Substance Use Disorders among Adolescents in the United States: 2000-2019.

OBJECTIVES: Substance use disorders (SUDs) are characterized by impairment caused by the recurrent use of alcohol, illicit drugs, or both. SUDs are pervasive and endemic among US adolescents, with potentially negative health and social consequences. Although the term experimentation normalizes adolescent substance abuse, the long-term consequences of this behavior beginning in adolescence can be detrimental to not only the adolescent but also the adult into which he or she develops. Our objective was to examine the epidemiology of SUD among hospitalized US adolescents, 13 to 19 years of age, during the time period 2000-2019. METHODS: A case-control study was conducted using 5,260,104 hospital discharge records (394,952 SUD and 4,865,152 non-SUD) from the 2000-2019 Kids' Inpatient Database. SUD and clinical outcomes variables were identified based on the International Classification of Diseases, Ninth/Tenth Revisions, Clinical Modification, coding. SUD rates (per 1000 discharges) were calculated and adjusted odds ratios (aORs) with their 95% confidence intervals (CIs) were computed using logistic regression models for predictors of SUDs among hospitalized adolescents. RESULTS: The prevalence of SUDs was estimated to be 75.10 cases per 1000 discharges (95% CI 74.86-75.31). Demographically, the highest crude rates (per 1000 discharges) were seen among Native American (139.58) and White (91.97) patients. Adolescent patients who experienced SUD were twice as likely as nonusers to be 16 to 19 years of age (aOR 2.2, 95% CI 2.13-2.19) or to be male (aOR 2.2, 95% CI 2.22-2.27). SUD was significantly associated with cooccurring conditions, including anxiety (aOR 2.5, 95% CI 2.48-2.53), depression (aOR 2.3, 95% CI 2.30-2.35), mood disorder (aOR 2.17, 95% CI 2.14-2.20), schizophrenia (aOR 2.6, 95% CI 2.52-2.64), sexually transmitted infections (aOR 2.3, 95% CI 2.23-2.45), hepatitis (aOR 3.0, 95% CI 2.87-3.15), and suicide (aOR 1.33, 95% CI 1.30-1.35). CONCLUSIONS: The study examined the epidemiology, risk factors, and common characteristics of hospitalized adolescent patients with SUDs. The high burden of psychiatric and medical comorbidities observed among this patient group warrants designing effective and comprehensive substance use prevention and treatment programs for youths.

Psychological predictors of functional outcomes in service members with traumatic brain injury.

PRIMARY OBJECTIVE: Research is increasingly demonstrating the significant impact that non-medical factors can have on outcomes of service members (SMs) with mild traumatic brain injury (mTBI). Thus, the current study examined which demographic, TBI-related factors, and psychological variables are most predictive of functional outcomes. RESEARCH DESIGN: Retrospective database analysis from medical chart review. METHODS AND PROCEDURES: One hundred forty-one patients who received rehabilitation services at an outpatient TBI military treatment facility between 2013 and 2018. Data collected included demographic variables, time since injury, neuropsychological measures, psychological diagnoses, Personality Assessment Inventory (PAI) scores, and Walter Reed Functional Impairment Scale (FIS). Hierarchical linear regression models were used to predict functional outcomes (measured by FIS total, work, social functioning scales). MAIN OUTCOMES AND RESULTS: Results indicated that comorbid PTSD diagnosis and PAI Negative Impression Management (NIM) score were predictive of total functional, work, and social outcomes, over and above demographic and TBI-related factors. CONCLUSIONS: Current findings confirmed the importance of evaluating and treating psychological factors, as well as exploring one's responding style (NIM), when managing chronic mTBI in SMs. Given ongoing findings of psychological underpinnings to mTBI outcome, there is further need to focus on early interventions to optimize psychological and functional outcomes for SMs.

The clinical significance of an estimated fetal weight below the 10th percentile: a comparison of outcomes of <5th vs 5th-9th percentile.

BACKGROUND: The association between small-for-gestational-age (birthweight <10th percentile for gestational age) and neonatal morbidity is well established. Yet, there is a paucity of data on the relationship between suspected small for gestational age (sonographic-estimated fetal weight <10th percentile) at 2 thresholds and subsequent neonatal morbidity. OBJECTIVE: The objective of this study was to determine the relationship between sonographic-estimated fetal weight <5th percentile vs 5-9th percentile and neonatal morbidity. STUDY DESIGN: This retrospective study involved 5 centers and included nonanomalous, singletons with sonographic-estimated fetal weight <10th percentile for gestational age who delivered from 2009-2012. Composite neonatal morbidity included respiratory distress syndrome, proven sepsis, intraventricular hemorrhage grade III or IV, necrotizing enterocolitis, thrombocytopenia, seizures, or death. Odd ratios were adjusted for center, maternal age, race, body mass index at first visit, smoking status, use of alcohol, use of drugs, and neonatal gender. RESULTS: Of 834 women with suspected small-for-gestational-age fetuses, 513 (62%) had sonographic-estimated fetal weight <5th percentile, and 321 (38%) had sonographic-estimated fetal weight of 5-9th percentile for gestational age. At delivery, 81% of women with a suspected small-for-gestational-age fetus had a confirmed small-for-gestational-age fetus. In the group with a sonographic-estimated fetal weight <5th percentile, 59% of neonates had birthweight <5th percentile; in the group with a sonographic-estimated fetal weight 5-9th percentile, 41% had birthweight <5th percentile, and 36% had birthweight at 5-9th percentile. Neonatal intensive care unit admission differed significantly for those fetuses at <5th percentile (29%) compared with those fetuses at 5-9th percentile (15%; P<.001). The composite neonatal morbidity among the sonographic-estimated fetal weight <5th percentile group was higher than the sonographic-estimated fetal weight of 5-9th percentile group (31% vs 13%; adjusted odds ratio, 2.41; 95% confidence interval, 1.53-3.80). Similar findings were noted when the analysis was limited to sonographic-estimated fetal weight within 28 days of delivery (adjusted odds ratio, 2.22; 95% confidence interval, 1.34-3.67). CONCLUSION: Eight of 10 suspected small-for-gestational-age fetuses had birthweight <10th percentile for gestational age; the prediction of actual birthweight was more accurate in the <5th percentile group. Neonates with sonographic-estimated fetal weight of <5th percentile were more likely to be admitted to the neonatal intensive care unit and have complications than were those neonates with sonographic-estimated fetal weight of 5-9th percentile.

Intraoperative Use of QuikClot During Adenotonsillectomy: A Prospective Pediatric Trial.

BACKGROUND: Achieving hemostatic control after intracapsular adenotonsillectomy with minimal cauterization may potentially lead to improved outcomes with respect to return to normal diet, normal activity, and less use of narcotic pain medications. METHODS: A prospective, nonrandomized, consecutive series of children with obstructive tonsils and adenoids at a tertiary children's hospital was undertaken. RESULTS: One hundred consecutive children (52 boys/48 girls) ages 0-16 (mean=4.8, SD=3.7, median=4.0) years were recruited with complete data available on all 100. Mean total procedure time was 19.8 (SD=4.3, median=19.5) minutes, including mean total cauterization time of 155.3 (SD=59.7 seconds, median=143.0) (adenoids: mean=60.9, SD=31.5, median=53.0; tonsils: mean=94.5, SD=41.9, median=82.0) minutes. Mean estimated blood loss was 29.4 (SD=40.9, median=25.0) ml. There were no major complications (0/100 episodes of bleeding or dehydration after surgery). Mean return to normal diet was 3.4 (SD=2.2, median=3.0) days; mean return to normal activity was 2.8 (SD=2.1, median=3.0) days, and mean days to no further narcotics was 3.0 (SD=2.3, median=2.0) days. Mean days to complete recovery (normal diet, normal activity, and no narcotics) was 4.5 (SD=2.1, median=4.0, range: 1-10). Total cautery time was significantly correlated with time to complete recovery (P<.05). CONCLUSIONS: Intracapsular microdebrider tonsillectomy with adenoidectomy utilizing QuikClot to enhance the hemostasis results in recovery times better than previously reported for this common operation in children.

Different natriuretic responses in obese and lean rats in response to nitric oxide reduction.

BACKGROUND: Nitric oxide (NO) is an important regulator of renal sodium transport and participates in the control of natriuresis and diuresis. In obesity, the nitric oxide bioavailability was reportedly reduced, which may contribute to the maintenance of hypertension. The aim of this study was to determine the effect of NO depletion on renal sodium handling in a model of diet-induced obesity hypertension. METHODS: Obese hypertensive (obesity-prone (OP)) and lean normotensive (obesity-resistant (OR)) Sprague-Dawley rats were treated with 1.2 mg/kg/day N(G)-nitro-L-arginine-methyl ester (L-NAME) for 4 weeks to inhibit NO synthesis. Acute pressure natriuresis and diuresis were measured in response to an increase in perfusion pressure. NHE3 and Na(+), K(+)-ATPase protein expression were measured by Western blot and NHE3 activity was determined as the rate of pH change in brush border membrane vesicles. NHE3 membrane localization was determined by confocal microscopy. RESULTS: L-NAME did not significantly attenuate the natriuretic and diuretic responses to increases in renal perfusion pressure (RPP) in OP rats while inducing a significant reduction in OR rats. Following chronic NO inhibition, NHE3 protein expression and activity and Na(+), K(+)-ATPase protein expression were significantly increased in the OR but not in the OP group. Immunofluorescence studies indicated that the increase in NHE3 activity could be, at least in part, due to NHE3 membrane trafficking. CONCLUSIONS: Obese hypertensive rats have a weaker natriuretic response in response to NO inhibition compared to lean rats and the mechanism involves different regulation of the apical sodium exchanger NHE3 expression, activity, and trafficking.