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Nearly one in five, or about 300,000, soldiers who has served in Iraq or Afghanistan has post-traumatic stress disorder or major depression — illnesses that could cost the U.S. as much as $6.2 billion over two years in care, lost productivity and lost lives through suicide, according to a RAND report released on Thursday, the Washington Post reports (Scott Tyson, Washington Post, 4/18). The study was based on telephone interviews conducted from August 2007 to January with 1,965 soldiers who have served in Iraq or Afghanistan, in some cases more than once. The soldiers interviewed live in 24 communities with high concentrations of service members, reservists and veterans. Researchers also conducted focus groups. About 1.6 million people have served in Iraq or Afghanistan in the past five years (Alvarez, New York Times, 4/18).
In total, 31% of Iraq and Afghanistan soldiers have experienced a brain injury, stress disorder, or both, the report found. The study found that 19.5% of service members experienced a concussion or other traumatic brain injury during their service (Barnes, Los Angeles Times, 4/18). Of soldiers who reported having a traumatic brain injury, 43% were evaluated by a physician. The report also found that about 7% of soldiers surveyed have a probable brain injury and currently have PTSD. PTSD and major depression were most prevalent in women and reservists, according to the report (Jelinek, AP/Miami Herald, 4/18). The treatment costs for brain injuries have not been determined, but according to the report, based on the number of traumatic brain injury cases diagnosed through June 2007, the cost is expected to be between $600 million and $900 million.
According to the report, the stress of war has resulted in a disproportionately high psychological toll compared with physical injuries. The report warns of "long-term, cascading consequences" for the U.S. if the mental health problems are not treated. Consequences include higher rates of drug use, suicide and unemployment, and increased marital problems (Washington Post, 4/18).
The study was funded by a grant from the Iraq Afghanistan Deployment Impact Fund at the California Community Foundation (Carter, Washington Times, 4/18).
Treatment
The report also found "serious gaps in mental health care," according to the Post. According to the report, 53% of service members with PTSD or depression had sought treatment from a provider in the past year, about half of whom received "minimally adequate" treatment. To care for all of the service members, thousands more certified mental health professionals are needed in both military and civilian sectors, as some veterans are seeking care outside of the Department of Veterans Affairs system because of stigma attached to mental illness, according to the report (Washington Post, 4/18).
Terri Tanielian, one of the study’s authors, said, "When we asked folks what was limiting them from getting the help that they need, among the top barriers that were reported were really negative career repercussions." While the treatment costs might seem high to government officials, failure to treat mental illness could cost the government billions of dollars, according to Lisa Jaycox, another one of the study’s authors. She said, "We make the case that investing in treatment early would prevent some of the negative consequences from unfolding and save money."
Recommendations
The study recommended allowing service members to receive mental health care "off the record," to avoid any possible stigma. Researchers also recommended that fitness-for-duty reports for redeployment not be based on a soldier’s decision to seek mental health care (Los Angeles Times, 4/18). According to Jaycox, Department of Defense Secretary Robert Gates is considering removing a question from security clearance questionnaires about soldiers’ health care history. Col. Loree Sutton, head of the Defense Center of Excellence for Psychological Health and Traumatic Brain Injury, said removing the question would be a "big step forward to help our service members understand that seeking care, in fact, is a sign of strength" (New York Times, 4/18).
Gerald Cross, the VA’s principal deputy undersecretary for health, said VA was increasing outreach to veterans, regardless of whether they reported mental illness. Ira Katz, the VA’s mental health chief, said the VA budget for mental disorders increased from $2 billion in 2001 to $4 billion next year. However, Paul Sullivan, executive director of Veterans for Common Sense, said, "The VA is completely unprepared for the tidal wave," adding, "Unless the VA gets a massive amount of money (and) a set of new strong pro-veteran leaders, the situation will collapse" (Los Angeles Times, 4/18).
The report is available online.
Generic soma pills no prescription CBS’ "Evening News" on Thursday reported on the study. The segment includes comments from Carissa Picard of Military Spouses for Changes, Col. Casper Jones and a soldier diagnosed with PTSD (Dozier, "Evening News," CBS, 4/18). Video of the segment and expanded CBS News coverage are available online.
NBC’s "Nightly News" on Thursday also reported on the study. The segment includes comments from Tanielian and Sutton (Miklaszewski, "Nightly News," NBC, 4/17). Video of the segment is available online.
Reprinted with kind permission from You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
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A study recommended by David Spiegel of Faculty of 1000 Medicine (), looks at the relationship between depression care management and survival rates in older patients. He identifies it as "an important and well-conducted study of the effects of treatment of depression on survival in a primary care setting"
A leading authority on mind-body interactions and professor of psychiatry and behavioural sciences at Stanford University, Spiegel evaluates the research published in the Annals of Internal Medicine, stressing the finding that "Comorbid depression shortens survival time with cancer, and intervention with medication and psychotherapy can therefore extend survival among cancer patients."
The better survival rates were not seen in patients with depression and cardiovascular disease, only in those with cancer. Spiegel notes that this "is surprising given the well-known link between depression and poor cardiovascular disease outcome".
He concludes, "Vigorous diagnosis and treatment programs for comorbid depression in cancer patients should, based on this study, extend survival time."
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Article adapted by Medical News Today from original press release.
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1 Dr. David Spiegel, Faculty Member for F1000 Medicine Psychiatry Specialty, is a global authority on mind-body interactions and professor of psychiatry and behavioural sciences at Stanford University
2 The effect of a primary care practice-based depression intervention on mortality in older adults: a randomized trial.
Gallo JJ, Bogner HR, Morales KH, Post EP, Lin JY, Bruce ML
Ann Intern Med 2007 May 15 146(10):689-98

3 Faculty of 1000 Medicine’s evaluation of this article is available at
4 Faculty of 1000 Medicine, is a unique online service that helps clinicians and researchers stay informed of high impact articles and access the opinions of global leaders in medicine. Buy synthroid without prescription A distinguished international faculty select and evaluate key articles across medicine, providing a rapidly updated, authoritative guide to the medical literature that matters.
Source: Jemima Tonks
BioMed Central
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Researchers at National Jewish Medical and Research Center are conducting trials to evaluate a method to prevent allergic reactions to food. They are feeding peanut- and egg-allergic people increasing doses of an investigational protein extract from the foods to see if they can induce the participants’ immune systems to tolerate the food.
"We hope these trials will lead to the development of the first active, preventive treatment for food allergies," said pediatric allergist David Fleischer, MD, principal investigator for the National Jewish studies. "If successful, it would offer great hope for allergic patients and their families, whose lives are haunted by a daily fear of food."
Currently the only advice doctors can give to the estimated 12 million Americans who have food allergies is to avoid the food and carry a self-injectable dose of epinephrine in case they accidentally consume the allergenic food. There is no treatment available to prevent an allergic reaction to food other than strict avoidance of that food. It can often be difficult to determine if a food contains peanuts or eggs, especially when eating at a restaurant or food prepared by another person. It can even be difficult recognizing egg and peanut proteins listed on food ingredient labels, especially from products that are not manufactured in the U.S. As a result, thousands of people rush to emergency rooms every year suffering severe allergic reactions to food. As many as 200 people die from allergic reactions to food each year.
Allergists treating hay fever and other allergies have long used immunotherapy, also known as allergy shots, to reduce their patients’ sensitivity to pollen, cat and dog dander, and dust mites. However, it is not considered safe to give allergy shots to food-allergic patients because the shots can cause severe allergic reactions. Previous research has suggested that placing the allergenic food protein under the tongue or directly swallowing it, are safer methods of administering food immunotherapy. So that is how National Jewish researchers will try to desensitize allergic patients in the trials.
Study participants (ages 12-40 years for peanut allergy and 6-18 years for egg allergy) will start by consuming tiny amounts of either egg or peanut protein. Physicians and staff at National Jewish will observe them closely to see if they have any symptoms of an allergic reaction. Over the course of several months, participants will consume the protein daily at home, coming in every couple of weeks or so to slowly ramp up the amount of protein they consume until they reach a "maintenance dose."
Buy lasix without prescription Shortly after reaching the maintenance dose, participants will be tested with a larger amount of either egg or peanut to see if the immunotherapy has reduced the immune system’s response. Participants will continue taking the maintenance doses for one to three years to see if they can achieve long-term results. Six to eight weeks after discontinuing the immunotherapy, participants will again consume a larger amount of peanut or egg to see if they have become tolerant of the food.
"In traditional immunotherapy, the majority of hay fever patients achieve tolerance, which can last for years," said Dr. Fleischer, the principal investigator for the National Jewish study. "We hope to achieve similar results for our food allergic patients."
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Article adapted by Medical News Today from original press release.
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National Jewish is participating in this research as part of the Consortium of Food Allergy Research, a network of academic medical centers funded by the National Institute of Allergy and Infectious Diseases. The researchers are all highly experienced food allergists who have conducted thousands of food challenges.
Other participants in the research are the Mount Sinai School of Medicine in New York; John Hopkins University School of Medicine in Baltimore; Duke University School of Medicine in Durham, NC; and the University of Arkansas Children ’s Hospital Research Institute in Little Rock, AR.
Source: William Allstetter
National Jewish Medical and Research Center
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A hypertension medication called olmesartan medoxomil is effective in reversing the narrowing of the arteries that occurs in patients with high blood pressure, according to a new study.
Carlos M. Ferrario, M.D., one of the study’s lead investigators and director of the Hypertension and Vascular Research Center at Wake Forest University Baptist Medical Center, said, "We believe the data add to the growing evidence for the role of angiotensin receptor blockers in preventing or reversing vascular damage at many stages during this disease process."
The one-year study, titled Vascular Improvement with Olmesartan medoxomil Study (VIOS), was published in the current Journal of the American Society of Hypertension. The study evaluated the effects of an angiotensin receptor blocker (olmesartan medoxomil) vs. a beta-blocker (atenolol) on vascular function and structure in patients with stage 1 hypertension.
Olmesartan medoxomil is marketed in the United States as Benicar® and in Europe as Olmetec® by Daiichi Sankyo, Inc., which funded the study.
After one year of treatment, olmesartan medoxomil improved the artery abnormalities in high blood pressure patients and returned arterial architecture to normal levels. This was not seen with the atenolol.
Olmesartan medoxomil is a member of a class of antihypertensive medications that help lower blood pressure by blocking the angiotensin II receptor on the blood vessels that causes constriction and increase blood pressure. This medication also blocks the release of a hormone that causes salt retention and increased blood volume.
Hypertension affects one in three Americans and, if left uncontrolled for a long time, can cause organ damage, as well as heart disease, stroke and other problems.
Olmesartan is currently being reviewed in several trials, including the Randomized Olmesartan and Diabetes Microalbuminuria Prevention study (ROADMAP), which is investigating the drug’s effectiveness in preventing early stage kidney disease in 4,400 patients with type 2 diabetes.
The VIOS results were presented at the Hypertension 2008 symposium, a scientific conference co-hosted by the European and International Societies of Hypertension. Dr. Ferrario was in Berlin, Germany, for the symposium, where he conducted interviews with international media about the significance of the VIOS data.
Ferrario, professor of surgical sciences and of physiology and pharmacology, is the Dewitt Cordell Professor of Surgical Research at Wake Forest Baptist. His outstanding achievements in cardiovascular research include his breakthrough discoveries concerning the renin-angiotensin system and the use of novel antihypertensive medications for the prevention of heart attacks and strokes.
An internationally recognized center for the investigation of vascular disease and hypertension, the Hypertension & Vascular Research Center provides comprehensive care for hypertension and vascular disease, a mobile blood pressure clinic, early screening and management of peripheral artery disease.
Since it was established at Wake Forest, the Hypertension and Vascular Research Center has raised more than $23 million in funding from the National Institutes of Health and the American Heart Association. In addition, more than $3 million in grants have been awarded by pharmaceutical companies. The center has been awarded grant revenues totaling $4.7 million this academic year.
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Article adapted by Medical News Today from original press release.
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Wake Forest University Baptist Medical Center () is an academic health system comprised of North Carolina Baptist Hospital, Brenner Children’s Hospital, Wake Forest University Physicians, and Wake Forest University Health Sciences, which operates the university’s School of Medicine and Piedmont Triad Research Park. The system comprises 1,154 acute care, rehabilitation and long-term care beds and has been ranked as one of "America’s Best Hospitals" by U.S. generic propecia online buy News & World Report since 1993. Wake Forest Baptist is ranked 32nd in the nation by America’s Top Doctors for the number of its doctors considered best by their peers. The institution ranks in the top third in funding by the National Institutes of Health and fourth in the Southeast in revenues from its licensed intellectual property.
Source: Ann Hopkins
Wake Forest University Baptist Medical Center
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UroToday.com - A group from the UK led by Bridget Candy report a meta-analysis in the BJU International on phosphodiesterase type 5 inhibitors (PDE5i) for the treatment of erectile dysfunction (ED) secondary to treatments for prostate cancer (CaP).
Only randomized controlled trials were included and outcomes using validated scales such as the IIEF and SEP, successful sexual intercourse, time to effect, treatment satisfaction and health-related QOL were extracted. Of 10,340 citations, only 5 met full inclusion criteria for this review. In total, 959 men participants were included, 2 trials were multi-centered, 2 were cross-over designs, and all were pharmaceutical company funded. Two trials evaluated the effects of sildenafil, 2 tadalafil and one vardenafil. Most were at the highest recommended doses of these drugs. The authors rate the design of the 5 trials as fair. Attrition bias in the studies was 13-25%.
In all trials the PDE5i drugs were significantly favored over placebo. generic ultram online buy In 2 trials the combined odds ratio for improvement in erections was 10.09. In one trial the OR from successful intercourse was 2.88. All trials had reported side effects, most commonly dyspepsia, flushing, headache, nausea and rhinitis. In combined data from 2 trials totaling 513 patients, significantly fewer patients receiving the PDE5i withdrew secondary to inefficacy. In one trial, the effectiveness of the PD5i by dosage and unilateral vs. bilateral nerve sparing radical prostatectomy found no difference.
BJU Int. 2008 Apr 10 (Epub ahead of print)
doi: 10.1111/j.1464-410X.2008.07668.x
Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS
UroToday - the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice.
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