Highlights In white patients with chronic kidney disease, those with depressive symptoms had a higher risk of early death than those without depressive symptoms. This risk was much lower after accounting for use of anti-depressants, however. In black patients, the presence of depressive symptoms was not linked to risk of death. Results from the study will be presented at ASN Kidney Week 2017 October 31–November 5 at the Ernest N. Morial Convention Center in New Orleans, LA. Treatment of depressive symptoms may help lower the risk of early death in individuals with chronic kidney disease, but racial/ethnic differences may exist. The findings come from a study that will be presented at ASN Kidney Week 2017 October 31–November 5 at the Ernest N. Morial Convention Center in New Orleans, LA. Depression is common, under-recognized, and undertreated among patients with chronic kidney disease, especially among racial/ethnic minorities. Delphine Tuot, MD (University of California, San Francisco) and her colleagues assessed the presence of depressive symptoms among 3725 participants in the Chronic Renal Insufficient Cohort (CRIC). The team found that 23.3% of participants had depressive symptoms at the start of the study, with 17.0% prevalence of anti-depressant use. The rate of death was 3.37 per 100 person-years during a median of 6.7 years of follow-up. (A person-year is the number of years of follow-up multiplied by the number of people in the study.) In white individuals, those who experienced depressive symptoms had a 1.5-fold higher risk of death than those without depressive symptoms, even when taking into consideration socioeconomic factors, severity of kidney disease, and burden of other chronic conditions. This risk was much lower when the researchers accounted for use of anti-depressants, however. In black individuals, the presence of depressive symptoms was not linked to risk of death. The findings suggest that depressive symptoms may be differentially associated with the risk of early death among white and black individuals with CKD. “This study confirms prior research that depressive symptoms are common among individuals with CKD and suggests that there are potential long-term mortality benefits of treating depression among patients with mild to moderate kidney disease. More research is needed to understand differences in mortality risk among racial/ethnic subgroups,” said Dr. Tuot. Study: “Treatment of depression symptoms is associated with attenuated risk of all-cause mortality” (Abstract 2763107) ASN Kidney Week 2017, the largest nephrology meeting of its kind, will provide a forum for more than 13,000 professionals to discuss the latest findings in kidney health research and engage in educational sessions related to advances in the care of patients with kidney and related disorders. Kidney Week 2017 will take place October 31–November 5, 2017 in New Orleans, LA. Since 1966, the American Society of Nephrology (ASN) has been leading the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients. ASN has nearly 17,000 members representing 112 countries. For more information, please visit www.asn-online.org or contact us at 202-640-4660.
When people thank veterans for their service, they often are thinking of the commitment they made when they enlisted. They are less aware of the unique challenges veterans face transitioning from military service to civilian life. In 2016, there were 20.9 million veterans in the United States. Out of those, approximately 453,000 were unemployed, according to the Bureau of Labor Statistics. Returning veterans often find they have to reconnect and re-establish their roles with their families. They also struggle to obtain health care and navigate benefits. Vets4Warriors – a confidential, 24/7 peer support network for service members, veterans and their families operated out of Rutgers University Behavioral Health Care – helps ease this transition by providing solutions to physical, mental or social challenges before they turn into crises. Staffed by veterans trained in behavioral health, the network is available via phone (855-838-8255), live chat or text. Rutgers Today spoke to Maj. General (ret.) Mark Graham, Director of Vets4Warriors, about what the public should know about the challenges that veterans face – and how they can make the transition easier. What are the main reasons people call Vets4Warriors? Our peer support specialists make over 1,100 contacts each week with veterans, those on active duty and family members for reasons ranging from anxiety, loneliness, depression and post-traumatic stress disorder to financial and relationship issues. Often, callers just want to talk. Although we focus on peer support, we also connect callers to organizations that provide resources to help them get services such as health care, insurance, employment, housing and benefits. Our peers continue to follow up with callers for as long they need; we build relationships. How are veterans uniquely positioned to help other veterans in need? The military has a culture and structure that is different than the civilian world. There is a strong camaraderie and bond that forms in the military – whether a person has been deployed or not. When you’re in the military, your unit becomes your second family. That bond is severed when people leave the service; our peer support specialists fill that role, providing an empathetic ear that can only be given by someone who has “been there.” Many veterans – whether they just retired from service or have been out for decades –have a difficult time disclosing that they are struggling because they do not want to appear “weak.” However, when they call Vets4Warriors, they reach a peer who understands the culture and the connections made in the military. Since our conversations are confidential, outside of the military chain of command and answered immediately by a fellow veteran, we are able to establish an immediate trust. Peers don’t judge or share what they are told; it all stays in the vault. Whenever possible, we try to match callers to peers of the same gender and military branch. We also have military family members who can provide peer support to spouses and parents who are struggling with the demands that come with having a loved one who is serving or has just returned home. Vets4Warriors is based on the Reciprocal Peer Support model, which was developed at Rutgers University Behavioral Health Care Call Center. The idea is that by helping callers, the peer support specialists likewise receive support back. They reinforce each other. What challenges do veterans face when securing employment? How can civilians help? Many veterans have never applied to civilian jobs; they must learn a whole new skill set – in short order. Creating a resume can be difficult. They don’t know how to translate their military experience into civilian terms. They also are not used to listing their individual accomplishments; in the military, it’s never “I,” it’s “we.” Civilians can help by reviewing veterans’ resumes to ensure they are presenting their skills effectively and in a way that can be understood. Companies can be more attuned to how a veteran’s experiences translate to the workforce. For example, the military builds leadership skills. A lot of responsibility is given to young men and women, which increases as they progress through the ranks. These leadership qualities as well as veterans’ ability to be flexible and agile are skills that are important in the civilian workforce. Also, veterans have been trained to seek solutions from a variety of perspectives – another valuable skill. How can the public help ease the transition of returning veterans? Although veterans appreciate when people acknowledge their service, what they really want is to be given opportunities in the civilian world. Accept and welcome them into your community – where you live, work, worship and volunteer. Look for ways to engage them in your organizations; you’ll find they are great teammates.
Retired Lieutenant General and 21st U.S. Air Force Surgeon General Dr. Thomas W. Travis will be the featured speaker at the University of Texas Southwestern Medical Center Third Annual Tribute to Veterans, Nov. 7. Travis, the Senior Vice President for the Uniformed Services University of the Health Sciences’ Southern Region in San Antonio, Texas, will share a personal story about an Air Force medic who was severely wounded by an IED attack in Afghanistan, representative of the sacrifices made by Veterans and the medical advances seen in the current long war. “Veterans Day provides us with a wonderful opportunity to recognize our fellow UT Southwestern employees who are veterans of the U.S. Armed Forces and thank them for their dedication and service to our country. UT Southwestern Medical Center is committed to ensure a diverse workforce - one that fosters an environment of inclusiveness and respect. Welcoming veterans is part of that commitment,” said Ivan Thompson, UT Southwestern vice president for Human Resources. The event is being hosted by the UT Southwestern Office of Diversity & Inclusion and Equal Opportunity, along with the Veterans Business Resource Group. It starts at 11 a.m. in the Eugene McDermott Plaza, D1.600 Lecture Hall on South Campus. “We are honored to have General Travis as our keynote speaker for the University of Texas Southwestern Medical Center’s 2017 Veterans Day event,” said Kim Siniscalchi, Vice President for Strategic Initiatives and Executive Sponsor for the Veterans Business Resource Group. “In 2015, UT Southwestern held their inaugural Veterans Day event, and it was a huge success! Based on the positive feedback from our veterans, Dr. Podolsky [the university president] decided to make it an annual event honoring our veterans, families, and Health Professions Scholarship Program [medical] students. This year we have a unique opportunity to hear from the 21st Surgeon General of the U.S Air Force. And, not only is he a former surgeon general, he is also an experienced fighter pilot, and he has a great story to tell.” Travis served in the U.S. Air Force from 1976 until 2015. He entered the service as an ROTC program distinguished graduate from Virginia Polytechnic Institute and State University, and went on to become an F-4 pilot and aircraft commander prior to attending medical school at USU. He held a number of prestigious career assignments, including chief of medical operations for the Human Systems Program Office at Brooks Air Force Base in San Antonio, director of Operational Health Support and chief of the Aerospace Medicine division for the Air Force Medical Operations Agency in Washington, DC. He later became deputy Surgeon General of the U.S. Force, followed by Surgeon General, overseeing a $6.6 billion, 44,000-person integrated health care delivery system serving 2.6 million beneficiaries at 75 military treatment facilities worldwide. “When I was asked to speak to the UT Southwestern Medical Center as they honor Veterans this year, I immediately said yes. I have had the amazing opportunity to work closely with all of our uniformed services for many years,” said Travis. “I am very grateful to be able to recognize and thank the UT Southwestern veterans for their service, and hopefully provide some insights and inspiration to this important audience.” The Uniformed Services University of the Health Sciences (USU), founded by an act of Congress in 1972, is the academic heart of the Military Health System. USU students are primarily active-duty uniformed officers in the Army, Navy, Air Force and Public Health Service who receive specialized education in tropical and infectious diseases, TBI and PTSD, disaster response and humanitarian assistance, global health, and acute trauma care. A large percentage of the university’s more than 5,800 physician and 900 advanced practice nursing alumni are supporting operations around the work, offering their leadership and experience. USU’s graduate programs in biomedical sciences and public health are committed to excellence in research and oral biology. The university’s research program covers a wide range of clinical and basic science important to both the military and public health. For more information, visit www.usuhs.edu.
As a combat engineer in the Army, Stephen Bettini helped train soldiers to navigate and overcome obstacles. To fulfill an important objective, sometimes it meant building bridges. Other times, it meant removing them. Now, Bettini is building bridges of a different kind: Earlier this year, he was hired as Cedars-Sinai’s first full-time military veteran recruiter, a new position to help veterans establish and maintain careers in the health system. Bettini is trumpeting the message that Cedars-Sinai is veteran friendly — whether that means recruiting candidates at job fairs, assisting spouses in gaining employment or keeping veterans informed about available state and federal benefits. Cedars-Sinai already employs approximately 265 veterans and has made hiring more former service members a priority. “I’m excited to help bring in more veterans who are wonderfully talented men and women,” Bettini said. “They have a great set of skills we want to tap, and they are focused on mission. That’s who we need here.” Bettini said veterans not only possess the knowledge and experience to perform specific jobs, but they also have an abundance of what employers refer to as “soft skills”— personal traits that enable them to excel in the workplace. “Their soft skills are just off the scale,” Bettini said. “They are trained to work within diverse teams, to deal with adversity and to lead. They are very dedicated. Basically, they have everything the military instills in its people.” Creating and filling Bettini’s position was a top agenda item for Andy Ortiz, senior vice president of Human Resources and Organization Development. Ortiz, who joined Cedars-Sinai last year, grew up in a household that had the highest respect for veterans. His father served in the Vietnam War. “We have to have the best, most capable people to deliver on our mission as an organization, and from my perspective, vets fit that bill,” Ortiz said. “Hiring them is good to do for the community, and it is part of our talent strategy. It’s the right thing to do.” Hiring Bettini is the latest effort by Cedars-Sinai to support veterans and their spouses. In October, the organization was accepted into the Military Spouse Employment Partnership Program, a Department of Defense initiative that helps spouses of active duty military members land jobs in the private sector by pairing the military with leading businesses, including Amazon, Comcast, Southwest Airlines and Hyatt Hotels. In February, Cedars-Sinai was recognized by the Department of Defense for supporting employees in the National Guard and Reserve. Once on the job, Bettini quickly found that Cedars-Sinai enjoys strong name recognition and a stellar reputation. But like other large Southern California employers, some prospective employees weren’t sure they wanted to deal with the region’s high cost of living and congested roadways. “Commute times can be a barrier,” Bettini said. “But people also know we are among the best at what we do and they want to be part of that.” This is not the first time Bettini has acted as a recruiter. He formerly served as a nurse recruiter for Kaiser Permanente, and he worked as a recruiter toward the end of his Army hitch in several places, including Reseda and Glendale. Attitudes about veterans have dramatically changed since 1975 when Bettini enlisted in the Army. With the national trauma of the Vietnam War still fresh, Bettini remembers going to a bar and being insulted because he was in uniform. “The anti-military sentiment was pretty strong back then,” he said. The military was not Bettini’s original career plan. He wanted to be a baseball player and had a scholarship to play at the collegiate level, but a car accident left him with an injured leg. He lost his scholarship and eventually joined the Army. Bettini was stationed in Germany before the Berlin Wall was torn down. At the time, tourists from the west could take short trips into East Berlin. His brief look behind the Iron Curtain with its onerous state controls and flagging economy gave him a new appreciation for the sacrifices made to keep western Europe free. “It really made me feel proud of what the soldiers before had done and what I was doing there,” he said. He has a similar feeling about working at Cedars-Sinai. “I love being here,” Bettini said. “I want every organization to know Cedars-Sinai is here and that we are serious about hiring veterans.”
Since 9/11, more than 2 million men and women have deployed to Iraq, Afghanistan and other conflict zones as part of the war on terror. With up to 20 percent now reporting symptoms of post-traumatic stress disorder, both they -- and their families – must cope with the invisible wounds of war. Symptoms of PTSD can include irritability, isolation, agitation, jumpiness, nightmares, sleep disturbances and substance abuse. All of these can take a toll not just on the person with PTSD, but on their loved ones as well. Dr. Jo Sornborger, director of psychologic health for the UCLA Health Operation Mend program, specializes in the unique mental health needs of veterans and their families. Operation Mend provides advanced surgical and medical treatment, as well as comprehensive psychological support, for post 9/11 service members, veterans and their families. Too often, Sornborgor says, families tend to continuously focus the majority of their physical, emotional and mental resources into taking care of the family member with PTSD, inadvertently creating an imbalance that can both constrain the veteran’s healing and further stress the family. Sornborger points out, however, that a psychological injury such as post-traumatic stress does not mean a person is incapable of contributing to the family’s ability to function as a unit. “It might seem easier to avoid including the injured vet into the daily routines of household, but this strategy comes at a significant cost to the whole family in the long run. It often leaves them drained of internal resources, resentful and can erode the self-worth of the injured veteran,” says the licensed clinical psychologist. “If the family recalibrates the resource distribution, the household will run more efficiently, be more cohesive and everyone will feel like they belong and have a purpose.” To interview Dr.Sornborgor, please contact Amy Albin, UCLA Health Sciences Media Relations, at (310) 267-7095 or firstname.lastname@example.org. ** UCLA Health Operation Mend (www.operationmend.ucla.edu) provides advanced surgical and medical treatment as well as comprehensive psychological support for post 9/11 service members, veterans and their families. It also offer an intensive, six-week outpatient treatment program for PTSD and TBI in a collaboration between Wounded Warrior Project® and three other academic medical centers, including Emory Healthcare, Massachusetts General Hospital and Rush University Medical Center, in cooperation with the U.S. Department of Veterans Affairs.
The severity of symptoms can be reduced for individuals with emerging post-traumatic stress disorder through the use of smart phone apps, according to a new study published in the August edition of the journal Cyberpsychology, Behavior, and Social Networking by researchers at the Uniformed Services University (USU).About 10 to 20 percent of U.S. service members returning from Iraq and Afghanistan are believed to have post-traumatic stress disorder (PTSD), associated with impaired physical and mental health, as well as overall functional status. Sub-threshold PTSD, defined by an insufficient number of symptoms or severity to meet the full criteria of PTSD, is even more common than PTSD. Sub-threshold PTSD also has a 25 percent progression rate to the full disorder, which underscores the importance of early intervention. Considering prior studies have shown it may be more beneficial to address sub-threshold PTSD with lower intensity treatment, researchers at USU’s Center for Neuroscience and Regenerative Medicine (CNRM), in collaboration with the National Intrepid Center of Excellence at the Walter Reed National Military Medical Center, sought to test the feasibility and effectiveness of using not-so-intense smart phone apps to help reduce sub-threshold PTSD symptoms. The researchers provided apps to 144 service members and military family members identified as having sub-threshold PTSD. The apps were designed to foster engagement in social activities, while promoting relaxation, psychoeducation, and controlled breathing and meditation – approaches that have been linked with enhanced resilience and reduced likelihood of mental health conditions. Participants were divided into a randomized group and a control group, a majority of which were men and service members, and about half had been deployed to Iraq or Afghanistan. Every day for six weeks, the researchers sent text messages to the randomized group as reminders to use the apps on a daily basis. Meanwhile, the control group received daily texts with inspirational quotes, but weren’t directed to use the apps. Participants in both groups, regardless of whether they were directed to use the apps, reported reduced symptoms of PTSD, anxiety, and depression during the six-week period. However, the group receiving daily texts prompting them to use the apps, did report using the apps more.Participants used a variety of apps, including Tactical Breather, created by the National Center for Telehealth and Technology, a component of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury. This app was designed to teach service members how to use breathing to control their stress, emotions, and physiological responses to stress. Other apps featured techniques to help with relaxation and positive thinking via mindfulness exercises, inspirational quotes, and coping statements. Both groups of participants reported their reduced symptoms were sustained after three months, but after around six to 12 months, some showed a partial relapse. The researchers suggest evidence of relapse in general is not unexpected since PTSD, depression and anxiety are often more chronic than acute conditions. “Smartphone apps are easy to use anywhere, anytime, so military personnel could even use them just before, or during, deployment to help cope with the stress of deployment,” said Dr. Michael J. Roy, professor of medicine at USU and a retired Army colonel. Dr. Roy was lead author on the study, funded by CNRM. The researchers also suggest this app-based approach, on a long-term basis, could be beneficial in continuing to reduce sub-threshold PTSD symptoms over time, though further studies will need to be conducted. Automatic alerts could be set up on an individual’s phone, the researchers said, to help promote use of these apps on a long-term basis, or they could be promoted in follow-up visits to their primary or behavioral health care providers.Roy’s study co-authors include Dr. Michelle Costanzo, with USU’s Center for Neuroscience and Regenerative Medicine, Dr. Krista Highland, with USU’s Department of Military and Emergency Medicine, and Dr. Cara Olsen, with USU’s Department of Preventive Medicine and Biostatistics.
UAB clinical psychologist Dr. Josh Klapow says hurricane-weary residents of the Caribbean and Southeastern United States are in an emotional marathon to get back safely to home and now have to gear up emotionally for potentially another storm. People do have emotional bandwidth and thresholds, at some point the body and the mind gives up and give in. The emotional fatigue for victims, first responders, and the general public effects how we respond, how intensely we respond, how we are able to survive. Klapow says there are coping techniques that can help shore up the emotional and physiological reserves needed to handle a potential second strike. In the long run- however, a small number of people may permanently see an alteration of their psychological state. PTSD, depression, anxiety disorders are likely. UAB's broadcast studio is available for live or taped interviews.
A new study finds that patients with cancer, especially those aged 75 or older, are more likely to be admitted to the hospital – and less likely to be observed and released home – than patients without cancer. That’s despite the fact that inpatient admission is not always the best treatment option available. Observation status is often preferable because it minimizes patients' exposure to the inconvenience and risk of a hospital admission, while also reserving hospital resources for those who need it most. The research was led by Allison Lipitz-Snyderman, PhD, Assistant Attending Outcomes Research Scientist, Memorial Sloan Kettering Cancer Center, along with Adam Klotz, MD; Renee L. Gennarelli, MS; and Jeffrey Groeger, MD. The findings were published in the October issue of JNCCN – Journal of the National Comprehensive Cancer Network. “Observation status allows for additional time to be certain that a patient's clinical status is stabilized and that the correct diagnosis has been made, providing the treating staff, patient, and caregiver with a greater feeling of security upon discharge,” explained Dr. Groeger. “Not all acutely ill patients in the emergency department will ultimately require inpatient admission prior to safe discharge. Patients in observation status should be suitable for rapid discharge once symptoms resolve or diagnoses are confirmed.” After adjusting for patient characteristics, the researchers determined that there were only 43 observation status visits per 1,000 inpatient admissions among patients with cancer, versus 69 per 1,000 among the cancer-free group. In fact, cancer-free patients with prior inpatient admission were still more likely to be placed on observation status than those with cancer but without prior hospitalizations. The research focused on Medicare beneficiaries aged 66 and older. Dr. Lipitz-Snyderman and her team analyzed SEER-Medicare data for a total of 151,193 patients with cancer, matched to a demographically similar control group. Those with cancer had been diagnosed with breast, colon, lung, or prostate cancer between 2006 and 2008. Dr. Lipitz-Snyderman recommends more research to determine where there are opportunities to develop standards for emergency department staff to treat older patients with cancer in the most optimal way. “By implementing a set of standards and treatment protocols for addressing specific clinical conditions, we can increase the systematic use of observation status for patients with cancer,” said Dr. Groeger. “Some examples include the management of pain, nausea, vomiting, diarrhea, constipation, cellulitis, hypercalcemia, and steroid related hyperglycemia. Additionally, partnering with medical and surgical consultants can offer significant relief to patients with pleural effusions, ascites, as well as those with malfunction around the placement of catheters and drains.” “This study raises important questions about how to provide medical care for older adults with cancer who present to the emergency department,” said Dr. Louise C. Walter, MD, Professor of Medicine, Chief, Division of Geriatrics, UCSF Helen Diller Family Comprehensive Cancer Center. Dr. Walter is a member of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Panel for Older Adult Oncology. “As a geriatrician, I would go beyond advocating for developing standards for emergency department staff to manage more patients with cancer in observation status. We need to think broadly about the best location to provide medical care for this population. This should include implementing more Hospital at Home models and Housecalls programs to provide the same level of acute care for certain conditions in a patient's home, in order to avoid the hazards of long emergency department stays and unnecessary hospitalizations.” Complimentary access to the study, “A Population-Based Assessment of Emergency Department Observation Status for Older Adults with Cancer,” is available until December 11, 2017 on JNCCN.org. ### About JNCCN—Journal of the National Comprehensive Cancer Network More than 25,000 oncologists and other cancer care professionals across the United States read JNCCN—Journal of the National Comprehensive Cancer Network. This peer-reviewed, indexed medical journal provides the latest information about best clinical practices, health services research, and translational medicine. JNCCN features updates on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®), review articles elaborating on guidelines recommendations, health services research, and case reports highlighting molecular insights in patient care. JNCCN is published by Harborside Press. Visit JNCCN.org. To inquire if you are eligible for a FREE subscription to JNCCN, visit http://www.nccn.org/jnccn/subscribe.asp. Follow JNCCN on Twitter @JNCCN. About the National Comprehensive Cancer Network The National Comprehensive Cancer Network® (NCCN®), a not-for-profit alliance of leading cancer centers devoted to patient care, research, and education, is dedicated to improving the quality, effectiveness, and efficiency of cancer care so that patients can live better lives. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. As the arbiter of high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers. The NCCN Member Institutions are: Fred & Pamela Buffett Cancer Center, Omaha, NE; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; City of Hope Comprehensive Cancer Center, Los Angeles, CA; Dana-Farber/Brigham and Women’s Cancer Center | Massachusetts General Hospital Cancer Center, Boston, MA; Duke Cancer Institute, Durham, NC; Fox Chase Cancer Center, Philadelphia, PA; Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, WA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Mayo Clinic Cancer Center, Phoenix/Scottsdale, AZ, Jacksonville, FL, and Rochester, MN; Memorial Sloan Kettering Cancer Center, New York, NY; Moffitt Cancer Center, Tampa, FL; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, OH; Roswell Park Cancer Institute, Buffalo, NY; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO; St. Jude Children’s Research Hospital/The University of Tennessee Health Science Center, Memphis, TN; Stanford Cancer Institute, Stanford, CA; University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; UC San Diego Moores Cancer Center, La Jolla, CA; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; University of Colorado Cancer Center, Aurora, CO; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; The University of Texas MD Anderson Cancer Center, Houston, TX; University of Wisconsin Carbone Cancer Center, Madison, WI; Vanderbilt-Ingram Cancer Center, Nashville, TN; and Yale Cancer Center/Smilow Cancer Hospital, New Haven, CT. Clinicians, visit NCCN.org. Patients and caregivers, visit NCCN.org/patients. Media, visit NCCN.org/news. Follow NCCN on Twitter @NCCNnews and Facebook @National.Comprehensive.Cancer.Network.
About a quarter of adults whose marijuana use is problematic in early adulthood have anxiety disorders in childhood and late adolescence, according to new data from Duke Health researchers. The findings, publishing this week in the November issue of the Journal of the American Academy of Child and Adolescent Psychiatry, also shed light on an estimated 4 percent of adults who endured childhood maltreatment and peer bullying without resorting to chronic marijuana abuse, only to develop problems with the drug between the ages of 26 and 30. “Given that more states may be moving towards legalization of cannabis for medicinal and recreational purposes, this study raises attention about what we anticipate will be the fastest growing demographic of users -- adults,” said lead author Sherika Hill, Ph.D., an adjunct faculty associate at the Duke University School of Medicine. “A lot of current interventions and policies in the U.S. are aimed at early adolescent users. We have to start thinking about how we are going to address problematic use that may arise in a growing population of older users.” The findings are based on data from 1,229 participants in the Great Smoky Mountains Study, a long-term study of residents in 11 counties near the Appalachian Mountains in western North Carolina, where Hispanics and Latinos are underrepresented and Native Americans are overrepresented compared to the rest of the U.S. A cohort of children in the study were enrolled as young as age 9 and have now reached their 30s. From 1993 to 2015, researchers tracked data in numerous areas of interest, including mental health, education, work attainment, and use of drugs and alcohol. The researchers defined problematic cannabis or marijuana use as daily consumption or a habit that meets diagnostic guidelines for addiction. They tracked participants’ patterns of use from the college years (ages 19-21) into adulthood (ages 26-30). They found more than three-fourths (76.3 percent) of participants didn’t use or develop a problem with marijuana during this period. The remaining quarter developed problems that researchers grouped into three profiles -- those with limited problems, persistent problems and delayed problems. Limited users (13 percent) Limited problematic users had trouble with marijuana either while in school before age 16 or in their late teens and early 20s, but their habits dropped off as they aged. Researchers were somewhat surprised that this group reported the highest levels of family conflict and instability during childhood as compared to others in the study; these factors are often associated with more drug use. “When this group of children left home, they seemed to do better,” Hill said. “They didn’t have as many children at a young age, and they went further in their education when they were 19 to 21 compared to those with persistent and delayed profiles.” Persistent users (7 percent) This group had trouble with marijuana beginning as young as 9 years old and their chronic use continued into their late 20s and early 30s, the data showed. Large portions of this group had anxiety disorders in both childhood (27 percent) and at ages 19-21 (23 percent). They had the highest rates of psychiatric disorders and involvement in the criminal justice system, and most said the majority of their friends were drug users, too. “This suggests that a focus on mental health and well-being could go a long way to prevent the most problematic use,” Hill said. Delayed users (4 percent) This was a small but unique group that made it through adolescence and early adulthood without problematic marijuana use, only to become habitual users between ages 26 and 30. Blacks were five times as likely as whites to be delayed problematic users in the late 20s and early 30s after not having trouble with the between the ages 19-21 -- a peak time for most marijuana users. More than half of delayed users were both bullied by peers and mistreated by caregivers as children, yet also had lower rates of anxiety, alcohol use, and other hard drug use compared to persistent users. “What we don't yet understand is how childhood maltreatment didn’t prompt earlier problematic use of cannabis between ages 19 and 21 -- how individuals could be resilient to that kind of adverse experience for so long,” Hill said. “One theory is that they were somewhat protected by having fewer peers in late adolescence who were substance users, but this is one of the questions we will continue to seek answers for.” In addition to Hill, study authors include E. Jane Costello, Ph.D., and William Copeland, Ph.D., of Duke and Lilly Shanahan Ph.D., of the Jacobs Center for Productive Youth Development, University of Zurich. The research was supported by the National Institutes of Health (NIDA: R01DA036523, R01DA11301, P30DA23026; NIMH: MH094605, MH63970, MH63671, MH48085; NICHD: HD07376) and the William T. Grant Foundation. Full author disclosures are listed in the manuscript.
A few months into his second deployment in Afghanistan in 2015 — which interrupted his studies at the University of Virginia Darden School of Business — U.S. Army Staff Sgt. Michael Sargent found himself trapped by Taliban insurgents in a dark, muddy compound in the country’s tumultuous Helmand province. Sargent’s Special Forces team — an elite Army special operations unit nicknamed the “Green Berets” — led commando operations with Afghan counterparts, typically serving as guides and consultants as the U.S. military scaled down its operations in the country. The events of this particular evening, however, compelled Sargent and the rest of his team to take a very active role. The commando assault team Sargent was tasked with advising had entered the compound, but was forced to retreat under heavy enemy fire. Several commandos were wounded and two were missing. Sargent and a few other teammates returned to find them and again encountered stiff resistance. Ultimately, Sargent and one other soldier were stuck in the compound, trying to retrieve the body of a fallen commando while Taliban fighters fired on them and blocked their only exit. Sargent recalled quickly running through his dwindling options. “There was no way to get out without one of us having to expose our backs, and the gunfire exchanges were not as effective as we wanted,” he said. “So, my teammate twice provided suppressing fire while I advanced to deploy hand grenades into the enemy position. The second grenade started a fire near the insurgents.” The flames forced the Taliban fighters to stage one final assault before fleeing the growing fire, giving Sargent and his teammate the window of opportunity they needed. “At that point, we were able to neutralize the threat, retrieve the fallen commando and get out,” Sargent said. Sargent’s quick thinking that night saved his and his teammates’ lives, allowed them to return the commando’s body to his family and protected the commandos wounded earlier. They also earned him one of the military’s highest honors. In May 2016, Sargent received the Silver Star Medal, the U.S. military’s third-highest personal decoration for valor in combat. Later that year, in December, the United Service Organizations, or USO, presented him with the George Van Cleave Military Leadership Award. One soldier from each branch of the military is nominated for the annual award, which recognizes selfless leaders who inspire and uplift others. “It’s been an incredible, very humbling experience,” said Sargent, who returned to Darden in August 2016. A second deployment to Afghanistan was not part of Sargent’s original plan. After six years of active duty service as a Green Beret – including his first deployment to Afghanistan in 2011 – the Union College graduate had transitioned to the National Guard to pursue his MBA. His friend and mentor, fellow Union alumnus and Green Beret Kevin Flike, had attended business school after being wounded in combat and convinced Sargent it would give him the skills he needed to transition into civilian life. He knew several Darden alumni and was interested in the format of Darden’s Global Executive MBA program, which includes residencies in South America, Asia and Europe. “I had been given the opportunity to experience a lot of what the world had to offer through a military and government lens, but this gave me an opportunity to build on that from a business standpoint,” Sargent said. “It seemed perfect.” Indeed, Sargent loved his first year in the program. However, it was interrupted when, in May 2015, he learned that his Green Beret unit was scheduled to return to southern Afghanistan and the Helmand province, where Taliban insurgents were regaining strength. That information raised a tough question: Should he interrupt his education to redeploy with that team? The answer would put him on the path toward that dark Taliban compound. “On my first deployment, one of my teammates was killed and one of my closest friends [Flike] was shot and wounded,” Sargent said. “Leaving Afghanistan was bittersweet, because it felt a bit unfinished.” That feeling nagged him even as he switched gears at Darden and ultimately compelled him to return. “I knew I was putting a lot on the line, with all I had started to learn at Darden and the momentum I had developed there,” he said. “But I also knew I could not stand by and watch as my teammates went over there. I wanted to go and felt like I needed to. It just seemed right.” He worked with Darden administrators to determine the best way for him to leave and eventually return to the program. Ultimately, it meant leaving Sargent’s original class — the Class of 2016 — and later joining the Class of 2017 in its final year of the 21-month program. Sargent would have to pause his job search process, leave classmates he had already spent a year with and quickly relearn class concepts after a year off. “It is a challenge, because students who take time off and then return are stepping into a brand-new class that has already spent a year together in intensive residencies and grown very close,” said Larry Mueller, an assistant dean of global advising and former dean of the Global Executive MBA program. “Still, this was not the first time we had a student change classes to complete military service. There were many class members who were either in service or military veterans, so our students are certainly very welcoming and understanding.” When Sargent returned to the U.S. in February 2016, Mueller and other faculty members worked with him to make up missed classes and assignments and placed him on a learning team – small teams that students are assigned to for much of the program – that included a fellow veteran. Advisers in Darden’s Career Development Center helped him restart his search for a post-graduation job. “Coming back was a bit of a difficult transition, but my cohort was incredibly open and the professors were very willing to help me get back where I needed to be,” Sargent said. And, Mueller pointed out, the lessons Sargent learned in Afghanistan were also instructive for his classmates. “Michael had a really firm and real grasp on making leadership decisions that affect other people’s lives,” Mueller said. “Hearing from veterans like Michael gives students a great recognition of what it means to make sacrifices, honor commitments and be willing to be called upon for one’s specialized abilities. That is an education unto itself.” By June 2016, Sargent had accepted a job offer from Morgan Stanley, which he started immediately after graduating 11 months later. He is currently a year into a three-year training program with the firm’s wealth management division in Seattle, working as a wealth adviser associate. Though he loved his time in the military, Sargent said, the change has been a welcome one. “Morgan Stanley is a fantastic firm, and I am enjoying knowing where I will be in three weeks, six months or a year,” he said. “That sort of stability has allowed me to reconnect with family and friends, to go to all of those weddings and reunions and celebrations that I sometimes had to miss.” This story originally appeared on UVA Today. About the University of Virginia Darden School of Business The University of Virginia Darden School of Business delivers the world’s best business education experience to prepare entrepreneurial, global and responsible leaders through its MBA, Ph.D. and Executive Education programs. Darden’s top-ranked faculty is renowned for teaching excellence and advances practical business knowledge through research. Darden was established in 1955 at the University of Virginia, a top public university founded by Thomas Jefferson in 1819 in Charlottesville, Virginia.