Tag Archives: american

The DSM-5 is here: What the controversial new changes mean for mental health care

The most recent revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM) has arrived, and the latest changes have caused divisions among those in the psychiatric community.   Often touted as the psychiatrist’s “Bible,” the DSM is published by the American Psychiatric Association and establishes the almost universal standard by which doctors classify, diagnose and ultimately treat mental disorders – making it an essential part of the psychiatric profession.  The DSM is utilized not only by clinicians, but researchers and health insurance companies as well. Even government officials take interest in the DSM’s criteria in order to determine grant funding, insurance coverage and new health care policies. The latest version is the DSM’s fifth edition, and it is the manual’s first major revision in nearly 20 years since the publication of the DSM-IV in 1994.  The DSM-5’s release brings some radical new changes, which have been met with both praise and disgust from mental health professionals. Some of the most highly debated changes include the elimination of Asperger’s disorder and the addition of a few new controversial conditions such as cannabis withdrawal, gambling addiction and the highly contested disruptive mood dysregulation disorder (DMD). So what do these changes mean for those currently dealing with mental health disorders?  Read on to learn more about the DSM-5’s biggest changes and the possible impact they may have on mental health care. Combination of autism spectrum disorders into single category One of the most publicized changes in the DSM-5 involves grouping all of the subcategories of autism into a single category known as autism spectrum disorder (ASD).  This move effectively eliminates previously separate diagnoses of autism – including autistic disorder, Asperger’s disorder, childhood disintegrative disorder and pervasive development disorder “not otherwise specified” (PDD-NOS). This merging of categories creates a “sliding scale” for autism, meaning individuals will be diagnosed somewhere along the autism spectrum, given the personal severity of their symptoms. Many parents and health care providers have speculated that this transformation may end up excluding some of those already diagnosed with an autism disorder, like Asperger’s or PDD-NOS. “I think (exclusion from the spectrum) frankly yet to be determined, but if anything, the specificity is going to go up, meaning the false positives are going to be less likely,” Dr. Alexandar Kolevzon, associate professor of psychiatry and pediatrics at Mount Sinai Hospital in New York City, told FoxNews.com. “This universe of people with PDD-NOS – it’s possible that some of those patients may no longer meet those criteria.  Some of the debate revolves around Asperger’s, but it seems to me that most people diagnosed with Asperger’s will still be on the autism spectrum.” Over the past decade, the United States has seen a striking increase in the amount of autism diagnoses, with the Centers for Disease Control and Prevention estimating that one in 88 children suffers from an autism spectrum disorder.  According to Kolvezon, numerous epidemiological studies have found that the majority of children accounting for this incidence are those with PDD-NOS – a diagnosis given to those with communication issues and pattern behavior but who do not meet the full criteria for autism or another pervasive developmental disorder. Kolevzon said it’s possible that over-diagnosis of PDD-NOS has led to this increase in autism spectrum disorder cases. “What happens in the community is that the diagnosis of autism spectrum disorder virtually guarantees a whole host of therapies – such as speech therapy, occupational therapy, behavioral therapy, and potentially physical therapy,” Kolevzon said. “Theoretically, it’s possible that community providers and clinicians are incentivized to label kids with PDD-NOS, because it would make it more likely to receive appropriate services.” The autism spectrum disorder scale will further refine the way providers diagnose autism, Kolevzon said, by recognizing differences from person to person rather than trying to generalize them into one of four categories. The creation of disruptive mood dysregulation disorder Within the past decade, more and more children as young as 2 years old have been diagnosed with bipolar disorder, leading to the prescription of powerful antipsychotic medication that can be quite intense for children at such a young age. According to the Agency for Healthcare Research and Quality, hospital stays for childhood bipolar disorder have increased by 434 percent from 1997 to 2010.   The trend began in the mid-1990s, when doctors from Harvard University stated that bipolar disorder presented differently in children than that of adults. However, recent studies have found that many of these diagnoses were false, causing what many have described as the “false epidemic.” To combat this trend, the DSM-5 is eliminating the diagnosis of pediatric bipolar disorder and creating a brand new category called disruptive mood dysregulation disorder (DMDD), described as intense outbursts and irritability beyond normal temper tantrums in young children. While the move is meant to address an established problem, many are worried that the category will be applied too liberally. “My concern is this category will be applied to individuals where the reason for these blow ups is for something else.  You can see it in kids with anxiety disorders and ADHD….Even the head of the DSM committee asked, ‘Are we going to label kids with temper tantrums?’” Dr. Max Wiznitzer, a pediatric neurologist for UH Rainbow Babies & Children’s Hospital in Cleveland, Ohio, told FoxNews.com. “The thing is we have to make sure people are going to be rigorous in application and not just apply to any kid with temper tantrums or sleep deprivation.” ‘Dependence’ to ‘addiction,’ cannabis withdrawal and gambling disorders The DSM’s chapter on substance abuse has also undergone changes, now being called the Substance Use Disorders chapter.  The diagnostic criteria for these conditions have been expanded, but one of the biggest changes deals with the swapping of two seemingly similar words when describing these disorders: the term “dependence” is out and the term “addiction” is in. According to Dr. Yasmin Hurd, professor of psychiatry at Mount Sinai, the change is subtle but necessary. “It was quite confusing, especially with the term dependence,” Hurd told FoxNews.com.  “It had association with severe psychological dependencies, generating a lot of confusion.  Now the DSM-5 just talks about addiction, in context, being about the compulsive nature of the disorder.” For example, patients being prescribed pain medication may wind up hooked on the drug, but they are still taking the medication under the guidance of a physician.  They aren’t necessarily seeking out the medication by themselves, but if they are taken off the drug they may still have psychological withdrawal. In this case, they aren’t dependent on the drug, but they are addicted - according to the new guidelines. In addition to the word swap, new controversial categories of gambling disorders and cannabis withdrawal have been created in the DSM-5 – decisions based on multiple human and animal studies. “Experts in the field know that people who have severe cannabis use – they’ll go through cannabis withdrawal,” Hurd said. “There is a misnomer in our society that people can’t get addicted to marijuana.  That’s not true.  There are more people that meet the criteria for abuse of cannabis than any other illicit drug.” Similar to the changes made to the autism spectrum disorders, substance use disorders will also be categorized more on a sliding scale, depending on the severity of each patient’s symptoms. “You’re going to have many people with alcohol and cannabis addiction who have mild addiction, but very few heroin addicts are going to be mild,” Hurd said. Other major changes Along with the more controversial changes, the DSM-5 is also refining the criteria for post-traumatic stress disorders (PTSD), including a subtype for PTSD in preschool children.  The diagnosis for attention deficit hyperactivity disorder is also getting a revision, with the elimination of a previously required symptom and the changing of the required age of onset from age 7 to age 12. Obsessive compulsive disorder (OCD), once categorized under anxiety disorders, is now getting its own category of Obsessive-compulsive and related disorders.  Along with OCD, this category includes Body Dysmorphic Disorder (BDD), Trichotillomania (TTM, or hair pulling) and a brand new disorder called Hoarding Disorder. The DSM-5 incorporates many more changes that have psychiatrists locked in heated debate, but Wiznitzer noted that these tensions will always exist as long as doctors continue to learn more about the human brain. “Homosexuality used to be in the DSM as a psychiatric disorder; that was two versions ago,” Wiznitzer said. “Autism wasn’t even in the first two versions of the DSM, it was childhood schizophrenia.  Then we changed the criteria over time.  Basically anytime you change something, it’s always met with resistance.” Click for more information on the DSM-5.source : http://www.foxnews.com/health/2013/05/21/dsm-5-is-here-what-controversial-new-changes-mean-for-mental-health-care/

Increase in HIV infections among Navajo prompt fears of epidemic

An increase in HIV infections among the Navajo people in Gallup, N.M. has the medical community concerned over a possible epidemic, the New York Times reported. Among the reservation’s population, 47 new cases of HIV were diagnosed in 2012, which is a 20 percent increase from 2011, according to a report released last month by the federal Indian Health Service. Furthermore, data has revealed that cases of HIV among the Navajo have increased almost five-fold since 1999. “I’m scared to death,”  Dr. Jonathan Iralu, an infectious disease specialist who compiled the report and runs an HIV clinic in the impoverished Navajo community, told the New York Times. “The numbers show there is a dangerous rise, and the time to act is now, before it’s too late.” The tally of new cases within the tribe this year is the highest annual number recorded by the Indian Health Service. “I’m afraid that if we wait too long,” Dr. Iralu said, “it could turn into a true epidemic.” Iralu said that in the past, most cases of HIV in Native American communities would occur when members contracted the virus while traveling outside of the reservation and would then returning with the disease. However, he now believes that the infection is spreading within the reservation.   Despite the fact that education and routine screening programs have improved, there’s still a large stigma surrounding HIV in the Navajo community. Many of the reservation’s members are reluctant to discuss sex in public – and those with HIV often keep their disease a secret from family and friends, the New York Times reported. To combat these barriers to prevention, the Indian Health Service dedicated $5 million over the past three years for communities to create HIV various treatment and education programs. The Navajo AIDS network, the tribe’s health department and Iralu’s clinic are reportedly working on outreach efforts – such as running public service announcements, using social media to promote awareness and distributing condoms. Early detection remains critical among Native American communities. Though new infection rates among Navajos are roughly equal to infection rates among whites and lower than black and Hispanic communities, survival rates for Indians are much lower than other racial groups. Iralu suspects that lower screening rates, along with the increased risk among American Indian communities for diseases like diabetes or drug and alcohol abuse are contributing factors to the higher death rates. Click for more from the New York Times.source : http://www.foxnews.com/health/2013/05/21/increase-in-hiv-infections-among-navajo-prompt-fears-epidemic/

After a decade, global AIDS program looks ahead

The decade-old law that transformed the battle against HIV and AIDS in developing countries is at a crossroads. The dream of future generations freed from epidemic is running up against an era of economic recovery and harsh budget cuts. The President's Emergency Plan for AIDS Relief grew out of an unlikely partnership between President George W. Bush and lawmakers led by the Congressional Black Caucus. It has come to represent what Washington can do when it puts politics aside - and what America can do to make the world a better place. President Barack Obama, speaking at the recent dedication of Bush's presidential library, praised the compassion Bush showed in “helping to save millions of lives and reminding people in some of the poorest corners of the globe that America cares.” House Democratic leader Nancy Pelosi said of Bush in a statement that “while many events may distinguish his presidency, his devotion to combatting the scourge of HIV/AIDS will certainly define his legacy.” The AIDS program's future, however, is uncertain. Obama has upped the stakes, speaking in his State of the Union address this year of “realizing the promise of an AIDS-free generation.” But funding for the relief plan's bilateral efforts has dipped in recent years and it's doubtful that Congress, in its current budget-cutting mood, will reverse that trend when the current five-year program expires later this year. The AIDS program is also trying to find a balance between its goals of reaching more people with its prevention and treatment programs and turning over more responsibility to the host nations where it operates. “This has been an incredible achievement,” said Rep. Barbara Lee, D-Calif., a senior Congressional Black Caucus member who played major roles both in passing the original 2003 act and its 2008 renewal that significantly increased funding for AIDS, malaria and tuberculosis treatment in Africa and other areas of the developing world. She spoke of the more than 5 million people now receiving life-saving antiretroviral treatment and 11 million pregnant women who received HIV testing and counseling last year. “But I'm worried that with any type of level-funding or cuts we'll go backward,” she said. The 2008 act more than tripled funding from the 2003 measure, approving $48 billion over five years for bilateral and global AIDS programs, malaria and tuberculosis. It also ended U.S. policy making it almost impossible for HIV-positive people to get visas to enter the country. The AIDS program was the largest commitment ever by a nation to combat a single disease internationally. According to the U.N.'s UNAIDS and the Kaiser Family Foundation, in 2011 the United States provided nearly 60 percent of all international AIDS assistance. A decade ago, almost no one in sub-Saharan Africa was receiving antiretroviral treatment. By 2008, the AIDS program had boosted that number to 1.7 million. As of last year it was 5.1 million. The State Department says the program last year also helped provide treatment to some 750,000 HIV-positive pregnant women, allowing about 230,000 infants to be born HIV-free, supported 2 million male circumcisions and directly supported HIV testing and counseling for 46.5 million. “This is a remarkable story that the American people should know about,” Kimberly Scott of the Institute of Medicine, which recently completed an evaluation of the AIDS program, said at a forum sponsored by the Kaiser Family Foundation and the CSIS Global Health Policy Center. According to UNAIDS, the number of people living with HIV has leveled off, standing at about 34 million at the end of 2011. New infections that year reached 2.5 million, down 20 percent from 2001. AIDS-related deaths were 1.7 million, down from 2.3 million in 2005. Jennifer Kates, director of global health and HIV policy at Kaiser, said most countries where the program operates have yet to reach the “tipping point,” where new infections occurring in a year are less than the increase in people receiving treatment. Among the success stories were Ethiopia, where the 40,000 going on treatment in 2011 was almost four times the new infections. Still with a long way to go was Nigeria, which that year had 270,000 new HIV infections and a 57,000 increase in those getting treatment. Chris Collins, director of public policy at amfAR, The Foundation for AIDS Research, also warned of potential repercussions as the AIDS program shifts from being an emergency response to the AIDS epidemic to a more supportive role for country-based health programs. “The countries themselves largely are avoiding the important role that key populations play in epidemics,” he said, referring to gay men, those injecting drugs and sex workers. These groups face discrimination and criminal charges in many cases, and 90 percent of the money to help them now comes from external sources. Collins also spoke of the “huge mismatch” between the positive science and rhetoric on fighting AIDS and the money available. Since 2009 the funding for bilateral and global HIV and AIDS programs has largely stalled. Kaiser's Kates said that while there's still bipartisan support for the AIDS program in Congress, “the big question is will the financing be there to reach the goals” of treating more people and advancing toward that AIDS-free generation. “The challenge right now is that the global economic climate is different, the U.S. climate is different, but the need is still great.”source : http://www.foxnews.com/health/2013/05/21/after-decade-global-aids-program-looks-ahead/

Genetic testing guidelines under fire

If you underwent a genetic test for a heart condition, but the test also revealed that you have a high risk of colon cancer, would you want to know? A respected scientific society says your doctor should tell you, but the group is receiving criticism for its recommendation that “incidental findings” of genetic tests be shared with patients. Incidental findings are unexpected results, unrelated to the reason for testing. What to do with these findings has been a controversial issue for adults undergoing genetic testing, as well as children. In March, the American College of Medical Genetics and Genomics (ACMG) released guidelines saying that when patients receive genetic testing for any medical reason, they should be screened for mutations in an additional 57 genes, including mutations that strongly increase the risk of breast, ovarian and colon cancer. The ACMG argues that doctors have an obligation to look for and report these mutations because there are ways that people can act to reduce their of developing a medical disorder. However, some researchers and bioethicists say the new recommendations go too far, and take away patients' rights to refuse medical information they do not wish to know. Informed consent A crucial part of genetic testing ethics is ensuring that patients understand what a test might find, and what those findings could mean for future treatment. Under the new recommendations, a patient who consents to any genetic test is consenting to be screened for mutations in an additional 57 genes. Some bioethicists take issue with this approach, because patients may not wish to know their results for all of these genes. A positive result for any one of these mutations may increase patients' anxiety, or cause them to live their life differently, said Susan Wolf, a professor of law, medicine and public policy at the University of Minnesota. Under the new guidelines, “unless they are willing to have this extra analysis done, the only option is to walk away from the sequencings altogether,” Wolf said. “It's all or nothing.” Arthur Caplan, a bioethicist at New York University School of Medicine's Division of Medical Ethics, agreed that patients should have an opportunity to refuse. “People do not have any obligations to accept any findings that they hadnt been expecting,” Caplan said. And even calling such findings “incidental” is a misnomer, Wolf said, because under the new guidelines, researchers have to actively test for these gene mutations. What about kids? Earlier this year, both the American Academy of Pediatrics and the AMCG advised that children not be screened for genetic conditions that occur in adulthood (such as breast cancer), unless some action in childhood can lower the risk of disease or death. Children should wait until they are at least 18 years old to decide if they want to know their risk, the guidelines say. But under the new recommendations, children should be informed about any findings from the extra screening, including those that relate to adult disorders. Supporters of the new recommendations say that they are not at odds with earlier guidelines. Dr. Robert Green, of Harvard Medical School, and colleagues, wrote in the May 16 issue of the journal Science that if doctors are screening a child for a genetic disease that occurs in adulthood, the child would presumably have a family history of the disease. With incidental findings, no other family members, including the child, would be known to be at risk. So reporting an incidental finding could alert the child, as well as other family members including adults, to their risk of a certain condition, Green said. But others disagree, saying the new recommendations contradict earlier guidelines, and are not in children's best interest. “You've deprived the child of their own choice later as an adult,” Wolf said. Practical issues The guidelines also say that patients should be counseled about the implications of genetic testing before the test is ordered. But some argue that discussing all 57 genes would be demanding. “That is going to be a rather time consuming process,” said Dr. Harry Ostrer, a medical geneticist at the Albert Einstein College of Medicine in New York City. Wolf and others are calling on the AMCG to reconsider the new guidelines. The AMCG says that the guidelines will be reviewed yearly and updated in light of new evidence. But in the meantime, doctors are in a bind about what to do when screening patients. “It really creates a big dilemma because, when an organization like the AMCG makes a recommendation, it's seen as establishing a standard of care,” Ostrer said. If doctors don't follow the guidelines, patients could sue for malpractice if it turns out they are a carrier of a mutation that the additional screening would have caught, Ostrer said. Ostrer said he would like to see more evidence about how patients respond to being told about incidental findings. Studies looking at this question are being carried out now, he said. Copyright 2013 LiveScience, a TechMediaNetwork company. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.source : http://www.foxnews.com/health/2013/05/20/genetic-testing-guidelines-under-fire/

What do we eat? New food map will tell us

Do your kids love chocolate milk? It may have more calories on average than you thought. Same goes for soda. Until now, the only way to find out what people in the United States eat and how many calories they consume has been government data, which can lag behind the rapidly expanding and changing food marketplace. Researchers from the University of North Carolina at Chapel Hill are trying to change that by creating a gargantuan map of what foods Americans are buying and eating. Part of the uniqueness of the database is its ability to sort one product into what it really is - thousands of brands and variations. Take the chocolate milk. The government long has long classified chocolate milk with 2 percent fat as one item. But the UNC researchers, using scanner data from grocery stores and other commercial data, found thousands of different brands and variations of 2 percent chocolate milk and averaged them out. The results show that chocolate milk has about 11 calories per cup more than the government thought. The researchers led by professor Barry Popkin at the UNC School of Public Health, are figuring out that chocolate milk equation over and over, with every single item in the grocery store. It's a massive project that could be the first evidence of how rapidly the marketplace is changing, and the best data yet on what exact ingredients and nutrients people are consuming. That kind of information could be used to better target nutritional guidelines, push companies to cut down on certain ingredients and even help with disease research. Just call it “mapping the food genome.” “The country needs something like this, given all of the questions about our food supply,” says Popkin, the head of the UNC Food Research Program. “We're interested in improving the public's health and it really takes this kind of knowledge.” The project first came together in 2010 after a group of 16 major food companies pledged, as part of first lady Michelle Obama's campaign to combat obesity, to reduce the calories they sell to the public by 1.5 trillion. The Robert Wood Johnson Foundation agreed to fund a study to hold the companies accountable, eventually turning to UNC with grants totaling $6.7 million. Aided by supercomputers on campus, Popkin and his team have taken existing commercial databases of food items in stores and people's homes, including the store-based scanner data of 600,000 different foods, and matched that information with the nutrition facts panels on the back of packages and government data on individuals' dietary intake. The result is an enormous database that has taken almost three years so far to construct and includes more detail than researchers have ever had on grocery store items - their individual nutritional content, who is buying them and their part in consumers' diets. The study will fill gaps in current data about the choices available to consumers and whether they are healthy, says Susan Krebs-Smith, who researches diet and other risk factors related to cancer at the National Cancer Institute. Government data, long the only source of information about American eating habits, can have a lag of several years and neglect entire categories of new types of products - Greek yogurt or energy drinks, for example. With those significant gaps, the government information fails to account for the rapid change now seen in the marketplace. Now more than ever, companies are reformulating products on the fly as they try to make them healthier or better tasting. While consumers may not notice changes in the ingredient panel on the back of the package, the UNC study will pick up small variations in individual items and also begin to be able to tell how much the marketplace as a whole is evolving. “When we are done we will probably see 20 percent change in the food supply in a year,” Popkin says. “The food supply is changing and no one really knows how.” For example, the researchers have found that there has been an increase in using fruit concentrate as a sweetener in foods and beverages because of a propensity toward natural foods, even though it isn't necessarily healthier than other sugars. While the soda and chocolate milk have more calories on average than the government thought, the federal numbers were more accurate on the calories in milk and cereals. Popkin and his researchers are hoping their project will only be the beginning of a map that consumers, companies, researchers and even the government can use, breaking the data down to find out who is eating what and where they shop. Is there a racial divide in the brand of potato chips purchased, for example, and what could that mean for health? Does diet depend on where you buy your food - the grocery store or the convenience store…

Organic industry clout grows with consumer demand

The organic food industry is gaining clout on Capitol Hill, prompted by rising consumer demand and its entry into traditional farm states. But that isn't going over well with everyone in Congress. Tensions between conventional and organic agriculture boiled over this week during a late-night House Agriculture Committee debate on a sweeping farm bill that has for decades propped up traditional crops and largely ignored organics. When Rep. Kurt Schrader, D-Ore., a former organic farmer, offered an amendment to make it easier for organic companies to organize industrywide promotional campaigns, there was swift backlash from some farm-state Republicans, with one member saying he didn't want to see the industry get a free ride and another complaining about organics' “continued assault on agriculture.” “That's one of the things that has caught me and raises my concerns, is that industry's lack of respect for traditional agriculture,” said Rep. Austin Scott, R-Ga., referring to some organic companies' efforts to reduce the number of genetically modified crops in the marketplace. At the same time, Scott acknowledged that he and his wife buy organic foods. Growing consumer interest in organics has proved tough for some Republicans on the committee to ignore. Eight Republicans, most of them newer members of the committee, joined with all of the panel's Democrats in supporting the amendment, which was adopted 29-17. Rep. Vicky Hartzler, a Missouri Republican who owns a farm equipment business and a corn and soybean farm, said she supported the amendment not only because helping organics is good for agriculture but because many of her constituents eat organic foods. “Organics are a niche market in agriculture with a growing market share, so it makes sense for me to allow farmers to invest some of their own funds to promote their products,” she said. The amendment would allow the organic industry to organize and pay for a unified industry promotional campaign called a “checkoff” that is facilitated by the Agriculture Department but is no cost to the government. These promotional programs have traditionally been limited to individual commodities or crops, producing familiar campaigns like “Got Milk?” and “Beef: It's What's for Dinner.” The amendment would not set up such a program for organics, but it would allow USDA to approve an organic promotional campaign if the industry decided it wanted one. Laura Batcha of the Organic Trade Association says one reason the industry would approve a campaign is that many organic producers are concerned that consumers don't understand that products labeled “natural” aren't necessarily organic, which requires certification. The organic industry has exploded in the last decade, with $35 billion in sales and 10 percent growth just last year. There are more than 17,000 certified organic businesses in the country. Producers of organic crops and conventional crops have long been at odds, as organic products have grabbed market share - more than 4 percent of food and beverage sales in 2011 - and the industry has advertised organic foods as healthier than other foods. Organic products are required to be certified by the USDA and are grown without pesticides and genetically modified ingredients, mainstays of traditional agriculture. Government-managed promotional checkoff programs like the one that would be allowed under the amendment are required to be positive and not disparage other products, and some lawmakers seemed wary that such a campaign would be possible. “How do I present organic pork without disparaging non-organic pork?” asked House Agriculture Chairman Frank Lucas, R-Okla., who opposed the amendment. Mike Conaway, R-Texas, took issue with part of the amendment that would allow the organic producers to opt out of other commodity campaigns, an option that isn't given to conventional producers. “Looks to me like they have a free ride on this thing,” Conaway said, in an at times angry exchange with Schrader. Despite the rancor, the chances that the amendment will become law are good, as the Senate Agriculture Committee added the same amendment to its version of the farm bill. Schrader told his colleagues that embracing organics is essential to appealing to consumers in a time when big farms are often demonized by popular culture. He said that many young people are coming back to farms because of nontraditional agriculture. “American agriculture is under siege,” he said. “Urban folks do not understand where their food and fiber comes from. ... The point here is to hopefully position American agriculture where we're not always trying to catch up to what the American consumer wants.”source : http://www.foxnews.com/health/2013/05/17/organic-industry-clout-grows-with-consumer-demand/

Could marijuana reduce diabetes risk?

There's an unexpected link between marijuana use and factors related to Type 2 diabetes that has medical researchers intrigued. Several studies have found that marijuana users take in more food calories than nonusers, but they still have lower rates of obesity and diabetes, and lower average body mass index (BMI) levels. In a new study, researchers investigated what effects marijuana and its active ingredient tetrahydrocannabinol (THC) might have on people's metabolism, especially insulin levels. [5 Diets That Fight Diseases] Insulin resistance an important risk factor for diabetes is a metabolic disorder that occurs when the body's cells cannot properly intake insulin. The American Heart Association estimates 35 percent of U.S. adults have metabolic disorders that include insulin resistance. To examine the link between THC and metabolism, researchers gathered the results of 4,657 adults from the National Health and Nutrition Examination Survey, a cross-sectional study administered annually by the Centers for Disease Control and Prevention. Of the study's participants, 579 were current marijuana users, 1,975 had used the drug in the past but not recently, and 2,103 had never tried marijuana. Researchers analyzed the participants' fasting insulin levels, cholesterol levels, insulin resistance and waist sizes. Multiple benefits seen The results showed that the current marijuana users had 16 percent lower fasting insulin levels than nonusers, and 17 percent lower insulin-resistance levels. Additionally, the regular users of marijuana had smaller average waist sizes, and higher levels of high-density lipoprotein (HDL) cholesterol, aka “good cholesterol.” “These are indeed remarkable observations that are supported by basic science experiments that came to similar conclusions,” Dr. Joseph Alpert, professor of medicine at the University of Arizona College of Medicine, Tucson, said in a statement. Interestingly, only the current users of marijuana (not the former users) experienced the positive results, suggesting that the effects of marijuana use on insulin and insulin resistance only occur after recent use. To test their results, which were published in the latest issue of The American Journal of Medicine, the researchers also adjusted for participants who had been diagnosed with Type 2 diabetes. Much more research needed “After we excluded those subjects with a diagnosis of diabetes the associations between marijuana use and insulin levels, [insulin resistance], waist circumference and HDL-C were similar and remained statistically significant,” Dr. Elizabeth Penner, a co-author of the study, said in a statement. “Is it possible that THC will be commonly prescribed in the future for patients with diabetes or metabolic syndrome alongside antidiabetic oral agents or insulin for improved management of this chronic illness? Only time will answer this question for us,” Alpert said in an editorial accompanying the article in the journal. “We desperately need a great deal more basic and clinical research into the short- and long-term effects of marijuana in a variety of clinical settings such as cancer, diabetes and frailty of the elderly,” Alpert wrote. Copyright 2013 LiveScience, a TechMediaNetwork company. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.source : http://www.foxnews.com/health/2013/05/16/could-marijuana-reduce-diabetes-risk/

Tiny preemies get a boost from live music therapy

As the guitarist strums and softly sings a lullaby in Spanish, tiny Augustin Morales stops squirming in his hospital crib and closes his eyes. This is therapy in a newborn intensive care unit, and research suggests that music may help those born way too soon adapt to life outside the womb. Some tiny preemies are too small and fragile to be held and comforted by human touch, and many are often fussy and show other signs of stress. Other common complications include immature lungs, eye disease, problems with sucking, and sleeping and alertness difficulties. Recent studies and anecdotal reports suggest the vibrations and soothing rhythms of music, especially performed live in the hospital, might benefit preemies and other sick babies. Many insurers won't pay for music therapy because of doubts that it results in any lasting medical improvement. Some doctors say the music works best at relieving babies' stress and helping parents bond with infants too sick to go home. But amid beeping monitors, IV poles and plastic breathing tubes in infants' rooms at Chicago's Ann & Robert H. Lurie Children's Hospital, music therapist Elizabeth Klinger provides a soothing contrast that even the tiniest babies seem to notice “What music therapy can uniquely provide is that passive listening experience that just encourages relaxation for the patient, encourages participation by the family,” Klinger said after a recent session in Augustin's hospital room. The baby's parents, Lucy Morales and Alejandro Moran, stood at the crib and whispered lovingly to their son as Klinger played traditional lullabies, singing in Spanish and English. “The music relaxes him, it makes him feel more calm” and helps him sleep better too, Lucy Morales said. “Sometimes it makes us cry.” Some families request rock music or other high-tempo songs, but Klinger always slows the beat to make it easier on tender ears. “A lot of times families become afraid of interacting with their children because they are so sick and so frail, and music provides them something that they can still do,” Klinger said, who works full time as a music therapist but her services are provided for free. Music therapists say live performances in hospitals are better than recorded music because patients can feel the music vibrations and also benefit from seeing the musicians. More than two dozen U.S. hospitals offer music therapy in their newborn intensive care units and its popularity is growing, said Joanne Loewy, a music therapist who directs a music and medicine program at Beth Israel Medical Center in New York. Preemies' music therapy was even featured on a recent episode of the hit TV show “American Idol,” when show finalist Kree Harrison watched a therapist working with a tiny baby at Children's Hospital Los Angeles. “Music is such a huge part of our lives and to do something like this, make it a sort of healing process, is a cool thing,” Harrison said on the April 25 episode. Dr. Natalia Henner, a newborn specialist at Lurie hospital, said studies in nursing journals show music therapy for preemies “does help with promoting growth. And there's some good literature ... saying that the time to discharge is a little bit shorter in babies who've been exposed to more music therapy.” She said it “definitely facilitates bonding” between parents of preemies and other babies too sick to go home. Loewy led a study published last month in the journal Pediatrics, involving 11 U.S. hospitals. Therapists in the study played special small drums to mimic womb sounds and timed the rhythm to match the infants' heartbeats. The music appeared to slow the infants' heartbeats, calm their breathing, and improve sucking and sleeping, Loewy said. Soozie Cotter-Schaufele, a music therapist at Advocate Children's Hospital-Park Ridge near Chicago, says soothing rhythmic sounds of music can mimic womb sounds and provide a comforting environment for preemies. She sings and plays a small harp or guitar, and says the sounds help calm tiny babies while they're undergoing painful medical procedures. Cotter-Schaufele said she recently heard from a woman whose daughter was born prematurely at her hospital six years ago. She had played the 1960s folk song “Today” for the infant. The mother reported her daughter “`still loves that song,” She said `She didn't learn that song from me, she learned it from you,'” Cotter-Schaufele said.source : http://www.foxnews.com/health/2013/05/16/tiny-preemies-get-boost-from-live-music-therapy/

New cancer tools allow patients to reconsider chemo

After decades of using one-size-fits-all therapies to combat cancer, doctors are using new tools to help decide when their patients can skip chemotherapy or other harsh treatments. An approach to oncology that has been in place for decades is beginning to yield to an arsenal of long-term clinical studies, genetic tests and novel drugs that target cancer cells and their infrastructure. “What is happening is a combination of new technology and more-targeted cancer drugs,” said Dr Sandra Swain, medical director of the Cancer Institute at Washington Hospital Center and president of the American Society of Clinical Oncology (ASCO). “We've tried the approach of big, nonspecific treatments ... We have found that throwing chemo at patients has not (necessarily) cured them.” Traditional chemotherapy drugs work by interfering with the entire body's system of cell replication, causing harsh side effects like fatigue and hair loss. Since the completion of the human genome project in 2003, scientists have made progress in unlocking the genetic basis of a range of diseases, including cancer. That has paved the way for genetic testing as well as drugs that block specific pathways that cancer cells use to grow and reproduce. Such targeted cancer drugs, which sometimes preclude the need for chemotherapy, are being sold by companies ranging from Pfizer Inc, the world's largest drugmaker, to Ariad Pharmaceuticals Inc, which early this year launched its first drug, to treat leukemia. At the same time, large-scale studies that look at whether some types of patients are better off with less treatment are giving doctors more confidence to hold off on using traditional cancer drugs. Laurie Levin, now 64, was successfully treated in her 20s for non-Hodgkin's lymphoma, but faced a dilemma after being diagnosed with breast cancer in 2005 since the earlier radiation and chemotherapy had already raised her risk of developing heart problems or leukemia. A $4,000 genetic test showed that her breast cancer was unlikely to return, providing the confidence to undergo a lumpectomy and avoid chemotherapy. “It was like someone handed me my life back when I got those results,” she said. Use of the Oncotype DX test, which analyzes genes involved in tumor recurrence, has cut the use of chemotherapy in U.S. breast cancer patients by 20 percent over the past eight years, according to its maker, Genomic Health Inc. The company recently launched a similar test designed to measure whether men with prostate cancer need to undergo surgery or radiation. Tests and studies can clarify treatment, but costs remain on the upswing because the newest drugs are very expensive, with monthly price tags often in the thousands of dollars. By 2016 annual global sales of cancer drugs will nearly triple, to $88 billion from a decade earlier, according to IMS Health. 'RIGHT-SIZING TREATMENT' The “less is more” approach to cancer will be one highlight of ASCO's annual meeting in Chicago that begins at the end of this month. On Wednesday, ASCO released thousands of abstracts on new clinical trials of cancer treatments. One large, long-term study found that most men diagnosed with early-stage seminoma, a common type of testicular cancer, did fine with no treatment following surgery to remove the tumors. Cure rates for the disease have always been quite high. Several European countries, including Denmark where the study was conducted, monitor seminoma patients for any relapse before further treatment. In the United States, about half of early-stage patients are still given radiation or chemotherapy, according to ASCO. “Opting for surveillance spares patients, most of whom are young men, from the harmful side effects of chemotherapy and radiation without diminishing their chances for a long and healthy life,” said ASCO's incoming president, Dr Clifford Hudis, in a statement. Physicians say it is difficult to quantify in statistics, but there is growing recognition that less is more in terms of potentially toxic cancer treatments. The approach is especially important for young patients who will have many years ahead of them after beating an initial bout of cancer. “We are right-sizing treatment,” said Dr. James Mohler, chair of the department of urology at Roswell Park Cancer Institute in Buffalo, New York. He pointed to recent national guidelines calling for “active surveillance” of older men diagnosed with slower-growing prostate cancer. A study presented earlier this year at an ASCO meeting in Florida found similar survival rates for men with high-risk prostate cancer who received radiation and either 18 or 36 months of hormone therapy. The findings suggest the therapy, which causes significant side effects, could be given for less than the current standard of 24 to 36 months. Another recent study out of the Duke Cancer Institute in Durham, North Carolina, found that survival odds for women with early-stage breast cancer who underwent breast-preserving surgery such as lumpectomy were as good as, or even better than, the odds for women who had mastectomies. “We are going to see reevaluations of very successful therapies to determine whether or not we can achieve the same results using less treatment,” said Dr Armand Keating, director of the hematology division at the University of Toronto and president of the American Society of Hematology. The first-ever study showing that a type of leukemia could be cured without using chemotherapy was released in December. The Italian-German study found that a combination of a derivative of vitamin A, known as ATRA, and arsenic trioxide, a newer drug, worked as well as ATRA and chemotherapy in patients newly diagnosed with acute promyelocytic leukemia (APL). “APL used to be one of the most dreaded strains of cancer, but with ATRA and chemo the results are very gratifying,” Keating said. “Now we have two agents that are not chemo agents ... That to me is a milestone. I can't see any reason why this wouldn't become the standard of care.” A recent trial conducted in France found that omitting standard chemotherapy, which has been linked to heart damage, from the initial treatment of a type of childhood leukemia did not reduce survival outcomes. “The nice thing is you have omitted a potentially toxic agent that contributes to morbidity and maybe mortality down the road,” Keating said. The priciest therapies are designed to take advantage of genetic mutations associated with cancer cells, some of them found only in a small percentage of patients. A new drug for melanoma, BRAF inhibitor Zelboraf from Roche Holding AG, is designed to work by targeting a specific genetic mutation found in about half of all melanomas. Patients are first tested to see if they have it. Pfizer's lung-cancer drug Xalkori, which targets a mutation in the ALK gene, works in about 4 percent of lung cancer patients. It also has been effective as a treatment for a rare but aggressive type of childhood lymphoma. “We've been really trying for years to be more precise about who needs treatment ... Now we are more able to achieve it,” said Swain.source : http://www.foxnews.com/health/2013/05/16/new-cancer-tools-allow-patients-to-reconsider-chemo/

New study explores providers’ perceptions of parental concerns about HPV vaccination

Cervical cancer incidence and mortality are markedly higher for low-income and minority women due to higher rates of HPV and limited access to screening and treatment. Vaccination for HPV has the potential to reduce health care disparities in cervical cancer rates if girls are vaccinated prior to sexual experimentation. Although providers felt that parents wanted to prevent cervical cancer in their daughters, some had concerns about safety of the vaccine and promoting early or unsafe sexual activity. …