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Neonatal abstinence syndrome (NAS) is a group of problems associated with withdrawal symptoms of a newborn who was exposed to maternal opiate use while in the womb. West Virginia (WV) is of utmost concern as this state exhibits among the highest rates of opioid abuse and consequently, NAS. In this manuscript, we review factors associated with the prevalence of NAS in WV. We provide evidence suggesting that states exhibiting high Medicaid participation demonstrate a high NAS rate, further associating these two factors. Although a similar trend was observed in the substate geographic regions of WV, the presence of regional treatment facilities was negatively associated with NAS prevalence in WV, possibly suggesting that the establishment and utilization of more of these facilities may reduce NAS. Future research investigating factors that contribute to NAS is essential for the elimination of this syndrome.

Objective: The study sought to examine the functional health literacy in a sample of geriatric patients diagnosed with movement disorders. The hypothesis was that the study group would demonstrate marginal levels of health literacy scores on a standardized health literacy instrument., Design/setting: The study used a prospective analysis of patients referred to an outpatient movement disorders clinic in a Veterans Affairs Medical Center., Patients: Fifty-four men with a movement disorder volunteered for the study, with data analysis conducted on 44 of these patients., Main Outcome Measurements: The primary outcome measure was the Test of Functional Health Literacy in Adults (TOFHLA)., Results: Members of the current sample demonstrated adequate health literacy and scored significantly higher on the TOFHLA relative to the measure's normative sample. Younger age, more education, and higher Mini Mental Status Examination (MMSE) scores were predictive of health literacy., Conclusions: The extant literature strongly suggests that limited health literacy is a frequent problem across the United States and represents a considerable obstacle to the effective delivery of health care. In a group of movement disorder subjects with a Folstein MMSE of at least 24, health literacy was generally well preserved. Years with movement disorder and severity of disorder did not impact health literacy. Thus, practitioners should not be prejudiced in a belief that individuals with movement disorders cannot manage their medications.

The authors surveyed 378 third-year psychiatric residents on their attitudes toward psychiatric training, forms of psychotherapy, and the medical model; their treatment preferences for 4 given psychiatric disorders; and their career plans. Correlation coefficients and analysis of variance indicated clustering of attitudes along a dynamic-biological continuum, with medical education and experience with drug therapy rated highest of the training aspects and personal analysis or psychotherapy, training in psychoanalysis, and research rated lowest.

Massive changes in suicide rates over time have been recognized in the United States. An attempt has been made to describe these changes with age-period-cohort analyses. A variety of approaches has led us to conclude that suicide rates of non-white males, white and non-white females can be described adequately without a cohort effect. Recent suicide trends lead to the conclusion that a model based on a rising rate in more recently born white male cohorts coupled with an independent age effect could be rejected. If a cohort effect is postulated for more recent birth cohorts, it would require that the cohort suicide rate is decreasing with each successive birth cohort. Models based on high suicide rates in recent cohorts and additive age effects are probably misleading for future predictions. An association was noted between recent changes in the teenage and young adult suicide rates and rates of depression. Both may be the product of similar social influences.

Following the demonstration by Solomon and Hellon that in the past 30 years, successive birth cohorts in Alberta, Canada, carry successively higher suicide risks as they age, we examined data by birth cohort in the Vital Statistics of the United States by race and sex over a similar period. We found the same phenomenon, in reduced magnitude, in birth cohorts of much greater size. Not only does each successive birth cohort start with a higher suicide rate, at each successive five-year interval it has a higher rate than the preceding cohort had at that age. The regularity of this phenomenon over the past 25 years in the United States implies continually rising suicide rates in these birth cohorts. It suggests that whatever the cause of this effect, it is early and lasting. Birth cohort analysis appears to offer an important new tool for studying suicide. Its implications have only begun to be examined.