04.16.09
Posted in Uncategorized at 1:01 am by Pit
ATLANTA (AP) -- Mild brain injuries - once considered an under-recognized problem in returning military troops - are being overdiagnosed because the government is using soft criteria instead of hard medical evidence, an Army doctor and two other officials contend.
The three are taking aim at Department of Veterans Affairs' rule for treating such veterans and determining disability pay. They want to call many mild cases "concussions" rather than "brain injuries." They say the latter implies an ongoing, incompletely healed problem rather than a temporary one that's in the past.
"I think it's fair to say there's overdiagnosis of concussions going on," said Dr. Charles Hoge, a top Army psychiatrist. He's one of three authors of an article published in Thursday's New England Journal of Medicine.
Some veterans groups applaud efforts to better diagnose traumatic brain injuries, but say it's more likely that the military has been undertreating the problem.
"It stretches credulity to believe that all the people who have suffered traumatic brain injuries in Iraq and Afghanistan are getting the treatment they need. That's a laughable notion," said Jason Forrester, director of policy at Veterans for America, an advocacy group.
The military defines a concussion - or mild traumatic brain injury - as a blow or jolt to the head that caused loss of consciousness, altered consciousness or amnesia. Most are due to pressure waves from being near bomb blasts.
More than 300,000 U.S. veterans of the wars in Afghanistan and Iraq have suffered head injuries, many of them concussions that have gone untreated, according to a Rand Corp. study released last year.
Part of that estimate stems from a questionnaire given to service members as they finish their deployment, which may be months after a blow or jolt occurred, Hoge and his colleagues wrote. Service members can't always get a thorough medical assessment on the battlefield.
According to the authors, here's the problem: The questionnaire asks whether the person became dazed or confused at the time of an injury or blast, and it attributes such symptoms to concussion.
But a soldier can become dazed from stress, lack of sleep, the confusion of war, or other causes, they argue. In fact, Hoge published a study last year in the New England journal showing that many brain injury symptoms were actually due to post-traumatic stress syndrome, or PTSD.
The Rand study said some troops may incorrectly blame their problems on head injuries.
Trained doctors should be able to sort out the cause of symptoms. But Hoge and his colleagues argue that a concussion diagnosis can still occur, because of subjectivity and the fuzzy concussion definition.
"The problem is we're attempting to measure concussion many months after injury," said Hoge, director of psychiatry and neuroscience at the Walter Reed Army Institute of Research in Silver Spring, Md. He wrote the article with Herb Goldberg, a communications specialist at Walter Reed, and Carl Castro, a psychologist at the U.S. Army Medical Research and Materiel Command at Fort Detrick, Md.
The questionnaire should be revised and questions should be asked closer to the time of the incident, the authors said, and the military should refine its definition of concussion. They feel "concussion" better reflects the mild nature of the injury and promotes an expectation of recovery.
"It's a very, very, very mild physical injury" that often doesn't need medical treatment, Castro said.
The VA last year created a disability category for residual effects of traumatic brain injury that was based on subjective, poorly defined symptoms, Castro and his colleagues argued. More scientific diagnosis criteria are needed "to ensure that disability regulations do not generate disability," the authors wrote.
Treatment of mild traumatic brain injuries can cost up to $32,000 per case, the Rand report said. But if the diagnosis is wrong, patients are exposed to drug side effects and other risks, according to Hoge.
VA officials issued a statement this week saying they are proud of their efforts to treat traumatic brain injuries. Forrester, the veterans advocate, said estimates of concussions are probably low because some service members fear that being diagnosed with a neurological or psychological problem would hamper a military career.
Better assessment is needed for a complicated problems, he added. "These are the most difficult, thorny wounds of war," he said.
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On the Net:
New England Journal: http://nejm.org
© 2009 The Associated Press.
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Posted in Uncategorized at 1:01 am by Pit
ARLINGTON, Va. (AP) -- "Don't let the bedbugs bite."
Doesn't seem so bad in a cheerful bedtime rhyme, but it's becoming a really big problem now that the nasty critters are invading hospitals, college dorms and even swanky hotels.
With the most effective pesticides banned, the government is trying to figure out how to respond to the biggest bedbug outbreak since World War II.
Bedbugs live in the crevices and folds of mattresses, sofas and sheets. Then, most often before dawn, they emerge to feed on human blood.
Faced with rising numbers of complaints to city information lines and increasingly frustrated landlords, hotel chains and housing authorities, the Environmental Protection Agency hosted its first-ever bedbug summit Tuesday.
Organized by one of the agency's advisory committees, the two-day conference drew about 300 participants to a hotel in Arlington, just across the Potomac River from Washington. An Internet site notes that the hotel in question has had no reports of bedbugs.
One of the problems with controlling the reddish-brown insects, according to researchers and the pest control industry, is that there are few chemicals on the market approved for use on mattresses and other household items that are effective at controlling bedbug infestations.
Unlike roaches and ants, bedbugs are blood feeders and can't be lured by bait. It's also difficult for pesticides to reach them in every crack and crevice they hide out in.
"It is a question of reaching them, finding them," said Harold Harlan, an entomologist who has been raising bedbugs for 36 years, feeding them with his own blood. He has the bites to prove it.
The EPA, out of concern for the environment and the effects on public health, has pulled many of the chemicals that were most effective in eradicating the bugs in the U.S. At the same time, the appleseed-sized critters have developed a pesticide resistance because those chemicals are still in use in other countries.
Increasing international travel has also helped them to hitchhike into the U.S.
"One of our roles would be to learn of new products or safer products. ... What we are concerned about is that if people take things into their own hands and start using pesticides on their mattresses that aren't really registered for that, that's a problem," said Lois Rossi, director of the registration division in the EPA's Office of Pesticide Programs.
The EPA is not alone in trying to deal with the problem. An aide to Rep. G.K. Butterfield, D-N.C., says the congressman plans to reintroduce legislation next week to expand grant programs to help public housing authorities cope with infestations.
The bill will be called the "Don't Let the Bedbugs Bite Act."
"It was clear something needed to be done," said Saul Hernandez, Butterfield's legislative assistant.
Bedbugs are not known to transmit any diseases. But their bites can cause infections and allergic reactions in some people. The insects release an anticoagulant to get blood flowing, and they also excrete a numbing agent so their bites don't often wake their victims.
Those often hardest hit are the urban poor, who cannot afford to throw out all their belongings or take other drastic measures. Extermination can cost between $400-$900.
So bedbug problems increase, said Dini Miller, an entomologist and bedbug expert at Virginia Tech, who until 2001 saw bedbugs only on microscope slides dating from the 1950s. Now she gets calls and e-mails several times a day from people at their wits' end.
"I can't tell you how many people have spent the night in their bathtubs because they are so freaked out by bedbugs," Miller said. "I get these people over the phone that have lost their marbles."
Because the registration of new pesticides takes so long, one thing the EPA could do is to approve some pesticides for emergency use, Miller said.
Another tactic would be to screen pesticides allowed for use by farmers to see if they are safe in household settings.
Representatives of the pest control industry will be pushing for federal funding for research into alternative solutions, such as heating, freezing or steaming the bugs out of bedrooms.
"We need to have better tools," said Greg Baumann, a senior scientist at the National Pest Management Association. "We need EPA to consider all the options for us."
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On the Net:
Harvard School of Public Health: http://www.hsph.harvard.edu/bedbugs/
University of Kentucky Insect Advice: http://www.ca.uky.edu/entomology/entfacts/ef636.asp
© 2009 The Associated Press.
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Posted in Uncategorized at 1:01 am by Pit
WASHINGTON (AP) -- President Barack Obama's top health care adviser said Wednesday a compromise is within reach on a government health plan for the middle class that wouldn't drive private insurers out of business.
Offering the option of government coverage to workers and their families has become one of the most contentious issues in the debate about overhauling health care to cover the uninsured and curb costs. Obama has proposed a public plan, and liberals insist it be part of any final deal. Conservatives and businesses fear that could open the door for a government takeover of the system.
Nancy-Ann DeParle, director of the White House health reform office, said a public plan could be designed to address concerns about the federal government overreaching in its role.
"I'm actually very hopeful that we'll be able to reach an agreement on that, because it is part of the president's plan," DeParle said in a session with reporters at which she fielded repeated questions on the issue. "It's included because he wanted a mechanism to lower costs and to keep the private sector honest."
But the insurance industry remains skeptical, and many Republicans say any kind of public plan would be a deal breaker.
DeParle suggested one compromise might be that the public plan pays hospitals and doctors rates similar to what private insurers pay. That would address fears that government would use its muscle to pay rock-bottom prices for medical services, allowing the public plan to charge discounted premiums that private insurers couldn't compete with.
Even if the government plan paid private-market rates to doctors and hospitals, it could still cut costs, DeParle said. A government plan wouldn't have to turn a profit, and could also save on administrative expenses.
"If it's a policy disagreement, there are ways of bridging that gap," said DeParle.
However, DeParle acknowledged that ideological objections to government's role would be hard to overcome. She spoke at a forum sponsored by the Kaiser Family Foundation.
Most Americans may not realize it, but government already pays nearly half of the nation's health care tab. Government programs cover seniors, poor families, and many children. Obama has proposed to expand that.
His plan would offer middle class workers and their families the option of enrolling in a public plan, along with private insurance, through a new kind of purchasing pool. But Obama has avoided filling in the details, thereby giving himself some room to compromise.
Those details would be critical, according to a recent economic study. The Lewin Group, a consulting firm, found that a public plan would help to significantly reduce the number of uninsured. But depending on how it's designed, it could also take away much of the business from private insurers.
If a public plan was open to all employers and individuals, and paid doctors and hospitals the same low rates as Medicare, it would become the dominant insurer in the country, the study found. But if the plan were open only to individuals and small businesses, and paid rates similar to private insurers, its impact would be limited. In that case, the public plan would mainly be helping groups that now have a hard time getting private coverage.
Lewin is a subsidiary of UnitedHealthcare, the nation's largest health insurer. The consulting firm says it makes its own judgments, however, and its work is used by groups on all sides of the health care debate. For example, Lewin recently did a study for the Commonwealth Fund, a New York-based research center that released a health care proposal featuring a strong government plan.
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On the Web:
DeParle news conference: http://tinyurl.com/dhwj8s
© 2009 The Associated Press.
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Posted in Uncategorized at 1:01 am by Pit
BROOKLINE, Mass. (AP) -- The wife of a Massachusetts man whose tissue was donated for the nation's second face transplant said her husband told her before heart transplant surgery that he wanted to donate his organs if he didn't survive the operation.
Susan Whitman told The Boston Globe for a story in Wednesday's editions that she was surprised, however, when organ bank officials asked if she would approve of the donation of Joseph Helfgot's face.
Whitman and their four children held a conference call and quickly agreed it was the "right thing to do."
Helfgot, 60, learned to appreciate the value of life from his Holocaust survivor parents, friends and family said.
"It's easy to sign up and say you are an organ donor," Whitman said. "It's another to have your family understand and facilitate that. It's painful and it takes strength and a will to do it."
Helfgot never woke up after his April 5 heart transplant and the face operation took place on April 9, the day before Helfgot's funeral.
"He would be happy to know he went out with a bang," she said.
The recipient's identity hasn't been released, but Whitman said she would one day like to meet the man who received her husband's nose, roof of his mouth, upper lip, facial skin, muscles and nerves. Doctors have said the recipient will not look like the donor because his bone structure is different.
Helfgot was a New York City native who founded MarketCast, one of Hollywood's leading research companies.
Whitman said she went public with her story because she hoped to inspire others to become organ donors.
© 2009 The Associated Press.
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Posted in Uncategorized at 1:01 am by Pit
CHICAGO (AP) -- What we know for sure about diet and what protects the heart is a relatively short list.
That's the conclusion of new research based on an analysis of nearly 200 studies involving millions of people.
Vegetables, nuts and the Mediterranean diet made the grocery list of "good" heart foods. On the "bad" list: starchy carbs like white bread and the trans fats in many cookies and french fries.
The "question mark" list includes meat, eggs and milk and many other foods where there's not yet strong evidence about whether they're good or bad for the heart.
"I do research. I also buy groceries for my family every week," said study co-author Dr. Sonia Anand of McMaster University in Hamilton, Ontario, who hopes the findings "decrease the confusion around what we should eat and what we shouldn't eat."
The study, appearing in Monday's Archives of Internal Medicine, doesn't actually read like a shopping list. It's a complicated explanation of how the researchers rated 189 prior studies on the topic.
In short, they used criteria developed by Sir Austin Bradford Hill, the late British scientist who helped establish a link between smoking and lung cancer. When multiple studies on a certain food or diet showed a strong link with better heart health, that put the food or diet at the top of the list.
Dr. JoAnn Manson, chief of preventive medicine at Harvard's Brigham and Women's Hospital, said the analysis underlines that there's a big gray area and a shorter list of foods with strong links to heart health.
Linda Van Horn, professor of preventive medicine at Northwestern University's Feinberg School of Medicine, said the analysis is more about the strengths and limits of previous studies than advice for consumers.
But she said the analysis reaffirms the benefits of a Mediterranean diet - rich in vegetables, nuts, whole grains, fish and olive oil - compared to a Western diet, heavy on processed meats, red meat, refined grains and high-fat dairy.
Beyond that, she found no reason to tear up your grocery list based on the findings.
"It's really about the totality of the usual eating pattern, rather than whether you ate a hot dog on opening day of baseball season," Van Horn said.
The Heart and Stroke Foundation of Canada and the Canadian Institutes of Health supported the research.
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On the Net:
Archives: http://www.archinternmed.com
© 2009 The Associated Press.
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