American kids are increasingly likely to be admitted to the hospital for mental problems, although rates of non-psychiatric hospitalizations have remained flat, a new study shows.
From 1996 to 2007, the rate of psychiatric hospital discharges rose by more than 80 percent for 5-13-year-olds and by 42 percent for older teens.
"This occurs despite numerous efforts to make outpatient services for the more vulnerable kids more widely available," said Joseph C. Blader of Stony Brook State University of New York, whose findings appear in the Archives of General Psychiatry.
He said hospitalization is the last resort, because it's so disruptive for normal life.
"It's a pretty traumatic thing for a family when your child is admitted to a psych unit," he told Reuters Health.
Overall, short-term hospital admissions for mental illness rose from 156 to 283 per 100,000 children per year over the ten-year study period, based on data from the National Hospital Discharge Survey.
For adolescents, the rate increased from 683 to 969 per 100,000, while it went up from 921 to 996 for adults and dropped from 978 to 808 for people 65 and older.
The change for the elderly was expected, Blader said, because of cuts in Medicare reimbursement for inpatient hospitalizations.
For youngsters, bipolar disorder showed the steepest increase, while anxiety diagnoses dropped.
Although there have been concerns about overdiagnosis of bipolar disorder and other mental problems among children, Blader said that was unlikely to be hiking the rates.
That's because hospitalizations are based on whether or not people are considered a danger to themselves or others, not on psychiatric labels.
"Most typically it's volatile and aggressive behavior, or overreaction to minor provocations that lead to assaults on family members or peers," Blader told Reuters Health.
There was also a decline in the proportion of hospital stays paid for by private insurers. But whether that reflects a growing quality gap in mental health care or is a consequence of increased government coverage is unclear.
"There is no way these kinds of data are going give you the answers on a silver platter," Blader said.
He believes the rate hikes are real and alarming and says now is the time to study the underlying reasons.
"Whereas before we had hoped that more outpatient services would lead to a decrease in hospitalizations, the findings suggest a pressing need to learn what might have reversed that trend," Blader said.
Sources : http://www.reuters.com/article/2011/08/03/us-kids-mental-illness-idUSTRE7726UY20110803
Thursday, August 4, 2011
Young gay men who use meth may risk HIV
Young gay and bisexual men who use methamphetamine are more likely to take sexual risks that boost their chances of contracting HIV, a new study suggests.
Researchers say the findings underscore the fact that meth, and its associated HIV risk, is not just a problem of middle-aged white men.
Methamphetamine triggers a massive release of the feel-good chemical dopamine in the brain, making users feel disinhibited, energized -- and prone to sexual risk-taking.
Studies of gay and bisexual men have found that roughly 43 percent have ever used meth, and that the habit is strongly linked to their risk of contracting HIV, the virus that causes AIDS.
But much less has been known about meth use and HIV risk among teenagers and young men.
So for the new study, researchers surveyed 595 12- to 24-year-old gay and bisexual males from eight U.S. cities. They found that 31 percent had ever used hard drugs -- one-third of whom had used methamphetamine.
And young men who'd used meth were more likely to report a range of risk factors for HIV.
Nearly 86 percent said they'd had sex with at least two different partners in the past 90 days (versus 63 percent of non-drug users). Almost 52 percent had ever had sex with an injection-drug user (versus 11 percent), and one-third had had sex with someone who was HIV-positive (against 11 percent).
Despite all of that, meth users were less consistent with condoms: one-third said they used them every time they had sex, compared with 54 percent of young men who'd never used hard drugs.
"In many ways, these findings mirror what's been seen in older MSM (men who have sex with men)," said Dr. Robert Garofalo of Children's Memorial Hospital in Chicago.
That's concerning, he told Reuters Health in an interview, and it also points to a large public health need.
"There are not a lot of proven HIV prevention programs for this age group," Garofalo said. More programs, including ones that target meth abuse, need to be piloted, according to Garofalo and his colleagues.
"We shouldn't wait," he said. "This is a real public health crisis."
The findings, which appear in the Archives of Pediatrics & Adolescent Medicine, are not representative of all young gay and bisexual men in the U.S. The researchers recruited their participants from clubs, bars, parks and other urban venues where they might find higher-risk young men.
But the researchers also consider that a strong point of the study.
"It tells us something about where to find these young men, and where we might be able to run some type of intervention," said lead researcher Peter Freeman, who is also with Children's Memorial.
For parents and teenagers, he said, the findings highlight the importance of having open conversations about both drug use and risky sexual behavior.
Garofalo said there still may be many parents who do not know that methamphetamine is something they need to worry about. So the current findings may be something of an eye-opener for some, he added.
Finding effective ways to curb HIV risk among young gay and bisexual men will only become increasingly important, according to Garofalo and Freeman.
In 2004, Americans between the ages of 13 and 24 accounted for 13 percent of new HIV diagnoses.
And gay and bisexual males, especially minorities, have been particularly vulnerable. A study of seven cities by the U.S. Centers for Disease Control and Prevention found that 14 percent of African-American gay and bisexual males ages 15 to 22 had HIV. The same was true of 7 percent of Hispanics.
Sources : http://www.reuters.com/article/2011/08/03/us-gay-men-meth-risk-idUSTRE7726UR20110803
Researchers say the findings underscore the fact that meth, and its associated HIV risk, is not just a problem of middle-aged white men.
Methamphetamine triggers a massive release of the feel-good chemical dopamine in the brain, making users feel disinhibited, energized -- and prone to sexual risk-taking.
Studies of gay and bisexual men have found that roughly 43 percent have ever used meth, and that the habit is strongly linked to their risk of contracting HIV, the virus that causes AIDS.
But much less has been known about meth use and HIV risk among teenagers and young men.
So for the new study, researchers surveyed 595 12- to 24-year-old gay and bisexual males from eight U.S. cities. They found that 31 percent had ever used hard drugs -- one-third of whom had used methamphetamine.
And young men who'd used meth were more likely to report a range of risk factors for HIV.
Nearly 86 percent said they'd had sex with at least two different partners in the past 90 days (versus 63 percent of non-drug users). Almost 52 percent had ever had sex with an injection-drug user (versus 11 percent), and one-third had had sex with someone who was HIV-positive (against 11 percent).
Despite all of that, meth users were less consistent with condoms: one-third said they used them every time they had sex, compared with 54 percent of young men who'd never used hard drugs.
"In many ways, these findings mirror what's been seen in older MSM (men who have sex with men)," said Dr. Robert Garofalo of Children's Memorial Hospital in Chicago.
That's concerning, he told Reuters Health in an interview, and it also points to a large public health need.
"There are not a lot of proven HIV prevention programs for this age group," Garofalo said. More programs, including ones that target meth abuse, need to be piloted, according to Garofalo and his colleagues.
"We shouldn't wait," he said. "This is a real public health crisis."
The findings, which appear in the Archives of Pediatrics & Adolescent Medicine, are not representative of all young gay and bisexual men in the U.S. The researchers recruited their participants from clubs, bars, parks and other urban venues where they might find higher-risk young men.
But the researchers also consider that a strong point of the study.
"It tells us something about where to find these young men, and where we might be able to run some type of intervention," said lead researcher Peter Freeman, who is also with Children's Memorial.
For parents and teenagers, he said, the findings highlight the importance of having open conversations about both drug use and risky sexual behavior.
Garofalo said there still may be many parents who do not know that methamphetamine is something they need to worry about. So the current findings may be something of an eye-opener for some, he added.
Finding effective ways to curb HIV risk among young gay and bisexual men will only become increasingly important, according to Garofalo and Freeman.
In 2004, Americans between the ages of 13 and 24 accounted for 13 percent of new HIV diagnoses.
And gay and bisexual males, especially minorities, have been particularly vulnerable. A study of seven cities by the U.S. Centers for Disease Control and Prevention found that 14 percent of African-American gay and bisexual males ages 15 to 22 had HIV. The same was true of 7 percent of Hispanics.
Sources : http://www.reuters.com/article/2011/08/03/us-gay-men-meth-risk-idUSTRE7726UR20110803
Tuesday, August 2, 2011
Magnetic field exposure linked to asthma risk
Children whose mothers had high exposure to electromagnetic fields while pregnant may have an increased risk of developing asthma, U.S. researchers said on Monday in a study that adds to an ongoing debate.
Many prior studies have failed to consistently show that chronic exposure to electromagnetic fields -- from power lines and appliances such as microwaves ovens, hair dryers and vacuum cleaners -- are harmful to human health.
But many of these studies required people to estimate their exposure levels over several years, says Dr. De-Kun Li, senior research scientist at the Kaiser Permanente in Oakland, California, whose study appears in Archives of Pediatrics & Adolescent Medicine.
To get a more conclusive answer, Li designed a so-called prospective study in which 801 pregnant women wore monitors that measured their exposure to magnetic fields for 24 hours.
These monitors measured their exposure to low-frequency magnetic fields from electronics such as microwaves, hair dryers, fans, coffee grinders and fluorescent light bulbs, power lines, and transformer stations.
It did not monitor exposure to higher frequency electromagnetic fields generated by cellphones or cellphone towers.
The team used medical records to follow the women's children for 13 years. During the follow-up, 130 children, or 20.8 percent of study participants, developed asthma.
Most of these cases were diagnosed before age 5.
They then compared exposure levels during pregnancy to rates of asthma and found that children whose mothers had the highest exposure levels -- within the top 10 percent of women in the study -- were 3.5 times more likely to develop asthma than those who were in the bottom 10 percent.
The risk for children whose exposure was somewhere in the middle -- between 10 percent and 90 percent -- was 75 percent higher than for those in the lowest exposure group.
For the average population, Li said, children of women whose exposure levels were in the range of the bottom 10 percent in the study would have about a 13.6 percent absolute risk of developing asthma. Women whose exposure was in the highest range would have about a 33 percent risk of having children who developed asthma over the 13 year study period.
Some 13 percent of children under age 18 have asthma, which is caused by malfunction of the respiratory organs and the immune system.
Li said it is not clear why exposure to power lines might increase the risk of asthma, but he said there are several possibilities.
He said a prior study by his team found high exposure to electromagnetic fields increased the risk of miscarriages. And some animal studies have suggested that electromagnetic field exposure can affect immune response, which could increase the risk of asthma.
Exposure to power lines has been fodder for significant debate, and while many studies have found an effect of some sort -- ranging from immune disorders and poor semen quality to certain types of cancers -- Li said his study offers a stronger argument that concerns about magnetic fields may affect human health.
"This really needs to be studied," Li said. He said there have been a lot of dismissive attitudes about the health effects of exposure to magnetic fields, and he hopes his study -- which measured exposure levels ahead of time -- will encourage others to look further.
Still, he concedes that his findings need to be replicated by different scientists.
Li said if the findings are confirmed, it may offer new strategies for preventing the chronic disease in children.
Sources : http://www.reuters.com/article/2011/08/01/us-pregnancy-asthma-idUSTRE77066420110801
Many prior studies have failed to consistently show that chronic exposure to electromagnetic fields -- from power lines and appliances such as microwaves ovens, hair dryers and vacuum cleaners -- are harmful to human health.
But many of these studies required people to estimate their exposure levels over several years, says Dr. De-Kun Li, senior research scientist at the Kaiser Permanente in Oakland, California, whose study appears in Archives of Pediatrics & Adolescent Medicine.
To get a more conclusive answer, Li designed a so-called prospective study in which 801 pregnant women wore monitors that measured their exposure to magnetic fields for 24 hours.
These monitors measured their exposure to low-frequency magnetic fields from electronics such as microwaves, hair dryers, fans, coffee grinders and fluorescent light bulbs, power lines, and transformer stations.
It did not monitor exposure to higher frequency electromagnetic fields generated by cellphones or cellphone towers.
The team used medical records to follow the women's children for 13 years. During the follow-up, 130 children, or 20.8 percent of study participants, developed asthma.
Most of these cases were diagnosed before age 5.
They then compared exposure levels during pregnancy to rates of asthma and found that children whose mothers had the highest exposure levels -- within the top 10 percent of women in the study -- were 3.5 times more likely to develop asthma than those who were in the bottom 10 percent.
The risk for children whose exposure was somewhere in the middle -- between 10 percent and 90 percent -- was 75 percent higher than for those in the lowest exposure group.
For the average population, Li said, children of women whose exposure levels were in the range of the bottom 10 percent in the study would have about a 13.6 percent absolute risk of developing asthma. Women whose exposure was in the highest range would have about a 33 percent risk of having children who developed asthma over the 13 year study period.
Some 13 percent of children under age 18 have asthma, which is caused by malfunction of the respiratory organs and the immune system.
Li said it is not clear why exposure to power lines might increase the risk of asthma, but he said there are several possibilities.
He said a prior study by his team found high exposure to electromagnetic fields increased the risk of miscarriages. And some animal studies have suggested that electromagnetic field exposure can affect immune response, which could increase the risk of asthma.
Exposure to power lines has been fodder for significant debate, and while many studies have found an effect of some sort -- ranging from immune disorders and poor semen quality to certain types of cancers -- Li said his study offers a stronger argument that concerns about magnetic fields may affect human health.
"This really needs to be studied," Li said. He said there have been a lot of dismissive attitudes about the health effects of exposure to magnetic fields, and he hopes his study -- which measured exposure levels ahead of time -- will encourage others to look further.
Still, he concedes that his findings need to be replicated by different scientists.
Li said if the findings are confirmed, it may offer new strategies for preventing the chronic disease in children.
Sources : http://www.reuters.com/article/2011/08/01/us-pregnancy-asthma-idUSTRE77066420110801
Acute-care hospitals to see higher Medicare payments
The U.S. government announced an increase in reimbursement rates to acute-care hospitals for 2012, a sharp contrast to the cut it announced for skilled nursing facilities on Friday.
The Centers for Medicare and Medicaid Services (CMS) increased payment rates to acute-care hospitals by 1 percent, compared with a 0.5 percent cut it had proposed earlier.
The CMS expects the rate increase will result in Medicare's operating payments to acute-care hospitals rising by $1.13 billion, or 1.1 percent.
On Friday, the CMS cut 2012 payments for skilled nursing facilities by 11.1 percent, or $3.87 billion, leading to a sharp decline in shares of Skilled Healthcare, Kindred Healthcare and Sun Health Care.
There was a broad sell-off in healthcare stocks on Monday on fears that the debt-ceiling deal to be voted on by the U.S. Congress would cut healthcare spending for federal programs such as Medicare.
Acute-care hospital operators such as HealthSouth Corp, Kindred Healthcare Inc, Tenet Healthcare Corp and Community Health Systems Inc are expected to benefit from the hike in payment rate.
Sources : http://www.reuters.com/article/2011/08/01/us-acutecarehospitals-idUSTRE77062U20110801
The Centers for Medicare and Medicaid Services (CMS) increased payment rates to acute-care hospitals by 1 percent, compared with a 0.5 percent cut it had proposed earlier.
The CMS expects the rate increase will result in Medicare's operating payments to acute-care hospitals rising by $1.13 billion, or 1.1 percent.
On Friday, the CMS cut 2012 payments for skilled nursing facilities by 11.1 percent, or $3.87 billion, leading to a sharp decline in shares of Skilled Healthcare, Kindred Healthcare and Sun Health Care.
There was a broad sell-off in healthcare stocks on Monday on fears that the debt-ceiling deal to be voted on by the U.S. Congress would cut healthcare spending for federal programs such as Medicare.
Acute-care hospital operators such as HealthSouth Corp, Kindred Healthcare Inc, Tenet Healthcare Corp and Community Health Systems Inc are expected to benefit from the hike in payment rate.
Sources : http://www.reuters.com/article/2011/08/01/us-acutecarehospitals-idUSTRE77062U20110801
U.S. says insurers must fully cover birth control
 |
| A box of Tri-Cyclen Lo birth control medication for women is seen in a pharmacy in Toronto January 31, 2008. |
U.S. health insurance companies must fully cover women's birth control and other preventive health care services under Obama administration rules released on Monday.
The mandate from the Health and Human Services Department represents a landmark decision in a decades-long debate on women's health issues that has pitted family planning groups against conservative organizations.
"Under the law, we're making it illegal to charge women more just because of their gender," HHS Secretary Kathleen Sebelius said on Monday.
The guidelines, a product of last year's healthcare overhaul, go into effect on Monday, and require insurers to do away with co-payments on coverage of preventive care services for women in all new plans beginning in August 2012.
The rules largely follow recommendations from a scientific advisory group released last month.
The U.S. Institute of Medicine (IOM) said in a July report that all government-approved birth control methods -- including the "morning-after pill," taken shortly after sexual intercourse to stop a pregnancy -- should be included in the U.S. list of preventive health services.
The newly required coverage also includes free screenings for gestational diabetes, testing for human papillomavirus in women over 30, counseling for HIV and sexually transmitted infections, and screening for domestic violence.
"Today is a historic victory for women's health and women across the country," said Cecile Richards, president of Planned Parenthood Federation of America. "The decision by HHS is monumental for millions of women."
Conservative groups balked at the decision to force private insurers to fully cover birth control. "HHS says the intent of its 'preventive services' mandate is to help 'stop health problems before they start,'" said Cardinal Daniel DiNardo, chairman of the pro-life activities committee at the U.S. Conference of Catholic Bishops. "But pregnancy is not a disease, and children are not a 'health problem.'"
In a nod to conservative groups, the HHS included an amendment to its final rules that would allow religious employees and institutions to choose whether to cover contraception services in their insurance.
MORAL DEBATE
For at least 50 years, religious objections to birth control have made the topic a hot-button social issue in the United States.
In 1965, a Supreme Court ruling ended an era when states could ban the use of contraceptives, arguing that such power violated "the right to marital privacy." In 1972, another case upheld unmarried couples' rights to the use of contraceptives.
Monday's rules mark another turn in the debate and could help put birth control in financial reach for some women.
Many of the bigger employers must include birth control among the services covered by their insurance, but require women to pay part of the price. The HHS guidelines would get rid of the co-pay.
"(Contraception) is not controversial in the lives of women... To an extent, this is not really new, but it's filling in the gaps," said Judy Waxman, vice president for health and reproductive rights at the National Women's Law Center, a non-profit pro-choice education center.
There is some question about how much impact the rule will have on coverage of the "morning-after pill."
The HHS rule requires coverage of contraceptives "as prescribed." Two most commonly used government-approved emergency contraceptives -- "Plan B" from Teva Pharmaceuticals and "Next Choice" from Watson Pharmaceuticals -- are sold over the counter. The only prescription emergency pill is Watson's "ella," approved in 2010.
"It's regulatory sleight of hand on the part of HHS," said Dr. Michele Curtis, an obstetrician and gynecologist at the University of Texas-Houston Medical School.
Still, some women said the government's mandate for full coverage of birth control is a welcome step.
"I'm not on it now, but I took it in my twenties, and it cost a small fortune back then," said 47-year-old Carole Murphy, who was shopping at a local CVS on Monday. "It's good to have the option if you need it."
Sources : http://www.reuters.com/article/2011/08/01/us-usa-health-preventive-idUSTRE7703C420110801
Boys who masturbate likelier to have safe sex?
Masturbation could play an important role in sexual self-awareness and condom use in teenage boys, according to a new report.
Researchers found 86 percent of boys who said they'd worn a condom last time they had sex also reported masturbating over the past year, compared to only 44 percent of boys who didn't masturbate.
While that link doesn't prove that masturbation itself leads to safer sex, "the association of any behavior with increased condom use deserves further investigation, given the rates of unintended pregnancies and sexually transmitted infections in adolescents," the report says.
In 2009, there were nearly 410,000 births to girls aged 15 to 19 in the U.S., where teen motherhood racks up public costs of an estimated $9.1 billion.
The new study, supported by Trojan condom maker Church & Dwight Co, is based on a nationally representative survey of 820 adolescents between 14 and 17 years old.
Dr. Cynthia Robbins at Indiana University in Indianapolis and colleagues found that nearly three-quarters of boys said they masturbated, while less than half of girls did so.
Those kids who masturbated reported having more sex than those who didn't, including oral sex and vaginal intercourse.
After taking age and partner status into account, sexually active boys who masturbated were about eight times as likely to have used a condom during their last intercourse as boys who didn't masturbate.
For unknown reasons, there was no such link for girls.
Writing in the Archives of Pediatrics & Adolescent Medicine, the researchers note that masturbation is a highly stigmatized topic in the U.S., and that many doctors shy away from discussing the common phenomenon.
"The findings of this study together with existing publications on masturbation should be used by health care providers to inform, educate and reassure adolescents about masturbation to provide competent and comprehensive sexuality education in the clinical setting," they conclude.
Sources : http://www.reuters.com/article/2011/08/01/us-masturbate-idUSTRE7705VM20110801
Researchers found 86 percent of boys who said they'd worn a condom last time they had sex also reported masturbating over the past year, compared to only 44 percent of boys who didn't masturbate.
While that link doesn't prove that masturbation itself leads to safer sex, "the association of any behavior with increased condom use deserves further investigation, given the rates of unintended pregnancies and sexually transmitted infections in adolescents," the report says.
In 2009, there were nearly 410,000 births to girls aged 15 to 19 in the U.S., where teen motherhood racks up public costs of an estimated $9.1 billion.
The new study, supported by Trojan condom maker Church & Dwight Co, is based on a nationally representative survey of 820 adolescents between 14 and 17 years old.
Dr. Cynthia Robbins at Indiana University in Indianapolis and colleagues found that nearly three-quarters of boys said they masturbated, while less than half of girls did so.
Those kids who masturbated reported having more sex than those who didn't, including oral sex and vaginal intercourse.
After taking age and partner status into account, sexually active boys who masturbated were about eight times as likely to have used a condom during their last intercourse as boys who didn't masturbate.
For unknown reasons, there was no such link for girls.
Writing in the Archives of Pediatrics & Adolescent Medicine, the researchers note that masturbation is a highly stigmatized topic in the U.S., and that many doctors shy away from discussing the common phenomenon.
"The findings of this study together with existing publications on masturbation should be used by health care providers to inform, educate and reassure adolescents about masturbation to provide competent and comprehensive sexuality education in the clinical setting," they conclude.
Sources : http://www.reuters.com/article/2011/08/01/us-masturbate-idUSTRE7705VM20110801
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