Depression and alcohol abuse in asthmatic college students

Utilization and limitations of the American College Health Association's National College Health Assessment instrument: A systematic review

OBJECTIVE

To analyze the literature in which researchers have utilized the National College Health Assessment (NCHA) I or the NCHA II.

PARTICIPANTS AND METHODS

The authors selected peer-reviewed articles published between 2004 and July 2013 utilizing a single search term: National College Health Assessment. Articles were assessed for instrument use, limitations, and data analyses.

RESULTS

The search resulted in 72 articles for inclusion. Researchers used the instrument to either conduct a primary investigation or utilize reference group data for secondary analysis. Researchers used many data analyses, statistical tests, techniques, and methods. Limitations of the instrument were consistently mentioned by researchers.

CONCLUSIONS

Results indicate limitations in the NCHA. To ensure college health professionals are gaining the best information possible regarding students on their campuses, specific improvements to the NCHA are recommended.

Time and risk preferences and the use of asthma controller medication

OBJECTIVES

We investigated the role of risk tolerance, time preference, and asthma-specific attitudes in adherence to asthma control medications.

METHODS

Students with persistent asthma completed an online survey on asthma beliefs, risk tolerance, and time preference (n = 47). The time preference questions measure the degree to which the individual discounts future outcomes and essentially prefers immediate gratification to delayed gratification. The risk tolerance questions indicate the individual's dislike of uncertainty about outcomes. We analyzed the relationship between the independent and dependent variables.

RESULTS

Feelings of embarrassment and concern about medication, as well as risk tolerance and time preference, were found to be significant predictors of adherence to control medication in the logistic regression. Analysis of probabilities associated with different profiles shows that at high rates of risk tolerance and discounting of future outcomes, the probability of adherence is near 0 regardless of asthma-specific attitudes. Asthma attitudes have a statistically significant effect for individuals with low rates of risk tolerance and time preference.

CONCLUSIONS

The risk tolerance and time preferences of the target group should be considered when designing an asthma-intervention program. Individuals who strongly prefer immediate gratification over future benefits and are willing to tolerate uncertain outcomes are unlikely to adhere to controller medication, regardless of their asthma attitudes. In contrast, efforts to affect relevant attitudes will be most fruitful for individuals with low rates of risk tolerance and time preference. However, as we cannot extrapolate these results to a larger population, we must view them with caution.

Alcohol use disorders increase the risk for mechanical ventilation in medical patients

BACKGROUND

Annually, more than 300,000 patients receive mechanical ventilation in an intensive care unit in the United States. The hospital mortality for ventilated patients may approach 50%, depending on the primary diagnosis. In trauma and surgical patients, a diagnosis of alcohol use disorder (AUD) is common and is associated with a prolonged duration of mechanical ventilation. The objective of this study is to determine whether the presence of AUD and the development of alcohol withdrawal are associated with an increased use and duration of mechanical ventilation in patients with medical disorders that commonly require intensive care unit admission.

METHODS

We performed a retrospective cohort study using the Nationwide Inpatient Sample, a large all-payer inpatient database representing approximately 1,000 hospitals. For the years 2002 to 2003, adult patients with 1 of the 6 most common diagnoses associated with medical intensive care unit admission were included in the study. Both univariate analysis and multivariable logistic regression were performed to determine whether AUD and alcohol withdrawal were independently associated with the use and duration of mechanical ventilation in these patients.

RESULTS

There were a total 785,602 patients who fulfilled 1 of the 6 diagnoses, 26,577 (3.4%) had AUD, 3,967 (0.5%) had alcohol withdrawal, and 65,071 (8.3%) underwent mechanical ventilation (53% <96 hours, 47%> or =96 hours). Independent of the medical diagnosis, AUD was associated with an increased risk of requiring mechanical ventilation (13.7 vs 8.1%, odds ratio=1.49, 95% confidence interval [1.414; 1.574], p<0.0001) but was not associated with a prolonged duration of mechanical ventilation. However, the presence of alcohol withdrawal was associated with a longer duration of mechanical ventilation (57 vs 47%> or =96 hours, odds ratio=1.48, 95% confidence interval [1.266; 1.724], p<0.0001).

CONCLUSIONS

In patients with medical diagnoses associated with intensive care unit admission, AUD increases the risk for mechanical ventilation while the development of alcohol withdrawal is associated with a longer duration of mechanical ventilation.