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Giving birth at home looks safe, study finds

Among women with low-risk pregnancies, those who plan to give birth at home may face less of a risk from dangerous complications than women who plan a hospital birth, a new Dutch study suggests. For women in the study who had a low risk of complications and had given birth at least once previously, 1 in 1,000 home births resulted in severe problems, such as admission to an intensive care unit or requiring heavy blood transfusion. The rate of such complications for planned hospital births was 2.3 in 1,000 births. Home births also had a lower risk of certain less severe complications, such as bleeding after birth, and the need to remove the placenta manually. The rate of bleeding, or postpartum hemorrhage, was 19.6 in 1,000 for a planned home birth, compared with 37.6 in 1,000 for a planned hospital birth. The safety of giving birth at home versus the hospital is a topic of debate. While some worry that in case of an emergency, the time needed to transport a woman or baby from home to a hospital might worsen the problems, others have questioned whether it is wise to routinely recommend hospital births for low-risk women, where they could receive medical interventions they don't need that have potentially harmful effects. The new study sought to compare the rate of serious complications in home and hospital births in a large group of low-risk women in the Netherlands, a country that has one of the highest percentages of home births among Western countries. The researchers identified more than 146,000 low-risk pregnant women. Among these women, 92,333 (63 percent) had planned to give birth at home, and 54,419 (37 percent) were planning a hospital birth. The researchers found that the risk of complications was small in both groups, and there was no evidence that home birth would lead to an increased risk of severe complications.The difference between the groups was significant only in women who had given birth before. The results held when the researchers accounted for factors that can raise the risk of birth complications, such as the mother's age and ethnicity, as well as C-sections and augmentation of labor. The researchers noted that it is possible that women who previously had a relatively difficult birth may have been more likely to plan a hospital birth next time, even if there was no official medical indication. These findings likely only apply to areas where midwives are well trained to help women at home births, and where facilities for transportation in case of emergencies are adequate, the researchers said. The fact that the study did not find higher rates of severe complications among planned home births should not lead to complacency, the researchers said. “Every avoidable adverse maternal outcome is one too many,” they 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/2013/06/13/giving-birth-at-home-looks-safe-study-finds/

Babies have sympathy for bully victims, study suggests

Babies may be able to show sympathy before their first birthday, according to a new study in which 10-month-olds preferred the victims rather than the aggressors in a bullying encounter. The research, published June 12 in the journal PLOS ONE, is the first to find evidence of possible sympathy in children younger than toddlers, the researchers said. Sympathy is the feeling of concern for others. Because 10-month-olds can't yet express sympathy verbally, Kyoto University researcher Shoji Itakura and colleagues turned to a common tactic in baby-brain research: using simple animations to determine what infants prefer. They showed 40 babies an animation of a blue ball and a yellow cube. Half of the infants watched a short clip in which the blue ball chased the yellow cube around the screen, hitting it seven times before finally squishing it against a wall. The other half of the group saw the same movements, including the squishing, but the two shapes moved independently without interacting. In some cases, the “bully” and “victim” roles were swapped, so that the yellow cube was the bad guy. After watching the show, the babies were shown a real yellow cube and a real blue ball, and given the chance to reach for one of the objects. In cases where the babies had seen one shape beating up on the other, they overwhelmingly reached for the victim, 16 out of 20 times. In comparison, when the shapes hadn't interacted, the babies' choices were basically random nine went for the shape that had gotten squished, and the other 11 went for the nonsquished shape. Picking the victim The results could have simply indicated that babies preferred to steer clear of a nasty character, not that they felt sympathy for the bullied one. To rule out that possibility, the researchers conducted a second experiment with 24 babies, also 10 months old. These babies saw a show nearly identical to the first, except there was a third character: a red cylinder. The red cylinder was a neutral presence on-screen, neither bullying nor being bullied. After watching the animation, the babies were again given a choice of two toys. Half could pick between the “victim” shape and the neutral shape, while the other half got to choose between the bullying shape and the neutral shape. This time, 10 out of 12 babies given the neutral-or-bully option went with the neutral cylinder. Meanwhile, of the 12 given the neutral-or-victim option, 10 picked the victim. In other words, even when there was no mean character present that a baby might want to avoid, the babies still picked the victim. It goes too far to call this proof of sympathy, said Kiley Hamlin, an infant cognition researcher at the University of British Columbia who was not involved in the study. Nevertheless, Hamlin told LiveScience, the findings are “a great first step” in establishing the development of sympathy. Previously, Hamlin has reported that babies as young as 8 months old prefer to see wrongdoers punished rather than treated nicely. Brainy babies Some researchers have raised concerns about the kinds of animations used in infant cognition studies, arguing that babies might be marking their preferences based on extraneous information, like whether one character bounces or moves differently than the others. Itakura and colleagues aimed to control for those concerns by making sure their character shapes moved with the same speed and consistency. “They did a great job controlling for things like movement and amount of color on the stage,” Hamlin said. Though more studies will be needed to nail down babies' motivations for preferring victims of aggression, Hamlin said anecdotes suggest that even young babies notice others in distress, and seem bothered by that distress. “This is a nice way of saying, 'Okay, this is a far more abstract situation, is this something that 10-month-olds are noticing and responding to?” Hamlin said. “It seems to be that case that they are.” 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/2013/06/13/babies-have-sympathy-for-bully-victims-study-suggests/

Depression treatments: Brain scans may suggest best course

For people with depression, brain activity can predict whether talk therapy or medication will better relieve their symptoms, a new study suggests. In the study, published June 12 in the journal JAMA Psychiatry, people whose brain scans showed an overactive insula, a brain region involved in emotional processing, tended to improve with medication, but not talk therapy, whereas the reverse was true for those with an underactive insula. The study was small and the findings are preliminary. But if the results are confirmed in a larger trial, the technique could be used to help guide treatment decisions for people with depression, the researchers said. An evaluation of a depression patient, in a doctor's office, “doesn't really help us to know very well whether they should receive talk therapy or a medication,” said study co-author Dr. Boadie Dunlop, a psychiatrist at Emory University in Atlanta. But the new findings, “based on the activity of the brain, that could help us pick the best treatment for an individual,” he said. Poor success Depression treatments such as talk therapy or medication have a poor success rate, with only 40 percent of people typically seeing their symptoms resolve with the first treatment, Dunlop said. Spending two to three months on ineffective treatments can lead to lost productivity, higher risk of suicide, and continued suffering for patients and their families. [Where is the Suicide Belt?] To see whether there was a way to identify the best treatment for patients, Dunlop and his colleagues measured the brain activity of 82 patients with major depression using positron emission tomography (PET) scans. Afterward, they randomly assigned the participants to receive 12 weeks of a common antidepressant escitalopram (brand name Lexapro), or 12 weeks of cognitive behavioral therapy, a talk therapy that has been shown to improve depression. Of the original cohort, 67 people completed the study. Afterward, the researchers assessed the roughly 40 percent of people who were completely free of depression, as well as the approximately 25 percent who had hardly improved at all. (About 35 percent of people improved somewhat, but not enough to be considered symptom-free.) They found that people with an overactive brain region called the insula improved dramatically on medication, but not at all with talk therapy. People with an underactive insula improved with cognitive behavioral therapy, but not with medication, according to the study. Dunlop said that the people who improved somewhat showed the same trends, but to a lesser extent. Future applications It's not clear exactly why the insula, which processes bodily experiences of emotion, predicted people's response to treatment, but past studies had shown it was tied to depression, Dunlop said. The new research is based on a small number of people and must be confirmed in a larger trial, Richard Shelton, a psychiatrist at the University of Alabama at Birmingham, wrote in an email to LiveScience. In addition, Shelton noted that PET scans are expensive, costing about $1,500. They also involve low doses of radiation. “In an age of cost-containment, it seems unlikely that every person with depression entering treatment would undergo a brain scan first to guide treatment selection,” said Shelton, who was not involved in the study. But if the findings are confirmed, it would raise the possibility that PET scans could be used in some circumstances, to determine treatments for the patients with certain needs, Dunlop 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/2013/06/13/depression-treatments-brain-scans-may-suggest-best-course/

Infections linked to mood disorders

Infections and autoimmune disorders may increase the risk of developing a mood disorder such as depression later in life, a new study from Denmark suggests. In the study, which included more than 3 million people, those who were hospitalized for infections were 62 percent more likely to subsequently develop a mood disorder compared with people not hospitalized for infections. And those hospitalized for an autoimmune disease were 45 percent more likely to subsequently develop a mood disorder. Autoimmune diseases are those in which the immune system goes awry and attacks the body's own cells or tissues. The risk of mood disorders increased with the number of times a person was hospitalized. Those who were hospitalized three times with infections during the study had double the risk of a mood disorder, and those who were hospitalized seven times had triple the risk, compared to those not hospitalized with infections. The findings support the hypothesis that inflammation, from either an infection or autoimmune disease, may affect the brain in a way that raises the risk of mood disorders, the researchers say. If the link is confirmed in further studies, the researchers said, their estimates show that infections could be responsible for up to 12 percent of mood disorders. However, the study found an association, and cannot prove that infections or autoimmune diseases are the cause of mood disorders. It's possible that other factors, such as stress or the experience of hospitalization, may explain the link, said Ian Gotlib, a professor of psychology at Stanford University, who was not involved in the study. The study is published June 12 in the journal JAMA Psychiatry. Infections and mood disorders The study included people born in Denmark between 1945 and 1996 who were followed until the end of 2010. During the study, more than 91,000 people visited a hospital for a mood disorder, including bipolar disorder or depression. Of these, about 32 percent visited hospitals for an infection before their mood disorder, and 5 percent visited the hospital for an autoimmune disease before their mood disorder. The risk of a mood disorder was greatest in the first year following an infection or autoimmune disease. People who visited a hospital for both an infection and an autoimmune disease had a greater risk of developing a mood disorder than those who visited a hospital for either of the two conditions alone. This may indicate the two conditions interact to increase the risk of mood disorder, the researchers said. Because the study looked at information from only people hospitalized with infections, autoimmune disorders and mood disorders, its not clear whether the findings may apply to people with less severe infections, or mood disorders. What's the cause? Gotlib called the study “impressive” and said it raises important questions. Previous studies have shown that people with depression have lower numbers of T cells (a type of immune cell), and are at increased risk for autoimmune diseases, Gotlib said. But there are also many other risk factors for mood disorders that were not taken into account in this study, such as smoking and socioeconomic status, Gotlib said. Future studies should attempt to untangle whether infections are really the cause of mood disorders, or if the two just happen to occur together. In addition, studies should investigate how, on a biological level, infections and autoimmune diseases might affect the brain to cause mood disorders, Gotlib 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/2013/06/12/infections-linked-to-mood-disorders/

Stem cells may be secret to regenerating fingers and toes

Mammals can regenerate the very tips of their fingers and toes after amputation, and now new research shows how stem cells in the nail play a role in that process. A study in mice, detailed online June 12 in the journal Nature, reveals the chemical signal that triggers stem cells to develop into new nail tissue, and also attracts nerves that promote nail and bone regeneration. The findings suggest nail stem cells could be used to develop new treatments for amputees, the researchers said. [Inside Life Science: Once Upon a Stem Cell] More from LiveScience In mice and people, regenerating an amputated finger or toe involves regrowing the nail. But whether the amputated portion of the digit can regrow depends on exactly where the amputation occurs: If the stem cells beneath the nail are amputated along with the digit, no regrowth occurs, but if the stem cells remain, regrowth is possible. To understand why these stem cells are crucial to regeneration, researchers turned to mice. The scientists conducted toe amputations in two groups of mice: one group of normal mice, and one group that was treated with a drug that made them unable to make the signals for new nail cells to develop. They found that the signals that guided the stem cells' development into nail cells were vital to regenerating amputated digits. By five weeks after amputation, the normal mice had regenerated their toe and toenail. But the mice that lacked the nail signal failed to regrow either their nails or the toe bone itself, because the stem cells lacked the signals that promote nail-cell development. When the researchers replenished these signals, the toes regenerated successfully. In another experiment, the researchers surgically removed nerves from the mice toes before amputating them. This significantly impaired nail-cell regeneration, similar to what happened to the mice that lacked the signals to produce new nails. Moreover, the nerve removal decreased the levels of certain proteins that promote tissue growth. Together, the results show that nail stem cells are critical for regrowing a lost digit in mice. If the same turns out to be true in humans, the findings could lead to better treatments for amputees. Other animals, including amphibians, can also regenerate lost limbs. For example, aquatic salamanders can regrow complete limbs or even parts of their heart — a process that involves cells in their immune system. By studying these phenomena in other animals, it may be possible to enhance regenerative potential in people, the researchers 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/2013/06/12/stem-cells-may-be-secret-to-regenerating-fingers-and-toes/

How safe is Splenda? Group urges caution for artificial sweetener

The artificial sweetener sucralose (sold under the brand name Splenda) could potentially pose health risks, so it needs to be better understood before the sweetener should be assumed to be safe, one advocacy organization says. The Center for Science in the Public Interest, a nonprofit watchdog group, said today that it was downgrading its safety rating of sucralose from “safe” to “caution,” meaning that the additive “may pose a risk and needs to be better tested.” The change was spurred by a recent study from researchers in Italy that found that sucralose caused leukemia in mice, according to the CSPI. This study has not been published, and needs to be reviewed by other scientists to determine whether the findings are credible. While sucralose may turn out to be safer than other artificial sweeteners, “the forthcoming Italian study warrants careful scrutiny before we can be confident that the sweetener is safe for use in food, said CSPI executive director Michael F. Jacobson. The CSPI recommends people avoid the artificial sweeteners saccharin (Sweet N Low), aspartame (NutraSweet and Equal), and acesulfame potassium (Sunett and Sweet One). The issue of whether artificial sweeteners pose health risks is controversial. Many of the studies showing risks, including the new Italian study, have been done in animals, and it's not known whether the same effects would be seen in humans. In addition, rodents, like humans, may develop cancer as a result of old age, and not exposure to chemical additives. This issue has caused some to question the results of studies showing that aspartame-fed rats are at increased risk for cancer over their lifetimes. Even the CSPI says that it considers drinking diet soda, which often contains artificial sweeteners, to be safer than drinking regular soda. Regular soda “poses the greater and demonstrable risks of obesity, diabetes, heart disease, gout, tooth decay, and other health problems,” the CSPI said in a statement. To avoid both the risks of sugar and artificial sweeteners, the CSPI recommends drinking water, seltzer water, flavored unsweetened waters, seltzer mixed with some fruit juice or unsweetened iced tea. It's worth noting that the CSPI also gives caffeine a safety rating of “caution.” Caffeine “keeps many people from sleeping, causes jitteriness, and affects calcium metabolism,” the CSPI says. 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/2013/06/12/how-safe-is-splenda-group-urges-caution-for-artificial-sweetener/

Obese expectant mothers at increased risk of preterm birth

Women who are obese during pregnancy may be at increased risk of giving birth too early, a new study from Sweden suggests. In the study, obese women were more likely than normal-weight women to give birth to extremely premature babies those born between 22 and 27 weeks of pregnancy. (Pregnancy typically lasts 40 weeks.) In addition, the more obese a woman was, the greater her risk of preterm birth was, the study found. For women with severe obesity defined as having a body mass index (BMI) between 35 and 39.9 the risk doubled, and for women with extreme obesity (a BMI of 40 or higher), the risk was triple that faced by normal-weight women (those with a BMI between 18.5 and 24.9). Although these increases in risk were considerable, very few babies are born this prematurely. Most obese women in the study did not give birth to extremely premature babies. In the study, extremely premature birth occurred in 0.17 percent of normal-weight women, 0.21 percent of overweight women, 0.27 percent of mildly obese women, 0.35 percent of severely obese women and 0.52 percent of extremely obese women. Still, “considering the high morbidity and mortality among extremely preterm infants, even small absolute differences in risks will have consequences for infant health and survival,” the researchers wrote in the June 12 issue of the Journal of the American Medical Association. The study found an association, and cannot prove a cause-effect link between obesity and premature birth. However, the findings agree with the results of previous studies that have also shown such a link. Obesity is known to increase the risk of “medically indicated” premature birth that is, premature birth that is deliberately initiated by doctors, with a cesarean section or by inducing labor. This is because obesity increases the risk of medical disorders in pregnancy, such as preeclampsia and gestational diabetes. However, the new study also found a link between severe obesity and spontaneous extremely premature birth. The study examined information from more than 1.5 million births in Sweden between 1992 and 2010. Overall, about 5 percent of babies were born prematurely (before 37 weeks of pregnancy), including 4.36 percent who were moderately premature (between 32 and 36 weeks), 0.47 percent who were very premature (between 28 and 31 weeks) and 0.23 percent who were extremely premature. The findings still need to be confirmed in other populations, the researchers said. Because obesity in pregnancy can increase the risk of health problems for the mother and the baby, experts recommend that obese women limit their weight in pregnancy. The Institute of Medicine recommends normal-weight women gain 25 to 35 lbs. during pregnancy, overweight women gain 15 to 25 lbs. and obese women gain 11 to 20 lbs. 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/2013/06/11/obese-expectant-mothers-at-increased-risk-preterm-birth/

6 sex supplements contain hidden drugs, FDA warns

The Food and Drug Administration is cracking down on sex supplements again, warning the public on Monday about six products that were found to contain hidden drugs. The names of the tainted products are: Reload, Get It Up, Super Cheetah, Cave Diver, Nights to Remember and X Zen Platinum. All of the products are marketed for sexual enhancement, and sold on various websites and in some retail stores, the FDA said. All of the products were found to contain the drug sildenafil (sold under the brand name Viagra), and one was found to contain tadalafil (brand name Cialis). Sildenafil and tadalafil are prescription drugs used to treat erectile dysfunction. Sex supplements are not allowed to contain prescription drugs, and the drugs are not included on the products' labels. Undeclared drugs in supplements are dangerous because consumers ingest these drugs without being told about their risks. Sildenafil and tadalafil can cause adverse reactions, including dangerously low blood pressure, if taken along with other prescription drugs that contain nitrates, the FDA says. (Some drugs prescribed to treat chest pain and heart disease contain nitrates.) Consumers who take the products listed in today's warnings should stop using them immediately, and throw them away, the FDA says. Last month, the FDA recalled two sex supplements, called Vicerex and Black Ant, because the products contained sildenafil and tadalafil. Earlier this year, the FDA warned consumers that several other sexual enhancement supplements contained undeclared drugs. Because the FDA is unable to test and identify all tainted sexual enhancement products, consumers should exercise caution before buying any products in this category, the agency 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/2013/06/10/6-sex-supplements-contain-hidden-drugs-fda-warns/

Dear Kim Kardashian, read this before you eat your placenta

It never ceases to amaze me how many expectant mothers sensationalize their pregnancies for publicity. And we all know the 'mother' of all publicity seekers’ whose name starts with a “Kim” and ends with “Kardashian.” Perhaps all the bad press she’s been getting about her looks throughout her pregnancy has finally gotten to her. On Sunday's season premiere of “Keeping Up with the Kardashians,” the 32-year-old reality star revealed she might be interested in eating her own placenta after her baby girl is born, in order to help her look younger. Kim, I want to preface this article by reminding you of an old adage that I think applies here: Don't kill the messenger. For years, I’ve been hearing that some patients, after giving birth, request to keep their placentas — though I’ve never actually had this experience in my own practice. Some of these patients desire to keep their placentas for cultural reasons. However, a growing trend is on the rise of new moms that actually want to eat them. A couple of years ago, a feature in New York Magazine called “The Placenta Cookbook,” took an in-depth look at the placentophagia fad from the professional placenta-preparer, to the women who call on her for services. Aside from profiling some of the people who take part in this trend, the article included anecdotal recipes and tips to enjoy the afterbirth delicacy — and even shared step-by-step instructions on how to prepare placental capsules in an attempt to preserve the nutritional value thought to be contained in the tissue. Beyond this particular article, various websites exist where mothers discuss how to drain the blood from the tissue and exchange recipes ranging from roast placenta to placenta lasagne. The growing popularity of this phenomenon has to do with the belief that consuming the placenta may offer a new mother certain health benefits, although there are no scientific studies to back up these claims. For example, some people believe that the placenta can help with the treatment of postpartum depression, or “baby blues.” It has been suggested in the past that postpartum depression in some patients is spurred by the quickly shifting levels of female hormones after giving birth, and that by eating the placenta, the hormones will stabilize and postpartum depression can therefore be prevented. Another thought is that the placenta can offer some degree of pain relief due to certain chemicals contained within the tissue. In ancient Chinese medicine, placental extracts are commonly mixed with herbs taken to relieve pain, stimulate milk production, and even to cure impotence. As it turns out, humans are actually one of the only mammals that don’t regularly eat their own placentas. Some researchers believe it must be because the placenta offers some fundamental biological advantage. It is known to contain high levels of things like iron, vitamin B-12 and certain hormones. But before jumping on the placenta bandwagon, I must admit that I myself have failed to find any concrete benefits to eating your own placenta. The medical community rarely comments on this practice, to be honest. In hospitals, the placenta has always seen as a biohazardous material. Remember that this is human tissue, and in theory, it could carry infectious diseases. However, these days, many hospitals are actively looking into procedures for handling patients who request to take home their placenta after birth. Do the doctors give it to her? Do they package it neatly and present it along with the newborn baby? Surprisingly, it appears that as long as certain medical criteria are met — such as both the patient and placenta being healthy — many hospitals will comply with the growing number of requests. Now, I’m no lawyer, but I don’t think there are any legal implications that would apply to prevent a mother from taking a placenta. Certainly there have been isolated cases where patients have been denied their placentas and challenged the hospitals. In 2007, Anne Swanson took her case to court after a Las Vegas hospital refused to fulfill her request to take home her placenta and won. Actually, Las Vegas seems to be a hotbed of placental-eating activity – so much so that researchers at the University of Nevada, Las Vegas did a small survey of 200 postpartum mothers who consumed their placentas and found that 95 percent of them reported improvements in their recovery and lactation. The researchers admit that the results may be due to the placebo effect, but plan to study the phenomenon more in-depth in the future.  So this is my final take: If you want to eat your placenta because you believe in its supposed health benefits, go right ahead. Just be aware that this material has to be handled with care, and you have to protect those around you from being exposed to any tissue waste that you may find unsuitable for consumption. Finally, please, keep it away from my dinner table.  source : http://www.foxnews.com/health/2013/06/04/placenta-its-whats-for-dinner/

For veterans, mental health care often fragmented

For veterans with mental health conditions, prompt and continuous access to mental health care can be lifesaving. However, research shows that after deployment, veterans often go years without obtaining mental health care, and when they do, their care is often fragmented. A recent study found that, among veterans with mental health conditions such as post-traumatic stress disorder (PTSD) and depression, the average time between return from deployment and initiation of mental health care was two years. The study, which looked at veterans of the Iraq and Afghanistan wars who visited Veterans Affairs (VA) medical centers between 2001 and 2011, also found that an average of seven and a half years lapsed between the first mental health visit, and the start of treatment that would be considered “minimally adequate” for these conditions which would be eight treatment sessions within a year. By the end of the study, 75 percent of veterans had not received minimally adequate care. The findings were published in the December 2012 issue of the journal Psychiatric Services. Prompt care is important because mental illness can impair people's lives and interfere with their relationships and jobs, said study researcher Shira Maguen, a psychologist at the San Francisco Veterans Affairs Medical Center who treats patients with PTSD. “If we can get them into care sooner, thats less time that they have to live with some of those challenges after they return from deployment,” Maguen said. Many factors can interfere with veterans getting mental health care, including the stigma associated with mental illnesses (such as the belief that seeking care is a sign of weakness), concern that seeking care may jeopardize their careers, trouble finding transport to VA centers, and trouble getting appointments. (Last year, a report from the VA inspector general found that about half of veterans seeking a mental health evaluation waited an average of 50 days for an evaluation.) To broaden access to mental health care, the VA says it has taken steps to increase staffing and to partner with community health care centers. In a report released last week, the VA said it has made agreements with 15 local clinics in seven states to allow veterans to be treated at those clinics. Maguen said it is also important to identify the factors that keep veterans coming back for care. Her study found that most veterans who receive minimally adequate care do so within one year of their first visit. Follow-up appointments are critical for patients at risk for suicide studies show that one of the highest risk periods for suicide is the month following discharge from a hospital or emergency room for a suicidal episode. But a report from the VA inspector general released last month found that about one-third of veterans at high risk for suicide did not receive the required four mental health follow-up visits within a month after their discharge. What's more, for about a third of these at-risk veterans, there was no documented attempt to contact them to remind them of their appointments. “That kind of a clinical response is not acceptable,” said M. David Rudd, provost of the University of Memphis who has studied suicide risk among veterans. “You dont have control over whether or not somebody will keep and appointment. You do have control of whether you attempt to track them.” The inspector general report said the VA needs to improve its effort to reach out to patients who do not show up for mental health appointments. Rudd said the VA may want to consider conducting home visits for psychiatric patients who have trouble getting to VA centers. The inspector general report said the VA should consider expanding the use of telemental health services, such as videoconferencing. The VA also said this week it has increased capacity of its Veterans Crisis Line to connect veterans in crisis with trained mental health providers. 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/2013/05/31/for-veterans-mental-health-care-often-fragmented/