Video: Jane Pitt pens homophobic op-ed, receives star support

Has Amelia Earhart's beauty case been found?

??As the search for Amelia Earhart's plane probes the deep waters off Nikumaroro, a tiny desert island between Australia and Hawaii where the legendary aviator may have landed 75 years ago, new clues have surfaced in the artifacts unearthed on the coral atoll.

Source: http://www.msnbc.msn.com/id/3036697/vp/48168486#48168486

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Trade talk should heat up in baseball's 2nd half

There was a public outcry when R.A. Dickey did not start the All-Star game, a journeyman for the Chicago White Sox threw a perfect game and the Pittsburgh Pirates of all teams were in first place as the first half of the baseball season drew to a close.

What's next, postseason baseball in the nation's capital? It sure looks that way.

An eventful and unexpected first half that included Dickey knuckling his way to stardom with the Mets, Phil Humber's out-of-nowhere perfecto for the White Sox and the Yankees muzzling former slugger Reggie Jackson after some disparaging comments about Alex Rodriguez is only expected to get more intriguing as the season rounds second and heads for third.

The non-waiver trade deadline is looming at the end of the month, and the Baltimore Orioles and White Sox got ahead of the curve by acquiring Jim Thome and Kevin Youkilis, respectively, to bolster their offenses. Milwaukee's Zack Greinke, Philadelphia's Cole Hamels and Arizona's Justin Upton could be headed elsewhere as the contenders and pretenders separate themselves.

"There's several teams involved in races right now," said Detroit manager Jim Leyland, whose Tigers joined the Phillies and Red Sox on the list of big-spending underachievers in the first half of the season. "There's probably going to be a lot of teams that would like to go out and get somebody. But the more teams that want to get something, the tougher it is to get it."

And there's even more motivation for deals to be made in the first year of baseball's expanded postseason. The Fall Classic will be a little wilder this time around. A new format kicks in this year that adds an extra wild card team to each league. That means 10 teams will have a chance to get in and go for it all.

The Orioles, who trail the Yankees by seven games in the AL East, haven't been to the postseason since 1997, the Pirates haven't been there since 1992 and the nation's capital hasn't hosted a playoff baseball game since 1933, when Mel Ott homered in Game 5 of the World Series to help the New York Giants beat the Senators for the championship.

That was long before Natitude, long before "that's a clown question, bro" and certainly way before the All-Star game decided home-field advantage in the World Series. It's a new day, and if Bryce Harper and the Nationals or Andrew McCutchen and the Pirates somehow Buc the odds and make it to the Series, they'll be hosting the party after the National League beat the AL 8-0.

With so much on the line from here on out, the game in Kansas City could be one of the last nights of baseball without any juice for quite a while.

"We're playing for a lot more here," Pirates manager Clint Hurdle said. "We're playing for a city, the goal being to re-bond the city with its ballclub."

___

HOT RACES: The Yankees hold a seven-game lead over Baltimore in the AL East, but it's still early and every division is up for grabs. Here's a few of the races that are expected to remain tight until the final days.

?NL Central: The Pirates are just one game ahead of the Reds and only 2? games ahead of the defending champs in St. Louis.

?NL West: The Dodgers looked like the class of the league at the start of the season, but injuries to stars Matt Kemp and Andre Ethier have brought them back to the pack. And the Giants, just half a game back, are brimming with confidence after Pablo Sandoval, Melky Cabrera and Matt Cain led the NL to an 8-0 win in the All-Star game.

?AL West: The Rangers may be the best team in baseball, but the Los Angeles Angels have rebounded from a slow start to show that this will be no runaway. The Rangers lead by 4 games in search of their third straight AL crown.

___

TRADE BAIT: Several big names figure to be trading places by the end of the month as teams look for that extra edge to push them into the postseason.

?Felix Hernandez, RHP, Mariners: Seattle has been adamant that it is not considering moving King Felix. But if they ever would, now may be the time. The 26-year-old is 6-5 with a 3.13 ERA and is signed through 2014. He's already topped 1,500 innings pitched in his young career and the Mariners appear nowhere close to contending.

?Francisco Liriano, LHP, Twins: Got off to a horrendous start to the season and was moved to the bullpen. But it's what have you done for me lately, and the lefty who will be a free agent this winter is 3-2 with a 2.74 ERA and .175 opponents' batting average since rejoining the rotation. Last-place Twins need young assets, and Liriano may be best trade chip.

?Cole Hamels, LHP, and Shane Victorino, OF, Phillies: The Phils already moved Charlie Manuel favorite Jim Thome. Now these two mainstays, who are eligible for free agency at the end of the season, could be available for the right price.

?Carlos Quentin, OF, Padres: Any team looking for some proven power should consider Quentin, who topped 20 homers in each of the past four years for the White Sox. In his first season in spacious Petco Park, Quentin has just seven homers and could benefit from a change of scenery.

___

KEY INJURIES: These guys better get healthy if their teams expect to have a chance to play into October.

?CC Sabathia, LHP, Yankees: On the disabled list with a strained left groin, the Yankees desperately need their horse back at the top of the rotation. With Andy Pettitte out until late August at the earliest with a fractured left ankle, big No. 52 is more important than ever in New York.

?Evan Longoria, 3B, Rays: Longoria is on the shelf with a torn left hamstring that could keep him out for a while. In the meantime, the Rays will try to stay within shouting distance of the Yankees and the wild card without their leader.

?Kemp, OF, Dodgers: He has emerged as perhaps the best player in the game, a "five-tool guy" who has given the Dodgers their swagger. But he's played in just two games since May 14 because of a strained left hamstring, the kind of injury that can linger if it's not taken care of properly.

?Stephen Strasburg, RHP, Nationals: He has shown no ill effects coming off Tommy John surgery, which will make the second half all the more intriguing for the Nationals and their young flamethrower. GM Mike Rizzo has said that the team intends to hold Strasburg to an innings limit and will shut him down once he reaches that point to try to avoid another major arm injury. But if the Nats are in contention for a title, will they be able to hold true to that?

___

AP Sports Writers Larry Lage in Detroit and Paul Newberry contributed to this report.

Source: http://news.yahoo.com/trade-talk-heat-baseballs-2nd-half-192957393--mlb.html

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Dr. Pepper and Mr. Hot Dog

If you want to kill yourself, I guess you have a right to do it. ? There?s a real question as to whether McDonald?s and Coca-Cola should be sponsoring the Olympics, where they are supposed to have only healthy things. We've got to do something about this, and they can have a march and make a joke out of it, but there's a story in the Post today where the hospitals are having to increase the size of their gurneys and strengthen them. They can't even handle the patients, some of the patients are so heavy. This is going to be worse than smoking ever was. ? If somebody wants to have a march, I suppose it?s funny, but it is so tragic what is happening that I will say, the humor kind of escapes me.

Source: http://feeds.slate.com/click.phdo?i=9a9bab2b02c0601c2b4a4a1ed32dbc27

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Syria hit by diplomatic defection as U.N. battles divisions

BEIRUT (Reuters) - Syria's ambassador to Iraq defected on Wednesday in protest over President Bashar al-Assad's crackdown on a 16-month uprising as the U.N. Security Council remained deadlocked over the next steps in the crisis.

"I declare that I have joined, from this moment, the ranks of the revolution of the Syrian people," Nawah al-Fares said in a video statement posted on Facebook. He did not elaborate or say from where he had posted the statement.

Fares, who has close ties to Syrian security, was the first senior diplomat to quit the embattled government.

There has been no comment from Damascus or Baghdad and the White House said it was unable to confirm the defection, hailed by Assad's opponents as a sign of crumbling support.

But Assad's chief backer at the U.N. Security Council, Russia, remained firmly in the Syrian leader's camp as the 15-member group made little headway after international mediator Kofi Annan asked it to agree on "clear consequences" if the government or opposition fail to comply with his faltering plan for a political solution to the crisis.

Fares, a veteran of Assad's rule who held senior positions under the late president Hafez al-Assad, is from Deir al-Zor, the eastern city on the road to Iraq which has been the scene of a ferocious military onslaught by Assad's forces.

"This is just the beginning of a series of defections on the diplomatic level. We are in touch with several ambassadors," said Mohamed Sermini, a member of the main opposition umbrella group, the Syrian National Council.

The defection of Fares, a Sunni, could be a major blow to Assad, who wants to convince a skeptical world he is conducting a legitimate defense of his country against foreign-backed armed groups bent on toppling the government.

Fares' decision to jump ship follows the high-profile flight from Syria last week of Brigadier General Manaf Tlas, also a Sunni and once a close friend of Assad, whose minority Alawite sect has relied on Sunni allies to maintain control of Syria's majority Sunni population.

Tlas fled to Paris and has not spoken since of his intentions. Opposition sources said Fares was leaving Iraq but it was not clear where he would go.

"The apparent decision of yet another senior Syrian official to ditch Assad would be a chink in his armor," said one U.S. official, speaking on condition of anonymity.

"Although Ambassador Fares is not a member of Assad's inner circle, he's a respected Sunni figure and such a courageous act could help sway other Sunni elites to follow in his footsteps."

DIVIDED ON SANCTIONS

The apparent crack in Assad's diplomatic ranks came as international diplomacy inched along, plagued by divisions over what the next steps should be to address Syria's crisis.

Annan, appointed mediator by the United Nations and the Arab League, briefed the Security Council by video link from Geneva on the results of this week's diplomatic shuttle to Damascus, Tehran and Baghdad - three capitals forming a Shi'ite Muslim axis of power in the Middle East.

The deeply divided council must decide the future of a U.N. observer mission in Syria, known as UNSMIS, before July 20 when its 90-day mandate expires. It initially approved 300 unarmed military observers to monitor an April 12 ceasefire, which failed to take hold, as part of Annan's peace plan.

"He (Annan) called for the Security Council members to put aside their national interests and to put joint and sustained pressure on both parties with clear consequences for non-compliance," Britain's U.N. Ambassador Mark Lyall Grant said.

Russia and China, both veto-wielding permanent council members, have for months blocked moves by western and Arab countries aimed at increasing the pressure on Assad, leaving the council deadlocked.

Britain on Wednesday circulated a draft resolution to extend the monitors' mandate for 45 days and make compliance with Annan's transition plans for the country enforceable under Chapter 7 of the U.N. Charter, which allows the council to authorize actions ranging from diplomatic and economic sanctions to military intervention.

The draft resolution in particular threatens the Syrian government with sanctions if it does not stop using heavy weapons and withdraw its troops from towns and cities within 10 days of the adoption of the resolution.

The British text, drafted in consultation with the United States, France and Germany, counters a draft resolution circulated by Russia on Tuesday, which would extend UNSMIS for three months but makes no threat of sanctions.

Russia's Deputy U.N. Ambassador Alexander Pankin told reporters after Annan's briefing that Moscow believed sanctions were a "last resort".

IRAN, IRAQ SUPPORT

Annan said on Wednesday both Iran and Iraq supported a plan for a Syrian-led political transition in Damascus - buttressing his argument that Tehran should be involved in efforts to find a peaceful solution to the crisis despite the West's firm rejection of any Iranian role.

"Obviously, they will use their influence on the government and the parties in moving in that direction," he said.

But while Russia and China have also called for Iran to be included in the process, U.S. officials said there was still no sign that Tehran was ready to act constructively.

"Iran is definitely part of the problem in Syria. It is supporting, aiding and abetting the Assad regime materially and in many other ways and it has shown no readiness to contribute constructively," U.S. Ambassador to the United Nations Susan Rice told reporters.

Opposition leaders say there can be no peaceful transition unless Assad, who crushed popular protests from the moment they began, relinquishes power first. Assad, whose family has ruled Syria for 42 years, says he still has the backing of his people.

In Moscow, Syrian opposition talks with Russia ended in discord on Wednesday, and an opposition leader accused Moscow of pursuing policies that were helping to prolong the bloodshed in the country.

"The Syrian people don't understand Russia's position. How can Russia keep supplying arms? How can they keep vetoing resolutions? There needs to be an end to mass killings," said Burhan Ghalioun of the exiled Syrian National Council (SNC).

But one member of Syria's opposition said a broader shift may be starting in Moscow, which has stepped up its diplomacy in recent weeks amid hints it may be moderating its support for Assad as turmoil engulfs its long-time ally.

"We're trying to work out what exactly Russia is trying to do here. I think they're looking for a genuine solution," a member of the SNC delegation which held talks in Moscow said, asking not to be identified.

Assad's opponents say just under 13,000 armed and unarmed opponents of Assad, and around 4,300 members of security forces loyal to Damascus, have been killed since he launched a crackdown 16 months ago, using tanks and helicopter gunships to attack rebel strongholds inside Syria's biggest cities.

Activists on Wednesday reported a new bombardment of rebel areas of Homs, a hotbed of opposition to Assad, as well as fighting in many other parts of the country. State media reported on missile tests, part of war games that analysts say are a warning to Assad's foes.

Opposition figures have been calling for a no-fly zone and NATO strikes against Syrian forces, similar to those carried out in Libya last year which enabled rebel ground forces to end the rule of Muammar Gaddafi.

But while Assad has faced sanctions and international condemnation, major Western and Arab powers have shied away from the idea of direct military action.

(Additional reporting by Ben Blanchard in Beijing, Michelle Nichols at the United Nations, Mariam Karouny in Beirut, John Irish in Paris, Stephanie Nebehay and Tom Miles in Geneva and Tabassum Zakaria in Washington; Writing by Douglas Hamilton and Andrew Quinn; Editing by Kevin Liffey, Alison Williams and Jackie Frank)

Source: http://news.yahoo.com/china-backs-annans-call-iran-role-syria-talks-095547124.html

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Television section

For the week of June 18-24

1. NBA Finals, Game 5, ABC, 18.4 million.

2. NBA Finals, Game 4, ABC, 17.4 million.

3. "America's Got Talent" (Monday), NBC, 11.4 million.

4. "Big Bang Theory," CBS, 8.3 million.

5. "NCIS," CBS, 8.2 million.

6. "60 Minutes," CBS, 8.2 million.

7. "NCIS: Los Angeles," CBS, 7.4 million.

8. "Two Broke Girls," CBS, 7.1 million.

9. The Bachelorette," ABC, 7.0 million.

10. "America's Got Talent" (Tuesday), NBC, 7.0 million.

Source: http://today.msnbc.msn.com/id/3032450/ns/today-entertainment/

private practice

July/August 2012 Annals of Family Medicine tip sheet

[ Back to EurekAlert! ] Public release date: 9-Jul-2012
[ | E-mail | Share Share ]

Contact: Angela Sharma
asharma@aafp.org
913-269-2269
American Academy of Family Physicians

Opioid Use and Misuse for Chronic Pain: What is the Appropriate Role of Prescription Painkillers?

A cluster of articles in the July/August issue of Annals looks at opioid use for the management of chronic pain, including the escalating levels of misuse, overdose and addiction associated with opioid pain relievers. The role of opioids in the management of chronic pain is timely and consequential the volume of prescribed opioids has increased 600 percent from 1997 to 2007, and during roughly the same period, the number of unintentional lethal overdoses involving prescription opioids increased more than 350 percent, from approximately 4,000 in 1999 to more than 14,000 in 2007. Together, the articles attempt to clarify the appropriate role of opioids in long-term management of chronic noncancer pain.


Depressed Patients More Likely to Misuse Opioids

In a study of patients at two of the country's largest health plans, researchers found patients were much more likely to misuse opioids if they were depressed. The survey of 1,334 patients with no history of substance abuse who were on long-term opioid therapy for chronic pain, found that patients with moderate and severe depression were 1.8 and 2.4 times more likely, respectively, to misuse their opioid pain medications for non-pain symptoms than patients who were not depressed. Patients with mild, moderate and severe depression were 1.9, 2.9 and 3.1 times more likely, respectively, than patients who were not depressed to misuse their opioid medications by self-increasing their dose. The study also identified other risk factors for misuse, including male sex, lower average daily dose, less education, younger age, higher pain severity and white race. The researchers conclude clinicians should be alert to the risk of patients with depressive symptoms using opioids to relieve those symptoms, and they call for future research to examine whether treatment of depression decreases the risk of opioid misuse.

Depression and Prescription Opioid Misuse Among Chronic Opioid Therapy Recipients With No History of Substance Abuse
By Alicia Grattan, MD, et al
University of Washington School of Medicine, Seattle


Editorial: Primary Care Physicians Should Take the Lead in Setting Opioid Prescribing Standards

An editorial by Michael Von Korff, ScD, coauthor of the aforementioned study on depression and opioid misuse, reports on a May 2012 meeting convened by the Food and Drug Administration's Center for Drug Evaluation and Research to discuss the use of analgesics for the management of chronic noncancer pain. A participant and presenter at the meeting, Von Korff acknowledges the pendulum is swinging in the direction of more selective and conservative opioid prescribing. Because primary care is where long-term opioid prescribing most often occurs and is a gateway to nonpharmacologic approaches to chronic pain care, he asserts it is critical that primary care physicians take the leading role in defining how, when and for whom opioids should be used in long-term management of chronic pain.

Opioids for Chronic Noncancer Pain: As the Pendulum Swings, Who Should Set Prescribing Standards for Primary Care?
By Michael Von Korff, ScD
Group Health Research Institute, Seattle, Wash.


Editorial: Opioids Not Appropriate Therapy for Most Primary Care Patients

An editorial from a family physician at the University of Washington asserts opioids for chronic noncancer pain are not appropriate therapy for most patients in primary care settings because of their power to do harm and the availability of safer, alternative treatments for chronic pain, including physical therapy, cognitive behavioral therapy, low-dose tricyclic medications and treatment of co-occurring psychiatric illnesses. He suggests that when other interventions fail or are inadequate, cautious evidence-based consideration of low-dose opioids as an adjunct to other therapies may be considered. Entering into chronic opioid therapy, he concludes, requires a long-term commitment by clinician and patient alike to use this powerful, precious and dangerous medication with care and diligence.

Opioids for Chronic Pain: First Do No Harm
By Roger A. Rosenblatt, MD, MPH, and Mary Catlin, BSN, MPH
University of Washington, Seattle


Essay: Objective Evidence of Severe Disease Needed Before Prescribing Opioids

In an essay, a researcher at the University of California, San Francisco-Fresno proposes a new standard for the use of long-term opioids for chronic pain: the presence or absence of objective evidence of severe disease. The escalating number of deaths and overdoses associated with opioid pain relievers, he asserts, argues for more responsible prescribing. He concludes until we have measures of pain itself, clinicians should insist upon objective evidence of severe disease, including information from diagnostic studies or physical examination findings, before prescribing opioids for chronic pain.

Objective Evidence of Severe Disease: Opioid Use in Chronic Pain
By John A. Zweifler, MD, MPH
University of California, San Francisco-Fresno


Meditation and Exercise Training Associated with Reduced Acute Respiratory Illness Burden

Training in mindfulness meditation and sustained moderate-intensity exercise are associated with reduced illness severity and fewer days of missed work from acute respiratory infections. A study of 149 patients randomized to one of three study groups: 8-week training in mindfulness meditation, matched 8-week training in moderate intensity sustained exercise or observational control found substantial reductions in ARI illness among those randomized to exercise training and even greater benefits among those receiving mindfulness meditation training. Incidence, duration and global severity of ARI illness were 29 percent, 43 percent and 31 percent lower, respectively, in the exercise group, and 33 percent, 43 percent and 60 percent lower, respectively, in the mindfulness group, compared with the control group. Implications for the workplace, the authors note, may be especially important. Compared with the control group, all-cause absenteeism was 31 percent lower in both intervention groups. Looking at ARI-related absenteeism in particular, there were 48 percent fewer days missed in the exercise group, and 76 percent fewer in the meditation group. The authors assert these findings are especially notable given that no ARI prevention strategies, apart from hand washing, have ever been proven.

Meditation or Exercise for Preventing Acute Respiratory Infection: A Randomized Controlled Trial
By Bruce Barrett, MD, PhD, et al
University of Wisconsin, Madison


Patient-centered Personal Health Records Increase Preventive Service Delivery

An interactive preventive health record that provides patients access to their medical record, explains information in lay language, and provides individualized recommendations, resources and reminders is associated with a greater rate of being up to date on recommended preventive services. The trial, involving 4,500 patients in eight primary care practices, randomized patients to either receive a mailed invitation to use an IPHR or to usual care. Despite fairly low rates of use among patients invited to use the IPHR (10 percent at 4 months and 17 percent at 16 months), the proportion of patients up to date with all preventive services increased between baseline and 16 months by 3.8 percent among intervention patients and by 1.5 percent among control patients. Greater increases were observed among patients who used the IPHR. At 16 months, 25.1 percent of users were up to date with all services, double the rate among nonusers. Moreover, at four months, delivery of colorectal, breast and cervical cancer screening increased by 19 percent, 15 percent and 13 percent, respectively, among users. The authors conclude information systems that feature patient-centered functionality, such as the IPHR, have potential to increase preventive service delivery.

Interactive Preventive Health Record to Enhance the Delivery of Recommended Care: A Randomized Trial
By Alex H. Krist, MD, MPH, et al
Virginia Commonwealth University, Richmond


Postpartum Depression Screening Program is First to Demonstrate Improved Patient Outcomes

Primary care physicians given postpartum screening tools and education are more likely to diagnose and treat postpartum depression, and their patients have lower depressive symptoms at six and 12 months of follow-up. A practice-based study involving 28 practices randomized to either receive education and tools for postpartum depression screening or usual care found rates of diagnosis, treatment initiation and referral for psychiatric evaluation were all higher in the intervention group, indicating the program effectively raised awareness. Specifically, of the 1,897 patients included in the analysis, 654 had elevated screening scores indicative of depression, with comparable rates in the intervention and usual-care groups. Among the 654 women with elevated postpartum depression screening scores, those in the intervention practices were more likely to receive a diagnosis (P = .0006) and therapy for postpartum depression (P = .002). They also had lower depressive symptom levels at 6 months (P = .07) and 12 months (P = .001) postpartum. The study is the first large effectiveness study of screening and follow-up care for postpartum depression that has shown any improvement in maternal outcomes at 12 months. These findings, the authors assert, warrant dissemination efforts and continued evaluation of similar practical primary care-based programs that have minimal requirements for referrals to outside mental health services.

TRIPPD: A Practice-Based Network Effectiveness Study of Postpartum Depression Screening and Management
By Barbara P. Yawn, MD, MSc, et al
Olmsted Medical Center, Rochester, Minn.


Chemical Intolerance Prevalent in Primary Care

Evaluating the prevalence, comorbidity and impact of chemical intolerance on functional status and health care use in a sample of 400 primary care patients, researchers found chemical tolerance is prevalent, commonly comorbid with a range of medical and psychiatric conditions, and associated with poorer functional status with trends toward increased medical service use. Overall, 20 percent of the sample met criteria for chemical intolerance. The chemically intolerant group reported significantly higher rates of comorbid allergies and more often met screening criteria for possible major depressive disorder, panic disorder, generalized anxiety disorder, and alcohol abuse disorder, as well as somatization disorder. Controlling for demographics, patients with chemical intolerance were significantly more likely to have poorer functional status, with trends toward increased medical service use when compared with non-chemically intolerant patients. The authors conclude that although chemical intolerance is common in primary care, it often goes unrecognized and requires active investigation by the primary care physician. The presence of chemical intolerance among relatives, a history of medication intolerances/adverse drug reaction, complex multisystem conditions or a prior diagnosis of somatization disorder, they assert, should raise the index of suspicion of chemical intolerance and prompt screening using the Quick Environmental Exposure and Sensitivity Inventory tool.

Chemical Intolerance in Primary Care Settings: Prevalence, Comorbidity, and Outcomes
By David A. Katerndahl, MD, et al
University of Texas Health Science Center


Practice Intervention Shows Promise in Reducing Depression and Self-Harm in Older Patients

An educational intervention targeting general practitioners in Australia reduced the prevalence of depression and self-harm behavior among their older patients. The trial including 373 physicians and 21,762 patients aged 60 years and older testing an intervention that consisted of a practice audit with personalized feedback and printed educational material about screening, diagnosis and management of depression and suicide behavior in later life found those in the intervention group experienced a 10 percent reduction in the odds of depression and self-harm behavior over 2 years of follow up. The authors note the beneficial effect was primarily due to the relative reduction of self-harm behavior among patients who did not report symptoms at baseline. It did not reduce the prevalence of depression or self-harm behavior in patients who had symptoms at baseline. The authors call for the replication of these results with future research.

A Randomized Trial to Reduce the Prevalence of Depression and Self-Harm Behavior in Older Primary Care Patients
By Osvaldo P. Almeida, MD, PhD, FRANZCP, et al
University of Western Australia


Strong Physician-Patient Relationship Critical to the Diagnosis and Management of Depression in Palliative Care Patients

Family physicians in The Netherlands perceive the diagnosis and management of depression in palliative care patients as challenging, but generally feel competent to address the issue. Focus group discussions with 22 family physicians with varying experience in palliative care revealed physicians do not strictly apply criteria of depressive disorder when evaluating patients, but rather rely on their clinical judgment, and strongly considered patients' context and background factors. The participants acknowledged difficulty in discerning depression from normal sadness and identified a lack of knowledge, time and additional support sources as challenges. The authors recommend improving family physician education in this area by building on the elements the study participants identified as key in diagnosing depression and distinguishing it from normal sadness: strengthening continuity of care and relationship- building with patients and their families through the palliative trajectory and explicitly addressing sadness as part of the normal process of coming to terms with the prospect of end of life. They conclude that guidelines, criteria and other tools will provide valuable support only when applied in the context of such a patient-centered approach.

How Family Physicians Address Diagnosis and Management of Depression in Palliative Care Patients
By Franca Warmenhoven
Radboud Univeristy Nijmegen Medical Centre, The Netherlands

###

Annals of Family Medicine is a peer-reviewed, indexed research journal that provides a cross-disciplinary forum for new, evidence-based information affecting the primary care disciplines. Launched in May 2003, Annals is sponsored by seven family medical organizations, including the American Academy of Family Physicians, the American Board of Family Medicine, the Society of Teachers of Family Medicine, the Association of Departments of Family Medicine, the Association of Family Medicine Residency Directors, the North American Primary Care Research Group, and the College of Family Physicians of Canada. Annals is published six times each year and contains original research from the clinical, biomedical, social and health services areas, as well as contributions on methodology and theory, selected reviews, essays and editorials. Complete editorial content and interactive discussion groups for each published article can be accessed free of charge on the journal's Web site, www.annfammed.org.


[ Back to EurekAlert! ] [ | E-mail | Share Share ]

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AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.


[ Back to EurekAlert! ] Public release date: 9-Jul-2012
[ | E-mail | Share Share ]

Contact: Angela Sharma
asharma@aafp.org
913-269-2269
American Academy of Family Physicians

Opioid Use and Misuse for Chronic Pain: What is the Appropriate Role of Prescription Painkillers?

A cluster of articles in the July/August issue of Annals looks at opioid use for the management of chronic pain, including the escalating levels of misuse, overdose and addiction associated with opioid pain relievers. The role of opioids in the management of chronic pain is timely and consequential the volume of prescribed opioids has increased 600 percent from 1997 to 2007, and during roughly the same period, the number of unintentional lethal overdoses involving prescription opioids increased more than 350 percent, from approximately 4,000 in 1999 to more than 14,000 in 2007. Together, the articles attempt to clarify the appropriate role of opioids in long-term management of chronic noncancer pain.


Depressed Patients More Likely to Misuse Opioids

In a study of patients at two of the country's largest health plans, researchers found patients were much more likely to misuse opioids if they were depressed. The survey of 1,334 patients with no history of substance abuse who were on long-term opioid therapy for chronic pain, found that patients with moderate and severe depression were 1.8 and 2.4 times more likely, respectively, to misuse their opioid pain medications for non-pain symptoms than patients who were not depressed. Patients with mild, moderate and severe depression were 1.9, 2.9 and 3.1 times more likely, respectively, than patients who were not depressed to misuse their opioid medications by self-increasing their dose. The study also identified other risk factors for misuse, including male sex, lower average daily dose, less education, younger age, higher pain severity and white race. The researchers conclude clinicians should be alert to the risk of patients with depressive symptoms using opioids to relieve those symptoms, and they call for future research to examine whether treatment of depression decreases the risk of opioid misuse.

Depression and Prescription Opioid Misuse Among Chronic Opioid Therapy Recipients With No History of Substance Abuse
By Alicia Grattan, MD, et al
University of Washington School of Medicine, Seattle


Editorial: Primary Care Physicians Should Take the Lead in Setting Opioid Prescribing Standards

An editorial by Michael Von Korff, ScD, coauthor of the aforementioned study on depression and opioid misuse, reports on a May 2012 meeting convened by the Food and Drug Administration's Center for Drug Evaluation and Research to discuss the use of analgesics for the management of chronic noncancer pain. A participant and presenter at the meeting, Von Korff acknowledges the pendulum is swinging in the direction of more selective and conservative opioid prescribing. Because primary care is where long-term opioid prescribing most often occurs and is a gateway to nonpharmacologic approaches to chronic pain care, he asserts it is critical that primary care physicians take the leading role in defining how, when and for whom opioids should be used in long-term management of chronic pain.

Opioids for Chronic Noncancer Pain: As the Pendulum Swings, Who Should Set Prescribing Standards for Primary Care?
By Michael Von Korff, ScD
Group Health Research Institute, Seattle, Wash.


Editorial: Opioids Not Appropriate Therapy for Most Primary Care Patients

An editorial from a family physician at the University of Washington asserts opioids for chronic noncancer pain are not appropriate therapy for most patients in primary care settings because of their power to do harm and the availability of safer, alternative treatments for chronic pain, including physical therapy, cognitive behavioral therapy, low-dose tricyclic medications and treatment of co-occurring psychiatric illnesses. He suggests that when other interventions fail or are inadequate, cautious evidence-based consideration of low-dose opioids as an adjunct to other therapies may be considered. Entering into chronic opioid therapy, he concludes, requires a long-term commitment by clinician and patient alike to use this powerful, precious and dangerous medication with care and diligence.

Opioids for Chronic Pain: First Do No Harm
By Roger A. Rosenblatt, MD, MPH, and Mary Catlin, BSN, MPH
University of Washington, Seattle


Essay: Objective Evidence of Severe Disease Needed Before Prescribing Opioids

In an essay, a researcher at the University of California, San Francisco-Fresno proposes a new standard for the use of long-term opioids for chronic pain: the presence or absence of objective evidence of severe disease. The escalating number of deaths and overdoses associated with opioid pain relievers, he asserts, argues for more responsible prescribing. He concludes until we have measures of pain itself, clinicians should insist upon objective evidence of severe disease, including information from diagnostic studies or physical examination findings, before prescribing opioids for chronic pain.

Objective Evidence of Severe Disease: Opioid Use in Chronic Pain
By John A. Zweifler, MD, MPH
University of California, San Francisco-Fresno


Meditation and Exercise Training Associated with Reduced Acute Respiratory Illness Burden

Training in mindfulness meditation and sustained moderate-intensity exercise are associated with reduced illness severity and fewer days of missed work from acute respiratory infections. A study of 149 patients randomized to one of three study groups: 8-week training in mindfulness meditation, matched 8-week training in moderate intensity sustained exercise or observational control found substantial reductions in ARI illness among those randomized to exercise training and even greater benefits among those receiving mindfulness meditation training. Incidence, duration and global severity of ARI illness were 29 percent, 43 percent and 31 percent lower, respectively, in the exercise group, and 33 percent, 43 percent and 60 percent lower, respectively, in the mindfulness group, compared with the control group. Implications for the workplace, the authors note, may be especially important. Compared with the control group, all-cause absenteeism was 31 percent lower in both intervention groups. Looking at ARI-related absenteeism in particular, there were 48 percent fewer days missed in the exercise group, and 76 percent fewer in the meditation group. The authors assert these findings are especially notable given that no ARI prevention strategies, apart from hand washing, have ever been proven.

Meditation or Exercise for Preventing Acute Respiratory Infection: A Randomized Controlled Trial
By Bruce Barrett, MD, PhD, et al
University of Wisconsin, Madison


Patient-centered Personal Health Records Increase Preventive Service Delivery

An interactive preventive health record that provides patients access to their medical record, explains information in lay language, and provides individualized recommendations, resources and reminders is associated with a greater rate of being up to date on recommended preventive services. The trial, involving 4,500 patients in eight primary care practices, randomized patients to either receive a mailed invitation to use an IPHR or to usual care. Despite fairly low rates of use among patients invited to use the IPHR (10 percent at 4 months and 17 percent at 16 months), the proportion of patients up to date with all preventive services increased between baseline and 16 months by 3.8 percent among intervention patients and by 1.5 percent among control patients. Greater increases were observed among patients who used the IPHR. At 16 months, 25.1 percent of users were up to date with all services, double the rate among nonusers. Moreover, at four months, delivery of colorectal, breast and cervical cancer screening increased by 19 percent, 15 percent and 13 percent, respectively, among users. The authors conclude information systems that feature patient-centered functionality, such as the IPHR, have potential to increase preventive service delivery.

Interactive Preventive Health Record to Enhance the Delivery of Recommended Care: A Randomized Trial
By Alex H. Krist, MD, MPH, et al
Virginia Commonwealth University, Richmond


Postpartum Depression Screening Program is First to Demonstrate Improved Patient Outcomes

Primary care physicians given postpartum screening tools and education are more likely to diagnose and treat postpartum depression, and their patients have lower depressive symptoms at six and 12 months of follow-up. A practice-based study involving 28 practices randomized to either receive education and tools for postpartum depression screening or usual care found rates of diagnosis, treatment initiation and referral for psychiatric evaluation were all higher in the intervention group, indicating the program effectively raised awareness. Specifically, of the 1,897 patients included in the analysis, 654 had elevated screening scores indicative of depression, with comparable rates in the intervention and usual-care groups. Among the 654 women with elevated postpartum depression screening scores, those in the intervention practices were more likely to receive a diagnosis (P = .0006) and therapy for postpartum depression (P = .002). They also had lower depressive symptom levels at 6 months (P = .07) and 12 months (P = .001) postpartum. The study is the first large effectiveness study of screening and follow-up care for postpartum depression that has shown any improvement in maternal outcomes at 12 months. These findings, the authors assert, warrant dissemination efforts and continued evaluation of similar practical primary care-based programs that have minimal requirements for referrals to outside mental health services.

TRIPPD: A Practice-Based Network Effectiveness Study of Postpartum Depression Screening and Management
By Barbara P. Yawn, MD, MSc, et al
Olmsted Medical Center, Rochester, Minn.


Chemical Intolerance Prevalent in Primary Care

Evaluating the prevalence, comorbidity and impact of chemical intolerance on functional status and health care use in a sample of 400 primary care patients, researchers found chemical tolerance is prevalent, commonly comorbid with a range of medical and psychiatric conditions, and associated with poorer functional status with trends toward increased medical service use. Overall, 20 percent of the sample met criteria for chemical intolerance. The chemically intolerant group reported significantly higher rates of comorbid allergies and more often met screening criteria for possible major depressive disorder, panic disorder, generalized anxiety disorder, and alcohol abuse disorder, as well as somatization disorder. Controlling for demographics, patients with chemical intolerance were significantly more likely to have poorer functional status, with trends toward increased medical service use when compared with non-chemically intolerant patients. The authors conclude that although chemical intolerance is common in primary care, it often goes unrecognized and requires active investigation by the primary care physician. The presence of chemical intolerance among relatives, a history of medication intolerances/adverse drug reaction, complex multisystem conditions or a prior diagnosis of somatization disorder, they assert, should raise the index of suspicion of chemical intolerance and prompt screening using the Quick Environmental Exposure and Sensitivity Inventory tool.

Chemical Intolerance in Primary Care Settings: Prevalence, Comorbidity, and Outcomes
By David A. Katerndahl, MD, et al
University of Texas Health Science Center


Practice Intervention Shows Promise in Reducing Depression and Self-Harm in Older Patients

An educational intervention targeting general practitioners in Australia reduced the prevalence of depression and self-harm behavior among their older patients. The trial including 373 physicians and 21,762 patients aged 60 years and older testing an intervention that consisted of a practice audit with personalized feedback and printed educational material about screening, diagnosis and management of depression and suicide behavior in later life found those in the intervention group experienced a 10 percent reduction in the odds of depression and self-harm behavior over 2 years of follow up. The authors note the beneficial effect was primarily due to the relative reduction of self-harm behavior among patients who did not report symptoms at baseline. It did not reduce the prevalence of depression or self-harm behavior in patients who had symptoms at baseline. The authors call for the replication of these results with future research.

A Randomized Trial to Reduce the Prevalence of Depression and Self-Harm Behavior in Older Primary Care Patients
By Osvaldo P. Almeida, MD, PhD, FRANZCP, et al
University of Western Australia


Strong Physician-Patient Relationship Critical to the Diagnosis and Management of Depression in Palliative Care Patients

Family physicians in The Netherlands perceive the diagnosis and management of depression in palliative care patients as challenging, but generally feel competent to address the issue. Focus group discussions with 22 family physicians with varying experience in palliative care revealed physicians do not strictly apply criteria of depressive disorder when evaluating patients, but rather rely on their clinical judgment, and strongly considered patients' context and background factors. The participants acknowledged difficulty in discerning depression from normal sadness and identified a lack of knowledge, time and additional support sources as challenges. The authors recommend improving family physician education in this area by building on the elements the study participants identified as key in diagnosing depression and distinguishing it from normal sadness: strengthening continuity of care and relationship- building with patients and their families through the palliative trajectory and explicitly addressing sadness as part of the normal process of coming to terms with the prospect of end of life. They conclude that guidelines, criteria and other tools will provide valuable support only when applied in the context of such a patient-centered approach.

How Family Physicians Address Diagnosis and Management of Depression in Palliative Care Patients
By Franca Warmenhoven
Radboud Univeristy Nijmegen Medical Centre, The Netherlands

###

Annals of Family Medicine is a peer-reviewed, indexed research journal that provides a cross-disciplinary forum for new, evidence-based information affecting the primary care disciplines. Launched in May 2003, Annals is sponsored by seven family medical organizations, including the American Academy of Family Physicians, the American Board of Family Medicine, the Society of Teachers of Family Medicine, the Association of Departments of Family Medicine, the Association of Family Medicine Residency Directors, the North American Primary Care Research Group, and the College of Family Physicians of Canada. Annals is published six times each year and contains original research from the clinical, biomedical, social and health services areas, as well as contributions on methodology and theory, selected reviews, essays and editorials. Complete editorial content and interactive discussion groups for each published article can be accessed free of charge on the journal's Web site, www.annfammed.org.


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Source: http://www.eurekalert.org/pub_releases/2012-07/aaof-j2a070112.php

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Video: The Last Dive, Part 6

Dateline NBC

'Dateline NBC,' the signature broadcast for NBC News in primetime, premiered in 1992. Since then, it has been pioneering a new approach to primetime news programming. The multi-night franchise, supplemented by frequent specials, allows NBC to consistently and comprehensively present the highest-quality reporting, investigative features, breaking news coverage and newsmaker profiles.

Source: http://www.msnbc.msn.com/id/3032600/vp/48102144#48102144

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University of Calgary asks dog owners to send in pets? poop

Animal researchers at the University of Calgary are embarking on some stinky science.

They want dog owners in Calgary to scoop up their pets? poop and pass it on for a study examining gastrointestinal parasites.

Researcher Anya Smith says she hopes to find out how parasites are passed between dogs and other wild animals such as coyotes and rodents in urban parks.

More Related to this Story

She adds the results of the study could prove to be priceless.

And it won?t take much work for dog owners.

?It?s minimal effort to them,? Ms. Smith said. ?We will pick it up from a household. They don?t need to be home. We?ll send instructions on leaving it outside.?

In exchange for handing over their doggy doo, owners will get lab results detailing the health of their animals.

?This is a service that normally costs over $100,? Ms. Smith said.

About 6,000 invitations to take part in the study are to be mailed next week. They will target dog owners in specific communities near popular city parks.

In addition to providing an animal?s poop samples, owners must also complete an online survey.

Source: http://www.theglobeandmail.com/news/national/university-of-calgary-asks-dog-owners-to-send-in-pets-poop/article4390731/?cmpid=rss1

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La Russa, Washington fidget with All-Star lineups

KANSAS CITY, Mo. (AP) ? Ron Washington and Tony La Russa have been spending most of their spare moments the past few days fidgeting with potential lineups for next week's All-Star game.

Of course, La Russa has had a little more time on his hands.

After managing the St. Louis Cardinals to the championship last season, La Russa shuffled off into retirement as a three-time World Series-winning manager. Such success normally means you'll be asked to manage in the following year's Midsummer Classic and, retired or not, La Russa was quick to say yes when he was approached about calling the shots in his sixth All-Star game.

"There was never a 'not' side of it," La Russa said Thursday. "I was excited, thrilled, honored to be asked. I have some past All-Star experiences as a coach, and as a manager, and I think it's one of the best experiences you can have. As soon as I was asked, I said yes before the question was finished."

La Russa will be only the second retiree to manage an All-Star team in the game's 79-year history on Tuesday night at Kauffman Stadium, and the first since John McGraw in 1933. He hasn't regretted his decision, either, despite a couple of controversies that have arisen in the past few days.

He left Cardinals outfielder Matt Holliday off the NL roster, even though Holliday has been one of the hottest hitters in the game. The move earned the wrath of St. Louis fans who felt as if La Russa turned his back on his own guy ? never mind the fact that he no longer manages the team.

There also was a brief flap with Cincinnati Reds manager Dusty Baker, who suggested that second baseman Brandon Phillips and pitcher Johnny Cueto were left of the NL team because of a melee between the Reds and Cardinals during the 2010 season. La Russa dismissed such a notion.

Then there are those who believe someone who has retired should not have such a massive impact on a game with significant ramifications for players and managers still involved. After all, the winner gets home-field advantage in the World Series.

La Russa should know the value of that. His Cardinals won three of the four games played at Busch Stadium last season, including Game 6 to stay alive and Game 7 to wrap up the title.

"This isn't golf or tennis. This is a team, and each All-Star, if you put their hand on the baseball bible, they'd say, 'Hey, use me however you think will win the game,' because each team wants to win the game," La Russa said. "In the end, as a manager or coach, you have to keep your heart pure, and do your best as a manager or a coach."

That's why La Russa has been spending a lot of his down time tinkering with lineups, when and where to insert substitutes, and even how he'll catch knuckleballer R.A. Dickey of the Mets.

"You couldn't write a bad lineup. These guys are all stars," La Russa said. "But just to play around and see what the different combinations are, someone has to hit seventh, eighth and ninth, and that's a difficult thing with these guys."

Washington hasn't had nearly as much time to ponder various scenarios.

He squeezed in a conference call with the media on Thursday before leading Texas against the White Sox in the finale of a three-game series. The Rangers then head home for three games against Minnesota this weekend, before a huge contingent of them travels to Kansas City.

Along with the Rangers' coaching staff, a club-record seven players will be on their way, including outfielder Josh Hamilton, who shattered the record for total votes. Third baseman Adrian Beltre, catcher Mike Napoli and second baseman Ian Kinsler also made it by vote, and Washington used three of his selections on shortstop Elvis Andrus and pitchers Matt Harrison and Joe Nathan.

"I've been sitting and playing with my lineups for three or four days, and I've changed it many times," Washington said, "but when you look at it, you're looking at a lineup of All-Stars.

"It's difficult," he said, "but in the meantime, it's a lot of fun, and I'm more than certain by the time I'm ready to put it together finally, I'll be more than happy with it."

Source: http://news.yahoo.com/la-russa-washington-fidget-star-lineups-180450545--mlb.html

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