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Most state quitlines provide at least one counseling session to any adult tobacco user who calls, and many state quitlines provide a multi-call program that includes both reactive and proactive calls. Some state quitlines prioritize multi-call services for subpopulations with a higher prevalence of tobacco use and/or limited access to other tobacco cessation services. A study of quitline eReferrals in Wisconsin randomized 23 primary care clinics from two healthcare systems to one of two methods for referring adult patients who smoked to the Wisconsin quitline: a paper-based, fax-to-quit referral process or an eReferral process (Fiore et al. The fax referral process transmitted the same information in both directions via fax. Compared with clinics that were randomized to the fax referral process, clinics that were randomized to the eReferral process generated quitline referral rates that were 3- to 4-times higher and also generated higher rates of connecting patients with quitlines. The study, which was the first randomized study of this topic, concluded that eReferrals provide an effective means of referring patients who smoke to quitline services. Making cessation medication available to callers and promoting its availability results in more smokers calling quitlines and has the potential to increase quit rates among callers by providing them with the optimal combination of cessation counseling plus medications (An et al. The reach of state quitlines varies across states, over time, and by demographic factors, such as race/ethnicity (North American Quitline Consortium n. Data suggest that even among smokers who tried to quit in the previous year and were aware of quitlines, quitline reach was around 8% (Schauer et al. This limited awareness and reach, along with the variation in quitline services and eligibility for these services across states and over time, are largely the result of limited state funding for operating and promoting quitlines. States have developed the capacity to carefully titrate their activities to promote quitlines and the level of quitline services they provide to match available funding. Some states have been able to temporarily attain higher levels of reach, in some cases higher than 6%, during periods when they can fund quitlines at higher levels, often while also conducting specific policy and promotional efforts that drive increased calls to the quitline (Woods and Haskins 2007; Mann et al. Call volume to quitlines is highly sensitive to promotional activities (Anderson 2016). This shift in quitline practice stems in part from the recognition that many younger adults prefer to access cessation assistance through these alternative channels rather than over the telephone (Dreher et al. Between March 2014 and February 2015, 15,861 unique tobacco users registered for cessation services in the state-a 169% increase over calendar year 2013. Thus, the reach of quitlines can be expanded, and new populations can be engaged in cessation services when quitlines (a) broaden their cessation service offerings beyond traditional telephone-based quitline services and (b) allow tobacco users to choose the service that best meets their needs and suits their preferences (Keller et al. The current state of science and technology also allows the leveraging of mobile phone and tablet applications. These platforms include applications offered by for-profit and not-for-profit organizations and academic institutions and by federal agencies involving standardized text messages that enhance motivation to quit smoking or inform persons about quitting strategies, some of which offer real-time, live peer or professional advising or counseling (Smokefree. Preliminary evaluations suggest that these applications benefit users (Cole-Lewis et al. In 2016, cell phone ownership and usage were widespread: 95% of American adults owned a cell phone; 77% had a smartphone; and ownership levels were generally similar across all categories of race/ethnicity, age, education level, income level, and rural versus urban status (Pew Research Center 2017b). Texting is common among cell phone users, and many smartphone users report using their phones for texting, accessing the Internet, watching videos, and using apps (applications). Importantly, despite the widespread adoption of mobile technology, some populations-including some low-income and rural individuals and veterans-do not have equal access to mobile technology (Koutroumpisa and Leiponenb 2016; Markham et al. In 2011, the Community Preventive Services Task Force recommended mobile phone-based interventions, specifically automated texting programs, for tobacco cessation on the basis of sufficient evidence of their effectiveness in increasing tobacco use cessation among persons interested in quitting (The Community Guide 2011b). Potential advantages of mHealth interventions include greater reach to some disproportionately impacted populations (Markham et al. In addition, mHealth interventions may improve engagement through increased access to intervention services, decreased barriers to participation. The potential benefits from mHealth interventions are tempered by several challenges, including (1) inconsistent access to cell phones among low-income populations (despite the increasing adoption of cell phones, low-income populations may still struggle to maintain cell phone contracts, have regular access to minutes, and have data plans that allow for repeated use of interventions), (2) different types of devices. At this time, optimal methods are not in place to fully assess the expanding array of available mHealth cessation interventions. In addition, assessing the comparative effectiveness and cost-effectiveness of mHealth cessation interventions relative to other modalities, such as in-person and quitline interventions, will be important. Because of the rapid cycle of technological development, the use of adaptive and iterative research methods in assessing development and performing evaluations may be necessary. A series of three studies from New Zealand and the United Kingdom provided the initial evidence supporting the use of this platform for delivering smoking cessation interventions (Rodgers et al. Although the findings from studies of cessation texting interventions are generally encouraging, a review of these interventions found that, while smoking cessation outcomes measured at less than 6 months were better than those for controls, outcomes measured at 6 months or longer often failed to show differences between treatment and control groups (Scott-Sheldon et al.

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Okuma T, Inanaga K, Otsuki S, Sarai K, Takahashi R, Hazama H, Mori A, Watanabe M: Comparison of the antimanic efficacy of carbamazepine and chlorpromazine: a doubleblind controlled study. Dam M, Ekberg R, Loyning Y, Waltimo O, Jakobsen K: A double-blind study comparing oxcarbazepine and carbamazepine in patients with newly diagnosed, previously untreated epilepsy. Ichim L, Berk M, Brook S: Lamotrigine compared with lithium in mania: a double-blind randomized controlled trial. Arch Gen Psychiatry 2000; 57:841­849 [A] Treatment of Patients With Bipolar Disorder 73 Copyright 2010, American Psychiatric Association. Leucht S, Pitschel-Walz G, Abraham D, Kissling W: Efficacy and extrapyramidal side-effects of the new antipsychotics olanzapine, quetiapine, risperidone, and sertindole compared to conventional antipsychotics and placebo: a meta-analysis of randomized controlled trials. Sikdar S, Kulhara P, Avasthi A, Singh H: Combined chlorpromazine and electroconvulsive therapy in mania. Edwards R, Stephenson U, Flewett T: Clonazepam in acute mania: a double blind trial. Chouinard G: Clonazepam in acute and maintenance treatment of bipolar affective disorder. Meehan K, Zhang F, David S, Tohen M, Janicak P, Small J, Koch M, Rizk R, Walker D, Tran P, Breier A: A double-blind, randomized comparison of the efficacy and safety of intramuscular injections of olanzapine, lorazepam, or placebo in treating acutely agitated patients diagnosed with bipolar mania. Expert Opin Investig Drugs 2001; 10: 661­671 [F] Treatment of Patients With Bipolar Disorder 75 Copyright 2010, American Psychiatric Association. Deveaugh-Geiss J, Ascher J, Brrok S, Cedrone J, Earl N, Emsley R, Frangou S, Huffman R: Safety and tolerability of lamotrigine in controlled monotherapy, in American College of Neuropsychopharmacology Annual Meeting Poster Abstracts. Smeraldi E, Benedetti F, Barbini B, Campori E, Colombo C: Sustained antidepressant effect of sleep deprivation combined with pindolol in bipolar depression: a placebo-controlled trial. Colombo C, Lucca A, Benedetti F, Barbini B, Campori E, Smeraldi E: Total sleep deprivation combined with lithium and light therapy in the treatment of bipolar depression: replication of main effects and interaction. Peet M: Induction of mania with selective serotonin re-uptake inhibitors and tricyclic antidepressants. Okuma T, Inanaga K, Otsuki S, Sarai K, Takahashi R, Hazama H, Mori A, Watanabe S: A preliminary double-blind study on the efficacy of carbamazepine in prophylaxis of manicdepressive illness. Maj M, Pirozzi R, Magliano L, Bartoli L: Long-term outcome of lithium prophylaxis in bipolar disorder: a 5-year prospective study of 402 patients at a lithium clinic. Biol Psychiatry 1999; 45:953­958 [G] Treatment of Patients With Bipolar Disorder 77 Copyright 2010, American Psychiatric Association. Coryell W, Winokur G, Solomon D, Shea T, Leon A, Keller M: Lithium and recurrence in a long-term follow-up of bipolar affective disorder. Greil W, Kleindienst N, Erazo N, Muller-Oerlinghausen B: Differential response to lithium and carbamazepine in the prophylaxis of bipolar disorder. Godemann F, Hellweg R: [20 years unsuccessful prevention of bipolar affective psychosis recurrence. Psychiatr Serv 1998; 49:531­ 533 [A] Treatment of Patients With Bipolar Disorder 79 Copyright 2010, American Psychiatric Association. Colom F, Vieta E, Benabarre A, Martinez-Aran A, Reinares M, Corbella B, Gasto C: Topiramate abuse in a bipolar patient with an eating disorder. Watanabe S, Ishino H, Otsuki S: Double-blind comparison of lithium carbonate and imipramine in treatment of depression. Hassanyeh F, Davison K: Bipolar affective psychosis with onset before age 16 years: report of 10 cases. Strober M, DeAntonio M, Schmidt-Lackner S, Freeman R, Lampert C, Diamond J: Early childhood attention deficit hyperactivity disorder predicts poorer response to acute lithium therapy in adolescent mania. J Affect Disord 1998; 51:145­151 [B] Treatment of Patients With Bipolar Disorder 81 Copyright 2010, American Psychiatric Association. Neonatal sepsis is a major cause of mortality and neurodevelopmental impairment among neonates. Inherent factors like poorly developed innate immune system, immature skin barrier, mucosal defense mechanisms and blood brain barrier contribute to the increased susceptibility of the neonates to infection. Early recognition and aggressive management plays a pivotal role in saving these neonates. Bacterial infections are the most common cause of septicemia in neonates but fungal and viral infections can occur in the setting of an extreme premature baby and by vertical transmission from the mother.

Core trunk muscles act as synergistic stabilizers4,18,19 as they act as a hub where trunk and ground reactions converge and are modulated. They provide evidence that the central nervous system initiates contraction of abdominal muscles in a feed-forward manner in advance of lower limb motion, hence the interdependency and linkage between the trunk and lower limb in the control of postural stability. Foot and Ankle Influences to the Kinetic Chain (Bottom Up) Mobility and structure of the foot and ankle greatly influence proximal segments of the lower extremity during shock absorption and propulsion requirements. B, Weakness at posterior proximal hip and quadriceps produces femoral adduction and internal rotation with resultant knee valgus stress. Subtalar and midtarsal mobility enable triplanar pronation and supination, providing the kinetic chain with shock absorption and torque conversion of the femoral and tibial rotation at the foot­ground interface. Bobbert describes the angular velocity of foot dorsiflexion during jump landing as ranging from 578 degrees per second to 1025 degrees per second with varying heights of 20 cm and 60 cm, respectively. Dananberg and Guiliano30 write that the rocker effect of ankle dorsiflexion, calcaneus bone curvature, and hallux extension while walking and running serve to absorb landing forces and propel the body forward in the sagittal plane (Figure 10-4). Motion restrictions with sagittal plane ankle dorsiflexion or hallux extension, or both, will alter gait mechanics, shock absorption, and propulsion. Restoration of restricted foot and Evidence-Based Clinical Application: Sensory Influences of the Foot on the Lower Kinetic Chain Sensory deprivation of the feet has been shown to significantly alter lower extremity kinetic chain response and postural reflexes. During the controlled drops each subject landed and achieved an effortless erect posture. When visually deprived (subject blindfolded), three of the subjects responded with greater knee flexion than during the controlled ejections. However, with subjects blindfolded and feet chilled in ice water, no subject was able to regain erect posture as their postural reflex and postural stability was completely impaired. The necessity for feedback from sensory organs of the feet to coordinate a positive supporting reaction of the kinetic chain was demonstrated. Functional retraining through dynamic mobilization and weight-bearing exercise purportedly stimulates a neuromuscular response. Kaufman et al34 describe insufficient ankle dorsiflexion as a primary risk factor for injury among 449 Navy Seal candidates. They relate the 149 injuries to a prescreening assessment profile of flexibility and foot mechanics when following the Navy Seal candidates over 25 weeks of intensive training. Ankle dorsiflexion restriction, abnormal pronation, and supination foot mechanics, as well as hypermobility of ankle inversion, were all found to be risk factors for this Navy Seal group (Figures 10-11 through 10-12). Evidence-Based Clinical Application: Static Stretching versus Dynamic Functional Stretching Improving gastrosoleus flexibility is particularly difficult due to the shortening influence of the muscle tendon unit during sleeping hours when the foot is in end range of plantar flexion. Youdas et al35 reported on the effects of a 6-week program of static calf musculature stretching with 101 adults. A 6-week once-per-day static stretching regimen for up to 2 minutes was not sufficient to increase active dorsiflexion range of motion in this group. Functional gastrosoleus stretching exercises include dynamic movement and neuromuscular training into the direction of desired motion. Ryerson and Levit31 describe movement reeducation training to stimulate firing patterns of the foot and ankle with weight shift and foot posturing strategies for neuromuscular reeducation. Closed kinetic chain pronation defined as calcaneal eversion, talar adduction, and talar plantar flexion links to tibial rotation and knee flexion and thereby directly influences the knee and patellofemoral joints. When comparing injury-free runners with runners with a history of lower extremity pain patterns, they found that the injury-free group pronated more rapidly during the stance phase of running. Low-arched runners had significantly more medial, soft tissue, and knee injuries, while high-arched pes cavus foot types sustained more lateral, bony, and foot injuries. The authors describe that the injury patterns correlated planus foot types with greater rearfoot motion and higher velocities stressing more medial and soft tissue structures. Conversely, high-arched cavus foot types run with stiffer gait patterns and higher vertical load rates, sustaining more shock-related problems, such as stress fractures. C and D, Subtalar pronation and supination linked with tibial rotation and knee flexion-extension. The cavovarus-type foot strikes the ground in an inverted position, and rearfoot eversion motion is typically limited, diminishing the shock-absorbing capacity of the subtalar joint. This excessively supinating foot type commonly presents with a plantarflexed first metatarsal. Laterally directed overload can occur with resultant ankle instability, Jones fracture of the fifth metatarsal, metatarsalgia, peroneal tendon pathologies, and sesamoiditis.

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