Jagdish Khubchandani

Adverse Childhood Experiences Are Associated With Migraine and Vascular Biomarkers

Objectives.— Migraine is a risk factor for stroke in young women. Biomarker studies implicate endothelial activation as a possible mechanism. Emerging relationships of childhood adversity with migraine, and with inflammation, a component of endothelial activation, suggest that it may play a role in the migraine–stroke association. Our objective is to evaluate the relationship between adverse childhood experiences (ACEs), migraine, and vascular biomarker levels in premenopausal women.

Racial/Ethnic Disparities in Chronic Diseases of Youths and Access to Health Care in the United States

Racial/ethnic minorities are 1.5 to 2.0 times more likely than whites to have most of the major chronic diseases. Chronic diseases are also more common in the poor than the nonpoor and this association is frequently mediated by race/ethnicity. Specifically, children are disproportionately affected by racial/ethnic health disparities. Between 1960 and 2005 the percentage of children with a chronic disease in the United States almost quadrupled with racial/ethnic minority youth having higher likelihood for these diseases. The most common major chronic diseases of youth in the United States are asthma, diabetes mellitus, obesity, hypertension, dental disease, attention-deficit/hyperactivity disorder, mental illness, cancers, sickle-cell anemia, cystic fibrosis, and a variety of genetic and other birth defects. This review will focus on the psychosocial rather than biological factors that play important roles in the etiology and subsequent solutions to these health disparities because they should be avoidable and they are inherently unjust. Finally, this review examines access to health services by focusing on health insurance and dental insurance coverage and access to school health services.

Reducing Firearm-Related Violence on College Campuses—Police Chiefs' Perceptions and Practices

Abstract Context: Firearms are used in the majority of college aged suicides and homicides. With recent efforts by various gun lobbying groups to have firearms more accessible to college students on campuses, there is the potential for more firearm-related morbidity and mortality. Objective: This study assessed university police chiefs’ perceptions and practices concerning selected issues of firearm violence and its reduction on college campuses. Participants: The Directory of the International Association for College Law Enforcement Administrators was used to identify a national random sample of campus police chiefs (n = 600). The respondents were predominantly males (89%), 40 to 59 years of age (71%), Caucasian (85%), and worked for 21or more years in law enforcement (75%). Methods: In the fall of 2008, a 2-wave mailing procedure was used to ensure an adequate response rate to a valid and reliable questionnaire. Results: A total of 417 (70%) questionnaires were returned. A firearm incident had occurred in the past year on 25% of campuses and on 35% of campuses within the past 5 years. The majority of campuses (57%) had a plan in place for longer than a year to deal with an “active shooter” on campus. Virtually all (97%) of the campuses had a policy in place that prohibited firearms on campus. The primary barrier (46%) to a highly visible campus plan for preventing firearms violence was the perception that firearms violence was not a problem on their campus. Conclusions: A greater awareness of the importance of a highly visible campus firearm policy and its potential for reducing firearm trauma on college campuses is needed.

Overweight Misperception among Adolescents in the United States.

The purpose of this study was to examine the discrepancies between perceived and reported overweight status among U.S. adolescents (n>70,000), and to identify factors contributing to such discrepancies. We used the YRBSS data (years 2001-2009) and found statistically significant, gender and race specific discrepancies between perceived and reported overweight status. Factors such as BMI, school performance, and being sexually active are additional predictors of overweight misperception. The findings suggest that evidence based strategies should be employed to help adolescents establish correct weight perception. These strategies should also be tailored based on gender, race, and weight perception of target audience.

Vascular biomarkers in migraine

Aim Migraine has been associated with stroke as well as with several non-atherosclerotic vascular conditions leading to discussions about the potential role of endothelium in the etiopathogenesis of migraine and migraine-associated stroke. We present a systematic review of the literature on vascular biomarkers in migraine, including those suggesting endothelial activation and damage. Methods We conducted a systematic literature search from 1990 to 2013 using multiple research databases with the keywords “migraine,” “headache,” “vascular,” and “biomarkers.” We used selected inclusion and exclusion criteria to create a final pool of studies for this review. Results The literature search identified a total of 639 citations of which 129 were included in our review. The final pool of clinical- and population-based studies assessed the level of various biomarkers (e.g. inflammatory, prothrombotic, endothelial activation, endothelial repair) in migraineurs of varying ages, gender, and demographic characteristics. Although for each biomarker there is at least one study suggesting an association with migraine, in many cases the quality of evidence is poor and there are conflicting studies showing no relationship. The results were, therefore, in each case inconclusive. Conclusion This systematic review indicated that in migraine populations there are a number of positive vascular biomarker studies, including some involving novel biomarkers such as endothelial microparticles and endothelial precursor cells. These lend insight into possible pathophysiological mechanisms by which migraine may be associated with stroke. More high-quality studies are needed to establish whether a true association between promising vascular biomarkers and migraine exists.

Burden of musculoskeletal disorders in the Eastern Mediterranean Region, 1990-2013: findings from the Global Burden of Disease Study 2013.

Objectives We used findings from the Global Burden of Disease Study 2013 to report the burden of musculoskeletal disorders in the Eastern Mediterranean Region (EMR). Methods The burden of musculoskeletal disorders was calculated for the EMRs 22 countries between 1990 and 2013. A systematic analysis was performed on mortality and morbidity data to estimate prevalence, death, years of live lost, years lived with disability and disability-adjusted life years (DALYs). Results For musculoskeletal disorders, the crude DALYs rate per 100 000 increased from 1297.1 (95% uncertainty interval (UI) 924.3–1703.4) in 1990 to 1606.0 (95% UI 1141.2–2130.4) in 2013. During 1990–2013, the total DALYs of musculoskeletal disorders increased by 105.2% in the EMR compared with a 58.0% increase in the rest of the world. The burden of musculoskeletal disorders as a proportion of total DALYs increased from 2.4% (95% UI 1.7–3.0) in 1990 to 4.7% (95% UI 3.6–5.8) in 2013. The range of point prevalence (per 1000) among the EMR countries was 28.2–136.0 for low back pain, 27.3–49.7 for neck pain, 9.7–37.3 for osteoarthritis (OA), 0.6–2.2 for rheumatoid arthritis and 0.1–0.8 for gout. Low back pain and neck pain had the highest burden in EMR countries. Conclusions This study shows a high burden of musculoskeletal disorders, with a faster increase in EMR compared with the rest of the world. The reasons for this faster increase need to be explored. Our findings call for incorporating prevention and control programmes that should include improving health data, addressing risk factors, providing evidence-based care and community programmes to increase awareness.

Providing assistance to the victims of adolescent dating violence: a national assessment of school nurses' practices.

BACKGROUND This study assessed the perceptions and practices of school nurses regarding adolescent dating violence (ADV). METHODS The membership list of the National Association of School Nurses was used to identify a national random cross-sectional sample of high school nurses in the United States (N = 750). A valid and reliable survey instrument was developed and a 3-wave postal mailing procedure was used to maximize the return rate (57%). RESULTS Most school nurses (86.4%) reported that they did not have a protocol in their schools to respond to an incident of ADV. The majority of nurses reported that in the past 2 years, training to assist victims of ADV had not been provided to personnel in their schools (88.1%) and their schools did not conduct periodic student surveys that include questions on teen dating abuse behaviors (71.5%). Nurses who had a school protocol for responding to an incident of ADV perceived significantly fewer barriers to assisting victims of ADV and assisted more victims. Over half (55.3%) of high school nurses reported assisting a victim of ADV in the past 2 years. CONCLUSION Nurses appear to need more training in ADV. In addition, nurses found a number of barriers (eg, lack of training on ADV, lack of time, and lack of private space) to assisting student victims of ADV. Schools need to establish a means for assessing the status of ADV in their student population. Schools also need to provide in-service education for school personnel regarding prevention, assessment, and interdiction of ADV.

Student perceptions and practices regarding carrying concealed handguns on university campuses

Abstract Objective: This multisite study assessed college students perceptions and practices regarding carrying concealed handguns on campus. Participants: Undergraduate students from 15 public midwestern universities were surveyed (N = 1,800). Methods: Faculty members distributed the questionnaire to students in general education classes or classes broadly representative of undergraduate students. Results: Useable questionnaires were returned by 1,649 students (92%). The majority (78%) of students was not supportive of concealed handguns on campuses, and 78% claimed that they would not obtain a permit to carry a handgun on campus, if it were legal. Those who perceived more disadvantages to carrying handguns on campus were females, who did not own firearms, did not have a firearm in the home growing up, and were not concerned with becoming a victim of crime. Conclusions: The majority of students was not supportive of concealed handguns on campus and claimed that they would not feel safer if students and faculty carried concealed handguns.

Indian Students' Perspectives on Obesity and School-Based Obesity Prevention: A Qualitative Examination

Childhood obesity has recently been reported as a growing problem in low- and middle-income countries. One potential prevention strategy is to apply effective obesity prevention approaches from the United States and/or other Western countries into programs that can be implemented in developing countries such as India. The purpose of this study was to explore Indian students’ perceptions of social–contextual factors related to obesity and whether they perceived a role for school-based obesity prevention. This study was conducted as a first step in a model to translate interventions from one culture to another. A total of 183 fourth- and fifth-grade students of middle socioeconomic status participated in focus group discussions. Analyses were guided by the essential principles of qualitative research and informed by social cognitive and social ecological theories. Results yielded five relevant themes: (a) student health behavior knowledge, (b) parental influence on health behavior, (c) school influence on health behavior, (d) media influence on health behavior, and (e) contexts for health promotion intervention. We found that students had moderate knowledge related to health behaviors (i.e., food intake and physical activity); that parents, schools, and the media are all important contributors to healthy and unhealthy behavior; and that schools can play an important role in the prevention of obesity. Results suggest that Indian middle socioeconomic status students are already moderately aware of the health benefits to nutritious food intake and physical activity, but parents, schools, and the media can influence unhealthy behaviors.

Firearm Anticipatory Guidance Training in Psychiatric Residency Programs

ObjectiveMost suicides (60%) are committed with firearms, and most (80%) of individuals attempting suicide meet diagnostic criteria for mental illness. This study assessed the prevalence of firearm injury prevention training in psychiatric residency programs. Methods: A three-wave mail survey was sent to the directors of 179 psychiatric residency programs. Outcome measures were the portion of programs offering training in anticipatory guidance for firearms safety, the content of training if offered, and the perceived benefits and barriers to providing such training.ResultsA total of 115 directors responded, a response rate of 64%. The vast majority (79%) reported they had not seriously thought about providing firearm injury prevention training. However, more than half(55%) reported that they routinely screened patients for firearm ownership. The directors perceived more benefits than barriers to offering such training. Additionally, the majority (62%) thought APA should provide curriculum guidelines regarding firearm injury prevention training.ConclusionPsychiatrists are uniquely positioned for helping to prevent firearm suicides and homicides among the mentally ill. However, psychiatric residency programs are inadequately training residents and thereby keeping them from maximizing their roles as mental health professionals. Leadership is needed by APA to help reduce firearm violence in the United States.