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With the war in Iraq in its sixth year and a new generation of veterans requiring care, Geisinger Health System will host a conference May 13 that brings together military and civilian experts to better understand and meet the unique challenges faced by rural soldiers and their families.
The goal of the conference, Combat Stress Injuries/Posttraumatic Stress Disorder: Implications for Rural Veterans and Their Families, is to encourage regional healthcare workers to work together to triage vulnerable rural soldiers to the VA and other community agencies.
"We can improve the dissemination of behavioral healthcare in rural areas through partnerships and shared resources," said Geisinger President and CEO Glenn Steele Jr., MD, PhD. "This is an approach that could work nationally."
Today, rural soldiers returning from a deployment - and eager to get home - often find themselves miles away from the closest government facility. As a result, many postpone needed behavioral care.
The conference will focus on making sure rural soldiers receive timely care from the appropriate source. Attendees will include doctors, nurses, social workers, mental health counselors and veterans.
Florida State University Traumatology Institute Director Charles Figley, PhD is the keynote speaker. Buy fosamax without prescription Retired U.S. Army officer and former Wilkes-Barre television news anchor Keith Martin will serve as the conference moderator.
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Article adapted by Medical News Today from original press release.
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The Geisinger Rural Health Policy Institute and Florida State University Traumatology Institute are sponsoring the conference.
About Geisinger Health System
Founded in 1915, Geisinger Health System (Danville, PA) is one of the nation’s largest integrated health services organizations. Serving more than two million residents throughout central and northeastern Pennsylvania, the physician-led organization is at the forefront of the country’s rapidly emerging electronic health records movement. Geisinger is comprised of three medical center campuses, a 700-member group practice, a not-for-profit health insurance company and the Center for Health Research - dedicated to creating innovative new models for patient care, satisfaction and clinical outcomes. For more information, visit
Source: Patti Urosevich
Geisinger Health System
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Pfizer’s Lyrica reduced pain of fibromyalgia in patients regardless of whether they experienced symptoms of anxiety or depression at the beginning of the study, according to a pooled analysis presented today at the American Academy of Neurology annual meeting. The analysis, which looked at data pooled from previous clinical trials, also showed that patients’ self-reported improvements were more closely associated with improvements in pain and sleep than with improvements in fatigue or symptoms of anxiety or depression.
Fibromyalgia is the most common, chronic widespread pain condition in the United States and is thought to result from neurological changes in how patients perceive pain. Fibromyalgia is usually accompanied by poor sleep, stiffness and fatigue.
"The data showed that Lyrica reduced fibromyalgia pain, and alleviating that pain was associated with patients’ overall feeling of well-being," said Dr. Lesley Arnold, one of the study’s authors and associate professor in the department of psychiatry at the University of Cincinnati Medical Center. "Understandably, many patients with a chronic pain condition such as fibromyalgia also experience depression and anxiety, and importantly we found that Lyrica helped reduce pain in patients regardless of the presence of symptoms of these co-morbid conditions."
About the Analysis
Buy levitra without prescription The results are from a retrospective, pooled analysis of data from three placebo-controlled clinical trials (8 weeks, 13 weeks and 14 weeks long) of Lyrica in over 2,000 fibromyalgia patients. These studies randomized patients to receive Lyrica 150 mg, 300 mg, 450 mg or 600 mg or placebo. Patients were asked to measure their pain on a scale of zero to 10; the baseline score for study participants was 6.9 (150 mg, 450 mg, 600 mg) or 7.0 (300 mg). A score of 4.0 to 6.9 is considered moderate pain and a score of greater than 7.0 is considered moderate to severe pain on this 10-point scale.
In the studies, 38 percent of fibromyalgia patients had moderate to severe anxiety symptoms, while 27 percent had moderate to severe depressive symptoms, as assessed using the Hospital Anxiety and Depression Scales (HADS-A or HADS-D). Patients with severe depression or unstable psychiatric conditions were excluded from the studies.
The new analysis confirmed that Lyrica was significantly more effective than placebo in reducing pain in patients with fibromyalgia. Patients receiving 600 mg a day of Lyrica had a pain reduction of 2.08 on the pain scale; 450 mg a day had a reduction of 2.01; 300 mg a day had a reduction of 1.76; 150 mg a day had a reduction of 1.37, and placebo had a reduction of 1.25. Additionally, Lyrica was found to reduce pain in patients regardless of whether they had symptoms of anxiety or depression.
The analysis also examined the relationship between improvements in pain, sleep, fatigue, anxiety and depressive symptoms with patients reporting feeling "much improved" or "very much improved" as measured by the Patient Global Impression of Change (PGIC). The PGIC is a standardized, self-reported tool that measures the change in a patient’s overall status ranging from "very much improved" to "very much worse."
Pain reduction was found to have the greatest association on patients reporting improvement as measured by PGIC. The relationships between feeling much or very much improved were strongest for pain and sleep, and less pronounced for fatigue and symptoms of anxiety or depression, but statistically significant for all variables.
The most common side effects in the pooled analysis versus placebo of these three studies were dizziness and somnolence, followed by weight gain, blurred vision and dry mouth.
About Lyrica
In the United States, Lyrica® (pregabalin) capsules, CV, is approved for the management of fibromyalgia. Lyrica is also indicated for the management of neuropathic pain associated with diabetic peripheral neuropathy, postherpetic neuralgia (pain after shingles), and as adjunctive therapy for adults with partial onset seizures. The 600 mg/day is not an approved dosage for Lyrica in the management of fibromyalgia.
Important Safety Information
Lyrica is not for everyone. Lyrica may cause serious allergic reactions. Patients should tell their doctors right away about any serious allergic reaction such as swelling of the face, mouth, lips, gums, tongue or neck or if they have any trouble breathing. Other allergic reactions may include rash, hives and blisters. Patients should tell their doctors about any changes in eyesight, including blurry vision, muscle pain along with a fever or tired feeling, or skin sores due to diabetes.
Some of the most common side effects of Lyrica are dizziness, sleepiness, weight gain, blurred vision, dry mouth, feeling "high", swelling of hands and feet, and trouble concentrating. Patients may have a higher chance for swelling and hives if they are also taking angiotensin converting enzyme (ACE) inhibitors so they should let their doctors know if they are taking these medications. They may have a higher chance of swelling or gaining weight if they are also taking certain diabetes medicines.
Patients should not drive a car or operate machinery until they know how Lyrica affects them. Patients should not drink alcohol while on Lyrica. Patients should be especially careful about medicines that make them sleepy and should also tell their doctors if they are planning to father a child. Patients should tell their doctor if they are pregnant, plan to become pregnant, or are breast-feeding. If they have had a drug or alcohol problem, they may be more likely to misuse Lyrica. Patients should talk with their doctor before they stop taking Lyrica, or any other prescription medication. Lyrica is one of several treatment options for doctors to consider.

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Moving house or the separation of parents can significantly increase the risk of children developing allergies later on. These are the results from a long-term study correlating life-style, immune system development and allergies, led by the Helmholtz Center for Environmental Research in Leipzig (UFZ), the Helmholtz Zentrum Munchen and the "Institut f??r Umweltmedizinische Forschung" (IUF) in Duesseldorf. The researchers had examined blood samples taken from 234 six-year old children and discovered increased blood concentrations of the stress-related peptide VIP (vasoactive intestinal polypeptide) in connection with moving house or the separation of parents. The neuropeptide VIP could take on a mediator role between stress events in life and the regulation of immune responses, researchers write in the scientific journal Pediatric Allergy and Immunology. The fact that stress events can have an influence on the development of allergies has been known for a while. The mechanisms behind this however remained unexplained for a long time. In the study that has now been published, stress events were investigated for the first time during early childhood within a large epidemiological study using immune and stress markers.
Stress events during childhood are increasingly suspected of playing a role in the later development of asthma, allergic skin disorders, or allergic sensitisations. Dramatic life events like the death of a family member, serious illnesses of a family member or the separation of parents, but also harmless events like for example moving house are suspected of increasing the risk of allergies for the children affected. The immune system obviously plays a mediator role between stress on the one hand and allergies on the other. Since these mechanisms had hardly been understood before, researchers attempted to identify stress-related factors showing an influence on the immune system, in the context of an epidemiological study (LISA). At the same time as the blood tests, researchers together with colleagues from the Institute for Social Medicine at the University of L??beck also analysed the most diverse social factors in the children’s environment, in order to find out which factors are causing stress-related regulation deficiencies of the immune system. With children, whose parents had separated over the last year, researchers found increased blood concentrations of the neuropeptide VIP (vasoactive intestinal polypeptide) as well as an increased concentration of immune markers, which are related to the occurrence of allergic reactions, like for example the cytokine IL-4. By comparison, serious diseases or the death of close relatives led to no remarkable changes. Likewise, the unemployment of parents was not associated with increased concentrations of the stress-related peptides in the children’s blood. As tragic as these events are, they are obviously however of less significance for the stress reactions of children than for example a separation or the divorce of parents, UFZ researchers have concluded. As was already shown in an earlier publication from the same study, increased concentrations of the stress peptide VIP can also be proven in the blood of children after moving house (similar to the separation of parents). Preceding investigations in LISA showed that there is a relationship between an increased concentration of the neuropeptide VIP and allergic sensitisations among six-year old children. Even if the results were to be interpreted carefully, because of the comparatively small number of children affected, they nevertheless provide valuable indications as to what exactly happens to the body through stress.
generic clomid online buy The investigations are based on data from 6-year old children from the LISA study. LISA stands for "Lifestyle - Immune System - Allergy" and investigates the influences of life-styles on the immune system development in early childhood and the emergence of allergies. In addition to the Helmholtz Center for Environmental Research in Leipzig (UFZ), the Helmholtz Zentrum M??nchen, the German Research Center for Environmental Health, and the "Institut f??r Umweltmedizinische Forschung" (IUF) in Duesseldorf, other universities and clinics are also participating partners, including the Municipal Hospital "St. Georg" in Leipzig. For the LISA study over 3000 newborn children in the cities of Munich, Leipzig, Wesel and Bad Honnef were recruited between the end of 1997 and the beginning of 1999. Parents were repeatedly asked about various lifestyle-reloated factors and disease outcomes. Furthermore, blood tests were carried out at different times. At the age of six a total of 565 children were examined in Leipzig, and for 234 participants, blood analyses regarding stress and immune parameters were carried out. Over the course of the 6-year study nearly one third of the families living in Leipzig were affected by unemployment. For approximately half of all families, severe illnesses were experienced by close family members. By comparison, cases of death among family members or the separation of parents only affected every sixth or tenth child.
HELMHOLTZ CENTRE FOR ENVIRONMENTAL RESEARCH - UFZ
Permoserstra??e 15
D-04318 Leipzig

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The increased beating of the heart that one experiences when in a stressful situation is just one part of the body’s response to stress, something often known as the "fight-or-flight response". Another component of the fight-or-flight response is the suppression of pain, also known as stress-induced analgesia (SIA). Some of the nerves and nerve-produced peptides that are responsible for SIA have been identified, but much remains to be discovered. In a new study, a team of researchers in California, from AfaSci, Inc., Burlingame, and SRI International, Menlo Park, has revealed that nerves producing the peptide N/ORQ and nerves producing the peptide Hcrt are key in regulating SIA in mice.
Generic levitra pills no prescription The research team, which was led by Xinmin Xie and Thomas Kilduff, showed that in the brain of normal mice, Hcrt-producing nerve cells (Hcrt neurons) and N/ORQ-producing nerve cells interacted. N/ORQ affected the electrical current across Hcrt neurons and the release of neurotransmitters by these cells. Furthermore, administration of N/ORQ blocked SIA in normal mice, but this was overcome by administration of Hcrt at the same time. The authors therefore conclude that N/ORQ likely influences a variety of Hcrt-mediated processes, in addition to SIA, and suggest that these pathways might contribute to medical conditions caused by excessive stress, such as anxiety and post-traumatic stress disorder.
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Article adapted by Medical News Today from original press release.
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TITLE: Hypocretin/orexin and nociceptin/orphanin FQ coordinately regulate analgesia in a mouse model of stress-induced analgesia
Author Contact:
Xinmin (Simon) Xie
AfaSci Inc., Burlingame, California, USA.
Thomas S. Kilduff
SRI International, Menlo Park, California, USA.
View the PDF of this article at: https://www.the-jci.org/article.php?id=35115
Source: Karen Honey
Journal of Clinical Investigation
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University of Florida researchers have identified a
gene variation in heart disease patients who appear especially
vulnerable to the physical effects of mental stress - to the point where
blood flow to the heart is greatly reduced.
"Searching for the presence of this gene may be one way to better
identify patients who are at an increased risk for the phenomenon," said
David S. Sheps, M.D., a professor and associate chairman of
cardiovascular medicine at UF’s College of Medicine and the Malcom
Randall Veterans Affairs Medical Center.
Those with the gene variation are three times more likely to experience
dangerous decreases in blood flow to the heart - a condition doctors
call ischemia - than heart disease patients without it. Ischemia
increases the chance these patients will suffer a heart attack, heart
rhythm abnormalities or sudden death, UF researchers report in the April
14 issue of Archives of Internal Medicine.
"There’s no question that in certain populations it is associated with
worse prognosis than in patients who do not have mental stress-induced
ischemia in terms of overall adverse events and also mortality," Sheps
said. "And it has become apparent that it is far more prevalent than we
initially thought. Most of the studies that have been published to date
have involved populations of patients who had coronary disease and
positive exercise stress tests. But recently we and other investigators
have shown that a much broader category of patients also are prone to
mental stress ischemia."
Past studies have shown that as many as two-thirds of patients with
coronary artery disease who experience exercise-related reductions in
blood flow to the heart respond similarly to mental stress. These bouts
often produce no symptoms of chest pain and are rarely detectable on a
standard electrocardiogram. Yet previous UF research has shown that
these patients have a threefold greater risk of dying - as large a risk
factor as cigarette smoking or high cholesterol. Other studies have
linked stress experienced after mass disasters or natural catastrophes
with a rise in heart attacks and sudden death.
Psychological stress can leave the heart more prone to developing
arrhythmias or electrical instability and the blood more prone to
clotting. Stress appears to raise heart rate and rapidly hike blood
pressure, increasing the heart’s need for oxygen-rich blood, Sheps said.
Yet less oxygen is supplied, in part because coronary arteries
constrict, impeding blood flow. Doctors are concerned that this reaction
to stress in the laboratory is simply a snapshot of how patients respond
to the stress of life on a daily basis.
An estimated 10 percent of all patients with coronary disease experience
detectable mental stress-induced reductions in blood flow to the heart.
In some subsets of patients the phenomenon may be even more prevalent,
involving up to 40 percent of these patients.
UF researchers studied 148 patients with coronary artery disease who
were on average about 65 years old. Participants were asked to perform a
public speaking test designed to induce stress. Images were taken of
blood flow to the heart at rest and during the speech task. Blood
samples also were collected and analyzed for five common gene
variations.
About a fourth of the patients experienced mental stress-induced reduced
blood flow to the heart, and about two-thirds of them harbored a
particular variation of the adrenergic beta-1 receptor genotype that was
associated with a three-fold increased risk of this phenomenon, said
Mustafa Hassan, M.D., the study’s lead author and a research fellow in
UF’s division of cardiovascular medicine. This receptor typically helps
the body respond to stress by regulating blood pressure and heart rate,
but a common variability in its gene may make certain patients more
vulnerable to the effects of psychological stress.
The study was funded by the National Heart, Lung and Blood Institute and
also was supported by the Department of Veterans Affairs Medical Center
and the Buy lexapro pills UF colleges of Pharmacy and Dentistry.
Why does mental stress restrict blood flow in some patients even when
exercise fails to have the same effect? The effects of mental stress
could predominantly affect the heart’s smaller vessels, causing them to
spasm and temporarily limiting blood flow, Sheps speculated. In
contrast, exercise tends to affect the heart’s blood supply through
different mechanisms.
"We should focus our research on two areas," he said. "One is better
identification of patients who are prone to have this problem and two is
looking for effective treatments once we know they have it. We need to
know whether we can reverse this phenomenon. We are embarking on other
treatment studies fairly soon."
UF researchers are hunting for other genetic subtypes that could
identify other patients at increased risk, he added.
"One of the advantages of detecting these sorts of things is that we may
be able to in the future be more specific about what kind of treatment
might work better in certain patients depending on their genetic
makeup," Sheps said. "That is one of the important things happening in
many fields of medicine. There are many diseases that already have been
shown to respond differently to different types of treatment based on
genetic differences."
The University of Florida Health Science Center - the most comprehensive
academic health center in the Southeast - is dedicated to high-quality
programs of education, research, patient care and public service. The
Health Science Center encompasses the colleges of Dentistry, Public
Health and Health Professions, Medicine, Nursing, Pharmacy and
Veterinary Medicine, as well as the Veterinary Medical Teaching Hospital
and an academic campus in Jacksonville offering graduate education
programs in dentistry, medicine, nursing and pharmacy. Patient care
activities, under the banner UF&Shands, are provided through teaching
hospitals and a network of clinics in Gainesville and Jacksonville. The
Health Science Center also has a statewide presence through satellite
medical, dental and nursing clinics staffed by UF health professionals;
and affiliations with community-based health-care facilities stretching
from Hialeah and Miami to the Florida Panhandle.
University of Florida Health Science Center
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