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VA Reinforces Mental HealthTo meet the increasing needs for ser-vices byveteransof the wars in IraqandAfghanistan, the Department of Veter-ans Affairs (VA) is hiring nearly 1600mental health nurses,psychiatrists, psy-chologists, and social workers, as wellas about 300 support staff, the depart-ment announced in April.

The increased staffing, which willboost the existing20590 mental healthwork force by nearly 10%, is a responseto findings from a VA review of mentalhealthoperations that additional staff isneededbysome facilities to care for vet-

erans. The need for VA mental healthpersonnel is expected to increase for adecadeormoreafterthe end ofthewars,according to Secretary of Veterans Af-fairs Eric K. Shinseki.

Since 2007, the VA budget for men-talhealth care hasincreased 41% as thenumber of veterans served has in-creased by 35%. More than 1.3 mil-lion veteransaccessed VA mentalhealthcare in 2011.

Fentanyl Patch Warning

Unintentional exposure of children tofentanyl patches can cause life-threatening harm, warned the US FoodandDrugAdministration(FDA)inApril.

Theagencyrecentlyanalyzed26casesofsuchunintentionalexposuresover thepast15years,manyofwhichendedinhos-pitalizationordeath.Morethanhalfofthecases involved children 2 years old oryounger.Suchveryyoungchildrenareatparticular riskofexposurebecause theyaremobileandcuriousandmayfindlost,discarded, or improperlystored patches

and put themin their mouth orontheirskin, accordingto the agency. Childrenalsomaybeexposedwhenapatchbeingworn by an adult is inadvertently trans-ferredto a childwhocomes into contactwith that person.

The amount of fentanyl in transder-mal patches, even those that have beendiscardedafteruse, is sufficient tocause

serious harm to children, theFDAem-phasized. The agency stressed the im-

portance of proper use and storage of

fentanyl patches by patients, their care-givers, andhealthprofessionals to pre-vent such unintentional exposures.

Longer Labor First-time mothers during the early2000s spent 2.6 hours longer in labor

than didfirst-timemothers in the1960s,according to an analysis fundedby theEunice Kennedy Shriver National In-stitute of Child Health and HumanDevelopment.

The researcherscompared datafromabout 40000 deliveries between 1959and 1966 with data from 100000 de-liveries between 2002 and 2006 (Lau-ghonSKet al. Am J Obstet Gynecol. doi:10.1016/j.ajog.2012.03.003 [pub-lished online March 12, 2012]). Laborlasted on average 2 hours longer for

women from the later cohort who hadalreadydelivered1 childcompared withthe women in the earlier group. In-fants born more recently were born 5days earlier on average andwere likelyto weigh more.

Changes in delivery room practiceslikely account for these differences,the authors conclude. For example,

physicians in the 1960s were morelikely 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, theauthors noted that epidural use did notfully explain the differences. Demo-graphicdifferenceswerealso noted be-tween the2 groupsofmothers,with anolder age at delivery and somewhathigher body mass index among moth-ers in the 2000s.

Toxoplasmosis and PregnancyA new test to detect Toxoplasma gondiiinfection during pregnancy may helpidentify individuals at risk of the mostserious adverse outcomes, according toa study funded by the National Insti-tute of Allergy and Infectious Diseases(NIAID). NIAID researchers devel-oped the test, which can distinguish 2strains of T gondii.

Mothers who develop acute T gon-

dii infections during pregnancy are atincreased risk for miscarriage or giv-ing birth to infants with serious eye orbrain damage. But screening for suchinfections 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 onsamples from 193 infants born withcongenital T gondii infections between1981and 2009and their mothers, all of

whom were enrolled in the NationalCollaborative Chicago-based Congeni-talToxoplasmosisStudy.Resultsshowedthat the NE-II serotype of T gondiiwas associated with premature deliv-ery and more severe disease at birth.Treatment improved outcomes for in-fants who had been infected by eitherserotype. Bridget M. Kuehn

Unintentional exposures of children to fentanylpatches can cause serious harm.

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

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