Medicine/Science

The latest cool stuff out of some of the nation's best labs; news on medical research and what it may mean for patients.

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Mental Health Parity: If Not Now, When?

According to ABC News, the latest alleged Ft. Hood shooter was struggling with a number of mental health problems, “ranging from depression to anxiety to sleep disturbance,” and in the midst of being evaluated for post-traumatic stress disorder.

If true, it’s a familiar story of a stressed-out soldier with mental health issues and easy access to guns: we’ve been here before.

Of course, we don’t know exactly what kind of care or treatment this shooter was receiving — and the VA system is generally better than others. Still, it’s worth reviewing the history of legislation to put mental health services on equal footing with all other medical care.

(ndanger/flickr)

(ndanger/flickr)

The latest policy brief published in the journal Health Affairs, documents the convoluted history of mental health parity, the idea that mental health care and treatment be comparable with all other types of “physical” medical care (and why make the distinction, anyway)?

Parity efforts began in earnest in the late 1990s, but still aren’t fully implemented today, despite widespread support, including from notable advocates like former Congressman Patrick Kennedy.

The paper examines some of the obstacles remaining to true mental health parity, including these:

…”Critics have argued that parity legislation alone is not enough to fix other underlying problems in how our health system provides access to treatment of mental health and substance use disorders.

The supply and availability of mental health providers has been the subject of numerous research articles. A 2009 Health Affairs article by Peter Cunningham found that two-thirds of primary care physicians reported that they were unable to get outpatient mental health services for their patients–more than twice the percentage who reported trouble finding specialist referrals, nonemergency hospital admissions, or imaging services. Mental health professionals tend to be concentrated in high-population, high-income areas, and the lack of mental health care providers in rural areas as well as in pediatrics has been well documented. Finally, there is still a stigma associated with receiving mental health or substance use treatment. Eliminating the stigma and increasing the availability of high-quality providers are two keys to increasing access to care.

…Much of the debate in implementing parity is around determining equivalence of services between mental health/substance use benefits and medical/surgical benefits. Some of the treatments for mental health and substance use disorders do not have an equivalent medical/surgical treatment, Continue reading

Why To Exercise Today: A Longer Life, Even If You’ve Got Health Issues

Exercise is my religion: in my family we use it for mental health, good sleep, clearer minds, calmer moods and bursts of joy. It inevitably gives us a boost, even when we’re not feeling so hot.

And, according to a new study, exercise offers the ultimate health benefit, even to people who aren’t particularly healthy and suffer from elevated blood pressure and cholesterol levels or oversized waist lines. What’s the benefit? A longer life.

frodrig/flickr

frodrig/flickr

From the study, published in PLoS One:

The promotion of increased physical activity is clearly a powerful vehicle for prevention of cardiovascular disease and premature mortality. Every adult without major disease should benefit from increased physical activity, with the greatest health benefits associated with high levels of exertion. Our study confirms the independent role of recreational physical activity in predicting and reducing cardiovascular deaths, even after the common association with conventional risk factors and obesity has been accounted for. These findings support public health endeavor to promote exercise over and above the treatment of conventional risk factors.

From Gretchen Reynolds’ Times report:

More surprising, when the researchers controlled for each volunteer’s Framingham risk score and waist size, they found that exercising still significantly reduced people’s risk of dying from heart disease. The benefits were fainter, amounting to about half as much risk reduction as before adjustment for these health factors. But they accrued even among volunteers who had less-than-ideal blood pressure, cholesterol levels or waistlines. Someone with a high Framingham score who exercised had less risk of dying than someone with a similar score who did not.

The study’s results do not suggest, of course, that any of us should now willfully ignore cholesterol or other standard risk factors when considering heart health, said Satvinder Dhaliwal, a professor at Curtin University, who with Timothy Welborn and Peter Howat, conducted the study. But the data does suggest that “identifying and increasing physical activity” may be “at least as important as the measurement and treatment of lipids and hypertension,” he said.

Study: In ‘Healthy’ Fast Food Ads, Kids Mostly Just See French Fries

Just watch the video here and you’ll immediately get the gist of this study. To sum up: when fast food companies try to advertise to children their “healthier” dining options, (like apple slices) the kids, for the most part, don’t see beyond the fries.

The takeaway, according to researchers at Dartmouth, is that these ads from fast food giants like McDonald’s and Burger King “don’t send the right message.”

Here’s more from the Dartmouth news release:

In research published March 31, 2014 in JAMA Pediatrics, Dartmouth researchers found that one-half to one-third of children did not identify milk when shown McDonald’s and Burger King children’s advertising images depicting that product. Sliced apples in Burger King’s ads were identified as apples by only 10 percent of young viewers; instead most reported they were french fries.

Other children admitted being confused by the depiction, as with one child who pointed to the product and said, “And I see some…are those apples slices?”

The researcher replied, “I can’t tell you…you just have to say what you think they are.”

“I think they’re french fries,” the child responded. Continue reading

CDC: Autism Rate Up To 1 in 68 Kids, But Still No Why

A new CDC analysis of autism prevalence shows a nearly 30 percent jump in cases between 2008 and 2010: that means 1 out of every 68 eight-year-olds in the U.S. is diagnosed with the disorder.

But health officials still don’t agree on what’s driving the increase. Debate continues to rage over whether the increase in cases is due to changing definitions and greater awareness of autism spectrum disorders, or if it’s due to some environmental or other factor.

Karen Weintraub reports for USA Today:

…virtually every grade in every elementary school has at least one child with autism – a seemingly astonishing rise for a condition that was nearly unheard of a generation ago.

What’s still unknown is the driver of that increase. Many experts believe the rise is largely due to better awareness and diagnosis rather than a true increase in the number of children with the condition.

(Jesse Costa/WBUR)

(Jesse Costa/WBUR)

“We don’t know the extent those factors explain in terms of the increase, but we clearly know they do play a role,” said Coleen Boyle, director of the National Center on Birth Defects and Developmental Disabilities at the CDC. “Our system tells us what’s going on. It (only) gives us clues as to the why.”

The aging of parents is also known to be a factor; the chances of autism increase with the age of parents at conception.

“But that’s not the whole story is it?” said Robert Ring, chief science officer for Autism Speaks, a research and advocacy group. Whether something in the environment could be causing the uptick remains “the million-dollar question,” Ring said.

Despite their concern, experts said they were not surprised by the increase, because other data had suggested the numbers would continue to climb. In New Jersey, for instance, autism rates were 50% higher than in the rest of the nation in 2000, and they remained that much higher in 2010 – suggesting the national rates will continue to rise to catch up, said Walter Zahorodny, a psychologist who directs the New Jersey Autism Study. “To me it seems like autism prevalence can only get higher,” Continue reading

To Turn Undergrads On To Sex-Ed: Phallic Name Tags And Orgasm Trivia

Attention-grabbing nametags at a sex-ed event for undergrads (Photo: Sascha Garrey)

Attention-grabbing nametags at a sex-ed event for undergrads (Photo: Sascha Garrey)

By Sascha Garrey
Guest contributor

How do you get busy undergrads to focus on their sexual health? Try penis name tags.

That was among the many strategies deployed this week at a sex-themed trivia night organized by the Boston University Health and Wellness Office.

Diners who went to the Sunset Cantina just for the Mexican food on a recent evening were in for a surprise. Amidst the usual busy hum of this popular night spot, the thunderstorm of phrases like “female orgasm” and “pus-like discharge” booming continually across the restaurant may have shocked some into choking on their tacos.

The Cantina played host to BU’s sex-ed evening, ”Sex at the Sunset”: students sporting comical penis-shaped name tags were spread around the venue, talking excitedly and sipping drinks from pink, labia-inspired straws.

A team of peer-health educators, known as the BU Student Health Ambassadors (SHAs), partnered with Bedsider — a pro-sex health outreach organization that advocates for the responsible use of birth control — to bring this racy, but informative, event aimed at BU students as a casual and amusing opportunity to learn and talk about sex.

Meilyn Santamaria, a senior at BU majoring in health sciences and one of the SHAs, helped organize the event and was also the mastermind behind the mood enhancing playlist – hot, throwback tunes like “Sexual Healing” and “Like a Virgin” were thumping all night.

Santamaria has learned a thing or two as a peer-health educator. For instance, she says, approaches to sex-ed like this light, fun-filled evening are important because they engage kids on a different level; and they sure beat those dry, awkward gym class lectures on hygiene.

“You actually get to interact with the material,” says Santamaria. “It’s exciting, it’s fun, it’s a safe environment that is a less intimidating way for people to learn this kind of important information about sex.” Continue reading

Legislators, Again, Grapple With Mandatory Nurse-Patient Ratio

It’s an issue that crops up at the State House every few years and has never been resolved: Should there be a law limiting the number of hospital patients under the care of a nurse at any given time?

This question is back before state lawmakers in this session but this year it may also be on the election ballot.

Massachusetts Nurses Association members pile copies of studies in front of legislators at a State House hearing Monday. They claim the studies prove the need for mandatory, tight nurse-to-patient ratios at all hospitals in Massachusetts. (Martha Bebinger/WBUR)

Massachusetts Nurses Association members pile copies of studies in front of legislators at a State House hearing Monday. They claim the studies prove the need for mandatory, tight nurse-to-patient ratios at all hospitals in Massachusetts. (Martha Bebinger/WBUR)

Is there proof that assigning each nurse no more than four patients would improve care? At a State House hearing on Monday, Karen Coughlin, vice president of the Massachusetts Nurses Association, said yes. Coughlin pointed to one study in particular, “which found that every additional patient assigned to a nurse over four resulted in a 7 percent increase in the risk of death for all the patients under that nurses care.”

But this research, published in the Journal of the American Medical Association, also says it’s not clear exactly how many patients a nurse can care for, but five or six would be wise. California, the only state with a nurse-to-patient ratio law, has nurses caring for five general surgery patients and two in the intensive care unit.

Boston College nursing professor Judith Shindul-Rothschild argues that legal patient limit translates to better care for at least one disease in California as compared to Massachusetts.

“When we look at our patient outcomes for heart failure readmission, for instance, there is a difference,” Shindul-Rothschild said. “It’s not just staffing, but it’s partly due to staffing.”

Continue reading

Coerced Sex Common For Teen Boys And Young Men, Study Finds

A few nights ago, unable to wind down, I was searching for something to watch and stumbled across the film “Adore.” It’s about a pair of lifelong friends (grown women) who end up having affairs with each other’s young, hunky, 19- or 20-year-old sons. My first reaction was the same as one Netflix commenter:

“…if this had been two pals and each other’s teen daughter; well, you get the point. The movie would not have been made, or if so, it would have had an entirely different hue-to say the least. DOUBLE STANDARDS.”

Or, as A.O Scott wrote in his New York Times review:

“It is worth noting that the same movie about a couple of dads sleeping with each other’s 20-year-old daughters would need, at a minimum, to confront the ickiness of the situation. Really, such a movie would be unlikely to make it into theaters, in spite of the commonness of real-life relationships between older men and younger women.”

(Dustin Hoffman, Anne Bancoft in "The Graduate"; Movie-Fan/flickr)

(Dustin Hoffman, Anne Bancoft in “The Graduate”; Movie-Fan/flickr)

The film isn’t about sexually coercion; but it is about boundary breaking, and I thought of it again reading this new study on the pervasive, but largely unexamined problem of sexual coercion among boys and young men.

The study, published in the journal Psychology of Men and Masculinity, found that coerced sex is fairly common for teenage boys and college-age men and can lead to psychological distress and risky behavior, such as sexual risk-taking and alcohol use.

From the American Psychological Association news release:

A total of 43 percent of high school boys and young college men reported they had an unwanted sexual experience and of those, 95 percent said a female acquaintance was the aggressor…

“Sexual victimization continues to be a pervasive problem in the United States, but the victimization of men is rarely explored,” said lead author Bryana H. French, PhD, of the University of Missouri. “Our findings can help lead to better prevention by identifying the various types of coercion that men face and by acknowledging women as perpetrators against men.” Continue reading

Why To Exercise Today, Moms: For The Kids, Of Course

mikebaird/flickr

mikebaird/flickr

My 11-year-old daughter recently asked if she could take a hot yoga class with me. My first reaction was negative: it’s too hot, it’s not “fun” and it’s one of the few things I do that’s truly mine — 90 minutes in which I don’t have to worry about anyone else’s needs.

Of course, I said yes. And I’m glad I did. She made it through class, and was totally into it (though she wished there’d been more “tricks” and less pose-holding).

“That was great, Mom,” she said afterwards. “When’s the next class?” And whether she becomes a yoga fan or not, I consider those 90 minutes to be a small gift: another way for me to show her how strong and able a body can be, and how good it feels. It doesn’t much matter if it’s yoga or running or swimming or playing ultimate frisbee — our kids are clearly taking their physical activity cues from us.

A new study out of the U.K. confirms this: researchers report that physical activity levels in mothers and their pre-school kids are directly associated. The study, published in the journal Pediatrics, suggests that interventions to promote more physical activity among mothers (who, understandably, are often exhausted, harried and not great at fitting exercise into busy, kid-filled days) might also benefit their young children.

Here’s some of NPR’s report on the study of 554 mothers and their kids:

Mothers’ increased physical activity boosted children’s moderate and vigorous activity overall…

It’s not entirely clear whether it’s the mother’s activity that influences her child’s, or if mothers are more active because they’re busy keeping up with a playful child, says Esther van Sluijs, a behavioral epidemiologist at the University of Cambridge and the study’s lead author.

But busy mothers don’t have to drop all other priorities to play with their children all day. Van Sluijs says just small changes – walking to the park instead of driving or playing a good game of tag instead of a board game – can make a difference. Continue reading

Water Babies: Docs Challenge Growing Trend — Childbirth In A Tub

Lumina Gershfield-Cordova, after giving birth to her daughter in the water. (Photo: Erica Kershner)

Lumina Gershfield-Cordova, after giving birth to her daughter in the water. (Photo: Erica Kershner)

Earlier this month, Lumina Gershfield-Cordova gave birth to her healthy 8-pound daughter in a large tub of warm water.

And from that portable tub — set up in the bedroom of her Somerville, Mass., condo — came an atypical American birth story: Gershfield-Cordova describes the buoyancy of the water offering her delicious freedom to move, stretch, turn and, sometimes, relax in ways that are generally unavailable to a woman delivering a baby flat on her back in a hospital bed.

“It’s so wonderful the way the water supports your whole body,” she said. “You can assume positions you can’t get into when gravity is pulling down on you — it’s such a relief. You feel like a ballerina, or an athlete…I was able to work with my baby and together we found the right way for her to come out — there were actual moments of pleasure during her descent. It was amazing.”

Gershfield-Cordova, 35, is one data point in a growing trend. Actress Ricki Lake famously gave birth in a bathtub as part of her pro-natural childbirth documentary, “The Business of Being Born;” the movie created a kind of “Lake Effect” with more buzz around home birth in general, and water birth as well. One report recently quoted supermodel Gisele Bundchen saying her own child’s birth in the water was inspired by Lake’s film.

“It’s so wonderful the way the water supports your whole body…You can assume positions you can’t get into when gravity is pulling down on you — it’s such a relief.”

But it’s one thing to labor in the water, and quite another to actually give birth underwater, according to two prominent physician groups.

In a just-released joint opinion, the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics have come out squarely against childbirth in the water.

Their conclusion: laboring in water could be helpful for women as a way to reduce pain (and pain medication) and spend less time in labor, but giving birth underwater is too risky, with no peer-reviewed, randomized controlled trials showing benefits.

Despite such caveats from medical authorities, both water labor and water birth are becoming more popular around the world.

Consider: One percent of all births in the United Kingdom include some kind of immersion in water (one expert put the number closer to 5 percent); and in the U.S., according to a leading water birth advocate, most birthing centers and nearly 10 percent of the nation’s approximately 3,100 hospitals are now offering birthing tubs that allow women to either labor or deliver their babies in water.

Last year, in one private midwifery practice affiliated with a major medical center in Morristown, N.J., 50 percent of the 170 births were in water, says Lisa Lederer, president of the practice, Midwives of New Jersey. “The benefit is the ability to give birth naturally, without medication… it’s true pain relief without the side effects of epidurals or narcotics,” said Lederer, whose practice has been involved in about 1,000 water births since 2000. “Women will labor in the tub, and I ask them to get out to move around, to pee, or just for a change and they’ll beg to get back in and practically dive head first back in the water. This is not just nice or pretty — it actually helps them.”

Noting that water birth, along with home birth, is a growing trend in the U.S., Dr. George Macones, an obstetrician-gynecologist at Washington University in St. Louis, and chair of the committee that prepared the latest ACOG/AAP opinion, said: “I think there’s an important distinction between laboring in a tub and delivering in a tub. Most of us feel that laboring in a tub is fine, as long as the baby is doing well and mom is doing well. Delivering underwater is where there’s a bit more of a struggle — there isn’t a lot of data on this but there are a number of case reports of really bad things happening.” Mostly, he said, there are “concerns about the baby aspirating water.” Others cite infection as a potential problem.

Still, Macones said, at his hospital, where planning has begun for a new labor and delivery ward, “one of the hot topics is how many rooms will have tubs.”

The new ACOG/AAP opinion (which follows a 2005 AAP commentary on the risks of underwater delivery and 2012 ACOG guidelines on perinatal care) concludes that water birth should be considered an “experimental procedure ” and only performed as part of a clinical trial with informed consent — something that’s unlikely to happen in the U.S., according to Macones.

For comparison, here’s what the U.K. Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives stated back in 2006: “All healthy women with uncomplicated pregnancies at term should have the option of water birth available to them and should be able to proceed to a water birth if they wish.” The groups also also urged hospitals to support women in this pursuit: “…to achieve best practice with water birth it is necessary for organisations to provide systems and structures to support this service.”

Here’s more of the joint ACOG/AAP opinion, published online in the journal Pediatrics, and summarized in a news release:

Undergoing the early stages of labor in a birthing pool may offer some advantages to pregnant women. However, underwater delivery has no proven benefit to women or babies and may even pose a risk of serious health problems for the newborn…

“Many labor and delivery units are equipped with tubs to be used by laboring women, and immersion in water for relaxation and pain relief is appealing to some,” said Jeffrey L. Ecker, MD, chair of the College’s Committee on Obstetric Practice that developed the Committee Opinion. “But it is important to recognize that laboring in water is not the same as delivering underwater. Laboring in water may offer some potential benefits, but delivering underwater does not seem to have clear advantages, and the risk of rare, but serious, consequences to a delivering baby’s health is something women and providers should all be aware of.”

“The members of the committees conducted a thorough review of the literature, and came to the conclusion that there is no evidence to support delivering babies in water has benefits to the baby,” says Tonse Raju, MD, chief, Pregnancy and Perinatology Branch, the National Institute of Child Health and Human Development (NICHD), who served as the NICHD liaison to the AAP Committee on Fetus and Newborn.

The new recommendation acknowledges that there may be some positive effects of water immersion to pregnant women during the early stages of labor, such as decreased pain or use of anesthesia and shorter labors. However, there is no evidence that giving birth underwater improves newborn outcomes…

Potential risks of underwater delivery include a higher risk of maternal and neonatal infections; difficulty in the regulation of the baby’s body temperature; increased chance of umbilical cord damage; respiratory distress resulting from the baby inhaling tub water; and potential for seizures or asphyxiation of baby following birth.

The College and AAP say that underwater delivery should only be performed within the context of an appropriately designed clinical trial with informed consent.

Barbara Harper, an RN who founded the company Waterbirth International in the late 1980s after her two sons were born in water, has been called “the Billy Graham of water birth.” She says she’s personally attended around 600 water births and trained more than 7,000 physicians, nurses, medical students and others around the world — in Mexico, India, Israel, Malaysia, all over Europe, the U.K and U.S — on how to safely and effectively manage childbirth in the water. Based in Fort Lauderdale, Fla., Harper is currently in China conducting water birth training in medical schools and hospitals.

Harper refutes the ACOG assertion that water births are more risky than land births and cites a number of published studies and analyses that support her position, among them a 1999 British report that concluded: “perinatal mortality is not substantially higher among babies delivered in water than among those born to low risk women who delivered conventionally.”

Among water birth’s benefits, Harper says, are that it can speed up labor, give the mother more of a feeling of control, provide pain relief and reduce the need for drugs and inteventions such as epidurals, episiotomies and even cesarean sections. However, Harper says she has very strict criteria regarding who is eligible to give birth in a tub: “Anyone can labor in the water,” she says. “But if your labor goes into the pathology area and wanders out of normal physiology,” water birth should not be an option. She says, for instance, that women with preeclampsia, high blood pressure, abnormal bleeding or untreated infection or fever should not deliver babies in the water. Continue reading

Gun Laws: A New Litmus Test For Surgeon General?

Abortion has been a litmus test for U.S. Supreme Court nominees since the hearings for Robert Bork 27 years ago. Now, some doctors are worried that anything a physician says about guns may prove perilous for nominees to be U.S. surgeon general. Will Dr. Vivek Murthy, an internist at Boston’s Brigham and Women’s Hospital, set the precedent?

Dr. Vivek Murthy, President Obama's nominee for U.S. Surgeon General, testified before the US Senate HELP committee on Feb. 4, 2014.

Dr. Vivek Murthy, President Obama’s nominee for U.S. Surgeon General, testified before the US Senate HELP committee on Feb. 4, 2014.

President Obama tapped Murthy to become the nation’s next top doctor in November. Early last month, the 36-year-old was on Capitol Hill for a confirmation hearing, where most of the questions were about the Affordable Care Act.

Murthy is a strong supporter of the federal law and founded a national organization originally called Doctors for Obama, now Doctors for America. His group also urged Congress to pass stricter gun laws after the Sandy Hook Elementary shootings. That was a point of concern during the hearing for Sen. Lamar Alexander, a Republican from Tennessee.

“You said, in your advocacy for passage of gun control, last year, that you’re ‘tired of politicians playing politics with guns, putting lives at risk because they’re scared of the NRA,’ ” Alexander said and then continued with a question: “To what extent do you intend to use the surgeon general’s office as a bully pulpit for gun control?”

“Thank you, Sen. Alexander,” Murthy said, adjusting his microphone. “To start, I do not intend to use the surgeon general’s office as a bully pulpit for gun control. That is not going to be my priority. As we spoke about, my priority and focus is going to be on obesity prevention.”

Murthy cleared the Senate Health, Education, Labor and Pensions Committee with a vote of 13 to 9. Then, in late February, Chris Cox, director of the NRA’s Institute for Legislative Action, delivered a letter to Senate leaders opposing Murthy’s nomination.

Cox told Fox News that “Mr. Murthy’s not just a gun control supporter, he’s a gun control activist. And it’s clear that his agenda is to treat a constitutional freedom like a disease.”

Members of the National Rifle Association began calling their senators and the group said a vote for Murthy would be considered a vote against the NRA.

Continue reading