Thursday, February 26, 2009
Low-income women with diabetes who are pregnant or recently gave birth face almost twice the risk of depression compared to women without the blood sugar disorder, a new study found.
And, it didn't matter whether the women developed diabetes before or during pregnancy, or if they were taking insulin or oral medications. The risk of depression was still much stronger for women with diabetes, the study found.
"Those with diabetes have nearly twice the risk of depression during pregnancy and post-partum," said the study's lead author, Katy Backes Kozhimannil, a research fellow in the department of ambulatory care and prevention at Harvard Medical School in Boston.
And, Kozhimannil added, women who'd never been depressed before appeared to be at risk, too. "One in 10 women who had no indication of prior depression received a diagnosis of depression within a year following delivery," she said.
Results of the study were published in the Feb. 25 issue of the Journal of the American Medical Association.
Although the study didn't look at potential reasons for this association, Kozhimannil said there are biological changes that occur with diabetes that might increase the risk of depression. She also said the stress of managing a chronic illness might contribute to the risk of depression.
Post-partum depression affects about 10 percent of new mothers, usually between two and six months after birth, according to background information in the study. If left untreated, post-partum depression can affect the mother-child relationship as well as the child's development.
Risk factors for post-partum depression include a history of depression, troubled relationships, domestic violence, stressful life events, financial problems, lack of social or emotional support, a difficult pregnancy or delivery, and health problems with the baby. Previous studies have linked diabetes to an increased risk of depression in general, according to the study authors.
To assess whether or not diabetes is a factor in pre- and post-partum depression, Kozhimannil and her colleagues reviewed data on more than 11,000 women who gave birth between 2004 and 2006. All of the women were continuously enrolled in Medicaid during the study period.
From this low-income population, the researchers found that 15.2 percent of women with diabetes developed depression during or after their pregnancy. In women without diabetes, that number was 8.5 percent. In women who'd never been depressed before, 9.6 percent of those with diabetes developed depression, compared to 5.9 percent of those without the blood sugar condition.
"Health-care facilities need to pay particular attention for depression in women with diabetes during the post-partum period," said Kozhimannil. "Both diabetes and depression in the post-partum period are treatable."
Dr. Robert Welch, chairman of obstetrics and gynecology at Providence Hospital in Southfield, Mich., called the new research an interesting study, but said it left some important questions unanswered. For example, he wondered how many of these pregnancies were planned, and exactly how many of the women with diabetes were newly diagnosed?
"A new diagnosis may be overwhelming for a lot of women," he said.
Also, in a Medicaid population, it can be more difficult to get diabetes well monitored, which could add to the stress these women are already feeling, Welch said. "Diabetes is an expensive disease, and this study calls out the need for additional mid-level providers who have more time to assist in making (a depression) diagnosis," he said.
Both Welch and Kozhimannil said that while this study was done with low-income women, the findings may be similar for higher-income women, though the stressors may be different.
Welch recommended that no matter what your income, if you're expecting, you should try to set up a support system before the baby arrives. Try to set up extra help so you're not alone with the baby day after day, he said.
"Years ago, when you brought a baby home, grandma and other family members were there. Now, grandmothers are working. And, if you have diabetes, too, it's an overwhelming situation. You're fatigued from the new baby and have the stress of managing diabetes," he said.
Monday, February 16, 2009
But research is preliminary and more trials are needed, study says.
(SOURCES: Ronald Mitsuyasu, M.D., director of the University of California, Los Angeles Center for Clinical AIDS Research and Education; Rowena Johnston, Ph.D., vice president of research, Foundation for AIDS Research, New York City. Feb. 15, 2009, Nature Medicine, online)
SUNDAY, Feb. 15 (HealthDay News) -- Researchers are reporting promising results from the largest clinical trial of gene therapy for HIV patients. The findings, while encouraging, need to be replicated and more research must be done before an effective new treatment arrives, experts said.
"We know it works, but we need to make it better before we launch a later study," said study lead author Dr. Ronald Mitsuyasu, director of the University of California, Los Angeles Center for Clinical AIDS Research and Education.
Existing treatments work fairly well for many people with HIV, the virus that causes AIDS. But patients have to take expensive drugs for their entire lives, and side effects can be significant.
Gene therapy is considered a possible alternative to drug treatment. Researchers hope to fight the virus by inserting a gene or genes into the body of an infected individual.
Last week, the New England Journal of Medicine reported a case that showed the potential for gene therapy and HIV. According to the journal, the body of a man in Germany with AIDS became free of the virus after he received a bone marrow transplant from a man with a gene that made him virtually immune to HIV. The treatment may not be a cure because the AIDS virus can become undetectable while still remaining in the body.
In the new study, researchers focused on a molecule that targets the AIDS virus. The scientists recruited 74 HIV-positive people and intravenously gave them either the molecule -- called OZ1 -- via blood stem cells, or a placebo. The patients then cycled on and off their HIV drugs so the researchers could see if the virus rebounded.
The patients who got the gene therapy treatment had a "modest decline" in the level of virus in their bodies, Mitsuyasu said. After 100 weeks, immune systems were also stronger in those patients who received the gene therapy vs. those who did not. In fact, some patients are doing so well that they haven't returned to drug treatment, Mitsuyasu said.
The findings were published online Feb. 15 in the journal Nature Medicine.
The study was a "phase II" trial, meaning that a third study would be necessary before the treatment could be approved.
There's more to be done, however, Mitsuyasu said.
"We need to figure out how best to perfect this approach. There are a lot of things that we could potentially do," he said. But in the big picture, the research represents "the first clear indication in a randomized and controlled study that there is a biologic effect of gene therapy" for HIV, he added.
The new approach holds promise, said Rowena Johnston, vice president of research at the Foundation for AIDS Research (amFAR) in New York City.
"One of the striking successes of this particular approach is its apparent safety, which is no small matter given the history so far of gene therapy interventions," she said. "Gene therapy will probably represent an exciting new frontier that will receive increasing attention in the coming years. There are so many unexplored avenues to pursue with the real potential to provide a lasting solution for HIV/AIDS."
More information
To learn more about gene therapy, visit the Human Genome Project Information.
Monday, February 2, 2009
Older people often focus their wintertime worries on fears of slipping on the ice, but they ought to be equally concerned about the risks of being too cold, advises the U.S. National Institute on Aging.
The ability to endure lengthy exposure to the cold lessens as people age, putting the elderly at a greater risk for hypothermia -- the condition in which body temperature falls below normal and stays there for a prolonged period of time.
Certain medical conditions, medicines and a sedentary lifestyle can make older people extra vulnerable even to mild cold snaps.
But there are steps older adults can take to prevent hypothermia, including:
The ability to endure lengthy exposure to the cold lessens as people age, putting the elderly at a greater risk for hypothermia -- the condition in which body temperature falls below normal and stays there for a prolonged period of time.
Certain medical conditions, medicines and a sedentary lifestyle can make older people extra vulnerable even to mild cold snaps.
But there are steps older adults can take to prevent hypothermia, including:
- Dress in several layers of loose clothing when going out. Wear a hat, scarf, gloves or mittens, along with a warm coat.
- Wear long underwear under your clothes, along with socks and slippers, when inside. Use a blanket or afghan to keep legs and shoulders warm. Wear a hat or cap indoors if necessary.
- Set the thermostat to at least 68 degrees. Home temperatures from 60 to 65 degrees can trigger hypothermia in older people.
- Check with your doctor to see if any of your medications -- whether prescription or over-the-counter -- might increase your risk for hypothermia.
People with hypothermia tend to act confused, slow or sleepy, have slowed or slurred speech and might shiver or have stiffness in the limbs. If you suspect someone has hypothermia, take the person's temperature, and if it is 96 degrees or lower, call 911.
Cold temperatures resulted in more than 6,000 hospitalizations and 827 deaths in 2006, according to the latest figures the Agency for Healthcare Research and Quality. The group's analysis of 6,182 cold weather-related hospitalizations found that:
Cold temperatures resulted in more than 6,000 hospitalizations and 827 deaths in 2006, according to the latest figures the Agency for Healthcare Research and Quality. The group's analysis of 6,182 cold weather-related hospitalizations found that:
- Men accounted for about 40 percent more hospitalizations for exposure to cold than women.
- People 65 and older were hospitalized for cold-related incidents almost 7 times more than people age 18 to 44 and 3 times more than those 45 to 64.
- Hypothermia (which can cause loss of physical and mental abilities and, in extreme cases, death), frostbite, respiratory failure, and pneumonia were the most common reasons for cold weather-related hospitalizations.
