Some with head injuries feign disorders

A University of Granada study in Spain found four out of 10 patients with head injuries feign cognitive disorders such as depression, headaches or anxiety.Dr. Raquel Vilar Lopez said she used a lie detector -- which registers the physiological responses of blood pressure, heart beat, breathing rate and galvanic skin response -- to find out if a person is faking or exaggerating their symptoms.

The study found nearly half of the people who go to court feign psycho-cognitive disorders with the objective of profiting in some way. These "simulators" are not hypochondriacs or overanxious or obsessive patients, they just lie in order to receive some sort of compensation, Lopez said. Lopez used lie detectors on 80 psychology students and one group, without any disorders, were asked to fake them in order to confirm the validity of the test. In addition, 54 actual patients were analyzed by the doctors.

The researcher said that "although the lie detector itself has no scientific rigor, it could be an efficient instrument if combined with other tools."Part of the findings were presented at the International Neuropsychological Society and National Academy of Neuropsychology conferences as well as the Archives of Clinical Neuropsychology.

Hospitals lag in preventing infection

Forty percent of U.S. hospital-acquired infections are urinary tract infections, but less than 10 percent of hospitals have an approach to reduce UTIs.A study published in the journal Clinical Infectious Diseases found most hospitals aren't using basic tactics to keep patients from getting catheter-related UTIs and nearly one-third of hospitals don't track UTI rates.

Researchers at the University of Michigan Health System and the Veterans Administration Ann Arbor Healthcare System found nearly half of hospitals lack a system to tell which patients currently have a catheter, and three-quarters lack a system that tracks how long a patient has had a catheter or whether one has been removed.

The survey asked about practices used to prevent hospital-acquired UTIs including: the use of catheters coated with anti-microbial agents that inhibit bacterial growth; the use of condom-style catheters that reduce the risk of bacteria entering the urethra; the use of anti-microbial agents in drainage bags that collect urine; and the use of portable ultrasound bladder scanners to see if patients' bladders were being emptied without a catheter.Lead author Dr.

Sanjay Saint said less than one-third of hospitals used bladder scanners and anti-microbial catheters, the most common methods to reduce UTIs."For hospitalized patients, if you have a catheter, ask the doctor or nurse every day if you really still need it," Saint said in a statement

Exercise reduces arthritis symptoms

U.S. adults with arthritis tend to be less fit than their peers, but a study finds they can safely participate in exercise programs to increase fitness.Study leader Leigh F. Callahan of the University of North Carolina at Chapel Hill, N.C., said the study involved 346 patients with an average age of 70 who had self-reported arthritis.

The participants were divided into an intervention group that took part in the Arthritis Foundation Exercise Program -- exercise classes at basic and advanced levels that met for one hour twice a week for eight weeks -- and a control group that was offered the program after eight weeks.

The intervention group completed self-report assessments at three months and six months after completing the program.The study, published in Arthritis Care & Research, showed that the intervention group had significant improvements in pain, fatigue and managing arthritis at eight weeks, and maintained improvements in pain and fatigue at six months.

Gordon Brown outlines NHS reforms

Britons wanting to be treated by England's National Health Service may have to qualify to receive free care under a new plan, a report said Tuesday.

Smokers or people who are chronically overweight may have to agree to exercise or to other changes in their lifestyles in return for NHS treatment. Moreover, patients who miss or chronically arrive late for hospital appointments may have penalties imposed on them, The Times of London reported.

In a New Year message to NHS staff, British Prime Minister Gordon Brown said that a NHS constitution would set out the "the rights and responsibilities associated with an entitlement to NHS care."

Brown said these and other steps "will require a broadening and a deepening of reform to ensure that the NHS as a whole attaches the same priority to a personal and preventative service as many of you already reflect in your own day-to-day decisions."

Plans for a NHS constitution will be revealed later this year, the Times said. A government spokesperson said any proposed constitution would not change the underlying principle of the NHS -- free medical care for all, the newspaper reported

Survey Most U.S. adults in good health

Sixty-one percent of U.S. adults say they are in excellent or very good health, but 62 percent say they never participate in any type of physical activity.

The 2006 National Health Interview Survey, conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics, provides national estimates for a broad range of health measures for the U.S. civilian non-institutionalized adults.

The survey also found that 16 percent of adults did not have a usual place of healthcare, 11 percent had been told by a doctor or health professional that they had heart disease and 23 percent had been told on two or more visits that they had hypertension.

Twenty-one percent of all adults were current smokers and 21 percent were former smokers. Based on estimates of body mass index, 35 percent of adults were overweight and 26 percent were obese, the survey said.

The sample for the NHIS is redesigned and redrawn about every 10 years to better measure the changing U.S. population and to meet new survey objectives. A new sample was implemented in 2006 and data were collected for 24,275 adults.

Study Cell phones slow traffic all around

SALT LAKE CITY, Jan. 2 (UPI) -- A University of Utah study says drivers talking on cell phones go slower on the freeway and cause longer commuting times for all concerned.

University of Utah psychology professor Dave Strayer, psychology doctoral student Joel Cooper, doctoral student in civil and environmental engineering Ivana Vladisavljevic and Peter Martin, director of the University of Utah Traffic Lab, conducted the study using a PatrolSim driving simulator -- in which a person sits in a driver's seat equipped with gas pedal, brakes, steering and displays from a Ford Crown Victoria police patrol car, while traffic scenes are projected on three screens around the driver.

The study involved 36 University of Utah psychology undergraduates, who drove through six, 9.2-mile-long freeway scenarios corresponding to freeway speeds of 70 mph to 40 mph.

"Results indicated that when drivers conversed on a cell phone, they made fewer lane changes, had a lower overall mean speed and a significant increase in travel time in the medium and high density driving conditions," the researchers said in a statement.

Cooper is scheduled to present the study Jan. 16 at the Transportation Research Board's annual meeting in Washington.

Protein may detect breast cancer severity

MILAN, Italy, Jan. 2 (UPI) -- Researchers in Italy say a protein called NUMB can help doctors detect the seriousness of a patient's breast cancer.

Pier Paolo Di Fiore of the Campus IFOM-IEO in Milan, Italy, says his team thinks it has pinned down the protein that acts in breast cancer with the tumor suppressor p53, reports the Italian news agency ANSA.

''NUMB provides us with a new biomarker which can be used as a diagnostic indicator for breast cancer,'' Di Fiore told the journal Nature. "All you have to do is measure the quantity of NUMB in tissue taken from the patient.''

The researchers say a shortage of NUMB hampers the action of p53, resulting in unfavorable prognoses and perhaps resistance to chemotherapy.

System to let county doctors track patients' prescription records

As an emergency room physician, Whitcomb has prescribed painkillers and worried about patients going to another hospital or clinic for more pills and then abusing or selling them. Last year, a close friend's son mixed beer with the painkiller Percocet, lay down for a nap and never woke up.

"For your own safety and for patient safety, we need a way of checking to see where these patients are getting drugs," Whitcomb said. "Patients can take these prescriptions and sell them on the street, and we have no way of tracking who's doing it."

Whitcomb, now the medical director of patient access at Aurora Sinai Medical Center, hopes an effort he has spearheaded within the Medical Society of Milwaukee County will soon change all that. Within about six months, the group hopes to launch a database that will allow area doctors to check whether their patients have gotten prescriptions for potentially addictive painkillers from anyone else. In time, the medical society wants to bring pharmacies on board to flag doctors who prescribe large amounts of the drugs.

A Journal Sentinel investigation published a week ago found that area physicians are almost never criminally prosecuted for incorrectly prescribing potentially dangerous drugs and that several doctors have been allowed to keep their licenses despite repeated investigations by the state's Medical Examining Board.

Some doctors simply have not been well-educated on how to effectively treat pain, and they make mistakes, adding to the problem.

"The only thing we find in the legal system is the tip of the iceberg," Whitcomb said.

Bruce Kruger, executive vice president of the medical society, said the group's effort is a way to help bridge the gaps.

"As a community, we are trying to come up with a solution for what's been identified as a major public health issue," he said. "This isn't the home run, but it's certainly way beyond where we are today. It's a start."

At first, the database would cover only Milwaukee County, where its use would be voluntary for doctors. Patients could still abuse the system by visiting doctors in other parts of the state.

Within a year or so, the medical society plans to solve that problem by seeking legislation that would mandate a statewide system, Kruger said.

"If we can make it work, which I'm confident we can, we're not going to stop with just Milwaukee County," he said. "If it's a model that works, other providers will want to embrace it. Most providers want to do the right thing."
Preventing abuses

A society task force convened in April and chaired by Whitcomb is nearing its final draft of a written plan to curtail prescription drug abuse in the county. It includes a list of guidelines to help doctors differentiate potential drug abusers from patients with legitimate pain. Some of the warning signs include asking for refills early; getting prescriptions from several doctors and having them filled at different pharmacies; and complaining of conditions that are hard for doctors to assess, such as headaches and back pain.

If a patient exhibits the warning signs, or if a doctor plans long-term treatment with narcotics, the patient would have to sign a medication management agreement promising not to sell the medications or to use illegal drugs or alcohol, under the guidelines.

Although many doctors already use such agreements, the medical society's plan would standardize them across the county. In signing a new agreement, a patient would agree to its posting on the database, where other doctors would have access to it. Access to the database would be limited to protect patients' privacy. Doctors, in turn, would agree not to prescribe potentially addictive painkillers to someone who already has entered into an agreement with another doctor.

"This way, doctors are no longer practicing in isolation, and they're observed," Whitcomb said.

If a patient violates the agreement, a doctor can stop seeing him or her. The medical society's draft policy discourages abruptly cutting off patients from their medications, which could lead to withdrawal symptoms or to the use of illegal drugs. Instead, doctors should help the patient taper off the drugs or arrange for inpatient drug treatment.
Combining databases

Whitcomb and Kruger are optimistic that the medical society could combine its database with another effort, already under way, to electronically link patients' medical information throughout the county.

Several groups have worked for years toward setting up that computer network, which is receiving software and technical support from Microsoft and could be operational within weeks, Whitcomb said.

Microsoft has invested about $5 million in the pilot program, Kruger said. According to the company, Milwaukee is one of several test sites to see how well its new data-processing technology works and how it can be adapted to other health care systems nationwide.

Additional funding came from area health care systems and from a federal grant. Adding the medication management agreements to the system would cost about $50,000, which the medical society plans to pay for, Kruger said.

New Medicaid rules may cost Texas billion, report says

WASHINGTON – Texas would lose more than $3.3 billion in Medicaid funding if Congress doesn't stop new rules designed to arrest the growth of federal health care spending, according to a congressional report issued Monday.

The new rules target hospitals and other organizations that use Medicaid to provide health care to the uninsured. In a letter to the House Committee on Oversight and Government Reform, the Texas Health and Human Services Commission estimated that the changes to hospital reimbursements would create a shortfall that could imperil health care for 185,000 patients.

Medicaid accounts for 26 percent of Texas' total budget, a figure that has been rising and prompted the Legislature to overhaul the program last year.

However, the new federal rules would take effect before the Legislature's changes – designed to make private insurance more affordable for poor Texans – are introduced.

"If you pull the rug out from under us while we make that transformation, we are never going to be able to get there," said John Hawkins, vice president of government relations for the Texas Hospital Association.

Based on input from state officials, the House committee's report estimated that the Bush administration's new rules would take away almost $50 billion from states. That's more than three times the administration's estimate.

For many states, the biggest change would be a restriction in Medicaid reimbursements to hospitals to only the cost of medical services. That same rule also would reduce the ability of private hospitals to claim additional federal funds for treating the uninsured.

Those changes alone would cost Texas $127 million this year and $2.2 billion over five years, according to the state health commission.

Texas lawmakers say those changes would shortchange Texas hospitals by not allowing them to charge for related costs such as physician services and health information technology.

Last year, a bipartisan group of House members from Texas, led by Michael Burgess of Lewisville and Gene Green of Houston, objected to those changes in letter to Health Secretary Michael O. Leavitt.

"We are convinced that the proposed regulation would have a substantial negative impact on Texas," they wrote.

The other new regulations include banning the use of Medicaid funds to pay for graduate medical education – a use that is popular in other states but hasn't been done in Texas – and at-home rehabilitative care for the elderly. Another rule would make it more difficult for Texas to use Medicaid funds in its child and adult protective services budgets.

Yet Mr. Burgess, a Republican, said the committee's report may overstate the impact on states. He said it was designed to "shock" House members and doesn't address the need to curb runaway health care costs.

"We're on the path with state Medicaid spending that, quite honestly, we just cannot keep up," said Mr. Burgess, who is a doctor. "We're going to have to be honest with each other and make some hard decisions."

Douglas Hawthorne, CEO of Texas Health Resources, the largest hospital system in North Texas, disagreed with the proposed changes, saying they would hamper his company's faith-based initiative to serve the poor and elderly.

"Ultimately, this impacts every person in North Texas because it affects the health of our communities," Mr. Hawthorne said.

"This should not be a partisan issue, and we are working closely with members of the North Texas congressional delegation on both sides of the aisle to ensure adequate Medicaid funding to provide care," he said.

Texas has one of the lowest rates in the nation of reimbursement for nursing homes – about $106 per day for each Medicaid resident.

The cost of care in 2007 for each patient was about $114, according to a September report prepared for the American Health Care Association.

Tim Graves, president of the Texas Health Care Association, which represents nursing homes, said the changes would especially pinch rural nursing homes, where there are fewer residents to keep a facility in business.

Many other nursing homes could lose money because the administration is also scrutinizing high Medicare payments for residents with the most needs. The Medicare funding helps to cover the shortfall in Medicaid reimbursements, Mr. Graves said.

Nursing homes would react by deferring maintenance and freezing wages, which would worsen staff turnover, he said.

"It's bad already, and you don't want to make it worse," he said.

Chronic ills seen as focal point to reform health care

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An estimated 133 million Americans - 45% of the population - have at least one chronic disease. And chronic diseases now account for roughly 75% of all health care spending.

To Kenneth Thorpe, focusing on the growing prevalence of chronic diseases and their cost could be the starting point in building bipartisan support for health care reform.

Thorpe, a professor at Emory University in Atlanta, saw that when he helped Vermont design a sweeping set of reforms enacted in 2006 under a Republican governor and a Democratic-controlled Legislature. Those reforms, known as Catamount Health and the Blueprint for Health, included expanded coverage for the uninsured as well as steps to improve the prevention and treatment of chronic diseases.

The lesson was that health care reform also must include initiatives to slow the rise in health care costs, and one way to do that is by focusing on chronic disease. "We are talking about truly lowering health care spending," Thorpe said.

His experience in Vermont led him to found the Partnership to Fight Chronic Disease, a national coalition of 110 organizations, including such dissimilar groups as the Service Employees International Union and the U.S. Chamber of Commerce.

Thorpe was in Wisconsin last week to launch the Wisconsin chapter of the organization. The chapter, the sixth in the country, includes roughly 30 groups ranging from the AFL-CIO of Wisconsin to Wisconsin Manufacturers & Commerce and from the YMCA of Greater Milwaukee to the Professional Firefighters of Wisconsin.

"Everybody is frustrated about our inability to do anything," Thorpe said. "And all these groups are looking for ways to collaborate in a less contentious way."
Group's goals

One of the group's goals is to ensure that the rise in chronic diseases will be part of the debate on health care reform in the coming presidential election.

"If you want to fix health care, you have to go where the money is, and the money is in chronic illness," said Tommy Thompson, former secretary of the U.S. Department of Health and Human Services and former governor of Wisconsin.

Thompson and his wife, Sue Ann Thompson, president and founder of the Wisconsin Women's Health Foundation, will co-chair the Wisconsin chapter of the Partnership to Fight Chronic Disease.

Chronic diseases include a wide range of conditions, from mental illness, cancer and HIV/AIDS to high blood pressure, diabetes and asthma. Many of them stem from lifestyle - primarily smoking, poor diets and lack of exercise.

More than one-third of the U.S. population is obese - roughly more than 30 pounds overweight - and two-thirds is obese or overweight. That is double the number 20 years ago.

Thorpe has noted that 15% to 30% of the increase in health care spending in the past two decades is attributable to the increase in obesity.

By one estimate, if the rate of obesity was the same as 20 years ago, health care spending would be 10% lower today. That would work out to roughly $240 billion in savings this year.

Some chronic diseases have reached epidemic proportions among certain ethnic groups. African-Americans are 40% more likely to die from heart disease than whites. And Latinos are almost twice as likely to die from diabetes as whites.
Reform failures

Thorpe has written extensively about the higher prevalence of treatable diseases and its role in the increase in health care spending.

He also has seen his share of failed attempts at health care reform. He was an adviser to the Clinton administration's effort in 1993. He has worked on health care reform in New York and New Jersey, and he is advising Illinois' efforts.

"There's a sort of usual formula," Thorpe said. "They lay out the options for covering the uninsured."

The options never change.

"In most states, you can't get a plurality for any of them," he said. "And most people's second option is the status quo."

Yet roughly 85% of the population has health insurance. Their key concern is the cost. Further, 96% of the people who voted in 2006 were insured.

"That's one of the ways to get politicians' attention," Thorpe said.

Yet slowing the rise in costs is an issue that crosses the political spectrum. Wisconsin Manufacturers & Commerce, the state's largest business lobby, and the Service Employees International Union agree that more must be done to prevent and manage chronic disease.

"It's got to be part of any solution," said Nathan Hoffmann, a spokesman for the SEIU Wisconsin State Council.

Fighting chronic disease is just one component in health care reform, Thorpe said. Health care reform also must include expanding coverage for low-wage workers and people with pre-existing medical conditions.

"It's not either/or - not at all," he said. "But this provides a starting point."

The reform proposals put forth by the leading presidential candidates all support putting more emphasis on the prevention and treatment of chronic diseases. Yet fighting chronic disease also would require changing the focus and incentives in the health care system.

"The whole idea is doing the preventive maintenance," Thorpe said.

The current system is oriented toward providing specialty and acute care. That can be seen in how health plans and government health programs pay doctors. Primary-care doctors make a fraction of what specialists make. Yet primary-care doctors oversee much of the care for most chronic disease.

Other reforms could include bundling payments to doctors and hospitals for treating chronic disease and adopting the computer systems needed for electronic health records.

There also needs to be more research on what programs work best in preventing and treating chronic disease, Thorpe said. That work is just beginning.

"A lot of the basic stuff that you would think has been done, hasn't been done," he said.

The Partnership to Fight Chronic Disease plans to present a series of legislative proposals next year. The goal is to focus people on the right issues and to help move health care reform forward.

Targeting the cost of chronic disease could do that.