VA Reinforces Mental Health

To meet the increasing needs for ser-

vices by veterans of the wars in Iraq and
Afghanistan, the Department of Veter-
ans Affairs (VA) is hiring nearly 1600
mental healthnurses, psychiatrists, psy-
chologists, and social workers, as well
as about 300 support staff, the depart-
ment announced in April.
The increased staffing, which will
boost the existing 20590 mental health
work force by nearly 10%, is a response
to findings from a VA review of mental
health operations that additional staff is
needed by some facilities to care for vet-
erans. The need for VA mental health
personnel is expected to increase for a
decade or more after the endof the wars,
according to Secretary of Veterans Af-
fairs Eric K. Shinseki.
Since 2007, the VA budget for men-
tal health care has increased 41%as the
number of veterans served has in-
creased by 35%. More than 1.3 mil-
lionveterans accessedVAmental health
care in 2011.
Fentanyl Patch Warning
Unintentional exposure of children to
fentanyl patches can cause life-
threatening harm, warned the US Food
andDrugAdministration(FDA) inApril.
Theagencyrecentlyanalyzed26cases
of suchunintentional exposuresover the
past15years, manyofwhichendedinhos-
pitalizationordeath. Morethanhalf of the
cases involved children 2 years old or
younger. Suchveryyoungchildrenareat
particular riskof exposure because they
aremobileandcuriousandmayfindlost,
discarded, or improperly storedpatches
and put themin their mouth or on their
skin, according to the agency. Children
alsomaybeexposedwhenapatchbeing
worn by an adult is inadvertently trans-
ferredtoa childwhocomes intocontact
with that person.
The amount of fentanyl in transder-
mal patches, even those that have been
discarded after use, is sufficient to cause
serious harmto children, the FDAem-
phasized. The agency stressed the im-
portance of proper use and storage of
fentanyl patches by patients, their care-
givers, and health professionals to pre-
vent such unintentional exposures.
Longer Labor
First-time mothers during the early
2000s spent 2.6 hours longer in labor
thandidfirst-time mothers inthe 1960s,
according to an analysis funded by the
Eunice Kennedy Shriver National In-
stitute of Child Health and Human
Development.
The researchers compared data from
about 40 000 deliveries between 1959
and 1966 with data from 100 000 de-
liveries between 2002 and 2006 (Lau-
ghon SKet al. AmJ Obstet Gynecol. doi:
10.1016/j.ajog.2012.03.003 [pub-
lished online March 12, 2012]). Labor
lasted on average 2 hours longer for
women from the later cohort who had
already delivered1childcomparedwith
the women in the earlier group. In-
fants born more recently were born 5
days earlier on average and were likely
to weigh more.
Changes in delivery room practices
likely account for these differences,
the authors conclude. For example,
physicians in the 1960s were more
likely than current physicians to use
episiotomy or forceps to speed deliv-
eries. Additionally, more than half of
the modern mothers used epidural an-
esthesia, which is known to extend la-
bor time, compared with only 4% of
mothers who used epidural anesthe-
sia in the earlier cohort. However, the
authors noted that epidural use did not
fully explain the differences. Demo-
graphic differences were also noted be-
tween the 2 groups of mothers, with an
older age at delivery and somewhat
higher body mass index among moth-
ers in the 2000s.
Toxoplasmosis and Pregnancy
Anewtest to detect Toxoplasma gondii
infection during pregnancy may help
identify individuals at risk of the most
serious adverse outcomes, according to
a study funded by the National Insti-
tute of Allergy and Infectious Diseases
(NIAID). NIAID researchers devel-
oped the test, which can distinguish 2
strains of T gondii.
Mothers who develop acute T gon-
dii infections during pregnancy are at
increased risk for miscarriage or giv-
ing birth to infants with serious eye or
brain damage. But screening for such
infections in the United States is infre-
quent, according to the studys au-
thors (McLeod R et al. Clin Infect Dis.
doi:10.1093/cid/cis258 [published on-
line April 11, 2012]).
The researchers used the test on
samples from 193 infants born with
congenital T gondii infections between
1981 and 2009 and their mothers, all of
whom were enrolled in the National
Collaborative Chicago-based Congeni-
tal Toxoplasmosis Study. Results showed
that the NE-II serotype of T gondii
was associated with premature deliv-
ery and more severe disease at birth.
Treatment improved outcomes for in-
fants who had been infected by either
serotype.Bridget M. Kuehn
Unintentional exposures of children to fentanyl
patches can cause serious harm.
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HEALTH
AGENCIES
UPDATE

2012 American Medical Association. All rights reserved. JAMA, May 23/30, 2012Vol 307, No. 20 2139
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