth health and wellbeing. The findings in this study highlight the need for prevention strategies to promote protective environments and reduce known substance use and overall health inequities among TGE youth.

Suicide is the second leading cause of death among youth ages 10-19 in the USA. While suicide has long been recognized as a multifactorial issue, there is limited understanding regarding the complexities linking adverse childhood experiences (ACEs) to suicide ideation, attempt, and fatality among youth. In this paper, we develop a map of these complex linkages to provide a decision support tool regarding key issues in policymaking and intervention design, such as identifying multiple feedback loops (e.g., involving intergenerational effects) or comprehensively examining the rippling effects of an intervention. We use the methodology of systems mapping to structure the complex interrelationships of suicide and ACEs based on the perceptions of fifteen subject matter experts. Specifically, systems mapping allows us to gain insight into the feedback loops and potential emergent properties of ACEs and youth suicide. We describe our methodology and the results of fifteen one-on-one interviews, which are transformed into individual maps that are then aggregated and simplified to produce our final causal map. Our map is the largest to date on ACEs and suicide among youth, totaling 361 concepts and 946 interrelationships. Using a previously developed open-source software to navigate the map, we are able to explore how trauma may be perpetuated through familial, social, and historical concepts. In particular, we identify connections and pathways between ACEs and youth suicide that have not been identified in prior research, and which are of particular interest for youth suicide prevention efforts., Competing Interests: Conflict of interest The authors declare that they have no competing interests.

Purpose: Surveys suggest that the general public (i.e., adults or parents) supports sexual health education in schools. However, the number of schools providing sex education continues to decline in the United States. The purpose of this study is to conduct a meta-analysis of U.S.-based representative surveys to provide a pooled estimate of public support for sexual health education delivered in schools., Methods: A systematic search of three databases (Medline, PsycInfo, and ERIC) was conducted to identify survey measuring adult and parent attitudes toward sexual health education in school between 2000 and 2016. Meta-analyses were conducted in OpenMetaAnalyst via the metaphor package in R using a DerSimonian-Laird random effect models to account for heterogeneity between surveys., Results: A total of 23 citations met study inclusion and exclusion criteria, representing 15 unique probability surveys conducted with the public. Among the included surveys, 14 were nationwide and 11 included parents or an overrepresentation of parents. Across all survey findings, 88.7% (95% confidence interval = 86.2-91.2) of respondents supported sexual health education. Among surveys that only included parents or oversampled for parents, 90.0% (95% confidence interval = 86.5-93.4) supported sexual health education, and among nationally representative surveys, 87.7% (95% confidence interval = 85.1-90.6) of respondents supported sexual health education., Conclusion: These findings demonstrate overwhelming support for sexual health education delivered in schools. Additional research is needed to determine individual differences in support for specific sexual health education topics and skills delivered through classroom-based instruction., (Published by Elsevier Inc.)

Purpose: To examine the association between state laws protecting lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) students and school districts' recommendations or requirements for establishing gay-straight alliances (GSAs) in schools. Beginning in fall 2013, 19 state education agencies (SEAs) engaged in HIV/STI and pregnancy prevention activities in "priority" school districts. SEAs provided support to priority districts to require or recommend GSAs in their schools., Methods: This study used semi-annually collected program evaluation data and state law data from the Gay, Lesbian, and Straight Education Network. We assessed whether increases in the percentage of priority districts recommending or requiring schools to provide GSAs varied by the presence of nondiscrimination or enumerated antibullying laws with a difference-in-difference design., Results: States with nondiscrimination laws began with more priority districts recommending or requiring schools to provide GSAs (52.5%) compared to states without laws (47.5%). We found a significant interaction (p < .01) between increases in the percentage of priority districts recommending or requiring a GSA and having a state nondiscrimination law. Across the first 3 years of program implementation, there was a 30% increase (p < .01) in priority districts recommending or requiring schools to provide GSAs in states with nondiscrimination laws, compared to a 12% increase (p < .01) in states without laws. There was no significant interaction between states with enumerated antibullying laws and districts recommending or requiring a GSA., Discussion: State LGBTQ nondiscrimination laws for students may facilitate school district support of GSAs, which may decrease health risks among LGBTQ youth., (Copyright © 2022. Published by Elsevier Inc.)

Suicide rates are steadily increasing among youth in the USA. Although several theories and frameworks of suicide have been developed, they do not account for some of the features that define suicide as a complex problem, such as a large number of interrelationships and cycles. In this paper, we create the first c omprehensive m ap o f a dverse c hildhood experiences (ACEs) and suicide for youth, by combining a participatory approach (involving 15 subject-matter experts) and network science. This results in a map of 946 edges and 361 concepts, in which we identify ACEs to be the most important factor (per degree centrality). The map is openly shared with the community to support further network analyses (e.g., decomposition into clusters). Similarly to the high-impact Foresight Map developed in the context of obesity, the largest map on suicide and ACEs to date presented in this paper can start a discussion at the crossroad of suicide research and network science, thus bringing new means to address a complex public health challenge.

Between 2012 and 2018, incidents of opioid-involved injuries surged and the number of children in foster care due to parental drug use disorder increased. Treatments for opioid use disorder (OUD) might prevent or reduce the amount of time that children spend in the child welfare system. Using administrative data, we examined the impact of Medicaid expansion and state support for methadone as a medication for opioid use disorder (MOUD) on first-time foster care placements. Results show that first-time foster care entries due to parental drug use disorder experienced a reduction of 28 per 100,000 children in Medicaid expansion states with methadone MOUD covered by their state Medicaid programs. The largest reduction was found among non-Hispanic Black children and the youngest children (age 0-1 years). Policies that increase OUD treatment access may reduce foster care placements by reducing parents' drug use, a risk factor for child abuse/neglect and subsequent home removal., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Nonheterosexual (sexual minority) women report experiencing more sexual violence than heterosexual (sexual majority) women (1,2). Sexual minority women are often categorized as a collective whole, which fails to capture the nuances in sexual violence among subgroups of sexual minority women, such as bisexual and lesbian women (3). To estimate the prevalence of lifetime forced vaginal intercourse (forced sex) and of nonvoluntary first vaginal intercourse among women aged 18-44 years in the United States, CDC analyzed data from female respondents who were interviewed during 2011-2017 for the National Survey of Family Growth (NSFG); respondents were stratified by self-reported sexual identity, attraction, and behavior. Log-binomial regressions and analyses of variance (ANOVAs) were performed to compare experiences across each dimension of sexual orientation, controlling for demographic characteristics. Compared with sexual majority women,* prevalence of any male-perpetrated nonvoluntary first vaginal intercourse or forced sex (nonvoluntary or forced sex) was higher among women who identified as bisexual (36.1% versus 17.5%), reported attraction to the opposite and same sex (30.3% versus 15.8%), and reported sexual behavior with the opposite and same sex (35.7% versus 15.9%). These sexual minority women reported that their earliest experience of nonvoluntary or forced sex occurred at younger ages than did that of sexual majority women. Among women who were unsure of their sexual attraction, the prevalence of nonvoluntary first vaginal intercourse was also higher than among sexual majority women. These findings underscore the need for comprehensive prevention approaches tailored for sexual minority women and prevention of child sexual abuse, given the average ages at earliest nonvoluntary or forced sex experience among sexual minority women (range = 12.5-16.3 years). Additional research is needed into the circumstances of and norms or attitudes that influence perpetration of nonvoluntary or forced sex and broader sexual violence against sexual minority women. Prevention of nonvoluntary or forced sex victimization among sexual minority women will require comprehensive approaches to prevent sexual violence and child sexual abuse. Engaging sexual minority women in the development of sexual violence prevention efforts and research would help ensure that the experiences of sexual minority women across the spectrum are represented., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Background: In the United States, transgender youth are at especially high risk for HIV infection. Literature regarding HIV prevention strategies for this vulnerable, often-hidden population is scant. Before effective, population-based HIV prevention strategies may be adequately developed, it is necessary to first enhance the contextual understanding of transgender youth HIV risk and experiences with HIV preventive services., Methods: Two 3-day, online, asynchronous focus groups were conducted with transgender youth from across the United States to better understand participant HIV risk and experiences with HIV preventive services. Participants were recruited by using online advertisements posted via youth organizations. Qualitative data were analyzed by using content analysis., Results: A total of 30 transgender youth participated. The average age was 18.6 years, and youth reported a wide range of gender identities (eg, 27% were transgender male, 17% were transgender female, and 27% used ≥1 term) and sexual orientations. Four themes emerged: (1) barriers to self-efficacy in sexual decision-making; (2) safety concerns, fear, and other challenges in forming romantic and/or sexual relationships; (3) need for support and education; and (4) desire for affirmative and culturally competent experiences and interactions (eg, home, school, and health care)., Conclusions: Youth discussed experiences and perspectives related to their gender identities, sexual health education, and HIV preventive services. Findings should inform intervention development to improve support and/or services, including the following: (1) increasing provider knowledge and skills to provide gender-affirming care, (2) addressing barriers to services (eg, accessibility and affordability as well as stigma and discrimination), and (3) expanding sexual health education to be inclusive of all gender identities, sexual orientations, and definitions of sex and sexual activity., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2020 by the American Academy of Pediatrics.)

Introduction: HIV disproportionally burdens adolescent men who have sex with men (AMSM) and transgender youth. This study explores barriers and facilitators that professionals face in delivering HIV preventive services and education., Methods: Adolescent health providers (nurse practitioners, physicians, and other), school nurses, youth workers, and school educators were recruited nationally for this qualitative study., Results: Thirty-four professionals participated. Common categories identified across professional group were (1) effective strategies for building trust with youth, (2) perceived barriers/facilitators to sexual health communication, (3) perceived barriers/facilitators to effective HIV prevention, and (4) preferred content for HIV prevention tools., Discussion: Key elements for developing multidisciplinary resources to support AMSM and transgender youth should include (1) web-based or easily accessible sexual health educational materials, (2) resources for referrals, (3) trainings to support competence in caring for sexual and gender minority youth, and (4) guidance for navigating policies or eliciting policy change., (Copyright © 2019 National Association of Pediatric Nurse Practitioners. All rights reserved.)

Background: In an attempt to increase high school students' sexually transmitted disease (STD) testing rates, the Centers for Disease Control and Prevention's Division of Adolescent and School Health partnered with ICF and Chicago Public Schools to adapt and implement the "GYT: Get Yourself Tested" health marketing campaign for a high school., Methods: Clinic record data and student retrospective self-report surveys (n = 193) tested for differences between the GYT intervention school and a comparison school on a number of outcomes, including human immunodeficiency virus and STD testing., Results: Clinic record data showed that testing increased significantly more for the intervention than the comparison school during the GYT implementation period (B, 2.9; SE, 1.1, P < 0.05). Furthermore, the odds of being tested at the referral clinic were more than 4 times (odds ratio, 4.4) as high for students in the campaign school than for those in the comparison school (95% confidence interval, 2.3-8.2). Survey data did not show increased self-reported testing but, more students in the GYT school (92.7%) were aware of where to receive free, low-cost, or affordable human immunodeficiency virus and STD testing than students in the comparison school (76.0%; P < 0.01). Among sexually experienced students (n = 142), significantly more from the campaign school reported that they intended to test for STDs in the next 3 months (48.4% strongly agree and 33.2% agree) compared with those at the comparison school (27.4% strongly agree and 32.9% agree; P < 0.05)., Conclusions: Our pilot suggests that a student-led GYT campaign in high schools may successfully increase STD testing of students. Although some of the findings from this pilot evaluation are promising, they are limited, and broader implementation and evaluation is needed. Future evaluation efforts can include more rigorous study designs, multiple schools or districts, longer campaign and evaluation across an entire school or calendar year, or in combination with other school-based testing strategies like a mass school-based screening event.

Objective: This study aimed to examine variability in condom use trends by sexual risk behavior among US high school students., Methods: Data were from the 2003-2015 national Youth Risk Behavior Surveys conducted biennially among a nationally representative sample of students in grades 9 to 12. We used logistic regression to examine variability in trends of condom use during last sexual intercourse among female and male students by 4 sexual risk behaviors: drank alcohol or used drugs before last sexual intercourse, first sexual intercourse before age 13 years, 4 or more sex partners during their life, and 2 or more sex partners during the past 3 months., Results: Between 2003 and 2015, significant declines in self-reported condom use were observed among black female (63.6% in 2003 to 46.7% in 2015) and white male students (69.0% in 2003 to 58.1% in 2015). Among female students, declines in self-reported condom use were significant only among those who drank or use drugs before last sexual intercourse, had 4 or more sex partners during their life, or had 2 or more sex partners during the past 3 months. There was a significant interaction between trends in condom use and first sexual intercourse before age 13 years, suggesting more pronounced declines among female students who initiated first sexual intercourse before age 13 years compared with their female peers. Trends did not vary by sexual risk behavior for male students., Conclusions: Results suggest that declines in self-reported condom use have occurred among female students at greater risk for acquiring a sexually transmitted disease.

Purpose: The objective of this study was to examine the relationship between school involvement and connectedness with measures of sexual risk, substance use, and experience of violence among students who had sexual contact with the same sex or with both sexes., Methods: A sample of middle school and high school students who participated in a study conducted in a large urban school district were selected based on their reported experience of having initiated sexual activity with same-sex partners. In classroom-based surveys, we assessed self-reported involvement in school-based activities and feelings of school connectedness, as well as self-reported sexual risk, substance use, and experience of violence., Results: Significant protective associations were found between school involvement and lifetime alcohol and marijuana use, and between school connectedness and ever having been in a fight, feeling safe at school, and drug use other than marijuana (all p < .05)., Conclusions: Findings suggest that efforts to increase school involvement and connectedness provide a starting point for addressing significant health and safety concerns among students with same-sex sexual activity., (Published by Elsevier Inc.)

Purpose: Adolescent males are less likely to receive health care and have lower levels of sexual and reproductive health (SRH) knowledge than adolescent females. The purpose of this study was to determine if a school-based structural intervention focused on school nurses increases receipt of condoms and SRH information among male students., Methods: Interventions to improve student access to sexual and reproductive health care were implemented in six urban high schools with a matched set of comparison schools. Interventions included working with school nurses to improve access to sexual and reproductive health care, including the provision of condoms and information about pregnancy and sexually transmitted disease prevention and services. Intervention effects were assessed through five cross-sectional yearly surveys, and analyses include data from 13,740 male students., Results: Nurses in intervention schools changed their interactions with male students who visited them for services, such that, among those who reported they went to the school nurse for any reason in the previous year, those in intervention schools reported significant increases in receipt of sexual health services over the course of the study compared with students in comparison schools. Further, these results translated into population-level effects. Among all male students surveyed, those in intervention schools were more likely than those in comparison schools to report increases in receipt of sexual health services from school nurses., Conclusions: With a minimal investment of resources, school nurses can become important sources of SRH information and condoms for male high school students., (Published by Elsevier Inc.)

Limited information exists on heterosexual youth with sexual contact with same-sex partners in the United States (i.e., discordant heterosexual). We compared the prevalence of health risks between discordant heterosexual, heterosexual with only opposite-sex sexual contact, lesbian/gay, and bisexual students using the 2015 national Youth Risk Behavior Survey (YRBS). Nationwide, 3.2% of students were identified as discordant heterosexuals. The prevalence of several risk behaviors was significantly higher among discordant heterosexual students than their heterosexual peers with only opposite-sex sexual contact. Clinicians should consider sexual identity and sex of sexual partners when conducting risk-assessments to ensure they appropriately target populations for intervention., Competing Interests: Potential conflicts of interest The authors have no conflicts of interest relevant to this article to disclose.

Objective: The purpose of the current analysis is to examine subgroup differences in the distribution of opposite-sex sex partners in the United States across an approximate 10-year period to identify patterns that may inform sexually transmitted infection research and prevention., Methods: Data were drawn from the 2002 and 2011-2013 National Survey of Family Growth, a US probability-based household survey focusing on sexual and reproductive health. The measures included in this analysis were lifetime opposite-sex sex partners and opposite-sex sex partners in the past year. Analyses were conducted separately for men and women. All analyses were conducted in R and R-studio with the "survey" package, focusing on medians, the 80th, and 95th quartile., Results: In 2002, there were significant differences between men and women in median number of lifetime sex partners with men reporting more lifetime partners. However, in the 2011-2013 data, these differences are no longer significant. Still, the findings suggest that the top 20% and top 5% of men are reporting significantly more lifetime partners than their female counterparts. In comparison, partners in the past year remain relatively unchanged for both men and women., Conclusions: These findings suggest that there were important changes in the distribution of sex partners between 2002 and 2011-2013 that have implications for sexually transmitted infection prevention. Median lifetime partners are no longer different for women and men: however, the distribution of lifetime partners among men is becoming even more skewed.

Purpose: The association between parental monitoring and adolescent behavior is well established. Past research suggests that parents monitor adolescent activities through parental control, solicitation of information, and youth disclosure, which increase parents' knowledge of youth activity leading to decreased risk behavior. However, there is mixed evidence of the impact of these efforts on sexual behavior. We examined these strategies from the adolescent perspective and assessed their impact on the initiation of sexual activity across the transition from middle school to high school., Methods: Analyses include 533 primarily Latino adolescents, who had not yet had sex in eighth grade and were surveyed yearly through 10th grade., Results: Adolescents who in eighth grade reported greater parental knowledge and more family rules about dating were less likely to initiate sex between eighth and 10th grade. Exchange of information, through parental solicitation and youth disclosure, and parental control, through rules about friends and dating, as well as maternal relationship satisfaction were significant predictors of parental knowledge. There were no gender differences in the impact of dating rules and parental knowledge on sexual initiation, but the paths to acquiring knowledge did differ by gender., Conclusions: Results suggest that parental monitoring at earlier ages has an impact on sexual initiation. Effective monitoring is an active process within a family that includes setting boundaries and exchanging information. Interventions that encourage family rules, provide strategies for improving parental solicitation of information, and increase youth disclosure by enhancing the maternal-child relationship may be more likely to impact sexual initiation., (Published by Elsevier Inc.)

Access to school health clinics and nurses has been linked with improved student achievement and health. Unfortunately, no studies have examined how many students report using school clinics or nurses and for which services. This study addressed this gap with data from a nationally representative sample of 15- to 25-year-olds. Respondents who reported being in high school were provided a list of services and asked whether they had gone to a school nurse or clinic for any of the listed services. Nearly 90% reported having access to a school clinic or nurse. Among students with access, 65.6% reported using at least one service. Non-White students and younger students were more likely to report having access to a clinic or nurse. These results show many students have access to clinics or nurses and are using these services, although not uniformly for all services., (© The Author(s) 2016.)

Most models of community collaboration emphasize the ability of diverse partners to come together to enact systematic changes that improve the health of individuals and communities. The ability of these groups to leverage resources is thought to be an important marker of successful collaboration and eventual improvements in community health. However, there is a paucity of research addressing linkages between systems change activities and leveraged resources. This study used a sample of collaboratives (N = 157) that received technical assistance and funding through the Georgia Family Connection Partnership (GaFCP) between 2006 and 2007. Data were collected from collaborative report of activities and funding, member ratings of collaborative functioning, and characteristics of the communities served by the collaboratives drawn from US Census data. Cross-lagged regression models tested longitudinal associations between systems change activities and leveraged dollars. The results indicated that systems change activities predict increased leveraging of resources from state/federal and private partners. However, there was no evidence that systems changes were linked with leveraging resources from local groups and agencies. These findings have important implications for providing technical assistance and training to health partnerships. Furthermore, future research should consider the relative strength of different systems change activities in relation to the ability of coalitions to leverage resources.

Interorganizational collaboration has become a popular strategy for addressing population health and well-being. However, evidence for its effectiveness in achieving outcomes at the population level is limited, at least in part due to a variety of methodological challenges such as reduced sample size at the population level, the availability of suitable comparison groups of communities, and study durations that are too short to detect slowly emerging outcomes. The present study addresses these challenges by retrospectively examining the effectiveness of a mature network of community collaboratives, using latent growth modeling of longitudinal change in an archival community-level outcome, low infant birthweight, and propensity score matching of comparison communities. A group of 25 Georgia counties with collaboratives targeting low infant birthweight was compared to a weighted comparison group of counties from other southeastern states, using propensity score matching. We report results of full matching methods and outcome analyses examining differences in change in county rates of low infant birthweight from 1997 to 2004 between intervention and comparison counties. Results indicated significantly smaller increases in low weight birth rates in intervention counties than in comparison counties.

Objective: To test whether improved functional status correlates with more depressive symptoms after traumatic brain injury (TBI). This is based on the concept that increasing awareness of deficits may exacerbate depression, even while survivors are making functional improvements., Participants: A total of 471 individuals with TBI (72% white; 71% men; median Glasgow Coma Scale (GCS) score = 11) enrolled during acute care or inpatient rehabilitation and followed up at a median of 6 months., Main Measure: Beck Depression Inventory-II (BDI-II), Glasgow Outcome Scale-Extended, and Functional Status Examination (FSE)., Results: We found significant Spearman rank order correlations between BDI-II scores and the total FSE as well as all domains of the FSE. Lower functional levels correlated with more depressive symptoms. Modeling of predictive factors, including subject characteristics, injury-related characteristics, and outcome measures, resulted in 2 models, both containing age and GCS along with other factors., Conclusion: The relation between depressive symptoms and functional outcomes is complex and a fertile area for further research. The authors would encourage clinicians to monitor patients for depressive symptoms to help to prevent the detrimental impact on recovery.

Statin-associated muscle symptoms are a relatively common condition that may affect 10% to 15% of statin users. Statin myopathy includes a wide spectrum of clinical conditions, ranging from mild myalgia to rhabdomyolysis. The etiology of myopathy is multifactorial. Recent studies suggest that statins may cause myopathy by depleting isoprenoids and interfering with intracellular calcium signaling. Certain patient and drug characteristics increase risk for statin myopathy, including higher statin doses, statin cytochrome metabolism, and polypharmacy. Genetic risk factors have been identified, including a single nucleotide polymorphism of SLCO1B1. Coenzyme Q10 and vitamin D have been used to prevent and treat statin myopathy; however, clinical trial evidence demonstrating their efficacy is limited. Statin-intolerant patients may be successfully treated with either low-dose statins, alternate-day dosing, or using twice-weekly dosing with longer half-life statins. An algorithm is presented to assist the clinician in managing myopathy in patients with dyslipidemia.

A systematic classification of study designs would be useful for researchers, systematic reviewers, readers, and research administrators, among others. As part of the Human Studies Database Project, we developed the Study Design Typology to standardize the classification of study designs in human research. We then performed a multiple observer masked evaluation of active research protocols in four institutions according to a standardized protocol. Thirty-five protocols were classified by three reviewers each into one of nine high-level study designs for interventional and observational research (e.g., N-of-1, Parallel Group, Case Crossover). Rater classification agreement was moderately high for the 35 protocols (Fleiss' kappa = 0.442) and higher still for the 23 quantitative studies (Fleiss' kappa = 0.463). We conclude that our typology shows initial promise for reliably distinguishing study design types for quantitative human research.

Objective: Assess the prevalence of brain tissue hypoxia in patients with severe traumatic brain injuries (TBI), and to characterize the relationship between brain tissue hypoxia and functional outcome., Design: Retrospective review of severe TBI patients., Setting: Intensive care unit of a level I trauma center., Patients: Twenty-seven patients with severe TBI requiring intracranial pressure (ICP) monitoring. Median age was 22 yrs, and a majority (63%) had traumatic subarachnoid hemorrhage., Interventions: Hourly assessments of ICP, brain tissue oxygen, mean arterial pressure, fraction of inspired oxygen (FiO2), partial pressure of arterial carbon dioxide (PaCO2), and hemoglobin concentration (hemoglobin) were recorded. Outcome was assessed 6-9 months postinjury., Measurements and Main Results: Mean (SD) ICP and BTpO2 were 13.7 (6.6) cm H2O and 30.8 (13.6) mm Hg. A total of 13.5% (379) of the BTpO2 values recorded were < 20 mm Hg, only 86 of which were associated with ICP > or = 20 cm H2O. This prevalence was comparable with episodes of ICP elevations above 20 cm H2O (14.1%, 397). Hypoxic episodes were more common when cerebral perfusion pressure was below 60 mm Hg (relative risk = 3.0, p < 0.0001). We did not find an association in hypoxic risk and hemoglobin in the range of 7-12 g/dL or PaCO2 in the range of 25-40 mm Hg. Subjects with hourly episodes (epochs) of hypoxia > 20% of the time had poorer scores on outcome measures compared with those with fewer hypoxic epochs., Conclusions: Hypoxic episodes are common after severe TBI, and most are independent of ICP elevations. Most episodes of hypoxia occur while cerebral perfusion pressure and mean arterial pressure are within the accepted target range. There is no clear association between PaCO2 and hemoglobin with BTpO2. The young age and high prevalence of traumatic subarachnoid hemorrhage in this cohort may limit its generalizability. Increased frequency of hypoxic episodes is associated with poor functional outcome.

Myopathy has been reported in a small percentage of statin-treated patients for the past 30 years, but the etiologic mechanisms for inducing muscle injury have not yet been fully characterized. Statin-induced myopathy is now understood to be a heterogeneous condition that may be due to: mechanisms of the drug itself; interactions with other drugs; or genetic, metabolic and immunological vulnerabilities in individual patients. In some cases, statins may unmask latent conditions (e.g., asymptomatic baseline myopathy) that predispose patients to muscle toxicity. The definitions, epidemiology, clinical features, risk factors and proposed mechanisms of statin-induced myopathy are reviewed. Muscle metabolism can be adversely impacted by statin therapy, including changes in fatty acid oxidation, possibly reduced coenzyme Q(10) biosynthesis, and increased myocyte protein degradation via the activity of atrogin-1 and the ubiquitin-proteasome pathway. Statin therapy may also activate a variety of autoimmune phenomena that potentiate myocellular injury. Improving our understanding of statin-induced myopathy is a high clinical priority given the large number of patients eligible for statin therapy and the fact that the development of myalgia and myopathy are leading reasons cited by patients for statin discontinuation.

The incidence of chronic kidney disease (CKD) in the U.S. continues to increase, and now over 10% of the U.S. population has some form of CKD. Although some patients with CKD will ultimately develop renal failure, most patients with CKD will die of cardiovascular disease before dialysis becomes necessary. Patients with CKD have major proatherogenic lipid abnormalities that are treatable with readily available therapies. The severe derangements seen in lipoprotein metabolism in patients with CKD typically results in high triglycerides and low high-density lipoprotein (HDL) cholesterol. Because of the prevalence of triglyceride disorders in patients with CKD, after treating patients to a low-density lipoprotein goal, non-HDL should be calculated and used as the secondary goal of treatment. A review of the evidence from subgroup analysis of several landmark lipid-lowering trials supports treating dyslipidemia in mild to moderate CKD patients with HMG-CoA reductase inhibitors. The evidence to support treating dyslipidemia in hemodialysis patients, however, has been mixed, with several outcome trials pending. Patients with CKD frequently have mixed dyslipidemia and often require treatment with multiple lipid-lowering drugs. Although statins are the cornerstone of therapy for most patients with CKD, differences in their pharmacokinetic properties give some statins a safety advantage in patients with advanced CKD. Although most other lipid-lowering agents can be used safely with statins in combination therapy in patients with CKD, the fibrates are renally metabolized and require both adjustments in dose and very careful monitoring due to the increased risk of rhabdomyolysis. After reviewing the safety and dose alterations required in managing dyslipidemia in patients with CKD, a practical treatment algorithm is proposed.

Objective: To determine whether older persons are at increased risk for progressive functional decline after traumatic brain injury (TBI)., Design: Longitudinal cohort study., Setting: Traumatic Brain Injury Model Systems (TBIMS) rehabilitation centers., Participants: Subjects enrolled in the TBIMS national dataset., Interventions: Not applicable., Main Outcome Measures: Disability Rating Scale (DRS), FIM instrument cognitive items, and the Glasgow Outcome Scale-Extended., Results: Participants were separated into 3 age tertiles: youngest (16-26y), intermediate (27-39y), and oldest (> or =40y). DRS scores were comparable across age groups at admission to a rehabilitation center. The oldest group was slightly more disabled at discharge from rehabilitation despite having less severe acute injury severity than the younger groups. Although DRS scores for the 2 younger groups improved significantly from year 1 to year 5, the greatest magnitude of improvement in disability was seen among the youngest group. In addition, after dividing patients into groups according to whether their DRS scores improved (13%), declined (10%), or remained stable (77%) over time, the likelihood of decline was found to be greater for the 2 older groups than for the youngest group. A multiple regression model showed that age has a significant negative influence on DRS score 5 years post-TBI after accounting for the effects of covariates., Conclusions: This study supported our primary hypothesis that older patients show greater decline over the first 5 years after TBI than younger patients. In addition, the greatest amount of improvement in disability was observed among the youngest group of survivors. These results suggest that TBI survivors, especially older patients, may be candidates for neuroprotective therapies after TBI.

Purpose of Review: The 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (statins) are the cornerstone of therapy for dyslipidemia. A significant portion of patients are not adherent to statin therapy, due to either intolerance from muscle symptoms or fears of myopathy reported in the media. The diagnosis and management of patients with statin-induced myopathy will be reviewed., Recent Findings: Based on a review of healthy clinical-trial participants, the placebo-corrected incidences of minor muscle pain, myopathy (with significant elevations in creatinine kinase), and rhabdomyolysis are 190, 5, and 1.6 per 100,000 patient years, respectively. More recent prospective observational data yield better, real-world estimates of muscle complaints (>10%) in patients started on high-dose statins. Current data suggest that important patient characteristics, statin-drug pharmacokinetics, and statin-drug interactions play a role in myopathy. Myopathy is more related to statin dose and blood levels than to LDL reductions. Evidence for managing myopathic patients with coenzyme Q10 is not conclusive., Summary: It is important to maintain perspective by looking at the impact of statin myopathy relative to the impact of preventing atherosclerotic complications. The potential benefits of therapy must outweigh the risks. In the case of statin therapy the benefit/risk ratio is overwhelmingly positive.

Background: Assessment of injury severity is important in the management of patients with brain trauma. We aimed to analyze the usefulness of the head abbreviated injury score (AIS), the injury severity score (ISS), and the Glasgow Coma Scale (GCS) as measures of injury severity and predictors of outcome after traumatic brain injury (TBI)., Methods: Data were prospectively collected from 410 patients with TBI. AIS, ISS, and GCS were recorded at admission. Subjects' outcomes after TBI were measured using the Glasgow Outcome Scale (GOS-E) at 12 months postinjury. Uni- and multivariate analyses were performed., Results: Outcome information was obtained from 270 patients (66%). ISS was the best predictor of GOS-E (rs = -0.341, p < 0.001), followed by GCS score (rs = 0.227, p < 0.001), and head AIS (rs = -0.222, p < 0.001). When considered in combination, GCS score and ISS modestly improved the correlation with GOS-E (R = 0.335, p < 0.001). The combination of GCS score and head AIS had a similar effect (R = 0.275, p < 0.001). Correlations were stronger from patients 8)., Conclusions: GCS score, AIS, and ISS are weakly correlated with 12-month outcome. However, anatomic measures modestly outperform GCS as predictors of GOS-E. The combination of GCS and AIS/ISS correlate with outcome better than do any of the three measures alone. Results support the addition of anatomic measures such as AIS and ISS in clinical studies of TBI. Additionally, most of the variance in outcome is not accounted for by currently available measures of injury severity.

alpha-Linolenic acid (ALA) is a major dietary (n-3) fatty acid. Some clinical trials with ALA supplementation have shown reduced cardiovascular risk; however the specific cardioprotective mechanism is not known. We studied the effects of daily supplementation with ALA derived from flaxseed oil on concentrations of plasma LDL cholesterol, HDL cholesterol, intermediate density lipoprotein cholesterol, and lipid particle sizes. In a randomized double-blind trial, 56 participants were given 3 g/d of ALA from flaxseed oil in capsules (n = 31) or olive oil containing placebo capsules (n = 25) for 26 wk. Changes in plasma HDL cholesterol, LDL cholesterol, and triglyceride concentrations did not differ between the 2 groups at 26 wk. The adjusted plasma total cholesterol concentration at 26 wk was 0.45 mmol/L higher in the flaxseed oil group (5.43 +/- 0.03 mmol/L) compared with the olive oil group (5.17 +/- 0.07 mmol/L) (P = 0.026). ALA did not affect LDL, HDL, or IDL particle size; however, the concentrations of the large, less atherogenic LDL1 (P = 0.058) and LDL2 (P = 0.083) subfractions tended to be greater in the ALA group. In conclusion, ALA does not decrease CVD risk by altering lipoprotein particle size or plasma lipoprotein concentrations.

Objective: The use of Framingham equations to determine 10-year absolute coronary risk ('global risk') represents an accepted strategy to target coronary prevention measures and enhance clinical outcomes. The aim of this study was to determine the effects of providing global risk scores to physicians on the prescription of lipid-lowering therapy for patients at increased coronary risk., Research Design and Methods: This prospective, randomized controlled trial enrolled 368 primary-care patients without a history of coronary heart disease and not on therapy with a hydroxymethylglutaryl coenzyme A reductase inhibitor (i.e. statin). The study was conducted in the general medical clinics of an academic US teaching hospital. In the intervention group (n = 186) patients' charts were reviewed, 10-year absolute coronary risk computed, and this information conveyed via a simple educational tool appended to charts. In the control group (n = 182), charts were accompanied by a form with general information on coronary prevention goals and strategies., Main Outcome Measure: The primary endpoint was the proportion of high-risk patients receiving a new statin prescription. Secondary and tertiary endpoints included (1) the proportion of moderate-risk patients receiving a statin prescription; and (2) the proportion of patients in the whole cohort who had other coronary prevention measures recommended., Results: There was no significant difference in statin prescription to high-risk individuals in the intervention group (40.0%) compared with the control group (37.9%; p = 0.86). Moderate-risk individuals who were not eligible for treatment according to the National Cholesterol Education Program Adult Treatment Panel II guidelines were more likely to receive a statin prescription in the intervention group versus the control group (28.8% vs. 12.5%. p = 0.036), Conclusions: Although a simple global risk educational tool did not improve the targeting of statin therapy to patients at high absolute coronary risk, it may be of benefit in targeting moderate-risk individuals who do not have markedly elevated low-density lipoprotein cholesterol (LDL-C) levels. Future research should evaluate the effects of physicians performing their own Framingham risk calculations on statin prescribing and on cholesterol goal attainment.

Alpha-linolenic acid (ALA) is a major dietary (n-3) fatty acid. ALA is converted to longer-chain (n-3) PUFA, such as eicosapentaenoic acid (EPA) and possibly docosahexaenoic acid (DHA). EPA and DHA are fish-based (n-3) fatty acids that have proven cardioprotective properties. We studied the effect of daily supplementation with 3 g of ALA on the plasma concentration of long-chain (n-3) fatty acids in a predominantly African-American population with chronic illness. In a randomized, double-blind trial, 56 participants were given 3 g ALA/d from flaxseed oil capsules (n = 31) or olive oil placebo capsules (n = 25). Plasma EPA levels at 12 wk in the flaxseed oil group increased by 60%, from 24.09 +/- 16.71 to 38.56 +/- 28.92 micromol/L (P = 0.004), whereas no change occurred in the olive oil group. Plasma docosapentaenoic acid (DPA) levels in the flaxseed oil group increased by 25% from 19.94 +/- 9.22 to 27.03 +/- 17.17 micromol/L (P = 0.03) with no change in the olive oil group. Plasma DHA levels did not change in either group. This study demonstrates the efficacy of the conversion of ALA to EPA and DPA in a minority population with chronic disease. ALA may be an alternative to fish oil; however, additional clinical trials with ALA are warranted.

Clinical trial evidence exists that supports a role for the omega-3 polyunsaturated fatty acids in coronary heart disease prevention. However, the results from these clinical trials have varied and were conducted in diverse population groups using several different types of omega-3 polyunsaturated fatty acids, including eicosapentaenoic acid, docosahexaenoic acid, and alpha-linolenic acid (ALA). Thus, we systematically reviewed previously published reports assessing the different types of omega-3 polyunsaturated fatty acid interventions and cardiovascular outcomes. Fourteen randomized clinical trials were included in the review. Six trials were included with fish oil, with 1 large trial (10,000 patients) dominating the analysis. In aggregate, the fish oil trials demonstrated a reduction in total mortality and sudden death without a clinically significant reduction in nonfatal myocardial infarction. The 6 trials with ALA supplements or an ALA-enriched diet were of poorer design than the fish oil trials and had limited power. Many of the trials with ALA involved other changes in dietary components. In aggregate, the ALA trials demonstrated possible benefits in reducing sudden death and nonfatal myocardial infarction, but with wider confidence intervals than in the fish oil trials. In conclusion, the evidence suggests a role for fish oil (eicosapentaenoic acid, docosahexaenoic acid) or fish in secondary prevention because recent clinical trial data have demonstrated a significant reduction in total mortality, coronary heart disease death, and sudden death. The data on ALA have been limited by studies of smaller sample size and limited quality.

Clinical trials aimed at developing therapies for traumatic brain injury (TBI) require outcome measures that are reliable, validated, and easily administered. The most widely used of these measures, the Glasgow Outcome Scale (GOS) and the GOS-Extended (GOS-E), have been criticized as suffering from ceiling effects. In an attempt to develop a more useful and dynamic outcome measure, the Functional Status Examination (FSE) was developed, which grades outcome across 10 functional domains. The FSE has been demonstrated to be reliable and sensitive in monitoring recovery after TBI. This manuscript compares FSE with GOS-E in a cohort of patients with a wide range of injury severities. 177 individuals who survived at least 6 months after TBI were studied. The FSE and GOS-E were administered 6-12 months after injury. FSE and GOS-E scores correlated well with each other. FSE scores were distributed throughout the range, indicating that ceiling and floor effects were not present. Physiologic measures of injury severity (Glasgow Coma Score [GCS]) did not correlate with anatomic measures (Abbreviated Injury Scale [AIS] and Injury Severity Score [ISS]). GCS correlated weakly with both outcome measures, but AIS/ISS did not. We conclude that FSE and GOS-E are reliable outcome measures for TBI survivors, and FSE may offer some advantages over GOS-E due its ability to provide a more detailed description of deficits. The majority of the variance in outcome is not accounted for by currently available measures of injury severity.

Background: Transient paroxysmal alterations of consciousness or behavior are common sequelae of moderate and severe traumatic brain injury (TBI). Clinicians caring for patients with such episodes often diagnose them as epileptic seizures, a frequent and well-studied complication of TBI. As it is difficult to confirm this diagnosis, antiepileptic drugs are often used empirically. However, as such therapy is frequently ineffective, we studied the usefulness of prolonged video electroencephalogram (VEEG) monitoring in the clinical management of paroxysmal behaviors in TBI survivors., Methods: Records of patients referred evaluation in an epilepsy monitoring unit for management of medically intractable epilepsy were retrospectively reviewed. Patients with a documented history of moderate-to-severe brain injury preceding the onset of epilepsy were identified. These patients were studied by simultaneous videotape and scalp electroencephalographic recordings, and the majority also underwent magnetic resonance imaging and neuropsychologic studies., Results: Of the 1858 consecutive admissions over a 66-month period, 127 (7%) fulfilled enrollment criteria. VEEG monitoring was conducted for an average of 4.6 days. Monitoring was successful in establishing a diagnosis in 82% of the cases referred: 62% had focal seizures, 6% had generalized seizures, and 33% had psychogenic nonepileptic seizures. Of those with temporal lobe epilepsy, 53% had mesial temporal sclerosis, as shown by magnetic resonance imaging., Conclusions: VEEG is a useful procedure in the evaluation of TBI survivors with spells. The yield of diagnoses that may alter treatment is substantial. Additionally, mesial temporal sclerosis is associated with TBI. Given the variety of seizure types found in survivors of moderate-to-severe TBI, obtaining specific diagnosis of seizure type by VEEG monitoring impacts treatment options.