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Psychologists Investigate Cognitive Failings Of Eating Disorder Sufferers
Sufferers of eating disorders have problems with certain mental tasks; this is the finding of a comprehensive overview of studies examining the link between cognitive deficits and eating disorders, published online in the Journal of Neuropsychology today, 22nd July 2009.
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CDC Prioritizes H1N1 Vaccinations For Pregnant Women
When the H1N1 flu vaccine becomes available in the fall, pregnant women should be among the first groups vaccinated because of their high risk for serious complications, a Centers for Disease Control and Prevention expert panel said on Wednesday, the Washington Post reports. The 15-member committee advises CDC on vaccine policy. The priority list also includes caretakers of infants, health care workers, children and young adults, and older people with chronic conditions. Anthony Fiore, a physician and epidemiologist at CDC, told the committee that about 6% of H1N1 deaths and hospitalizations are among pregnant women (Brown, Washington Post, 7/30). According to a CDC study published online Wednesday in the journal Lancet, pregnant women who contract the H1N1 virus -- also known as "swine flu" -- are at least four times more likely to be hospitalized than other people with the virus, the AP/Google reports. The study analyzed the first 34 U.S. cases, including six deaths, in pregnant women from April to mid-June of 2009. Although it is not clear if pregnant women are more susceptible to the virus, they have a higher risk of complications after becoming infected. The study"s authors said pregnant women suspected of having H1N1 should be administered Tamiflu as soon as possible, prior to the completion of diagnostic testing. CDC"s Denise Jamieson, the lead author of the study, said that Tamiflu appears relatively safe for pregnant women, despite limited safety data on its use in that population.Most pregnant women who contract H1N1 have mild flu symptoms like a cough or fever, according to the World Health Organization. Jamieson said that CDC does not recommend specific precautions for pregnant women but that doctors should act quickly -- preferably within 48 hours -- if a pregnant woman shows symptoms. She added that the pregnant women who died were basically healthy, and nearly all had viral pneumonia before experiencing acute respiratory problems prior to their death (Cheng, AP/Google, 7/29).CDC"s priority groups include about 159 million people out of a total U.S. population of more than 300 million, the Chicago Tribune reports. The agency expects to have about 120 million doses of the vaccine by the end of October. Officials are confident there will be enough for their target groups because only 20% to 50% of those recommended to receive seasonal flu vaccines seek them out. However, if supplies of the vaccine are unexpectedly restricted, the panel recommended that a smaller group -- about 41 million of the most susceptible to adverse side effects from infection or most likely to spread the virus -- be given priority for the vaccine. This smaller group also includes pregnant women (Maugh, Chicago Tribune, 7/30).
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Complaints By The Elderly Valuable Information Or Trivialities?
What is done when the elderly lodge complaints about their services? elderly care? Why is it that staff describe complaints made by the elderly as "trivialities"? In two recent studies, Tove Persson, doctoral student at the School of Health Sciences, shows that staff, as well as social services directors in local administrations often trivialize complaints from the elderly, which in turn makes it difficult for the elderly to influence their everyday lives.
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Better Monitoring, Better Prognosis In Liver Disease

The latest research in liver disease being presented at Digestive Disease Week® 2009 (DDW®) has important implications for tracking disease development in patients and for current and future transplant recipients. Researchers are making great strides in diagnosing and treating liver disease. "The research being presented during DDW shows how widespread our efforts are in understanding and treating liver disease," said Brent Tetri, MD, Saint Louis University. "These studies take us one step closer to better monitoring of liver disease, improving our ability to accurately determine prognosis, more appropriate organ allocation and lower rejection rates in liver transplantation." DDW is the largest international gathering of physicians and researchers in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery. Text Messaging Reduces Rejection in Pediatric Liver Transplant Recipients (Abstract #175) Text messaging may improve compliance rates in pediatric liver transplant recipients, reduce organ rejection and provide significant cost savings with medications and hospitalizations, according to a new study. Children and adolescents who receive liver transplants often have trouble remembering to take their medication regularly; in addition to being less vigilant than adults, liver patients also suffer memory problems. Missing medication is especially dangerous since their bodies can reject the transplanted liver after only two missed doses of medication. But because young people are generally technologically savvy, researchers sought to determine whether sending text messages would result in improved adherence. The study looked at 41 young people who were on average 15 years old and at various stages after receiving a liver transplant. The MediM AS system from CareSpeak Communications, which funded the study, was used to decide which time of day patients/or caregivers preferred to receive a medication reminder via text message, which were then sent accordingly. To ensure that patients not only received the message but also took their medication, patients had 15 minutes to send a reply text confirming intake. If they did not, MediM AS system would automatically alert their parents to follow up with their child via another text message. Researchers tracked by computer how many times patients replied, did not reply or had to have parental intervention. To determine the effectiveness of the text reminders, researchers looked at two factors: the level of medication in the patient"s blood and whether their bodies rejected the liver transplant. Patients who took medication erratically had a higher deviation of medication in their blood, compared to patients who took their medication regularly. In the year prior to the study, 12 of 41 patients experienced rejection that required hospitalization and treatment because the patient"s body rejected the transplant due to improper medication dosage. But one year into this study, just two patients suffered rejection of the liver. Lead investigator Tamir Miloh, MD, assistant professor in pediatric hepatology and surgery at Mount Sinai Hospital in New York, said that since one liver transplant for graft loss costs a few hundred thousand dollars, and with the costs associated with rejection therapy, the text reminders may help save res and reduce complications of rejection therapy. "The implications for this study are vast because this practice could be used for many other chronic diseases," said Dr. Miloh, who is currently conducting another randomized study with more patients. Previous studies have looked at the effectiveness of text reminders, but not on liver patients and not on a scale of this size. Dr. Miloh presented these data on Sunday, May 31. The Point of Care 13C Methacetin Breath Test Accurately Predicts Long Term Prognosis with Chronic Liver Disease: A Non-Invasive Liver Function Test (Abstract #S1837) Researchers at the Hadassah Hebrew University Medical Center in Israel have discovered an effective new tool for assessing the prognosis of patients with chronic liver disease that could have important implications in determining which patients are most appropriate candidates for liver transplantation. Previously, prognosis in patients with chronic liver disease has been determined by using a combination of blood tests. However, this method is limited to predicting prognosis for up to three months and may only change after a life threatening complication has occurred. Using a test called the 13C-Methacetin breath test, a rapid, non-invasive procedure, investigators were able to accurately predict the survival of liver disease patients for a period of up to two years. The test is conducted with the patient drinking a cup of water containing a dissolved substrate. The device then measures the appearance of tagged CO2 (the product of the hepatic metabolism of the 13C-Methacetin) in the exhaled breath; the patient does not do anything except sitting and breathing normally. Studying 575 patients with varying types and degree of liver disease, investigators showed that the breath test can predict which patients will develop complications that will affect their prognosis. "The potential for this test is tremendous," said Gadi Lalazar, MD, of the liver unit at the Hadassah Hebrew University Medical School. "Not only can we predict long term prognosis in patients with chronic liver disease, but we can also use it in acute liver disease to determine liver function on a daily basis and determine how well therapy is working. This is something we have never been able to do before." Researchers believe that the accuracy of the test, and its capacity to assess liver function, makes the breath test a potentially powerful new tool in predicting prognosis of liver related complications, prioritizing patients for organ transplantation, and predicting their ability to survive surgery. Dr. Lalazar presented these data on May 31. Cumulative Incidence and Risk Factors of Hepatocellular Carcinoma (HCC) in Patients with End-Stage Liver Disease Secondary to Nonalcoholic Steatohepatitis (Abstract #290) There is a significant risk of developing of liver cancer in patients with nonalcoholic steatohepatitis, or NASH, according to a study from the Cleveland Clinic. The study also found that mild alcohol consumption may significantly increase the risk of developing liver cancer in patients with end stage liver disease. NASH is one of two stages of non-alcoholic fatty liver disease, the most common liver disease in the U.S. Unlike the benign stage known as fatty liver, NASH has the potential to cause cirrhosis and liver failure. Until now, evidence linking NASH with liver cancer has been limited and inconsistent. In a retrospective study of more than 500 patients with either HCV-cirrhosis (hepatitis C) or NASH-cirrhosis over a three year period, researchers found that 20 percent of patients with HCV-cirrhosis and 12.8 percent of patients with NASH-cirrhosis developed hepatocellular carcinoma (liver cancer). The annual risk for developing liver cancer in HCV patients is 4 percent per year and that of NASH patients is 2.6 percent per year. The annual risk for NASH patients was previously unknown. While the rates are higher for patients with HCV, the risk of developing liver cancer for NASH patients is significant. Investigators also sought to identify modifiable risk factors in effort to potentially reduce the burden of liver cancer in this patient population. They found that even mild alcohol consumption may significantly increase the liver cancer risk in patients with end-stage liver disease. "This study offers valuable insight into the care of patients with NASH," said Nizar N. Zein, MD, chief of hepatology and medical director of liver transplantation at the Cleveland Clinic. "Not only do we need to adjust the way we follow these patients, including tracking and preparing for the potential development of liver cancer, but we may also need to counsel this patient population against any alcohol intake given its risk." Dr. Zein presented these data on June 1. Public Awareness and Attitudes towards Non Alcoholic Fatty Liver Disease (NAFLD) (Abstract #T1006) Patient awareness of non-alcoholic fatty liver disease (NAFLD) and its complications is poor and must be improved to ensure prevention, detection and treatment of the condition. NAFLD is the most common cause of abnormal liver enzymes and one of the most common causes of cirrhosis of the liver in the U.S. It poses a significant health burden worldwide. In the U.S., chronic liver disease and cirrhosis are the tenth leading cause of death. Researchers conducted a survey of 5,000 outpatient adults asking about awareness levels of NAFLD and its risk factors. Ninety-eight percent of the patients said their physicians had never talked about NAFLD with them. By contrast, a previous study on colorectal cancer found that 40 percent were aware of that disease and its risk factors. "It is both disturbing and significant that a surprisingly high number of respondents were uninformed about this silent but deadly disease," said Sury Anand, MD, chief of gastroenterology at Brooklyn Hospital Center. The survey also found that 95 percent did not realize that fat in the liver could cause serious health problems and 80 percent had never heard of cirrhosis. Dr. Anand said prevention is especially critical since treatment options for NAFLD are limited. Public awareness of NAFLD must rise to the level of other chronic diseases and conditions, which can best be achieved with the active participation of primary care physicians, pediatricians and other providers in counseling their patients to adopt preventive lifestyle modifications. He recommends that doctors encourage patients to maintain healthy weight by having a good balanced diet and regular exercise to fend off NAFLD in the similar way that patients need

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