Forensics Talk

"Perception Of Unsafe Neighborhoods Disables The Elderly"

Medical News Today

Article Date: 29 May 2009 - 0:00 PDT

     "Elderly people who live below the poverty line and perceive their neighborhoods to be dangerous are more likely to have a mobility disability. Researchers writing in the open access journal BMC Public Health suggest that even perceiving one's neighborhood as unsafe can 'get into the body' and, ultimately, prove hazardous for elder health.

Cheryl Clark MD, ScD, from Brigham and Women's Hospital, Boston, led a team of researchers who studied 1,884 people aged 65 and older. They measured both the individuals' perceptions of danger and the levels of violent crime actually reported in the areas where they lived. Although these measures correlated quite well, it was the elder's sense that the neighborhood was unsafe that was most strongly associated with the development of a disability. Clark said, "Our results suggest that dangerous neighborhoods get from the mind into the body and engender mobility disability through psychosocial or psychological processes". . . " Read More

Teen Obesity as Deadly as Smoking

WebMD                                                                                           

     Study Shows Obese Teens Have Similar Risk for Early Death as Teen Smokers

By Salynn Boyles                                                                                     
WebMD Health News

Reviewed by Louise Chang, MD

 

     Feb. 25, 2009 -- Obese teens are just as likely to die before they reach old age as teens who are heavy smokers, while those who are overweight, but not obese, have the same risk for early death as lighter smokers, a new study shows.

Researchers followed 45,000 Swedish men from the time they were drafted into the military at the age of 18 until most were in their mid-50s.

They found that those who were obese in their late teens had nearly double the risk of dying during the almost four decades of follow-up, compared to those whose weight was normal at age 18.

This was a similar increase in risk as seen in men who smoked more than 10 cigarettes a day in their late teens.

Men who were overweight, but not obese, in their teens and did not smoke had a similar risk for early death as normal-weight teens who smoked one to 10 cigarettes a day . . . Read More

Cheap Viagra Can Kill: Make Sure It's The Real Thing!

Kevin MD.com

     "When looking for a prescription of Viagra, Cialis, or Levitra, make sure you get the real thing.

Amy Tuteur points to a recent NEJM article detailing cases in Singapore where hospitalized men were found to have taken imitation erectile dysfunction medications containing contaminents like the glucose-lowering medication glyburide, as well as host of herbal substances.

Glyburide, in particular, can be deadly in those who do not have diabetes, as the drug can lower blood sugar leading to brain damage or death.

But the news gets worse.

Dr. Tuteur notes that there is a thriving counterfeit male enhancement drug market in the United States, and worse, in one scheme, money spent on Viagra knockoffs went on to fund Middle Eastern terrorist groups.

So, in your search for male sexual enhancement, get the genuine medication. It matters."

No Takers For Free Governmental Child Insurance?

HIPAA Blog

"Slightly Off topic: what happens if you pass a bill to put 4 million uninsured children on a governmental child insurance program, but they don't sign up? One thing never, never, never mentioned in the uninsured/underinsured debate is how many are that way by choice. Can't afford it? Hey, I know people making $200,000 a year who "can't afford" to pay their taxes; "can't afford it" can be as low a bar as you want it to be. Here's an example of what I'm talking about. There was a story (LA Times, I think) a few years ago about how much of the CHIP money in California was spent not on providing care, but sending social workers into the community to try to sign people up (for basically free insurance). They had a hard time getting takers."

Beyond the HIPAA Privacy Rule: Enhancing Privacy, Improving Health Through Research

HIPAA Blog                                                                                                                      

  IOM: HIPAA is flawed. The Institutes of Medicine had determined that the current privacy regime in HIPAA hinders medical research, and they're proposing a new privacy regime, at least where medical research is involved. They do put their finger on the issue -- best privacy and best healthcare are diametrically opposed, and the problem is finding a good balance.

After Severe Heart Attack Women Get Less Needed Hospital Treatment And More Likely To Die

Medical News Today

Main Category: Cardiovascular / Cardiology
Also Included In: Women's Health / Gynecology;  Heart Disease
Article Date: 09 Dec 2008 - 1:00 PST

     A new US study suggests that following a severe heart attack, women are less likely to get the care they need in hospital at the time they need it and they are more likely to die compared to men.

The study was the work of Dr Hani Jneid, lead author and assistant professor of Cardiovascular Medicine at Baylor College of Medicine in Houston, Texas, and colleagues. It is published in the 8 December issue of Circulation: Journal of the American Heart Association.

Jneid and colleagues found that women and men have about the same overall in-hospital death rate after heart attack, but women are twice as likely as men to die after being admitted to hospital following a severe type of heart attack called ST-elevation myocardial infarction (STEMI). They are also less likely to receive the treatment they need on time.

They did the study because an earlier paper on deaths following STEMI that showed women's death rate at 10.2 compared to 5.5 for men said this was because the women were older and had higher risk factors compared to the men. . . Read More

Obstructive Sleep Apnea Could Be Risk Factor For Sudden Cardiac Death

Medical News Today

Main Category: Sleep / Sleep Disorders / Insomnia
Also Included In: Cardiovascular / Cardiology;  Ear, Nose and Throat
Article Date: 10 Nov 2008 - 4:00 PST

     After studying the sleep characteristics of nearly 11,000 adults in an overnight sleep laboratory, Mayo Clinic researchers suggest that obstructive sleep apnea (OSA) - and, in particular, the low nighttime oxygen saturation of the blood it causes - may be a risk factor for sudden cardiac death (SCD).

OSA is a condition that disrupts breathing during sleep and is associated with obesity.

The study identified OSA as one of two traits that contribute to the highest risk of SCD. The other is age - patients who are 60 years old or older.

SCD can happen when the heart's electrical system malfunctions; if treatment - cardiopulmonary resuscitation and defibrillation - is not administered quickly, a person dies.

If further studies validate these findings, OSA would join established risk factors such as smoking, obesity, high cholesterol and high blood pressure. Mayo Clinic cardiologist Apoor Gami, M.D., the lead researcher on the study, presents the findings today at the American Heart Association's Scientific Sessions 2008 in New Orleans. . . Read More

Cognitive Deficits And Sleep-breathing Disorders In Children

Medical News Today

Editor's Choice
Main Category: Sleep / Sleep Disorders / Insomnia
Also Included In: Pediatrics / Children's Health
Article Date: 08 Oct 2008 - 18:00 PDT

     Like adults, children can suffer from sleep-disordered breathing (SDB) such as snoring or obstructive sleep apnea (OSA). In new research published in the November issue of the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine, scientists explore the interaction between sleep, breathing, and brain function and find that about two-thirds of children with SDB have some degree of cognitive deficit. The new study finds that is quite difficult to correlate the severity of the cognitive deficit to the severity of the SDB, possibly because other crucial issues are involved or because researchers are not measuring the correct factors.

Principal investigator Raouf Amin, M.D. (professor of pediatrics and director, Division of Pulmonary Medicine at Cincinnati Children's Hospital Medical Center) said that, "A history of snoring is a predictor for cognitive deficit in children with SDB." He added: "However, the frequency of apnea events during sleep does not predict cognitive deficit and does not correlate with the degree of cognitive deficit. Such a paradox raised the question of whether there are some variables that we do not traditionally measure in the sleep laboratory that might modify the effect of SDB on cognition."
Read More

Message To Reduce Risky Sexual Activity Reaches Across All Teens

Medical News Today

Main Category: Sexual Health / STDs
Article Date: 26 Nov 2008 - 0:00 PST

     Although teens who engage in risky health behaviors such as smoking and drunk driving are likelier to participate in sexual activity than more cautious peers, interventions aimed at reducing sexual activity appear to be similarly effective in high-risk and low-risk teens, a new study finds.

No matter where they fell on the risk spectrum, teens seemed positively influenced by intervention messages in the 1990s and early 2000s, when there was a decline in sexual experience and number of sexual partners across the board.

"The three biggest changes in adolescent behaviors in the last 16 years have been delaying sex, increasing the use of condoms and reducing the number of partners," said lead author John Santelli, M.D. "All three are areas that HIV education has clearly identified as goals."

However, while interventions aimed at reducing risky sexual behaviors in adolescents seemed successful for a while, the new data also show that this trend might be reversing, Santelli said.

Santelli works with the Heilbrunn Department of Population and Family Health at the Mailman School of Public Health at Columbia University.

He and his colleagues analyzed data from the Youth Risk Behavior Survey a nationally representative survey of U.S. high school students collected from 1991 to 2007. They categorized students into groups according to risky behaviors such as smoking or alcohol use and then looked each group's sexual activity when it came to four parameters: ever having sexual intercourse, having four or more lifetime partners, current sexual activity and the use of contraception during the last sexual experience.

The study appears online in the Journal of Adolescent Health.

Students who engaged in nonsexual high risk behaviors were three times more likely than lower risk students to say they had had four or more lifetime sexual partners. About 87 percent of students engaging in the highest risk behaviors had ever had sex, compared with only 13 percent of those engaging in low or no risk nonsexual behaviors.

Sylvana Bennett, M.D., of the University of California, San Diego Medical Center, also noted that the positive trend might be reversing, and that the reversal coincides with "a nationwide policy shift away from programs that included contraceptive information toward abstinence-only programs."

She said "troubling findings of an increasing teen birth rate in 2006 and the increasing number of sexually experienced teens after a low in 1999," just after "the federal government began limiting its funding to programs that did not mention contraception except to point out its limitations" in 2000.

"We don't know why we were successful in the 90s," Santelli said. "It looks like we were reaching the low-risk kids and the high-risk kids, but now it looks like [birth rates] might be coming up again and that's disturbing."

Santelli J, et al. Trends in sexual risk behaviors, by nonsexual risk behavior involvement, U.S. high school students, 1991 - 2007. J Adolesc Health online, 2008.

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Serious Problems In Maternity Care Quality And Value, Cesarean Section And Other Interventions Overused

Medical News Today

Main Category: Pregnancy / Obstetrics
Also Included In: Pediatrics / Children's Health;  Women's Health / Gynecology
Article Date: 09 Oct 2008 - 3:00 PDT

     Over 31% of U.S. births are now by cesarean section although a 5% to 10% rate is best for mothers and babies. The extra cost is well over $2.5 billion per year. The excess cesareans buy no reduction in maternal and newborn deaths. But they cause unneeded exposure to the dozens of adverse effects more common with c-sections. This is just the most striking example of how health care provided to mothers giving birth exposes them to avoidable harm and expense. These conclusions are found in Evidence-Based Maternity Care: What It Is and What It Can Achieve, a report released today by Childbirth Connection, The Reforming States Group, and the Milbank Memorial Foundation.

The report cites an extensive body of evidence to make the case that, despite paying top dollar, American women do not receive the best maternity care. It is the most comprehensive review to date of how maternity care is delivered, financed, and experienced by mothers, families, and health care payers. It concludes that maternity care can be significantly improved using evidence-based care. . . Read More

Stop, Stop, You're Killing Me!

Trusted.MD

by Sid Schwab

     Featured in: Surgery Insiderurgery Insider

Actually, you're killing us all. More conditions for which Medicare won't pay.

" 'Never events.' What a great term. In case you haven't heard it, the reference is to complications or outcomes for which, in essence, it's considered (by Medicare) that there's no excuse. Should never happen. No how. And, incidentally, for which we won't pay. The list is expanding.

There's only so much one can say without tearing out one's hair or shooting someone. It seems self-evident: bad stuff happens under the best of circumstances. If you do everything right, manage an incision perfectly with just the right timing and choice of antibiotics, proper preparation, everything done properly, some will still get infected. Given low-dose heparin, intra-operative booties, early ambulation, there will still be the occasional patient with deep vein thrombosis. The best surgeons, doing everything right, will have "never events." Unless they "never" operate.

So where are we headed? To a point, it would seem, where Medicare and -- as is the case as the other insurers inevitably follow suit -- the entire system will expect and pay only for perfect outcomes. And what will be the inevitable result? More and more doctors refusing to accept Medicare patients. And, most assuredly, fewer and fewer people choosing to become doctors (surgeons, anyway!) in the first place. Brilliant."

Contrasting Personal vs. Professional Uses of Social Media: The Case of Healthcare Blogging

Trusted.MD

by Hippocrates

     Featured in: Hippocratesppocrates

Where is the boundary between personal and professional use of the Internet? What does this mean for healthcare social media?

I was planning to write a post on the differences in "personal vs. professional" uses of blogs and social media for a while, but wanted to wait for some good material to analyze before hitting the "Publish" button.

The recent study in Journal of General Internal Medicine, called Content of Weblogs Written by Health Professionals (full-text PDF hosted by Pharmalot), looks at habits of an "average" medical blogger and tries very hard to paint them in a negative light, questioning their "professionalism".

This sets the stage for drawing personal vs. professional contrast:

Firstly, let me offer some definitions to make it easier:

1. Professional blogger: One of the few who are "blogging for dollars", derive direct income or have blogging in official job description. Think journalists, network bloggers or communication professionals.
2. Blogging professional: Professional (healthcare or otherwise) who blog to support their reputation and career pursuits, not generating direct income. Think vendors and consultants promoting their warez.
3. Personal blogger: Anyone who blogs without a business purpose. They do it to satisfy the various needs for self-expression. Think of medical student diaries or MySpace pictures posted by your teenage niece . . . Read More

 

 

 

 

 

by Hippocrates

Our Two Brains

Trusted.MD

by Venri Gurd

Featured in: Nutrition & Life

    When our emotional (limbic) brain and our cognitive (neocortex) brain are in conflict, we suffer negative emotions.

Our skull actually contain two brains, one inside the other, much like the yolk sits inside the white of an egg. The deep and primitive emotional/instinctive brain is known as the limbic system, and it is found in all mammals. It is our unconscious, survival brain which runs our autonomic nervous system, regulating breathing, heart-rate, sexual drive, hormones etc. It takes in all kinds of information, most completely below our level of awareness, and forces us to pay attention to stuff that it perceives may harm us. We don't feel the emotions of our limbic system in our head; we feel them in the body - nervousness in our gut, love in our heart, fear in our throat or in the hairs of our skin, for example. It is said that all our emotions are stored in the body. The limbic system is the source of our passion.

The neocortex (literally the "new bark") is much newer in terms of our evolutionary history, it surrounds the emotional brain forming our cognitive brain, and is our source of rational, logical thought. The neocortex, particularly the prefrontal cortex just behind our forehead, is the source of reason, and is what separates us from our fellow creatures on this planet. The neocortex and the limbic brain don't communicate with each other very well - they each do their own thing and come to their own conclusions. Rational thought seems to stay in the head, whereas our emotions are communicated via the body primarily . . . Read More

Brain And Reproductive Development Affected By Compounds From Soy, New Study Shows

Medical News Today

 Main Category: Pregnancy / Obstetrics
Also Included In: Endocrinology;  Neurology / Neuroscience;  Biology / Biochemistry
Article Date: 02 Aug 2008 - 0:00 PDT

     Two hormone-like compounds linked to the consumption of soy-based foods can cause irreversible changes in the structure of the brain, resulting in early-onset puberty and symptoms of advanced menopause in research animals, according to a new study by researchers at North Carolina State University. The study is a breakthrough in determining how these compounds can cause reproductive health problems, as well as in providing a key building block for how to treat these problems.

The study is the first to show that the actual physical organization of a region of the brain that is important for female reproduction can be significantly altered by exposure to phytoestrogens - or plant-produced chemicals that mimic hormones - during development. Specifically, the study finds that the compounds alter the sex-specific organization of the hypothalamus - a brain region that is essential to the regulation of puberty and ovulation. The study also shows that the phytoestrogens could cause long-term effects on the female reproductive system.

While the study examined the impact of these compounds on laboratory rats, neurotoxicologist Dr. Heather Patisaul - who co-authored the study - says the affected "circuitry" of the brain is similar in both rats and humans. Patisaul is an assistant professor in NC State's Department of Zoology. Her co-author is Heather Bateman, a doctoral student in the department.

Patisaul says this finding is extremely important because, while the changes in brain structure cannot be reversed, "if you understand what is broken, you may be able to treat it." Patisaul says she is in the process of evaluating the effects of these compounds on the ovaries themselves. Read More . . .

Is Health Blogging Recognized As The Force of Influence By Policy Makers?

 Trusted.MD

by hippocrates

     I should have posted this earlier, but please mark your calendars for tomorrow. Kaiser Family Foundation is holding a webcast titled "The Health Blogosphere: What It Means for Policy Debates and Journalism".

The LIVE webcast will begin at 1 p.m. ET on Tuesday, July 29, 2008 and may be well worth tuning into. Why? The cream of the crop in DC health policy blog and media circles will be there, including HHS Secretary Michael Leavitt, who happens to be the first Cabinet official to start a blog.

What is notable about the event?

In a few short years healthcare blogging went from the realm of early adoption by a handful of individuals to an institutional and influential phenomenon. Granted, the penetration of bloggers in the ranks of physicians, patients or hospital administrator is still quite low. But in the policy arena, airing your issue advocacy on the Internet in real time has become di rigeur.

Traditional media is adopting blogs at a breakneck rate as well (Jacob Goldstein of WSJ Health Blog is joining the call) and the distinction between traditional and social media keeps blurring. Inclusion of blogging into the communication strategy mix is becoming a standard practice. People no longer rely just on dead-tree paper to get their news and views. Even in healthcare.

The webcast is expected to drill into the details of these trends:

Questions to be explored with the panelists include: Why do individuals and organizations blog? How does blogging impact the broader work of an organization? Are there different standards used when blogging versus other writing? Have blogs impacted the news business significantly? What kind of influence are blogs having on political and policy debates?

If you are involved in health policy or communications, this webcast looks like a must-attend event.