December 18, 2007, 9:24 PM CT

Health care in American prisons

That question is addressed in a special issue of Journal of Correctional Health Care (JCHC), opening up correctional system health care issues to outside evaluation and input. In key articles and commentaries, all written by eminent experts and pioneers in the field, JCHC explores the history of prison health care, from when the only option was for inmates to provide basic first aid for each other, to the current realities of clinics and individualized care behind bars. It also takes a close look at follow-up care after an inmate is released and the prospects for the future of correctional health care.

Change has not been without its problems, writes John R. Miles, MPA, JCHC editor, but the conditions experienced by inmates in the past are not tolerated today. The standard of decency continues to evolve. We must continue in our quest to ensure that inmates and all citizens of our nation have access to good quality and affordable care. The public health and safety of our nation is everyones concern......... Posted by: Janet      Read more         Source

December 18, 2007, 8:44 PM CT

Colon cancer screenings may not pay off

Even though current guidelines advocate colorectal cancer screenings for those with severe illnesses, they may bring little benefit and may actually pose harm, as per a recent study by Yale School of Medicine scientists reported in the Archives of Internal Medicine.

The study offers a new approach for assessing who is likely to benefit from a screening so that screening recommendations can be tailored more effectively to individual patients.

First author R. Scott Braithwaite, M.D., and colleagues developed a new method of evaluating medical screening tests like colonoscopy, called the payoff time, which is the minimum amount of time it takes for the benefits from a test to exceed its harms (i.e., its complications and side effects). The method can also be applied to patients of any age and illness.

To estimate the payoff time for using colonoscopy to screen for colorectal cancer, the team focused on two patient groups that included 50-year-old men with HIV, and 60-year-old women with congestive heart failure.

Braithwaite said the payoff time for colorectal cancer screening was as long as five years for 50-year-old men and as long as 2.9 years for 60-year-old women. Because patients with severe congestive heart failure have a life expectancy of less than 2.9 years, they were more likely to be harmed than benefited by colorectal cancer screening, say the researchers, whereas patients with HIV have a life expectancy of greater than five years, so they were likely to benefit from colorectal cancer screening......... Posted by: Sue      Read more         Source

December 17, 2007, 10:32 PM CT

How Doctors Deal With The Risks

Risk is an inherent element of the hospital system and the resulting dangers are often normalised by medical staff to allow them to do their job, as per research by a University of Nottingham academic.

Dr Justin Waring, Lecturer in Medical Sociology and Health Policy at the University, observed that medical staff were inevitably pessimistic about the ability of their management team to understand the level of risk that doctors and nurses dealt with on a day-to-day basis. They felt that management were too far removed from the realities of clinical safety to judge best practice and that the priorities and targets that drive risk management - such as cost savings and cutting waiting times - diverged from those of the clinicians.

Dr Waring identified the operating theatre as a complex 'hub' within the hospital system, which had a symbiotic relationship with other departments - including surgical wards, the anaesthetic department, sterile services and lab and imaging services. Problems in the operating theatre were found to 'spill over' into related departments, creating 'cascade chains' of risk, which clinicians in all areas then had to deal with.

As a result, medical staff develop ritualistic behaviours that are based on shared cultural norms and expectations - just to get the job done. They tolerate and endure levels of risk and sub-standard working; accommodate or accept the presence of risk by making small modifications to clinical practice; and innovate, developing new procedures to work around risk. This emphasis on coping has come to be seen as a mark of professionalism among medical staff......... Posted by: JoAnn      Read more         Source

December 17, 2007, 10:23 PM CT

The science of shivering

Scientists at Oregon Health & Science Universitys Neurological Sciences Institute have uncovered the system that tells the body when to perform one of its most basic defenses against the cold: shivering. The researchers have discovered the brains wiring system, which takes temperature information from the skin and determines when a person should start shivering. Their findings appear in the advance online edition of the journal Nature Neuroscience.

Shivering, which is actually heat production in skeletal muscles, requires quite a bit of energy and is commonly the last strategy the body uses to maintain its internal temperature to survive in a severe cold environment. Other strategies to defend against the cold, such as reducing heat loss to the environment by restricting blood flow to the skin, also appear to be controlled by the sensory mechanism that we found, explained Kazuhiro Nakamura, Ph.D., an OHSU Fellow for Research Abroad from the Japan Society for the Promotion of Science. He published the research along with his colleague Shaun Morrison, Ph.D., a senior scientist. One fascinating aspect of this study is that it shows the sensory pathway for shivering, which can be thought of as brain wiring, is parallel to but not the same as the sensory pathway for conscious cold detection. In other words, your body is both consciously and subconsciously detecting the cold at the same time using two different but related sensory systems......... Posted by: Scott      Read more         Source

December 17, 2007, 10:17 PM CT

Protecting aging Americans against infectious disease

Scientists at Oregon Health & Science University have uncovered new information about the bodys immune system in a study that suggests new strategies may be in order for protecting the countrys aging population against disease. The research is reported in the current edition of the Proceedings of the National Academy of Science.

The research focused on an important component of the bodys immune system, a certain type of white blood cell called nave T-cells. These cells are called naive because they have no experience of encountering germs. However, once they encounter germs, they learn and adapt to become strong defenders of the organism. The cells play an important role in the vaccination process because vaccines, which contain either weakened or dead viruses, teach nave T-cells how to recognize germs and prepare the body for fighting infectious diseases at a later date. Prior research shows that an individuals supply of nave T-cells diminishes over their lifetime, meaning that in old age a person is more susceptible to infections such as the flu.

Our research identified one actual process by which nave T-cells are lost during the later part of life, explained Janko Nikolich-Zugich, Ph.D., a senior scientist at the OHSU Vaccine and Gene Therapy Institute and the Oregon National Primate Research Center and a professor of molecular microbiology and immunology in the OHSU School of Medicine......... Posted by: Mark      Read more         Source

December 17, 2007, 9:30 PM CT

Underuse of colorectal cancer screening

Two recently released studies confirm an alarming reality, that a majority of Americans who should be getting screened for colorectal cancer are not. Men and women over the age of 50 should be screened for colorectal cancer, but as per a research studyin the journal Cancer, scientists observed that among an assessment of Medicare beneficiaries between 1998 and 2004, only 25.4 percent of people were screened, despite Medicare coverage for colorectal cancer screening. As per figures released by the Agency for Healthcare Research and Quality, only half of all Americans age 50 and over have had a screening colonoscopy.

These numbers are very discouraging and, unfortunately they confirm prior studies that show not enough people are getting screened for colorectal cancer. This disease is preventable and treatable when caught in its early stages, and screening is a covered benefit for those eligible for Medicare, said Grace Elta, MD, president of the American Society for Gastrointestinal Endoscopy (ASGE). We know that screening works. As per a recent study by leading cancer groups, including the American Cancer Society and the CDC, deaths from colorectal cancer dropped nearly 5 percent between 2002 and 2004. Prevention through screening and the removal of premalignant polyps were among the reasons credited for the decline. The ASGE encourages all people age 50 and older to talk to their doctor about getting screened for colorectal cancer......... Posted by: Sue      Read more         Source

December 17, 2007, 9:05 PM CT

Toward engineered blood vessels

MIT researchers have found a way to induce cells to form parallel tube-like structures that could one day serve as tiny engineered blood vessels.

The scientists observed that they can control the cells' development by growing them on a surface with nano-scale patterning. A paper on the work was posted this month in an online issue of Advanced Materials.

Engineered blood vessels could one day be transplanted into tissues such as the kidneys, liver, heart or any other organs that require large amounts of vascular tissue, which moves nutrients, gases and waste to and from cells.

"We are very excited about this work, said Robert Langer, MIT Institute Professor and an author of the paper. It provides a new way to create nano-based systems with what we hope will provide a novel way to someday engineer tissues in the human body.

The work focuses on vascular tissue, which includes capillaries, the tiniest blood vessels, and is an important part of the circulatory system. The team has created a surface that can serve as a template to grow capillary tubes aligned in a specific direction.

The scientists built their template using microfabrication machinery at Draper Laboratory in Cambridge. Normally such technology is used to build micro-scale devices, but the scientists adapted it to create nano-scale patterns on a silicone elastomer substrate. The surface is patterned with ridges and grooves that guide the cells' growth......... Posted by: Scott      Read more         Source

December 17, 2007, 8:50 PM CT

Social and Financial Implications of Adult ADHD

Mount Laurel, NJ, December 17, 2007 Nationally recognized Attention Deficit Hyperactivity Disorder (ADHD) authority Russell Barkley, Ph.D., has embarked on a national speaking tour to discuss the symptoms of ADHD in adults and the potentially serious consequences these symptoms may have on the life of an adult living with this disorder. ADHD is believed to affect an estimated 8.1 percent of adults, or 9.2 million adults across the U.S. based on a retrospective survey of adults aged 18 to 44, projected to the full U.S. adult population. The purpose of this tour is to help raise awareness about the importance of identifying, diagnosing and treating adult ADHD.

In children, ADHD may interfere with paying attention in school, completing homework or making friends. Difficulties experienced in childhood may continue into adulthood. The symptoms of ADHD in adults may lead to potentially serious consequences. Surveys have shown that when compared with their non-ADHD peers, adults with ADHD may be:.

• Three times more likely to be currently unemployed

• Two times more likely to have problems keeping friends

• Forty-seven percent more likely to have trouble saving money to pay bills

• Four times more likely to have contracted a sexually transmitted disease

........ Posted by: JoAnn      Read more         Source

December 13, 2007, 10:06 PM CT

Effective new treatment for schizophrenia

Schizophrenia is one of the most debilitating of the major psychiatric disorders, and is also one of the most difficult to treat. Eventhough numerous antipsychotic therapys are available, they can cause significant side effects and a number of patients experience only a partial relief of their symptoms and up to 30% no relief at all. In a new study scheduled for publication in the December 15th issue of Biological Psychiatry, Marder and his colleagues examined the efficacy and safety of a new psychotropic agent for the therapy of schizophrenia in a 6-week, randomized, placebo-controlled trial.

The authors studied paliperidone extended-release (ER) tablets, an investigational drug which orally delivers the active metabolite of the drug risperidone, which is an already established efficacious antipsychotic. The authors recruited 444 patients who were experiencing an acute episode of schizophrenia and, after evaluating the severity of their symptoms, administered one of four therapys for 6 weeks: 6 mg or 12 mg/day of paliperidone ER, 10 mg/day of olanzapine (the active comparator), or placebo. During the six weeks of therapy, the researchers monitored the patients for side effects and assessed their symptom improvement.

Dr. Stephen Marder, senior author on the paper, explains the findings: This double-blind study observed that two doses of paliperidone extended release tablets were more effective than placebo for treating the symptoms of acute schizophrenia. Patients receiving the most effective dose of paliperidone (6 mg) also demonstrated improvements in their social functioning. Jeffrey A. Lieberman, M.D., Chairman of the Department of Psychiatry at Columbia University and Director of the New York State Psychiatric Institute, comments, This study demonstrates the efficacy of the 9-hydroxy metabolite of risperidone that has antipsychotic efficacy and an acceptable safety profile which provides psychiatry experts with yet another therapy option. It has practical advantages with its long half life, duration of action and extended release formulation. Dr. Lieberman cautions though that this finding is not a novel or breakthrough therapy and does not provide major differences or advantages over existing therapys. Additional studies are currently underway to further evaluate the long-term (up to one year) efficacy and safety of paliperidone ER in the therapy of schizophrenia......... Posted by: JoAnn      Read more         Source

December 13, 2007, 10:05 PM CT

Green tea may protect brain cells against Parkinson's

Does the consumption of green tea, widely touted to have beneficial effects on health, also protect brain cells" Authors of a new study being published in the December 15th issue of Biological Psychiatry share new data that indicates this may be the case. The authors investigated the effects of green tea polyphenols, a group of naturally occurring chemical substances found in plants that have antioxidant properties, in an animal model of Parkinsons disease.

Parkinsons disease is a progressive, degenerative disorder of the central nervous system, resulting from the loss of dopamine-producing brain cells, and there is presently no cure. According to Dr. Baolu Zhao, corresponding and senior author on this article, current treatments for Parkinsons are associated with serious and important side effects. Their previous research has indicated that green tea possesses neuroprotective effects, leading Guo and colleagues to examine its effects specifically in Parkinsons. The authors discovered that green tea polyphenols protect dopamine neurons that increases with the amount consumed. They also show that this protective effect is mediated by inhibition of the ROS-NO pathway, a pathway that may contribute to cell death in Parkinsons.

Considering the popularity of green tea beverages worldwide, there is enormous public interest in the health effects of its consumption. John H. Krystal, M.D., Editor of Biological Psychiatry and affiliated with both Yale University School of Medicine and the VA Connecticut Healthcare System, reminds us that many health-related claims have been made for a wide variety of naturally-occurring substances and many of these claims, as in the case of St. Johns Wort and Ginko Biloba, have not held up in rigorous clinical studies. Thus, it is extremely important to identify the putative neuroprotective mechanisms in animal models, as Guo and colleagues have begun to do for Parkinsons disease. ........ Posted by: Daniel      Read more         Source