Jan Dyer

The VHA offers several preventive care programs to veterans who are at high risk for various chronic illnesses: For instance, 20% of veterans smoke, and > 70% of VHA patients are overweight.

Although those programs are well supported and have strong evidence for effectiveness, they’re underused, say researchers from Durham VAMC and Duke University in North Carolina, VA Ann Arbor Healthcare System in Michigan, and VA Salt Lake City Center for Informatics Decision Enhancement and Surveillance and University of Utah. The VHA’s MOVE! Program produced significant weight loss among participants—the only problem was that < 10% of eligible veterans actually joined.

The researchers conducted the ACTIVATE trial, which involved a web-based health risk assessment (HRA) coupled with a health coaching intervention to link veterans to a local prevention program. In the study, veterans completed an online HRA. The researchers then tested whether 2 telephone-based coaching sessions were more effective in getting the veterans to enroll in prevention programs than did completing the HRA.

The coaching was not designed to change behavior but specifically aimed at helping veterans set a “first step” goal by choosing a program to enroll in that aligned with their values and preferences as well as risk factors highlighted by their HRA surveys.

The results aren’t in, but the researchers expect their findings to help the VHA implement its plan to engage veterans in preventive health care. Their “robustly designed trial,” they say, “will add valuable knowledge at a critical time when VHA and other health systems are working to understand how to effectively incorporate HRA findings into the busy clinic flow of primary care.”

The VHA offers several preventive care programs to veterans who are at high risk for various chronic illnesses: For instance, 20% of veterans smoke, and > 70% of VHA patients are overweight.

Although those programs are well supported and have strong evidence for effectiveness, they’re underused, say researchers from Durham VAMC and Duke University in North Carolina, VA Ann Arbor Healthcare System in Michigan, and VA Salt Lake City Center for Informatics Decision Enhancement and Surveillance and University of Utah. The VHA’s MOVE! Program produced significant weight loss among participants—the only problem was that < 10% of eligible veterans actually joined.

The researchers conducted the ACTIVATE trial, which involved a web-based health risk assessment (HRA) coupled with a health coaching intervention to link veterans to a local prevention program. In the study, veterans completed an online HRA. The researchers then tested whether 2 telephone-based coaching sessions were more effective in getting the veterans to enroll in prevention programs than did completing the HRA.

The coaching was not designed to change behavior but specifically aimed at helping veterans set a “first step” goal by choosing a program to enroll in that aligned with their values and preferences as well as risk factors highlighted by their HRA surveys.

The results aren’t in, but the researchers expect their findings to help the VHA implement its plan to engage veterans in preventive health care. Their “robustly designed trial,” they say, “will add valuable knowledge at a critical time when VHA and other health systems are working to understand how to effectively incorporate HRA findings into the busy clinic flow of primary care.”

The VHA offers several preventive care programs to veterans who are at high risk for various chronic illnesses: For instance, 20% of veterans smoke, and > 70% of VHA patients are overweight.

Although those programs are well supported and have strong evidence for effectiveness, they’re underused, say researchers from Durham VAMC and Duke University in North Carolina, VA Ann Arbor Healthcare System in Michigan, and VA Salt Lake City Center for Informatics Decision Enhancement and Surveillance and University of Utah. The VHA’s MOVE! Program produced significant weight loss among participants—the only problem was that < 10% of eligible veterans actually joined.

The researchers conducted the ACTIVATE trial, which involved a web-based health risk assessment (HRA) coupled with a health coaching intervention to link veterans to a local prevention program. In the study, veterans completed an online HRA. The researchers then tested whether 2 telephone-based coaching sessions were more effective in getting the veterans to enroll in prevention programs than did completing the HRA.

The coaching was not designed to change behavior but specifically aimed at helping veterans set a “first step” goal by choosing a program to enroll in that aligned with their values and preferences as well as risk factors highlighted by their HRA surveys.

The results aren’t in, but the researchers expect their findings to help the VHA implement its plan to engage veterans in preventive health care. Their “robustly designed trial,” they say, “will add valuable knowledge at a critical time when VHA and other health systems are working to understand how to effectively incorporate HRA findings into the busy clinic flow of primary care.”

Does the course of posttraumatic stress disorder (PTSD) differ depending on whether the person is in the military or has left? Researchers from Naval Health Research Center and the VA wondered whether separation from the military could create a “significant disruption of routine, order, and structure,” which might exacerbate PTSD symptoms, and would the symptoms subside as the veteran adjusted to civilian life?

Using data from the Millennium Cohort Study, researchers examined trajectories of PTSD among 22,080 military personnel across 4 time points, about 3 years apart, from 2001 to 2013. They compared trajectories between people who separated before the second time point or remained in the military across the entire study period. The researchers assessed PTSD screening and symptoms using the PTSD Checklist-Civilian, for which higher scores represent more severe symptoms.

The researchers say 4 distinct classes described symptom trajectories: resilient, delayed onset, improving, and elevated-recovering. Overall, the trajectories were similar for veterans and active-duty personnel. Veterans had a higher likelihood of screening positive for PTSD at baseline before separation and were more likely to newly screen positive for PTSD at waves 2, 3, and 4. Of participants who screened positive for PTSD, veterans had more severe symptoms compared with active-duty personnel at baseline but not at any subsequent assessments.

However, differences between the “elevated-recovering” classes grew over time, showing that veterans did not recover as soon or as “dramatically,” the researchers say. This might be due to symptoms being exacerbated by the change in routine.

The good news is that most veterans and active-duty personnel fell into the resilient class (82% and 87%, respectively). The researchers cite other studies that have found resilience is the most common response to PTSD.

The researchers noted several risk factors for slower recovery, such as lower physical well-being and a history of multiple life stressors. The “delayed onset” group may be a good target for interventions, they suggest. This group reported high use of VA care, but still 26% reported no VA care, indicating that they could benefit from continued efforts to identify and treat them.

Does the course of posttraumatic stress disorder (PTSD) differ depending on whether the person is in the military or has left? Researchers from Naval Health Research Center and the VA wondered whether separation from the military could create a “significant disruption of routine, order, and structure,” which might exacerbate PTSD symptoms, and would the symptoms subside as the veteran adjusted to civilian life?

Using data from the Millennium Cohort Study, researchers examined trajectories of PTSD among 22,080 military personnel across 4 time points, about 3 years apart, from 2001 to 2013. They compared trajectories between people who separated before the second time point or remained in the military across the entire study period. The researchers assessed PTSD screening and symptoms using the PTSD Checklist-Civilian, for which higher scores represent more severe symptoms.

The researchers say 4 distinct classes described symptom trajectories: resilient, delayed onset, improving, and elevated-recovering. Overall, the trajectories were similar for veterans and active-duty personnel. Veterans had a higher likelihood of screening positive for PTSD at baseline before separation and were more likely to newly screen positive for PTSD at waves 2, 3, and 4. Of participants who screened positive for PTSD, veterans had more severe symptoms compared with active-duty personnel at baseline but not at any subsequent assessments.

However, differences between the “elevated-recovering” classes grew over time, showing that veterans did not recover as soon or as “dramatically,” the researchers say. This might be due to symptoms being exacerbated by the change in routine.

The good news is that most veterans and active-duty personnel fell into the resilient class (82% and 87%, respectively). The researchers cite other studies that have found resilience is the most common response to PTSD.

The researchers noted several risk factors for slower recovery, such as lower physical well-being and a history of multiple life stressors. The “delayed onset” group may be a good target for interventions, they suggest. This group reported high use of VA care, but still 26% reported no VA care, indicating that they could benefit from continued efforts to identify and treat them.

Does the course of posttraumatic stress disorder (PTSD) differ depending on whether the person is in the military or has left? Researchers from Naval Health Research Center and the VA wondered whether separation from the military could create a “significant disruption of routine, order, and structure,” which might exacerbate PTSD symptoms, and would the symptoms subside as the veteran adjusted to civilian life?

Using data from the Millennium Cohort Study, researchers examined trajectories of PTSD among 22,080 military personnel across 4 time points, about 3 years apart, from 2001 to 2013. They compared trajectories between people who separated before the second time point or remained in the military across the entire study period. The researchers assessed PTSD screening and symptoms using the PTSD Checklist-Civilian, for which higher scores represent more severe symptoms.

The researchers say 4 distinct classes described symptom trajectories: resilient, delayed onset, improving, and elevated-recovering. Overall, the trajectories were similar for veterans and active-duty personnel. Veterans had a higher likelihood of screening positive for PTSD at baseline before separation and were more likely to newly screen positive for PTSD at waves 2, 3, and 4. Of participants who screened positive for PTSD, veterans had more severe symptoms compared with active-duty personnel at baseline but not at any subsequent assessments.

However, differences between the “elevated-recovering” classes grew over time, showing that veterans did not recover as soon or as “dramatically,” the researchers say. This might be due to symptoms being exacerbated by the change in routine.

The good news is that most veterans and active-duty personnel fell into the resilient class (82% and 87%, respectively). The researchers cite other studies that have found resilience is the most common response to PTSD.

The researchers noted several risk factors for slower recovery, such as lower physical well-being and a history of multiple life stressors. The “delayed onset” group may be a good target for interventions, they suggest. This group reported high use of VA care, but still 26% reported no VA care, indicating that they could benefit from continued efforts to identify and treat them.

Researchers from The Cancer Genome Atlas (TCGA) Research Network analyzed 178 primary cervical cancers, and found > 70% had genomic alteration in 1 or both of 2 important cell signaling pathways. They also found that a subset of tumors showed no evidence of HPV infection.

“This aspect of the research is one of the most intriguing findings to come out of the TCGA program, which has been looking at more than 30 tumor types over the past decade,” said Jean-Claude Zenklusen, PhD, director of the TCGA program office.

The researchers found several instances of amplification of genes that code for known immune targets, which may predict responsiveness to immunotherapy. They also identified several novel mutated genes. Particularly interesting, the researchers say, was the identification of a unique set of 8 cervical cancers that showed molecular similarities to endometrial cancers; the cancers were mainly HPV negative. That finding “confirms that not all cervical cancers are related to HPV infection and that a small percentage of cervical tumors may be due to strictly genetic or other factors,” said Zenklusen.

Researchers from The Cancer Genome Atlas (TCGA) Research Network analyzed 178 primary cervical cancers, and found > 70% had genomic alteration in 1 or both of 2 important cell signaling pathways. They also found that a subset of tumors showed no evidence of HPV infection.

“This aspect of the research is one of the most intriguing findings to come out of the TCGA program, which has been looking at more than 30 tumor types over the past decade,” said Jean-Claude Zenklusen, PhD, director of the TCGA program office.

The researchers found several instances of amplification of genes that code for known immune targets, which may predict responsiveness to immunotherapy. They also identified several novel mutated genes. Particularly interesting, the researchers say, was the identification of a unique set of 8 cervical cancers that showed molecular similarities to endometrial cancers; the cancers were mainly HPV negative. That finding “confirms that not all cervical cancers are related to HPV infection and that a small percentage of cervical tumors may be due to strictly genetic or other factors,” said Zenklusen.

Researchers from The Cancer Genome Atlas (TCGA) Research Network analyzed 178 primary cervical cancers, and found > 70% had genomic alteration in 1 or both of 2 important cell signaling pathways. They also found that a subset of tumors showed no evidence of HPV infection.

“This aspect of the research is one of the most intriguing findings to come out of the TCGA program, which has been looking at more than 30 tumor types over the past decade,” said Jean-Claude Zenklusen, PhD, director of the TCGA program office.

The researchers found several instances of amplification of genes that code for known immune targets, which may predict responsiveness to immunotherapy. They also identified several novel mutated genes. Particularly interesting, the researchers say, was the identification of a unique set of 8 cervical cancers that showed molecular similarities to endometrial cancers; the cancers were mainly HPV negative. That finding “confirms that not all cervical cancers are related to HPV infection and that a small percentage of cervical tumors may be due to strictly genetic or other factors,” said Zenklusen.

A child who has a cold, flu, or other acute illness may be what parents often call “fussy”: irritable, teary, and clingy. Such changes in behavior and mood, or “sickness behavior (SB),” are usually thought to be linked to fever.  Actually, those symptoms are the immune system’s reactions to invasion by a pathogen, say French researchers—and they may be present whether the child has fever or not. The researchers’ say their multicenter study is the first to show dissociation between SB and the severity of the fever.

The researchers evaluated 6 parameters over the 2 hours preceding consultations with the parents of 200 children with and 200 without fever. Children with particularly painful illnesses and chronic diseases were excluded from the study. Parents used rating scales to report degrees of change in the time the child spent playing, the distance covered (ie. how far from the parent the child roamed), time the child spent seeking comfort, time spent whining or crying, time spent in a state of irritation or anger, most distorted facial expression (on a chart). The researchers also assessed time spent sleeping and appetite in the 24 hours before the consultation. Sickness behavior can’t be reduced to the observation of those 8 behavioral parameters, the researchers note, but they were easy for parents to use and assess.

The mean values of the 8 parameters differed significantly between the 2 groups but were independent of the height of fever in the febrile children. That independence suggests that SB and fever are expressions of 2 autonomous metabolic pathways that are activated simultaneously in febrile conditions, the researchers say, which is in accordance with current pathophysiologic knowledge.

Their findings are in harmony with current treatment recommendations, the researchers say. Because it’s hard to know when behavior changes are due to SB, pain, fatigue, or something else in a febrile child—especially one who is too young to talk about it—it’s more important to focus on relieving the discomfort than in reducing the fever.

Source:

Corrard F, Copin C, Wollner A, et al. PLoS One. 2017;12(3): e0171670.
doi: 10.1371/journal.pone.0171670.

A child who has a cold, flu, or other acute illness may be what parents often call “fussy”: irritable, teary, and clingy. Such changes in behavior and mood, or “sickness behavior (SB),” are usually thought to be linked to fever.  Actually, those symptoms are the immune system’s reactions to invasion by a pathogen, say French researchers—and they may be present whether the child has fever or not. The researchers’ say their multicenter study is the first to show dissociation between SB and the severity of the fever.

The researchers evaluated 6 parameters over the 2 hours preceding consultations with the parents of 200 children with and 200 without fever. Children with particularly painful illnesses and chronic diseases were excluded from the study. Parents used rating scales to report degrees of change in the time the child spent playing, the distance covered (ie. how far from the parent the child roamed), time the child spent seeking comfort, time spent whining or crying, time spent in a state of irritation or anger, most distorted facial expression (on a chart). The researchers also assessed time spent sleeping and appetite in the 24 hours before the consultation. Sickness behavior can’t be reduced to the observation of those 8 behavioral parameters, the researchers note, but they were easy for parents to use and assess.

The mean values of the 8 parameters differed significantly between the 2 groups but were independent of the height of fever in the febrile children. That independence suggests that SB and fever are expressions of 2 autonomous metabolic pathways that are activated simultaneously in febrile conditions, the researchers say, which is in accordance with current pathophysiologic knowledge.

Their findings are in harmony with current treatment recommendations, the researchers say. Because it’s hard to know when behavior changes are due to SB, pain, fatigue, or something else in a febrile child—especially one who is too young to talk about it—it’s more important to focus on relieving the discomfort than in reducing the fever.

Source:

Corrard F, Copin C, Wollner A, et al. PLoS One. 2017;12(3): e0171670.
doi: 10.1371/journal.pone.0171670.

A child who has a cold, flu, or other acute illness may be what parents often call “fussy”: irritable, teary, and clingy. Such changes in behavior and mood, or “sickness behavior (SB),” are usually thought to be linked to fever.  Actually, those symptoms are the immune system’s reactions to invasion by a pathogen, say French researchers—and they may be present whether the child has fever or not. The researchers’ say their multicenter study is the first to show dissociation between SB and the severity of the fever.

The researchers evaluated 6 parameters over the 2 hours preceding consultations with the parents of 200 children with and 200 without fever. Children with particularly painful illnesses and chronic diseases were excluded from the study. Parents used rating scales to report degrees of change in the time the child spent playing, the distance covered (ie. how far from the parent the child roamed), time the child spent seeking comfort, time spent whining or crying, time spent in a state of irritation or anger, most distorted facial expression (on a chart). The researchers also assessed time spent sleeping and appetite in the 24 hours before the consultation. Sickness behavior can’t be reduced to the observation of those 8 behavioral parameters, the researchers note, but they were easy for parents to use and assess.

The mean values of the 8 parameters differed significantly between the 2 groups but were independent of the height of fever in the febrile children. That independence suggests that SB and fever are expressions of 2 autonomous metabolic pathways that are activated simultaneously in febrile conditions, the researchers say, which is in accordance with current pathophysiologic knowledge.

Their findings are in harmony with current treatment recommendations, the researchers say. Because it’s hard to know when behavior changes are due to SB, pain, fatigue, or something else in a febrile child—especially one who is too young to talk about it—it’s more important to focus on relieving the discomfort than in reducing the fever.

Source:

Corrard F, Copin C, Wollner A, et al. PLoS One. 2017;12(3): e0171670.
doi: 10.1371/journal.pone.0171670.

High-dose immunosuppressive therapy and autologous hematopoietic cell transplant (HDIT/HCT) has had “highly promising” results for patients with relapsing-remitting multiple sclerosis (MS), according to researchers from the HALT-MS trial. In the 5-year study, 69% of 24 participants survived without progression of disability, relapse, or new brain lesions, despite not taking MS medications.

Findings published at the 3-year mark were encouraging. The event-free survival rate was 78%. The extended findings suggest that “onetime treatment with HDIT/HCT may be substantially more effective than long-term treatment with the best available medications” for these patients, said NIAID Director Anthony Fauci, MD.

The treatment “resets” the immune system, the researchers say. First, doctors collect the patient’s blood-forming stem cells, then give the patient chemotherapy to deplete the immune system. Finally, the doctors return the patient’s stem cells to rebuild the immune system.

Adverse events were consistent with those routinely observed after HDIT/HCT. Adverse effects recorded at 4 and 5 years were not related to the transplant and were not considered severe. Three patients died, but their deaths were not related to the study treatments.

Five years later, most trial participants remained in remission and stabilized, and some showed improvements, such as recovering mobility.

High-dose immunosuppressive therapy and autologous hematopoietic cell transplant (HDIT/HCT) has had “highly promising” results for patients with relapsing-remitting multiple sclerosis (MS), according to researchers from the HALT-MS trial. In the 5-year study, 69% of 24 participants survived without progression of disability, relapse, or new brain lesions, despite not taking MS medications.

Findings published at the 3-year mark were encouraging. The event-free survival rate was 78%. The extended findings suggest that “onetime treatment with HDIT/HCT may be substantially more effective than long-term treatment with the best available medications” for these patients, said NIAID Director Anthony Fauci, MD.

The treatment “resets” the immune system, the researchers say. First, doctors collect the patient’s blood-forming stem cells, then give the patient chemotherapy to deplete the immune system. Finally, the doctors return the patient’s stem cells to rebuild the immune system.

Adverse events were consistent with those routinely observed after HDIT/HCT. Adverse effects recorded at 4 and 5 years were not related to the transplant and were not considered severe. Three patients died, but their deaths were not related to the study treatments.

Five years later, most trial participants remained in remission and stabilized, and some showed improvements, such as recovering mobility.

High-dose immunosuppressive therapy and autologous hematopoietic cell transplant (HDIT/HCT) has had “highly promising” results for patients with relapsing-remitting multiple sclerosis (MS), according to researchers from the HALT-MS trial. In the 5-year study, 69% of 24 participants survived without progression of disability, relapse, or new brain lesions, despite not taking MS medications.

Findings published at the 3-year mark were encouraging. The event-free survival rate was 78%. The extended findings suggest that “onetime treatment with HDIT/HCT may be substantially more effective than long-term treatment with the best available medications” for these patients, said NIAID Director Anthony Fauci, MD.

The treatment “resets” the immune system, the researchers say. First, doctors collect the patient’s blood-forming stem cells, then give the patient chemotherapy to deplete the immune system. Finally, the doctors return the patient’s stem cells to rebuild the immune system.

Adverse events were consistent with those routinely observed after HDIT/HCT. Adverse effects recorded at 4 and 5 years were not related to the transplant and were not considered severe. Three patients died, but their deaths were not related to the study treatments.

Five years later, most trial participants remained in remission and stabilized, and some showed improvements, such as recovering mobility.

Roughly 25% of veterans have diabetes mellitus (DM) as opposed to 9% of the general public. A small percentage of veterans have type 1 DM, which according to research, can be caused by both physical and mental trauma that affects the pancreas.

“Managing type 1 diabetes currently requires a constant juggling act between checking bloodglucose levels frequently and delivering just the right amount of insulin while taking into account meals, physical activity, and other aspects of daily life, where a missed or wrong delivery could lead to potential complications,” said Dr. Andrew Bremer, of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). But that may change soon as we draw near to a functional “artificial pancreas,” a fully automated system that will sense rising glucose levels and adjust insulin automatically.

 The FDA approved a hybrid model of an artificial pancreas in 2016, which still required users to adjust insulin intake. Now, 4 separate projects are designed to be the “potential last steps” toward requesting regulatory approval for permanent use of a fully automated system, according to NIDDK. The research studies beginning this year will look at safety, efficacy, user-friendliness, physical and emotional health of participants, and cost. The participants will live at home and monitor themselves with remote monitoring by study staff.

“Nearly 100 years since the discovery of insulin,” said NIDDK Director Dr. Griffin P. Rodgers, “a successful artificial pancreas would mark another huge step toward better health for people with type 1 diabetes.”

Roughly 25% of veterans have diabetes mellitus (DM) as opposed to 9% of the general public. A small percentage of veterans have type 1 DM, which according to research, can be caused by both physical and mental trauma that affects the pancreas.

“Managing type 1 diabetes currently requires a constant juggling act between checking bloodglucose levels frequently and delivering just the right amount of insulin while taking into account meals, physical activity, and other aspects of daily life, where a missed or wrong delivery could lead to potential complications,” said Dr. Andrew Bremer, of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). But that may change soon as we draw near to a functional “artificial pancreas,” a fully automated system that will sense rising glucose levels and adjust insulin automatically.

 The FDA approved a hybrid model of an artificial pancreas in 2016, which still required users to adjust insulin intake. Now, 4 separate projects are designed to be the “potential last steps” toward requesting regulatory approval for permanent use of a fully automated system, according to NIDDK. The research studies beginning this year will look at safety, efficacy, user-friendliness, physical and emotional health of participants, and cost. The participants will live at home and monitor themselves with remote monitoring by study staff.

“Nearly 100 years since the discovery of insulin,” said NIDDK Director Dr. Griffin P. Rodgers, “a successful artificial pancreas would mark another huge step toward better health for people with type 1 diabetes.”

Roughly 25% of veterans have diabetes mellitus (DM) as opposed to 9% of the general public. A small percentage of veterans have type 1 DM, which according to research, can be caused by both physical and mental trauma that affects the pancreas.

“Managing type 1 diabetes currently requires a constant juggling act between checking bloodglucose levels frequently and delivering just the right amount of insulin while taking into account meals, physical activity, and other aspects of daily life, where a missed or wrong delivery could lead to potential complications,” said Dr. Andrew Bremer, of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). But that may change soon as we draw near to a functional “artificial pancreas,” a fully automated system that will sense rising glucose levels and adjust insulin automatically.

 The FDA approved a hybrid model of an artificial pancreas in 2016, which still required users to adjust insulin intake. Now, 4 separate projects are designed to be the “potential last steps” toward requesting regulatory approval for permanent use of a fully automated system, according to NIDDK. The research studies beginning this year will look at safety, efficacy, user-friendliness, physical and emotional health of participants, and cost. The participants will live at home and monitor themselves with remote monitoring by study staff.

“Nearly 100 years since the discovery of insulin,” said NIDDK Director Dr. Griffin P. Rodgers, “a successful artificial pancreas would mark another huge step toward better health for people with type 1 diabetes.”

Some patients who experience long-term grief may be slipping through the health care net. With data collected in 2 National Institute of Mental Health-funded treatment studies, researchers used proposed criteria from DSM-5 to identify patients with a stress-response syndrome of “persistent impairing grief”—that is, persistent complex bereavement disorder (PCBD), prolonged grief disorder (BGD) and complicated grief (CG). They studied 2 groups of patients in university-based psychiatric research clinics: 240 grief-treatment seeking participants scored ≥ 30 on the Inventory of Complicated Grief (ICG), and 86 bereaved adults scored < 20 on the ICG.

The PCBD criteria diagnosed 70% of the first group, PGD criteria identified 59.6%, and CG criteria identified 99.6%. None of the 3 proposed criteria identified cases in the bereaved comparison group. Only the CG criteria produced rates of case identification sufficient to be of clinical utility, the researchers say.

Their findings are “virtually identical” with those of the community-based National Military Family Bereavement Study, the researchers say, in which all 3 criteria sets identified < 2% of the bereaved military family survey population that scored < 20 on the ICG.

There are treatments specific to grief, the researchers note. But as of yet there is no gold standard for diagnosing persistent impairing grief. The researchers say the solution could lie in using the CG criteria set and modifying decision rules for CBD or PGD criteria or developing a new group of symptoms and decision rules. However it’s done, the researchers conclude, they see a “pressing need” to establish criteria that can lead to correct diagnosis and targeted treatment.

Some patients who experience long-term grief may be slipping through the health care net. With data collected in 2 National Institute of Mental Health-funded treatment studies, researchers used proposed criteria from DSM-5 to identify patients with a stress-response syndrome of “persistent impairing grief”—that is, persistent complex bereavement disorder (PCBD), prolonged grief disorder (BGD) and complicated grief (CG). They studied 2 groups of patients in university-based psychiatric research clinics: 240 grief-treatment seeking participants scored ≥ 30 on the Inventory of Complicated Grief (ICG), and 86 bereaved adults scored < 20 on the ICG.

The PCBD criteria diagnosed 70% of the first group, PGD criteria identified 59.6%, and CG criteria identified 99.6%. None of the 3 proposed criteria identified cases in the bereaved comparison group. Only the CG criteria produced rates of case identification sufficient to be of clinical utility, the researchers say.

Their findings are “virtually identical” with those of the community-based National Military Family Bereavement Study, the researchers say, in which all 3 criteria sets identified < 2% of the bereaved military family survey population that scored < 20 on the ICG.

There are treatments specific to grief, the researchers note. But as of yet there is no gold standard for diagnosing persistent impairing grief. The researchers say the solution could lie in using the CG criteria set and modifying decision rules for CBD or PGD criteria or developing a new group of symptoms and decision rules. However it’s done, the researchers conclude, they see a “pressing need” to establish criteria that can lead to correct diagnosis and targeted treatment.

Some patients who experience long-term grief may be slipping through the health care net. With data collected in 2 National Institute of Mental Health-funded treatment studies, researchers used proposed criteria from DSM-5 to identify patients with a stress-response syndrome of “persistent impairing grief”—that is, persistent complex bereavement disorder (PCBD), prolonged grief disorder (BGD) and complicated grief (CG). They studied 2 groups of patients in university-based psychiatric research clinics: 240 grief-treatment seeking participants scored ≥ 30 on the Inventory of Complicated Grief (ICG), and 86 bereaved adults scored < 20 on the ICG.

The PCBD criteria diagnosed 70% of the first group, PGD criteria identified 59.6%, and CG criteria identified 99.6%. None of the 3 proposed criteria identified cases in the bereaved comparison group. Only the CG criteria produced rates of case identification sufficient to be of clinical utility, the researchers say.

Their findings are “virtually identical” with those of the community-based National Military Family Bereavement Study, the researchers say, in which all 3 criteria sets identified < 2% of the bereaved military family survey population that scored < 20 on the ICG.

There are treatments specific to grief, the researchers note. But as of yet there is no gold standard for diagnosing persistent impairing grief. The researchers say the solution could lie in using the CG criteria set and modifying decision rules for CBD or PGD criteria or developing a new group of symptoms and decision rules. However it’s done, the researchers conclude, they see a “pressing need” to establish criteria that can lead to correct diagnosis and targeted treatment.

About 1 in 4 American adults who say they have good or excellent hearing has hearing damage. According to a Vital Signs report, much of the damage is due to everyday loud sounds, such as leaf blowers, concerts, even portable devices. The rumble of a washing machine approaches the 85 decibels at which extended exposure can cause hearing damage. Sixty seconds of listening to a nearby siren (120 dB) also can cause hearing damage.

CDC researchers analyzed > 3,500 hearing tests conducted on adult participants in the 2012 National Health and Nutrition Examination Survey. Of those participants, 20% who reported no job-related noise exposure nonetheless had hearing damage in a pattern usually caused by noise.

People may delay reporting hearing loss because they don’t know or won’t admit they have a problem, the CDC says. Only 46% of adults who reported having trouble hearing saw a health care provider (HCP) for their hearing in the past 5 years. But chronic noise exposure has been associated with worsening heart disease, increased blood pressure, and other adverse health effects.

The CDC suggests HCPs ask patients (even those as young as 20) about their hearing. For instance, they can ask, “Do you find it difficult to follow a conversation if there is background noise?” and “Can you usually hear and understand what someone says in a normal tone of voice when you can’t see that person’s face?”

At routine health care visits, the CDC suggests HCPs explain to patients how noise exposure can permanently damage hearing. They also suggest recommending earplugs or noise-canceling headphones. About 70% of people exposed to loud noise never or seldom wear hearing protection, CDC says.  The CDC suggests advising patients to turn down the volume when watching TV, listening to music, and using earbuds or headphones, as well as asking whether patients are taking medicines that increase the risk of hearing damage. If patients show or report hearing problems, the CDC suggests HCPs examine their hearing or refer them to a hearing specialist.

About 1 in 4 American adults who say they have good or excellent hearing has hearing damage. According to a Vital Signs report, much of the damage is due to everyday loud sounds, such as leaf blowers, concerts, even portable devices. The rumble of a washing machine approaches the 85 decibels at which extended exposure can cause hearing damage. Sixty seconds of listening to a nearby siren (120 dB) also can cause hearing damage.

CDC researchers analyzed > 3,500 hearing tests conducted on adult participants in the 2012 National Health and Nutrition Examination Survey. Of those participants, 20% who reported no job-related noise exposure nonetheless had hearing damage in a pattern usually caused by noise.

People may delay reporting hearing loss because they don’t know or won’t admit they have a problem, the CDC says. Only 46% of adults who reported having trouble hearing saw a health care provider (HCP) for their hearing in the past 5 years. But chronic noise exposure has been associated with worsening heart disease, increased blood pressure, and other adverse health effects.

The CDC suggests HCPs ask patients (even those as young as 20) about their hearing. For instance, they can ask, “Do you find it difficult to follow a conversation if there is background noise?” and “Can you usually hear and understand what someone says in a normal tone of voice when you can’t see that person’s face?”

At routine health care visits, the CDC suggests HCPs explain to patients how noise exposure can permanently damage hearing. They also suggest recommending earplugs or noise-canceling headphones. About 70% of people exposed to loud noise never or seldom wear hearing protection, CDC says.  The CDC suggests advising patients to turn down the volume when watching TV, listening to music, and using earbuds or headphones, as well as asking whether patients are taking medicines that increase the risk of hearing damage. If patients show or report hearing problems, the CDC suggests HCPs examine their hearing or refer them to a hearing specialist.

About 1 in 4 American adults who say they have good or excellent hearing has hearing damage. According to a Vital Signs report, much of the damage is due to everyday loud sounds, such as leaf blowers, concerts, even portable devices. The rumble of a washing machine approaches the 85 decibels at which extended exposure can cause hearing damage. Sixty seconds of listening to a nearby siren (120 dB) also can cause hearing damage.

CDC researchers analyzed > 3,500 hearing tests conducted on adult participants in the 2012 National Health and Nutrition Examination Survey. Of those participants, 20% who reported no job-related noise exposure nonetheless had hearing damage in a pattern usually caused by noise.

People may delay reporting hearing loss because they don’t know or won’t admit they have a problem, the CDC says. Only 46% of adults who reported having trouble hearing saw a health care provider (HCP) for their hearing in the past 5 years. But chronic noise exposure has been associated with worsening heart disease, increased blood pressure, and other adverse health effects.

The CDC suggests HCPs ask patients (even those as young as 20) about their hearing. For instance, they can ask, “Do you find it difficult to follow a conversation if there is background noise?” and “Can you usually hear and understand what someone says in a normal tone of voice when you can’t see that person’s face?”

At routine health care visits, the CDC suggests HCPs explain to patients how noise exposure can permanently damage hearing. They also suggest recommending earplugs or noise-canceling headphones. About 70% of people exposed to loud noise never or seldom wear hearing protection, CDC says.  The CDC suggests advising patients to turn down the volume when watching TV, listening to music, and using earbuds or headphones, as well as asking whether patients are taking medicines that increase the risk of hearing damage. If patients show or report hearing problems, the CDC suggests HCPs examine their hearing or refer them to a hearing specialist.

Bullets and bullet fragments are not always removed if they don’t threaten the injured person’s life. But “retained” bullet fragments (RBFs) can lead to nonspecific symptoms of lead toxicity years later, such as, fatigue, abdominal pain, and memory loss.

Routine testing of adults with RBFs is infrequent, the CDC says. Usually, testing for blood levels of lead is done to monitor occupational exposure. But the number of people with RBFs who have toxic blood lead levels (BLLs) may be higher than thought. At BLLs ≥ 10 µg/dL, hypertension, kidney dysfunction, possible subclinical neurocognitive deficits, and adverse reproductive outcomes have been documented.

Related: The Long Legacy of Agent Orange

CDC researchers analyzed data from 41 states for 145,811 adults with elevated BLLs from all causes, reported by the Adult Blood Lead Epidemiology and Surveillance program from 2003 to 2012. Of those reported cases, 349 had levels ≥ 80 µg/dL. RBF-associated cases accounted for 0.3% of adults with elevated BLLs, but 4.9% of adults with BLLs ≥ 80 µg/dL. The maximum recorded RBF-associated BLL was 306 µg/dL. Further, RBF-associated cases were “overrepresented” among people with BLLs ≥ 80 µg/dL: 3.7%, compared with 0.2% of people without RBF-related elevated lead levels.

As of 2004, the researchers say, < 100 cases of lead toxicity caused by RBFs had been reported in the medical literature. They advise asking any patient who has elevated BLLs with an unknown lead exposure source about RBFs. A low index of suspicion could delay diagnosis or even contribute to an incorrect diagnosis.

Related: Cutting Down on Dialysis-Related Infections

Moreover, BLLs can fluctuate in people with RBFs, they note. A patient with a low BLL at the time of testing can have an increase in BLL and become symptomatic when RBFs migrate, such as into a joint space. The CDC researchers suggest baseline and intermittent BLL tests for people with a history of RBFs.

Bullets and bullet fragments are not always removed if they don’t threaten the injured person’s life. But “retained” bullet fragments (RBFs) can lead to nonspecific symptoms of lead toxicity years later, such as, fatigue, abdominal pain, and memory loss.

Routine testing of adults with RBFs is infrequent, the CDC says. Usually, testing for blood levels of lead is done to monitor occupational exposure. But the number of people with RBFs who have toxic blood lead levels (BLLs) may be higher than thought. At BLLs ≥ 10 µg/dL, hypertension, kidney dysfunction, possible subclinical neurocognitive deficits, and adverse reproductive outcomes have been documented.

Related: The Long Legacy of Agent Orange

CDC researchers analyzed data from 41 states for 145,811 adults with elevated BLLs from all causes, reported by the Adult Blood Lead Epidemiology and Surveillance program from 2003 to 2012. Of those reported cases, 349 had levels ≥ 80 µg/dL. RBF-associated cases accounted for 0.3% of adults with elevated BLLs, but 4.9% of adults with BLLs ≥ 80 µg/dL. The maximum recorded RBF-associated BLL was 306 µg/dL. Further, RBF-associated cases were “overrepresented” among people with BLLs ≥ 80 µg/dL: 3.7%, compared with 0.2% of people without RBF-related elevated lead levels.

As of 2004, the researchers say, < 100 cases of lead toxicity caused by RBFs had been reported in the medical literature. They advise asking any patient who has elevated BLLs with an unknown lead exposure source about RBFs. A low index of suspicion could delay diagnosis or even contribute to an incorrect diagnosis.

Related: Cutting Down on Dialysis-Related Infections

Moreover, BLLs can fluctuate in people with RBFs, they note. A patient with a low BLL at the time of testing can have an increase in BLL and become symptomatic when RBFs migrate, such as into a joint space. The CDC researchers suggest baseline and intermittent BLL tests for people with a history of RBFs.

Bullets and bullet fragments are not always removed if they don’t threaten the injured person’s life. But “retained” bullet fragments (RBFs) can lead to nonspecific symptoms of lead toxicity years later, such as, fatigue, abdominal pain, and memory loss.

Routine testing of adults with RBFs is infrequent, the CDC says. Usually, testing for blood levels of lead is done to monitor occupational exposure. But the number of people with RBFs who have toxic blood lead levels (BLLs) may be higher than thought. At BLLs ≥ 10 µg/dL, hypertension, kidney dysfunction, possible subclinical neurocognitive deficits, and adverse reproductive outcomes have been documented.

Related: The Long Legacy of Agent Orange

CDC researchers analyzed data from 41 states for 145,811 adults with elevated BLLs from all causes, reported by the Adult Blood Lead Epidemiology and Surveillance program from 2003 to 2012. Of those reported cases, 349 had levels ≥ 80 µg/dL. RBF-associated cases accounted for 0.3% of adults with elevated BLLs, but 4.9% of adults with BLLs ≥ 80 µg/dL. The maximum recorded RBF-associated BLL was 306 µg/dL. Further, RBF-associated cases were “overrepresented” among people with BLLs ≥ 80 µg/dL: 3.7%, compared with 0.2% of people without RBF-related elevated lead levels.

As of 2004, the researchers say, < 100 cases of lead toxicity caused by RBFs had been reported in the medical literature. They advise asking any patient who has elevated BLLs with an unknown lead exposure source about RBFs. A low index of suspicion could delay diagnosis or even contribute to an incorrect diagnosis.

Related: Cutting Down on Dialysis-Related Infections

Moreover, BLLs can fluctuate in people with RBFs, they note. A patient with a low BLL at the time of testing can have an increase in BLL and become symptomatic when RBFs migrate, such as into a joint space. The CDC researchers suggest baseline and intermittent BLL tests for people with a history of RBFs.