The Latest Happenings
▣ Myths in Diabetes Care: A Clinician’s Perspective
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Myths in diabetes are common among patients suffering from the disease, but myths can also affect the clinicians managing these individuals. Understanding myths and misconceptions about the care of patients with diabetes is important in optimizing outcomes. Here are some common myths held by clinicians and some potential solutions to overcome potential barriers: Myth: “My patients aren’t interested in or concerned about making the changes they need to make in order to control their diabetes.” Solution: In general, people are not opposed to change but resent when others try to change them. While it can be discouraging when patients don’t take advantage of sound advice, it’s critical that physicians make every effort to understand diabetes from their patient’s perspectives. Most people want to live long, healthy lives, and every person has the ability to make changes. Management of patients with diabetes is not one-size-fits-all. Asking patients what is hardest or most concerning will help you understand what is motivating for them. It’s a good way to engage them in their care. Myth: “I don’t have the time to get everything addressed in one office visit.” Solution: Time constraints can have a significant impact on physicians, and no one expects that you can do it all. There are other options to help your patients. The use of a multidisciplinary team improves outcomes. Office staff can handle some of the simpler issues for patients, such as linking them to trusted diabetes information on the internet or connecting them with diabetes self-management educators. They can search community diabetes support groups and create simple handouts to guide patients to these groups. Taking a few extra steps to get patients the help they need early can save time down the road. Myth: “My patients won’t be happy taking insulin, so I want to avoid using it.” Solution: Findings from the Diabetes Attitudes, Wishes, and Needs study indicate that insulin is often viewed as a last resort by both patients and clinicians. As a result, many practitioners use insulin as a threat to motivate patients to lose weight and exercise. Unfortunately, threats are not effective in the long term. A more useful approach would be to talk about the continuum of treatment. Be up front with patients and inform them that their treatment will change until an effective approach is found. Educating patients about the progression of therapy from the beginning is a useful approach to overcome the myth that insulin is a last resort or a failure on the part of the patient. Treatments will change over time, so patients won’t be on the same regimen their entire life. Myth: “My patients won’t understand the directions and information I give them.” Solution: Health literacy is a problem for many patients, but keep in mind that literacy isn’t a measure of intelligence. Some of the wisest patients are not the best educated. To avoid potential bias, find what sparks a patient’s interest and talk to them in a way that they can understand what they’re being told. A simple approach is to have a patient tell the provider what they’ll tell their family when they get home from the doctor’s office. This so-called “teach back” method can demonstrate patient understanding on the directions they’ve received. Taking an extra minute to perform this exercise can increase patient understanding and avoid potential harm. Martha M. Funnell, MS, RN, CDE, has indicated to Physician’s Weekly that she has worked as a consultant for Novo Nordisk, Eli Lilly and Company, sanofi-aventis, Intuity Medical, and Merck. American Diabetes Association. Diabetes Myths. Available at: http://www.diabetes.org/diabetes-basics/diabetes-myths/. Meece J. Dispelling myths and removing barriers about insulin in type 2 diabetes. Diabetes Educator. 2006;32:9S-18S. Available at: http://tde.sagepub.com/content/32/1/9S.full. Anderson RM, Funnell MM. Patient empowerment: myths and misconceptions. Patient Educ Couns. 2010;79:277-282. Adler E, Paauw D. Medical myths involving diabetes. Prim Care. 2003;30:607-618. Pearce LC. New evidence-based diabetes nutrition recommendations: correcting myths and updating practice.Home Healthc Nurse. 2003;21:249-257. Alberti G. The DAWN (Diabetes Attitudes, Wishes, and Needs) study. Pract Diabetes Int. 2002;19:22-24. Peyrot M, Rubin RR, Lauritzen T, the International DAWN Advisory Panel. Resistance to insulin therapy among patients and providers: results of the cross-national Diabetes Attitudes, Wishes, and Needs study. Diabetes Care. 2005;28:2673-2679. Funnell MM. The Diabetes Attitudes, Wishes, and Needs (DAWN) study. Clin Diabetes. 2006;24:154-155.
“Taking a few extra steps to get patients the help they need early can save time down the road.”
▣ Psychiatric Disorders Common After Traumatic Injuries
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▣ Tai Chi Reduces OA Knee Pain
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| Investigators in Boston have found that Tai Chi appears to reduce pain and improve physical function, self-efficacy, depression, and health-related quality of life for knee osteoarthritis (OA). In an analysis of 40 patients, participants were randomly assigned to 60 minutes of Tai Chi or attention control twice weekly for 12 weeks. Those partaking in Tai Chi exhibited significantly greater improvement in pain scores and physical function. Chair stand time, depression scores, and self-efficacy scores were also higher in the Tai Chi group. No severe adverse events were observed in the study. Source: Arthritis Care & Research, November 2009. |
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▣ Chronic Lower Back Pain: Analyzing Recovery
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| Australian researchers have found that more than one-third of patients with recent onset, non-radicular chronic low back pain recover within 12 months. The cumulative probability of being pain-free was 35% at 9 months and 42% at 12 months. For complete recovery, rates of being pain-free were 35% at 9 months and 41% at 12 months. The prognosis was less favorable for those who had taken previous sick leave for low back pain, those with high disability levels or high pain intensity at the onset of chronic low back pain, and for those who perceived themselves as having a high risk of persistent pain. Source: British Medical Journal, October 6, 2009. |
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▣ Analyzing Infectious Disease Rates in Hospitals
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| A national investigation has found that the infectious disease (ID) hospitalization rate increased from 1998 to 2006 among adults aged 30 and up, particularly in older adults. Approximately 4.5 million hospital days and $865 billion in hospital charges were associated with primary ID hospitalizations over the study period. Lower respiratory tract infections accounted for the largest proportion of ID hospitalizations (34.4%). Source: Clinical Infectious Diseases, October 1, 2009. |
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▣ Three in Every One Thousand U.S. Children Diagnosed with Tourette Syndrome
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The first-ever national estimate among a nationally representative sample of U.S. children revealed that 3 out of every 1000 children between the age of 6 and 17 in the United States have been diagnosed with Tourette Syndrome (TS), according to a study by the Centers for Disease Control and Prevention (CDC) released in the Morbidity and Mortality Weekly Report.
The study, “Prevalence of Diagnosed Tourette Syndrome in Children in the United States, 2007,” found that a TS diagnosis is three times more common in boys than in girls, and approximately twice as common in children between 12-17 years as those aged 6-12 years. Among children with TS, 27% were reported as having moderate or severe TS and 79% of children had also been diagnosed with at least one additional mental health or neurodevelopmental condition.
Tourette Syndrome is a neurological disorder that typically begins during early childhood, with symptoms being most severe between the ages of 10 and 12 years. TS is characterized by recurring multiple motor tics and at least one vocal tic. Tics are involuntary, repetitive, stereotyped, usually sudden and rapid movements or vocalizations that may be suppressed for short periods of time.
“TS and tic disorders have been linked to higher rates of Attention Deficit/Hyperactivity Disorder, obsessive-compulsive disorder, and impairments associated with these conditions, such as learning disabilities and problems with peer relations,” said Dr. Rebecca Bitsko, Health Scientist at the Centers for Disease Control and Prevention. “Given the high number of children diagnosed with TS who have another mental health or neurodevelopmental condition, it is necessary to further study the relation between these conditions.”
Further, the data showed that non-Hispanic white children were more than twice as likely as non-Hispanic black children or Hispanic children to have a parent-reported TS diagnosis.
“Having an estimate of the number of U.S. children who are diagnosed with TS is a first step toward understanding the overall impact of this condition in the population,” said Dr. Bitsko. “Further research must examine differences in access to health care for children with TS in different population groups, the impact of TS on the quality of life, long term outcomes for children with TS, and strategies for reducing the impact of conditions associated with TS.”
The study analyzed data from interviews with parents (or guardians) from 91,642 households from April 2007 through July 2008 collected through the National Survey of Children′s Health (NSCH). The NSCH is the first large, national, population-based survey of U.S. children up to 18 years old that included questions on TS. This random-digit-dialed telephone survey is sponsored and directed by the Health Resources and Services Administration′s Maternal and Child Health Bureau and conducted by CDC through the State and Local Area Integrated Telephone Survey program. Interviews were completed in 66.0% of identified households with children which represents a 46.7% response of all possible eligible households.
For more information about Tourette Syndrome and other birth defects please call toll free 1-800 CDC-INFO or visit http://www.cdc.gov/ncbddd/tourette/default.htm.
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▣ The Novel H1N1 Flu (Influenza A) Pandemic Avoid Getting Infected or Transmitting Flu To Others
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The Novel H1N1 Flu (Influenza A) Pandemic
Avoid Getting Infected or Transmitting Flu To Others
The world Health Organization has declared the current H1N1 Flu as a Pandemic (Phase 6 on the Pandemic Scale), the first Flu pandemic in 41 years. While this has been done because of the geographic distribution of the viral infection (virus isolated in at least 74 countries) and not its severity, the wide distribution of the virus carries the hallmark of its ability to cause widespread influenza (flu), which could be life threatening in certain population groups. The infection is likely to spread through places of public congregation, including educational institutions, places of worship and other events and places where people gather and come in close contact. With the impending Haj season, there is a potential for spread of infection amongst people from different countries, who may bring infection to the gathering or carry it back with them to their homelands.
Who is at increased risk of H1N1 Influenza?
The old and the very young, pregnant and new mothers, people with lung disease and chronic illnesses may be at increased risk. In general, anyone at increased risk of getting infections is at increased risk of getting H1N1 Flu, if exposed.
How does H1N1 influenza virus spread?
The H1N1 flu spreads from person to person in the same way as seasonal flu, which is mainly spread person to person through coughing or sneezing by people infected with the influenza virus. People may become infected by touching something with germs on it and then touching their mouth or nose. Germs on hard surfaces, such as counters and doorknobs, can be picked up on hands and spread to the respiratory system when people touch their mouth or nose. It is important to wash your hands frequently.
How can H1N1 flu virus be prevented?
Simple measures, as enumerated below, can significantly reduce transmission of H1N1 and seasonal flu:
** Wash your hands with soap and water or cleaning them with alcohol-based (at least 60% alcohol) sanitizers, especially after you cough or sneeze and before you eat.
** Cover your nose and mouth with a clean tissue when you cough or sneeze, and throw the tissue in the trash immediately after you use it.
** Cough and sneeze into your sleeve if you do not have tissue available.
** Avoid touching your eyes, nose or mouth when hands are not clean, as infection can spread that way.
** Avoid close contact with people who are sick or may have symptoms of cold.
If you do get sick, stay at home and limit contact with others (people with H1NI flu may transmit their infection 1 day before and 7 days after symptoms of flu appear)
(The current CDC recommendations do not favor the use of facemasks unless there is increased risk of exposure to HIN1 Flu or underlying health conditions that increase the chance of getting H1N1 Flu)
What are the symptoms of human swine flu?
The symptoms of H1N1 flu virus are similar to the symptoms of typical human seasonal influenza. Symptoms include high fever, cough, sore throat, headache, body aches, chills, fatigue, eye pain, shortness of breath, and lack of appetite. Some people with H1N1 flu have also reported nausea, vomiting, and diarrhea. Symptoms or complications such as severe respiratory distress or pneumonia may develop in moderate or severe cases, as well as people with chronic health conditions.
What to do if you or your child has symptoms?
If you or your child gets sick, you can take these steps to feel better.
Children and adults who are sick should stay at home. Do not send children to school or daycare.
Drink lots of fluids (juice, water, Pedialyte).
Get plenty of rest.
Keep your child comfortable.
For fever, sore throat, and muscle aches, you can use fever-reducing medicines that your doctor recommends based on your child’s age. Do not use aspirin with children or teenagers; it can cause Reye’s syndrome, a life-threatening illness.
Keep clean tissues and a trash bag close, and throw the tissue in the trash immediately after you use it.
Wash your hands frequently.
A person who is sick should recover in his or her own room as much as possible.
If someone in your home is sick, keep the person away from those who are not sick.
Is there a vaccine for H1N1 influenza virus?
Experts are working internationally to develop a vaccine that will protect persons from this particular strain of influenza. This vaccine is likely to be available in USA in October 2009. The seasonal influenza vaccine will be available in September 2009 and is recommended for individuals to offer protection against the seasonal strains that may be circulating, regardless of whether a novel strain has emerged. People proceeding on Haj are well advised to be vaccinated against seasonal and H1N1 flu to decrease their chances of getting seasonal or novel influenza.
Where do I get more information about H1N1 flu virus and about protecting myself?
▣ Breast Cancer, Physical Activity, & Emotional Health
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| Emotional health-related quality of life (HRQL) following a diagnosis of breast cancer appears to be important for sustaining physical activity in the first 1 to 2 years after a diagnosis. Research showed that physical activity increased gradually during the first 18 months, then declined steadily over the next 42 months. The following was associated with less physical activity: • Poor physical health. • Depressive symptoms. • Lower emotional HRQL. Investigators added that physical activity interventions among breast cancer survivors should address depressive symptoms early in the course of treatment. Source: Psycho-Oncology, April 2009. |
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▣ Can More Vitamin C Reduce Gout Risk?
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| Higher vitamin C intake appears to be independently associated with a lower risk of gout, according to a study published in the March 9, 2009 Archives of Internal Medicine. For every 500-mg increase in total daily vitamin C intake, the risk of gout decreased by 17%. Patients taking 1,000-mg to 1,499-mg supplements of vitamin C had a 34% lower risk of gout. The researchers noted that supplemental vitamin C intake may be beneficial to prevent gout. |
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▣ Trouble With Migraines During Pregnancy
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Among pregnant women admitted to hospitals, there appears to be a strong relationship between active peripartum migraine and vascular diagnoses during pregnancy, according to researchers in North Carolina. The following diagnoses were jointly associated with migraine codes during pregnancy: stroke (odds ratio, 15.05), myocardial infarction/heart disease (odds ratio, 2.11), pulmonary embolus/VTE (odds ratio, 3.23), and hypertension (odds ratio, 8.61). Preeclampsia/gestational hypertension, smoking, and diabetes were also associated with migraine codes during pregnancy. The study was published in the March 10, 2009 BMJ.
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| An abstract of the study is available at www.bmj.com/. |
▣ Childhood Cancer Survivors & Breast Cancer Screenings
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Childhood Cancer Survivors & Breast Cancer Screenings |
A study published in the January 28, 2009 JAMA recommends that more female pediatric cancer survivors who were treated with chest radiation should undergo annual screening mammograms. Among women who had childhood cancers treated with chest radiation, 63.5% of those ages 25 to 39 had not had mammography screening for breast cancer within the previous 2 years. Another 23.5% of women ages 40 to 50 also had not had mammography screening during that stretch of time. Screening rates were higher among women who reported receiving a physician recommendation than those who did not.
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| An abstract of the study is available at http://jama.ama-assn.org/. |