Health and Medical Reporting

Rural areas show low access to drug abuse treatment

2008-04-24T15:48:00.003-04:00

Researchers have found that those in rural populations have inadequate accessibility to drug abuse services, according to an article in the fall 2007 issue of the Journal of Rural Health. The authors found that while there is increasing literature on access to mental health services, there is a lack of it concerning drug abuse services in rural areas.

"A survey of Iowa's acute care hospitals found that 40 percent of rural facilities needed but did not offer substance abuse prevention and mental health promotion services," said the study.

When it comes to utilized access, rural drug addicts have equal or worse utilized access than urban residents. The study concludes that much more research needs to be done in this area to improve both the amount of treatment available and the actuality of a person utilizing it.

Link between education and mortality and life expectancy

2008-04-24T15:01:00.003-04:00

A study in the March/April 2008 issue of Health Affairs shows a link between education and life expectancy. "Between the 1980s and 2000, life expectancy increases occurred nearly exclusively among high-education groups," stated the report.

Comparing the years 1981-88 with 1991-98, life expectancy at age twenty-five grew 1.4 years for people with a high school education but only 0.5 years for those with a low education. Also, in 2000, "life expectancy for a 25-year-old with a high school diploma or less was fifty years. For a person with some college, life expectancy was nearly 57 years."

The gap was largest among women in general. Life expectancy at 25 declined for the less educated women and rose a year or more for more educated women.

Heart disease, cancer and COPD contributed to 60 percent of the deaths in the sample in 1990 and 2000. It was also shown that increased education differences among the elderly account for much of the growing gap in mortality and life-expectancy. Smoking was also a big factor and results showed that smoking was more prevalent among the less educated. Obesity is also more common among the less-educated. Thus, the study concluded that better efforts to provide successful health interventions among less-educated groups may be needed to reduce socioeconomic disparities in health.

Improving breast cancer treatment

2008-04-24T14:04:00.003-04:00

In addition to standard chemotherapy for breast cancer, one study shows that weekly treatment with a therapy called paclitaxel improves disease-free and overall survival in women with breast cancer.

Published in The New England Journal of Medicine, the study compared two different drugs--docetaxel and paclitaxel--in the treatment of breast cancer.

A previous study showing the benefits of paclitaxel established a new standard of care for operable breast cancer and led to approval of paclitaxel for a certain type of breast cancer. Another study caused a similar occurrence with docetaxel. This study however, showed that paclitaxel was most helpful.

Limited food choices and obesity

2008-04-24T09:58:00.003-04:00

Is there a link between obesity and food sufficiency (or insufficiency) in the household? There is no strong evidence to suggest such a link, according to a study published in April's American Journal of Public Health.

Similar U.S. and Canadian studies in the past provided varying and inconclusive results, which largely relied on self-reported data concerning height and weight. Recent trends show that rates of obesity are higher when the data is self-reported than when it is measured.

The new study looked at both self-reported and measured height and weight data among a sample population in Canada. Also, two different models were used to determine sufficiency of food in the household. For example, one question was "Were you or anyone in your household concerned that there would not be enough to eat because of lack of money?"

"When self-reported height and weight data were used, obsesity was significantly higher in households experiencing any of the dimensions of food insecurity," reported the authors. "Rates were not different on any of these dimension when measured height and weight data were used." The four household food security status groups created were: food secure, food insecure without hunger, food insecure with mild hunger, and food insecure with severe hunger.

However, further analysis showed an association between obesity and food insecurity with mild hunger. Under one of the models, when measured height and weight were used, females living in households with food insecurity and mild hunger were almost three times more likely to be obese than those living in food-secure households.

Despite the one association, there appears to be no link (or a weak one) between obesity and the level of food sufficiency in the household. One hypothesis is that "decreased food purchasing power results in the purchasing of energy-dense foods and thus increased energy intakes." This person may tend towards obesity as a result of eating energy-dense, nutrient poor foods. Still no study shows any conclusive evidence of this.

Study finds improvements to be made in pre-hospital stroke training in rural Montana

2008-04-23T13:48:00.005-04:00

Improvement in stroke-care training is needed for first responders and emergency medical technicians in frontier areas of Montana, according to the spring 2008 issue of Journal of Rural Health. A 2006 telephone survey amongst rural and urban Montana technicians revealed that while both had similar levels of stroke knowledge, stroke screens and stroke protocols were less likely to be used in the frontier areas.

Respondents in frontier counties were more likely to be older, have fewer EMS personnel working in their service and to be located farther away from a health care facility with CT scan compared to respondents in urban counties.

The new drugs being used to treat stroke are most effective if administered within three hours of symptom onset. Patients are more likely to arrive at the emergency department within these three hours if transported by EMS rather than private vehicle. This has caused many states to implement stroke protocols and screening tools to be administered by EMS providers.

From the survey, opportunities for improvement were found and a high level of interest in further training was identified.

Hospitals: bacterial breeding grounds

2008-03-29T10:53:00.003-04:00

My favorite session at the journalism conference so far has been the one Friday on the reporting and prevention of hospital acquired infections. Each of the panelists spoke very passionately about the subject. Especially emotional was hearing from the woman on panel who's son died two years ago from hospital acquired MRSA.

Fortunately I have not had to spend much time in a hospital but when I am there, or even in the doctor's office I am very aware of the invisible bacteria lurking on every surface. I am a firm supporter of better cleaning habits in hospitals yet I can't help but think that spread of bacteria is inevitable. Nevertheless, it sounds like there are certain things hospitals and employees can do that are fairly simple, such as washing or changing out their lab coats more regularly.

The session reminded me of when my grandmother was in the hospital two years ago with cancer. My aunt took it upon herself to disinfect the room herself. At least patients or their families have some control. Of course it should be the responsibility of the hospital to adequately disinfect the room after each patient, but as is often the case, individuals must look after their own health.

Something else comes to mind: hospital cafeterias. Whenever I hear of people who go to the hospital just to eat lunch there, I wonder what risk is involved. Panelists mentioned that certain cleaners won't kill a bacteria called c. diff. We pick up all kinds of bacteria in our everyday lives but why spend more time at a place that is full of sick people than we have to?

Mental Illness: How do we treat it?

2008-03-28T12:11:00.004-04:00

Panelists at the conference session on violence and mental health disagreed with the ways that mental illness should be viewed and treated.

One of the speakers, Harvey Rosenthal, is a man who works at a hospital and also has bipolar disorder strongly advocated for better services that are more attractive and engaging. He said that many programs today have low expectations for a mentally ill person's recovery and have an overemphasis on medication.

I have always thought that certain types of severe mental illness seem to leave the people that are afflicted with them in a hopeless situation. I would like to hear about cases in which these people show great progress with treatment. The panelists did talk about how people who are treated can show substantial recovery rates and are no more likely to commit acts of violence than anyone else. However, I rarely read or hear about people who are in effective treatment programs. I agree with Harvey Rosenthal in thinking these positive stories would be good for journalists to tell because it could reduce the stigma associated with mental illness, as well as highlight the kind of treatment programs that lead to happy healthy people.

I am also skeptical and wary of most medication. While it seems like some mental illnesses require medication I think that any look into alternative methods of treatment is an excellent idea.

About a year ago I heard one particular horror story from a parent who's son was on anti-depressant medication as treatment for another non-mental problem. In his supposedly "rare" case, the treatment not only made him hear voices that told him to kill himself, he also began experiencing other symptoms that included memory problems. Luckily he told his mother what he was experiencing and got to the doctor. His mother told me he almost experienced permanent brain damage. This confirmed my opinion that these types of medication are suspicious. I'm no expert and I'm sure they help a lot of people but I guess my point is that people should be aware of a medication's potential side effects and try to stay informed on what their doctor is prescribing, rather than blindly following their orders.

Economics of Health 101

2008-03-28T09:37:00.005-04:00

As I sat in the room at the first session of the Health Journalism conference this morning in Washington, D.C., I tried to make sense of the subject matter. The "economics of health" has always confused me and I am sorry to say that the 101 session did little to alleviate that, however I did learn a few statistics and the main message that we need to decrease spending on Medicare and Medicaid.

Most people get insurance from the private sector and 60 percent of that is employment based. I also learned that apparently, between 1996 and 2000 there was an expansion in the availability of coverage.

Gail Wilensky with Project HOPE stated that these federally and state funded programs are heading for a "fiscal breakdown." She noted that while we often attribute this problem to the increase in older Americans, she said that the biggest problem is excess spending. Older Americans account for 15 percent of the problem.

Wilensky then introduced some sensible next steps for Medicare, two of which included introducing more competition and changing/realigning financial incentives for providers. These sound good to me.

Then she talked about increasing the age at which full benefits can be obtained. She said that since many people can continue working well into their 60s that they should be encouraged to do that. This seems to coincide with the work until you die mentality that I disagree with. I think people should be able to retire at a decent age while they can still get around and do things they've always wanted to do. Unless you want to work, I don't think you should feel like you have to work into your late 60s to get full health care benefits.

Meth: Healing the Damage

2008-03-06T09:01:00.004-05:00

A study found in the February 2004 issue of American Journal of Psychiatry concluded that people who abuse methamphetamine may be able to recover from some of the brain damage after a prolonged period of abstinence.

Dopamine transporter loss has been found in the brains of meth users. This is thought to be associated with reduced motor speed and impaired verbal learning. While significant recovery in function has been seen in those who've been off the drug for a while, complete neuropsychological function may not be restored.

In this study meth users were tested against healthy subjects. Compared to healthy people, the meth users showed a significant reduction in striatal metabolism, whether tested after a short or long period of abstinence. However, thalamic metabolism was lower after a short abstinence interval but not after a long one. These findings support the idea that some recovery is possible while certain damage may be permanent.

Good Drugs, Bad Drugs

2008-03-06T08:24:00.002-05:00

While street drugs are a major problem, abuse of prescription drugs is the second most prevalent form of abuse among teens, with marijuana being first. An article in the December 2007 issue of Contemporary Justice Review discusses how schools may be contributing to the problem.

Through D.A.R.E. programs and the like, marijuana is discouraged but little attention has been given to prescription drugs. Furthermore, schools often encourage the use of Ritalin (ADD medication) and may even pass it out in schools. In contrast, the consequences of being caught with marijuana can be harsh.

The article explores the similarities and differences between the two types of drugs. They found similarities in ease of attainment, reasons for use and nonchalant attitudes about the drugs. Another similarity is that both fit into the wider problem of America's drug culture.

With both parents and teachers wanting well-behaved and attentive children, the temptation to put a child on Ritalin is enticing. Parents are also often mis-informed or under-informed by doctors.

The article concludes that students are sent mixed messages about drugs and which are the "good" and the "bad."

A Building Contractor's Perspective

2008-03-06T07:56:00.003-05:00

If you drive down Daniels Bridge Road in Athens you may notice some large new-looking office complexes. In one such complex you can find Aldridge, a building contractor that built the office buildings that it currently has a space in. Through its commercial construction of schools, office buildings, churches and more, Aldridge has seen its fair share of construction theft.

According to Charlie Whalen, vice president of construction and development, theft is a continuing problem and most of it consists of inside jobs. Because 85% of the work on any given job is done by subcontractors, there are a lot of different people involved. Employees of other firms may steal materials themselves or help outside parties do so. Whalen stated that coppers and steels have been hot commodities lately and have required them to up their security measures. Now, one out of 15 jobs requires 24 hour supervision.

Whalen cited one incident in Jefferson when they were building Athens Regional. Over $10,000 in material was stolen and $16,000-$17,000 worth was lost in lost time. From talking with insurance people and police officials, Whalen knows that a large percentage of the theft is drug related.

That oh-so-valuable copper can be found in large electrical wiring, plumbing piping and refrigerant lines for air conditioning. In commercial construction, Whalen said those are the three largest sources of copper. When it comes to using alternative materials to reduce theft, Whalen noted that aluminum products can be used in electrical work but there are no alternatives to copper in the other two materials.

Because of the rising copper prices Whalen said it's harder to sell a project these days. Business owners are trying to hold off until prices go down and private development has slowed as well.

You guessed it!....more about drugs

2008-03-02T23:36:00.003-05:00

According to Athens County Police Drug Commander Mike Hunsinger, crack cocaine is the most “problematic” drug being sold in the Athens area. Hunsinger said the term problematic refers to a drug’s tendency to foster other criminal activity, such as thefts committed to support drug habits and violent crime. Approximately 80 to 90 percent of the crime in the area is drug related, including many copper and construction thefts.

"Copper?," I said, wondering what one had to do with the other. Hunsinger explained that copper is highly valuable these days and drug users, especially crack and meth addicts, will steal the metal and sell it to support their habits.

This aspect of drug use and its effects on the Athens-area community has become the subject of my feature story for health and medical journalism class. When I mention this topic to others their response is similar to my initial reaction, "huh?" While metal theft is not a new occurrence, perhaps the relationship between it and drug use is not well-known by those outside of law enforcement or others who are directly affected. My plan is to piece together the story in Athens as I learn about the issue through the key players, i.e. contractors, business and home owners, scrap metal dealers, law enforcement and drug addicts.

From treatment to prevention

2008-02-26T22:15:00.004-05:00

When it comes to fighting drug abuse, there are two sides of the spectrum: prevention and treatment. University of Georgia professor Dionne Godette started out on the treatment end. With a Master's degree in counseling from Johns Hopkins, Godette started out her career counseling at centers for addiction and pregnancy. There she encountered a lot of young women who were "pregnant, addicted and having all sorts of trouble." This experience prompted Godette to get into public health. She then earned her doctorate in health education and health behavior from The University of North Carolina at Chapel Hill.

Addiction counseling also made Godette realize that prevention may be a better area for her to work in. She related the depressing nature of the job, where the clients would repeatedly re-enter treatment. Godette noticed that many people treated as adults reported that they had started using drugs or alcohol as an adolescent.

As a faculty member of UGA's College of Public Health, Godette focuses part of her research efforts on understanding the period of life between adolescence (12-17) and young adulthood (18-30) and the role that it serves in determining the risk or resilience for problems associated with alcohol, tobacco and other drugs among U.S. based minorities.

Godette said she has an overall interest in disparities in outcomes. In other words, once members of various populations have started using, how are the outcomes different among the different groups?

One area where Godette is trying to break ground centers around the concept of social capital. She explained that social capital influences use and outcomes and that it encompasses things such as trust within a neighborhood or community. It is a measure of social cohesion in the larger community and how those factors play into individual behaviors.

Godette has been researching on the prevention end for about 10 years and said that the downside of prevention is that the effects aren't apparent. With treatment, Godette could see the fruits of her labor as she watched a client get their lives back on track. However, she concluded that in her opinion, prevention is more worthwhile.

Inside a drug and alcohol treatment facility

2008-02-19T19:35:00.004-05:00

Dennis Cain is the program director of one of northeast Georgia's only 28-day residential recovery program for drug and alcohol addicts, run by Advantage Behavioral Health Systems. According to Cain, the program has a good reputation in surrounding communities. And the program offers various levels of treatment, according to the particular needs of the individual.
The crisis stabilization unit serves to manage withdrawals and detox for around 3-7 days. From there the person is referred to the alcohol and drug program. Besides the 28-day residential treatment, there is a voluntary outpatient program that meets twice a week for three hours each time and then there is an aftercare program that meets once a week for a year. Cain said they've been working with the Athens Police Department to break the cycle of having people repeatedly getting arrested for public drunkenness and the like.
The activity therapy aspect involves a partnership with UGA. Clients are taken to museums, art exhibits and other activities. They are also connected with other community resources such as 12-step programs and Alcoholics Anonymous or Narcotics Anonymous groups.
Currently the residential program can facilitate eight men and six women. There is a wait list for these spots.
Cain noted that the biggest problem with state mental health and substance abuse treatment lies with the treatment of crack cocaine and methamphetamine addiction. Right now there is no established protocol for treating withdrawal and detox from meth or crack like there is for alcohol. Because the withdrawal symptoms are so vague and vast, there is no protocol for medically treating them. Therefore, Advantage, which is state-funded, cannot detox someone coming off these drugs. While the person may enter the crisis unit on the basis of suicidal tendencies, there is nothing they can do to treat the withdrawal after that initial crisis is stabilized.
"Basically," said Cain, "in order for them to enter our program they ahve to quit using on their own."

Social and Environmental Factors of Rural Drug Use

2008-01-31T14:13:00.000-05:00

Those living in a rural setting deal with a unique set of factors that either contribute to or deter drug abuse. An article in the fall 2007 issue of The Journal of Rural Health discusses the various social and environmental factors that impact drug use in rural populations.
Poverty and unemployment rates are higher in rural areas than in urban ones. Furthermore, Internet access is now widely available in rural areas, which has increased availability of drugs through on-line purchase. Expansion of interstate highway systems has also made rural areas more accessible.
According to the authors, the family has traditionally served as a protective influence, however, due to a number of factors such as poverty and decimation of rural economies, there is more domestic abuse, depression and substance abuse within families. Family history of drug abuse and peer pressure are also cited as contributing factors.
Positive influences of rural communities include a strong sense of family and community and greater support from these networks. Churches have helped promote prosocial outcomes and schools have become more likely in the last 5 years to recognize the relationship between increased school involvement and abstention from drugs.
As a result smaller tight-knit communities, individuals in rural areas are less likely to seek out treatment due to perceived stigma. Other inhibitors to getting treatment include lack of availability and transportation issues.

Citation:
(Social and Environmental Factors and Their Influence on Drug Use Vulnerability and Resiliency in Rural Populations by Brian Dew, PhD; Kirk Elifson, PhD; and Michael Dozier, MS in The Journal of Rural Health, Fall 2007, pp: 16-21. Volume 23)

Welcome

2008-01-29T16:45:00.000-05:00

There are so many health issues to investigate....where to start? Well, I am reading an article in The Journal of Rural Health about the social and environmental factors that contribute to drug use and vulnerability in rural populations. There seems to be a lot of coverage in this journal lately of country folks and their drug addictions. A post on this particular article is forthcoming. This topic is of particular interest to me, being from a rural town in North Carolina.

I look forward to exploring the issue of substance abuse further, as well as other health-related topics.