[RESEARCH] New onset and persistent symptoms of post-traumatic stress disorder self reported after deployment and combat exposures: prospective population based US military cohort study
Objective To describe new onset and persistence of self reported post-traumatic stress disorder symptoms in a large population based military cohort, many of whom were deployed in support of the wars in Iraq and Afghanistan.
Design Prospective cohort analysis.
Setting and participants Survey enrolment data from the millennium cohort (July 2001 to June 2003) obtained before the wars in Iraq and Afghanistan. Follow-up (June 2004 to February 2006) data on health outcomes collected from 50 184 participants.
Main outcome measures Self reported post-traumatic stress disorder as measured by the posttraumatic stress disorder checklist—civilian version using Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria.
Results More than 40% of the cohort were deployed between 2001 and 2006; between baseline and follow-up, 24% deployed for the first time in support of the wars in Iraq and Afghanistan. New incidence rates of 10-13 cases of post-traumatic stress disorder per 1000 person years occurred in the millennium cohort. New onset self reported post-traumatic stress disorder symptoms or diagnosis were identified in 7.6-8.7% of deployers who reported combat exposures, 1.4-2.1% of deployers who did not report combat exposures, and 2.3-3.0% of non-deployers. Among those with self reported symptoms of post-traumatic stress disorder at baseline, deployment did not affect persistence of symptoms.
Conclusions After adjustment for baseline characteristics, these prospective data indicate a threefold increase in new onset self reported post-traumatic stress disorder symptoms or diagnosis among deployed military personnel who reported combat exposures. The findings define the importance of post-traumatic stress disorder in this population and emphasise that specific combat exposures, rather than deployment itself, significantly affect the onset of symptoms of post-traumatic stress disorder after deployment.
Post-op diabetes risk factors
Filed under: Research
In the January 2007 issue of the the journal Liver Transplantation, the official journal of the American Association for the Study of Liver Disease (AASLD), French scientists published an article suggesting a link between certain risk factors and new-onset diabetes mellitus (NODM) following liver transplantation.
Specifically, a history of impaired fasting glucose, obesity and hepatitis C infection -- when paired with the use of an of immunosppressant -- was shown to be associated with an increased risk of NODM.
The study, conducted by a team of researchers at the Hospital Paul Brousse in Villejuif, France, included 211 patients from 10 transplant centers who had undergone a liver transplant between October of 2003 and June of 2004. The patients' records were reviewed and their fasting blood sugar levels were recorded 3, 6, 12, and 18 months after the surgery. Those patients with NODM had their date of diagnosis noted, in addition to the immunosuppressive treatment and diabetes management they received.
The results demonstrated an incident of NODM of 22.7 percent, with most cases being diagnosed within three months after transplant surgery. Moreover, 12.4 percent of the patients with normal glucose levels before the surgery developed impaired fasting glucose.
Avandia latest: Glaxo fights back
Filed under: Drugs, Daily News
GlaxoSmithKline has its hands full right now big-time, defending its conduct over the ever-deepening Avandia scandal. But the big-name pharma company isn't giving up the fight. (No surprise there...) Today Glaxo ran full-page advertisements in a number of prominent US newspapers. The move is described by Britain's Guardian as the launching of a major PR war. The ads are featured in fifteen major newspapers, says the Guardian, including The New York Times, The Washington Post, The Wall Street Journal, and the LA Times. The ad is a direct appeal to patients, taking the form of an open letter from Glaxo's chief medical officer, Dr. Ronald Krall. (Guess he's working some late nights at the moment, huh?) The ads were timed to appear one day before the congressional hearing on the US Food and Drug Administration's work on Avandia and consumer safety, which is scheduled for tomorrow. Another Glaxo-penned letter defending Avandia was also published in the medical journal the Lancet. Said a company spokesman of today's ads: "We are determined to make sure the science we feel backs us up is heard."
This article also notes that weekly prescriptions for Avandia have fallen by sixteen percent since the recent publication of a damaging article by Dr. Steven Nissen in the New England Journal of Medicine. Nissen asserted that Avandia could increase the risk of heart attack by forty-three percent and the risk of cardiac-related death by sixty-four percent.
By the way, it is worth checking out the Wikipedia entry on Glaxo for a brief rundown of the company's history, including previous wrangles with the media and the law over its products. Note, though, the entry has not yet been updated in the wake of the Avandia scandal.
Magazine industry loses a giant: Peter A. Banks
Filed under: Type 1, Type 2, Childhood, Adult Onset, Magazines, Support, Personalities
Peter A. Banks, renowned past publisher of the American Diabetes Association's (ADA) Diabetes Forecast magazine died on July 21 at his home. Mr. Banks had colon cancer.
For years and years, my parents subscribed to Diabetes Forecast. My brother had been diagnosed with type 1 diabetes in the mid-1970s, and in an effort to gather the latest news on type 1, my parents were avid readers.
Mr. Bank's career with the ADA spanned 20 years from 1986-2006. He was named publisher of Diabetes Forecast in 1999. Over the next seven years as publisher, Diabetes Forecast circulation rose nearly 20 percent. Before that time, he also served as editorial director. In his last year with the ADA, Mr. Banks was recognized one of the 40 most influential publishers in the magazine industry by Folio Magazine's The Folio: 40.
In receiving the honor, Folio recognized Mr. Bank's metamorphosis of Diabetes Forecast from an association magazine into a pass-along phenomenon. With 2006 members-only subscriptions standing at 460,000, actual readership of Diabetes Forecast was ten times that -- over 4 million. At the time, Banks explained people were desperate for knowledge of diabetes, and pass-along readers were poorer people without good medical care. They relied upon Diabetes Forecast to deliver up-to-date news on the disease. Banks stood by the magazine's philosophy of care for people with diabetes. In 2003, he turned down nearly $1 million in advertising revenue from junk food manufacturers in the interest of the health of readers. In the past year, he founded Banks Publishing, a consulting business.
Mr. Banks is survived by his wife of 27 years, Lucy Godfrey Banks, two children, Alison Banks and David Banks, his father John Banks, two sisters and a brother. Read more about Mr. Bank's many contributions to society in the Washington Post and at Banks Publishing. Photo from Banks Publishing.
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No Benefit Found for Post-Stroke Tight Glucose Control
Filed under: Type 1, Type 2, Childhood, Adult Onset, Research
British researchers have found that tight glucose control during hospitalization for a stroke may not improve survivalThe study involved 933 patients enrolled within 24 hours of a stroke who had glucose in the range of 6.0 to 17 mmol/l. Participants received saline solution or continuous glucose, potassium, insulin infusions to reduce their blood glucose. Patients were monitored every two hours with glucose adjusted if needed every eight hours. The researchers found that both treatment and placebo groups had improvement in glucose levels. The treatment group had an overall mean 0.57 mmol/l reduction in glucose over 24 hours while glucose levels also fell spontaneously with simple saline hydration. There was also no difference in the secondary outcome of disability. There was a significant reduction in systolic blood pressure in the treatment group. A researcher noted, "In the majority of patients, treatment with a simple saline infusion will correct mild to moderate hyperglycemia."
The saline and glucose relationship is similar to the way the noninvasive glucose monitors measure blood sugar (aka Glucowatch)., This relationship between sodium and glucose in the blood moves inverse. When your sugar levels are elevated, your sodium is down. When you force sodium into your blood, your sugar is suppressed. Doctors must proceed with caution in light of this study. When it comes to aggressively lowering glucose, especially after a trauma, it could be more harmful than helpful.
Every toenail tells a story
Filed under: Research
Diabetes can do a lot of harm to your feet. The worst case scenario is severe nerve or tissue damage necessitating amputation. Early intervention is critical for avoiding this drastic measure, and researchers are looking at various ways in which this can be done. A brand new example of this kind of research comes courtesy of the foot docs at CLEAR - Scholl's Center for Lower Extremity Ambulatory Research at Rosalind Franklin University of Medicine and Science, which is located in Chicago. CLEAR researchers found that nearly three out of four diabetics who are at high risk for amputation have diseased toenails. The finding was announced recently at a conference for the American Academy of Dermatology, being held in Washington, DC. Says co-author of the study, Stephanie Wu, the study helped confirm what many suspected but was previously unproven. "It appears," said Dr. Wu, "that if you have certain pre-existing risk factors for amputation coupled with a clinically diseased nail, chances are you have a significant fungal infection based on laboratory cultures." It is hoped that this knowledge can help prevent amputations by helping physicians identify those who are at risk more quickly than might have previously been the case.
Avandia controversy stirs Congress to investigate FDA
Filed under: Type 2, Adult Onset, Drugs, Research, Daily News
Remember learning about "checks and balances" in U.S. History class? When state leaders gathered in 1787 to draft the Constitution, they established three branches of government (legislative/executive/judicial) to protect individual freedom and prevent government from abusing its own power. Now, Congress is questioning the balance of powers over at the Food and Drug Administration (FDA).
Republicans and Democrats in the House and Senate have called for an investigation into the FDA in the wake of the New England Journal of Medicine study which suggests the popular diabetes medication, Avandia, significantly increases the risk of heart attacks. A House hearing is set for June 6.
Original trials by the drug's maker, GlaxoSmithKline, revealed twice the rate of ischemic heart disease for patients taking Avandia versus recipients of placebos. The medical reviewer for the FDA initially expressed concern, but determined the risk was more benign following further analysis.
Internally, the FDA has one set of officials who approve drugs and another set who track the safety of drugs after approval. But there is an unequal balance of power between the safety and approval offices. Congressional investigators report the safety group recommended months ago Avandia receive its severest warning. The review group disagreed. Here's the catch -- the reviewers hold more power than the safety officials.
Senator Charles E. Grassley, Republican of Iowa and others in Congress have pushed for a separation of the approval and safety offices, and increased power for the safety group. Just this month, Senator Grassley proposed such a split, but it failed by one vote. House staffers believe the Avandia case re-ignites Senator Grassley's proposal as the House is soon entering debates to change the drug agency. Here is a previous post covering the Avandia concerns and the full story on the FDA.
Is Congress listening? Experts urge funding for Native American kids
Filed under: Type 2, Drugs, Daily News, Support
An issue in dire need of attention - climbing rates of Type 2 diabetes amongst Native Americans - has made it to Washington. Experts on diabetes and its impact on Native Americans went to Washington Thursday to basically beg for money to continue with the treatment and prevention programs currently in place.Charles Grim, head of the Indian Health Service, testified yesterday to the Senate Indian Affairs Committee (SIAC) about the disastrous impact diabetes is having in Native American (aka American Indian) and Alaska Native communities. "In some communities, the prevalence rate is as high as 60 percent among adults," said Grim. But the scariest thing is how fast diabetes is spreading amongst younger people. According to the Indian Health Service, diabetes grew by 128 percent amongst teenagers between 1990 and 2004. It also affected many more younger children, but not as badly: the rate of increase for the same period was 77 percent for kids younger than fifteen.
In addition to the testimony of Grim, two North Dakota physicians also spoke at the hearing, urging the SIAC to renew funding for prevention and treatment programs that are currently due to expire next year. Said one of the docs, "We don't want history to repeat itself." The other, Dr. Biron Baker of Bismark, ND, was openly critical of ongoing efforts to stem the spread of diabetes, saying "Administrative ineptitude within the Indian Health Service is a glaring problem."
I guess the answer to the question "Is Congress listening?" is yes. Problem is, those in government who want to help have to come up with money for these programs. Then there are those who take a more cautious approach before they'll approve treatment and prevention programs. People like Wyoming Republican Craig Thomas, who was quoted as saying he wants to see evidence that current programs are effective before throwing his weight behind proposals to improve services. Funny how the money is always available for other pet projects and disastrous wars, but not for stuff like public health programs...
Lifestyle strategies for your healthiest heart
Filed under: Women Heart Health, Men Heart Health, Aging Heart Health
We often post tips and facts about having a healthy heart, but over at That's Fit, I think this post sums up what you need to do to have a healthy heart. Here's what they recommend:- Get a good night's sleep
- Get active -- this especially includes resistance training
- Drink wine in moderation
- Eat fish, or some other source of Omega 3's
- Floss regularly
- Quit smoking
- Take a daily walk
- An aspirin a day can take the heart problems away -- but talk to your doctor first.
What does the Vagas Nerve have to do with Diabetes?
Filed under: Type 2, Adult Onset, Research, Daily News
According to scientists at Washington University School of Medicine in St. Louis, interrupting nerve signals to the liver can prevent diabetes and hypertension in mice.
Mice were treated to become diabetic with glucocorticoids, a class of steroid hormones characterized by an ability to bind with the cortisol receptor. Once diabetes was established, the researchers surgically removed the vagus nerve. The vagus nerve is the only nerve that starts in the brainstem and extends all the way down to the abdomen. More impressive is the fact that once the nerve was removed from the diabetic mice, insulin resistance and high blood pressure was prevented or reversed. This is an interesting discovery because people with asthma, arthritis, and organ transplants often rely on steroid treatments. It just so happens that many of them go on to develop insulin resistance.
Don't go ripping your vagus nerve out just yet. A fun fact about the vagus nerve is that it's name is taken from the Latin word meaning "wanderer". The vagal nerve pathway can influence seizures, depression and other disorders. Although the research is thoroughly enlightening, it is still very green. Hang on to your vagus nerve while the research continues.