all Department of Health Care Policy stories

Percentage of Katrina survivors with mental disorders increasing

404132862 — Sun, 04 Nov 2007 13:15:53 -0500

According to the most comprehensive survey yet conducted of people affected by Hurricane Katrina, the percentage of pre-hurricane residents of the affected areas in Alabama, Louisiana, and Mississippi who have mental disorders has increased significantly compared to the situation five to eight months after the hurricane.

Obesity is contagious

404132862 — Thu, 26 Jul 2007 15:37:43 -0400

Public health officials have been working hard to account for the dramatic rise in U.S. obesity rates. Many obvious factors, such as poor diet and a sedentary lifestyle, certainly contribute to the swelling statistics. However, these and other explanations tend to focus exclusively on how individuals’ choices and behaviors affect their own weight.

Now, researchers from Harvard Medical School and the University of California, San Diego have found that obesity is hardly a private matter. Reporting in the July 26 edition of the New England Journal of Medicine, the researchers found that obesity spreads through social ties.

Prostate cancer treatment increases risk of diabetes, heart disease

70652986 — Mon, 26 Mar 2007 06:28:11 -0400

A treatment mainstay for prostate cancer puts men at increased risk for diabetes and cardiovascular disease, according to a large observational study published in the Sept. 20, 2006, Journal of Clinical Oncology.

"Men with prostate cancer have high five-year survival rates, but they also have higher rates of non-cancer mortality than healthy men," says study author Nancy Keating, MD, MPH, assistant professor of health care policy and of medicine at Harvard Medical School. "This study shows that a common hormonal treatment for prostate cancer may put men at significant risk for other serious diseases. Patients and physicians need to be aware of the elevated risk as they make treatment decisions."

The principal systemic therapy for prostate cancer involves blocking testosterone production. This is done either by removal of the testes (bilateral orchiectomy), or more commonly, by regular injections of a gonadotropin-releasing hormone (GnRH) agonist drug. GnRH agonists are the main therapy for metastatic prostate cancer and may also improve survival for some men with locally advanced cancers.

However, little is known about the efficacy of GnRH agonists in treating men with less-advanced local or regional prostate cancer, many of whom receive this therapy. Earlier studies have found GnRH agonists to be associated with obesity and insulin resistance, a precursor to diabetes.

"Our study found that men with local or regional prostate cancer receiving a GnRH agonist had a 44 percent higher risk of developing diabetes and a 16 percent higher risk of developing coronary heart disease than men who were not receiving hormone therapy," says Keating, who is also a physician at Brigham and Women's Hospital.

"Doctors should think twice about prescribing GnRH agonists in situations for which studies have not demonstrated improved survival until we better understand the risks of treatment," says co-author Matthew Smith, MD, PhD, associate professor of medicine at HMS and a medical oncologist at Massachusetts General Hospital. "For men who do require this treatment, physicians may want to talk with their patients about strategies, such as exercise and weight loss, which may help to lower risk of diabetes and heart disease."

This work was supported by the Prostate Cancer Specialized Program of Research Excellence (SPORE) of the National Cancer Institute, one of the National Institutes of Health.

Under-diagnosed rage disorder more prevalent than previously thought

70652986 — Mon, 26 Mar 2007 06:27:47 -0400

A seldom-studied mental illness called Intermittent Explosive Disorder, characterized by recurrent episodes of angry and potentially violent outbursts — seen in cases of road rage or spousal abuse — has been found to be much more common than previously thought.

Depending upon how broadly it is defined, this disorder affects as many as 7.3 percent of adults, or 16 million Americans, in their lifetimes. In a year, Intermittent Explosive Disorder affects nearly 4 percent of Americans, or 8.6 million adults, reports Ronald Kessler, PhD, professor of health care policy at Harvard Medical School, and colleagues. The study also found that Intermittent Explosive Disorder may predispose people to other mental illnesses and substance abuse. These results are reported in the June 2006 issue of Archives of General Psychiatry.

Intermittent Explosive Disorder attacks are out of proportion to the social stressors triggering them and are not due to another mental disorder or the effects of drugs or alcohol, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). People with this disorder overreact to situations with uncontrollable rage, feel a sense of relief during the angry outburst, and then feel remorseful about their actions.

"Intermittent Explosive Disorder is not a clinical term well- known in society, but the weight of these numbers should help patients and physicians come to recognize the pervasiveness of this disorder and develop appropriate treatment strategies," says Kessler, senior author of the study. The study is based on data from the National Comorbidity Survey Replication (NCS-R), a nationally representative face-to-face household survey of 9,282 American adults, conducted from 2001 to 2003. The NCS-R is carried out in conjunction with the World Health Organization World Mental Health Survey Initiative.

This work was funded by the National Institute of Mental Health, the National Institute on Drug Abuse, the Substance Abuse and Mental Health Services Administration, the Robert Wood Johnson Foundation, and the John W. Alden Trust.

Whites more likely than blacks to die soon after spouse's death

70652986 — Mon, 26 Mar 2007 06:24:40 -0400

A longitudinal study of 410,272 elderly American couples indicates that the "widowhood effect" - the increased probability of death among new widows and widowers - is large and enduring among white couples but undetectable among black couples, suggesting that blacks may somehow manage to extend marriage's well-documented health benefits into widowhood.

The results, by Harvard sociologists Felix Elwert and Nicholas A. Christakis, are published in the February 2006 issue of American Sociological Review.

"The health effects of a spouse's death differ radically between blacks and whites," says Elwert, a doctoral student in sociology. "We found strong evidence of the widowhood effect among white couples: Men were 18 percent more likely to die shortly after their wives' deaths, and women were 16 percent more likely to die shortly after their husbands' deaths. By contrast, the estimated effect of a black spouse's death on the mortality of his or her surviving spouse is essentially zero."

Upon marrying, blacks and whites appear to receive the same health benefits, which previous research has attributed to factors such as emotional support, economic well-being, caretaking when ill, enhanced social support and kinship, and the promoting of healthy behaviors and discouraging of taking risks. Elwert and Christakis suggest such benefits may be longer-lasting for blacks, persisting even after a spouse's death.

Citing prior research, the investigators identify several possible reasons for this enduring marriage benefit among blacks. Almost twice as likely to live with relatives and far more active in religious organizations, elderly blacks tend to have stronger and more extensive social networks than elderly whites. Black couples are also less likely than whites to adhere to a rigidly gendered division of labor, which may reduce mutual dependence.

The 'widow effect' is real

70652986 — Mon, 26 Mar 2007 06:24:53 -0400

In findings that highlight how health effects can reverberate through a social network, a researcher at HMS and his colleague report that the serious illness of an elderly spouse increases the risk of death of a husband or wife. In fact, a few illnesses in a spouse, such as dementia, may pose more of a risk to the partner than if the spouse had died.

It was already known that disease in one spouse can harm the health of a partner. Many studies have shown that a spouse’s demise can be fatal to the other half. The new analysis extends this literature.

Harvard studies Katrina survivors

70652986 — Mon, 26 Mar 2007 06:23:44 -0400

A new project, funded by a $1 million grant from the National Institute of Mental Health, will recruit Katrina survivors around the country to serve on the Hurricane Katrina Community Advisory Group.

The group, numbering 2,000 survivors - half from New Orleans and half from other affected areas - will speak every three months by phone with trained interviewers who will solicit specific information as well as give the survivors an opportunity to tell their stories in an open-ended fashion. The information will appear in a series of online reports available to the general public.

"We plan to stay with this group over the next two years so that we can keep our fingers on the psychological pulse of this population," said Ronald Kessler, professor of health care policy at Harvard Medical School and one of the advisory group's scientific collaborators.

Each interview will include a recorded oral history with descriptions of each advisory group member's experiences during and after the hurricane in order to build a permanent archive that can be used by historians, policymakers, the press, and the public to understand the experiences of people who lived through Katrina. These recordings will be placed on the initiative's Web site: http:// www.HurricaneKatrina.med.harvard.edu. Both oral histories and quantitative information will be collected and presented to policymakers.

Study shows new compound may reduce risk of vision loss in patients with diabetes

70652986 — Mon, 26 Mar 2007 06:21:31 -0400

The PKC-Diabetic Retinopathy Study (DRS) was designed to evaluate the safety and effect of an oral treatment, RBX, on retinopathy progression or visual loss in patients with moderately severe to very severe nonproliferative diabetic retinopathy. In the study, patients with type 1 or type 2 diabetes received either RBX or a placebo over three to four years. The study measured the effect of three orally administered doses of RBX on progression of diabetic retinopathy, moderate visual loss and sustained moderate visual loss. The study was conducted at Joslin Diabetes Center and assorted national and international medical centers.

The oral treatment RBX inhibits the activity of the enzyme protein kinase C. PKC is essential to the normal production of energy in the body, but one form of the enzyme - PKC-beta - has been linked to diabetic complications of the eye and other parts of the body. Thus RBX was designed to be selective for the single PKC-beta isoform.

"Our results demonstrate that although RBX did not prevent progression to proliferative diabetic retinopathy, it may reduce the risk of moderate vision loss caused by macular edema," said study chairman Lloyd Paul Aiello, M.D., Ph.D., head of Joslin's section on eye research, director of Joslin's Beetham Eye Institute and associate professor of ophthalmology at Harvard Medical School.

Suicides are down, researchers say

70652986 — Mon, 26 Mar 2007 06:19:33 -0400

The suicide rate among men and women ages 18 to 54 years fell 6 percent since 1990. In 1990-92, the rate was approximately 15 out of every 100,000 adults. It was down to about 14 out of 100,000 in 2000-02. At the same time, 3,000 out of every 100,000 people reported that they had suicidal thoughts, and 500 of every 100,000 actually attempt suicide. These numbers come from National Comorbidity Surveys from 1990-92 and 2001-03.

Possible reasons for the study's findings are that suicide-related behaviors would have increased instead of remaining static without treatments that have successfully lowered completed suicides, or that new treatments are up dramatically, but the pain remains.

But Ronald Kessler, professor of health care policy at Harvard Medical School, rejects these theories, explaining that most patients receive inadequate treatment and that increased treatment is too late or ineffective.

To reduce suicidal behavior, Kessler and his colleagues want to see improvements in the quality of care and in letting suicidal people know help is out there for them. He characterizes available treatments as a "hodge podge," varying widely among primary care physicians, psychologists, and psychiatrists, although guidelines admittedly exist.

Kessler says that although advocate groups and celebrities encourage people to seek help, there is still much work to be done in the fight against suicide.

Study challenges proposed changes to clinical definition of mental illness

70652986 — Mon, 26 Mar 2007 05:38:05 -0400

As the American Psychiatric Association prepares for the Diagnostic and Statistical Manual of Mental Disorders's fifth edition, there is debate over whether to eliminate milder forms of diseases to prevent overtaxing the mental health care system.

According to Ronald Kessler, HMS professor of health care policy, tightening the DSM's definitions is a serious matter.

Improved procurement could more than double organ availability

70652986 — Mon, 26 Mar 2007 05:31:55 -0400

Although millions of people across the country are registered organ donors, only 2 percent of them annually suffer brain death and meet the other medical requirements for being a cadaveric donor. The U.S. Department of Health and Human Services suggests that the number of actual donors may be further limited by organ procurement organizations that do not utilize the most efficient practices. Though the need for transplantable organs far outweighs the supply, the number of organs donated could actually be more than doubled -- saving thousands of lives every year -- if the procurement process were improved. These findings by researchers from Harvard Medical School, Boston University, and the Institute for Healthcare Improvement appeared in the summer issue of Health Care Financing Review. "We needed to know if we have a supply of potential donors who can meet the demand for organs," said Edward Guadagnoli, first author on the study and an associate professor of health care policy at Harvard Medical School. "We didn't know until we used a statistical model to estimate that number." The researchers determined that the number is about 17,000 potential donors each year.

Millions of Americans suffer from major depression

70652986 — Mon, 26 Mar 2007 06:18:59 -0400

A Harvard Medical School study found high rates of depression throughout the U.S. population. The researchers analyzed the depression of over 9,000 Americans and evaluated depression's effect on daily activities and treatment received, if any.

Critics have theorized that depression has been reported as more widespread than it really is, said survey leader Ronald Kessler, HMS professor of health care policy. "But we found that the majority of people with depression are severe cases, and only a small minority are mild cases."

The inadequate treatment received by 80 percent of those who were treated sprang from inappropriate dosing of antidepressants by physicians, patient discontinuation of treatment, and the use of unproven treatments. "Emphasis on screening and expansion of treatment needs to be accompanied by a parallel emphasis on treatment quality improvement," Kessler's team writes.

The study found that women and people previously married were most at risk for major depression over a lifetime; in a 12- month period, depression was more common among homemakers, people never married, and those who had not completed high school or who were living in poverty.

The researchers found depression affects roughly 6.6 percent of American adults in a given year, and 16.2 percent of American adults in a lifetime.

Wide variation in physician career satisfaction seen across local markets

70652986 — Mon, 26 Mar 2007 05:27:47 -0400

Physician career satisfaction levels are relatively consistent from year to year, and a clear majority of physicians nationally are satisfied with their careers. However, a survey showed significant variation in satisfaction levels across local health care markets. It also found that nationally, 18 percent of physicians were somewhat or very dissatisfied. "Physician career satisfaction is one indicator of the overall health of our health care delivery system," says lead author Bruce Landon, assistant professor of health care policy and medicine at the Harvard Medical School Department of Health Care Policy and Beth Israel Deaconess Medical Center. "For example, excellent, but dissatisfied physicians could decide to leave the practice of medicine early, and highly talented students might opt for different career paths if the perception exists that medicine is not a fulfilling career," he said. "Both of these outcomes would clearly weaken patient care and the health care system in general." For each of three years, roughly 80 percent of primary care and specialist physicians were somewhat or very satisfied with their careers, and nearly 18 percent were somewhat or very dissatisfied with their careers. The results appeared in the Jan. 22, 2003 Journal of the American Medical Association.

Outpatient cardiology care improves survival odds after heart attack

70652986 — Mon, 26 Mar 2007 05:27:54 -0400

Previous research suggests that patients may live longer if they are under a cardiologist's care while hospitalized for myocardial infarction. In a new study, John Ayanian, Harvard Medical School associate professor of medicine in the Department of Health Care Policy, and colleagues examined the records of patients covered under Medicare to see whether this held true for outpatient care. They found that elderly heart attack patients who visit a cardiologist's office in the months after leaving the hospital are less likely to die within two years than patients who visit only their primary care doctor, and patients who visit both a cardiologist and a primary care doctor have even better outcomes.

Information Age will change doctors' role in healing

70652986 — Mon, 26 Mar 2007 05:25:14 -0400

Even as the Internet allows patients access to information previously only available through their doctors, patients still trust the information they get from their doctors more than they do from Web sites, current surveys suggest. Because of this, doctors may fill the role of advisers or consultants, helping patients not only sort through the information that is available, but make rational decisions based on that information. Writing in the Milbank Quarterly, Professor of Medicine David Blumenthal explains that with an increasing number of patients having access to an increasing amount of health information through the Internet, doctors are losing their place in society as the exclusive source of medical knowledge. This trend has the potential, at a minimum, to greatly reduce the current imbalance in competence between doctors and laypersons, possibly resulting in a de-professionalization of medicine. "Supported by humanity's need for a healing class and by physicians' genuine technical competence, the [medical] profession will survive," says Blumenthal, of Massachusetts General Hospital. "However, the work it does will likely change somewhat, as will its role in society and the relationships between doctors and patients."