DiversityNursing Blog

James McIntosh

It is vital that treatment for stroke is given as quickly as possible in order to minimize the amount of long-term damage that occurs. Unfortunately, a new study has suggested that one third of Americans would be unable to access a primary stroke center within 1 hour should they need to.

The study, published online in Neurology, was a population-level virtual trial simulating how long it would take for patients to access stroke care following changes to systems of treatment.

"Research has shown that specialized stroke care has the potential to reduce death and disability," says study author Dr. Michael T. Mullen. "Stroke is a time-critical disease. Each second after a stroke begins, brain cells die, so it is critically important that specialized stroke care be rapidly accessible to the population."

According to the authors, stroke is one of the leading causes of death and disability in the US, occurring when the flow of blood to a portion of the brain is blocked or an artery in the brain ruptures or leaks.

In 2012, the beginnings of a three-tiered regionalized system of care were implemented. This involved the designation of certain hospitals as primary stroke centers (PSCs) and comprehensive stroke centers (CSCs), with CSCs providing the highest level of care.

Dr. Mullen and his colleagues decided to create virtual models in order to estimate what percentage of the population would have access to a comprehensive stroke center after selectively converting a number of primary stroke centers to facilities providing a higher level of care.

"In this report, we demonstrate how mathematical optimization modeling can inform the strategic development of the US network of stroke centers by simulating the conversion of PSCs into CSCs," the authors write. "This allows for virtual trials of competing system configurations in order to design a system that maximizes population access to care."

Reduced access to specialized stroke care could worsen pre-existing disparities in health

Data from 2010 was utilized, at which point there were 811 PSCs and no CSCs in the US. The researchers converted up to 20 PSCs in each state into CSCs and calculated how long it would take local populations to access these treatment facilities by ambulance or plane in optimum conditions.

After converting the PSCs to CSCs, the researchers found that only 63% would live within a 1-hour drive of a CSC, with an additional 23% within a 1-hour flight of one. 

"Even under optimal conditions, many people may not have rapid access to comprehensive stroke centers, and without oversight and population level planning, actual systems of care are likely to be substantially worse than these optimized models," says Dr. Mullen.

Levels of access to care also varied in different geographical areas. Worryingly, access to care was lowest in an area often referred to as the "Stroke Belt" - 11 states where stroke death rates are more than 10% higher than the national average, predominantly situated in the southeast of the US.

"Reduced access to specialized stroke care in these areas has the potential to worsen these disparities," says Dr. Mullen. "This emphasizes the need for oversight of developing systems of care."

The authors suggest the actual number of CSCs that will be established is likely to be much smaller than 20 per state, and that increasing the number of CSCs is not an ideal way to improve access for patients due to the high costs involved.

A number of limitations are acknowledged, such as using trauma data to calculate the amount of time taken to reach a hospital, and calculating population access to hospitals using where people live, rather than where strokes occur. However, the authors argue that the majority of strokes (over 70%) occur at home.

In a linked editorial, Dr. Adam G. Kelly and Dr. John Attia suggest that CSC status is likely to be determined more by financial motives, however, rather than a population health basis.

They write that timely accessibility of PSC services, either on-site or via telemedicine, should be the first priority in the organization of regional stroke care. Following this, "CSCs should be added in a coordinated, stepwise manner with regional needs - not hospital bottom lines - as the major determinant for new CSCs."

Source: www.medicalnewstoday.com

Sandee LaMotte

"Our data raise questions about the current recommendations," said Mayo pulmonologist, Dr. David E. Midthun, one of the study authors. "We do not have the best tool to identify who is at risk for lung cancer."

Current U.S. Preventive Services Task Force guidelines recommend annual low-dose CT screening for adults age 55 to 80 who have smoked 30 pack-years (one pack a day for 30 years), and who currently smoke or have stopped smoking within the last 15 years. This criteria is used by doctors and insurance companies to recommend and pay for scans.

According to the researchers, the percentage of lung cancer patients who smoked at least 30 pack-years declined over the study period while the proportion of cancer patients who had quit for more than 15 years rose. 

"As smokers quit earlier and stay off cigarettes longer, fewer are eligible for CT screening, which has been proven effective in saving lives," said epidemiologist Dr. Ping Yang in a statement released by the Mayo Clinic Cancer Center. "Patients who do eventually develop lung cancer are diagnosed at a later stage when treatment can no longer result in a cure."

Over the study period the percentage of lung cancer patients who would have been eligible for CT screening under current guidelines fell dramatically: from 56.8% in 1984-1990 to 43.3% in 2005-2011. The proportion of men who would have been eligible decreased from 60% to 49.7%, while the percentage of women dropped from 52.3% to 36.6%. 

Researchers worry about the trend. "We don't want to disincentive patients to stop smoking," Midthun told CNN in a phone interview. "When I told one of my patients about the study, his first question was, 'If I stop smoking will I have to stop screening?'"

"We want people to stop smoking, and we don't want them to lie or continue smoking just so they can be screened," added Midthun. "We need better tools to make risk calculations for those who should be screened."

The Mayo study did not take into account other risk factors for lung cancer, such as personal and family history for lung cancer or Chronic Obstructive Pulmonary Disease (COPD) because they are not in the current guidelines for reimbursement. For example, COPD "raises a person's risk for lung cancer by four to six times," said Midthun, yet "only age and pack year history are in the guidelines."

"There's nothing magical in 30-year pack history," added Midthun. He told CNN that age is an equally important factor. "For example, if a person stops smoking at age 55, his risk of lung cancer at age 70 is higher than it was at age 55 when he quit."

The study was published in the February 24, 2015 issue of JAMA, the journal of the American Medical Association. It was funded by the Mayo Clinic and grants from the National Institutes of Health and the National Institute on Aging.

Source: www.cnn.com

I find it strangely interesting that this time last year, as I was enduring the beginning of my life with a TBI, I had no idea that March was National Brain Injury Awareness Month. This year I feel compelled to shout it from the rooftops (or the computer screen)! Over the next few weeks, I intend to share with you stories and journeys of those living with a traumatic brain injury (TBI) or caring for a loved one who is recovering from one. My hope is to educate those who aren't familiar with TBI, and to help other TBI-ers understand that they are not alone, and that their symptoms are not just "in their head" (pun intended). 

Let me start by offering you some statistics on TBI from BrainTrauma.org:

• Traumatic brain injury (TBI) is the leading cause of death and disability in children and adults from ages 1 to 44.

 

• Brain injuries are most often caused by motor vehicle crashes, sports injuries, or simple falls on the playground, at work or in the home.

 

 

• Every year, approximately 52,000 deaths occur from traumatic brain injury.

 

 

• An estimated 1.5 million head injuries occur every year in the United States emergency rooms. 

 

 

• An estimated 1.6 million to 3.8 million sports-related TBIs occur each year.

 

 

• At least 5.3 million Americans, 2 percent of the U.S. population, currently live with disabilities resulting from TBI.

 

 

• Moderate & severe head injury (respectively) is associated with a 2.3 and 4.5 times increased risk of Alzheimer's disease.

 

 

• Males are about twice as likely as females to experience a TBI.

 

 

• Exposures to blasts are a leading cause of TBI among active duty military personnel in war zones.

 

 

• Veterans' advocates believe that between 10 and 20 percent of Iraq veterans, or 150,000 and 300,000 service members have some level of TBI.

 

 

• 30 percent of soldiers admitted to Walter Reed Army Medical Center have been diagnosed as having had a TBI.

 

• The number of people with TBI who are not seen in an emergency department or who receive no care is unknown.

There are three levels of traumatic brain injuries: mild, moderate and severe. Don't let these names fool you. A mild TBI is just as serious as a moderate or severe one. The names refer to loss of consciousness and mental alteration as a result of the trauma. In my case, we think I was unconscious for only about a minute or so, therefore classifying me as "mild". But like I said, don't let the name fool you. The resulting damage can be the same for all three -- a TBI does not discriminate. 

A TBI changes you. Literally and figuratively. My personality is different. My energy levels and sleep patterns are foreign to me. The confused woman in the kitchen staring at the oven is someone I am just now starting to understand. The woman who has to write a Post-it note for every single task on her to-do list is no longer the multi-tasker she once was. The woman who used to type at 100 words per minute with zero mistakes now has to take her time and correct many keystroke errors as she goes because her brain gets confused with letters.

I am finally coming to terms with this "new me." It has been just over a year since I fell on the ice, landing full force on my skull. In the beginning I was angry. I was confused. I was in a lot of pain, both physically and emotionally. People didn't understand. Didn't believe me. Couldn't understand my hidden injuries. I didn't have a strong support system, but what I did have was determination! 

Life with an "invisible" injury or illness can be a real challenge. Since I posted my last blog, "Life With a Traumatic Brain Injury," on The Huffington Post last month, I have made an entirely new circle of friends. I created a group on Facebook, affectionately named "The TBI Tribe." This is a safe place where we can hang out, talk, vent frustrations, share in each other's successes, and more importantly, have a place where we all feel like we fit in. I was craving an environment where others understood my struggles and didn't pass judgement. I have found exactly that in this tribe! 

I want to share with you a little bit about one of my new friends, Jennifer L. White from St. Louis, Missouri:

In July of 2000 Jennifer collapsed in her Atlanta, Georgia apartment. She called 911 and told them she was dying. She did, in fact, die in the ambulance on her way to the hospital. Fortunately medics were able to resuscitate her. Doctors determined that she had had a stroke and performed brain surgery to eradicate the brain bleed. She spent 10 days in the ICU followed by several months in a rehab facility. Overnight she went from the vice president of a large marketing firm, to unemployable and on disability. The massive stroke has left Jennifer with cognitive deficiencies, balance issues, and double vision. She jokes that she can, however, make a killer peanut butter sandwich! It's important to have a good sense of humor when dealing with a TBI. Aside from her impairments, Jennifer looks completely healthy and "normal." A few words from Jennifer:

The brain injury has affected me in a variety of ways. Emotionally, I am fragile but working hard to toughen my spirit.  I am much more introspective (I don't know if this is from the actual brain injury or the fact I now have more time to be introspective). Things are just harder for me than most people.   I have to actually think seriously about where I am stepping. 

I define my life in two ways: before and after the stroke.  It has certainly delivered me a tough blow. I have been advised not to have children. I am scared that I am predisposed to have something else happen to me, and I am sorry that I don't find sweetness in the sweet things in life because I am more bitter than I want to be.  But call me crazy... I am glad to be alive. 

I hope that you will join me this month as I share with you more stories and continue to bring awareness to the world about TBI.

Source: www.huffingtonpost.com

DONALD G. McNEIL Jr.

A major study testing whether Americans would take their H.I.V. drugs every day if they were paid to do so has essentially failed, the scientists running it announced Tuesday at an AIDS conference here.

Paying patients in the Bronx and in Washington — where infection rates are high among poor blacks and Hispanics — up to $280 a year to take their pills daily improved overall adherence rates very little, the study’s authors said.

The hope was that the drugs would not only improve the health of the people taking them, but help slow the spread of H.I.V. infections. H.I.V. patients who take their medicine regularly are about 95 percent less likely to infect others than patients who do not. The Centers for Disease Control and Prevention estimates that only a quarter of all 1.1 million Americans with H.I.V. are taking their drugs regularly enough to not be infectious.

Paying patients $25 to take H.I.V. tests, and then $100 to return for the results and meet a doctor, also failed, the study found.

“We did not see a significant effect of financial incentives,” said Dr. Wafaa M. El-Sadr, an AIDS expert at Columbia University and the lead investigator. But, she said, there is “promise for using such incentives in a targeted manner.”

Cash payments might still work for some patients and some poor-performing clinics, she said.

Other H.I.V.-prevention research released here Tuesday offered good news for gay men but disappointing results for African women.

Two studies — both of gay men, one in Britain and the other in France — confirmed earlier research showing that pills to prevent infection can be extremely effective if taken daily or before and after sex. Both were stopped early because they were working so well that it would have been unethical to let them continue with men in control groups who were not given the medicine.

But a large trial involving African women of a vaginal gel containing an antiviral drug failed — apparently because 87 percent of the women in the trial were unable to use the gel regularly.

The failure of the cash-incentives trial was a surprise and a disappointment to scientists and advocates. It had paid out $2.8 million to 9,000 patients in 39 clinics over three years, but the clinics where money was distributed did only 5 percent better than those that did not — a statistically insignificant difference.

Some small clinics and those where patients had been doing poorly at the start of the study did improve as much as 13 percent, however.

People in other countries have been successfully paid to stop smoking while pregnant and to get their children to school. In Africa, paying poor teenage girls to attend school lowered their H.I.V. rates; scientists concluded that it eased the pressure on them to succumb to “sugar daddies” — older men who gave them money for food, clothes and school fees in return for sex.

One study presented here at the annual Conference on Retroviruses and Opportunistic Infections estimated that every prevented H.I.V. infection saved $230,000 to $338,000. Much of that cost is borne by taxpayers.

Mathematical modeling suggested that paying people up to $5,000 a year could be cost effective, Dr. El-Sadr said, but $280 was settled on after a long, difficult debate.

Paying more than $280 at some clinics was not an option, she said; achieving statistical relevance would have meant signing up even more clinics. The study had already involved almost every H.I.V. patient in the Bronx and Washington.

“I don’t think anyone has an answer to what amount would be sufficient without being excessive,” Dr. El-Sadr said.

One advocate suggested that more money could work — in the right setting.

“In South Africa, $280 is a lot of money,” said Mitchell Warren, the executive director of AVAC, an organization that lobbies for AIDS prevention. “For that much, you’d definitely get some behavior change.”

The two studies among gay men looked at different ways to take pills. A 2010 American study, known as iPrEx, showed that taking Truvada — a combination of two antiretroviral drugs — worked if taken daily.

The British study, known as PROUD, used that dosing schedule, and men who took the pill daily were protected 86 percent of the time.

In the French trial, known as Ipergay, men were advised to take two pills in the two days before they anticipated having sex and two in the 24 hours afterward.

Those who took them correctly also got 86 percent protection.

“The problem,” Dr. Susan P. Buchbinder, director of H.I.V. prevention research for the San Francisco health department, said in a speech here commenting on the study, “is that studies have shown that men are very good at predicting when they will not have sex and not good at predicting when they will.”

The African study, known as FACTS 001, was a follow-up to the smaller trial from 2010, which showed that South African women who used a vaginal gel containing tenofovir, an antiviral drug, before and after sex were 39 percent better protected than women who did not.

But it also found that many women failed to use the gel because it was messy or inconvenient or because partners objected.

In this trial, there was virtually no effect.

One problem, said Dr. Helen Rees, the chief investigator, was that the women were very young — the median age was 23, and most lived with their parents or siblings.

“They had no privacy for sex,” she said. “They had to go outside to use the product.”

Mr. Warren, of AVAC, said: “The women wanted a product they could use. But this particular product didn’t fit into the realities of their daily lives.”

The development means that advocates are hoping even more that other interventions for women now in trials will work. They include long-lasting injections of antiretroviral drugs and vaginal rings that can be inserted once a month and leach the drugs slowly into the vaginal wall.

Another trial in Africa, the Partners Demonstration Project, conducted among couples in which one partner had H.I.V. and the other did not, found it was extremely effective to simultaneously offer treatment to the infected partner and preventive drugs to the uninfected one until the other’s drugs took full effect.

In the group getting the treatment, there were zero infections that could be traced to partners who were in the study.

Source: www.nytimes.com

It’s something each of the nation’s 3.1 million RNs understands intimately: Being a nurse is intense. The hospitals and clinics where they work are often stressful. And patient care and healthcare systems have never been more complex.

Nationally, nurse turnover stands at 20 percent, but nearly 40 percent of nurses are ready to leave their job after a single year. About 14 percent leave the field altogether, and the ‘working wounded’ that remain are at best demoralized and at worst error-prone. And dealing with RN turnover is among the biggest, costliest burdens in healthcare today.

It’s why University of Virginia School of Nursing’s Compassionate Care Initiative has sponsored a new Public Radio documentary series – Resilient Nurses, now available online – which will be heard on many public radio stations starting this month and also on Sunday Feb. 22 on the NPR Channel (#122) of SiriusXM satellite radio at 4pm ET / 1pm PT.  

Hosted by award-winning documentary producer David Freudberg of Humankind, the program takes a no-holds-barred look at what ails American RNs: the stress, the exhaustion, and the pressured environments that often lead to their burnout. 

But beyond sourcing RNs’ biggest challenges, Freudberg offers a promising glimpse into the growing number of nurses hoping to improve their lot by harnessing well-being through resilience. Freudberg also chronicles the growing movement of resilience at a handful of American clinics and hospitals where administrators realize the very real financial and personal stake they have in helping their nurses effectively handle stress. 

And the stories are inspiring. Sharing the voices of these powerful, real nurses may be an important step in healing the profession’s broken hearts, strengthening American RNs’ care and practice through a practitioner-centered approach to well-being. 

The Resilient Nurses audio podcast is now available online. Editors and bloggers may download and publish graphics and a brief program description from http://www.humanmedia.org/nurse/resources.php.

We hope the program will inspire nurses, nursing professors, nursing students and others in healthcare to begin their own resilient practices.

Christine Phelan Kueter, writer

Source: U.Va. School of Nursing

By PAM BELLUCK

Conventional wisdom has it that hot flashes, which afflict up to 80 percent of middle-aged women, usually persist for just a few years. But hot flashes can continue for as long as 14 years, and the earlier they begin the longer a woman is likely to suffer, a study published on Monday in JAMA Internal Medicine found.

In a racially, ethnically and geographically diverse group of 1,449 women with frequent hot flashes or night sweats — the largest study to date — the median length of time women endured symptoms was 7.4 years. So while half of the women were affected for less than that time, half had symptoms longer — some for 14 years, researchers reported.

“It’s miserable, I’ll tell you what,” said Sharon Brown, 57, of Winston-Salem, N.C., who has endured hot flashes for six years. At her job at a tax and accounting office, she has had to stop wearing silk.

Mary Hairston found that acupuncture helped with her hot flashes. CreditKaren Tam for The New York Times 

Over all, black and Hispanic women experienced hot flashes for significantly longer periods than white or Asian women. And in a particularly unfair hormonal twist, the researchers found that the earlier hot flashes started, the longer they were likely to continue.

Among women who got hot flashes before they stopped menstruating, the hot flashes were likely to continue for years after menopause, longer than for women whose symptoms began only when their periods had stopped.

“That having symptoms earlier in the transition bodes ill for your symptoms during menopause — that part is certainly new to me,” said Dr. C. Neill Epperson, director of the University of Pennsylvania’s Center for Women’s Behavioral Wellness, who was not involved in the study. Perhaps, she and others suggested, early birds are more biologically sensitive to hormonal changes.

And many women fall into the early bird category. In this study, only a fifth of cases started after menopause. One in eight women began getting hot flashes while still having regular periods. For two-thirds of women, they began in perimenopause, when periods play hide and seek but have not completely disappeared.

In numerical terms, women who started getting hot flashes when they were still having regular periods or were in early perimenopause experienced symptoms for a median of 11.8 years. About nine of those years occurred after menopause, nearly three times the median of 3.4 years for women whose hot flashes did not start until their periods stopped.

“If you don’t have hot flashes until you’ve stopped menses, then you won’t have them as long,” said Nancy Avis, a professor of social sciences and health policy at Wake Forest Baptist Medical Center and the study’s first author. “If you start later, it’s a shorter total duration and it’s shorter from the last period on.”

Hot flashes, which can seize women many times a day and night — slathering them in sweat, flushing their faces — are linked to drops in estrogen and appear to be regulated by the hypothalamus in the brain. Studies have found that women with hot flash symptoms also face increased risk of cardiovascular problems and bone loss.

Researchers followed the women in the study, who came from seven American cities, from 1996 to 2013. All of them met the researchers’ definition for having frequent symptoms: hot flashes or night sweats at least six days in the previous two weeks.

None had had a hysterectomy or both ovaries removed, and none were on hormone therapy. (If they started taking hormone therapy during the study period, their data stopped being included, Dr. Avis said.)

Although some smaller studies have also found that symptoms can last many years, the new research drew praise from experts because, among other things, it included a larger and much more diverse group of women. One-third of them were African-Americans in Pittsburgh, Boston, Chicago and Ypsilanti, Mich. It also included women of Japanese descent in Los Angeles; women of Chinese descent in Oakland, Calif.; and Hispanic women in Newark — about 100 in each group.

“It’s such a real-world study of women we are seeing day in and day out,” said Dr. Risa Kagan, an obstetrician-gynecologist at the University of California, San Francisco, and the Sutter East Bay Medical Foundation in Berkeley. “There is no other study like this.”

Researchers found significant differences between ethnic groups. African-Americans reported the longest-lasting symptoms, continuing for a median of 10.1 years — twice the median duration of Asian women’s symptoms. The median for Hispanic women was 8.9 years; for non-Hispanic whites, 6.5 years.

Reasons for ethnic differences are unclear. “It could be genetic, diet, reproductive factors, how many children women have,” Dr. Avis said.

The study also found that women with longer-lasting symptoms tended to have less education, greater perceived stress, and more depression and anxiety.

“I’m not at all suggesting that hot flashes are manifestations of depression, but they’re both brain-related phenomena, and depression is also more common in the same groups,” said Dr. Andrew Kaunitz, an obstetrician-gynecologist at the University of Florida who was not involved in the study. It is unclear if stress and emotional issues help cause hot flashes or result from them.

“Women with more stress in their lives may be more aware of their symptoms and perceive them to be more bothersome,” said Dr. JoAnn E. Manson, chief of preventive medicine at the Harvard-affiliated Brigham and Women’s Hospital and an author of a commentary accompanying the study. “But also having significant night sweats that interrupt sleep can lead to stress.”

Dr. Manson said the new study should help women and doctors anticipate that symptoms may continue longer, and might suggest that some women try different approaches at different times.

Women who are still menstruating, she said, “can become pregnant,” so low-dose contraceptives, which also tame hot flashes, might be recommended until menopause. Hormone therapy might then be prescribed for several years, she said.

But hormone therapy has been linked to increased risk of breast cancer and heart disease for some women. Effective non-hormonal therapies also exist, experts said, including low-dose antidepressants.

Dr. Manson, a past president of the North American Menopause Society, has helped the society develop a free app, MenoPro, to assist women deal with hot flashes, starting with nonmedical approaches like lowering the thermostat and cutting back on spicy foods, caffeine and alcohol.

Ms. Brown and Mary Hairston, 53, tried acupuncture in another study by Dr. Avis and colleagues, and found it helped. Before that, Ms. Hairston said, “every night I would just wake up, dripping wet.”

Now, when she starts sweating at the Italian restaurant where she waitresses, “I go stand in the cooler,” she said. “I used to get cold all the time and I would say I couldn’t wait to have hot flashes. Well, I got over that real quick.”

Source: www.nytimes.com

JESSICA FIRGER

Scientists have discovered a highly aggressive new strain of HIV in Cuba that develops into full-blown AIDS three times faster than more common strains of the virus. This finding could have serious public health implications for efforts to contain and reduce incidences of the virus worldwide.

Researchers at the University of Leuven in Belgium say the HIV strain CRF19 can progress to full blown AIDS within two to three years of exposure to virus. Typically, HIV takes approximately 10 years to develop into AIDS. Patients with CRF19 may start getting sick before they even know they've been infected, which ultimately means there's a significantly shorter time span to stop the disease's progression. 

The scientists began studying the cases in Cuba when reports began coming in that a growing number of HIV-infected patients were developing AIDS just three years after diagnosis with the virus. The findings of their study were published in the journal EBioMedicine.

Having unprotected sex with multiple partners can expose a person to numerous strains of the HIV virus. Research has found that when this occurs, the different strains can combine and form a new variant of the virus.

When HIV first enters the human body it latches on to anchor points of a certain protein, known as CCR5 on the cell membranes, which then allows it to enter human cells. Eventually the virus then latches onto another protein of the cell membrane, known as CXCR4. This marks the point when asymptomatic HIV becomes AIDS. In CRF19, the virus makes this move much sooner. 

For the study, the researchers analyzed blood samples of 73 recently infected patients. Among the group, 52 already had full-blown AIDS, while the remaining 21 were HIV-positive but the virus had not yet progressed. The researchers compared their findings to blood samples of 22 AIDS patients who had more common strains of the virus. 

The researchers found that patients with CRF19 had higher levels of the virus in their blood compared with those who had more common strains. 

They also had higher levels of the immune response molecules known as RANTES, which bond to CCR5 proteins in early stages of the virus. The abnormally high level of RANTES in patients infected with the new strain indicates that the virus runs out of CCR5 anchor points much earlier and moves directly to CXCR4 anchor points.

Thanks to advances in medical treatment and the development of highly effective antiretroviral drugs, HIV/AIDS is no longer a death sentence. But the researchers caution that patients with the new strain of the virus are more likely to be diagnosed when they already have full-blown AIDS and when damage from the disease has taken a toll.

The researchers suspect that this aggressive form of HIV occurs when fragments of other subsets of the virus cling to each other through an enzyme that makes the virus more powerful and easily replicated in the body.

There are currently 35 million people worldwide living with HIV/AIDS, according to the most recent data from the World Health Organization. Scientists have identified more than 60 different strains of the HIV 1 virus, with each type typically found predominantly in a specific region of the world.

Source: www.cbsnews.com

Jana Kasperkevic

Far from offering patients pennies for their thoughts, mental health therapists often end up billing them hundreds of dollars per month.

The cost is a growing burden as depression among US adolescents and adults rises. The US is suffering a mental health crisis, with a San Diego State University study in October finding that one in 10 Americans is depressed – and more report symptoms of depression.

More Americans are seeking help, and that help can come at a financial sacrifice of thousands of dollars a year. Aside from the cost of often-weekly visits to psychologists – which may or may not be defrayed by insurance – there can be additional costs for psychiatrists and any medicine they prescribe.

The cost of therapy is especially acute for young Americans, many of whom are underemployed and burdened with college debt. This year, a record number of college freshmen reported being depressed. And while many campuses provide free mental health care, affordable help is often harder to find after students leave school.

The Guardian interviewed seven young professionals about their experiences to find out how young Americans manage to pay for therapy – and if they think it’s worth it. To protect their identities, we have kept their surnames anonymous.

Click on the titles below to read their stories: 

‘I just can’t afford to go’

– AK, 27

‘Why do I need to pay someone to listen to me?’

– Matt, 23

Therapy was ‘the best chance I had of feeling OK’

– JE, 29

‘I needed someone to help me find courage to leave [my job]’

– Eve, 33

‘At its best, it’s paying for a friend’

- John, 27

‘Therapy is not a magic wand’

-Jenn, 26 

‘I’d rather be sad’

– Alex, 27

Source: www.theguardian.com

While debate about recreational marijuana use continues, researchers are investigating the effectiveness of cannabis for treating pain, spasticity, and a host of other medical problems. In a symposium organized by the McGill University Health Centre (MUHC) as part of the 2015 American Association for the Advancement of Science Annual Meeting held this week in San Jose, California,  experts from North America and the U.K. share their perspectives on the therapeutic potential of medical cannabis and explore the emerging science behind it.

"We need to advance our understanding of the role of cannabinoids in health and disease through research and education for patients, physicians and policy-makers," says Dr. Mark Ware, director of clinical research at the Alan Edwards Pain Management Unit at the MUHC, in Canada.

As a pain specialist Dr. Ware regularly sees patients with severe chronic pain at his clinic in Montreal, and for some of them, marijuana appears to be a credible option. "I don't think that every physician should prescribe medical cannabis, or that every patient can benefit but it's time to enhance our scientific knowledge base and have informed discussions with patients."

Increasing numbers of jurisdictions worldwide are allowing access to herbal cannabis, and a range of policy initiatives are emerging to regulate its production, distribution, and authorization. It is widely believed that there is little evidence to support the consideration of cannabis as a therapeutic agent. However, several medicines based on tetrahydrocannabinol (THC), the psychoactive ingredient of cannabis, have been approved as pharmaceutical drugs.

Leading British cannabis researcher Professor Roger Pertwee, who co-discovered the presence of tetrahydrocannabivarin (THCV) in cannabis in the 70's, recently published with collaborators some findings of potential therapeutic relevance in the British Journal of Pharmacology. "We observed that THCV, the non-psychoactive component of cannabis, produces anti-schizophrenic effects in a preclinical model of schizophrenia," says Pertwee, professor of Neuropharmacology at Aberdeen University. "This finding has revealed a new potential therapeutic use for this compound."

Neuropsychiatrist and Director of the Center for Medicinal Cannabis Research (CMCR) at the University of California, San Diego Dr. Igor Grant is interested in the short and long-term neuropsychiatric effects of marijuana use. The CMCR has overseen some of the most extensive research on the therapeutic effects of medical marijuana in the U.S. "Despite a commonly held view that cannabis use results in brain damage, meta analyses of extensive neurocognitive studies fail to demonstrate meaningful cognitive declines among recreational users," says Dr. Grant. "Bain imaging has produced variable results, with the best designed studies showing null findings."

Dr. Grant adds that while it is plausible to hypothesize that cannabis exposure in children and adolescents could impair brain development or predispose to mental illness, data from properly designed prospective studies is lacking.

Source: www.sciencedaily.com