More research urged on stress disorder
Thu, 18 Oct 2007 15:05:35 GMT
By LAURAN NEERGAARD, AP Medical Writer
WASHINGTON - There isn't enough evidence to tell if most treatments for post-traumatic stress disorder work, says a scientific review that highlights the urgency of finding answers as thousands of suffering veterans return from Iraq.
The one proven treatment: So-called exposure therapies, where PTSD patients are gradually exposed to sights and sounds that essentially simulate their trauma, to help them learn to cope, advisers to the government reported Thursday.
The lack of evidence for other therapies doesn't mean patients should give them up — they still should get whatever care their personal doctors deem most promising, stressed Thursday's report from the Institute of Medicine.
"The take-home message for patients should be that they seek care," said Dr. David Matchar of Duke University, who co-authored the report.
"That is the way medicine is practiced — we do the best we can with what we've got," he added. But, "we need better."
While PTSD was first recognized in Vietnam veterans, war is far from its only trigger. Crime, accidents and other trauma can cause it in civilians, too. Sufferers experience flashbacks and physical symptoms that make them feel as if they are reliving the trauma, even many years later.
Today, PTSD is the most commonly diagnosed mental disorder among veterans returning from Iraq and Afghanistan, affecting an estimated 13 percent and 6 percent of them, respectively, says the new report — which concluded it's not even clear if veterans and civilians will need different types of therapy for PTSD.
Delays in getting care for both mental and physical health problems plague many injured veterans, as the Pentagon and Department of Veterans Affairs struggle with backlogs in processing disability benefits and in coordinating services. Ensuring prompt PTSD care was a key recommendation of a presidential panel appointed last summer to investigate those problems.
Thursday's report addresses a somewhat different issue: Once a patient arrives for treatment, what to offer? The VA asked the prestigious Institute of Medicine to review the scientific evidence for a variety of medications and psychological treatments — before the department updates its own treatment guidelines.
Exposure therapies already are offered in the VA system, and "we will redouble our efforts to ensure our mental health staff are trained to provide these effective psychotherapies," said Antonette Zeiss, a clinical psychologist who is deputy chief of VA's mental health services.
Other existing treatments will remain, too, she said, but VA officials planned to meet Thursday to begin planning new research to better prove their value.
"The other treatments have not definitely been shown to be effective. That's different from being shown to be ineffective," Zeiss cautioned. "They are some of the best clinical tools we have. But we should continue to try to understand them better, understand for whom they work."
NC Med Board to appeal executions ruling
Thu, 18 Oct 2007 14:59:55 GMT
RALEIGH, N.C. - The state Medical Board will appeal a judge's decision that the panel overstepped its authority by threatening to punish physicians for participating in executions.
The board's policy effectively triggered a moratorium on the state's death penalty. North Carolina has not executed a condemned inmate since August 2006.
The ruling issued last month by Superior Court Judge Donald Stephens said executions are not medical procedures and whether to ban doctors from them is strictly a legislative decision.
Board spokeswoman Dena Konkel said Thursday the board isn't commenting further on its decision. The board, which licenses and disciplines doctors in North Carolina, is meeting this week in Raleigh.
State law requires that a doctor be present during a lethal injection, and a federal judge demanded last year that a doctor oversee the process of putting an inmate to death.
The state had revised its lethal injection process in an attempt to satisfy the judge, requiring that a physician monitor "the essential body functions of the condemned inmate" and notify the warden if the inmate shows signs of "undue pain and suffering."
Parents use religion to avoid vaccines
Thu, 18 Oct 2007 08:21:42 GMT
By STEVE LeBLANC, Associated Press Writer
BOSTON - Sabrina Rahim doesn't practice any particular faith, but she had no problem signing a letter declaring that because of her deeply held religious beliefs, her 4-year-old son should be exempt from the vaccinations required to enter preschool.
She is among a small but growing number of parents around the country who are claiming religious exemptions to avoid vaccinating their children when the real reason may be skepticism of the shots or concern they can cause other illnesses. Some of these parents say they are being forced to lie because of the way the vaccination laws are written in their states.
"It's misleading," Rahim admitted, but she said she fears that earlier vaccinations may be to blame for her son's autism. "I find it very troubling, but for my son's safety, I feel this is the only option we have."
An Associated Press examination of states' vaccination records and data from the Centers for Disease Control and Prevention found that many states are seeing increases in the rate of religious exemptions claimed for kindergartners.
"Do I think that religious exemptions have become the default? Absolutely," said Dr. Paul Offit, head of infectious diseases at Children's Hospital in Philadelphia and one of the harshest critics of the anti-vaccine movement. He said the resistance to vaccines is "an irrational, fear-based decision."
The number of exemptions is extremely small in percentage terms and represents just a few thousand of the 3.7 million children entering kindergarten in 2005, the most recent figure available.
But public health officials say it takes only a few people to cause an outbreak that can put large numbers of lives at risk.
"When you choose not to get a vaccine, you're not just making a choice for yourself, you're making a choice for the person sitting next to you," said Dr. Lance Rodewald, director of the CDC's Immunization Services Division.
All states have some requirement that youngsters be immunized against such childhood diseases as measles, mumps, chickenpox, diphtheria and whooping cough.
Twenty-eight states, including Florida, Massachusetts and New York, allow parents to opt out for medical or religious reasons only. Twenty other states, among them California, Pennsylvania, Texas and Ohio, also allow parents to cite personal or philosophical reasons. Mississippi and West Virginia allow exemptions for medical reasons only.
From 2003 to 2007, religious exemptions for kindergartners increased, in some cases doubled or tripled, in 20 of the 28 states that allow only medical or religious exemptions, the AP found. Religious exemptions decreased in three of these states — Nebraska, Wyoming, South Carolina — and were unchanged in five others.
The rate of exemption requests is also increasing.
For example, in Massachusetts, the rate of those seeking exemptions has more than doubled in the past decade — from 0.24 percent, or 210, in 1996 to 0.60 percent, or 474, in 2006.
In Florida, 1,249 children claimed religious exemptions in 2006, almost double the 661 who did so just four years earlier. That was an increase of 0.3 to 0.6 percent of the student population. Georgia, New Hampshire and Alabama saw their rates double in the past four years.
The numbers from the various states cannot be added up with accuracy. Some states used a sampling of students to gauge levels of vaccinations. Others surveyed all or nearly all students.
Fifteen of the 20 states that allow both religious and philosophical exemptions have seen increases in both, according to the AP's findings.
While some parents — Christian Scientists and certain fundamentalists, for example — have genuine religious objections to medicine, it is clear that others are simply distrustful of shots.
Some parents say they are not convinced vaccinations help. Others fear the vaccinations themselves may make their children sick and even cause autism.
Even though government-funded studies have found no link between vaccines and autism, loosely organized groups of parents and even popular cultural figures such as radio host Don Imus have voiced concerns. Most of the furor on Internet message boards and Web sites has been about a mercury-based preservative once used in vaccines that some believe contributes to neurological disorders.
Unvaccinated children can spread diseases to others who have not gotten their shots or those for whom vaccinations provided less-than-complete protection.
In 1991, a religious group in Philadelphia that chose not to immunize its children touched off an outbreak of measles that claimed at least eight lives and sickened more than 700 people, mostly children.
And in 2005, an Indiana girl who had not been immunized picked up the measles virus at an orphanage in Romania and unknowingly brought it back to a church group. Within a month, the number of people infected had grown to 31 in what health officials said was the nation's worst outbreak of the disease in a decade.
Rachel Magni, a 35-year-old stay-at-home mother in Newton, Mass., said she is afraid vaccines could harm her children and "overwhelm their bodies." Even though she attends a Protestant church that allows vaccinations, Magni pursued a religious exemption so her 4-year-old daughter and 1-year-old son, who have never been vaccinated, could attend preschool.
"I felt that the risk of the vaccine was worse than the risk of the actual disease," she said.
Barbara Loe Fisher, co-founder and president of the National Vaccine Information Center, one of the leading vaccine skeptic groups, said she discourages parents from pursuing religious exemptions unless they are genuine. Instead, Fisher said, parents should work to change the laws in their states.
"We counsel that if you do not live in a state that has a philosophical exemption, you still have to obey the law," she said.
Even so, Fisher said, she empathizes with parents tempted to claim the religious exemption: "If a parent has a child who has had a deterioration after vaccination and the doctor says that's just a coincidence, you have to keep vaccinating this child, what is the parent left with?"
Offit said he knows of no state that enforces any penalty for parents who falsely claim a religious exemption.
"I think that wouldn't be worth it because that's just such an emotional issue for people. Our country was founded on the notion of religious freedom," he said.
In 2002, four Arkansas families challenged the state's policy allowing religious exemptions only if a parent could prove membership in a recognized religion prohibiting vaccination. The court struck down the policy and the state began allowing both religious and philosophical exemptions.
Religious and medical exemptions, which had been climbing, plummeted, while the number of philosophical exemptions spiked.
In the first year alone, more parents applied for philosophical exemptions than religious and medical exemptions combined. From 2001 to 2004, the total number of students seeking exemptions in Arkansas more than doubled, from 529 to 1,145.
Dr. Janet Levitan, a pediatrician in Brookline, Mass., said she counsels patients who worry that vaccines could harm their children to pursue a religious exemption if that is their only option.
"I tell them if you don't want to vaccinate for philosophical reasons and the state doesn't allow that, then say it's for religious reasons," she said. "It says you have to state that vaccination conflicts with your religious belief. It doesn't say you have to actually have that religious belief. So just state it."
Report warns Britain of rising obesity
Thu, 18 Oct 2007 01:50:51 GMT
By TARIQ PANJA, Associated Press Writer
LONDON - Most British citizens could be obese by 2050, a new government report warns, and the nation's health secretary called Wednesday for a fundamental shift in the way the nation tackles obesity.
Health Secretary Alan Johnson didn't blame British eating habits, calling obesity "a consequence of abundance, convenience and underlying biology."
"As this report starkly demonstrates, people in the U.K. are not more gluttonous than previous generations and individual action alone will not be sufficient," he said in a speech to Parliament.
The obesity analysis by the Foresight program, run by the Office for Science, concludes that excess weight has become the norm and described Britain as an "obesogenic" society.
Obesity costs Britain the equivalent of $90 million a year already. Obese people have a greater risk for life-threatening conditions, including diabetes, heart disease, and cancer.
The number of overweight and obese people has tripled in the last 25 years. One in four adults are now obese, according to the most recent Health Study for England.
By comparison, about one-third of adults in the United States are obese; two-thirds are overweight.
The Foresight report projects that by 2050, 60 percent of British men, 50 percent of women and a quarter of children and young people will be obese unless drastic action is taken.
The study's authors, who based their findings on research from 250 experts over two years, said there was scant proof that current anti-obesity policies worked. The government pledged to draw up new plans to combat bulging waistlines.
Solutions to the problem will not be found "in exhortations to greater individual responsibility or in the futility of isolated initiatives," the health secretary said.
The report made a series of proposals:
_Earlier action when young children start gaining too much weight.
_Targeting people who are at increased risk.
_Controlling high-calorie foods.
_Changing the design of towns to make them more physically demanding.
_Increasing employer responsibility.
"There is a danger that the moment to act radically and dramatically will be missed," said Sir David King, the government's chief scientific adviser and head of the Foresight report. "It is a problem that is getting worse every year."
King and his fellow authors said obesity was inevitable in developed societies like Britain, where convenience foods, labor-saving devices, cars and sedentary work are part of daily life.
"We are facing a far worse scenario than even our gloomiest predictions," said Philip James, chairman of the International Obesity TaskForce, in a statement. "We need to respond rapidly and decisively."
___
On the Net:
http://www.foresight.gov.uk/Obesity/Obesity_final/14.pdf
Report Moonlight spurs corals to spawn
Thu, 18 Oct 2007 20:38:11 GMT
WASHINGTON - By the light, of the silvery moon, corals get in tune, and soon, it's a spawning delight. While their silvery moon was written about people, songwriters Ray Noble and Snookie Lanson understood the motivation. Now, scientists think they may have found out how reef-building corals manage to coordinate their sex lives in moonlight bay.
In late spring, it's reef madness as corals release sperm and eggs into the water for a few nights after a full moon. But how do they know? Researchers led by Oren Levy of the Center for Marine Studies at the University of Queensland, Australia, studied corals on Australia's Great Barrier Reef.
They report in Friday's issue of the journal Science that while corals don't have eyes they are able to sense changes in light — especially blue light — and respond to them. The corals contain ancient proteins called cryptochromes which react to light. Cryptochromes have also been found in mammals and insects where they effect the circadian clock that regulates the daily rhythms of life.
This finding indicates that the basic means used by mammals today to regulate daily patterns was in use at the beginnings of multicellular animals, the researchers said. And, they added, it supports the idea that these proteins evolved under the blue light of the ancient seas.
The research was funded by the Marie Curie International Outgoing Fellowship and the ARC Center for Excellence in Coral Reef Studies.
___
On the Net:
http://www.sciencemag.org
Test rates driving ability in Parkinson39s patients
Wed, 17 Oct 2007 20:50:43 GMT
By Michelle Rizzo
NEW YORK -
A short screening test,
developed by a Belgian team, which measures four clinical
variables can accurately predict the fitness of patients with
Parkinson's disease to drive, according to findings published
in the current issue of the journal Neurology.
&;Physicians often rely on a medical history and an
interview with the patient and the next of kin regarding
driving problems,&; lead author Dr. Hannes Devos noted in
comment to Reuters Health. However, &;physicians often
overestimate the driving skills of their patients.&;
Devos of Catholic University in Leuven and colleagues
developed a brief, efficient screening system to help
physicians assess the fitness of Parkinson's disease patients
to drive a car.
Eighty individuals, including 40 with Parkinson's disease
and 40 healthy subjects matched to the patients for age and
other variables, were assessed using a driving simulator, a
driving history survey, and the Clinical Dementia Rating scale.
In addition, the Parkinson's patients underwent a screening
test and an evaluation designed by the Belgian Road Safety
Institute. This included visual, intellectual and on-road
testing.
The combination of assessments that included disease
duration, sensitivity to contrasts, Clinical Dementia Rating,
and the motor part of the Unified Parkinson's Disease Rating
Scale provided the best screening test to predict fitness to
drive.
Overall, 36 patients with Parkinson's disease
were correctly classified as pass or fail using this screening
method.
&;When the result on the formula is positive, the patient
can continue to drive without further restrictions,&; Devos
explained. When the patient fails, he may be allowed to drive
with restrictions or be considered unfit to drive, he said.
&;Further assessment at an official driving assessment center
then seems to be the right course of action.&;
Parkinson's disease &;is often regarded as a disease that
mainly affects motor functions, while visual and cognitive
functions are often disregarded,&; Devos noted. &;Nonetheless,
problems with attention, visuospatial organization, planning
and judgment, and contrast sensitivity are also seen in
Parkinson's disease.&;
&;It is my opinion that the driving performance of
Parkinson's disease patients is often overestimated and that
they should be evaluated on a more regular basis,&; Devos
concluded.
SOURCE: Neurology October 2, 2007.
DNA test betters Pap in detecting cervical cancer study
Thu, 18 Oct 2007 16:41:23 GMT
WASHINGTON -
The human papillomavirus screening test for cervical cancer is far more accurate than the traditional Pap test, according to a Canadian study published Wednesday in the United States.
The first round of the Canadian Cervical Cancer Screening Trial, led by Eduardo Franco, Director of the Division of Cancer Epidemiology at McGill's Faculty of Medicine, put the HPV test's accuracy in detecting pre-cancerous lesions at 94.6 percent, compared to 55.4 for the Pap test.
The study is published in the October 18 edition of The New England Journal of Medicine.
The trial, funded by a grant from the Canadian Institutes of Health Research, followed 10,154 women aged 30-69 in Montreal, Quebec and St. John's, Newfoundland from 2002-2005.
&;We already knew before conducting this study that the sensitivity of Pap left a lot to be desired,&; said Franco.
The Papanicolaou test was invented by Georgios Papanicolaou in the 1940s and requires technicians to look under a microscope for abnormalities in cell samples collected from the patient's cervix. It has been the standard screening procedure for cervical cancer for almost 50 years.
The HPV test also requires the collection of cervical samples, but the analysis process is automated and detects the DNA of high-risk HPV strains known to cause cervical cancer.
&;Women currently vaccinated against cervical cancer will still need to be screened, because the vaccines that are available now only prevent about 70% of all cervical cancers, and they're primarily for young women,&; said Franco.
&;The HPV test may be ideal for vaccinated women once they reach screening age, because it gives us an opportunity to monitor the protection that the vaccine is supposed to give them,&; he added.
Cervical cancer kills more than one quarter of a million women worldwide each year.
