‘Big Cleanout’ no cure for hoarding
United States (KaiserHealth) – If basic cable is any indication, we have a fascination with hoarding. “We all love a good train wreck,” says Mark Odom, clinical consultant to the Orange County (Calif.) Task Force on Hoarding. He says many people – including psychiatrists – think hoarders are obsessive/compulsive. It’s even listed that way in the “bible” of psychiatric disorders, the DSM IV.
But that’s not necessarily true, according to several studies presented at the annual conference of the American Society on Aging, which wrapped up this weekend in San Francisco. Hoarders are more likely to be depressed, anxious or have social phobias than to have OCD.
Shadwwulf via en.wikipedia
And the problem worsens with age. University of California, San Francisco researcher Monika Eckfield studied 22 older adults and found that changes in their social environment created boredom and isolation. So, for some, shopping became a socially-appropriate way to interact with the world. And then, they don’t get rid of anything once they bring purchases home.
All 16 women and 6 men described “blockages,” with no motivation to discard many things, though no one kept everything. One woman said her house was “constipated,” Eckfield reports.
And the hoarding was not because they had lived in the same place for decades; even people who moved in the last 5 to 10 years didn’t purge when they moved. They hired helpers, who packed, moved and then stacked boxes. Eckfield said their homes “looked like storage lockers.” In fact, because they seemed to lack the capability or help to unpack, and then they couldn’t find things like kitchen supplies, they went out and bought more.
In the March issue of the International Journal of Geriatric Psychiatry, R. Scott Mackin, also from UCSF, and a team of researchers found that about 15 percent of older adults with depression had “severe compulsive hoarding behaviors,” while just 2 percent to 5 percent of non-depressed older adults are hoarders.
He notes that both depression and hoarding are “frontally mediated” – that is, both seem to affect the frontal lobes of the brain, which are associated with planning, motivating and organizing.
The hoarders had much more trouble categorizing objects – such as sorting cards based on color or shapes – and solving problems.
These “cognitive deficits” need to be taken into account before intervening to clean out the hoarder’s home, the team concluded.
Christiana Bratiotis, of the Boston University School of Social Work, says cognitive behavioral therapy can help. Prior to a recent study the school did with the Elder Services of Merrimack Valley (Mass,), the agency used only large scale clean-outs to clear the clutter. She said 100 percent of the time, the elders began hoarding again immediately. And they were angry, distressed and distrustful of anyone (family members, social workers) who tried to intervene again.
For their study, social workers visited 26 people, ages 60-90, weekly for up to a year. They found that the older adults described themselves as “packrats” or “collectors,” not hoarders. The social workers worked with them slowly, to reduce the mistrust and to build organizing skills. They put the hoarders in control of all the decision-making, except eliminating imminent risk (such as papers on the stove) and found that by the end of the year, most could tolerate incremental changes and none had been evicted.
That jives with the Orange County task force’s experience. Mark Odom notes that an effective strategy for them is to emphasize “harm reduction.” He said by invoking regulation-enforcers, such as landlords or fire departments, hoarders had “exterior motivation” to clear at least some of the clutter.
“It’s about house ‘safe and functional,’” he said, “not ‘house beautiful.’”
– Provided by Kaiser Health News.
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Fight against child sex tourism needs a boost
MOMBASA, Kenya (IRIN) – When police in Kenya’s coastal tourist city of Mombasa conduct night raids, it is not unusual for a large number of sex workers arrested to be under 18.
The government faces a struggle to end a trade that many young girls see as a fast way out of poverty and into a more glamorous life.
Munirah* spends her days looking for customers at the city’s Kenyatta Public Beach. Just 15, she already has one child and is the sole breadwinner for her household.
“My widowed mother lost both her hands while working at a steel processing factory in Mombasa, forcing me to do what I am doing,” she told IRIN/PlusNews.
Munirah says she has been selling sex for six months and has already slept with several men, mainly tourists. Most of her clients prefer sex without a condom. When asked if she was aware of the risks of HIV, she shrugged and admitted she had never been for an HIV test.
According to Grace Odembo, a field coordinator with the NGO, Solidarity with Women in Distress, SOLWODI, many of the girls on the streets have limited formal education and therefore little chance of gainful legal employment.
She said “beach boys” – young men who hang around the beaches – acted as pimps for tourists seeking young girls and were paid handsome commissions, fuelling the cycle of child sex work.
“This large number of small girls you see loitering along the beaches looking for wazungu [white men] and even those engaging in legitimate businesses such as selling curios… they fall prey to beach boys who [tell] them they’ll be introduced to perfect rich suitors, only to have them end up in the arms of sex pests instead,” Odembo said.
According to a 2006 study by the government and the UN Children’s Fund, as many as 30 percent of teenage girls in the coastal towns of Diani, Kilifi, Malindi and Mombasa were involved in casual sex work. More than 10 percent of girls began transactional sex before the age of 12.
The study also found that 35.5 percent of all sex acts involving children and tourists took place without condoms.
In 2004, Kenya introduced the “Code of Conduct for the Protection of Children Against Sexual Exploitation in Travel and Tourism” to create awareness and prevent commercial sexual exploitation of children. However, the code seems to have done little to deter tourists seeking sex with minors.
Members of Kenya’s tourism sector say poverty is the main reason young girls turn to sex work, and why it is so difficult to fight the phenomenon.
“The parents, most of whom happen to be poor, instead encourage their daughters [to sell sex] so as to supplement their family earnings,” said Titus Kangangi, chairman of the Kenya Association of Hoteliers. “In many cases, a guardian sides with the accused whenever sexual abuse charges are brought.”
Out of court settlements are the norm in such cases, with tourists paying off families of young girls to avoid jail terms.
Action needed
Tourism Minister Najib Balala told IRIN/PlusNews it was important to rid the coast of its reputation of a haven for child sex tourism.
“This embarrassing tag must be dealt with right from the community level; it is a cartel that needs so much attention if we have to win,” he said. “It has cost the region and country credible tourists and investors, who now see the country as a sex destination.”
Balala said the government was putting more effort into adhering to the code of conduct by cancelling the business licences of establishments allowing tourists to check in with underage girls.
SOLWODI counsels young women and offers alternative incomes through microfinance loans. However, its resources are limited and for many girls, the small loans from NGOs are no match for the income they earn from wealthy tourists.
Poverty is key
Odembo said the government needed to be more vigilant in keeping young girls off the streets. “The government needs to come up with enough rescue centres within the region,” she said. “They should also get to the bottom of why a child found loitering in the beach isn’t attending school.”
According to James Weru, programmes director for the NGO, African Pro-poor Tourism Development Centre , tackling poverty is key to ending child sex tourism.
“Tourism is one of Kenya’s biggest income earners, but less than 20 percent of this income trickles down to local economies and as a result, locals remain very poor,” he said. “The government needs to spread the income out to benefit the locals so that there is less temptation to go into sex work.”
He noted that it would also be important to enforce adherence to the code of conduct and to back this up with serious legal consequences for defaulters.
“We also need to carry out education for tourists and ensure that we are getting the right kind of tourists,” Weru added. “Many governments have lists of paedophiles who are blacklisted from entering their countries, but we have no such measures in Kenya.”
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*Only one name used to protect the child’s identity
– Provided by Integrated Regional Information Networks.
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Catherine Zeta-Jones opens up about bipolar illness
Los Angeles, CA, United States (AHN Entertainment) – Catherine Zeta-Jones has opened up about her bipolar disorder. The 41-year-old actress, who was recently admitted to a mental health facility, said going public with her illness is worth it, saying she hopes she has encouraged a person suffering from a similar disorder to seek out help.
The Academy Award-winning actress was diagnosed with bipolar II disorder earlier this month. The mental illness is marked by prolonged periods of depression alternating with episodes of mild mania.
She said in a statement to People magazine, “This is a disorder that affects millions of people and I am one of them. If my revelation of having bipolar II has encouraged one person to seek help, then it is worth it.”
“There is no need to suffer silently and there is no shame in seeking help.”
Zeta-Jones privately struggled with husband Michael Douglas’ battle with throat cancer. And while Douglas, 66, recovered, she didn’t. She realized that she needed help in the face of her mounting depression.
A close friend said, “The simple things would just seem overwhelming, like going out to dinner. There was just a little piece of her chipped away. It was hard to watch because I knew how hard she was trying.”
Zeta-Jones checked into Silver Hill Hospital in Canaan, CT, in early April. She and Douglas are both parents to 10-year-old son Dylan and 8-year-old daughter Carys.
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Berwick: Obama’s plan to trigger Medicare cuts won’t be necessary
Philadelphia, United States (KaiserHealth) – A day after President Barack Obama proposed strengthening an independent commission to control Medicare’s costs, the program’s administrator said such oversight won’t be necessary because new efforts to reduce waste should slow down spending and even improve the quality of care.
“We don’t have to get to that point,” Medicare chief Donald Berwick told Kaiser Health News Thursday in Philadelphia, where he was addressing a conference of health care journalists. Medicare, the government’s health insurance program for 48 million older and disabled Americans, spent about $509 billion last year.
Under the deficit reduction outline Obama unveiled Wednesday, if Medicare spending grows faster than gross domestic product plus 0.5 percentage point, it would trigger cost reduction recommendations from Medicare’s Independent Payment Advisory Board. The board’s proposals would then go to Congress. If Congress declined to approve those cuts or make equivalent cuts of its own, the secretary of Health and Human Services would be required to enforce them. The 15-member board was created by the federal health care overhaul law, which set the trigger point slightly higher: a rise in per capita gross domestic product plus 1 percentage point.
Berwick called Obama’s proposal “a very wise default system – a Plan B,” adding that “he is right to hold our feet to the fire.”
But he said that improving the quality of care and reducing waste will avoid the trigger and yield big savings by keeping people healthy and avoiding medical complications.
“There are two ways to save money,” Berwick told the journalists meeting. “One is to cut and the other is to improve.” He cited hospitals that have dramatically reduced patients’ bed sores and another that adopted efficiency steps from Toyota to save millions of dollars while also delivering better care.
“The aim is to make the best the norm,” he said.
Berwick said the health law provides other tools to improve health care quality and delivery. These include accountable care organizations, in which doctors and hospitals coordinate patient care, and the newly created Center for Medicare and Medicaid Innovation to “nurture invention” that will lower costs and raise quality.
He also pointed to a patient safety initiative the Obama administration announced this week to reduce preventable hospital-acquired infections and complications. It could save 60,000 lives and cut Medicare costs by an estimated $50 billion over 10 years, officials estimated.
In contrast, Berwick said the Republican proposal to refashion Medicare by giving vouchers to seniors to buy private insurance would reduce health benefits. Such vouchers would eventually cut access to health care, because they would not keep pace with the rate of health care inflation and would not cover seniors’ medical bills.
It would abandon people “who need us to be there, the elderly, the disadvantaged, the disabled,” he said. “It is a withdrawal of support from people who badly need our help and who will end up worse off.”
Contact Susan Jaffe at jaffe.khn@gmail.com.
– Provided by Kaiser Health News.
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Americans Like Their Health Care, But Think The System Stinks
Washington, D.C., United States (KaiserHealth) – If America has the best health care system in the world, as some people like to say, then the setups in other countries must really be crummy.
How come? Well, check out the disheartening results of a poll just out from the Robert Wood Johnson Foundation and the Harvard School of Public Health. Fifty-five percent of adults surveyed gave the U.S. health care system a C or D, when asked to assign it a grade. Eleven percent gave it an F.
Can we send the health system to its room until it gets those grades up?
Familiarity trumps data when it comes to picking a hospital, the poll finds. Most people – 57 percent – would chose a hospital they or someone they know has had experience with over a hospital that does well on quality measures – 38 percent.
Indeed, when it comes to health care, people’s views are a little more charitable when the questions focus on their personal experience instead of the abstract. When asked about the quality of care they’ve actually received, nearly a third – 31 percent – of people give it an A. Thirty-four percent say it’s a B. Only 13 percent grade it D or F.
When it comes to some things, such as picking a surgeon, data seem to count for a little bit more. People were pretty much evenly divided on whether the experience of family or friends would be decisive (48 percent were in that camp) and about an equal proportion (47 percent) leaned toward quality ratings.
Data-driven decision making for surgery, at least, seems to be gaining steam. In 2000, the same question got 50 percent in the family-and-friends column and 38 percent in the quality-ratings column.
The results were presented at a meeting of the American Hospital Association. In a statement, Robert Blendon, professor of Health Policy and Political Analysis at the Harvard School of Public Health, said:
The pace of change in having consumers use independent expert ratings when they choose a hospital has been slower than anticipated. More can be done to encourage this.
Blendon’s group conducted the poll, which included responses from 1,034 people and has a margin of error of +/- 3.7 percentage points.
– Provided by Kaiser Health News.
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Medicaid To Offer Rewards For Healthy Behavior
Washington, D.C., United States (KaiserHealth) – A federal grant program authorized in the health overhaul law is offering states $100 million to reward Medicaid recipients who make an effort to quit smoking or keep their weight, blood pressure or cholesterol levels in check.
The grant program is meant to encourage states, many of which are under pressure to cut Medicaid costs, to experiment with an uncertain approach to wellness: offering incentives for healthy behavior.
“Medicaid is almost the sweet spot for financial rewards,” said George Loewenstein, a behavioral economist at Carnegie Mellon University who has studied the effect of financial incentives on behavior. Medicaid recipients, he explains, are economically disadvantaged and have more to gain from incentives.
Loewenstein, however, is dubious about whether incentives, especially those tied to weight loss, could really work. He’s not alone.
Behavioral incentive programs have shown some promise in specific settings, but they are largely untested in the Medicaid population.
The federal dollars for Medicaid incentives reflect a sharpening emphasis on the role of preventive health in targeting the underlying causes of chronic disease, a central pillar of the Obama administration’s health care agenda. States have until May 2 to submit their final proposals to the Centers for Medicare & Medicaid Services for funding, and a number have indicated an interest.
And while states have some flexibility about how they design their incentives, federal guidelines provide a basic profile. Medicaid enrollees who demonstrate a commitment to improving their health will be eligible to receive financial rewards such as coupons or gift certificates. For those who are overweight or trying to quit smoking, that commitment might take the form of weight management classes or tobacco cessation counseling. States are encouraged to provide rewards “on a tiered basis” for attempts at participation, “actual behavior change,” and “achievement of health goals.”
Chronic conditions such as diabetes, bad cholesterol and high blood pressure account for more than 75 percent of the $2.5 trillion the U.S. spends annually on health care, according to data from the Department of Health and Human Services. Cigarette smoking, 10 percent more prevalent among Medicaid enrollees than the population at large, cost Medicaid programs an average of $607 million in 2004, according to the National Center for Health Statistics, and is also the leading preventable cause of death in the U.S.
States Have Mixed Results
To date, a few states have tried transplanting the corporate wellness model to Medicaid, with mixed results. State health officials seem to agree that participation from health care providers and other community organizations, often a challenge, was critical in making their programs work.
West Virginia’s approach, which provides an enhanced coverage plan with added benefits to Medicaid enrollees who agree to adhere to healthy behaviors, has been widely criticized by health advocates.
Idaho, which launched an incentive program in 2007, offers $200 in vouchers to Medicaid enrollees who consult with a doctor about losing weight or quitting smoking. Recipients can use the vouchers for gym memberships, weight management programs, nutrition counseling and tobacco cessation products. Tobacco counseling courses are offered free of charge through public health districts in the state. Idaho is now enrolling about 1,500 new Medicaid participants each year.
According to Tom Kearns, who manages Idaho’s Preventive Health Assistance initiative, participants have written in with positive feedback – but the state doesn’t have data to show whether the incentives are cost-effective or have a large-scale impact on participants’ behavior.
“There’s a lot of challenges in tracking the outcomes of this long-term,” Kearns said. “Ultimately we’d like to have a large enough population to track.”
The state has worked hard to find partners who are willing to accept its vouchers and so far has more luck with community groups, such as the YMCA, than private companies.
Florida has also tried using incentives in its Medicaid managed care pilot program.
The program allows Medicaid enrollees living in five counties to earn up to $125 worth of credits each fiscal year in exchange for their compliance with certain “healthy behaviors,” like getting a flu shot or adhering to a prescribed drug regimen. Participants can redeem the credits at participating pharmacies for over-the-counter products such as bandages and diapers.
But logistical setbacks have dampened the impact of the incentives. At first, few were aware that the program even existed, and some pharmacies refused to accept the Medicaid credits. Several hundred people have received credits for participating in a diabetes or hypertension disease management program since 2006, but as of February, only two individuals were on the record for having attended a smoking cessation course, and six individuals have been credited for entering a weight management or exercise program.
“There’s a question about whether this is really incentivizing anything … that link is very dubious,” said Greg Mellowe, policy director at the consumer advocacy group Florida CHAIN. Most of the credits distributed through Florida’s rewards program in the past five years, Mellowe contends, were awarded for routine visits and immunizations that Medicaid recipients would have sought anyway – and not for significant behavioral changes.
Research On Incentives Is Inconclusive
Research is scant on the effects of incentive programs on mitigating chronic diseases. A smattering of studies have shown that complex behavioral programs with built-in incentives can sometimes produce short-term results-if the incentives are large enough. A 2009 study published in the New England Journal of Medicine found that a program offering people $750 to quit smoking: 15 percent of participants eligible for a reward managed to quit, compared with 5 percent of participants who enrolled in a traditional tobacco cessation program.
A similar study about incentive-based weight loss programs, published by some of the same researchers in the Journal of the American Medical Association, was less optimistic. That study found that financial rewards did help participants lose more weight temporarily, but the losses weren’t fully sustained in the end.
Few behavioral studies have attempted to determine whether people who receive the incentives are able to maintain their short-term success long term – the ultimate goal of incentive-based prevention program. Fewer attempts have been made to address how the design of an incentive program should be adjusted according to the demographics of the target population, such as insuring that low-income participants have transportation to get to appointments and classes.
“In and of itself, without health education and other forms of engagement, it seems to fall short,” said Judith Solomon, vice president for health policy at the Center on Budget and Policy Priorities. “The incentives are never going to be enormous because it’s never going to be affordable.”
– Provided by Kaiser Health News.
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Kentucky manufacturing plant hit by tornado, seven people injured
Hopkinsville, KY, United States (AHN) – According to reports seven people were injured and a manufacturing plant was heavily damged.
The Hopkinsville TG Automotive Sealing Kentucky (TGASK) plant in Hopkinsville was struck Monday afternoon by a tornado after the region was under placed under a severe storm warning earlier in the day.
The seven victims suffered non-life threatening injuries and were transported to a nearby hospital.
Over 100 people were in the TGASK building when the storm hit at noon. The area was battered by strong winds which knocked down and snapped power lines.
Police and first responders say the facility suffered heavy structural damage to the facility, which manufactures weather sealing components for vehicles.
“We’ve got a partial collapse with the roof taken off,” said Randy Graham with the Christian County Emergency Management Agency.
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Naked standoff ends with Florida man being taken into custody wearing a towel
Lauderdale Lakes, FL, United States (AHN) – A naked man involved in an hour long standoff with Broward SWAT officers was eventually taken into custody wearing only a towel.
The incident began about 11 a.m. at a Lauderdale Lakes retirement community when the Broward Sherriff’s Office SWAT team was received a call about a man who barricaded himself in an apartment.
Apparently reports came in to police earlier of a disturbed man firing shots at the Hawaiian Gardens complex. Local police were forced to evacuated nearby residents as they investigated.
After some coaxing he eventually came out wearing only a towel but police securely behind shields and other protection.
He was taken into custody with a peaceful surrender.
Neighbors identified the man as Richard Dickert. They said it appears he had gone off his medication.
One neighbor described as a good man and a “really nice guy,” who often hung out by the pool and simply needed his meds.
However it wasn’t his first outburst. He’s been known to throw things out of his window before.
Officials say he will be taken to a psychiatric clinic for evaluation under Florida’s Baker Act.
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Bangladesh scientist has breakthrough in burn injury dressing
Dhaka, Bangladesh (AHN) – A Bangladesh-born agro-scientist has invented a bio-based wound dressing that cures injuries 40 percent faster than any other conventional medicine currently available. That’s potentially good news for people with severe wounds and similar physical injuries from acid attack and fire.
Dr. Azam Ali, who lives in New Zealand, has created bio-based materials to create new wound dressings, bone-graft implant products and medical suture technology using low-volume protein sources from the wool from New Zealand sheep.
He told state-run news agency BSS that the new wound dressing dramatically brings down treatment time while the result is far better because the bio-based wound dressing accelerates the wound healing process and tissue growth.
Ali, a senior scientist with AgResearch, a leading research station in New Zealand, said the treatment would be costlier than existing synthetic products, but it would heal acid wounds and burn victims to the extent they can get back to normal life.
He said that Bangladesh can use shrimp shells instead of wool to produce the same products with similar quality and effectiveness.
‘There is lot of shrimp shells available at the industry where shrimp are being processed regularly for either export or domestic use,” he quipped.
The scientist sees very bright prospects of using the new product in Bangladesh because of the availability of natural raw materials.
Two of his wound-care medical products are now being used at New Zealand hospitals and are approved for use in Australia, United States and the European Union.
The breakthrough innovation won Ali the globally-reputed Bayer Innovation of the Year Award in 2010.
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Study: Exercise, sex can trigger heart attack, cardiac arrest
Boston, MA, United States (AHN) – Researchers who analyzed previous studies linking exercise and sex to heart attacks and cardiac arrests found that such physical activities can increase the risk of suffering or dying from heart attack.
But the study, published in the latest issue of the Journal of the American Medical Association, also found that the risk of heart attack and sudden cardiac death is lesser in people who regularly exercise.
According to the study’s lead author, Dr. Issa Dahabreh of Tufts Medical Center in Boston, people are 3.5 times more likely to suffer from a heart attack or sudden cardiac death when they are exercising.
A heart attack is also 2.7 times more likely to occur during sexual activity or immediately after sex, the study said.
The time a person is exposed to such risk is short, only from one to two hours during and after exercise or sexual activity, co-researcher Jessica Paulus said.
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