Tuesday, October 31, 2006

Substance abuse help

I came across an interesting website that should be touted to every teen and every parent with teenagers (maybe more particularly with even younger children). It is the website of the Partnership for a Drug-Free America.

It is a great site with information for teens, real information and not “preachy”. Included is information about recognizing whether you or a friend has a “problem” with alcohol or other drugs, and information on helping a friend with a “problem”. It also has personal stories about recovery and in memorial of those that didn’t recover.

There is also a section for parents with information on a wide array of abused substances, support forums, and what to do if your child has a “problem”. It also has a “fun” little test, called The Two-Minute Challenge, testing your knowledge about some important facts about substance abuse. I’m going to help you cheat and give you the answer to what I think is one of the most important questions. I always make a point to tell folks that you can’t scare your kids straight, but if you give them real information they can/will choose to make the right choices and not take chances (at least it is the most likely way to effect behavior in this regard).
4.) One of the most important factors in whether kids decide to try drugs is? Correct! Correct Answer: B. Understanding the perceived risk of using drugs and whether the drugs are deemed socially acceptable. Research shows that perception of risk is one of the most important factors in influencing the decision to use drugs. (Source: Monitoring the Future)

Take a look at the site and its information; it may come in handy in the future.

Monday, October 30, 2006

Tonight's talk on alcohol and adolescent brains

Alcohol (and more specifically ethanol, “drinking alcohol”) is a poison and a depressant drug. The fact that it is a poison often surprises people, but remember it can run your car and it is used in biology to kill insect specimens.

Ethanol has special effects on the adolescent brain, which shouldn’t be surprising when you consider that the adolescent brain is “under construction”. Just raise some kids into and/or through adolescence and you come to realize that it is “damaged” and “getting fixed” (the latter by about the time they are 22).

“Binge” drinking is particularly damaging and that is what most adolescent drinking is. Ethanol affects learning and memory much more significantly in adolescents than adults. Those effects are compounded with significant ethanol consumption (repeat or continued) as an adult. It also appears that changes occur in the adolescent brain with ethanol use that makes it more likely to develop “problem drinking” as an adult.

A significant difference between adolescent and adult drinkers is that for adolescents ethanol has less of a sedation effect and coordination is affected a bit differently. This diminishes the “natural” effects of ethanol to get an individual to stop drinking during one “setting”. Blood alcohol levels can get higher in an adolescent because it takes more for them to become “falling-down drunk” (a “natural” drinking stopper).

However, ethanol still poisons the eyes in both adolescents and adults. Initially ethanol impairs papillary constriction, so bright lights appear brighter and harder to at (think headlights). Then gaze becomes disconjugate giving you double vision. Both of these things make driving very dangerous. At the same time, ethanol makes you “stupid”. You may choose to “follow” the taillights of a parked car. You lose inhibitions, increasing the likelihood of risk taking and making “bad” choices.

This stuff can lead to your death or the death of others. A developing adolescent brain bathed in ethanol is a recipe for death and disaster.

Friday, October 27, 2006

Driving is risky

I’m working on a brief talk I am going to be doing at a public forum next Monday about the effects of alcohol on the adolescent brain. While underaged drinking is a serious problem, and car crashes and deaths caused by drunk drivers is a serious problem (prompting the forum) they are not the “only” problem.

A bit less than 25% of teens killed in car crashes (compared to a bit over 25% of adults killed in car crashes) involve drunk drivers. Serious, yes, but again not the only problem. The Chicago Tribune yesterday ran a story (part of an ongoing, episodic series on teen drivers, their problems and deaths) pertinent to the point that drunk driving is not the only problem.

There are nearly as many fatal crashes involving 16 and 17 year olds that occur between 3 to 5 pm Monday through Friday as there are fatal crashes between 9 pm to 2 am Friday and Saturday nights. The latter more likely having a contribution from alcohol consumption. (National Highway Administration data via AAA via Tribune)

So while it does seem to make sense to focus on the toll of drunk drivers and easier to get folks fired up about drunk drivers killing with their cars, we must also look at the bigger picture. We must work to decrease all car crashes, from all causes. The media used to talk about the carnage on our roads and we ought to keep that in mind and work in a multi-pronged fashion to limit all car crash deaths.

Thursday, October 26, 2006

Demand quality medical care

“Missed diagnoses, incorrect drug dosing, failure to treat promptly”. “100,000 Americans die annually from medical errors”.

As I have mentioned in regards to the “Vance case”, it was the system that failed her, that resulted in her death. We must fix the system to prevent similar deaths in the future. I got 4 more emails decrying the quality of care received by Ms Vance and the care the authors of the emails had received at various places across the country.

There is hope and some of the hope inducing programs are highlighted in a recent Newsweek series. Programs like “Medically Induced Trauma Support Services” that provides support to anyone involved in a “medical misadventure”. The “Executive Walk-Rounds” that occur at Brigham and Women’s Hospital that ensure administrators are abreast of hospital problems, errors and potential errors and that “patient-safety officers” intervene early and remedy the situations. The “Hopkins (Johns Hopkins Medical Center) Center for Innovation in Quality Patient Care” and their “Comprehensive Unit-based Safety Program” exist to head off problems or intervene quickly so they are not repeated. The “100,000 Lives Campaign” to decrease medical errors and preventable problems using proven protocols across the nation.

We deserve quality care in every hospital in our country and in every episode of medical care. As is pointed out in the series the “old” philosophy was to “accept” a certain error rate, just as manufacturing accepts/expects a certain defect rate in their products, but we must be about “striving for perfection” in healthcare in this country. Will we ever be perfect? No, but we must strive and accept no less a goal. “…doctors, nurses, pharmacists and technicians will always make mistakes—it’s the safety net around them that needs to be fixed”. “…we have to put systems in place that stop that error from causing harm”.

Tuesday, October 24, 2006

"Woman's Heart Attack Death Ruled a Homicide"

I got 67 emails last Thursday from all over the US after a link was placed on the WomenHeart website about a recent death here in Lake County and the inquest jury’s verdict. The death was of a 49 year old female who presented to a local ER with 10 out of 10 chest pain, shortness of breath and nausea. She died waiting in the waiting room, 10-20 feet from the care she needed to interrupt her heart attack. The jury came back with a verdict of “homicide”. It was the jury’s feeling, and certainly mine, that this case demands a change, an improvement, in the system that allowed this woman to die on a couch in a waiting room after a 2 hour wait. The emails I received reinforced that opinion.

Many wrote of their experiences of having symptoms “ignored”, and having heart damage as a result. Many felt they were ignored because they were woman. At least one added minority status as a contributor to lack of treatment.

Our country should not have a healthcare system that fails so many in our “community”. It is obviously a system problem and it must be addressed before it kills again. No one should “hang” for this death or any individual death that is a result of a system problem, but we must call attention to the problem that is killing folks. We must demand change. We must demand quality healthcare. Individual malpractice suits are not affecting the system, so we must find other ways to bring this discussion to the fore.

Demand quality. Don’t let people die waiting for, asking for, care.

Monday, October 23, 2006

No typical days

What is your typical day like? I have no typical days.

Last Friday (my birthday, by the way) began with a 2 hour meeting of the regional Child Death Review Team, of which I am a member. We discussed 3 child death cases in the region and whether anything could have been done prior to them to prevent the death or if something could be done in the future to prevent similar deaths. Quite often these can be disheartening discussions, because nothing could have been done to prevent these deaths or can be done to prevent similar deaths. However, sometimes there is that ray of hope/possibility and we make our recommendations for education (public or otherwise) or policy changes. We always hope that we can impact some child and prevent (forestall) their untimely death.

After the meeting I went into Chicago to get the dental records we used later in the day to positively identify an individual who died by train, a suicide. Identification is critical in “our line of work” and it was worth the trip to be sure we knew who the decedent was, no guessing or surmising. The drive gave me time to ponder the imponderability of death. As someone once said, “death is as much a part of our life as the air that we breathe”.

Today my Senior Deputy and I went to notify a family that their son had died this morning in an auto crash. Always a “raw” experience, never are 2 notifications the same. Sons aren’t supposed to die before their parents. A “great tragedy” has happened to those fine folks. It is also a “raw” moment for your heart, but you have to have the feeling or the notifications get too rote and hollow.

I never have a typical day and death is indeed imponderable.

Wednesday, October 18, 2006

"Local Outreach to Suicide Survivors"

Lake County Suicide Prevention Task Force meeting today.

One of the topics we discussed (there were many) was my wanting to start a “first responders” program for family and friends surviving someone who died by suicide (called “survivors” in this field) here in Lake County. This sort of program has come up in 2 discussions with different individuals of late (about 2 different programs). It is time to move beyond the coincidence and act to get it started here.

One such program (one also thought of as a prototype) exists in Baton Rouge. A small team of trained suicide survivors and Baton Rouge Crisis Intervention Center staff go to the scene of suicide to provide information about available resources and “to be a breath of hope for the grieving survivors”. The goal is to let the survivors know that there are resources (and hope) available as soon after the death occurs as feasible.

The hope is that getting the survivors tied into help as soon as possible will ensure that they receive all of the benefit that such help can provide with grieving, adapting, moving forward, and surviving themselves.

I look forward to being able to provide this service here in Lake County.

Tuesday, October 17, 2006

Alcohol killing kids

I learned at a meeting this morning that the IL Liquor Commission is running a pilot program to better hold accountable folks who provide alcohol to those less than 21 years of age. I hope it works well so that they will be able to roll it out state-wide in the not too distant future. The program called TrAIL (Tracking Alcohol in IL) consists of investigations triggered when underage drinking is “suspected in an incident that results in serious consequences”. This would include car crashes, treated alcohol overdose, and the like. Bringing in a specific investigator immediately after a triggering event will improve investigative success in tracing the source of the alcohol and allow for prosecution as indicated.

As we discussed at our meeting, to really be able to decrease underage drinking (and its attendant problems like death and date rape) we need to impact “social norms”. It can’t continue to be “OK” for underage individuals to have access to alcohol either from retail outlets (a more easily controllable source) or from “social” sources (parents, friends, etc). We can’t continue to allow kids to die having a “good time”.

Monday, October 16, 2006

Be aware of Depression

A mailing I got today informed me that October is Depression Awareness Month. "Clinical" Depression can be characterized by:

1) Loss of interest in or ability to feel pleasure (no more WOW moments) with the intensity of the feelings interfering with eating, sleeping, and other usual activities (including sex). There are intense negative feelings, particualrly about yourself.
2) "Clinical" Depression lasts all day, every day for at least 2 weeks, the individual experiences it as an indefinite, possibly infinite, time sensation.
3) "Clinical" Depression is so significant that it impairs functioning- socially, occupationally, academically, and/or with home life.

Depression can be treated, but the individual must seek help and get help. They may need your help to do that or you may need someone's help doing that. Don't let depression kill, seek help.

Friday, October 13, 2006

Teach that others matter

Another important “tool” kids (and adults) need is the knowledge that “others matter” and the ability to act accordingly. I think this starts quite young when kids learn to share and to consider others in addition to themselves.

If this could be inculcated in everyone I think it would go a long way to preventing violence and/or limiting its severity. It seems to me that the lack of the realization that “others matter” is often at the root of violent action. It is more difficult to act violently toward another if you think of them as someone with worth, someone you might share something with. It is much easier to be violent toward someone you see strictly as “them”, particularly as a “them” divorced from your experience and with no personal worth or value.

This “others matter” most often needs to be a personal social experience, but can be generalized to more “others” from even limited experience. It is not something that can be acquired vicariously over the Internet or through some other media source, unless preset with some experience of “others”. For this we need some personal experience, we need to teach kids (and have them experience) how to act with others, that others matter and that it is good to share.

Thursday, October 12, 2006

MySpace demon

I attended a meeting of the 19th Circuit Court Family Coordinating Council yesterday (minor peeve: organization names that sound like they support that which they exist to prevent/eradicate). In addition to updating us about what the various committees are doing, we had a discussion on possible symposium topics.

Part of the discussion centered around the “tools” parents need to raise their children “safe”, but in thinking about it I think that there is a greater need for “tools” kids need to grow up “safe”. Granted there would be considerable overlap, but unless we target the information at kids it may not get to them and they might not listen to it if it does. Targeting this toward kids certainly makes sense in the context of family violence in its many forms (along with ineffectual parenting and other parenting problems, which exist for a variety of reasons). Society has changed (in case you missed it or are too young to have seen the before) and I don’t mean from the artificial “Leave It To Beaver” world people mistakenly think existed in the past. But I do agree with one of the other folks at the meeting who said kids lack people to talk to, confide in, and get decent information and advice from (particularly in the setting of family violence, e.g. spouse/partner violence or child abuse in its many forms).

People tend to demonize the Internet and social networking sites in particular, but the reality is that we are becoming more Internet centered. Is the Internet an asset (my position) or a “trap” where predators lurk at every turn? I think it can help remedy a fair share of the social isolation we experience today (although real human contact is essential and can not be replaced), particularly kids from “problem” homes or those with other “reasons” for their isolation. Kids need others to talk to, even if they have the most ideal parents. They need peers and mentors to learn not to take risks, not to make bad choices, and to learn alternatives to those actions (or inactions). We need to teach kids how to use the social networking sites, and other Internet resources, while at the same time patrolling them just as we do our streets and malls to make certain that they are safe places. Used properly these sites can be sources of support, good information, socialization, and “life skills” learning.

Don’t ban these sites, make sure that they live up to their potential and make sure kids know how to use them “properly”. Making good choices and not take chances extends to the cyber-world as well.

What other “tools” do kids and/or parents need? Let me think…

Tuesday, October 10, 2006

Resource "work"

The queries I get are at times “unusual”.

Recently, someone wanted to do an art project that “works from its own power” and wanted information about whether a “closed system” of decomposition would fill that bill. He wanted to tap “(non-human) after-life processes” as “energy” to drive something that would satisfy the project goals/requirements. Interesting concept (although likely quite odiferous).

Another: Someone with a Hollywood telephone exchange (are they still called that?) looking for answers to questions about autopsy findings in a mummified corpse. Without giving too much away, there are modern ways to mummify that the Ancient Egyptians likely never even thought of. (And, yes, I told her I had a niggling fear that I was going to read about this in the papers someday, although she assures me she is a writer)

It is fun thinking through these things. I often critique TV shows and movies (burdening my wife with having to listen to my ranting/rambling while trying to watch the show), so I might as well think up some of this stuff without a show on in front of me. I see it as focused imagination with some talent for “writing”, although a different phrase actually came to mind as I was typing this, i.e. Mental [activity not for general audiences].

Friday, October 06, 2006

Remember those that are dying and being wounded in Iraq

At least part of the reason that my father took his own life in 1971 was 2 stints in Vietnam (he was an Army "lifer"). I see too many echos of his likely thoughts in some of those that have served in Iraq. This diary post really got me today.

Each day when I go to my computer the first thing I do is go to the Iraq war casualties website and check on the numbers of soldiers killed and wounded in action and the numbers of Iraqi's killed. Today those numbers were 2,732 soldiers killed in action, 19,910 soldiers wounded in action and 43,546 - 48,343 Iraqi's killed. Day in and day out the numbers go up and up and as they do I ask myself that eternal question, why?
· SGT MAJOR MYERS's diary :: ::
It seems to me that in almost all of my posts I write these numbers and even though I have no definitive answer as to why they are dying I do have an answer as to why I write the numbers. I do this in hopes that someone will - really - understand what these numbers mean. That, that someone will "get it", and repeat it and then another someone will understand and then another and still another and finally the 300 million people that are estimated to be breathing in this country this month will all understand. That they will understand that with each of these deaths a piece of us dies and with each of these wounds we are wounded and it is only they who can stop the killing and maiming.
To that someone who might be listening let me share this with you. Regardless of the circumstances; "justly" or "unjustly" the taking of a human life is an act that never leaves you. Knowing that you were personally responsible for taking a human life leaves an eternal, deep, and painful scar on your soul; at least I believe that if you are human it does. Let me share one other thing. The eyes are indeed windows into the soul and I know that when I look at the faces and into the eyes of those who are orchestrating the war in Iraq I do not see scarred souls but instead I see the soulless ice of those who do not care.
Each day as I look at my newspaper it is not the reality of stories of dying soldiers and civilians I see spread across the page but the sad soap opera that is our administration in Washington D.C. It is stories of corruption, graft, and moral bankruptcy that I see and then, even further back after the ads for cars and furniture and every other consumable good, I see the lone article with the number of lives given and taken, buried in the pages of tomorrows fish wrap, without ceremony or homage and before their bodies have hardly grown cold.

Wednesday, October 04, 2006

End Child Abuse, part 2

Just a few more things about child abuse from the article and talk I mentioned yesterday.

Even though the “most common age at which (child) sexual abuse begins is three”, the average age of victims who get to court is 10, with a median of 13. This occurs because we don’t “find” the cases as early as we ought and because of the general inability and/or unwillingness to work with children at the young age at which we should “work” with them. The current system is failing these kids. It must be fixed.

Despite the fact that child abuse and neglect is a “public health epidemic” we, as a society, do not invest the resources we should to address it. The toll on individuals and on society is huge, but our efforts are limited. Despite the fact that the rate of child abuse is 10 times greater than the rate of cancer, “federal research dollars invested is 5 cents for every $100 of societal cost associated with child abuse whereas we invest $2 for every $100 of societal cost associated with cancer”.

We need a systemic, coordinated national effort to end (or nearly eradicate) child abuse and neglect in our country. We need to support efforts to do that.

Tuesday, October 03, 2006

End Child Abuse in 20 years

I was reading an article written by an individual (Victor Vieth of the National Center for Prosecution of Child Abuse) that lectured at the Child Death Review Team symposium that I attended recently. As someone said that I shared a copy with: “an interesting read”. I thought I’d throw a couple of things from the article into my blog.

His is a plan to end child abuse in the United States within 120 years. Seems like a long time, but it is a huge problem. The timeline is laid out so that during the first 40 years everyone responsible for every step of finding, reporting, treating, prosecuting every child abuse incident is fully trained and working in a system that functions as it should. Also the next generations of these individuals are trained, ready to be trained and committed to the fight. Over the next 80 years child abuse is ended. He admits that it won’t all go away, but by and large it will be gone from our society. It is a multigenerational problem and will require a multigenerational attack and solution.

I wish him and his plan well and all success. It has got to happen, the toll is too great.

In case you are uncertain about the problem, beyond the shear scope of the problem, the numbers of the abused, two facts stand out. First: “only 40% of abuse cases and 35% of the most serious cases known to professionals mandated to report were in fact reported”. “65% of social workers, 53% of physicians and 58% of physician assistants were not reporting cases of suspected abuse”. “There were several reasons why mandated reporters do not report”. (None seem all that “good” to me) Second: “the large volume of children whose allegations are either not investigated or that result in CPS (Child Protective services) finding of “unsubstantiated” are just as likely to be victims of abuse (later on) as are those children whose allegations are substantiated”.

The system isn’t working. It isn’t working for the kids. It isn’t working for our society. This plan from the National Child Protection Training Center sounds like the way to go. We can end child abuse within 120 years. I am sorry that I won’t see that eventuality, but I will do what I can to get us moving in that direction.

Monday, October 02, 2006

Teen driven program on teen driving

I am certain that crash reenactments don’t work to keep kids from dying in car crashes. (We do them because the adults involved feel like they are “doing something”.) I am pretty certain that trying to scare kids into behaving “right” (driving right, not doing drugs, etc.) doesn’t work. I keep looking for something that works. I don’t want to do nothing and I don’t want to “just do something”. I want to do something that works, that is proven to be effective. That is where we should spend our time and energy. That is how we are going to save lives.

Sunday’s Trib had an article about an approach that likely will work. It is a program designed and driven by teens that encourages “smart driving”. It “encourages them to preserve their lives…and to speak up when they feel uncomfortable with their friends driving habits”. “What we learned in our research is teens don't aspire to be safe drivers because being a safe driver isn't cool”.

You have to get teens’ attention at their “level”, where they will “identify” with what is being done/”pushed” and “take it” as their own. The programs for change must be “teen-led”. Then and only then will you change behavior. We must do this so that they take fewer chances and make the “right” choices. Then we will save lives and forestall death.