Jan Dyer

When telemental health care (TMH) works, it works well, the research agrees. For rural patients who often do not have easy access to health care TMH can be a lifesaver. The VA uses TMH to deliver care to veterans in rural VA medical centers, community-based outpatient clinics, and residential areas.  However, TMH is still relatively new in many rural communities, say researchers from University of Mississippi in Oxford and Augusta University in Georgia, and few studies have examined the delivery tool from an administrative standpoint. The literature suggests TMH will save money—the exploratory study, however, suggests otherwise.

The researchers interviewed 6 providers selected from the 15 community mental health (MH) centers (CMHCs) in rural Mississippi as well as an independent MH counselor who develops policy for the Mississippi Counselors Association. They asked respondents about the feasibility of TMH in the Mississippi Delta; in particular, the benefits, the costs, and the role of the state in facilitating the service. The researchers also collected data from a grant-funded pilot project conducted in the Mississippi Delta region by the Delta Health Alliance, a nonprofit organization in partnership with the University of Mississippi Medical Center, which ran from 2008 to 2011. Telepsychiatry sessions are not currently being used in the region, but before the project ended, it was responsible for > 1,000 videoconferencing clinical sessions.

The initial counseling sessions were “awkward” for some patients, the interviewees said, and some clients felt the consultation was “less personal.” Getting used to the technology may take some time. Once clients acclimated the feedback was positive.

The health care providers were concerned by not being able to observe in-person nonverbal clues, such as poor hygiene, that would normally help them evaluate the client’s health. The nurse at the CMHC helped fill a gap, the researchers say, created by technology.

The researchers determined that the benefit side was weighty: For instance, patients had better access to well-trained MH professionals and to the state hospital, and family could visit inpatients via videoconferencing. Staff had better access to professional development and training.

However, cost issues were a definite concern. The project would not have been feasible without grant funding, the researchers say. Medicaid reimburses for TMH services but not for technology setup costs and maintenance. Moreover, the interviews with administrators, the researchers say, indicated that TMH did not save the organization money. Costs for the equipment, installation, rent, and other supplies were prohibitive.

Although start-up costs are high, overall systematic costs go down, with savings on travel-related costs, including fewer missed appointments. Broadband technology, videoconferencing software, webcams, and education all take money. “If policymakers are serious” about TMH, the researchers conclude, they should allocate appropriate funding and resources.

Source:
Holland J, Hatcher W, Meares WL. J Health Hum Serv Adm. 2018;41(1):52-86.

When telemental health care (TMH) works, it works well, the research agrees. For rural patients who often do not have easy access to health care TMH can be a lifesaver. The VA uses TMH to deliver care to veterans in rural VA medical centers, community-based outpatient clinics, and residential areas.  However, TMH is still relatively new in many rural communities, say researchers from University of Mississippi in Oxford and Augusta University in Georgia, and few studies have examined the delivery tool from an administrative standpoint. The literature suggests TMH will save money—the exploratory study, however, suggests otherwise.

The researchers interviewed 6 providers selected from the 15 community mental health (MH) centers (CMHCs) in rural Mississippi as well as an independent MH counselor who develops policy for the Mississippi Counselors Association. They asked respondents about the feasibility of TMH in the Mississippi Delta; in particular, the benefits, the costs, and the role of the state in facilitating the service. The researchers also collected data from a grant-funded pilot project conducted in the Mississippi Delta region by the Delta Health Alliance, a nonprofit organization in partnership with the University of Mississippi Medical Center, which ran from 2008 to 2011. Telepsychiatry sessions are not currently being used in the region, but before the project ended, it was responsible for > 1,000 videoconferencing clinical sessions.

The initial counseling sessions were “awkward” for some patients, the interviewees said, and some clients felt the consultation was “less personal.” Getting used to the technology may take some time. Once clients acclimated the feedback was positive.

The health care providers were concerned by not being able to observe in-person nonverbal clues, such as poor hygiene, that would normally help them evaluate the client’s health. The nurse at the CMHC helped fill a gap, the researchers say, created by technology.

The researchers determined that the benefit side was weighty: For instance, patients had better access to well-trained MH professionals and to the state hospital, and family could visit inpatients via videoconferencing. Staff had better access to professional development and training.

However, cost issues were a definite concern. The project would not have been feasible without grant funding, the researchers say. Medicaid reimburses for TMH services but not for technology setup costs and maintenance. Moreover, the interviews with administrators, the researchers say, indicated that TMH did not save the organization money. Costs for the equipment, installation, rent, and other supplies were prohibitive.

Although start-up costs are high, overall systematic costs go down, with savings on travel-related costs, including fewer missed appointments. Broadband technology, videoconferencing software, webcams, and education all take money. “If policymakers are serious” about TMH, the researchers conclude, they should allocate appropriate funding and resources.

Source:
Holland J, Hatcher W, Meares WL. J Health Hum Serv Adm. 2018;41(1):52-86.

When telemental health care (TMH) works, it works well, the research agrees. For rural patients who often do not have easy access to health care TMH can be a lifesaver. The VA uses TMH to deliver care to veterans in rural VA medical centers, community-based outpatient clinics, and residential areas.  However, TMH is still relatively new in many rural communities, say researchers from University of Mississippi in Oxford and Augusta University in Georgia, and few studies have examined the delivery tool from an administrative standpoint. The literature suggests TMH will save money—the exploratory study, however, suggests otherwise.

The researchers interviewed 6 providers selected from the 15 community mental health (MH) centers (CMHCs) in rural Mississippi as well as an independent MH counselor who develops policy for the Mississippi Counselors Association. They asked respondents about the feasibility of TMH in the Mississippi Delta; in particular, the benefits, the costs, and the role of the state in facilitating the service. The researchers also collected data from a grant-funded pilot project conducted in the Mississippi Delta region by the Delta Health Alliance, a nonprofit organization in partnership with the University of Mississippi Medical Center, which ran from 2008 to 2011. Telepsychiatry sessions are not currently being used in the region, but before the project ended, it was responsible for > 1,000 videoconferencing clinical sessions.

The initial counseling sessions were “awkward” for some patients, the interviewees said, and some clients felt the consultation was “less personal.” Getting used to the technology may take some time. Once clients acclimated the feedback was positive.

The health care providers were concerned by not being able to observe in-person nonverbal clues, such as poor hygiene, that would normally help them evaluate the client’s health. The nurse at the CMHC helped fill a gap, the researchers say, created by technology.

The researchers determined that the benefit side was weighty: For instance, patients had better access to well-trained MH professionals and to the state hospital, and family could visit inpatients via videoconferencing. Staff had better access to professional development and training.

However, cost issues were a definite concern. The project would not have been feasible without grant funding, the researchers say. Medicaid reimburses for TMH services but not for technology setup costs and maintenance. Moreover, the interviews with administrators, the researchers say, indicated that TMH did not save the organization money. Costs for the equipment, installation, rent, and other supplies were prohibitive.

Although start-up costs are high, overall systematic costs go down, with savings on travel-related costs, including fewer missed appointments. Broadband technology, videoconferencing software, webcams, and education all take money. “If policymakers are serious” about TMH, the researchers conclude, they should allocate appropriate funding and resources.

Source:
Holland J, Hatcher W, Meares WL. J Health Hum Serv Adm. 2018;41(1):52-86.

What’s the best way to encourage patients to get screened for HIV? Money is a time-honored effective incentive, but researchers from University of California say the default option may be even better. They conducted, to their knowledge, the first head-to-head study of 2 types of behavioral economics interventions (cash incentives vs opt-out) in any health behavior context. The working hypothesis was based on “nudge theory,” a concept in behavioral science, political theory, and economics that says using positive reinforcement and indirect suggestions can influence behavior and decision making.

In the study, patients aged 13 to 64 years were told the emergency department was offering rapid screening HIV tests, with results available within 2 hours. Then each patient was given a test offer: opt-in (“You can let me, your nurse, or your doctor know if you’d like a test today”); active choice (“Would you like a test today?”); or opt-out (“You will be tested unless you decline.”) Patients assigned to a positive monetary incentive were told “To encourage testing today we are offering a $1 (or $5 or $10) cash incentive.”

Of 8,715 patients, 4,831 (55%) accepted an HIV test. Those offered no monetary incentive accepted 52% of test offers. The $1 offer did not increase test acceptance, but the $5 and $10 offers increased acceptance rates by 10.5 and 15 percentage points, respectively. Active-choice increased acceptance by 11.5 percentage points compared with that of opt-in offers.

However, opt-out testing—essentially a default option—had the largest effect, increasing acceptance by 24 percentage points. The next most effective was the $10 incentive.

The researchers say the effects were consistent across all levels of patient risk of infection, although the effects were somewhat attenuated when defaults and incentives were used together. In general, higher risk patients tested at higher rates than did lower risk patients.

Defaults have been “understudied in medicine,” the researchers say. The study not only reaffirms that behavioral economics “nudges” work, but also that “small interventions can have significant effects.” Moreover, the finding that moving from opt-in to opt-out testing influenced behavior more than even the largest incentive reinforces the notion that “medicine is not just a transaction, and what we say to patients matters.”

Source:
Montoy JCC, Dow WH, Kaplan BC. PLoS One. 2018;13(7):e0199833.
doi: 10.1371/journal.pone.0199833.

What’s the best way to encourage patients to get screened for HIV? Money is a time-honored effective incentive, but researchers from University of California say the default option may be even better. They conducted, to their knowledge, the first head-to-head study of 2 types of behavioral economics interventions (cash incentives vs opt-out) in any health behavior context. The working hypothesis was based on “nudge theory,” a concept in behavioral science, political theory, and economics that says using positive reinforcement and indirect suggestions can influence behavior and decision making.

In the study, patients aged 13 to 64 years were told the emergency department was offering rapid screening HIV tests, with results available within 2 hours. Then each patient was given a test offer: opt-in (“You can let me, your nurse, or your doctor know if you’d like a test today”); active choice (“Would you like a test today?”); or opt-out (“You will be tested unless you decline.”) Patients assigned to a positive monetary incentive were told “To encourage testing today we are offering a $1 (or $5 or $10) cash incentive.”

Of 8,715 patients, 4,831 (55%) accepted an HIV test. Those offered no monetary incentive accepted 52% of test offers. The $1 offer did not increase test acceptance, but the $5 and $10 offers increased acceptance rates by 10.5 and 15 percentage points, respectively. Active-choice increased acceptance by 11.5 percentage points compared with that of opt-in offers.

However, opt-out testing—essentially a default option—had the largest effect, increasing acceptance by 24 percentage points. The next most effective was the $10 incentive.

The researchers say the effects were consistent across all levels of patient risk of infection, although the effects were somewhat attenuated when defaults and incentives were used together. In general, higher risk patients tested at higher rates than did lower risk patients.

Defaults have been “understudied in medicine,” the researchers say. The study not only reaffirms that behavioral economics “nudges” work, but also that “small interventions can have significant effects.” Moreover, the finding that moving from opt-in to opt-out testing influenced behavior more than even the largest incentive reinforces the notion that “medicine is not just a transaction, and what we say to patients matters.”

Source:
Montoy JCC, Dow WH, Kaplan BC. PLoS One. 2018;13(7):e0199833.
doi: 10.1371/journal.pone.0199833.

What’s the best way to encourage patients to get screened for HIV? Money is a time-honored effective incentive, but researchers from University of California say the default option may be even better. They conducted, to their knowledge, the first head-to-head study of 2 types of behavioral economics interventions (cash incentives vs opt-out) in any health behavior context. The working hypothesis was based on “nudge theory,” a concept in behavioral science, political theory, and economics that says using positive reinforcement and indirect suggestions can influence behavior and decision making.

In the study, patients aged 13 to 64 years were told the emergency department was offering rapid screening HIV tests, with results available within 2 hours. Then each patient was given a test offer: opt-in (“You can let me, your nurse, or your doctor know if you’d like a test today”); active choice (“Would you like a test today?”); or opt-out (“You will be tested unless you decline.”) Patients assigned to a positive monetary incentive were told “To encourage testing today we are offering a $1 (or $5 or $10) cash incentive.”

Of 8,715 patients, 4,831 (55%) accepted an HIV test. Those offered no monetary incentive accepted 52% of test offers. The $1 offer did not increase test acceptance, but the $5 and $10 offers increased acceptance rates by 10.5 and 15 percentage points, respectively. Active-choice increased acceptance by 11.5 percentage points compared with that of opt-in offers.

However, opt-out testing—essentially a default option—had the largest effect, increasing acceptance by 24 percentage points. The next most effective was the $10 incentive.

The researchers say the effects were consistent across all levels of patient risk of infection, although the effects were somewhat attenuated when defaults and incentives were used together. In general, higher risk patients tested at higher rates than did lower risk patients.

Defaults have been “understudied in medicine,” the researchers say. The study not only reaffirms that behavioral economics “nudges” work, but also that “small interventions can have significant effects.” Moreover, the finding that moving from opt-in to opt-out testing influenced behavior more than even the largest incentive reinforces the notion that “medicine is not just a transaction, and what we say to patients matters.”

Source:
Montoy JCC, Dow WH, Kaplan BC. PLoS One. 2018;13(7):e0199833.
doi: 10.1371/journal.pone.0199833.

Young women may not want to hear it, but fat could be their friend. Researchers from the Premenopausal Breast Cancer Collaborative Group have found that women aged 18 – 24 years with high body fat have a lower risk of developing breast cancer before menopause.

The researchers pooled data from 19 different studies, involving about 800,000 women from around the world. Overall, 1.7% of the women developed breast cancer. The researchers found that the relative risk of premenopausal breast cancer dropped 12% to 23% for each 5-unit increase in body mass index, depending on age. They saw the strongest effect at ages 18 – 24 years: Very obese women in this age group were 4.2 times less likely to develop premenopausal breast cancer than women with low body mass index (BMI) at the same age.

The researchers do not know why high BMI might protect against breast cancer in some women. Breast cancer is relatively rare before menopause, although previous studies have suggested that the risk factors might be different for younger vs older women, says Dale Sandler, PhD, co-author of the group and head of the Epidemiology Branch at the National Institute of Environmental Health Sciences. For instance, it is well known that women who gain weight, particularly after menopause, have a higher risk. The fact that this study found that the risk not only is not increased, but actually decreased, in younger women points to the possibility that different biologic mechanisms are at work, Sandler says.

Nonetheless, the researchers caution that young women should not intentionally gain weight to offset the risk.

Source:
National Institutes of Health. https://www.nih.gov/news-events/news-releases/nih-study-associates-obesity-lower-breast-cancer-risk-young-women. Published June 27, 2018. Accessed July 18, 2018.

Young women may not want to hear it, but fat could be their friend. Researchers from the Premenopausal Breast Cancer Collaborative Group have found that women aged 18 – 24 years with high body fat have a lower risk of developing breast cancer before menopause.

The researchers pooled data from 19 different studies, involving about 800,000 women from around the world. Overall, 1.7% of the women developed breast cancer. The researchers found that the relative risk of premenopausal breast cancer dropped 12% to 23% for each 5-unit increase in body mass index, depending on age. They saw the strongest effect at ages 18 – 24 years: Very obese women in this age group were 4.2 times less likely to develop premenopausal breast cancer than women with low body mass index (BMI) at the same age.

The researchers do not know why high BMI might protect against breast cancer in some women. Breast cancer is relatively rare before menopause, although previous studies have suggested that the risk factors might be different for younger vs older women, says Dale Sandler, PhD, co-author of the group and head of the Epidemiology Branch at the National Institute of Environmental Health Sciences. For instance, it is well known that women who gain weight, particularly after menopause, have a higher risk. The fact that this study found that the risk not only is not increased, but actually decreased, in younger women points to the possibility that different biologic mechanisms are at work, Sandler says.

Nonetheless, the researchers caution that young women should not intentionally gain weight to offset the risk.

Source:
National Institutes of Health. https://www.nih.gov/news-events/news-releases/nih-study-associates-obesity-lower-breast-cancer-risk-young-women. Published June 27, 2018. Accessed July 18, 2018.

Young women may not want to hear it, but fat could be their friend. Researchers from the Premenopausal Breast Cancer Collaborative Group have found that women aged 18 – 24 years with high body fat have a lower risk of developing breast cancer before menopause.

The researchers pooled data from 19 different studies, involving about 800,000 women from around the world. Overall, 1.7% of the women developed breast cancer. The researchers found that the relative risk of premenopausal breast cancer dropped 12% to 23% for each 5-unit increase in body mass index, depending on age. They saw the strongest effect at ages 18 – 24 years: Very obese women in this age group were 4.2 times less likely to develop premenopausal breast cancer than women with low body mass index (BMI) at the same age.

The researchers do not know why high BMI might protect against breast cancer in some women. Breast cancer is relatively rare before menopause, although previous studies have suggested that the risk factors might be different for younger vs older women, says Dale Sandler, PhD, co-author of the group and head of the Epidemiology Branch at the National Institute of Environmental Health Sciences. For instance, it is well known that women who gain weight, particularly after menopause, have a higher risk. The fact that this study found that the risk not only is not increased, but actually decreased, in younger women points to the possibility that different biologic mechanisms are at work, Sandler says.

Nonetheless, the researchers caution that young women should not intentionally gain weight to offset the risk.

Source:
National Institutes of Health. https://www.nih.gov/news-events/news-releases/nih-study-associates-obesity-lower-breast-cancer-risk-young-women. Published June 27, 2018. Accessed July 18, 2018.

As if it were not bad enough that illnesses from mosquito, tick, and flea bites tripled between 2004 and 2016, 9 new germs spread by mosquitoes and ticks were discovered or introduced into the US in the same 13 years.

According to the CDC’s first summary collectively examining data trends for all nationally notifiable diseases caused by the bite of an infected mosquito, tick, or flea, the most common tickborne diseases in 2016 were Lyme disease and ehrlichiosis/anaplasmosis. The most common mosquito-borne viruses were West Nile, dengue, and Zika.

The increase is due to many factors, the CDC says, but 1 issue is that mosquitoes and ticks are moving into new areas, putting more people at risk. The US is “not fully prepared” to meet the public health threat, the CDC warns: About 80% of vector control organizations lack critical prevention and control capacities. Reducing the spread of the diseases and responding effectively to outbreaks will require additional capacity at the state and local levels for tracking, diagnosing, and reporting cases.

As if it were not bad enough that illnesses from mosquito, tick, and flea bites tripled between 2004 and 2016, 9 new germs spread by mosquitoes and ticks were discovered or introduced into the US in the same 13 years.

According to the CDC’s first summary collectively examining data trends for all nationally notifiable diseases caused by the bite of an infected mosquito, tick, or flea, the most common tickborne diseases in 2016 were Lyme disease and ehrlichiosis/anaplasmosis. The most common mosquito-borne viruses were West Nile, dengue, and Zika.

The increase is due to many factors, the CDC says, but 1 issue is that mosquitoes and ticks are moving into new areas, putting more people at risk. The US is “not fully prepared” to meet the public health threat, the CDC warns: About 80% of vector control organizations lack critical prevention and control capacities. Reducing the spread of the diseases and responding effectively to outbreaks will require additional capacity at the state and local levels for tracking, diagnosing, and reporting cases.

As if it were not bad enough that illnesses from mosquito, tick, and flea bites tripled between 2004 and 2016, 9 new germs spread by mosquitoes and ticks were discovered or introduced into the US in the same 13 years.

According to the CDC’s first summary collectively examining data trends for all nationally notifiable diseases caused by the bite of an infected mosquito, tick, or flea, the most common tickborne diseases in 2016 were Lyme disease and ehrlichiosis/anaplasmosis. The most common mosquito-borne viruses were West Nile, dengue, and Zika.

The increase is due to many factors, the CDC says, but 1 issue is that mosquitoes and ticks are moving into new areas, putting more people at risk. The US is “not fully prepared” to meet the public health threat, the CDC warns: About 80% of vector control organizations lack critical prevention and control capacities. Reducing the spread of the diseases and responding effectively to outbreaks will require additional capacity at the state and local levels for tracking, diagnosing, and reporting cases.

Cancer death rates continue to decline in the US in all major racial and ethnic groups, according to the National Cancer Institute’s (NCI) latest Annual Report to the Nation on the Status of Cancer. The data are an “encouraging indicator of progress” in cancer research, says NCI Director Ned Sharpless, MD. “It’s clear that interventions are having an impact.”

Overall incidence, or rates of new cancers, dropped by 1.8% in men and 1.4% in women from 1999 to 2015. Between 2011 and 2015, death rates dropped for 11 of the 18 most common cancer types in men and 14 of the 20 most common types in women. The researchers say the “significant declines” also hold “significant differences” in rate by sex, race, and ethnicity. For example, black men and white women had the highest incidence rates, and black men and black women had the highest death rates.

However, over the same period, death rates for cancers of the liver, pancreas, and brain and nervous system rose in both men and women. Death rates for cancer of the uterus rose (the researchers say obesity is thought to be a contributing factor) and death rates for cancers of the oral cavity and pharynx and soft tissue increased in men, perhaps associated with human papillomavirus infection.

In a companion study, when researchers explored prostate cancer trends in more detail they found overall prostate cancer incidence rates declined an average of 6.5% each year between 2007 and 2014, from 163 new cases per 100,000 men to 104 new cases. Still, after a 2-decade steady decline, rates leveled off. Incidence of distant disease rose from 7.8 new cases per 100,000 to 9.2, but there was no increase in the rates of cases with aggressive histologic grade.

Interestingly, the researchers also report a decline in recent prostate-specific antigen screening between 2010 and 2013 national surveys. “The increase in late-stage disease and the flattening of the mortality trended occurred contemporaneously with the observed decrease in PSA screening,” said Serban Negoita, MD, DrPH, of NCI’s Surveillance Research Program. However, while “suggestive,” Negoita adds, their observation does not demonstrate causality: many factors contribute to incidence and mortality, such as improvements in staging and treating cancer.

Cancer death rates continue to decline in the US in all major racial and ethnic groups, according to the National Cancer Institute’s (NCI) latest Annual Report to the Nation on the Status of Cancer. The data are an “encouraging indicator of progress” in cancer research, says NCI Director Ned Sharpless, MD. “It’s clear that interventions are having an impact.”

Overall incidence, or rates of new cancers, dropped by 1.8% in men and 1.4% in women from 1999 to 2015. Between 2011 and 2015, death rates dropped for 11 of the 18 most common cancer types in men and 14 of the 20 most common types in women. The researchers say the “significant declines” also hold “significant differences” in rate by sex, race, and ethnicity. For example, black men and white women had the highest incidence rates, and black men and black women had the highest death rates.

However, over the same period, death rates for cancers of the liver, pancreas, and brain and nervous system rose in both men and women. Death rates for cancer of the uterus rose (the researchers say obesity is thought to be a contributing factor) and death rates for cancers of the oral cavity and pharynx and soft tissue increased in men, perhaps associated with human papillomavirus infection.

In a companion study, when researchers explored prostate cancer trends in more detail they found overall prostate cancer incidence rates declined an average of 6.5% each year between 2007 and 2014, from 163 new cases per 100,000 men to 104 new cases. Still, after a 2-decade steady decline, rates leveled off. Incidence of distant disease rose from 7.8 new cases per 100,000 to 9.2, but there was no increase in the rates of cases with aggressive histologic grade.

Interestingly, the researchers also report a decline in recent prostate-specific antigen screening between 2010 and 2013 national surveys. “The increase in late-stage disease and the flattening of the mortality trended occurred contemporaneously with the observed decrease in PSA screening,” said Serban Negoita, MD, DrPH, of NCI’s Surveillance Research Program. However, while “suggestive,” Negoita adds, their observation does not demonstrate causality: many factors contribute to incidence and mortality, such as improvements in staging and treating cancer.

Cancer death rates continue to decline in the US in all major racial and ethnic groups, according to the National Cancer Institute’s (NCI) latest Annual Report to the Nation on the Status of Cancer. The data are an “encouraging indicator of progress” in cancer research, says NCI Director Ned Sharpless, MD. “It’s clear that interventions are having an impact.”

Overall incidence, or rates of new cancers, dropped by 1.8% in men and 1.4% in women from 1999 to 2015. Between 2011 and 2015, death rates dropped for 11 of the 18 most common cancer types in men and 14 of the 20 most common types in women. The researchers say the “significant declines” also hold “significant differences” in rate by sex, race, and ethnicity. For example, black men and white women had the highest incidence rates, and black men and black women had the highest death rates.

However, over the same period, death rates for cancers of the liver, pancreas, and brain and nervous system rose in both men and women. Death rates for cancer of the uterus rose (the researchers say obesity is thought to be a contributing factor) and death rates for cancers of the oral cavity and pharynx and soft tissue increased in men, perhaps associated with human papillomavirus infection.

In a companion study, when researchers explored prostate cancer trends in more detail they found overall prostate cancer incidence rates declined an average of 6.5% each year between 2007 and 2014, from 163 new cases per 100,000 men to 104 new cases. Still, after a 2-decade steady decline, rates leveled off. Incidence of distant disease rose from 7.8 new cases per 100,000 to 9.2, but there was no increase in the rates of cases with aggressive histologic grade.

Interestingly, the researchers also report a decline in recent prostate-specific antigen screening between 2010 and 2013 national surveys. “The increase in late-stage disease and the flattening of the mortality trended occurred contemporaneously with the observed decrease in PSA screening,” said Serban Negoita, MD, DrPH, of NCI’s Surveillance Research Program. However, while “suggestive,” Negoita adds, their observation does not demonstrate causality: many factors contribute to incidence and mortality, such as improvements in staging and treating cancer.

The Targeted Capacity Expansion: Medication Assisted Treatment-Prescription Drug Opioid Addiction grant program will expand access to treatment and recovery support services in states, tribes, and tribal organizations with the highest per-capita rates of primary treatment admissions for heroin and prescription opioids. The funding includes the areas with the “most dramatic increases” for heroin and prescription opioids, as identified by SAMHSA’s 2015 Treatment Episode Data Set.

“We know medication-assisted treatment is an effective, essential tool in fighting the opioid crisis,” said HHS Secretary Alex Azar, “and HHS will continue working to expand access to it.” 

The Targeted Capacity Expansion: Medication Assisted Treatment-Prescription Drug Opioid Addiction grant program will expand access to treatment and recovery support services in states, tribes, and tribal organizations with the highest per-capita rates of primary treatment admissions for heroin and prescription opioids. The funding includes the areas with the “most dramatic increases” for heroin and prescription opioids, as identified by SAMHSA’s 2015 Treatment Episode Data Set.

“We know medication-assisted treatment is an effective, essential tool in fighting the opioid crisis,” said HHS Secretary Alex Azar, “and HHS will continue working to expand access to it.” 

The Targeted Capacity Expansion: Medication Assisted Treatment-Prescription Drug Opioid Addiction grant program will expand access to treatment and recovery support services in states, tribes, and tribal organizations with the highest per-capita rates of primary treatment admissions for heroin and prescription opioids. The funding includes the areas with the “most dramatic increases” for heroin and prescription opioids, as identified by SAMHSA’s 2015 Treatment Episode Data Set.

“We know medication-assisted treatment is an effective, essential tool in fighting the opioid crisis,” said HHS Secretary Alex Azar, “and HHS will continue working to expand access to it.” 

Combining clopidogrel and aspirin following a small stroke or minor stroke symptoms reduces the risk of a new stroke, heart attack, or other ischemic event within 90 days, say researchers from the National Institute of Neurological Disorders and Stroke.

In POINT (Platelet-Oriented Inhibition in New TIA and minor ischemic stroke), an international clinical trial, 5% of the combination therapy group and 6.5% of the aspirin-only group had an ischemic event within 90 days. The benefit of the combination was concentrated in the first 2 weeks, while the risk of bleeding was constant over 90 days, says Walter Koroshetz, MD, director of NINDS, thus the treatment may be most valuable in acute management of a minor ischemic stroke or TIA.

The study was stopped early not only because the combination therapy was more effective than aspirin alone in preventing severe strokes, but also due to the risk of severe hemorrhage. The combination therapy was associated with an increase in major bleeding, although many of the episodes were not fatal and occurred outside the brain: 0.9% of the combination group had a major hemorrhage, compared with 0.4% of the aspirin-only group.

 “Overall, the risk of severe bleeding was very small,” says lead investigator S. Claiborne Johnston, MD, PhD, “but it was not zero.”

Combining clopidogrel and aspirin following a small stroke or minor stroke symptoms reduces the risk of a new stroke, heart attack, or other ischemic event within 90 days, say researchers from the National Institute of Neurological Disorders and Stroke.

In POINT (Platelet-Oriented Inhibition in New TIA and minor ischemic stroke), an international clinical trial, 5% of the combination therapy group and 6.5% of the aspirin-only group had an ischemic event within 90 days. The benefit of the combination was concentrated in the first 2 weeks, while the risk of bleeding was constant over 90 days, says Walter Koroshetz, MD, director of NINDS, thus the treatment may be most valuable in acute management of a minor ischemic stroke or TIA.

The study was stopped early not only because the combination therapy was more effective than aspirin alone in preventing severe strokes, but also due to the risk of severe hemorrhage. The combination therapy was associated with an increase in major bleeding, although many of the episodes were not fatal and occurred outside the brain: 0.9% of the combination group had a major hemorrhage, compared with 0.4% of the aspirin-only group.

 “Overall, the risk of severe bleeding was very small,” says lead investigator S. Claiborne Johnston, MD, PhD, “but it was not zero.”

Combining clopidogrel and aspirin following a small stroke or minor stroke symptoms reduces the risk of a new stroke, heart attack, or other ischemic event within 90 days, say researchers from the National Institute of Neurological Disorders and Stroke.

In POINT (Platelet-Oriented Inhibition in New TIA and minor ischemic stroke), an international clinical trial, 5% of the combination therapy group and 6.5% of the aspirin-only group had an ischemic event within 90 days. The benefit of the combination was concentrated in the first 2 weeks, while the risk of bleeding was constant over 90 days, says Walter Koroshetz, MD, director of NINDS, thus the treatment may be most valuable in acute management of a minor ischemic stroke or TIA.

The study was stopped early not only because the combination therapy was more effective than aspirin alone in preventing severe strokes, but also due to the risk of severe hemorrhage. The combination therapy was associated with an increase in major bleeding, although many of the episodes were not fatal and occurred outside the brain: 0.9% of the combination group had a major hemorrhage, compared with 0.4% of the aspirin-only group.

 “Overall, the risk of severe bleeding was very small,” says lead investigator S. Claiborne Johnston, MD, PhD, “but it was not zero.”

Neuroimaging studies have consistently reported reduced activation of the medial prefrontal cortex (mPFC) in patients with posttraumatic stress disorder (PTSD) while they recall and imagine stressful personal events. During script-driven imagery (SDI) sessions, patients with PTSD exhibit increased psychophysiologic (eg, heart rate, skin conductance, and facial electromyographic) responses to trauma-related memories. However, the origin of the responses remained unclear. Are they familial, acquired, or resulting from trauma exposure?

Researchers from Harvard University, University of California Los Angeles, and University of New England conducted a study of 26 male identical twin pairs to help find the answer. The participants were divided into 4 groups: combat-exposed with PTSD (ExP+), their combat-unexposed twins without PTSD, combat-exposed participants without PTSD, and their combat-unexposed twins without PTSD. They engaged in SDI during functional magnetic resonance (fMRI) imaging and concurrent skin conductance measurement.

The results of the fMRI tests showed diminished activation in the medial prefrontal cortex of the patients with PTSD compared with the other groups. The SC response scores did not correlate significantly with PTSD symptom severity.

Contrary to the researchers’ predictions, mPFC activation was not inversely correlated with PTSD symptom severity. However, they say their finding of reduced mPFC activation in the ExP+ group provides evidence that the abnormality is an acquired characteristic. If those findings are replicated, such objectively measured biologic characteristics could potentially aid in diagnosing PTSD or assessing treatment response.

Source:
Dahlgren MK, Laifer LM, VanElzakker MB, et al. Psychol Med. 2018;48(7):1128-1138.
doi: 10.1017/S003329171700263X.

Neuroimaging studies have consistently reported reduced activation of the medial prefrontal cortex (mPFC) in patients with posttraumatic stress disorder (PTSD) while they recall and imagine stressful personal events. During script-driven imagery (SDI) sessions, patients with PTSD exhibit increased psychophysiologic (eg, heart rate, skin conductance, and facial electromyographic) responses to trauma-related memories. However, the origin of the responses remained unclear. Are they familial, acquired, or resulting from trauma exposure?

Researchers from Harvard University, University of California Los Angeles, and University of New England conducted a study of 26 male identical twin pairs to help find the answer. The participants were divided into 4 groups: combat-exposed with PTSD (ExP+), their combat-unexposed twins without PTSD, combat-exposed participants without PTSD, and their combat-unexposed twins without PTSD. They engaged in SDI during functional magnetic resonance (fMRI) imaging and concurrent skin conductance measurement.

The results of the fMRI tests showed diminished activation in the medial prefrontal cortex of the patients with PTSD compared with the other groups. The SC response scores did not correlate significantly with PTSD symptom severity.

Contrary to the researchers’ predictions, mPFC activation was not inversely correlated with PTSD symptom severity. However, they say their finding of reduced mPFC activation in the ExP+ group provides evidence that the abnormality is an acquired characteristic. If those findings are replicated, such objectively measured biologic characteristics could potentially aid in diagnosing PTSD or assessing treatment response.

Source:
Dahlgren MK, Laifer LM, VanElzakker MB, et al. Psychol Med. 2018;48(7):1128-1138.
doi: 10.1017/S003329171700263X.

Neuroimaging studies have consistently reported reduced activation of the medial prefrontal cortex (mPFC) in patients with posttraumatic stress disorder (PTSD) while they recall and imagine stressful personal events. During script-driven imagery (SDI) sessions, patients with PTSD exhibit increased psychophysiologic (eg, heart rate, skin conductance, and facial electromyographic) responses to trauma-related memories. However, the origin of the responses remained unclear. Are they familial, acquired, or resulting from trauma exposure?

Researchers from Harvard University, University of California Los Angeles, and University of New England conducted a study of 26 male identical twin pairs to help find the answer. The participants were divided into 4 groups: combat-exposed with PTSD (ExP+), their combat-unexposed twins without PTSD, combat-exposed participants without PTSD, and their combat-unexposed twins without PTSD. They engaged in SDI during functional magnetic resonance (fMRI) imaging and concurrent skin conductance measurement.

The results of the fMRI tests showed diminished activation in the medial prefrontal cortex of the patients with PTSD compared with the other groups. The SC response scores did not correlate significantly with PTSD symptom severity.

Contrary to the researchers’ predictions, mPFC activation was not inversely correlated with PTSD symptom severity. However, they say their finding of reduced mPFC activation in the ExP+ group provides evidence that the abnormality is an acquired characteristic. If those findings are replicated, such objectively measured biologic characteristics could potentially aid in diagnosing PTSD or assessing treatment response.

Source:
Dahlgren MK, Laifer LM, VanElzakker MB, et al. Psychol Med. 2018;48(7):1128-1138.
doi: 10.1017/S003329171700263X.

Many patients with traumatic brain injury (TBI) may not be receiving follow-up care, according to findings from Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI), a long-term NIH-funded study.

Of 831 patients who completed questionnaires 2 weeks and 3 months after sustaining TBI, 44% reported seeing a health care provider within 3 months. Of those, 15% visited a clinic that specialized in head injury. Approximately half saw a general practitioner; close to a third reported seeing ≥ 1 type of doctor.

Among the 279 patients with ≥ 3 symptoms of moderate to severe postconcussion, 41% had not had a follow-up visit at 3 months. Moreover, half of the patients were discharged without TBI educational materials. 

Rates and components of follow-up care varied widely from institution to institution even among patients with the same initial degree of injury.

Many patients with traumatic brain injury (TBI) may not be receiving follow-up care, according to findings from Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI), a long-term NIH-funded study.

Of 831 patients who completed questionnaires 2 weeks and 3 months after sustaining TBI, 44% reported seeing a health care provider within 3 months. Of those, 15% visited a clinic that specialized in head injury. Approximately half saw a general practitioner; close to a third reported seeing ≥ 1 type of doctor.

Among the 279 patients with ≥ 3 symptoms of moderate to severe postconcussion, 41% had not had a follow-up visit at 3 months. Moreover, half of the patients were discharged without TBI educational materials. 

Rates and components of follow-up care varied widely from institution to institution even among patients with the same initial degree of injury.

Many patients with traumatic brain injury (TBI) may not be receiving follow-up care, according to findings from Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI), a long-term NIH-funded study.

Of 831 patients who completed questionnaires 2 weeks and 3 months after sustaining TBI, 44% reported seeing a health care provider within 3 months. Of those, 15% visited a clinic that specialized in head injury. Approximately half saw a general practitioner; close to a third reported seeing ≥ 1 type of doctor.

Among the 279 patients with ≥ 3 symptoms of moderate to severe postconcussion, 41% had not had a follow-up visit at 3 months. Moreover, half of the patients were discharged without TBI educational materials. 

Rates and components of follow-up care varied widely from institution to institution even among patients with the same initial degree of injury.

Many forms of therapy rely on the patient being able to verbally communicate thoughts and feelings. Arts-based therapies, however, can help people explore sensitive and controversial topics that might be hard to talk about.

Body mapping, which has been in use for more than 30 years, is an interesting, revealing, and productive way of using art to help patients “talk” about their thoughts and feelings. Several studies have used body maps as therapy for patients with HIV/AIDS, but researchers from University of New South Wales, Sydney, theorized that it could be particularly helpful for patients with cognitive disability who have complex support needs as well as those who are socially marginalized.

In body-mapping sessions, participants trace outlines of their bodies and then “populate” the outlines with drawings, magazine photos, symbols, words, and other visual representations of the experience they are investigating. It is a form of storytelling that allows the participant to engage physically, visually, verbally, and relationally (through dialogue and interaction with the researcher).

The researchers used body mapping in 2 studies, first with 29 adults with cognitive disability and complex support needs, such as mental illness and sensory impairment, to explore experiences of support planning. In the second study, one of the researchers used body mapping with 13 teens and young adults with complex support needs (eg, drug and alcohol misuse) to explore support they received during a life transition.

The body-mapping technique, the researchers say, shifts the power balance between researcher and participant, because the patient is in control of the images used and where they are placed on the map. Patients could decide not only how they spoke about the topic, but also which topic they spoke about. The researchers say, “we were often taken to surprising places” that might not have come up in an interview, as when participants used images to reveal aspects of cultural heritage and sexual orientation that had not come up in conversation. For example, a transsexual woman in the second study was uncomfortable with the process until she covered her incorrectly gendered body with another piece of paper on which she could redraw her body as she wished.

Body mapping does not suit everyone, the researchers acknowledge. Participants need to be able to engage in a level of abstraction and reflection about personal experiences. It is important to have other methods available for those who do not want to take part. The researchers say one way they protected patients was by recruiting through service providers so support could be “embedded in existing relationships.” The potential vulnerabilities of the patients mean researchers need to be flexible, they add, and allow the method to evolve, much like the patients’ personal stories.

Source:
Dew A, Smith L, Collings S, Savage ID. FQS. 2018;19(2).
doi: http://dx.doi.org/10.17169/fqs-19.2.2929.  

Many forms of therapy rely on the patient being able to verbally communicate thoughts and feelings. Arts-based therapies, however, can help people explore sensitive and controversial topics that might be hard to talk about.

Body mapping, which has been in use for more than 30 years, is an interesting, revealing, and productive way of using art to help patients “talk” about their thoughts and feelings. Several studies have used body maps as therapy for patients with HIV/AIDS, but researchers from University of New South Wales, Sydney, theorized that it could be particularly helpful for patients with cognitive disability who have complex support needs as well as those who are socially marginalized.

In body-mapping sessions, participants trace outlines of their bodies and then “populate” the outlines with drawings, magazine photos, symbols, words, and other visual representations of the experience they are investigating. It is a form of storytelling that allows the participant to engage physically, visually, verbally, and relationally (through dialogue and interaction with the researcher).

The researchers used body mapping in 2 studies, first with 29 adults with cognitive disability and complex support needs, such as mental illness and sensory impairment, to explore experiences of support planning. In the second study, one of the researchers used body mapping with 13 teens and young adults with complex support needs (eg, drug and alcohol misuse) to explore support they received during a life transition.

The body-mapping technique, the researchers say, shifts the power balance between researcher and participant, because the patient is in control of the images used and where they are placed on the map. Patients could decide not only how they spoke about the topic, but also which topic they spoke about. The researchers say, “we were often taken to surprising places” that might not have come up in an interview, as when participants used images to reveal aspects of cultural heritage and sexual orientation that had not come up in conversation. For example, a transsexual woman in the second study was uncomfortable with the process until she covered her incorrectly gendered body with another piece of paper on which she could redraw her body as she wished.

Body mapping does not suit everyone, the researchers acknowledge. Participants need to be able to engage in a level of abstraction and reflection about personal experiences. It is important to have other methods available for those who do not want to take part. The researchers say one way they protected patients was by recruiting through service providers so support could be “embedded in existing relationships.” The potential vulnerabilities of the patients mean researchers need to be flexible, they add, and allow the method to evolve, much like the patients’ personal stories.

Source:
Dew A, Smith L, Collings S, Savage ID. FQS. 2018;19(2).
doi: http://dx.doi.org/10.17169/fqs-19.2.2929.  

Many forms of therapy rely on the patient being able to verbally communicate thoughts and feelings. Arts-based therapies, however, can help people explore sensitive and controversial topics that might be hard to talk about.

Body mapping, which has been in use for more than 30 years, is an interesting, revealing, and productive way of using art to help patients “talk” about their thoughts and feelings. Several studies have used body maps as therapy for patients with HIV/AIDS, but researchers from University of New South Wales, Sydney, theorized that it could be particularly helpful for patients with cognitive disability who have complex support needs as well as those who are socially marginalized.

In body-mapping sessions, participants trace outlines of their bodies and then “populate” the outlines with drawings, magazine photos, symbols, words, and other visual representations of the experience they are investigating. It is a form of storytelling that allows the participant to engage physically, visually, verbally, and relationally (through dialogue and interaction with the researcher).

The researchers used body mapping in 2 studies, first with 29 adults with cognitive disability and complex support needs, such as mental illness and sensory impairment, to explore experiences of support planning. In the second study, one of the researchers used body mapping with 13 teens and young adults with complex support needs (eg, drug and alcohol misuse) to explore support they received during a life transition.

The body-mapping technique, the researchers say, shifts the power balance between researcher and participant, because the patient is in control of the images used and where they are placed on the map. Patients could decide not only how they spoke about the topic, but also which topic they spoke about. The researchers say, “we were often taken to surprising places” that might not have come up in an interview, as when participants used images to reveal aspects of cultural heritage and sexual orientation that had not come up in conversation. For example, a transsexual woman in the second study was uncomfortable with the process until she covered her incorrectly gendered body with another piece of paper on which she could redraw her body as she wished.

Body mapping does not suit everyone, the researchers acknowledge. Participants need to be able to engage in a level of abstraction and reflection about personal experiences. It is important to have other methods available for those who do not want to take part. The researchers say one way they protected patients was by recruiting through service providers so support could be “embedded in existing relationships.” The potential vulnerabilities of the patients mean researchers need to be flexible, they add, and allow the method to evolve, much like the patients’ personal stories.

Source:
Dew A, Smith L, Collings S, Savage ID. FQS. 2018;19(2).
doi: http://dx.doi.org/10.17169/fqs-19.2.2929.