Between 20 and 70 percent of Canadians affected by mental illness shun medical treatment. Such avoidance of services provided by doctors and psychologists is particularly acute among men, according to a recent study published in the Journal of Behavioral Health Services & Research.

In Canada, less than 10 percent of the population utilizes mental health services for problems ranging from depression to schizophrenia. But this number isn’t representative of the real number of people suffering from mental illness, according study author Aline Drapeau, a researcher at the Universit?© de Montr?©al’s Department of Psychiatry and Centre de recherche Fernand-Seguin of the Louis-H. Lafontaine Hospital.

According to data from the Statistics Canada Canadian Community Health Survey, women are 1.5 times more likely than men to turn to psychiatric services, twice as likely to consult a psychologist and 2.5 times more likely to turn to a general practitioner.

While these numbers might suggest that more women suffer from mental illness, Drapeau disagrees. “In comparable circumstances, women consult more often than men,” she says. The discrepancy, says Drapeau, shows how men and women do not perceive symptoms in the same way as programmed in their social anchorages.

“Social anchorages is an enculturation mechanism by which a person learns his or her social roles,” says Drapeau. “Men and women don’t always have the same cultural reference points because socially acceptable attitudes and behaviors can vary for both sexes.”

For instance, parental obligations aren’t perceived equally in the workplace. For women, it is perceived as positive to attend to maternal duties. For men, forgoing work to take care of the kids is perceived more negatively.

The same parallels exist in mental health. “If mental disease is seen in a negative light in the workplace, a man will be more reluctant than a woman to use the services available to treat their disease,” says Drapeau.

Other factors, such as tight finances or even type of employment, can influence whether men use mental health services. But the root of the problem, Drapeau stresses, is that men have greater difficulty acknowledging and accepting their symptoms.

Source:
Sylvain-Jacques Desjardins

University of Montreal Continue reading →

Individuals with single-gene mutations that mean they have abnormally low levels of the protein alpha-1 antitrypsin are highly susceptible to emphysema, a progressive lung disease that causes severe shortness of breath. Previous attempts to correct single-gene defects that cause lung disease by gene transfer have failed to achieve sustained gene expression in the mouse lung. However, a team of researchers, at Boston University School of Medicine, has now developed an approach that enabled them to attain sustained in vivo expression of normal human alpha-1 antitrypsin at levels able to improve emphysema in mice.

The team, led by Darrell Kotton, introduced gene-carrying lentiviral vectors into the windpipe of mice and found that they selectively and efficiently transferred the genes they were carrying to resident cells known as alveolar macrophages. These cells were long-lived and continued to express the transferred genes for at least two years. In a mouse model of emphysema, introduction into the windpipe of lentiviral vectors carrying the gene responsible for making normal human alpha-1 antitrypsin led to sustained alpha-1 antitrypsin expression in the lung and reduced disease. The authors therefore conclude that targeting genes to alveolar macrophages provides a way to achieve sustained gene expression in the lung and suggest that this might provide a therapeutic approach for overcoming overcome lung diseases caused by single-gene defects, for example emphysema caused by alpha-1 antitrypsin deficiency.

TITLE: Amelioration of emphysema in mice through lentiviral transduction of long-lived pulmonary alveolar macrophages

AUTHOR: Darrell N. Kotton, Boston University School of Medicine, Boston, Massachusetts, USA.

JCI online December 21, 2009

Source: Karen Honey

Journal of Clinical Investigation Continue reading →

Patients undergoing knee or hip replacements recover more quickly when treated with targeted pain-blocking medications that may eliminate the need for general anesthesia during surgery and intravenous narcotics drugs after surgery.

The February issue of Mayo Clinic Health Letter explains the newer pain management options and their benefits.

A decade ago, patients undergoing hip or knee replacements were almost exclusively given general anesthesia during surgery and intravenous narcotic pain medications afterward. This approach works for most people and still is commonly practiced. But both general anesthesia and intravenous narcotic drugs can cause nausea, vomiting, grogginess, decreased bowel function and other side effects.

In the early 2000s, Mayo Clinic anesthesiologists began developing new anesthesia protocols for joint replacement surgery that used known anesthetic and pain relief techniques in new combinations. Their goal was to eliminate the need for general anesthesia and intravenous narcotics and the resulting side effects.

The new procedures may vary but typically involve:

A choice: Even with the new protocols, patients may choose regional anesthesia, where the lower half of the body is numbed, or general anesthesia.

Oral pain medications early on: A combination of oral narcotic pain medications are given prior to surgery. Oral narcotics have fewer side effects than narcotics given intravenously. This technique is helpful for recovery whether general or regional anesthesia is used.

Sedation: Sedative drugs given before surgery help patients using regional anesthesia nap during the procedure, but not lose consciousness.

Nerve blocks: Through a catheter, a continuous infusion of numbing medicine is pumped near the surgery site for 48 hours. Nerve blocks are performed in conjunction with general or regional anesthesia.

Oral pain medications after surgery: For more than 95 percent of patients, pain that occurs after the nerve blocks are removed can be managed with oral pain medications such as acetaminophen (Tylenol, others), tramadol (Ultram, others) or oxycodone. Intravenous narcotic medications are used as a last resort.

Patients who receive regional anesthesia report significantly less pain after surgery than those receiving general anesthesia and intravenous narcotics. These patients are out of bed sooner, begin physical therapy sooner and leave the hospital one to two days before patients who were given general anesthesia and intravenous narcotics. With the newer protocols, patients may still experience typical side effects including nausea and vomiting, but to a lesser degree than with the older anesthesia methods.

Another benefit is that regional anesthesia protocols make surgery an option for older adults with more complicated conditions. A decade ago, older adults often were not considered candidates for surgery because they would have fared poorly with older anesthesia techniques.

Doctors report few downsides to these newer pain management approaches. Nerve injury is a rare potential complication. For most people, the regional anesthesia protocols are a change for the better, resulting in less pain, fewer complications and a quicker recovery.

Source: Mayo Clinic

View drug information on Oxycodone and Aspirin. Continue reading →

For young children, all states currently require the use of child safety seats, and the minimum age and weight requirements to graduate to seat belts has been increasing over time. A new study in the journal Economic Inquiry reveals that lap-and-shoulder seat belts perform as well as child safety seats in preventing serious injury. However, safety seats tend to be better at reducing less serious injuries.

Steven D. Levitt of the University of Chicago and author of the book Freakonomics and Joseph J. Doyle of the Massachusetts Institute of Technology analyzed three large representative samples of crashes reported to the police, as well as linked hospital data, among motor vehicle passengers aged 2-6 years of age. Researchers used the data to compare seat belts and child safety seats in preventing injury.

Results show that lap-and-shoulder seat belts perform as well as child safety seats in preventing serious injury. Safety seats were associated with a statistically significant 25 percent reduction in less serious injuries. Lap belts are somewhat less effective than the other two types of restraints, but far superior to riding unrestrained.

“Our comparisons across restraint types incorporate the way they are used, or misused, in practice,” the authors conclude. “Because many child safety seats are, in actual use, improperly installed, our estimates are likely to understate the benefits associated with their proper use. From a public policy perspective, however, understanding how safety devices work in practice, as opposed to under ideal circumstances, is of great importance.”

###

This study is published in Economic Inquiry.

Steven D. Levitt is affiliated with the University of Chicago.

Published since 1962, (formerly Western Economic Journal), EI is widely regarded as one of the top scholarly journals in its field. Besides containing research on all economics topic areas, a principal objective is to make each article understandable to economists who are not necessarily specialists in the article’s topic area. Nine Nobel laureates are among EI’s long list of prestigious authors.

Source: Amy Molnar

Wiley-Blackwell Continue reading →

Almirall, S.A. (ALM.MC) and Forest Laboratories, Inc. (NYSE: FRX) announced positive top-line results of ATTAIN, a six month double-blind placebo-controlled pivotal Phase III study comparing the efficacy and safety of inhaled aclidinium bromide 200??g and 400??g twice daily (BID) versus placebo, in 828 patients with moderate to severe COPD.

Aclidinium 200?µg and 400?µg produced statistically significant increases from baseline in morning pre-dose (trough) FEV1 versus placebo at week 24 (99mL and 128mL, respectively; p Continue reading →

The Royal Australian College of General Practitioners (RACGP) has released a new online learning activity designed to support general practitioners and other members of the general practice team in developing high quality care plans for people with intellectual disability, and in understanding eligibility requirements for Medicare-funded care plans.

“For patients with intellectual disability care plans are a critical part of managing their health and well-being. This new education module, which is relevant to all members of the general practice team, takes a case-based approach to assisting patients to manage their health needs,” said Dr Chris Mitchell, RACGP President, and GP in Northern NSW.

“GPs are often the first point of contact within the health system for people with intellectual disability. Their health care needs are often complex; completing a care plan is an important part of ensuring these patients receive the care they need,” said Dr Mitchell.

This educational activity, developed with the support of the Australian Government and Monash University, Centre for Developmental Disability Health Victoria, is now available through the RACGP’s online education portal gplearning at gplearning.au. By completing this activity GPs can earn category 2 QA&CPD points.

This module has been linked to the RACGP Curriculum for general practice learning objectives and is an ideal introduction for general practice registrars on best clinical practice in the management of intellectual disability. This activity is available online; GPs can complete this learning activity anywhere at any time.

After working through this module participants should be able to:

- Identify patients who would benefit from a care plan
- Describe the requirements, structure and regulation of the Medicare Benefits Schedule (MBS) care planning items
- List the other professionals and services that could usefully contribute to the care plan and understand how to involve them
- Prioritise management goals and use the structure of a care plan to contribute to meeting those goals
- Describe how the routine use of care plans can help prevent potential health and well being problems from being missed.

The activity forms part of an active learning module comprising six activities.

Source
Royal Australian College of General Practitioners Continue reading →

DMAA: The Care Continuum Alliance released landmark principles for population health improvement and a model for an integrated, physician-guided delivery system for population-based chronic condition care.

The DMAA paper, “Advancing the Population Health Improvement Model,” describes the elements of a fully connected health system that leverages teams of care providers focused on proactive, coordinated, quality care across all stages of disease — from general prevention and wellness to individual care for people with existing conditions.

“These principles mark a milestone in the evolution of DMAA and population-based care,” DMAA Chairman William C. Popik, MD, said. “Today we reaffirm, unequivocally, the paramount role of the physician, as well as the valuable contributions of population health professionals, to high-quality, coordinated care.”

The DMAA population health improvement model comprises three core components:

- the central care delivery and leadership roles of the primary care physician;
- the critical importance of patient activation, involvement and personal responsibility; and
- the patient focus and expanded care coordination capacity provided by wellness, disease and chronic care management programs.

“The patient — and the patient-physician relationship — are at the center of this new model, supported by proven strategies developed through population-based care to keep the well healthy, prevent disease and minimize the ill effects of chronic conditions,” DMAA President and CEO Tracey Moorhead said. “This strength of this model lies in its comprehensive, coordinated team approach.”

The DMAA model emphasizes the need to explicitly recognize and proportionately reward cost-effective care that achieves targeted improvement goals for population health. To best achieve this, payers, purchasers, patients and their advocates and other members of the health care team must promote and ensure appropriate reimbursement for cognitive services, care coordination, referral activities and adherence to desired processes, such as the use of evidence-based clinical guidelines.

“We must realign payment models to reward physicians and other health care professionals for keeping populations healthy, rather than simply treating the sick,” said Dr. Popik, a board-certified family physician. “Our model strongly emphasizes evidence-based care and the need to appropriately compensate those who practice it.”

Under the DMAA model, accountable measures of success in population health should include clinical process and outcomes indicators; assessment of patient satisfaction, functional status and quality of life; economic and care utilization indicators; and effect on care disparities. DMAA is a leader in developing industry consensus guidelines on measuring clinical and financial outcomes in population-based care. Its two-volume Outcomes Guidelines Report has been widely adopted as a standard for assessing population health improvement program outcomes.

Key elements of the DMAA Population Health Improvement Model include:

- Population identification strategies and processes;

- Comprehensive needs assessments that assess physical, psychological, economic, and environmental needs;

- Proactive health promotion programs that increase awareness of the health risks associated with certain personal behaviors and lifestyles;

- Patient-centric health management goals and education which may include primary prevention, behavior modification programs, and support for concordance between the patient and the primary care provider;

- Self-management interventions aimed at influencing the targeted population to make behavioral changes;

- Routine reporting and feedback loops which may include communications with patient, physicians, health plan and ancillary providers;

- Evaluation of clinical, humanistic, and economic outcomes on an ongoing basis with the goal of improving overall population health.

The principles, available here, also list numerous other model components, including recognition of cultural sensitivities; assistance to family, friends and other unpaid caregivers; and physician support for data collection and analysis, among others.

“The convergence of these roles, resources and capabilities in the population health improvement model ensures higher levels of quality and satisfaction with care delivery,” DMAA says in the document released today. “Further, coordination and integration are important tools to address health care workforce shortages, individual access to coverage and care, and affordability of care.”

About DMAA: The Care Continuum Alliance

DMAA: The Care Continuum Alliance convenes all stakeholders providing services along the care continuum toward the goal of population health improvement. These care continuum services include strategies such as health and wellness promotion, disease management and care coordination. DMAA: The Care Continuum Alliance promotes the role of population health improvement in raising the quality of care, improving health outcomes and reducing preventable health care costs for people with chronic conditions and those at risk for developing chronic conditions. DMAA: The Care Continuum Alliance represents more than 200 corporate and individual stakeholders, including health plans, disease management organizations, health information technology innovators, employers, physicians, nurses and other health care professionals and researchers and academicians.

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Woodworking is a popular hobby, with table saws being owned and used by an estimated 6 million to 10 million people in the United States. Although table saws are associated with more injuries than any other woodworking tool, there have been no previously published national studies of table saw-related injuries. A recent study conducted by the Center for Injury Research and Policy of The Research Institute at Nationwide Children’s Hospital found that from 1990-2007, an estimated 565,670 non-occupational table saw-related injuries were treated in US hospital emergency departments, averaging 31,500 injuries per year. Although a 27 percent increase in the number of injuries was found over the 18-year study period, there was no change in the rate of injuries per 10,000 US population.

According to the study, available online as a Publication Ahead-of-Print for the Journal of Trauma, lacerations (66 percent) were the most common type of injury while amputations (10 percent) were the most serious. The majority of injuries (86 percent) were to the fingers or thumb. Males (97 percent) and adults (97 percent) accounted for the majority of table saw-related injuries. In comparison to adults, children were more likely to injure their heads, faces and necks and to be injured at school.

“While the majority of the children who were injured were between the ages of 14 and 17 years, children as young as 6 years were found to be injured while operating a table saw,” said study author Brenda Shields, MS, research coordinator at the Center for Injury Research and Policy at Nationwide Children’s Hospital. “More research is needed to determine appropriate age restrictions.”

Most of the table saw-related injuries resulted from contact with the blade of the saw. In cases when the mechanism of injury was documented, kickback was the most common mechanism (72 percent), followed by debris being thrown by the saw (10 percent), lifting or moving the saw (6 percent), or getting a glove or clothing caught in the blade (4 percent).

A new technology that could prevent some of these injuries is the SawStop, which can detect contact between a person and a saw blade and then instantly react to stop and retract the blade. “Although this technology could be beneficial in preventing serious injuries, it is currently too expensive for the average home woodworker to afford,” said Shields. “We recommend that all table saws be equipped with such technology and be made available at an affordable price.”

Other recommendations to prevent table saw-related injuries include keeping table saws in an area that is not accessible to children, protecting the blade with a rigid cover when not in use, reading the owner’s manual carefully for safety rules, and completing a table saw-specific safety course before operating the saw.

This is the first published study to describe the epidemiology of non-occupational table saw-related injuries using a nationally representative sample. Data for this study were collected from the National Electronic Injury Surveillance System (NEISS), which is operated by the U.S. Consumer Product Safety Commission. The NEISS dataset provides information on consumer product-related and sports and recreation-related injuries treated in hospital emergency departments across the country.

The Center for Injury Research and Policy (CIRP) of The Research Institute at Nationwide Children’s Hospital works globally to reduce injury-related pediatric death and disabilities. With innovative research as its core, CIRP works to continually improve the scientific understanding of the epidemiology, biomechanics, prevention, acute treatment and rehabilitation of injuries. CIRP serves as a pioneer by translating cutting edge injury research into education, policy and advances in clinical care.

Source: Nationwide Children’s Hospital Continue reading →

Emergency personnel often lack the trauma expertise necessary to treat victims of severe accidents or other emergencies. Some victims die because they do not reach hospital emergency rooms fast enough. But now a system for remote treatment could help improve survival rates.

The DICOEMS project has developed a wireless technology platform enabling doctors in hospital emergency rooms to remotely manage treatment of accident and other emergency victims. With specially equipped handheld computers or smart phones, paramedics and other emergency personnel first on the scene can send images and critical patient information, including vital data such as pulse, respiration, and ECG, to specialists at hospital emergency departments. Doctors can monitor the patient’s condition via streaming video from the ambulance, make a diagnosis and provide detailed medical procedures for paramedics to follow.

“DICOEMS could significantly improve survival rates for victims of accidents or other medical emergencies by reducing the chance of inappropriate treatment,” says Matteo Colombo, a technical specialist at Synergia 2000, the Milan-based project coordinator. “The system will improve decision support, diagnosis and risk management in critical situations occurring far from hospital emergency rooms,” says Colombo.

With DICOEMS’s global positioning system, central emergency systems can check an ambulance’s position and tell the driver the fastest, most efficient route to the emergency site, and then from the site to the hospital. Central switchboard operators will have access to a specialised database allowing them to direct ambulances to the hospital best equipped to treat the patient’s condition.

The project also sought to improve use of patient data. “We found out that there was a big gap in how medical information from an emergency was stored, so emergency-intervention data was not followed up on properly and not available to other health-care providers. This is especially a problem if the patient has a recurring condition,” says Colombo.

DICOEMS employs a Grid network management system to efficiently integrate geographically dispersed and often heterogeneous databases. In an emergency, DICOEMS could allow identification of patients and access to their recent medical history, before the ambulance reaches the hospital. The system’s multi-channel environment could also enable a patient’s personal physician to remotely participate in his or her treatment.

An important component of the system is a text-search tool for matching patient clinical data with the most appropriate hospital and doctors for his or her problems. “In Monza Emergency Center ([using the free, single emergency telephone number,] 118), we tested this function with a database of cardiovascular terminology. This way, emergency switchboard operators can type in key words describing a cardiological emergency, and the system returns the most suitable hospitals for the patient’s condition, also noting their availability,” says Colombo.

DICOEMS has conducted two major pilot projects. The main Italian emergency services tested the remote emergency system, and the UK partner, Guy’s and St. Thomas Hospital NHS Trust, tested the data integration and transfer capacity. “We hope to arrange an agreement allowing Guy’s and St. Thomas Hospital to serve as the bridge between the DICOEMS Italian organisation and the UK’s entire NHS system,” says Colombo.

The DICOEMS system is scheduled to go into use by Italian ambulance centres by year’s end, following approval by local authorities. “In Italy, there is already a strong willingness by ambulance associations to use the new system,” says Colombo. “We have also received positive feedback from the European Commission,” says Colombo.

The next step is to find partners to exploit the new technology. “In Eastern Europe, since there are no computer-assisted programs like this, DICOEMS could be sold as a whole system. Similar, though less advanced, systems already exist in Western Europe, so these countries could implement modules. DICOEMS is very flexible,” concludes Colombo.

About the IST RESULTS

Over 3.6 billion euros have been spent on thousands of near-market projects by the European Commission’s Information Society Technologies (IST) research initiative with more investment planned for the future. IST Results has been developed by DG Information Society of the European Commission to help you find out what is happening in your own area of interest and benefit from this massive investment. The IST Results service gives you online news and analysis on the emerging results from Information Society Technologies research. The service reports on prototype products and services ready for commercialisation as well as work in progress and interim results with significant potential for exploitation.

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The head of the United Nations World Food Programme (WFP)
condemned the killing of a truck driver in Afghanistan, Ezatollah,
while
delivering WFP humanitarian assistance on 2 December in one of the
most
dangerous parts of the country. His assistant was abducted and
remains
missing.

“We strongly deplore this attack, as we do all acts of aggression
against
humanitarian workers assisting people in desperate need,” said
WFP
Executive Director, Josette Sheeran. “No loss of life can be tolerated.
Our
deep condolences go to the family of Mr. Ezatollah.”

In the early hours of 2 December, a truck carrying 14 tons of high
energy
biscuits for WFP was ambushed by armed men on the road from Kandahar
to
Helmand in southern Afghanistan. The driver was shot dead. In October
and
November, two other attacks on trucks delivering WFP food occurred in
the
same area.

The death of the WFP-contracted driver was confirmed yesterday. Police
investigations are continuing. The truck and its cargo are still missing.

Attacks on WFP trucks and convoys are a frequent hazard in various parts
of
the world. In October, three contract truck drivers were shot dead while
working for WFP in Darfur, Sudan.

WFP is the world’s largest humanitarian agency. Last year we gave food to
88 million people – mostly women and children – in 78 of the world’s
poorest countries.

WFP now has a dedicated ISDN line in Italy for quality two-way
interviews
with WFP officials.

wfp Continue reading →