Tag Archives: Centers for Disease Control

Lancet study: Insufficient evidence that medicinal cannabinoids improve mental health

30 Oct

The National Institute on Drug (NIH) Abuse article What is medical marijuana?

The term medical marijuana refers to using the whole, unprocessed marijuana plant or its basic extracts to treat symptoms of illness and other conditions. The U.S. Food and Drug Administration (FDA) has not recognized or approved the marijuana plant as medicine.
However, scientific study of the chemicals in marijuana, called cannabinoids, has led to two FDA-approved medications that contain cannabinoid chemicals in pill form. Continued research may lead to more medications.
Because the marijuana plant contains chemicals that may help treat a range of illnesses and symptoms, many people argue that it should be legal for medical purposes. In fact, a growing number of states have legalized marijuana for medical use.
Why isn’t the marijuana plant an FDA-approved medicine?
The FDA requires carefully conducted studies (clinical trials) in hundreds to thousands of human subjects to determine the benefits and risks of a possible medication. So far, researchers haven’t conducted enough large-scale clinical trials that show that the benefits of the marijuana plant (as opposed to its cannabinoid ingredients) outweigh its risks in patients it’s meant to treat.
Read more about the various physical, mental, and behavioral effects of marijuana in our Marijuana DrugFacts.
Medical Marijuana Laws and Prescription Opioid Use Outcomes
A new study underscores the need for additional research on the effect of medical marijuana laws on opioid overdose deaths and cautions against drawing a causal connection between the two. Early research suggested that there may be a relationship between the availability of medical marijuana and opioid analgesic overdose mortality. In particular, a NIDA-funded study published in 2014 found that from 1999 to 2010, states with medical cannabis laws experienced slower rates of increase in opioid analgesic overdose death rates compared to states without such laws.1
A 2019 analysis, also funded by NIDA, re-examined this relationship using data through 2017. Similar to the findings reported previously, this research team found that opioid overdose mortality rates between 1999-2010 in states allowing medical marijuana use were 21% lower than expected. When the analysis was extended through 2017, however, they found that the trend reversed, such that states with medical cannabis laws experienced an overdose death rate 22.7% higher than expected.2 The investigators uncovered no evidence that either broader cannabis laws (those allowing recreational use) or more restrictive laws (those only permitting the use of marijuana with low tetrahydrocannabinol concentrations) were associated with changes in opioid overdose mortality rates.
These data, therefore, do not support the interpretation that access to cannabis reduces opioid overdose. Indeed, the authors note that neither study provides evidence of a causal relationship between marijuana access and opioid overdose deaths. Rather, they suggest that the associations are likely due to factors the researchers did not measure, and they caution against drawing conclusions on an individual level from ecological (population-level) data. Research is still needed on the potential medical benefits of cannabis or cannabinoids.
Read more in our Marijuana Research Report. https://www.drugabuse.gov/publications/research-reports/marijuana/marijuana-safe-effective-medicine https://www.drugabuse.gov/publications/drugfacts/marijuana-medicine

Resources:

Marijuana medical benefits – large review finds very few https://www.skepticalraptor.com/skepticalraptorblog.php/marijuana-medical-benefits-large-review/

Marijuana and Cannabinoids | NCCIH
https://nccih.nih.gov/health/marijuana

Science Daily reported the Lancet study: Insufficient evidence that medicinal cannabinoids improve mental health:

Meta-analysis finds inadequate evidence that cannabinoids relieve depression, anxiety disorders, attention-deficit hyperactivity disorder, Tourette syndrome, post-traumatic stress disorder, or psychosis.
The most comprehensive analysis of medicinal cannabinoids and their impact on six mental health disorders — combining 83 studies including 3,000 people — suggests that the use of cannabinoids for mental health conditions cannot be justified based on the current evidence. This is due to a lack of evidence for their effectiveness, and because of the known risks of cannabinoids.
The new findings, published in The Lancet Psychiatry journal, find insufficient evidence medicinal cannabinoids improve disorders overall or their symptoms, although there is a very low quality evidence that pharmaceutical tetrahydrocannabinol (THC) may lead to a small improvement in symptoms of anxiety in individuals with other medical conditions, such as chronic pain or multiple sclerosis.
Medicinal cannabinoids include medicinal cannabis and pharmaceutical cannabinoids, and their synthetic derivatives, THC and cannabidiol (CBD). Around the world, these are increasingly being made available for medicinal purposes (e.g. in the United States, Australia, and Canada), including for the treatment of mental health disorders. However, there are concerns around the adverse effects of this availability, as there is a large body of evidence indicating that non-medicinal cannabis use can increase the occurrence of depression, anxiety, and psychotic symptoms.
Professor Louisa Degenhardt of the National Drug and Alcohol Research Centre (NDARC) at UNSW Sydney, Australia, and lead author of the study says: “Our findings have important implications in countries where cannabis and cannabinoids are being made available for medical use. There is a notable absence of high-quality evidence to properly assess the effectiveness and safety of medicinal cannabinoids compared with placebo, and until evidence from randomised controlled trials is available, clinical guidelines cannot be drawn up around their use in mental health disorders.”
She continues: “In countries where medicinal cannabinoids are already legal, doctors and patients must be aware of the limitations of existing evidence and the risks of cannabinoids. These must be weighed when considering use to treat symptoms of common mental health disorders. Those who decide to proceed should be carefully monitored for positive and negative mental health effects of using medicinal cannabinoids.”
This study follows The Lancet Series on Drug Use, which includes a paper on cannabis where the authors assess the current and possible future public health impacts of the legalisation of cannabis production, sale, and use in the Americas. They summarise the overall evidence on medicinal use of cannabinoids, regulation, and how medicinal use may have affected recreational use.
The authors set out to examine the available evidence for all types of medicinal cannabinoids. They included all study designs and investigated the impact on remission from and symptoms of six mental health disorders in adults: depression, anxiety, attention-deficit hyperactivity disorder (ADHD), Tourette syndrome, post-traumatic stress disorder (PTSD), and psychosis.
They included published and unpublished studies between 1980 and 2018 and included 83 eligible studies, 40 of which were randomised controlled trials (RCTs) (the others were open-label trials, where participants knew which treatment they were taking). Of the 83 studies, 42 looked at depression (including 23 RCTs), 31 looked at anxiety (17 RCTs), eight looked at Tourette syndrome (two RCTs), three were on ADHD (one RCT), 12 were on PTSD (one RCT), and 11 were on psychosis (six RCTs).
In most RCTs examining depression and anxiety, the primary reason for cannabinoid use was for another medical condition such as chronic non-cancer pain or multiple sclerosis. In the studies looking at the other four disorders, the cannabinoid was used to treat the mental health disorder. Few randomised controlled trials examined the role of pharmaceutical CBD or medicinal cannabis; most looked at THC, with or without CBD.
The authors found that pharmaceutical THC (with or without CBD) improved anxiety symptoms among individuals with other medical conditions (seven studies of 252 people), though this may have been due to improvements in the primary medical condition. The authors suggest further research should explicitly study the effects of cannabinoids on anxiety and depression…. https://www.sciencedaily.com/releases/2019/10/191028213912.htm

Citation:

Insufficient evidence that medicinal cannabinoids improve mental health
Date: October 28, 2019
Source: The Lancet
Summary:
The most comprehensive analysis of medicinal cannabinoids and their impact on six mental health disorders — combining 83 studies including 3,000 people — suggests that the use of cannabinoids for mental health conditions cannot be justified based on the current evidence. This is due to a lack of evidence for their effectiveness, and because of the known risks of cannabinoids.

Journal Reference:
Nicola Black, Emily Stockings, Gabrielle Campbell, Lucy T Tran, Dino Zagic, Wayne D Hall, Michael Farrell, Louisa Degenhardt. Cannabinoids for the treatment of mental disorders and symptoms of mental disorders: a systematic review and meta-analysis. The Lancet Psychiatry, 2019; DOI: 10.1016/S2215-0366(19)30401-8

Here is the press release from the Lancet:

NEWS RELEASE 28-OCT-2019

The Lancet Psychiatry: Insufficient evidence that medicinal cannabinoids improve mental health

Meta-analysis finds inadequate evidence that cannabinoids relieve depression, anxiety disorders, attention-deficit hyperactivity disorder, Tourette syndrome, post-traumatic stress disorder, or psychosis
THE LANCET
Meta-analysis finds inadequate evidence that cannabinoids relieve depression, anxiety disorders, attention-deficit hyperactivity disorder, Tourette syndrome, post-traumatic stress disorder, or psychosis.
The most comprehensive analysis of medicinal cannabinoids and their impact on six mental health disorders – combining 83 studies including 3,000 people – suggests that the use of cannabinoids for mental health conditions cannot be justified based on the current evidence. This is due to a lack of evidence for their effectiveness, and because of the known risks of cannabinoids.
The new findings, published in The Lancet Psychiatry journal, find insufficient evidence medicinal cannabinoids improve disorders overall or their symptoms, although there is a very low quality evidence that pharmaceutical tetrahydrocannabinol (THC) may lead to a small improvement in symptoms of anxiety in individuals with other medical conditions, such as chronic pain or multiple sclerosis.
Medicinal cannabinoids include medicinal cannabis and pharmaceutical cannabinoids, and their synthetic derivatives, THC and cannabidiol (CBD). Around the world, these are increasingly being made available for medicinal purposes (e.g. in the United States, Australia, and Canada), including for the treatment of mental health disorders. However, there are concerns around the adverse effects of this availability, as there is a large body of evidence indicating that non-medicinal cannabis use can increase the occurrence of depression, anxiety, and psychotic symptoms.
Professor Louisa Degenhardt of the National Drug and Alcohol Research Centre (NDARC) at UNSW Sydney, Australia, and lead author of the study says: “Our findings have important implications in countries where cannabis and cannabinoids are being made available for medical use. There is a notable absence of high-quality evidence to properly assess the effectiveness and safety of medicinal cannabinoids compared with placebo, and until evidence from randomised controlled trials is available, clinical guidelines cannot be drawn up around their use in mental health disorders.” [1]
She continues: “In countries where medicinal cannabinoids are already legal, doctors and patients must be aware of the limitations of existing evidence and the risks of cannabinoids. These must be weighed when considering use to treat symptoms of common mental health disorders. Those who decide to proceed should be carefully monitored for positive and negative mental health effects of using medicinal cannabinoids.” [1]
This study follows The Lancet Series on Drug Use, which includes a paper on cannabis where the authors assess the current and possible future public health impacts of the legalisation of cannabis production, sale, and use in the Americas. They summarise the overall evidence on medicinal use of cannabinoids, regulation, and how medicinal use may have affected recreational use. [2]
The authors set out to examine the available evidence for all types of medicinal cannabinoids. They included all study designs and investigated the impact on remission from and symptoms of six mental health disorders in adults: depression, anxiety, attention-deficit hyperactivity disorder (ADHD), Tourette syndrome, post-traumatic stress disorder (PTSD), and psychosis.
They included published and unpublished studies between 1980 and 2018 and included 83 eligible studies, 40 of which were randomised controlled trials (RCTs) (the others were open-label trials, where participants knew which treatment they were taking). Of the 83 studies, 42 looked at depression (including 23 RCTs), 31 looked at anxiety (17 RCTs), eight looked at Tourette syndrome (two RCTs), three were on ADHD (one RCT), 12 were on PTSD (one RCT), and 11 were on psychosis (six RCTs).
In most RCTs examining depression and anxiety, the primary reason for cannabinoid use was for another medical condition such as chronic non-cancer pain or multiple sclerosis. In the studies looking at the other four disorders, the cannabinoid was used to treat the mental health disorder. Few randomised controlled trials examined the role of pharmaceutical CBD or medicinal cannabis; most looked at THC, with or without CBD.
The authors found that pharmaceutical THC (with or without CBD) improved anxiety symptoms among individuals with other medical conditions (seven studies of 252 people), though this may have been due to improvements in the primary medical condition. The authors suggest further research should explicitly study the effects of cannabinoids on anxiety and depression.
Pharmaceutical THC (with or without CBD) worsened negative symptoms of psychosis (one study, 24 people) and did not significantly affect any other primary outcomes for the mental health disorders examined. It also increased the number of people who had adverse events (ten studies; 1,495 people) and withdrawals due to adverse events (11 studies; 1,621 people) compared with placebo across all mental health disorders examined.
The study highlights the limited evidence and the low quality of the evidence that exists around using cannabinoids for treatment of mental health conditions. There is a need for high-quality research to understand the effects of different cannabinoids on a range of outcomes for people with mental health disorders.
Professor Degenhardt says: “Cannabinoids are often advocated as a treatment for various mental health conditions. Countries that allow medicinal cannabinoid use will probably see increased demand for such use. Clinicians and consumers need to be aware of the low quality and quantity of evidence for the effectiveness of medicinal cannabinoids in treating mental health disorders and the potential risk of adverse events. Given the likely interest but scant evidence to guide patient and clinician decisions around cannabinoids for mental health, there is an urgent need for randomised controlled trials to inform whether there are benefits of cannabinoids for these indications.” [1]
The authors highlight that their analysis and conclusions are limited by the small amount of available data, small study sizes, and the differences in findings between small studies. There is no recommended approach for addressing these issues in systematic reviews, but they tried to minimise them by keeping the focus of the review narrow. They also note that most studies are based on pharmaceutical cannabinoids, rather than medicinal cannabis, but plant products are most often used by those taking cannabinoids for medicinal purposes in the USA.
In a related Comment article, Professor Deepak Cyril D’Souza of Yale University School of Medicine, USA, says: “The process of drug development in modern medicine is to first demonstrate efficacy and safety in clinical trials before using the drug clinically. With cannabinoids, it seems that the cart (use) is before the horse (evidence). For cannabinoids to be used in the treatment of psychiatric disorders they should be tested in RCTs and subjected to the same regulatory approval process as other prescription medications.”
###
NOTES TO EDITORS
This study was funded by Australian Therapeutic Goods Administration, the Commonwealth Department of Health, Australia, Australian National Health and Medical Research Council and the US National Institutes of Health. It was conducted by researchers from the National Drug and Alcohol Research Centre, UNSW, the University of Brisbane, Australia and King’s College London, UK.
The labels have been added to this press release as part of a project run by the Academy of Medical Sciences seeking to improve the communication of evidence. For more information, please see: http://www.sciencemediacentre.org/wp-content/uploads/2018/01/AMS-press-release-labelling-system-GUIDANCE.pdf if you have any questions or feedback, please contact The Lancet press office pressoffice@lancet.com
[1] Quote direct from author and cannot be found in the text of the Article.
[2] Paper available here (begins page 29): http://www.thelancet-press.com/embargo/EMBARGOED-druguseseries.pdf
A press release for this report is also available.
Peer-reviewed / Meta-analysis / People
Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.

The Centers for Disease Control and Addiction wrote in Marijuana: How Can It Affect Your Health?

Marijuana is the most commonly used illegal drug in the United States, with 37.6 million users in the past year,1 and marijuana use may have a wide range of health effects on the body and brain. Click on the sections below to learn more about how marijuana use can affect your health.
ADDICTION
About 1 in 10 marijuana users will become addicted. For people who begin using before the age of 18, that number rises to 1 in 6. 1-3
Some of the signs that someone might be addicted include:
• Unsuccessful efforts to quit using marijuana.
• Giving up important activities with friends and family in favor of using marijuana.
• Using marijuana even when it is known that it causes problems fulfilling everyday jobs at home, school or work.4
People who are addicted to marijuana may also be at a higher risk of other negative consequences of using the drug, such as problems with attention, memory, and learning. Some people who are addicted need to smoke more and more marijuana to get the same high. It is also important to be aware that the amount of tetrahydrocannabinol (THC) in marijuana (i.e., marijuana potency or strength) has increased over the past few decades. The higher the THC content, the stronger the effects on the brain. In addition, some methods of using marijuana (e.g., dabbing, edibles) may deliver very high levels of THC to the user.5 Researchers do not yet know the full extent of the consequences when the body and brain (especially the developing brain) are exposed to high concentrations of THC or how recent increases in potency affect the risk of someone becoming addicted. 5
References
1. Lopez-Quintero, C, et al. (2011). Probability and predictors of transition from first use to dependence on nicotine, alcohol, cannabis, and cocaine: results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Drug Alcohol Depend. 115(1-2): p. 120-30.
2. Hall, W, Degenhardt L. (2009). Adverse health effects of non-medical cannabis use. Lancet. 374(9698): p. 1383-91.
3. Budney, AJ, Sargent JD, and Lee, DC. (2015). Vaping cannabis (marijuana): parallel concerns to e-cigs? Addiction. 110(11): p. 1699-704.
4. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
5. National Institute on Drug Abuse. Is marijuana addictive?external icon (2017) Rockville, MD: National Institutes of Health, National Institute on Drug Abuse.
BRAIN HEALTH
Marijuana use directly affects the brain — specifically the parts of the brain responsible for memory, learning, attention, decision making, coordination, emotions, and reaction time.1
What are the short-term effects of marijuana on the brain?
Heavy users of marijuana can have short-term problems with attention, memory, and learning, which can affect relationships and mood.
What are the long-term effects of marijuana on the brain?
Marijuana also affects brain development. When marijuana users begin using as teenagers, the drug may reduce attention, memory, and learning functions and affect how the brain builds connections between the areas necessary for these functions.
Marijuana’s effects on these abilities may last a long time or even be permanent. This means that someone who uses marijuana may not do as well in school and may have trouble remembering things. 1-3
The impact depends on many factors and is different for each person. It also depends on the amount of tetrahydrocannabinol (THC) in marijuana (i.e., marijuana potency or strength), how often it is used, the age of first use, and whether other substances (e.g., tobacco and alcohol) are used at the same time.
Marijuana and the developing brain
Developing brains, like those in babies, children, and teenagers are especially susceptible to the hurtful effects of marijuana. Although scientists are still learning about these effects of marijuana on the developing brain, studies show that marijuana use by mothers during pregnancy may be linked to problems with attention, memory, problem-solving skills, and behavior problems in their children. 3-7
References
1. Batalla A, Bhattacharyya S, Yücel M, et al. (2013). Structural and functional imaging studies in chronic cannabis users: a systematic review of adolescent and adult findings. PloS One. 8(2):e55821. doi:10.1371/journal.pone.0055821.
2. Filbey, FM, et al., Long-term effects of marijuana use on the brain. (2014) Proc Natl Acad Sci USA. 111(47): p. 16913-8.
3. Goldschmidt, L, et al. (2002). Richardson, Effects of prenatal marijuana exposure on child behavior problems at age 10. Neurotoxicol Teratol. 22(3): p. 325-36.
4. Fried, PA, Watkinson, B, and Gray, R. Differential effects on cognitive functioning in 9- to 12-year olds prenatally exposed to cigarettes and marihuana. Neurotoxicol Teratol, 1998. 20(3): p. 293-306.
5. Leech, SL, et al., (1999). Prenatal substance exposure: effects on attention and impulsivity of 6-year-olds. Neurotoxicol Teratol. 21(2): p. 109-18.
6. Goldschmidt, L, et al., (2008) Prenatal marijuana exposure and intelligence test performance at age 6. J Am Acad Child Adolesc Psychiatry. 47(3): p. 254-63.
7. El Marroun, H, et al., (2011). Intrauterine cannabis exposure leads to more aggressive behavior and attention problems in 18-month-old girls. Drug Alcohol Depend. 118(2-3): p. 470-4.
CANCER
Marijuana and cannabinoids (the active chemicals in marijuana that cause drug-like effects throughout the body, including the central nervous system and the immune system). The main active cannabinoid in marijuana is delta-9-THC. Another active cannabinoid is cannabidiol (CBD), which may relieve pain and lower inflammation without causing the “high” of delta-9-THC. Although marijuana and cannabinoids have been studied with respect to managing side effects of cancer and cancer therapies, there are no ongoing clinical trials of marijuana or cannabinoids in treating cancer in people.9 Studies so far have not shown that cannabinoids help control or cure the disease.2 And like many other drugs, marijuana can cause side effects and complications.
Relying on marijuana alone as treatment or for managing side effects while avoiding or delaying conventional medical care for cancer may have serious health consequences.2
How can marijuana affect symptoms of cancer?
Studies of man-made forms of the chemicals found in the marijuana plant can be helpful in treating nausea and vomiting from cancer chemotherapy.1 Studies have found that marijuana can be helpful in treating neuropathic pain (pain caused by damaged nerves).1
At this time, there is not enough evidence to recommend that patients inhale or ingest marijuana as a treatment for cancer-related symptoms or side effects of cancer therapy.
Is there a link between marijuana and cancer?
Smoked marijuana delivers THC and other cannabinoids to the body, but it also delivers harmful substances to users and those close by, including many of the same substances found in tobacco smoke, which are harmful to the lungs and cardiovascular system.3
Researchers have found limited evidence of an association between current, frequent, or chronic marijuana smoking and testicular cancer (non-seminoma-type).4
Because marijuana plants come in different strains with different levels of active chemicals, it can make each user’s experience very hard to predict. More research is needed to understand the full impact of marijuana use on cancer.
References
1. National Academies of Sciences E, and Medicine. (2017). The health effects of cannabis and cannabinoids: Current state of evidence and recommendations for researchexternal icon. Washington, D.C.
2. National Cancer Institute. (2017). Cannabis and Cannabinoids (PDQ®)–Patient Versionexternal icon. Rockville, MD: National Institutes of Health, National Cancer Institute.
3. U.S. Department of Health and Human Services. (2014). The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General pdf icon[PDF – 36MB]external icon. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.
4. Gurney, J, et al. (2015). Cannabis exposure and risk of testicular cancer: a systematic review and meta-analysis. BMC Cancer. 15: p. 897.
CHRONIC PAIN
Even though pain management is one of the most common reasons people use medical marijuana in the U.S., there is limited evidence that marijuana works to treat most types of chronic pain.
A few studies have found that marijuana can be helpful in treating neuropathic pain (pain caused by damaged nerves). 1 However, more research is needed to know if marijuana is any better or any worse than other options for managing chronic pain.
References
1. National Academies of Sciences E, and Medicine. (2017). The health effects of cannabis and cannabinoids: Current state of evidence and recommendations for researchexternal icon. Washington, D.C.
HEART HEALTH
Using marijuana makes the heart beat faster.1 It could also lead to increased risk of stroke and heart disease. 2-6 However, most of the scientific studies linking marijuana to heart attacks and strokes are based on reports from people who smoked it. Smoked marijuana delivers THC and other cannabinoids to the body, but it also delivers harmful substances to users and those close by, including many of the same substances found in tobacco smoke, which are harmful to the lungs and cardiovascular system. 3 So it’s hard to separate the effects of the compounds in marijuana on the cardiovascular system from the hazards posed by the irritants and other chemicals contained in the smoke. More research is needed to understand the full impact of marijuana use on the circulatory system to determine if marijuana use leads to higher risk of death from these causes.
References
1. Sidney, S. (2002) Cardiovascular consequences of marijuana use. J Clin Pharmacol. 42(11 Suppl): p. 64S-70S.
2. Wolff, V, et al. (2013). Cannabis-related stroke: myth or reality? Stroke. 44(2): p. 558-63.
3. Wolff, V, et al. (2015). Characteristics and Prognosis of Ischemic Stroke in Young Cannabis Users Compared With Non-Cannabis Users. J Am Coll Cardiol. 66(18): p. 2052-3.
4. Franz, CA and Frishman, WH. (2016) Marijuana Use and Cardiovascular Disease. Cardiol Rev. 24(4): p. 158-62.
5. Rumalla, K, Reddy, AY, and Mittal, MK. (2016). Recreational marijuana use and acute ischemic stroke: A population-based analysis of hospitalized patients in the United States. J Neurol Sci. 364: p. 191-6.
6. Rumalla, K, Reddy, AY, and Mittal, MK. (2016). Association of Recreational Marijuana Use with Aneurysmal Subarachnoid Hemorrhage. J Stroke Cerebrovasc Dis. 25(2): p. 452-60.
LUNG HEALTH
How marijuana affects lung health is determined by how it’s consumed. In many cases, marijuana is smoked in the form hand-rolled cigarettes (joints), in pipes or water pipes (bongs), in bowls, or in blunts—emptied cigars that have been partly or completely refilled with marijuana. Smoked marijuana, in any form, can harm lung tissues and cause scarring and damage to small blood vessels. 1-2 Smoke from marijuana contains many of the same toxins, irritants, and carcinogens as tobacco smoke. 3 Smoking marijuana can also lead to a greater risk of bronchitis, cough, and phlegm production. 4-8 These symptoms generally improve when marijuana smokers quit.9-10
Secondhand marijuana smoke
The known health risks of secondhand exposure to cigarette smoke—to the heart or lungs, for instance—raise questions about whether secondhand exposure to marijuana smoke poses similar health risks. While there is very little data on the health consequences of breathing secondhand marijuana smoke, there is concern that it could cause harmful health effects, including among children.
Recent studies have found strong associations between those who said there was someone in the home who used marijuana or a caretaker who used marijuana and the child having detectable levels of THC — the psychoactive ingredient in marijuana. 5,11 Children exposed to the psychoactive compounds in marijuana are potentially at risk for negative health effects, including developmental problems for babies whose mothers used marijuana while pregnant. 8 Other research shows that marijuana use during adolescence can impact the developing teenage brain and cause problems with attention, motivation, and memory.12
References
1. Tashkin, DP. (2013) Effects of marijuana smoking on the lung. Ann Am Thorac Soc. 10(3): p. 239-47.
2. Moir, D, et al. (2008). A comparison of mainstream and sidestream marijuana and tobacco cigarette smoke produced under two machine smoking conditions. Chem Res Toxicol. 21(2): p. 494-502.
3. U.S. Department of Health and Human Services. (2014). The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General pdf icon[PDF – 36MB]external icon. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.
4. Aldington, S, et al., Effects of cannabis on pulmonary structure, function and symptoms. Thorax, 2007. 62(12): p. 1058-63.
5. Moore, C, et al. (2011). Cannabinoids in oral fluid following passive exposure to marijuana smoke. Forensic Sci Int. 212(1-3): p. 227-30.
6. Tan, WC, et al. (2009). Marijuana and chronic obstructive lung disease: a population-based study. CMAJ. 180(8): p. 814-20.
7. Taylor, DR, et al. (200). The respiratory effects of cannabis dependence in young adults. Addiction. 95(11): p. 1669-77.
8. National Academies of Sciences E, and Medicine. (2017). The health effects of cannabis and cannabinoids: Current state of evidence and recommendations for researchexternal icon. Washington, D.C.
9. Hancox, RJ, et al. (2015). Effects of quitting cannabis on respiratory symptoms. Eur Respir J, 2015. 46(1): p. 80-7.
10. Tashkin, DP, Simmons MS, and Tseng, CH. (2012). Impact of changes in regular use of marijuana and/or tobacco on chronic bronchitis. COPD. 9(4): p. 367-74.
11. Wilson KM, Torok MR, Wei B, et al. (2017). Detecting biomarkers of secondhand marijuana smoke in young children. Pediatr Res. 81:589–592.
12. Broyd, SJ, et al. (2016). Acute and Chronic Effects of Cannabinoids on Human Cognition-A Systematic Review. Biol Psychiatry. 79(7): p. 557-67.
MENTAL HEALTH
Marijuana use, especially frequent (daily or near daily) use and use in high doses, can cause disorientation, and sometimes cause unpleasant thoughts or feelings of anxiety and paranoia. 1
Marijuana users are significantly more likely than nonusers to develop temporary psychosis (not knowing what is real, hallucinations and paranoia) and long-lasting mental disorders, including schizophrenia (a type of mental illness where people might see or hear things that aren’t really there). 2
Marijuana use has also been linked to depression and anxiety, and suicide among teens. However, it is not known whether this is a causal relationship or simply an association.
References
1. National Academies of Sciences E, and Medicine. (2017). The health effects of cannabis and cannabinoids: Current state of evidence and recommendations for researchexternal icon. Washington, D.C.
2. Volkow ND, Swanson JM, Evins AE, et al. (2016). Effects of cannabis use on human behavior, including cognition, motivation, and psychosis: a review. JAMA Psychiatry. 73(3):292-297. doi:10.1001/jamapsychiatry.2015.3278.
POISONING
Edibles, or food and drink products infused with marijuana and eaten, have some different risks than smoking marijuana, including a greater risk of poisoning. Unlike smoked marijuana, edibles can:
• Take from 30 minutes to 2 hours to take effect. So some people eat too much, which can lead to poisoning and/or serious injury.
• Cause effects that last longer than expected depending on the amount, the last food eaten, and medications or alcohol used at the same time.
• Be very difficult to measure. The amount of THC, the active ingredient in marijuana, is very difficult to measure and is often unknown in edible products. Many users can be caught off-guard by the strength and long-lasting effects of edibles.
It is also important to remember that marijuana affects children differently than adults. Since marijuana has become legal in some states, children have accidentally eaten marijuana products that looked like candy and treats, which made them sick enough to need emergency medical care. 3
If you use marijuana products, keep them in childproof containers and out of the reach of children. For additional questions, you can contact your health care provider, your health department, the Poison Helplineexternal icon at 1-800-222-1222, or 911 if it’s an emergency.
RISK OF USING OTHER DRUGS
The concept of marijuana as a “gateway drug”—where using marijuana leads a person to use other drugs—generates a lot of disagreement. Researchers haven’t found a definite answer yet. 1-2 However, most people who use marijuana do not go on to use other, “harder” drugs. 1
It is important to remember that people of any age, sex, or economic status can become addicted to marijuana or other drugs. Things that can affect the likelihood of substance use include:
• Family history.
• Having another mental health illness (such as anxiety or depression).
• Peer pressure.
• Loneliness or social isolation.
• Lack of family involvement.
• Drug availability.
• Socioeconomic status. 2
References
1. National Institute on Drug Abuse. Is marijuana a gateway drug? (2017). Rockville, MD: National Institutes of Health, National Institute on Drug Abuse.
2. Robertson EB, David SL, Rao SA. (2003) Preventing Drug Use Among Children and Adolescents. A Research-Based Guide for Parents, Educators, and Community Leaders pdf icon[PDF-725KB]external icon. National Institute on Drug Abuse, 2nd edn. NIH Publication no. 04-4212 (A). Bethesda, MD: US Department of Health and Human Services.
3. Colorado Department of Public Health and Environment (2017) Monitoring Health Concerns Related to Marijuana in Colorado: 2016external icon.
Reference
1. Substance Abuse and Mental Health Services Administration. (2017). Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Healthexternal icon. Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.
2. Batalla A, Bhattacharyya S, Yücel M, et al. (2013). Structural and functional imaging studies in chronic cannabis users: a systematic review of adolescent and adult findings. PloS One. 8(2):e55821. doi:10.1371/journal.pone.0055821. https://www.cdc.gov/marijuana/health-effects.html

THE JURY IS OUT ON THE MEDICAL USES OF MARIJUANA.

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Infectious Diseases Society of America study: Fatal measles case highlights importance of herd immunity in protecting the vulnerable

4 Nov

The Centers for Disease Control and Prevention (CDC) lay out the case for vaccination:
Why Are Childhood Vaccines So Important?

It is always better to prevent a disease than to treat it after it occurs.
Diseases that used to be common in this country and around the world, including polio, measles, diphtheria, pertussis (whooping cough), rubella (German measles), mumps, tetanus, rotavirus and Haemophilus influenzae type b (Hib) can now be prevented by vaccination. Thanks to a vaccine, one of the most terrible diseases in history – smallpox – no longer exists outside the laboratory. Over the years vaccines have prevented countless cases of disease and saved millions of lives.
Immunity Protects us From Disease
Immunity is the body’s way of preventing disease. Children are born with an immune system composed of cells, glands, organs, and fluids located throughout the body. The immune system recognizes germs that enter the body as “foreign invaders” (called antigens) and produces proteins called antibodies to fight them.
The first time a child is infected with a specific antigen (say measles virus), the immune system produces antibodies designed to fight it. This takes time . . . usually the immune system can’t work fast enough to prevent the antigen from causing disease, so the child still gets sick. However, the immune system “remembers” that antigen. If it ever enters the body again, even after many years, the immune system can produce antibodies fast enough to keep it from causing disease a second time. This protection is called immunity.
It would be nice if there were a way to give children immunity to a disease without their having to get sick first.
In fact there is:
Vaccines contain the same antigens (or parts of antigens) that cause diseases. For example, measles vaccine contains measles virus. But the antigens in vaccines are either killed, or weakened to the point that they don’t cause disease. However, they are strong enough to make the immune system produce antibodies that lead to immunity. In other words, a vaccine is a safer substitute for a child’s first exposure to a disease. The child gets protection without having to get sick. Through vaccination, children can develop immunity without suffering from the actual diseases that vaccines prevent.
More Facts
• Newborn babies are immune to many diseases because they have antibodies they got from their mothers. However, this immunity goes away during the first year of life.
• If an unvaccinated child is exposed to a disease germ, the child’s body may not be strong enough to fight the disease. Before vaccines, many children died from diseases that vaccines now prevent, such as whooping cough, measles, and polio. Those same germs exist today, but because babies are protected by vaccines, we don’t see these diseases nearly as often.
• Immunizing individual children also helps to protect the health of our community, especially those people who cannot be immunized (children who are too young to be vaccinated, or those who can’t receive certain vaccines for medical reasons), and the small proportion of people who don’t respond to a particular vaccine.
• Vaccine-preventable diseases have a costly impact, resulting in doctor’s visits, hospitalizations, and premature deaths. Sick children can also cause parents to lose time from work. https://www.cdc.gov/vaccines/vac-gen/howvpd.htm

A key component of the effectiveness of the effectiveness of vaccines is herd protection.

PBS NOVA reported in What is Herd Immunity?

What is “herd immunity?”
Just as a herd of cattle or sheep uses sheer numbers to protect its members from predators, herd immunity protects a community from infectious diseases by virtue of the sheer numbers of people immune to such diseases. The more members of a human “herd” who are immune to a given disease, the better protected the whole populace will be from an outbreak of that disease.
There are two ways an individual can become immune to an infectious disease: by becoming infected with the pathogen that causes it or by being vaccinated against it. Because vaccines induce immunity without causing illness, they are a comparatively safe and effective way to fill a community with disease-resistant people. These vaccinated individuals have protected themselves from disease. But, in turn, they are also protecting members of the community who cannot be vaccinated, preventing the chain of disease from reaching them and limiting potential outbreaks. Every vaccinated person adds to the effectiveness of this community-level protection.
What do thresholds have to do with herd immunity?
The microbes that cause disease all have different infectious features. Some, like measles and influenza, pass from person to person more easily than others. Some tend to have more severe consequences in specific demographic groups. For example, the symptoms of pertussis, or whooping cough, are distressing at any age but can be fatal in infants, the age group with the highest death rate from pertussis. Each of these features—such as transmissibility and severity—affects a given disease’s threshold, or the minimum percentage of immune individuals a community needs to prevent an outbreak.
To set a threshold, epidemiologists—experts in infectious disease transmission—use a value called “basic reproduction number,” often referred to as “R0.” This number represents how many people in an unprotected population one infected person could pass the disease along to. For example, R0 for measles is between 12 and 18, while for polio, it is between five and seve. The higher this number is, the higher the immunity threshold must be to protect the community. Because measles is extremely contagious and can spread through the air, for example, the immunity threshold needed to protect a community is high, at 95%. Diseases like polio, which are a little less contagious, have a lower threshold—80% to 85% in the case of polio….. https://www.pbs.org/wgbh/nova/article/herd-immunity/

Infectious Diseases Society of America (IDSA) reported about the importance of herd protection in cases where a disease can prove fatal with out herd protection.

Science Daily reported in Fatal measles case highlights importance of herd immunity in protecting the vulnerable:

Last year, a 26-year-old man receiving treatment for leukemia went to a Swiss hospital’s emergency room with a fever, a sore throat, and a cough, and was admitted. His condition worsened, and 17 days later, he died from severe complications of measles. The man’s weakened immune system was unable to fight off the disease, even though he was vaccinated against measles as a child.
A new report in Open Forum Infectious Diseases describes the man’s case, highlighting the importance of maintaining high vaccination coverage in the community to help protect people with compromised immune systems from measles and other vaccine-preventable infections. “Measles is not harmless, it’s a serious disease,” said the report’s lead author, Philipp Jent, MD, of Bern University Hospital and the University of Bern in Switzerland. “There is a responsibility to vaccinate yourself to protect others, not only to protect yourself.”
Following the patient’s admission in February of 2017, he developed additional symptoms over the next several days, including a progressive rash, mouth sores, and conjunctivitis, that suggested measles, although he had been fully vaccinated against the disease with the recommended two doses of the measles, mumps, and rubella (MMR) vaccine in the 1990s. A throat swab test confirmed the measles infection. Treatment with ribavirin (an antiviral drug), immunoglobulins (a type of antibody), and vitamin A did not improve his condition. He subsequently developed severe pneumonia and died.
The case illustrates how serious measles can be, particularly for people with compromised immune systems due to cancer treatment or other causes. It also underscores the importance of herd immunity in protecting these vulnerable individuals, the report’s authors noted. When vaccination rates in a community are high enough, vaccine-preventable diseases like measles are less likely to spread, which helps protect those who cannot be vaccinated (such as newborns not old enough to be immunized) or, like the patient in this case, for whom vaccines are not as effective.
When the proportion of people in a community who are vaccinated drops below this threshold, however, as it has for measles immunizations in several European countries, outbreaks are more likely. More than 41,000 children and adults in Europe were infected with measles during the first half of 2018, according to the World Health Organization, exceeding the annual total of European cases reported in any previous year this decade. In the U.S., there had been 142 confirmed cases of measles in 2018 as of early October, according to the U.S. Centers for Disease Control and Prevention (CDC). Data released by CDC in October also showed a gradual but concerning climb in the numbers of U.S. children who reach their second birthday without having received any recommended vaccines…. https://www.sciencedaily.com/releases/2018/11/181101133918.htm

Citation:

Fatal measles case highlights importance of herd immunity in protecting the vulnerable
Date: November 1, 2018
Source: Infectious Diseases Society of America
Summary:
A new report describes a recent case highlighting the importance of maintaining high vaccination coverage in the community to help protect people with compromised immune systems from measles and other vaccine-preventable infections.

Journal Reference:
Philipp Jent, Mafalda Trippel, Manuel Frey, Alexander Pöllinger, Sabina Berezowska, Rupert Langer, Hansjakob Furrer, Charles Béguelin. Fatal Measles Virus Infection After Rituximab-Containing Chemotherapy in a Previously Vaccinated Patient. Open Forum Infectious Diseases, 2018; 5 (11) DOI: 10.1093/ofid/ofy244

Here is the press release from IDSA:

Fatal Measles Case Highlights Importance of Herd Immunity in Protecting the Vulnerable
Last year, a 26-year-old man receiving treatment for leukemia went to a Swiss hospital’s emergency room with a fever, a sore throat, and a cough, and was admitted. His condition worsened, and 17 days later, he died from severe complications of measles. The man’s weakened immune system was unable to fight off the disease, even though he was vaccinated against measles as a child.
A new report in Open Forum Infectious Diseases describes the man’s case, highlighting the importance of maintaining high vaccination coverage in the community to help protect people with compromised immune systems from measles and other vaccine-preventable infections. “Measles is not harmless, it’s a serious disease,” said the report’s lead author, Philipp Jent, MD, of Bern University Hospital and the University of Bern in Switzerland. “There is a responsibility to vaccinate yourself to protect others, not only to protect yourself.”
Following the patient’s admission in February of 2017, he developed additional symptoms over the next several days, including a progressive rash, mouth sores, and conjunctivitis, that suggested measles, although he had been fully vaccinated against the disease with the recommended two doses of the measles, mumps, and rubella (MMR) vaccine in the 1990s. A throat swab test confirmed the measles infection. Treatment with ribavirin (an antiviral drug), immunoglobulins (a type of antibody), and vitamin A did not improve his condition. He subsequently developed severe pneumonia and died.
The case illustrates how serious measles can be, particularly for people with compromised immune systems due to cancer treatment or other causes. It also underscores the importance of herd immunity in protecting these vulnerable individuals, the report’s authors noted. When vaccination rates in a community are high enough, vaccine-preventable diseases like measles are less likely to spread, which helps protect those who cannot be vaccinated (such as newborns not old enough to be immunized) or, like the patient in this case, for whom vaccines are not as effective.
When the proportion of people in a community who are vaccinated drops below this threshold, however, as it has for measles immunizations in several European countries, outbreaks are more likely. More than 41,000 children and adults in Europe were infected with measles during the first half of 2018, according to the World Health Organization, exceeding the annual total of European cases reported in any previous year this decade. In the U.S., there had been 142 confirmed cases of measles in 2018 as of early October, according to the U.S. Centers for Disease Control and Prevention (CDC). Data released by CDC in October also showed a gradual but concerning climb in the numbers of U.S. children who reach their second birthday without having received any recommended vaccines.
“Ongoing efforts to raise confidence in vaccines and increase population immunity should be intensified,” the authors wrote in the case report’s conclusion. Physicians caring for people with compromised immune systems, the authors noted, should also ensure that those in close contact with these patients, such as family members and friends, are fully vaccinated.
Fast Facts
• People with weakened immune systems are at risk for contracting vaccine-preventable diseases, such as measles, even if they have been vaccinated.
• In this case, a 26-year-old Swiss man undergoing treatment for leukemia contracted measles and died from severe complications of the infection, despite being fully vaccinated against measles as a child.
• Maintaining high enough levels of vaccination coverage in the broader community, also known as herd immunity, can limit the spread of measles and other diseases and help protect those who are especially vulnerable.
Editor’s Note: The report authors’ affiliations, acknowledgments, and disclosures of financial support and potential conflicts of interests, if any, are available in the full report.
Fatal Measles Virus Infection After Rituximab-Containing Chemotherapy in a Previously Vaccinated Patient
https://academic.oup.com/ofid/article-lookup/doi/10.1093/ofid/ofy244

There is an ongoing public debate about possible risks of vaccination for some individuals vs. the greater good of vaccination for the commons.

Kevin M. Malone and Alan R. Hinman wrote in Chapter 13 of Vaccination Mandates: The Public Health Imperative and Individual Rights:

BACKGROUND
Concept for Community Disease Prevention
Garrett Hardin’s classic essay The Tragedy of the Commons3 describes the challenges presented when societal interest conflicts with the individual’s interest. Hardin notes the incentives present when the cattle of a community are commingled in a common pasture. At capacity, each owner still has an incentive to add additional cattle to the common because even though the yield from each animal decreases with the addition of more cattle, this decrease is offset for the individual owner by the additional animal. With this incentive, individual owners continue to add cattle to the commons to reap their individual benefit, leading to the inevitable failure of the common from overgrazing. The community interest in maximizing food production, therefore, can be achieved only by placing controls on the interests of the individual owners in favor of those of the community. Analogously, a community free of an infectious disease because of a high vaccination rate can be viewed as a common. As in Hardin’s common, the very existence of this common leads to tension between the best interests of the individual and those of the community. Increased immunization rates result in significantly decreased risk for disease. Although no remaining unimmunized individual can be said to be free of risk from the infectious disease, the herd effect generated from high immunization rates significantly reduces the risk for disease for those individuals. Additional benefit is conferred on the unimmunized person because avoidance of the vaccine avoids the risk for any adverse reactions associated with the vaccine. As disease rates drop, the risks associated with the vaccine come even more to the fore, providing further incentive to avoid immunization. Thus, when an individual in this common chooses to go unimmunized, it only minimally increases the risk of illness for that individual, while conferring on that person the benefit of avoiding the risk of vaccine induced side effects. At the same time, however, this action weakens the herd effect protection for the entire community. As more and more individuals choose to do what is in their “best” individual interest, the common eventually fails as herd immunity disappears and disease outbreaks occur. To avoid this “tragedy of the commons,” legal requirements have been imposed by communities (in recent times, by states) to mandate particular vaccinations.
Vaccine Safety and Effectiveness
Vaccines are safe and effective. However, they are neither perfectly safe nor perfectly effective. Consequently, some persons who receive vaccines will be injured as a result, and some persons who receive vaccines will not be protected. Most adverse events associated with vaccines are minor and involve local soreness or redness at the injection site or perhaps fever for a day or so. Rarely, however, vaccine can cause more serious adverse events. Whether an adverse event that occurs after vaccination was caused by the vaccine or was merely temporally related and caused by some totally independent (and often unknown or unidentified) factor is often difficult to ascertain. This is particularly problematic during infancy, when a number of conditions may occur spontaneously…. https://www.cdc.gov/vaccines/imz-managers/guides-pubs/downloads/vacc_mandates_chptr13.pdf

The issue for those balancing individual decision-making and the needs of public health are how much coercion is necessary to compel individual vaccination with the goal of protecting public health.

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University of Exeter study: Asthma attacks reduced in tree-lined urban neighborhoods

19 Nov

The Centers for Disease Control and Prevention describe how to tell if you have asthma:

How Can You Tell if You Have Asthma?
It can be hard to tell if someone has asthma, especially in children under age 5. Having a doctor check how well your lungs work and check for allergies can help you find out if you have asthma.
During a checkup, the doctor will ask if you cough a lot, especially at night, and whether your breathing problems are worse after physical activity or at certain times of year. The doctor will also ask about chest tightness, wheezing, and colds lasting more than 10 days. They will ask whether anyone in your family has or has had asthma, allergies, or other breathing problems, and they will ask questions about your home. The doctor will also ask if you have missed school or work and about any trouble you may have doing certain things.
The doctor will also do a breathing test, called spirometry, to find out how well your lungs are working. The doctor will use a computer with a mouthpiece to test how much air you can breathe out after taking a very deep breath. The spirometer can measure airflow before and after you use asthma medicine.
What Is an Asthma Attack?
An asthma attack may include coughing, chest tightness, wheezing, and trouble breathing. The attack happens in your body’s airways, which are the paths that carry air to your lungs. As the air moves through your lungs, the airways become smaller, like the branches of a tree are smaller than the tree trunk. During an asthma attack, the sides of the airways in your lungs swell and the airways shrink. Less air gets in and out of your lungs, and mucous that your body makes clogs up the airways even more.
You can control your asthma by knowing the warning signs of an asthma attack, staying away from things that cause an attack, and following your doctor’s advice. When you control your asthma:
• you won’t have symptoms such as wheezing or coughing,
• you’ll sleep better,
• you won’t miss work or school,
• you can take part in all physical activities, and
• you won’t have to go to the hospital.
What Causes an Asthma Attack?
An asthma attack can happen when you are exposed to “asthma triggers”. Your triggers can be very different from those of someone else with asthma. Know your triggers and learn how to avoid them. Watch out for an attack when you can’t avoid the triggers. Some of the most common triggers are tobacco smoke, dust mites, outdoor air pollution, cockroach allergen, pets, mold, and smoke from burning wood or grass…. http://www.cdc.gov/asthma/faqs.htm

Urban trees can affect the quality of life and health.

The Nature Conservancy published How Urban Trees Can Save Lives:

The Planting Healthy Air report documents which cities stand to benefit most from tree plantings, in terms of both heat and PM reduction, and how much investment would be required to achieve meaningful benefits.
The analysis found that investing just US$4 per resident in each of these cities in tree planting efforts could improve the health of millions of people, and that trees are as cost-effective as many other common solutions.
Most of the cooling and filtering effects created by trees are fairly localized, so densely populated cities—as well as those with higher overall pollution levels—tend to see the highest overall return on investment (ROI) from tree plantings…. https://global.nature.org/content/healthyair

Exeter University reported that asthma attacks were reduced in tree-lined urban areas.

Science Daily reported in Asthma attacks reduced in tree-lined urban neighborhoods:

People living in polluted urban areas are far less likely to be admitted to hospital with asthma when there are lots of trees in their neighbourhood, a study by the University of Exeter’s medical school has found.
The study into the impact of urban greenery on asthma suggests that respiratory health can be improved by the expansion of tree cover in very polluted urban neighbourhoods.
The study, published in the journal Environment International, looked at more than 650,000 serious asthma attacks over a 15 year period. Emergency hospitalisations were compared across 26,000 urban neighbourhoods in England.
In the most polluted urban areas, trees had a particularly strong association with fewer emergency asthma cases. In relatively unpolluted urban neighbourhoods trees did not have the same impact.
In a typical urban area with a high level of background air pollution — for example, around 15 micrograms of fine particulate matter (PM2.5) per cubic metre, or a nitrogen dioxide concentration around 33 micrograms per cubic metre — an extra 300 trees per square kilometre was associated with around 50 fewer emergency asthma cases per 100,000 residents over the 15 year study period.
The findings could have important implications for planning and public health policy, and suggest that tree planting could play a role in reducing the effects of air pollution from cars.
Over 5.4 million people receive treatment for asthma in the UK with an annual cost to the NHS of around £1 billion. 18 per cent of adults report asthma in the previous 12 months, and a quarter of 13-14 year olds report symptoms. Asthma causes over a thousand deaths a year.
The study led by Dr Ian Alcock, research fellow at the University of Exeter’s Medical School, found that trees and green space were both related to a decrease in people admitted to hospital with asthma…. https://www.sciencedaily.com/releases/2017/11/171117103814.htm

Citation:

Asthma attacks reduced in tree-lined urban neighborhoods
Date: November 17, 2017
Source: University of Exeter
Summary:
People living in polluted urban areas are far less likely to be admitted to hospital with asthma when there are lots of trees in their neighborhood, a new study has found.
Journal Reference:
1. Ian Alcock, Mathew White, Mark Cherrie, Benedict Wheeler, Jonathon Taylor, Rachel McInnes, Eveline Otte im Kampe, Sotiris Vardoulakis, Christophe Sarran, Ireneous Soyiri, Lora Fleming. Land cover and air pollution are associated with asthma hospitalisations: A cross-sectional study. Environment International, 2017; 109: 29 DOI: 10.1016/j.envint.2017.08.009

Here is the press release from the University of Exeter:

Asthma attacks reduced in tree-lined urban neighbourhoods
People living in polluted urban areas are far less likely to be admitted to hospital with asthma when there are lots of trees in their neighbourhood, a study by the University of Exeter’s medical school has found.
The study into the impact of urban greenery on asthma suggests that respiratory health can be improved by the expansion of tree cover in very polluted urban neighbourhoods.
The study, published in the journal Environment International, looked at more than 650,000 serious asthma attacks over a 15 year period. Emergency hospitalisations were compared across 26,000 urban neighbourhoods in England.
In the most polluted urban areas, trees had a particularly strong association with fewer emergency asthma cases. In relatively unpolluted urban neighbourhoods trees did not have the same impact.
In a typical urban area with a high level of background air pollution – for example, around 15 micrograms of fine particulate matter (PM2.5) per cubic metre, or a nitrogen dioxide concentration around 33 micrograms per cubic metre – an extra 300 trees per square kilometre was associated with around 50 fewer emergency asthma cases per 100,000 residents over the 15 year study period.
The findings could have important implications for planning and public health policy, and suggest that tree planting could play a role in reducing the effects of air pollution from cars.
Over 5.4 million people receive treatment for asthma in the UK with an annual cost to the NHS of around £1 billion. 18 per cent of adults report asthma in the previous 12 months, and a quarter of 13-14 year olds report symptoms. Asthma causes over a thousand deaths a year.
The study led by Dr Ian Alcock, research fellow at the University of Exeter’s Medical School, found that trees and green space were both related to a decrease in people admitted to hospital with asthma.
Dr Alcock said:
“We wanted to clarify how urban vegetation may be related to respiratory health. We know that trees remove the air pollutants which can bring on asthma attacks, but in some situations they can also cause localised build-ups of particulates by preventing their dispersion by wind. And vegetation can also produce allergenic pollen which exacerbates asthma.
We found that on balance, urban vegetation appears to do significantly more good than harm. However, effects were not equal everywhere. Greenspace and gardens were associated with reductions in asthma hospitalisation at lower pollutant levels, but not in the most polluted urban areas. With trees it was the other way round. It may be that grass pollens become more allergenic when combined with air pollutants so that the benefits of greenspace diminish as pollution increases. In contrast, trees can effectively remove pollutants from the air, and this may explain why they appear to be most beneficial where concentrations are high.”
Co-author Dr Rachel McInnes, Senior Climate Impacts Scientist at the Met Office, added: “This finding that the effects of different types of vegetation – green space and gardens, and tree cover – differ at both very high and very low air pollution levels is particularly relevant for public health and urban planning policies. We also know that the interaction between pollen and air pollution, and the effect on health and asthma is highly complex and this study confirms that more research is required in this area. Large collaborative research projects, like this from the NIHR Health Protection Research Unit in Environmental Change and Health are a very effective way to carry out this type of cross-disciplinary work.”
Date: 17 November 2017 http://www.exeter.ac.uk/news/university/title_622600_en.html

Pascal Mittermaier wrote in Why Plant Trees in Cities? Because They Protect Our Most Vulnerable Residents:

So how do we make cities cooler and healthier? Urban planners and public health officials are grappling with the best way to approach this issue. But there’s one solution we can implement now: plant more trees. Trees and other vegetation naturally cool the air around them by shading surfaces and releasing water vapor. While the effects are local—most of the improvement is within 100 meters—they can still be meaningful, reducing temperatures by up to 2°C.
Trees also provide another significant public health benefit: they reduce fine particulate matter air pollution, a problem that contributes to 5 percent of all deaths worldwide each year. Our organization, The Nature Conservancy, has carried out a study of 245 cities around the world that stand to benefit from tree-planting initiatives, assessing their efficiency and return on investment. Compared to other ways to cool outdoor air temperatures and reduce fine particle matter, trees deliver similar benefits per dollar spent—and, planting trees is the only intervention that addresses both air pollution and heat…. https://newcities.org/perspectives-why-plant-trees-in-cities-because-they-protect-our-most-vulnerable-residents/

One program which all residents of urban areas can participate is the planting of urban trees and encouraging public officials to expand and protect tree canopy.

Resources:

Asthma.com
http://www.asthma.com/additional-resources.html

Asthma Health Center
http://www.webmd.com/asthma/guide/asthma-support-resources

Asthma Resources
http://www.webmd.com/asthma/asthma-resources

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Journal of the American Medical Association special report: CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016

15 Mar

HELPGUIDE.ORG defines substance abuse and also describes some of the traits of a substance abuser.

Drug abuse, also known as substance abuse, involves the repeated and excessive use of chemical substances to achieve a certain effect. These substances may be “street” or “illicit” drugs, illegal due to their high potential for addiction and abuse. They also may be drugs obtained with a prescription, used for pleasure rather than for medical reasons.
Different drugs have different effects. Some, such as cocaine or methamphetamine, may produce an intense “rush” and initial feelings of boundless energy. Others, such as heroin, benzodiazepines or the prescription oxycontin, may produce excessive feelings of relaxation and calm. What most drugs have in common, though, is overstimulation of the pleasure center of the brain. With time, the brain’s chemistry is actually altered to the point where not having the drug becomes extremely uncomfortable and even painful. This compelling urge to use, addiction, becomes more and more powerful, disrupting work, relationships, and health. http://helpguide.org/mental/drug_substance_abuse_addiction_signs_effects_treatment.htm

In a 2014 article the National Institute on Drug Abuse took a cautious approach in linking pain killers and drug abuse.

The National Institute on Drug Abuse wrote in Abuse of Prescription Pain Medications Risks Heroin Use:

Text Description of Infographic

In 2010 almost 1 in 20 adolescents and adults – 12 million people – used prescription pain medication when it was not prescribed for them or only for the feeling it caused.  While many believe these drugs are not dangerous because they can be prescribed by a doctor, abuse often leads to dependence.  And eventually, for some, pain medication abuse leads to heroin.

Top Figure: 1 in 15 people who take non medical prescription pain relievers will try heroin within 10 years.

Left  Graph: Number of people who abused or were dependent on pain medications and percentage of them that use heroin.  Pie charts show in 2004 1.4 million people abused or were dependent on pain medications and 5% used heroin. In 2010, 1.9 million people abused or were dependent on pain medications and 14% used heroin.

Right Top Graph:  Heroin users are 3 times as likely to be dependent.  14% of non medical prescription pain reliever users are dependent. Yet, 54% of heroin users are dependent.

Right Bottom Graph:  Heroin emergency room admissions are increasing.  In 2005 there were less than 200,000 emergency room visits related to heroin. By 2011 this number had increased to almost 260,000….https://www.drugabuse.gov/related-topics/trends-statistics/infographics/abuse-prescription-pain-medications-risks-heroin-use

The CDC issued new recommendations regarding prescribing pain medication.

Kimberly Leonard of U.S. News wrote in Getting a Painkiller from a Doctor Is About to Get Harder:

Government health officials on Tuesday provided strategies for primary care doctors who treat patients suffering from chronic pain. Among the recommendations: to use urine drug testing before prescribing highly addictive painkillers like oxycontin, codeine and morphine.

The guidance, put forth by the Centers for Disease Control and Prevention, is part of the government’s response to the epidemic of people dying from opioid overdoses, which include prescription painkillers but also the drug’s cheaper alternative, heroin. Data from the CDC show that in 2014 these deaths surpassed car accidents as the No. 1 cause of injury-related death.

For the most part, the CDC recommends limiting opioid prescriptions to people who have cancer, are receiving end-of-life or palliative care, or are suffering with serious illnesses. Primary care doctors have been in part responsible for the surge in addiction: Since 1999, the prescribing and sales of opioids has quadrupled, and primary care doctors account for nearly half of these prescriptions….                                                                                                           http://www.usnews.com/news/articles/2016-03-15/cdc-issues-guidance-on-prescription-painkillers

Citation:

Special Communication | March 15, 2016

CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016 FREE ONLINE FIRST

Deborah Dowell, MD, MPH1; Tamara M. Haegerich, PhD1; Roger Chou, MD1

[+] Author Affiliations

JAMA. Published online March 15, 2016. doi:10.1001/jama.2016.1464

Text Size: A A A

Article

Tables

Supplemental Content

References

ABSTRACT

ABSTRACT | INTRODUCTION | GUIDELINE DEVELOPMENT PROCESS | RECOMMENDATIONS | DISCUSSION | CONCLUSIONS | ARTICLE INFORMATION | REFERENCES

Importance  Primary care clinicians find managing chronic pain challenging. Evidence of long-term efficacy of opioids for chronic pain is limited. Opioid use is associated with serious risks, including opioid use disorder and overdose.

Objective  To provide recommendations about opioid prescribing for primary care clinicians treating adult patients with chronic pain outside of active cancer treatment, palliative care, and end-of-life care.

Process  The Centers for Disease Control and Prevention (CDC) updated a 2014 systematic review on effectiveness and risks of opioids and conducted a supplemental review on benefits and harms, values and preferences, and costs. CDC used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework to assess evidence type and determine the recommendation category.

Evidence Synthesis  Evidence consisted of observational studies or randomized clinical trials with notable limitations, characterized as low quality using GRADE methodology. Meta-analysis was not attempted due to the limited number of studies, variability in study designs and clinical heterogeneity, and methodological shortcomings of studies. No study evaluated long-term (≥1 year) benefit of opioids for chronic pain. Opioids were associated with increased risks, including opioid use disorder, overdose, and death, with dose-dependent effects.

Recommendations  There are 12 recommendations. Of primary importance, nonopioid therapy is preferred for treatment of chronic pain. Opioids should be used only when benefits for pain and function are expected to outweigh risks. Before starting opioids, clinicians should establish treatment goals with patients and consider how opioids will be discontinued if benefits do not outweigh risks. When opioids are used, clinicians should prescribe the lowest effective dosage, carefully reassess benefits and risks when considering increasing dosage to 50 morphine milligram equivalents or more per day, and avoid concurrent opioids and benzodiazepines whenever possible. Clinicians should evaluate benefits and harms of continued opioid therapy with patients every 3 months or more frequently and review prescription drug monitoring program data, when available, for high-risk combinations or dosages. For patients with opioid use disorder, clinicians should offer or arrange evidence-based treatment, such as medication-assisted treatment with buprenorphine or methadone.

Conclusions and Relevance  The guideline is intended to improve communication about benefits and risks of opioids for chronic pain, improve safety and effectiveness of pain treatment, and reduce risks associated with long-term opioid therapy.

Here is the recommendation for patients from LeShaundra Cordier Scott, MPH, CHES; Sarah Lewis, MPH, CHES:

RECOMMENDATIONS FOR SAFER AND MORE EFFECTIVE PAIN MANAGEMENT

A JAMA article was published online on March 15, 2016, describing a new Centers for Disease Control and Prevention opioid prescribing guideline for chronic pain. The guideline provides recommendations based on available science for safer, more effective treatment of chronic pain outside of active cancer, palliative care, and end-of-life care.

The recommendations ask health care practitioners to

  • Use nonopioid medications and other therapies such as physical therapy instead of or in combination with opioids.
  • Prescribe the lowest effective dosage of opioids to reduce risks of opioid use disorder and overdose.
  • Discuss potential benefits and harms of opioids with patients.
  • Assess improvements in pain and function regularly.
  • Use tools such as urine drug tests and prescription drug monitoring programs to inform themselves about patients’ other medications that increase risk.
  • Monitor patients for signs of whether opioid use disorder might be developing and arrange treatment if needed

 

WHAT YOU CAN DO

 

If you have chronic pain, be sure to

  • Consider ways to manage your pain that do not include opioids, such as physical therapy, exercise, nonopioid medications, and cognitive behavioral therapy.
  • Make the most informed decision with your doctor.
  • Never take opioids in greater amounts or more often than prescribed.
  • Avoid taking opioids with alcohol and other substances or medications you have not discussed with your doctor.

If you or someone close to you has an addiction to pain medication, talk to your doctor or contact the Substance Abuse and Mental Health Services Administration’s treatment help line at (800) 662-HELP.

For More Information

To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA’s website at www.jama.com. Spanish translations are available in the supplemental content tab.

ARTICLE INFORMATION

The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.

Published Online: March 15, 2016. doi:10.1001/jama.2016.3224.

Here is the press release from the American Medical Association:

March 15, 2016

AMA Responds to CDC Guidelines on Opioids

For immediate release:
March 15, 2016

CHICAGO – In response to the Centers for Disease Control and Prevention (CDC) guidelines issued today, the American Medical Association (AMA) noted its shared goal of reducing harm from opioid abuse and seeking solutions to end this public health epidemic and applauds the agency for making the issue a high priority. As with any guideline development of this magnitude, we appreciated the opportunity to add the voice of patients and physicians.

“While we are largely supportive of the guidelines, we remain concerned about the evidence base informing some of the recommendations, conflicts with existing state laws and product labeling, and possible unintended consequences associated with implementation, which includes access and insurance coverage limitations for non-pharmacologic treatments, especially comprehensive care, and the potential effects of strict dosage and duration limits on patient care,” said Patrice A. Harris, MD, the AMA board chair-elect and chair of the AMA Task Force to Reduce Opioid Abuse.

“We know this is a difficult issue that doesn’t have easy solutions and if these guidelines help reduce the deaths resulting from opioids, they will prove to be valuable. If they produce unintended consequences, we will need to mitigate them. They are not the final word. More needs to be done, and we plan to continue working at the state and federal level to engage policy makers to take steps that will help end this epidemic.”

###

Media Contact:
Jack Deutsch
AMA Media & Editorial
202-789-7442
Jack.Deutsch@ama-assn.org

If you or a member of your family is prescribed pain medication, the course of treatment should follow CDC recommendations.

Where information leads to Hope. © Dr. Wilda.com

Dr. Wilda says this about that ©

Blogs by Dr. Wilda:

COMMENTS FROM AN OLD FART©
http://drwildaoldfart.wordpress.com/

Dr. Wilda Reviews ©
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Dr. Wilda ©
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Baylor University study: ‘Violence Free Zone’ program can be effective

25 Mar

The Centers for Disease Control (CDC) collects statistics about school violence. According to School Violence: Data & Statistics, the CDC reports:

The first step in preventing school violence is to understand the extent and nature of the problem. The Centers for Disease Control and Prevention (CDC), the U.S. Department of Education, and the U.S. Department of Justice gather and analyze data from a variety of sources to gain a more complete understanding of school violence.
According to the CDC’s School Associated Violent Death Study, between 1% and 2% of all homicides among school-age children happen on school grounds or on the way to and from school or during a school sponsored event. So the vast majority of students will never experience lethal violence at school.1
Fact Sheets
• Understanding School Violence Fact Sheet[PDF 254 KB]
This fact sheet provides an overview of school violence. http://www.cdc.gov/violenceprevention/pdf/school_violence_fact_sheet-a.pdf
• Behaviors that Contribute to Violence on School Property[PDF 92k]
This fact sheet illustrates the trends in violence-related behaviors among youth as assessed by CDC’s Youth Risk Behavior Surveillance System (YRBSS). YRBSS monitors health risk behaviors that contribute to the leading causes of death and disability among young people in the United States, including violence. http://www.cdc.gov/HealthyYouth/yrbs/pdf/us_violenceschool_trend_yrbs.pdf
• Understanding Youth Violence [PDF 313KB]
This fact sheet provides an overview of youth violence.
• Youth Violence: Facts at a Glance[PDF 128KB]
This fact sheet provides up-to-date data and statistics on youth violence…. http://www.cdc.gov/violenceprevention/pdf/yv-datasheet-a.pdf http://www.cdc.gov/violenceprevention/youthviolence/schoolviolence/data_stats.html

A Baylor University study examined an intervention strategy which might be effective in reducing school violence.

Science Daily reports in ‘Violence-free’ zones improve behavior, performance in middle, high school students:

A youth violence-reduction mentoring program for trouble-plagued schools in urban centers has contributed to improved student behavior and performance at high-risk middle and high schools in Wisconsin and Virginia, according to a new Baylor University case study.

The “Violence-Free Zone” is the national model of mentoring students in areas with high levels of crime and violence. The mentoring program is designed to address behaviors that result in truancies, suspensions, violent incidents, involvement in drugs and gangs and poor academic performance in public middle and high schools.

Four evaluations of VFZ programs conducted between 2007 and 2013 show positive impact, including a unique return-on-investment (ROI) analysis of a VFZ high school in Milwaukee, according to study leaders Byron Johnson, Ph.D., director of the Program on Prosocial Behavior in Baylor’s Institute for Studies of Religion, and William Wubbenhorst, non-resident fellow at Baylor and scholar in faith-based and community initiatives.

The case study evaluates improvements at two VFZ high schools in Richmond, as well as the impact of the Milwaukee VFZ program on youths mentored by adults who work full time in the schools as hall and cafeteria monitors and role models. They work closely with safety officers, teachers and counselors.
Among the key findings:

1. A four-year study (academic years 2007 to 2010) of the VFZ Program in Milwaukee’s School for Career and Technical Education showed a: • 44 percent reduction in the average number of behavioral incidents per VFZ student per month • 79 percent reduction in average number of suspension days per VFZ student per month • 23 percent reduction in truancy incidents per VFZ student per month • 9.3 percent increase in GPA per VFZ student • 24 percent higher rate of graduation from high school than non-VFZ students • 8 percent higher college enrollment rate (as compared to the Wisconsin state level) • 64 percent increase in the number of students reporting a more positive school climate (as compared to the year prior to the VFZ program start)

2. A Return-On Investment Analysis of the Milwaukee school’s program showed an estimated lifetime savings of $8.32 for every $1 invested in the VFZ program, based on reduced administrative costs from fewer suspensions; reduced police costs from service calls; reduced juvenile detention costs; lower truancy rates; savings from reduced number of auto thefts within 1,000 feet of the school; savings from reductions of such high-risk behaviors as drinking, violence against intimate partners or violence against oneself; and projected increases in lifetime earning associated with higher high school graduation and college enrollment rates.

3. A four-year study (from academic years 2009-2012) of overall school-level trends of the VFZ program in Richmond showed a: • 44 percent reduction in the average number of suspensions per student • 27 percent reduction in the average number of suspension days per student • 18 percent increase in the average grade point average

4. A one-year study (academic year 2013-14) of VFZ students in three middle schools and eight high schools in Milwaukee showed a: • 7 percent decrease in the average number of non-violent incidents per VFZ student per month • 31 percent decrease in the average number of violent incidents per VFZ student per month.
The Milwaukee Violence-Free Zone program was created and is directed by the Washington, D.C.-based Center for Neighborhood Enterprise and implemented in Milwaukee schools by CNE’s community partners, Running Rebels Community Organization and the Milwaukee Christian Center. The Richmond program was operated in partnership with the Richmond Outreach Church.

“The VFZ initiative not only is measurably effective in reducing violence, it is cost-effective,” said CNE President Robert L. Woodson. “It produces saving to the community by avoiding court and incarceration costs and by promoting attendance and academic achievement. It makes it possible for teachers to teach and students to learn.” For more information about the Multi-State Mentoring Research study, visit http://www.cneonline.org/
http://www.sciencedaily.com/releases/2015/03/150323111642.htm

Here is an excerpt describing the Violence Free Zone concept:

Reducing Youth Violence: The Violence-Free Zone Violence-Free Zone Initiative:
A Proven Model for Stopping Violence in the Schools and Creating Peace in the Community
The Violence-Free Zone is the national model of a youth violence reduction and high-risk- student mentoring program created by the Center for Neighborhood Enterprise. Designed to operate in the most trouble-plagued schools in urban centers with high levels of crime and violence, the VFZ has produced measurable decreases in violent and non-violent incidents and suspensions in more than 30 schools across the country. The principles developed in the Violence-Free Zone model have also proved applicable to suburban and rural communities.
Three studies by evaluators from Baylor University reported that the VFZ had measurable impact in improved safety, reduction in suspensions and truancies, and increased academic performance. Educators and law enforcement officers from sites around the country have praised the VFZ for changing the culture of previously violent schools and reducing crimes in surrounding neighborhoods.
How It Works
The goal of the Violence-Free Zone initiative is to reduce violence and disruptions in the schools and prepare students for learning. The Center provides overall management and direction to the Violence-Free Zone initiative sites, and selects established youth-serving organizations to be CNE’s community partners and implement the VFZ program in the schools. These organizations have the goal of stopping violence in their neighborhoods and have demonstrated that they have the trust and confidence of young people. The Center provides training in the Violence-Free Zone national model as well as technical assistance, administrative and financial oversight, and linkages to sources of support.
Central to the program are the Youth Advisors, mature young adults who are from the same neighborhoods as the students in the schools they serve. The Youth Advisors command respect because they have faced and overcome the same challenges as the students. Carefully screened, hired, and managed by the local community-partner organization, the Youth Advisors work in the schools as hall monitors, mediators, and character coaches, and they mentor the high risk students that often are responsible for disruptions…. http://www.cneonline.org/reducing-youth-violence-the-violence-free-zone/

Citation:

Violence-free’ zones improve behavior, performance in middle, high school students

Date: March 23, 2015

Source: Baylor University

Summary:
A youth violence-reduction mentoring program for trouble-plagued schools in urban centers has contributed to improved student behavior and performance at high-risk middle and high schools in Milwaukee, Wisconsin, and Richmond, Virginia, according to findings of a new case study.

Here is the press release from Baylor University:

‘Violence-Free’ Zones Improve Behavior and Performance in Middle and High School Students, Baylor University Study Finds
March 20, 2015
WACO, Texas (March 23, 2015) — A youth violence-reduction mentoring program for trouble-plagued schools in urban centers has contributed to improved student behavior and performance at high-risk middle and high schools in Milwaukee, Wisconsin, and Richmond, Virginia, according to findings of a new Baylor University case study.
The “Violence-Free Zone” (VFZ) is the national model of mentoring students in areas with high levels of crime and violence. The VFZ mentoring program is designed to address behaviors that result in truancies, suspensions, violent incidents, involvement in drugs and gangs and poor academic performance in public middle and high schools.
Four evaluations of VFZ programs conducted between 2007 and 2013 show positive impact, including a unique return-on-investment (ROI) analysis of a VFZ high school in Milwaukee, according to study leaders Byron Johnson, Ph.D., director of the Program on Prosocial Behavior in Baylor’s Institute for Studies of Religion, and William Wubbenhorst, non-resident fellow at Baylor, scholar in faith-based and community initiatives and co-president of Social Capital Valuations, LLC.
The case study also includes an evaluation of school-level improvements at two VFZ high schools in Richmond, as well as the impact of the Milwaukee VFZ program specifically on youths directly receiving mentoring services from the VFZ “Youth Advisers” — adults who work full time in the schools as hall and cafeteria monitors, role models and mentors. They work closely with school safety officers, teachers and counselors to provide a support system for students.
Among the key findings:
1. A four-year study (academic years 2007 to 2010) of the VFZ Program in Milwaukee’s School for Career and Technical Education showed a:
44 percent reduction in the average number of behavioral incidents per VFZ student per month
79 percent reduction in average number of suspension days per VFZ student per month
23 percent reduction in truancy incidents per VFZ student per month
9.3 percent increase in GPA per VFZ student
24 percent higher rate of graduation from high school than non-VFZ students
8 percent higher college enrollment rate (as compared to the Wisconsin state level)
64 percent increase in the number of students reporting a more positive school climate (as compared to the year prior to the VFZ program start)
2. A Return-On Investment Analysis of the Milwaukee school’s program showed an estimated lifetime savings of $8.32 for every $1 invested in the VFZ program, based on reduced administrative costs from fewer suspensions; reduced police costs from service calls; reduced juvenile detention costs; lower truancy rates; savings from reduced number of auto thefts within 1,000 feet of the school; savings from reductions of such high-risk behaviors as drinking, violence against intimate partners or violence against oneself; and projected increases in lifetime earning associated with higher high school graduation and college enrollment rates.
3. A four-year study (from academic years 2009-2012) of overall school-level trends of the VFZ program in Richmond showed a:
44 percent reduction in the average number of suspensions per student
27 percent reduction in the average number of suspension days per student
18 percent increase in the average grade point average
4. A one-year study (academic year 2013-14) of VFZ students in three middle schools and eight high schools in Milwaukee showed a:
7 percent decrease in the average number of non-violent incidents per VFZ student per month
31 percent decrease in the average number of violent incidents per VFZ student per month
The Milwaukee Violence-Free Zone program was created and is directed by the Washington, D.C.-based Center for Neighborhood Enterprise (CNE) and implemented in Milwaukee schools by CNE’s community partners, Running Rebels Community Organization and the Milwaukee Christian Center. The Richmond program was operated in partnership with the Richmond Outreach Church.
“The VFZ initiative not only is measurably effective in reducing violence, it is cost-effective,” said CNE President Robert L. Woodson. “It produces saving to the community by avoiding court and incarceration costs and by promoting attendance and academic achievement. It makes it possible for teachers to teach and students to learn.”
For more information about the Multi-State Mentoring Research study, visit the Center for Neighborhood Enterprise’s website at http://www.cneonline.org
ABOUT BAYLOR UNIVERSITY
Baylor University is a private Christian University and a nationally ranked research institution, characterized as having “high research activity” by the Carnegie Foundation for the Advancement of Teaching. The University provides a vibrant campus community for approximately 16,000 students by blending interdisciplinary research with an international reputation for educational excellence and a faculty commitment to teaching and scholarship. Chartered in 1845 by the Republic of Texas through the efforts of Baptist pioneers, Baylor is the oldest continually operating University in Texas. Located in Waco, Baylor welcomes students from all 50 states and more than 80 countries to study a broad range of degrees among its 12 nationally recognized academic divisions. Baylor sponsors 19 varsity athletic teams and is a founding member of the Big 12 Conference.
ABOUT THE INSTITUTE FOR STUDIES OF RELIGION
Launched in August 2004, the Baylor Institute for Studies of Religion (ISR) exists to initiate, support and conduct research on religion, involving scholars and projects spanning the intellectual spectrum: history, psychology, sociology, economics, anthropology, political science, epidemiology, theology and religious studies. The institute’s mandate extends to all religions, everywhere, and throughout history, and embraces the study of religious effects on prosocial behavior, family life, population health, economic development and social conflict. While always striving for appropriate scientific objectivity, ISR scholars treat religion with the respect that sacred matters require and deserve.
School violence is a complex set of issues and there is no one solution. The school violence issue mirrors the issue of violence in the larger society. Trying to decrease violence requires a long-term and sustained focus from parents, schools, law enforcement, and social service agencies.

Resources:

A Dozen Things Students Can Do to Stop School Violence                                                  http://www.sacsheriff.com/crime_prevention/documents/school_safety_04.cfm

A Dozen Things. Teachers Can Do To Stop School Violence.                                                        http://www.ncpc.org/cms-upload/ncpc/File/teacher12.pdf

Preventing School Violence: A Practical Guide                                                                          http://www.indiana.edu/~safeschl/psv.pdf

Related:

Violence against teachers is becoming a bigger issue                                                                        https://drwilda.com/2013/11/29/violence-against-teachers-is-becoming-a-bigger-issue/

Hazing remains a part of school culture                                                                                            https://drwilda.com/2013/10/09/hazing-remains-a-part-of-school-culture/

FEMA issues Guide for Developing High-Quality School Emergency Operations Plans  https://drwilda.com/2013/07/08/fema-issues-guide-for-developing-high-quality-school-emergency-operations-plans/

Study: 1 in 3 teens are victims of dating violence                                                                           https://drwilda.com/2013/08/05/study-1-in-3-teens-are-victims-of-dating-violence/

Pediatrics article: Sexual abuse prevalent in teen population                                                        https://drwilda.com/2013/10/10/pediatrics-article-sexual-abuse-prevalent-in-teen-population/

Where information leads to Hope. © Dr. Wilda.com

Dr. Wilda says this about that ©

Blogs by Dr. Wilda:

COMMENTS FROM AN OLD FART©
http://drwildaoldfart.wordpress.com/

Dr. Wilda Reviews ©
http://drwildareviews.wordpress.com/

Dr. Wilda ©
https://drwilda.com/

Centers for Disease Control report: Nearly 8 in 10 children miss developmental screenings

17 Sep

The goal of this society should be to raise healthy and happy children who will grow into concerned and involved adults who care about their fellow citizens and environment. A physical examination is important for children to make sure that there are no health problems. The University of Arizona Department of Pediatrics has an excellent article which describes Pediatric History and Physical Examination http://www.peds.arizona.edu/medstudents/Physicalexamination.asp

PHYSICAL EXAMINATION
Every child should receive a complete systematic examination at regular intervals. One should not restrict the examination to those portions of the body considered to be involved on the basis of the presenting complaint.
Approaching the Child
Adequate time should be spent in becoming acquainted with the child and allowing him/her to become acquainted with the examiner. The child should be treated as an individual whose feelings and sensibilities are well developed, and the examiner’s conduct should be appropriate to the age of the child. A friendly manner, quiet voice, and a slow and easy approach will help to facilitate the examination.
Observation of the Patient
Although the very young child may not be able to speak, one still may receive much information from him/her by being observant and receptive. The total evaluation of the child should include impressions obtained from the time the child first enters until s/he leaves; it should not be based solely on the period during which the patient is on the examining table. In general, more information is obtained by careful inspection than from any of the other methods of examination.
Sequence of Examination
Skill, tact and patience are required to gather an optimal amount of information when examining a child. There is no routine one can use and each examination should be individualized. Ham it up and regress. Get down to the child’s level and try to gain his trust. The order of the exam should conform to the age and temperament of the child. For example, many infants under 6 months are easily managed on the examining table, but from 8 months to 3 years you will usually have more success substituting the mother’s lap. Certain parts of the exam can sometimes be done more easily with the child in the prone position or held against the mother. After 4 years, they are often cooperative enough for you to perform the exam on the table again.
Wash your hands with warm water before the examination begins. You will impress your patient’s mother and not begin with an adverse reaction to cold hands in your patients. With the younger child, get to the heart, lungs and abdomen before crying starts. Save looking at the throat and ears for last. If part of the examination is uncomfortable or painful, tell the child in a warm, honest, but determined tone that this is necessary. Looking for animals in their ears or listening to birdies in their chests is often another useful approach to the younger child.
If your bag of tricks is empty and you’ve become hoarse from singing and your lips can no longer bring forth a whistle, you may have to turn to muscle. Various techniques are used to restrain children and experience will be your best ally in each type of situation.
Remember that you must respect modesty in your patients, especially as they approach pubescence. Some time during the examination, however, every part of the child must have been undressed. It usually works out best to start with those areas which would least likely make your patient anxious and interfere with his developing confidence in you.

The article goes on to describe how the physical examination is conducted and what observations and tests are part of the examination. The Cincinnati Children’s Hospital describes the Process of the Physical Examination http://www.cincinnatichildrens.org/health/p/exam/

Christina Samuels reported in the Education Week article, CDC: Nearly Eight in 10 Children Miss Developmental Screenings:

Only about 21 percent of parents in 2007 reported that they were asked to fill out a questionnaire from their health-care provider asking about their child’s developmental, communication, or social behaviors—an essential step in steering children to early-intervention services, according to the Centers for Diseases Control and Prevention in Atlanta.
The CDC released the information Sept. 10 as part of an analysis on the use of several preventive services for infants, children and adolescents. In general, children are not receiving enough preventive care, the agency concluded. CDC recommendations are that young children be screened for developmental delays at 9, 18, and either 24 or 30 months, and for autism spectrum disorder at 18 months and at either 24 or 30 months.
For its analysis, the CDC turned to the 2007 National Survey of Children’s Health and focused on children from 10 to 47 months olds. Children were not more or less likely to be screened based on gender, race or ethnicity, family structure, parental education, household income, or location. However, parents were the least likely to report an official screening if the child had not had insurance in the past year; only 9 percent of parents reported that request.
The study did note that a majority of parents, about 52 percent, reported that a health-care advisor asked them informally if they had any concerns about their child’s learning, development, or behavior. However, indications of a parental concern or risk for a developmental delay did not result in additional screening for those children, and informal inquiries are less likely to pick up on the children who need help, the report said. Health-care providers may be overrelying on their own judgment or distrustful of parent reports, the researchers hypothesized.
The CDC noted other gaps in the preventive screening that connect to potential disabilities. Using surveys collected in 2009 and 2010, the CDC found that 50 percent of infants who failed their hearing screening were not documented to have received testing needed to diagnose hearing loss.
Also, 67 percent of children ages 1 to 2 years were not tested for blood lead or results were not reported to CDC in 2010; lead exposure can lead to serious negative consequences for a child’s developing brain. http://blogs.edweek.org/edweek/early_years/2014/09/cdc_nearly_eight_in_10_children_miss_developmental
_screenings.html

Here are the key findings from the CDC report:

Key Findings
Morbidity and Mortality Weekly Report published a supplement that examined the use of selected clinical preventive services among infants, children, and adolescents in the United States. This supplement indicates that millions of U.S. infants, children, and adolescents did not receive key clinical preventive services. Increased use of clinical preventive services could improve the health of infants, children, and adolescents and promote healthy lifestyles that will enable them to achieve their full potential.
Read the full article: Use of Selected Clinical Preventive Services to Improve Health of Infants, Children, and Adolescents¬¬ – United States, 1999-2011
Main Findings from this Report
Use of clinical preventive services among U.S. infants, children, and adolescents is not optimal. There are large disparities by demographics, geography, and healthcare coverage and access in the use of these services. This report provides a baseline snapshot of use of selected clinical preventive services for U.S. infants, children, and adolescents prior to 2012, before or shortly after implementation of the Affordable Care Act.
Report findings include:
• Breastfeeding: One in six (17%) pregnant women did not receive breastfeeding counseling during prenatal care visits in 2010.1
• Hearing: Half (50%) of infants who failed their hearing screening were not documented to have received testing needed to diagnose hearing loss during 2009–2010.2
• Child Development: In 2007, parents of almost eight in ten (79%) children aged 10–47 months were not asked by healthcare providers to complete a formal screen for developmental delays in the past year.3
• Lead Poisoning: Two-thirds (67%) of children aged 1–2 years were not tested for blood lead or results were not reported to CDC in 2010.4
• Vision: According to their parents, approximately one in five (22%) children aged 5 years never had their vision checked by a healthcare provider during 2009–2010. Approximately one in four children did not have their blood pressure measurement documented at clinic visits during 2009–2010.5
• Hypertension: Approximately one in four (24%) outpatient clinic visits for preventive care made by 3–17 year-olds during 2009–2010 had no documentation of blood pressure measurement.6
• Dental: In 2009, more than half (56%) of children and adolescents did not visit the dentist in the past year, and nearly nine of ten (86%) children and adolescents did not receive a dental sealant or a topical fluoride application in the past year.7
• Human Papillomavirus (HPV) Vaccination: Nearly half (47%) of female adolescents aged 13–17 years had not received their recommended first dose of HPV vaccine in 2011, and almost two-thirds (65%) had not received all three recommended vaccine doses.8
• Tobacco: Approximately one in three (31%) outpatient clinic visits made by 11–21 year-olds during 2004–2010 had no documentation of tobacco use status, and eight of ten (80%) of those who screened positive for tobacco use did not receive any cessation assistance.9
• Chlamydia: During 2006–2010, almost two-thirds (60%) of sexually active females aged 15–21 years did not receive chlamydia screening in the past year.10
• Reproductive Health: During 2006–2010, approximately one in four (24%) sexually experienced females aged 15–19 years and more than one in three (38%) sexually experienced males aged 15–19 years did not receive a reproductive health service from a healthcare provider in the past year.11
These findings come from the second of a series of periodic reports from CDC to monitor and report on progress made in increasing the use of clinical preventive services to improve population health. There are many important clinical preventive services for infants, children, and adolescents. Healthcare providers, parents, and guardians can find out more about the preventive care children need by visiting http://www.cdc.gov/prevention.
About this Study collapsed
Clinical Preventive Services collapsed
The Affordable Care Act collapsed
CDC’s Activities http://www.cdc.gov/childpreventiveservices/key-findings.html

See, Developmental Monitoring and Screening http://www.cdc.gov/ncbddd/childdevelopment/screening.html

The increased rate of poverty has profound implications if this society believes that ALL children have the right to a good basic education. Moi blogs about education issues so the reader could be perplexed sometimes because moi often writes about other things like nutrition, families, and personal responsibility issues. Why? The reader might ask? Because children will have the most success in school, if they are ready to learn. Ready to learn includes proper nutrition for a healthy body and the optimum situation for children is a healthy family. Many of societies’ problems would be lessened if the goal was a healthy child in a healthy family. There is a lot of economic stress in the country now because of unemployment and underemployment. Children feel the stress of their parents and they worry about how stable their family and living situation is.

A healthy child in a healthy family who attends a healthy school in a healthy neighborhood ©

Related:

People MUST talk: AIDS epidemic in Black community
https://drwilda.wordpress.com/2012/08/02/people-must-talk-aids-epidemic-in-black-community/

Study: When teachers overcompensate for prejudice
https://drwilda.wordpress.com/2012/05/10/study-when-teachers-overcompensate-for-prejudice/

Location, location, location: Brookings study of education disparity based upon neighborhood https://drwilda.wordpress.com/2012/04/18/location-location-location-brookings-study-of-education-disparity-based-upon-neighborhood/

Jonathan Cohn’s ‘The Two Year Window’
https://drwilda.wordpress.com/2011/12/18/jonathan-cohns-the-two-year-window/

Hard times are disrupting families https://drwilda.com/2011/12/11/hard-times-are-disrupting-families/

3rd world America: The link between poverty and education
https://drwilda.com/2011/11/20/3rd-world-america-the-link-between-poverty-and-education/

3rd world America: Money changes everything https://drwilda.com/2012/02/11/3rd-world-america-money-changes-everything/

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University of St. Thomas study: Sleep problems equal to marijuana use and drinking in predicting poor academic performance in college

4 Jun

Moi has posted quite a bit about the effect of sleep deprivation on children and teens. A study of older men published in the Journal Sleep details the effect of sleep deprivation on older men. The bottom line is that no matter one’s age, in order to fully function, people need adequate rest. See, Study: Poor sleep quality can lead to cognitive problems in older men https://drwilda.com/2014/04/02/study-poor-sleep-quality-can-lead-to-cognitive-problems-in-older-men/

Sarah Klein reported in the Huffington Post article, Sleep Problems Equal To Binge Drinking, Marijuana Use In Predicting Poor Academic Performance:

While the temptations to stay up late are many, a small new study suggests a very good reason for college students to hit the hay. Those who are poor sleepers are more likely to get worse grades and to withdraw from a course, according to a new study. In fact, the effects of poor sleep were about as strong as binge drinking and marijuana use on a student’s academic performance.
The researchers analyzed data from over 43,000 students included in the spring 2009 American College Health Association’s National College Health Assessment (NCHA). After controlling for potentially confounding factors that might predict how a college student fares academically, like clinical depression, feelings of isolation or chronic health problems, the researchers found that getting poor sleep was a strong predictor of problems at school.
While few students are likely to have a clinical sleep disorder, Roxanne Prichard, Ph.D., associate professor of psychology at the University of St. Thomas in St. Paul, Minnesota tells The Huffington Post, about 60 percent say they have some kind of problem sleeping. But for all the effort colleges put into anti-drinking and de-stressing campaigns, little time or money is spent to promote better sleep — and doing so could help both students and the colleges themselves, she says…. http://www.huffingtonpost.com/2014/06/03/sleep-drinking-marijuana_n_5433148.html?utm_hp_ref=education&ir=Education

Citation:

Poor sleep equal to binge drinking, marijuana use in predicting academic problems

Date: June 2, 2014
Source: American Academy of Sleep Medicine
Summary:
College students who are poor sleepers are much more likely to earn worse grades and withdraw from a course than healthy sleeping peers, new research shows. Results show that sleep timing and maintenance problems in college students are a strong predictor of academic problems. The study also found that sleep problems have about the same impact on grade point average (GPA) as binge drinking and marijuana use.
See, Poor sleep equal to binge drinking, marijuana use in predicting academic problems http://www.sciencedaily.com/releases/2014/06/140602102011.htm

Here is the press release from the American Academy of Sleep Medicine:

FOR IMMEDIATE RELEASE
American Academy of Sleep Medicine
Sunday, June 1, 2014

CONTACT: Lynn Celmer, 630-737-9700, ext. 9364, lcelmer@aasmnet.org

Poor sleep equal to binge drinking, marijuana use in predicting academic problems
DARIEN, IL – A new study shows that college students who are poor sleepers are much more likely to earn worse grades and withdraw from a course than healthy sleeping peers.
Results show that sleep timing and maintenance problems in college students are a strong predictor of academic problems even after controlling for other factors that contribute to academic success, such as clinical depression, feeling isolated, and diagnosis with a learning disability or chronic health issue. The study also found that sleep problems have about the same impact on grade point average (GPA) as binge drinking and marijuana use. Its negative impact on academic success is more pronounced for freshmen. Among first-year students, poor sleep— but not binge drinking, marijuana use or learning disabilities diagnosis—independently predicted dropping or withdrawing from a course. Results were adjusted for potentially confounding factors such as race, gender, work hours, chronic illness, and psychiatric problems such as anxiety.
“Well-rested students perform better academically and are healthier physically and psychologically,” said investigators Roxanne Prichard, PhD, associate professor of psychology and Monica Hartmann, professor of economics at the University of St. Thomas in St. Paul, Minnesota.
The research abstract was published recently in an online supplement of the journal Sleep and will be presented Tuesday, June 3, in Minneapolis, Minnesota, at SLEEP 2014, the 28th annual meeting of the Associated Professional Sleep Societies LLC.
Data from the Spring 2009 American College Health Association National College Health Assessment (NCHA) were analyzed to evaluate factors that predict undergraduate academic problems including dropping a course, earning a lower course grade and having a lower cumulative GPA. Responses from over 43,000 participants were included in the analysis.
According to Prichard, student health information about the importance of sleep is lacking on most university campuses.
“Sleep problems are not systematically addressed in the same way that substance abuse problems are,” she said. “For colleges and universities, addressing sleep problems early in a student’s academic career can have a major economic benefit through increased retention.”
For a copy of the abstract, “What Is The Cost Of Poor Sleep For College Students? Calculating The Contribution to Academic Failures Using A Large National Sample,” or to arrange an interview with Roxanne Prichard or an AASM spokesperson, please contact AASM Communications Coordinator Lynn Celmer at 630-737-9700, ext. 9364, or lcelmer@aasmnet.org.
Established in 1975, the American Academy of Sleep Medicine (AASM) improves sleep health and promotes high quality patient centered care through advocacy, education, strategic research, and practice standards. With about 9,000 members, the AASM is the largest professional membership society for physicians, scientists and other health care providers dedicated to sleep medicine. For more information, visit http://www.aasmnet.org.

According to the Centers for Disease Control (CDC), insufficient sleep is a public health epidemic.

In the article, Insufficient Sleep Is a Public Health Epidemic, the CDC reports:

How Much Sleep Do We Need? And How Much Sleep Are We Getting?
How much sleep we need varies between individuals but generally changes as we age. The National Institutes of Health suggests that school-age children need at least 10 hours of sleep daily, teens need 9-105 hours, and adults need 7-8 hours. According to data from the National Health Interview Survey, nearly 30% of adults reported an average of ≤6 hours of sleep per day in 2005-2007.3 In 2009, only 31% of high school students reported getting at least 8 hours of sleep on an average school night.4
Sleep Hygiene Tips
The promotion of good sleep habits and regular sleep is known as sleep hygiene. The following sleep hygiene tips can be used to improve sleep.
• Go to bed at the same time each night and rise at the same time each morning.
• Avoid large meals before bedtime.
• Avoid caffeine and alcohol close to bedtime.
• Avoid nicotine.
(Sleep Hygiene Tips adapted from the National Sleep Foundation ) http://www.cdc.gov/features/dssleep/

More Americans of all ages need to begin getting a good night’s sleep.

Resources:

National Sleep Foundation’s Teens and Sleep
http://www.sleepfoundation.org/article/sleep-topics/teens-and-sleep

Teen Health’s Common Sleep Problems
http://kidshealth.org/teen/your_body/take_care/sleep.html

CBS Morning News’ Sleep Deprived Kids and Their Disturbing Thoughts http://www.cbsnews.com/2100-500165_162-6052150.html

Psychology Today’s Sleepless in America http://www.psychologytoday.com/blog/sleepless-in-america

National Association of State Board’s of Education Fit, Healthy and Ready to Learn http://eric.ed.gov/?id=ED465734

U.S. Department of Education’s Tools for Success
http://www2.ed.gov/parents/academic/help/tools-for-success/index.html

Related:

Another study: Sleep problems can lead to behavior problems in children https://drwilda.com/2013/03/30/another-study-sleep-problems-can-lead-to-behavior-problems-in-children/

Stony Brook Medicine study: Teens need sleep to function properly and make healthy food choices https://drwilda.com/2013/06/21/stony-brook-medicine-study-teens-need-sleep-to-function-properly-and-make-healthy-food-choices/

University of Massachusetts Amherst study: Preschoolers need naps Does school start too early? https://drwilda.com/tag/too-little-sleep-raises-obesity-risk-in-children/

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