Fayette County Health Department Offering Flu Vaccine

Fayette County Health Department will hold a flu vaccine clinic October 14, 15 and16 at its health center by appointment only. Flu vaccine will continue to be offered each while supplies last. The vaccination is part of a flu campaign being implemented by the Board of Health to get the vaccine to as many people as possible.

In general, anyone who wants to reduce their chances of getting the flu can get vaccinated. However, certain people should get vaccinated each year. They are either people who are at high risk of having serious flu complications or people who live with or care for those at high risk for serious complications. High-risk categories are:

• adults aged 50 years and older
• persons of any age with underlying chronic medical conditions
• residents of nursing homes and long-term care facilities
• children aged 6 months to 4 years
• women who are pregnant during the flu season
• children aged 6 months -18 years on chronic aspirin therapy
• health care workers involved in direct patient care, and Influenza, commonly called "flu," is caused by influenza viruses that infect the respiratory tract. The influenza infection causes more severe illness than most other viral respiratory infections like the common cold.

Most people who get the flu recover in one to two weeks, but some people develop serious complications, such as pneumonia.

Every year, more than 200,000 people in the U.S. are hospitalized as a result of the flu. Influenza infection can even cause death, and in an average year, about 36,000 deaths are caused by the flu in the U.S. The young, the elderly, and people with chronic medical conditions are most at risk of developing serious complications from the flu.

For people who do not receive the flu vaccine, health officials encourage them to take the following steps to reduce their chances of getting the flu:

• Wash your hands regularly
• Cover coughs and sneezes
• Keep household surfaces clean
• Don’t attend work or school when ill
• Don’t share glasses or eating utensils

The cost is of the vaccine is $25.00. Checks (no out of state), cash, debit cards, credit cards, Medicaid and Medicare (part B) will be accepted. Persons must present a Medicaid/Medicare card at the time of service. Residents using Medicare need to bring their red, white and blue card as well as any other Medicare or insurance cards.

Influenza vaccine for the 2008-09 season does not provide protection against avian or pandemic influenza.

If you would like to make an appointment to receive a flu shot, please call the Fayette County Health Department at 770.305.5416.
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GT Designs Prosthetic Vein Valve to Improve Venous Blood Flow

Engineers at the Georgia Institute of Technology have developed a prosthetic vein valve to help improve the lives of those suffering from a condition known as chronic venous insufficiency. The condition, which affects more than seven million people in the United States alone, occurs when valves in a person’s veins can no longer ensure a one-way flow of blood back to the heart.

“Blood flows to the toes because of gravity, but the body uses vein valves to pump blood in one direction back to the heart,” said David Ku, the Lawrence P. Huang Endowed Chair in Engineering and Entrepreneurship and Regents’ Professor in the George W. Woodruff School of Mechanical Engineering at Georgia Tech. “However, sometimes a vein valve dissolves away after a blood clot. The loss of the valve leaflets allows blood to flow the wrong way, causing swelling in the legs and ankles.”

Ku is leading a research team that has developed a prosthetic vein valve to replace damaged, non-functioning valves. The prosthetic vein valve design and results from laboratory studies were presented at the Society for Biomaterials Fall Symposium in Atlanta on September 12. The research – under way for the past five years – is funded by the Wallace H. Coulter Foundation and the National Collegiate Inventors and Innovators Alliance.

Ku’s collaborators on this project include Rudy Gleason, an assistant professor with joint appointments in the Georgia Tech School of Mechanical Engineering and Department of Biomedical Engineering; Ross Milner, an assistant professor of surgery at Emory University; consultant Harris Bergman, a former Georgia Tech graduate student and now president of Amigent; former Georgia Tech graduate students Rahul Sathe and Laura-Lee Farrell; and current graduate students David Bark and Prem Midha.

Individuals with chronic venous insufficiency are commonly prescribed therapies – including anticoagulants, bed rest and compression hosiery – that target their symptoms rather than the cause. Damaged vein valves can sometimes be repaired, but when that isn’t possible, some surgical options are available to replace deep venous valves, such as valve transplantation. However, replacing the valve with a prosthetic one is likely the better option because finding a suitable donor valve in one of the patient’s legs can be difficult, according to Ku.

“Previous studies have shown that even if a donor valve is found, implanting it can cause significant trauma to the patient’s leg,” explained Ku, who has doctoral degrees in mechanical engineering and medicine. “To avoid these complications, other prosthetic vein valves have been designed, but most have demonstrated poor clinical potential for humans.”

Ku and his collaborators believe the valve they have developed will overcome previous difficulties. The one-way flap is made of poly(vinyl alcohol) cryogel, a material patented by Georgia Tech in 1999. The material has many useful attributes, including its biocompatibility with body tissue because of its attraction to water; the ability to adjust its mechanical strength; flexibility comparable to that of natural body tissue; and composition of organic polymer, rather than silicone.

The researchers will begin conducting preclinical animal trials at Emory University in October to test the in vivo biocompatibility and performance of the prosthetic vein valve prototype in sheep. Sheep were chosen because their cardiovascular geometry and physiology are similar to those of humans.

In each animal trial, two prosthetic vein valves will be implanted by Milner. The researchers will test the biocompatibility and performance of the devices for four weeks, using imaging techniques to check that the valves remain in the proper location, are open and allow blood to pass through the vein.

The animal trials will be conducted after several years of optimizing the valve design and testing it in the laboratory. When the Georgia Tech researchers started designing the valve, they wanted it to be as similar as possible to normal, anatomic venous valves. They focused on two major design criteria: the valve had to withstand high pressures without leaking and the valve had to open with small pressure gradients, even after 500,000 cycles of opening and closing, which is equivalent to a half year.

“It was important for us to test the long-term feasibility of these valves because they’re going to be implanted and used for years,” explained Ku. “But since test methods have not been well established for evaluating a prosthetic vein valve, we developed our own.”

Sathe conducted the initial laboratory tests and found that the valve met the mechanical design criteria – it could withstand pressures of more than 500 millimeters of mercury and opened with a pressure gradient of 2.6 millimeters of mercury, which matched physiologic vein valve function. Detailed laboratory testing procedures and results were described in the June 2007 issue of the Journal of Medical Devices.

Next, Farrell developed a laboratory method to test whether blood clots would form inside the prosthetic valve. Results showed that the new generation of valves remained open with no clot formation after 120 minutes of blood flow, whereas control valves lined with polyester closed up after approximately six minutes of perfusion and showed blood cells adhering to the valves.

The laboratory tests showed that the prosthetic vein valve exhibited low flow resistance, strong competency, fatigue-resistance, low clot formation probability and material flexibility, which allowed the researchers to move forward to the animal studies.

The next step after conducting the animal studies will be human clinical trials. The device will require an investigational device exemption from the Food and Drug Administration so that the device can be used in a clinical study to collect safety and effectiveness data.

“There are 400,000 patients per year who are just miserable with the complications from this disease and could benefit from these valves, so we’d like to help them as soon as possible,” added Ku.

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Keppra XR(TM) Approved for Sale in US by FDA

Epilepsy is a chronic neurological disorder affecting approximately three million people in the US-making it more common than multiple sclerosis and Parkinson's disease combined. It is caused by abnormal, excessive electrical discharges of the nerve cells, or neurons, in the brain. Epilepsy is characterized by a tendency to have recurrent seizures and defined by two or more unprovoked seizures. There are many different seizure types and epileptic syndromes. Forty percent of patients taking only one AED continue to experience seizures, and approximately 30% of patients taking adjunctive therapy continue to experience seizures. This highlights the ongoing need for the development of new AEDs. For more information about epilepsy, visit www.epilepsyfoundation.org, www.epilepsy.com, or www.epilepsyadvocate.com.

PRNewswire --- UCB announced today that the U.S. Food and Drug Administration (FDA) has approved Keppra XR(TM) (levetiracetam extended-release tablets) for use as an add-on to other antiepileptic treatments for people with partial-onset seizures who are 16 years of age and older. Keppra XR(TM) is expected to be available in U.S. pharmacies at the end of September 2008.

The goal of therapy with antiepileptic drugs (AED) is freedom from seizures and minimal side effects. While many people with epilepsy are successfully treated with one or more of the currently available antiepileptic drugs, a significant percentage still live with uncontrolled seizures or intolerable side effects.

"With solid clinical trial data supporting Keppra XR(TM) efficacy and tolerability, this once-daily antiepileptic drug can play an important role in treating people with epilepsy," said lead investigator Dr. Jukka Peltola, Department of Neurology, Tampere University Hospital, Finland. "We found in the clinical trial that Keppra XR(TM) provided significant partial onset seizure control in once-daily dosing when added to other antiepileptic drugs and that it was generally well-tolerated."

Important Safety Information

Keppra XR(TM) extended-release tablets are indicated as adjunctive therapy in the treatment of partial onset seizures in patients 16 years of age and older with epilepsy.

Keppra XR(TM) causes somnolence, dizziness, and behavioral abnormalities. The most common adverse reactions observed with Keppra XR(TM) in combination with other AEDs were somnolence and irritability.

The adverse reactions that may be seen in patients receiving Keppra XR(TM) are expected to be similar to those seen in patients receiving immediate- release Keppra(R) tablets.

Keppra(R) immediate-release tablets cause somnolence and fatigue, coordination difficulties, and behavioral abnormalities (e.g., psychotic symptoms, suicidal ideation, and other abnormalities), as well as hematological abnormalities. In adults experiencing partial onset seizures, the most common adverse reactions observed with Keppra(R) in combination with other AEDs were somnolence, asthenia, infection and dizziness.

Keppra XR(TM) should be gradually withdrawn to minimize the potential of increased seizure frequency.

Dosing must be individualized according to the patient's renal function status. The dosage should be reduced in patients with impaired renal function receiving Keppra XR. In patients with end stage renal disease on dialysis, it is recommended that immediate-release Keppra(R) be used instead of Keppra XR(TM).

For full prescribing information, please see www.KeppraXR.com.

In order to ensure patient access to this valuable medication in the U.S., UCB is initiating a co-pay support program. For more information, contact U.S. UCB Medical Information at 1-866-822-0068 (press 9).

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FDA Approves Expanded Uses for Gardasil to Include Preventing Certain Vulvar and Vaginal Cancers

The U.S. Food and Drug Administration today announced the approval of the vaccine Gardasil for the prevention of vaginal and vulvar cancer caused by Human Papillomavirus (HPV) types 16 and 18 in girls and women ages 9 to 26. These two HPV types cause 70 percent of cervical cancers, and are known to also cause some vulvar and vaginal cancers, but the percentages are not well defined.

“There is now strong evidence showing that this vaccine can help prevent vulvar and vaginal cancers due to the same viruses for which it also helps protect against cervical cancer,” said Jesse L. Goodman, M.D., M.P.H., director of the FDA’s Center for Biologics Evaluation and Research. “While vulvar and vaginal cancers are rare, the opportunity to help prevent them is potentially an important additional benefit from immunization against HPV.”

The FDA originally approved Gardasil in 2006 for girls and women ages 9 to 26 for the prevention of cervical cancer caused by HPV types 16 and 18, precancerous genital lesions caused by HPV types 6, 11, 16, and 18 and genital warts caused by HPV types 6 and 11.

HPV includes more than 100 related viruses and more than 30 types can be transmitted via sexual contact. According to the U.S. Centers for Disease Control and Prevention, HPV is the most common sexually transmitted infection in the United States with 6.2 million Americans becoming infected with genital HPV each year.

For most women, the body’s own defense system will clear HPV, thereby preventing serious health problems. However, some HPV types can cause abnormal cell growth in areas of the cervix, vagina, vulva, and other areas that years later may turn into cancer.

Regarding the prevention of vulvar and vaginal cancer, Gardasil’s manufacturer, Merck & Co. Inc., followed more than 15,000 participants from the original studies for about two additional years. Approximately half had received Gardasil as part of the original study—the other half did not receive Gardasil and served as a control group.

Among females who tested negative for HPV types 16 or 18 at the start of the study, Gardasil was highly effective in preventing these types of HPV-related precancerous vulvar and vaginal lesions, which are considered to be the precursors for cancer. In the control group that did not receive the vaccine, 10 individuals developed precancerous vulvar lesions and nine developed precancerous vaginal lesions, all related to HPV types 16 or 18. No one in the Gardasil group developed either kind of precancerous lesion due to HPV types 16 or 18.

There was no evidence for benefit among women found to have been previously infected, prior to immunization, with the HPV types included in the vaccine. Therefore, to receive Gardasil’s full potential for benefit, it is important to be vaccinated prior to becoming infected with the HPV strains contained in the vaccine.

Gardasil’s label has been revised to note that presently available information is insufficient to support use beyond age 26, the current FDA-approved age. Also, new information has been added showing that Gardasil does not protect against diseases caused by HPV types not contained in the vaccine.

No vaccine is 100 percent effective, and Gardasil does not protect against HPV infections that a woman may already have at the time of vaccination. Therefore, all women should get regular Pap tests, even after they have been vaccinated. Routine Pap screening remains critically important to detect precancerous changes, which would allow treatment before cancer develops.

Since the FDA approved Gardasil in 2006, the majority of reported adverse events have not been serious. The most commonly reported adverse events have included syncope (fainting), pain at the injection site, headache, nausea, and fever. Fainting is common after injections and vaccinations, especially in adolescents. Falls after fainting may sometimes cause serious injuries, such as head injuries, which can be prevented with simple steps, such as keeping the vaccinated person seated for up to 15 minutes after vaccination. This observation period is also recommended to watch for severe allergic reactions, which can occur after any immunization.

As part of the original approval, Merck committed to a safety surveillance study of 44,000 individuals in a managed care organization. The study is assessing short- and long-term safety for all of Gardasil’s approved uses.

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FDA Approves Treatment for Rare Neurologic Disease

The U.S. Food and Drug Administration today announced that it has approved an immune globulin product called Gamunex for the treatment of chronic inflammatory demyelinating polyneuropathy (CIDP), a rare autoimmune disorder characterized by progressive weakness and impaired sensory function in the legs and arms.

The FDA designated Gamunex as an orphan drug to treat CIDP. The orphan drug designation provides manufacturers with financial incentives to develop treatments for rare diseases, those affecting fewer than 200,000 people in the United States.

"This approval is part of the FDA's effort to address unmet medical needs in patients who are suffering from rare and serious diseases," said Jesse L. Goodman, M.D., M.P.H., director of the FDA's Center for Biologics Evaluation and Research.

CIDP, which affects about 25,000 people in the United States, is caused by an immune system attack on the body's peripheral nervous system. The effects of CIDP—progressive muscle weakness, loss of deep tendon reflexes, tingling, and numbness—are caused by damage to the strong, fatty material that covers and protects the nerve fibers, called the myelin sheath.

Immune globulin (antibody) products are obtained from pooled human blood plasma, which contains antibodies that fight infections. These products are often given to patients with compromised immune systems, who are at increased risk for certain infectious disease. They are also used to adjust the immune response in certain autoimmune diseases.

Researchers think it is likely that Gamunex helps improve muscle function in patients with CIDP by modulating the immune system's response to the inflammation that damages the myelin sheaths, but the exact mechanism is not known.

The FDA based its approval of Gamunex on clinical trials that showed Gamunex was effective at improving certain motor functions for up to 48 weeks after the initial treatment. Researchers used the Inflammatory Neuropathy Cause and Treatment scale (INCAT) to measure a patient's ability to perform tasks such as walking and motor tasks for the hands.

The trials showed improved CIDP patient INCAT scores for muscle function after receiving Gamunex every three weeks for a 24-week period. Twenty-eight of 59 patients treated with Gamunex had improved INCAT scores compared to 13 of 58 patients treated with placebo.

In addition, patients with improved INCAT scores participated in a follow-up trial for an additional 24 weeks. Eighty-six percent of the patients who continued to receive Gamunex maintained their improved INCAT scores compared to 61 percent of the patients who received placebo during the follow-up trial.

Adverse reactions were similar to those of other immune globulin products and included headache, fever, increased blood pressure, rash, joint pain, chills, back pain, nausea, and lightheadedness.

Gamunex is manufactured by Talecris Biotherapeutics Inc. of Research Triangle Park, N.C.

The Flu Season is Upon Us – Flu Shots Available at Clayton State

The flu is already making news, and the summer isn’t even over. Cases of the flu have been reported in Georgia, and people are wondering if they will need a prescription to get a flu shot.

In answer to both these problems, the Clayton State University Health Services (UHS) is again offering flu shots for students, faculty, staff and the community. On Wednesday, Oct. 22 and Thursday, Oct. 23, from 10 a.m. to 3 p.m. on both days, UHS will officially kick off its annual flu shot campaign for the 2008/09 season in the James M. Baker University Center. However, early birds can come to UHS, located in the University’s Student Center room 211, starting on Monday, Sept. 22, between 2 p.m. and 4 p.m., for flu shots.

According to Latrice Barlow, UHS office manager, the issue of prescriptions and flu shots will not affect University Health Services’ ability to administer the shots, no matter what the outcome of the current debate over the newly-discovered law.

“It really won’t affect University Health or our ability to administer the shot,” she says. “Even if prescriptive orders are being required to administer the shot in the stores and pharmacies, since we have a physician, an RN and two nurse practitioners on staff, we will be OK.”

UHS has about 250 doses of the flu vaccine in stock, and can get more if the demand is there. The fees for the shots are as follows: $15 for students, $17 for Clayton State faculty and staff, and $23 for the public.

A unit of the University System of Georgia, Clayton State University is an outstanding comprehensive metropolitan university located 15 miles southeast of downtown Atlanta.
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President Bush and SBA Acting Administrator Baruah Meet With Women Entrepreneurs To Promote Health Savings Accounts

President George W. Bush and U.S. Small Business Administration (SBA) Acting Administrator Sandy K. Baruah met in Oklahoma City today with women small business owners to discuss the benefits of Health Savings Accounts (HSAs), which can be used to obtain affordable healthcare coverage.

An HSA is a tax-preferred account owned by an individual and used to pay for current and future medical expenses, including deductibles, co-payments and other forms of cost-sharing.
President Bush and Administrator Baruah participated in a roundtable discussion at SBA’s Women’s Business Center with local women entrepreneurs. They listened to first-hand testimony of women business owners who are currently benefiting from these accounts, and those who are considering them.

Both leaders highlighted the many benefits of Health Savings Accounts and answered questions for those who have yet to start these HSAs.

“In my roles at the U.S. Dept. of Commerce and now as head of the SBA, I have met with many small business owners throughout the country, and they have shared their concerns with me. A topic that always arises is the rising cost of health care. Health Savings Accounts provide small business owners and the self-employed with an affordable option to health care coverage,” said Baruah.

Today’s roundtable discussion was a joint effort of the U.S. Small Business Administration, the National Economic Council and the Department of the Treasury to promote the benefits of Health Savings Accounts. This joint effort uses many resources to educate the small business community of the benefits of Health Savings Accounts.

A new Web site www.hsa.gov has been developed as an online resource for small businesses and individuals considering Health Savings Accounts. Also, SBA, NEC and Treasury have produced a fact sheet highlighting the benefits of Health Savings Accounts. SBA will distribute the fact sheet to its district offices and resource partners as a greater outreach effort to promote Health Savings Accounts.

In addition to www.hsa.gov and the fact sheet, an online training module outlining the basics of Health Savings Accounts will be available for small businesses and individuals.
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Cognitive Behavioral Therapy Effective for Treating Trauma Symptoms in Children and Teens

Individual and group cognitive behavioral therapy is effective in reducing depressive disorders, anxiety, post traumatic stress disorder or other trauma symptoms in children and teenagers, according to an extensive review of dozens of studies conducted by the Task Force on Community Preventive Services, an independent group of scientists partially funded by the federal government.

However, many clinicians are using other types of therapy, such as art, play or drug therapy, which are not proven to be effective. The findings are published in the September issue of the American Journal of Preventive Medicine.

Cognitive therapy focuses on a person′s thoughts and beliefs, and how they influence mood and actions, and aims to change a person′s distorted thinking patterns. Behavioral therapy focuses on actions and aims to change unhealthy behavior patterns.

Mental Health organizations have estimated that more than 75 percent of U.S. mental health professionals who treat children and teens with post traumatic stress disorder are using therapies that are not known to be effective.

“The good news is there is substantial research showing the effectiveness of group or individual cognitive behavioral therapy in treating children and teens experiencing the psychological effects of trauma. We hope these findings will encourage clinicians to use the therapies that are shown to be effective,” said Robert Hahn, Ph.D., MPH, coordinating scientist at the Centers for Disease Control and Prevention’s Community Guide Branch and an author of the Task Force report.

In addition to individual and group cognitive therapy, the Task Force evaluated other interventions including art therapy, play therapy, drug therapy, and psychological debriefing, but could not find sufficient scientific evidence to support their use. The Task Force recommends that more research be done on other forms of therapy to determine whether or not they might be effective.

“Childhood trauma is a widespread problem with both short- and long-term consequences. Many kids with symptoms of trauma go undiagnosed, which can lead to unhealthy behaviors in adulthood such as smoking and alcohol or drug abuse,” Hahn said. “Increased screening to identify trauma symptoms in children can help these kids get the therapy they need and lessen the likelihood they will engage in these risky health behaviors when they become adults.”


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Stem Cell Regeneration Repairs Congenital Heart Defect

Mayo Clinic investigators have demonstrated that stem cells can be used to regenerate heart tissue to treat dilated cardiomyopathy, a congenital defect. Publication of the discovery was expedited by the editors of Stem Cells and appeared online in the "express" section of the journal's Web site at Stem Cells.

The study expands on the use of embryonic stem cells to regenerate tissue and repair damage after heart attacks and demonstrates that stem cells also can repair the inherited causes of heart failure.

"We've shown in this transgenic animal model that embryonic stem cells may offer an option in repairing genetic heart problems," says Satsuki Yamada, M.D., Ph.D., cardiovascular researcher and first author of the study. "Close evaluation of genetic variations among individuals to identify optimal disease targets and customize stem cells for therapy opens a new era of personalized regenerative medicine," adds Andre Terzic, M.D., Ph.D., Mayo Clinic cardiologist and senior author and principal investigator.

How They Did It

The team reproduced prominent features of human malignant heart failure in a series of genetically altered mice. Specifically, the "knockout" of a critical heart-protective protein known as the KATP channel compromised heart contractions and caused ventricular dilation or heart enlargement. The condition, including poor survival, is typical of patients with heritable dilated cardiomyopathy.

Researchers transplanted 200,000 embryonic stem cells into the wall of the left ventricle of the knockout mice. After one month the treatment improved heart performance, synchronized electrical impulses and stopped heart deterioration, ultimately saving the animal's life. Stem cells had grafted into the heart and formed new cardiac tissue. Additionally, the stem cell transplantation restarted cell cycle activity and halved the fibrosis that had been developing after the initial damage. Stem cell therapy also increased stamina and removed fluid buildup in the body, so characteristic in heart failure.

The researchers say their findings show that stem cells can achieve functional repair in non-ischemic (cases other than blood-flow blockages) genetic cardiomyopathy. Further testing is underway.

Others members of the multidisciplinary team are: Timothy Nelson, M.D., Ph.D.; Ruben Crespo-Diaz; Carmen Perez-Terzic, M.D., Ph.D.; Xiao-Ke Liu, M.D., Ph.D.; and Atta Behfar, M.D., Ph.D., of Mayo Clinic; Takashi Miki, M.D., Chiba University, Japan; and Susumu Seino, M.D., Kobe University, Japan.

The research was supported by the National Institutes of Health, the American Heart Association, the Marriott Foundation, the Ted Nash Long Life Foundation, the Ralph Wilson Medical Research Foundation, and the Japanese Ministry of Education, Science, Sports, Culture and Technology.
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Piedmont Physicians Raise Awareness of Cervical and Other Gynecological Cancers

Every six minutes, an American woman is diagnosed with gynecologic cancer, including cervical, endometrial, ovarian, peritoneal, tubal, vaginal and vulvar cancers. Each year more than 80,000 American women are diagnosed with a gynecologic cancer, defined as the uncontrolled growth and spread of abnormal cells in the female reproductive organs.

September is Gynecologic Cancer Awareness Month and according to the Gynecologic Cancer Foundation, early detection plays a critical role in the treatment process. In addition, the Foundation says that gynecologic cancers should only be treated by a cancer specialist, such as a gynecologic oncologist. Any woman is at risk for developing a gynecologic cancer. Although they are often discussed as a group, gynecologic cancers have a spectrum of different causes, prevention and detection methods, treatment, and likelihoods of a cure.

“Gynecologic cancer is a serious concern for women, but there are ways to prevent, detect and treat this cancer,” said Alfred Dwayne Jenkins, M.D., gynecologic oncologist at Piedmont Fayette Hospital. “If more women were screened regularly, many unnecessary deaths from cervical cancer could be avoided.”

Biomedical research has discovered that some genes, called oncogenes, promote the growth of cancer. These genetic mutations are acquired during life through smoking, aging or environmental influences, or are inherited from parents or grandparents. Many cancers of the cervix, vagina and vulva are caused by a virus that blocks normal gene function. Only a few of the specific genes leading to reproductive cancers have been identified. Knowing family history can increase the chance of early diagnosis and can help take action toward prevention.

Screening and self-examinations conducted regularly can result in the detection of certain types of gynecologic cancers in their earlier stages, when treatment is more likely to be successful and a complete cure is a possibility. Diet, exercise and lifestyle choices play a significant role in the prevention of cancer. Additionally, knowledge of family history can increase the chance of prevention or early diagnosis by determining if someone may have a gene which makes them susceptible to cancer.

Dr. Jenkins has been a part of the Piedmont Healthcare family since early last year, working with Piedmont Gynecologic Oncology located on the Piedmont Hospital campus. He also holds part-time office hours at Piedmont Fayette Hospital in Fayetteville. Dr. Jenkins is board-certified in obstetrics and gynecology and gynecologic oncology. He performed the first gynecologic robotics procedure in the state of Florida while serving as director of the Division of Gynecologic Oncology at M.D. Anderson Cancer Center-Orlando. Dr. Jenkins is also interested in minimally invasive surgery and fertility-sparing treatment of malignancies.

Dr. Jenkins is accepting new patients and welcomes virtually all major insurance plans. His Fayetteville office is located at 1267 Highway 54 West, Suite 5200, Fayetteville, Ga. on the PFH campus. For more information or to schedule an appointment, please call 404-605-2100.
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U.S. Hospitals Could Benefit from Indian Approach

U.S. hospitals and policymakers could find many valuable lessons in recent accomplishments in the Indian hospital market, according to an interdisciplinary team from Duke University’s schools of business, law and medicine, whose work was published in the Sept. 10 issue of Health Affairs.

Indian hospitals are developing innovative ways to produce low-cost and high-quality patient care, the Duke team concludes. Important attributes severely lacking in the U.S. market – price and quality competition, innovation that improves quality and reduces costs, and affordable care to middle-class budgets – are present in many Indian hospitals.

For example, open heart surgery performed by U.S.-trained surgeons can cost as little as $6,000 in India, as compared with $100,000 in the states, the authors say.

Driven by cost-based competition and a growing middle-class with increasing but limited resources to purchase health services, Indian hospitals have introduced innovations in areas ranging from customer service to labor practices to manufacturing. Most of the innovations reflect new organizational practices and market-oriented strategies, rather than simply relying on low-cost labor.

“As a market for private health care has emerged in India, so have dramatically innovative practices for refining the delivery of services,” said Duke law professor Barak Richman.

The result is greater choice of providers at reasonable prices as hospitals seek to differentiate themselves in the marketplace. “Within this competitive environment, we see dynamic innovation, as economists would expect would emerge from competitive markets. The big question is why the same innovation has not occurred in the U.S.," he said. "Indian accomplishments thus offer lessons both on how to innovate and, more significantly, how to organize a marketplace that will foster valuable innovations.”

The authors cite the example of Care Hospitals, a series of facilities around Hyderabad, and the Fortis Hospital network of hospitals in New Delhi. Both groups of hospitals provide high-quality health care services. The two groups both view patients as consumers, but cater to different markets. Care focuses on providing services to budget-conscious patients, while Fortis delivers services for middle-class patients, but also offers the potential for more luxurious amenities for wealthier clientele.

“These hospital groups have defined their target markets and, while largely maintaining consistent quality standards for clinical care, are providing non-clinical amenities and services at a level commensurate with their patients’ abilities to pay for care,” said Krishna Udayakumar, assistant professor of medicine.

Indian hospitals have pursued innovations in nearly every aspect of their operations, including the identification of new and more affordable sources of labor, integration of engineering management approaches to using data to improve quality, and the introduction of novel ways to increase organizational efficiency.

The authors contrast the development of specialty heart hospitals in the United States that emerged over the same time period as many of the Indian hospitals they examined, but which do not achieve the cost and quality combinations reported in India. They argue that the administrative framework for the health care system in the United States serves as a barrier to achieving the desirable outcomes of organizational innovation.

The authors argue that U.S. hospitals have much to learn from Indian practices.

“We’re excited about the study of organizational innovation and its relationship to the cost and quality of health care," said Will Mitchell, J. Rex Fuqua Professor of International Management in the business school. "We wanted to contrast these two markets to see how organizations respond to these very different market environments, and to see if there are innovative organizational models in the dynamic India hospital market that have lessons for North America.”

Added Kevin Schulman, professor of medicine and business administration, “As we search for policy solutions to the health care crisis in the United States, it’s critical to find examples of solutions in other markets. With these data, we can have the courage to reassess some of our traditional frameworks as we try to re-engineer our system.”

By Laura Brinn

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Successful Natural Treatment for Autism: A Progress Report

24-7 - Parents of autistic children are being trained in a simple, non-drug based, procedure that activates the alternative cellular energy (ACE) pathway in their children. The parents act as clinical investigators and openly document the changes observed during and after the therapy. Among the documented results are markedly improved social interactions with far better eye contact, joyfulness, verbal speech, reading ability, attention span and following of instructions. In one patient, previous uncontrollable epileptic seizures in a child have now ceased allowing for the discontinuation of anti-seizure medication. The results are posted on www.iminhere.ca

The premise of the study is that autism is a collection of symptoms of brain damage caused primarily by infection with a stealth adapted virus acquired by the fetus during pregnancy. It is part of a much wider epidemic of illnesses caused by stealth adapted viruses. Public Health officials have been reluctant to recognize these viruses as a significant cause of chronic illnesses. Hopefully, this reluctance will give way to a more proactive response as the positive findings from the autism clinical trial become more widely publicized and discussed.

Parents and other supporters of patients with autism can assist by informing others of the trail and by joining the ranks of participating clinical investigators. A similar natural energy based protocol is being developed for evaluation in other illnesses attributed to stealth adapted viruses as well as in diseases caused by conventional viruses.

Additional information on stealth adapted viruses is available at www.s3support.com Enquiries on these viruses and on the enrollment opportunities in the ongoing clinical studies can be addressed to s3support@mail.com W. John Martin, MD, PhD. Institute of Progressive Medicine.

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Outreach Program for Troubled College Students Shows Positive Results

A pilot program called the College Screening Project, a suicide prevention outreach program, was successful in identifying and treating college students with severe depression and feelings of desperation that may have led to suicide. The study, supported by the American Foundation for Suicide Prevention (AFSP), was conducted with Emory University students over six college semesters from 2002-2005.

Depression is a significant risk factor for suicide, and according to the Centers for Disease Control and Prevention (CDC) suicide is the third leading cause of death for teenagers and young adults, behind accidents and homicides.

"A profound percentage of the students who participated in AFSP's College Screening Project reported current (past four weeks) suicide ideation and were subsequently treated," says Charles B. Nemeroff, MD, PhD, Reunette W. Harris Professor and chair of the Department of Psychiatry and Behavioral Sciences at Emory University. “That represents a large number of lives that were improved, and possibly saved, because of this program.”

The study, which began as simply an outreach program, revealed some startling statistics about suicide risk and depression in college students:
•11 percent of the participants in the screening project reported current suicidal ideation
•16.5 percent of the participants in the screening project had made at least one lifetime suicide attempt
•More than half had clinically significant depression
•Suicide ideation was related not just to depression, but also to feelings of desperation and feeling overwhelmed or out of control.

“These are important emotions to look for in at risk students," says Nemeroff.

From 2002-2005, approximately 8,000 students were invited to participate in the AFSP program and asked to complete a brief questionnaire that covered depression and related problems. The invitations were distributed on a secure, project-developed website. During the three-year study interval, a total of 729 Emory students participated by completing the questionnaire.

An experienced clinician reviewed the responses and a detailed personalized assessment was returned to each student's secured email address. Students whose questionnaire results suggested significant problems were urged to come in for a face-to-face evaluation. In addition, a dialogue feature on the website gave the students the option to exchange follow-up messages with the clinician while remaining anonymous.

Study data showed that 91 percent of the students who filled out the questionnaire viewed the counselor's assessment; 34 percent engaged in dialogues and 20 percent came in for an evaluation. More than 80 students characterized as high-risk entered psychotherapy after the in-person evaluation.

The study also found that among students designated to be at-risk, the rates of those coming for in-person evaluation and entering treatment were three times higher for those who engaged in online dialogues than for those who did not. In addition, for some students who dialogued with the counselor the online relationship appeared to have had a therapeutic effect.

Steve Garlow, MD, PhD, a study co-author, believes that college students are particularly vulnerable when it comes to feelings of depression, but don't seek treatment because of concerns about the stigma attached to mental illness. "The students responded to this program because it was readily available and they were using technology that they could relate to and trusted to keep their identity anonymous."

David Moore, MD, study investigator and psychiatrist at Emory University's Student Health Center says, "We have always tended to be proactive, but this project was so effective that we continued to use the AFSP program at Emory. We believe it is a very effective tool for supporting our students."

Dr. Charles Nemeroff was principal investigator for the study, and currently serves as President of the American Foundation for Suicide Prevention.

Drs. Moore and Garlow are assistant professors in Emory's Department of Psychiatry and Behavioral Sciences. Jill Rosenberg, LCSW, project counselor, was with the department when the study was implemented.

The University of North Carolina, Chapel Hill (UNC) was included in the project for the last three of the six semesters.

In addition to Emory faculty, study authors included, Ann Haas, PhD, and J. John Mann, MD, with the AFSP; Bethany Koestner, BS, with the AFSP at the time the project was implemented; Jan Sedway, PhD, and Linda Nicholas, MD, with the Department of Psychiatry at the University of North Carolina School of Medicine, Chapel Hill and Herbert Hendin, MD, with New York Medical College in Valhalla.

The research was supported by unrestricted grants to the American Foundation for Suicide Prevention from Eli Lilly and Company, Wyeth Pharmaceuticals, Janssen Pharmaceuticals and Solvay Pharmaceuticals, Inc.

An article describing key findings of the initial implementation of the program recently appeared in the journal Depression and Anxiety (Vol 25: 482-488) 2008 and a second article summarizing the combined results of the pilot test that included both Emory University and UNC was published in the Journal of American College Health (Vol 57 (1): 15-22 (2008).
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Zen Training Speeds the Mind's Return After Distraction, Brain Scans Reveal

Experienced Zen meditators can clear their minds of distractions more quickly than novices, according to a new brain imaging study.

After being interrupted by a word-recognition task, experienced meditators’ brains returned faster to their pre-interruption condition, researchers at Emory University School of Medicine found.

The results are published online by the journal Public Library of Science One (PLoS ONE). Read the results.

Giuseppe Pagnoni, PhD, Emory assistant professor of psychiatry and behavioral sciences, and co-workers used functional magnetic resonance imaging (fMRI) to examine changes in blood flow in the brain when people meditating were interrupted by stimuli designed to mimic the appearance of spontaneous thoughts.

The study compared 12 people from the Atlanta area with more than three years of daily practice in Zen meditation with 12 others who had never practiced meditation.

While having their brains scanned, the subjects were asked to focus on their breathing. Every once in a while, they had to distinguish a real word from a nonsense word presented at random intervals on a computer screen and, having done that, promptly “let go” of the just processed stimulus by refocusing on their breath.

The authors found that differences in brain activity between experienced meditators and novices after interruption could be seen in a set of areas often referred to as the "default mode network." Previous studies have linked the default mode network with the occurrence of spontaneous thoughts and mind wandering during wakeful rest.

After interruption, experienced meditators were able to bring activity in most regions of the default network back to baseline faster than non-meditators. This effect was especially prominent in the angular gyrus, a region important for processing language.

"This suggests that the regular practice of meditation may enhance the capacity to limit the influence of distracting thoughts. This skill could be important in conditions such as attention deficit and hyperactivity disorder, obsessive-compulsive disorder, anxiety disorder and major depression, characterized by excessive rumination or an abnormal production of task-unrelated thoughts," Pagnoni says.

Dr. Pagnoni recently moved from Emory to the University of Modena and Reggio Emilia in Italy.

The research was funded by a National Institutes of Health grant to the Emory Center for Research on Complementary and Alternative Medicine in Neurodegenerative Diseases.

Reference:
Pagnoni et al, PLoS One, Volume 3, Issue 9 (September 2008) “Thinking about Not-Thinking”: Neural Correlates of Conceptual Processing during Zen Meditation.

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Lowering the Drinking Age Affects Teenage Brain Development and Death Rate

In response to controversial efforts by the Amethyst Initiative to revisit the debate on lowering the national drinking age from 21 to 18, the Georgia Underage Drinking Prevention Initiative of The Council on Alcohol and Drugs affirms its opposition to any attempts to change the Minimum Legal Drinking Age (MLDA). Lowering the drinking age would have terrible consequences for youth and communities throughout Georgia. Underage drinking, particularly on college campuses, is pervasive and has major repercussions, but lowering the drinking age is not the solution.

The Amethyst Initiative was launched last month with support from many college chancellors and presidents who believe that the 21-year-old drinking age is not working and has helped to create a culture of binge drinking. To date about 120 university leaders nationwide have given their support to this Initiative.

2007 Monitoring the Future results reveal that now 28% of high school seniors have never used alcohol in their lifetime.1 This means that more than three times as many 18-year-olds have not consumed any alcohol since the drinking age was raised to 21. Clearly this is a societal prevention success that we should not undermine by lowering the drinking age back to 18. The issue of whether to lower the drinking age should be dependent on results and research—not rhetoric.

Given that we know that prevention works, and that we are achieving success, we cannot afford to return to the outdated policy of lowering the drinking age. Instead, we need to collectively reinforce the progress we have made to date. Comprehensive community-wide strategies involving all sectors of the community have proven effective in reducing underage drinking. Such efforts can include, but are not limited to: addressing access and availability of alcohol, changing community norms, community organizing and mobilization, environmental policy changes, heightened enforcement, media advocacy and messaging, and school-community partnerships. These prevention efforts have contributed to a 21.7% decrease in the number of 12th grade students reporting lifetime prevalence of alcohol use between 1984, when the 21-year-old mandate was issued, and 2007.2

Additionally, science confirms that the adolescent brain is not fully developed until the early- to mid-20s.3

As a result, alcohol use prior to age 21 can create problems in brain development and function. In fact, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), even a “single, moderate dose of alcohol can disrupt learning more powerfully in people in their early twenties, compared to those in their late twenties. The effects of repeated alcohol consumption during adolescence may also be long-lasting. Studies in humans have detected cognitive impairments in adolescent alcohol users weeks after they stopped drinking, and a different pattern of brain response to tests of memory than among non-abusers.” It is in the best interest of our youth to ensure that the age of onset for alcohol use is delayed as long as possible. This is proven by the fact that youth who begin drinking before the age of 15 are four times more likely to develop alcohol dependence as an adult than those who wait until age 21.4

The National Highway Traffic Safety Administration reports show that the Minimum Legal Drinking Age of 21 has reduced traffic fatalities involving drivers aged 18 to 20 years by 13%, saving 900 lives every year. Approximately 36 of those young lives saved each year are in Georgia. “The State has a duty to protect its children. Reducing the legal drinking age undermines this obligation,” says Chuck Wade, President and CEO of The Council on Alcohol and Drugs.

Furthermore, since the federal 10% highway fund incentive—which encourages states to mandate that the drinking age is 21—was passed, more than 25,000 lives have been saved.5

Though lowering the drinking age will remove the immediate enforcement issue on college campuses and shift this responsibility to society at large, it will not change the major costs and consequences associated with alcohol abuse. Consider the following statistics:

● 65.9% of those youth reporting heavy alcohol use had also engaged in one or more of the following delinquent behaviors: participating in a serious fight at school or at work, participating in a group-against-group fight, attacking someone with the intent to seriously hurt that person, stealing or attempting to steal something worth $50 or more, selling illegal drugs, and/or carrying a hand gun within the last year.6

● Among college students, underage drinking was involved in 50,000 incidents of alcohol related date rape and 430,000 assaults were committed by students who were drinking.7

● Last year, underage drinking was a factor in 7,286 fatal car accidents.8

● Underage drinking is also costly: It cost the citizens of Georgia $1.5 billion in 2005. This translates to a cost of $1,753 per year for each youth in the state. Georgia ranks 40th among the 50 states.9

The Council on Alcohol and Drugs is a 39-year-old nonprofit alcohol and drug prevention agency and an affiliate of the Georgia Chamber of Commerce. The Council on Alcohol and Drugs is a substance abuse prevention and education agency that develops programs and materials based on the most current research on drug use and its impact on the community. The Council's mission is to build healthy, stable communities by combating substance abuse, and related problems, through prevention education, information, and advocacy. The Council has also renewed its efforts in the prevention and reduction of underage alcohol consumption in Georgia. For more information contact Simone Powell at The Council on Alcohol and Drugs at 404-223-2484 or spowell@livedrugfree.org, or visit the website: www.livedrugfree.org.

1Johnston, L. D., O'Malley, P. M., Bachman, J. G. & Schulenberg, J. E. (December 11, 2007). Overall, illicit drug use by American teens continues gradual decline in 2007. University of Michigan News and Information Services: Ann Arbor, MI. Available: www.monitoringthefuture.org.
2Ibid.
3Winters, Ken. (2008). Adolescent brain development and drug abuse: Research indicates that brain development is still in progress during adolescence; immature brain regions may place teenagers at elevated risk to effects of drugs. Philadelphia, PA. Available: http://www.tresearch.org/headlines/2008Jan_TeenBrain.pdf.
4Grant, B. F. (1998). Alcohol Health and Research World. “The impact of a family history of alcoholism on the relationship between age at onset of alcohol use and DSM-IV alcohol dependence: Results from the National Longitudinal Alcohol Epidemiologic Survey.” Volume 22, Issue 2. Bethesda, MD.
5U.S. Department of Transportation, National Highway Traffic Safety Administration. (2007). Traffic safety facts 2006: A compilation of motor vehicle crash data from the fatality analysis reporting system and the general estimates system. Washington, DC. Available: http://www-nrd.nhtsa.dot.gov/Pubs/TSF2006FE.pdf.
6Office of Applied Studies, Substance Abuse and Mental Health Services Administration. (2005). The NSDUH report: Alcohol use and delinquent behaviors among youths. Available: http://www.oas.samhsa.gov/2k5/alcDelinquent/alcDelinquent.pdf.
7National Institute on Alcohol Abuse and Alcoholism. (2002). A call to action: Changing the culture of drinking at U.S. colleges. Bethesda: NIAAA. Available: http://www.collegedrinkingprevention.gov/Reports/TaskForce/TaskForce_TOC.aspx.
8U.S. Department of Transportation, National Highway Traffic Safety Administration. (2007). 2006 Traffic safety annual assessment—alcohol-related fatalities. Washington, DC. Available: http://www-nrd.nhtsa.dot.gov/Pubs/810821.pdf.
9The International Institute for Alcohol Awareness (IIAA). (2006). A Project of the Pacific Institute for Research and Evaluation (PIRE). www.beawarenow.org.
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