British patients get therapy on computer
Thu, 04 Oct 2007 21:22:04 GMTBy MARIA CHENG, AP Medical Writer
LONDON - For nearly her entire life, Mary had a crippling fear of cramped spaces that meant she couldn't travel on airplanes, subways, or cars. Seeing a psychologist didn't help. So she tried something else. The 61-year-old bookkeeper, who only gave her first name to protect her privacy, sat down in front of a computer and spilled out her problems to a kind of psychiatric computer game called "Fearfighter."
Last year, "Fearfighter" was one of two programs endorsed by Britain's health advisory watchdog for people with panic attacks, mild depression, or phobias.
People uncomfortable with getting advice from a computer can still choose to see therapists, but the option of logging on for help is now available — and will be paid for by the government-run National Health Service.
In Britain, patients registered with the NHS routinely wait up to six months to see a psychiatrist; nearly 90 percent of people with mild depression never actually see a therapist.
The computer programs now mean that for some patients, getting psychiatric counseling is as easy as getting a password from their general practitioner to access the program online.
"Six months for some patients might be too long," said Dr. Paul Grime, an occupational medicine expert at London's Royal Free Hospital.
Since the endorsement was made last February, many British psychiatric patients have skipped the weekly sessions at their doctor's office. Instead, they now log on at home, or go to libraries to use computers designated to run the programs, where there is a health professional ready to help if necessary.
The computers are not authorized to prescribe medicine. A qualified human is required for that.
The computerized treatment is possible because people with phobias, from fear of spiders to fear of heights, tend to get the same basic therapy.
"The idea is that the repetitive parts of the therapy are done by a computer, which can then make decisions based on these answers," said Dr. Isaac Marks, a professor emeritus at King's College Institute of Psychiatry in London, and co-developer of "Fearfighter."
Treating short-term problems like phobias or mild depression often simply means teaching patients new ways to think or react — something a computer can be programmed to do, Marks said.
In Britain, a few thousand people are estimated to have already been treated with the programs.
Judy Leibowitz, a clinical psychologist who runs mental health programs in London, said the anonymity of computer therapy was a selling point for certain patients.
"There are lots of people who are not that keen on pouring out their heart to a therapist," she said.
Still, psychiatrists shouldn't worry that they might become obsolete.
"We still need therapists to be creative and do all the things a computer can't, like express empathy and respond to the idiosyncrasies of a person's life situation and their history," said Dr. Jesse Wright, a psychiatrist at the University of Louisville, who has studied the use of computer therapy.
Serious psychiatric problems like bipolar disorder, suicidal tendencies or schizophrenia are too complex to be cured by computer programs.
Britain decided to roll out the anti-panic and depression computer programs nationwide after a group of experts sifted through evidence and concluded that the programs work just as well as face to face psychiatric care.
"We wanted to be confident that this wasn't just a second-best option," said Dr. Steven Pillings, of University College London, who led the British committee that made the recommendations.
Many trials done in Britain, the United States and elsewhere showed that patients counseled by computers made just as much progress as those counseled by real, live therapists. Using computers to treat patients was also much cheaper and could help cash-strapped health systems expand care. One study estimated that therapists using computer programs could double the number of their patients.
In "Fearfighter," patients are taught to recognize the signs that trigger their panic attacks in the hopes of preventing one. But if that doesn't work, they're also instructed on how to cope with their fears.
The program asks patients to identify the personal triggers that set off their panic attacks. They're told to become more observant of these red flags, and to keep a diary of things they avoid because it makes them nervous. Then, the computer gives them homework: They must seek out uncomfortable situations to practice their new skills.
In the anti-depression program, patients watch staged vignettes in the lives of depressed people, using professional actors. For example, in a scene where a character has an argument with their spouse, patients are shown how the person thinks through different ways of responding. It is then up to the patients to decide how the character will react, in a process that psychiatrists say helps them develop new thinking patterns.
The computer programs take roughly 10 weeks of hourly sessions, including scheduled telephone calls from a health worker to check on progress.
For Mary, computer therapy seems to have worked. Before using "Fearfighter," she had been too afraid to fly or ride the subway.
But after eight weeks, Mary told program developers that she had taken a subway ride without even a twinge of anxiety. The computer treatment, she said, was far more effective than talking to a human psychologist.
"I am very puzzled how this could have happened so quickly," she said.
Kids use of heartburn drugs surges
Thu, 04 Oct 2007 21:22:28 GMTBy LINDSEY TANNER, AP Medical Writer
CHICAGO - The number of young children on prescription drugs for heartburn and other digestive problems jumped about 56 percent in recent years and researchers say obesity and overuse might be contributing to the surprising increase.
The surge was found in a Medco Health Solutions Inc. analysis released Thursday of U.S. prescription data for 2002-2006. It suggests that more than 2 million U.S. children 18 and under used drugs for digestive or gastrointestinal complaints last year.
"It's a signal that something's going on that we need to keep an eye on," said Dr. Robert Epstein, Medco's chief medical officer. "Whether it's parents getting their children diagnosed more frequently, or obesity," or other factors, "it bears further study," he said.
Researchers at Medco, a pharmacy benefits management company based in Franklin Lakes, N.J., analyzed prescription drug claims of more than 575,000 U.S. children.
They calculated that 557,259 infants and children up to age 4, or about 3 percent of youngsters in that age range, were taking these drugs last year. That's about a 56 percent increase from 2002.
There was a 31 percent increase among children aged 5 to 11, climbing to an estimated 551,653 children, or 2 percent in that age group in 2006, the analysis found.
Almost 1 million children aged 12 to 18 had prescriptions for the drugs last year, but that was up only 6 percent over 2002.
Acid-reducing drugs called proton pump inhibitors are the most common medicines prescribed for GI problems, the analysis said. They are used for acid reflux associated with heartburn, and a related condition called gastroesophageal reflux disease or GERD.
Some of these, including Prevacid, were approved for use in children during the study period, which likely also contributed to the prescription surge, said Dr. Benjamin Gold, an Emory University specialist in children's digestive diseases.
Heartburn is a common complication of being overweight and the surge happened during the nation's rising obesity epidemic, said Dr. Renee Jenkins, president-elect of the American Academy of Pediatrics. She noted that more than 10 percent of U.S. preschoolers and 30 percent of older children are considered overweight.
Gold said there's no hard data on how many children have acid reflux or GERD. But there's some evidence that the numbers are rising, and obesity could be playing a role, he said.
Heartburn and acid reflux are also extremely common in infants and young children. Many of them outgrow it and drug treatment often isn't needed, so the increase raises concerns about whether these drugs are sometimes being used unnecessarily, said Jenkins, a Howard University pediatrics professor.
While some children do require treatment including prescription drugs, many get better with no treatment or lifestyle changes such as smaller, more frequent meals or cutting down on fatty foods, she said.
Still, parents increasingly are demanding that doctors prescribe medicine for reflux, in part because of direct-to-consumer marketing, Gold said. But also, symptoms including frequent spitting up, irritability and stomach aches are troublesome and many parents prefer a quick fix, he said.
Gold said reflux drugs are generally safe but there is some evidence linking long-term use with an increased risk of infections including pneumonia and bowel inflammation.
To avoid overuse, Jenkins said parents should be willing to try non-drug approaches for treating reflux and other digestive problems in young children.
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On the Net:
Medco: http://www.medco.com
Reflux: http://digestive.niddk.nih.gov/ddiseases/pubs/gerinchildren/
Obesity a problem in HIV population
Thu, 04 Oct 2007 21:35:57 GMTBy ALICIA CHANG, AP Science Writer
LOS ANGELES - Early in the AIDS epidemic, people infected with the virus often lost a dangerous amount of weight, at times looking gaunt and ghostly. Today, they are facing the opposite problem. Many who have HIV, but not full-blown AIDS, are struggling with obesity, which has overtaken "wasting syndrome" as the top concern.
AIDS researchers and advocacy groups say the waistlines of HIV patients are growing right along with the girths of uninfected Americans as the disease shifts from a death sentence to a chronic condition.
Exact numbers are hard to pin down. But new research suggests that nearly two-thirds of the HIV population may be overweight or obese, mirroring the U.S. population.
Doctors say there's a growing need to screen people with the AIDS virus for obesity, which raises the risk of diabetes, high blood pressure and cholesterol problems.
"We used to worry that they would lose weight and become wasted," said Dr. Nancy Crum-Cianflone of TriService AIDS Clinical Consortium in San Diego. "Maybe we should redirect our concerns to making sure they are maintaining a healthy, normal weight."
About a million people in the United States are living with HIV or AIDS, federal statistics show. At the height of the epidemic, many had wasting syndrome, the uncontrollable loss of 10 percent of body weight along with other symptoms like fever or diarrhea.
A turning point in the AIDS crisis came with advances in modern medicine. Powerful drugs that keep the virus at bay also boost the body's immune system. The result is that more HIV patients are living longer than their counterparts two decades ago, and may be prone to poor eating habits and lack of exercise.
Some experts offer psychological explanations. Since the hallmark of HIV has been weight loss, some patients may be piling on the pounds to avoid looking abnormally thin.
"It's very clear now that HIV is no longer a wasting disease in America," said Dr. John T. Brooks, an epidemiologist in AIDs prevention at the Centers for Disease Control and Prevention. Brooks did not participate in the study.
Crum-Cianflone became interested in the problem after noticing her patients were steadily getting fat and decided to study how common obesity was in the HIV population.
She and her colleagues pored through medical records of 663 patients with HIV at Navy hospitals in San Diego and Bethesda, Md. Researchers analyzed medication records, duration of HIV infection and whether patients had a history of diabetes or high blood pressure.
Sixty-three percent in the study were overweight or obese. Only 3 percent were underweight and none were considered to be "wasted." Among those with full-blown AIDS, about 30 percent were overweight or obese.
The numbers are particularly striking because most of those studied were in the military and tend to be in better shape than the rest of the population. Previous research had suggested about 40 percent of HIV patients are overweight.
Researchers did not find a connection between the AIDS drugs and excess weight. When patients gained weight, they tended to put on an average of 13 pounds over a decade. Those who became infected younger, those who had the virus for a longer time, or those who had high blood pressure were more likely to get fat.
Results were to be presented Thursday at an infectious disease meeting in San Diego.
"These folks are in more ways than not becoming like everyone else. If they're overeating, they're going to get fat," said Dr. Michael Saag, director of the AIDS Center at the University of Alabama at Birmingham, who had no role in the study.
"It would be very sad to survive HIV and die of something else that was preventable," said Brooks of the CDC.
At AIDS Project Los Angeles, pudgy HIV patients outnumber the very thin.
"Many of our clients don't even know what wasting is. They never knew that look," said Janelle L'Heureux, a nutritionist with the AIDS service group.
The problem is more evident in those who are poor, because they more often eat junk food and don't have money to join a gym. To help obese HIV patients, the group offers classes on how to read nutrition labels and cook healthy meals.
Jack Gebhardt, 56, of Los Angeles, said he started packing on the pounds after he quit smoking shortly before he was diagnosed with HIV 12 years ago. After working out three times a week, Gebhardt, who is 5-feet-8, went from 217 to 172 pounds.
A diabetic who is on disability, Gebhardt currently cannot afford a gym membership and has seen his weight creep back up to 182.
"I'd still like to lose a lot more weight," he said.
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On the Net:
CDC page on HIV/AIDS: http://www.cdc.gov/hiv/
Woman 60 pregnant with donated embryo
Thu, 04 Oct 2007 21:15:43 GMTBy MARI YAMAGUCHI, Associated Press Writer
TOKYO - A 60-year-old woman impregnated in the United States via in-vitro fertilization will become what is believed to be the oldest single mother in Japan to give birth from a donated egg, medical officials said Thursday.
The woman, whose name is being withheld by officials because of privacy concerns, recently found an obstetrician willing to handle her case 15 weeks into her pregnancy after being rejected by other clinics, her doctor said.
"Considering that she's 60 years old and single, which means high risk and an uncertain future for a child, I had to make a tough decision about whether to handle the pregnancy," said Yahiro Netsu, gynecologist at Suwa Maternity Clinic in Nagano, central Japan, in a telephone interview with The Associated Press. "But she wanted a child, and I decided to do all I can to help her through expected difficulties."
Surrogate births and artificial insemination are extremely rare in Japan because of ethical concerns in the tradition-bound medical profession, a lack of donors and dearth of doctors willing to provide such treatments.
Though there is no law banning single women from having the procedures, births from donated eggs are strictly limited to married couples under a Japanese medical association guideline, prompting many women and couples to seek the treatments in the U.S. and other countries.
"But when they come back being pregnant, they are rejected" as most doctors follow strict guidelines set by the obstetrics and gynecology society, Netsu said.
The case was a typical example underscoring the problem in Japan, where single motherhood is also exceedingly rare.
Kyodo News agency said that the woman is believed to be the oldest single woman to give birth from donated eggs.
But an official at Japan Society of Obstetrics and Gynecology said it was difficult to confirm that because such procedures are rare and not regulated by the government, and could possibly occur without being reported.
The oldest known pregnancy case in Japan involved a 60-year-old married woman who gave birth in 2001 after in vitro fertilization using a donated egg in the U.S. and her husband's sperm, the Yomiuri newspaper reported Thursday.
The society official, who spoke on condition of anonymity citing sensitivity of the topic, said that the case highlighted a need for Japan to establish a law regulating such procedures.
The oldest woman in the world to give birth is believed to be a Romanian who had a daughter in January 2005 at age 66. Last year, a 63-year-old woman gave birth to a baby boy by Caesarean section in Britain.
