Posts Tagged ‘medicine’
An ethics issue: Physicians dispensing drugs for healthy people? And for kids to study?
Posted on: March 26, 2013
Adderall and other ADHD medications, a disorder characterized by problems with attention and hyperactivity, are used as “smart drugs” or “study drugs” by students who find the pills give them a mental edge. These drugs are among the most prescribed drugs in America.
Adderall is the only drug class that showed increased use in 2012, the federal survey reported.
Nancy Shute posted on Shot this March 14, 2013 under “Neurologists Warn Against ADHD Drugs To Help Kids Study”
Ten milligram tablets of the prescription drug Adderall. Jb Reed/Bloomberg via Getty Images
The brain docs are directing that advice first and foremost to their fellow physicians, the ones who have been writing all those scrips for people who don’t have ADHD, or who perhaps don’t think about all the pills their patients sell on the student black market.
“We don’t believe that doctors are supposed to be drug dispensers for healthy people,” says William Graf, a professor of pediatrics and neurology at the Yale School of Medicine. “This is an ethics issue.”
But the message is also being sent to teenagers and their parents, some of whom who might think that giving their child a little leg up for a big test isn’t such a bad thing. The buzz term for that? “Pediatric neuroenhancement.”
Prescribing ADHD drugs to children who don’t have the disorder is “not justifiable,” according to the American Academy of Neurology’s new position paper: Children’s brains are still developing, the paper says, and they don’t have the ability to weigh the risks and benefits of medication.
Prescribing study drugs is “inadvisable” in teenagers, a word chosen to reflect both teenagers’ growing autonomy, and the fact that the Academy can’t tell doctors what drugs they can and can’t prescribe.
The number of children diagnosed with ADHD rose 24 percent from 2001 to 2011, according to a study published earlier this year. Over the same time, the number of prescriptions for Adderall and other ADHD drugs has soared exponentially.
More pills in circulation means more pills that can be bought, borrowed, or snitched.
Various surveys report that 8 to 35% of college students say they have used stimulant pills to improve school performance.
The neurologists are not saying that stimulant drugs shouldn’t be used to treat ADHD, “We’re not touching that here,” Graf told Shots.
What they are saying is that doctors have a moral obligation to protect the best interests of the child — who doesn’t yet have legal control over health care decisions — and to prevent the misuse of medication.
Amphetamines like Adderall and Vyvanse can be addictive, which is why they’re classified as Schedule II controlled substances, along with Oxycontin and morphine.
Side effects can be as simple as insomnia, or as serious as sudden high blood pressure, irregular heartbeat, and seizures.
Other popular ADHD drugs like Concerta and Ritalin are methamphetamine and are considered less risky. But they can cause a wide range of side effects including insomnia, aggression, mood and behavior changes, twitching, and shaking.
About 15% of 12th graders say they misuse prescription drugs, according to the 2012 Monitoring the Future survey, and about 6% say they’ve misused Ritalin or Adderall.
“As a society we have a pill for everything,” Graf says. “It’s one thing if you’re taking something from the Vitamin Shoppe. It’s another thing if you’re talking about amphetamines.”
Doctors should talk with patients and parents about why they feel the need for academic performance enhancing drugs. They should point out that there are other ways to deal with competition and anxiety.
“We have to get back to the basics,” Graf says. “Sleep, exercise, and social interaction.”
What are the Brain’s Survival Skills? And Fear beyond the Amygdala
Can scientists use the brain’s inherent survival mechanisms to develop better stroke treatment?
Strokes are a major cause of death and disability worldwide, with 150,000 people affected in the UK every year.
Most strokes happen when a blood vessel that supplies blood to the brain is blocked due to blood clots or fat deposits. Once blood is cut off from an area of the brain, brain cells are starved for oxygen and nutrients and start to die within minutes.
A new study in Nature Medicine, scientists at the University of Oxford reveal a novel way in which the brain protects itself in response to stroke.
Ranya Bechara posted on Feb. 27, 2013 “Stroke Vs Brain: Harnessing the Brain’s Survival Skills”
Other ways of protecting the brain against stroke damage are in high demand.
In this study, the research team from Oxford University (in collaboration with other researchers from Greece, Germany, and Canada, and the UK) decided to try a new approach. They investigated a phenomenon that has been known for years: some brain cells have an inherent defence mechanism that allows them to survive when deprived of oxygen.
These cells are located in the part of the brain responsible for forming memories: a pretty sea-horse shaped structure called the hippocampus.
The scientists analysed the proteins produced by these cells and found that the key to their survival is a protein called hamartin. This protein is released by the cells in response to oxygen deprivation, and when its production was supressed, the cells became more vulnerable to the effects of stroke.
Photo credit: http://www.vascularinfo.co.uk
Original article is available here
Fear beyond the Amygdala
Ranya Bechara posted on Feb. 6, 2013
Male Nurses Make More Money: Isn’t it normal and natural?
Hospital patients are more likely than ever to see a male nurse at their bedside — and odds are he earns more than the female nurse down the hall.
Men made up close to 10% of all registered nurses in 2011, according to a new Census report released today. That may not sound like much, but it’s up from less than 3% in 1970 and less than 8% in 2000.
Women still dominate nursing in terms of employment — but not in terms of earnings. The average female nurse earned $51,100 in 2011, 16% less than the $60,700 earned by the average man in the same job.
Ben Casselman posted in Real Time Economics (The Wall Street Journal)
It’s no mystery what is drawing men into nursing. Male-dominated professions such as construction and manufacturing hemorrhaged jobs during the recession and have been slow to rebound during the recovery.
The health-care sector, meanwhile, actually added jobs during the recession and has continued to grow since. All told, health-care employment is up by nearly 1.4 million since the recession began, while employment in the construction and manufacturing sectors is down by nearly 3.6 million.
Education and health workers have an unemployment rate of 5.4%, versus 7.9% for factory workers and 16.1% for construction workers.
The difference in earnings is partly due to the fact that men were more likely than women to work full-time. When looking only at full-time, year-round workers, the gap narrows, but it doesn’t disappear; female nurses working full-time, year-round earned 9% less than their male counterparts.
- Getty Images
Part of the reason, the Census study suggests, is a previously documented phenomenon known as the “glass escalator” in which men earn higher wages and faster promotions in female-dominated professions.
In nursing, men are more concentrated in the highest-earning segments of the field. They make up 41% of nurse anesthetists, who earn nearly $148,000 on average, but only 8% of licensed practical nurses, who make just $35,000.
Even within a given field, men tend to earn more.
Among full-time, year-round registered nurses, women earned 7% less than men in 2011. The study’s authors note, however, that the wage gap is smaller in nursing than in the economy as a whole, where women earn on average 77 cents to the dollar, according to the Census report.
Men also appear to have an easier time getting hired, although the high demand for nurses means unemployment rates are low across categories — less than 2% for registered nurses, and even lower for more advanced professionals. Among licensed practical nurses, the only category with meaningful levels of unemployment, men had an unemployment rate of 4%, versus 5.1% for women.
Male nurses are more likely than female nurses to:
1. Have a doctoral degree.
2. More likely to work evening or night shifts, and
3. More likely to be immigrants.
Female nurses are more likely to work in doctor’s offices or schools, and are far more likely to be over age 65 — a reflection of nursing’s status as a female-dominated profession until recently.
But overall, male and female nurses are demographically similar. The typical nurse of either sex is between age 35 and 54, has some college or a bachelor’s degree and works for a private-sector hospital.
It just cannot protect you from all of the different cold viruses out there. Scientists are still working on the cure for the common cold.
Until then, it’s important to get protected from the virus that we do have something for, something that is much more serious than a cold – that is, influenza.
Alvinyu published in Heartland Health Centers on December 19, 2012 under:
The Facts about the Flu Vaccine
Every year I am surprised by all of the misconceptions surrounding the flu vaccine.
So I thought I’d take this opportunity to do some myth-busting. The flu vaccine protects you from influenza, an ever-evolving virus that can lead to hospitalization and even death.
There are 2 kinds of flu vaccines:
1. the flu shot and the nasal spray flu vaccine. The flu shot will NOT make you sick. It is made from inactivated or killed virus. This killed virus cannot infect you. Those killed particles do, on the other hand, make your body make antibodies to influenza. Consider antibodies to be like soldiers. These antibodies help you fight off the influenza virus in case you happen to catch it. At the first site of the influenza virus, these soldiers/antibodies immediately recognize the virus and help to protect your body.
2. The nasal spray flu vaccine is made of weakened virus, but even that does not cause the severe symptoms of influenza.
It CAN, in some people, lead to symptoms like muscle ache, headache, runny nose, wheezing and even fever. The nasal spray flu vaccine is for healthy 2 to 49 year olds, including women who are not pregnant.
Healthy means someone without a medical condition that predisposes them to the complications of influenza.
For example, the nasal spray flu vaccine is NOT suitable for someone with asthma. Your provider will figure out whether the shot or nasal spray is right for you.
So, who should get the flu vaccine?
Just about everyone who is 6 months old or older. The flu vaccine is NOT approved for those under 6 months of age.
Anyone who lives with or takes care of a baby who is under 6 months old, should especially get a flu vaccine to reduce your risk of catching the influenza virus and spreading it to an already vulnerable infant.
Certain people are especially high risk for getting complications to the flu and, therefore, are even more in need of the vaccine.
This includes people with asthma, diabetes, lung disease, pregnant women and people 65 years old or older.
Remember, while the nasal spray flu vaccine is not suitable for a number of these patient populations, the flu shot is.
Also, people who live with or take care of these high-risk patients should get vaccinated, to help protect those most at risk.
Each season a new influenza vaccine is developed to protect you from whichever virus researchers think will be the most common strain that season, from each of the 3 most common kinds of influenza (influenza B, influenza A [H1N1] and influenza A [H3N2]).
So even if you got a flu shot last year or the year before, you still need one this year.
The influenza virus is always changing.
Thus, we need to get the vaccine every year to protect us from the newest strain. The flu season can start as soon as October and extend all the way into May (Think of if sort of like a school year).
So, it is NOT too late to get your influenza vaccine for this season.
Protect yourself. Protect your friends and family. Protect your community.
Say no to the flu by saying yes to the flu vaccine.
Tania Hossain, MD, MPH
Pediatrician
Dr. Hossain received her medical degree and completed her pediatric residency at Loyola University Chicago Stritch School of Medicine. She received her Master’s in Public Health, with a concentration in Maternal and Child Health from Boston University.
Dr. Hossain is dedicated to providing care to the underserved and helping to reduce disparities.
Her interests include newborns/infants, asthma, preventative medicine, obesity and eating disorders.
Dr. Hossain is fluent in Bengali and Spanish.
Community health centers compare well with private practices, researcher finds
Government-funded community health centers, which serve low-income and uninsured patients, provide better care than do private practices, a researcher at the Stanford University School of Medicine has found.
The Affordable Care Act, which the U.S. Supreme Court upheld June 28, depends on community health centers to provide services to previously uninsured patients.
MANDY ERICKSON published in the Stanford School of Medicine on July 10, 21012:
Randall Stafford, MD, PhD, professor of medicine at the Stanford Prevention Research Center, and colleagues at University of California-San Francisco looked at the actions physicians took when patients visited private practices versus the actions that were taken at community health centers, also referred to as Federally Qualified Health Centers and FQHC Look-Alikes, both of which receive government support.
Their study was published online July 10 in the American Journal of Preventive Medicine. Stafford is the senior author.
The results of the study are particularly encouraging given that the Affordable Care Act, which the U.S. Supreme Court upheld June 28, depends on community health centers to provide services to previously uninsured patients.
“If community health centers are going to be taking up some of the new demand, we can be confident that they’re giving relatively good care,” Stafford said.
Stafford and his colleagues analyzed records of 73,074 visits to private practices, FQHCs and FQHC Look-Alikes. Both FQHCs and Look-Alikes receive enhanced Medicare and Medicaid reimbursement; FQHCs also receive government grants.
The researchers acquired the records from the National Ambulatory Medical Care Survey, which the National Center for Health Statistics gathered between 2006 and 2008.
They evaluated the physicians’ adherence to professional and federal guidelines for 18 measures, which included treatments for specific diseases, screening for certain conditions, and diet and lifestyle counseling. “We looked at fairly common conditions that are seen in primary care,” said lead author L. Elizabeth Goldman, MD, of UCSF.
The researchers found that community health center physicians performed as well as their private practice colleagues in 13 of the 18 measures.
For the remaining five measures — use of ACE inhibitors for congestive heart failure, use of beta blockers, use of inhaled corticosteroids for adult asthmatics, blood pressure screening and avoidance of electrocardiograms in low-risk patients — the community physicians followed recommendations a higher percent of the time.
Given that patients at community health centers have more health and socioeconomic challenges and therefore take up more physician time, said Stafford, “The fact that community health centers look better is perhaps surprising.”
“On the other hand, having worked in community health centers, I can see how it makes sense,” he added. “These are centers where physicians are not as profit-driven and many have incentives more in line with providing quality care.”
Stafford added that the government has provided the centers with technology that helps manage patient care, which may explain their superior performance. And they are generally larger than private practices: “Having a number of colleagues helps you develop better practices. In a solo practice, you have rare opportunities to debate the best way to practice medicine.”
When the researchers adjusted the data so that the patients’ characteristics were statistically equal, the community health center physicians performed better on three additional measures: aspirin for congestive heart failure, statins for congestive heart failure, and avoidance of benzodiazepine, which has serious long-term side effects, for depression.
(The statistical adjustment did not alter the balance in the other previous measures, and if anything, the magnitude of the difference increased in favor of the community physicians.)
The study was funded by awards from the Agency for Healthcare Research and Quality and the National Heart, Lung and Blood Institute. In addition to Stafford and Goldman, other researchers from UCSF and Johns Hopkins Medical School contributed to the study.
Information about Stanford’s Department of Medicine, which also supported this work, is available at http://med.stanford.edu/medicine.
Adonis Diaries 