Buy Propecia: Finasteride

Nearly 80 percent of Americans live within two hours by ground or helicopter transport of a verified burn center, but there are significant regional variations in access to these centers, a new study finds.

A verified burn center is one in which the quality of care has been assessed and confirmed by the American Burn Association. More than a half-million burn injuries and about 4,000 burn-related deaths occur each year in the United States, according to the association.

The study found that there were 128 self-reported burn centers in the United States in 2008, including 51 verified burn centers. The centers were served by 782 helipads and 804 helicopters. About 25 percent of the U.S. population lived within one hour by ground transport of a verified burn center, the study found. It also reported that 46 percent lived within two hours by ground transport and 68 percent lived within four hours by ground transport.

If taken by helicopter, about 54 percent could get to a verified burn center in an hour, and 79 percent in two hours, the study found. By helicopter, 75 percent could get to any self-reported burn center in an hour, and 96 percent in two hours.

The researchers noted that one-third of the U.S. population must be transported by air to reach a verified burn center within two hours.

Access varied greatly by region, the study authors reported in the Oct. 28 issue of the Journal of the American Medical Association.

“The greatest proportion of the population with access was highest in the northeast region and lowest in the southern United States,” wrote Dr. Matthew B. Klein, of the University of Washington in Seattle, and his research colleagues.

The regional variations identified in the study “may be an influential predictor of optimal regionalization strategy,” they wrote. “For states and regions with a relatively high baseline rate of access, the best strategy for improving access and reducing time to definitive care may involve optimization of air and ground emergency medical service systems. For states and regions with a relatively low baseline rate of access, the best strategy may involve construction or verification of new regional burn care facilities.”

The study did not determine optimal distribution of burn centers throughout the country, but the data “provide important information about population access that may be used to guide resource allocation in burn care,” the researchers concluded.

For people in their 70’s, light to moderate alcohol intake may offer women, but not men, some protection against loss of mobility, a study hints.

But the investigators caution that most of this benefit is tied to the drinkers’ lifestyle.

The study looked at associations between alcohol intake and the mobility levels reported by 3,061 healthy men and women who were 70 to 79 years old and living in the Pittsburgh, Pennsylvania and Memphis, Tennessee areas.

At enrollment, none had difficulty walking a quarter mile, climbing 10 steps, or performing basic activities of daily living. Every 6 months over the next 6.5 years, the participants had either a clinical examination or completed a mobility survey.

From these evaluations, Dr. Cinzia Maraldi of the University of Ferrara in Italy and colleagues determined that 24 percent of the study subjects had become unable to walk a quarter mile, climb 10 steps without resting, or perform daily activities. Another 49 percent developed difficulty performing these tasks.

When Maraldi’s team looked at mobility according to weekly alcohol intake, as determined at study enrollment, moderate drinking in men and light to moderate drinking in women appeared to be associated with lower loss of mobility.

For men, moderate intake was defined as 8 to 14 drinks per week. For women, light drinking was 1 to 3 drinks per week and moderate drinking, 4 to 7 drinks a week.

However, most of the apparent protective effect on mobility of light and moderate alcohol intake was found to be due to lifestyle factors of the drinkers - particularly lower body weight, higher physical activity levels, higher income, and more education.

In the Journal of the American Geriatrics Society, Maraldi and colleagues suggest caution in “attributing a direct benefit of moderate alcohol intake on functional ability,” since these findings show that lifestyle plays a more important role in elder’s ability to maintain mobility.

A higher risk of cardiovascular-related death isn’t the reason why kidney failure patients starting dialysis are at increased risk of death, according to new research that challenges previous thinking.

A number of studies have found that cardiovascular disease accounts for 40 percent to 50 percent of deaths in patients with end-stage kidney disease, and “it is believed that the life span of patients receiving dialysis is reduced mainly as a consequence of premature cardiovascular death,” noted the authors of the new study.

Using data from between January 1994 and January 2007, the researchers compared the death rates in 123,407 dialysis patients in Europe and in the general European population.

Among dialysis patients, non-cardiovascular causes accounted for 50.8 percent of deaths while cardiovascular disease caused 39.1 percent of deaths. In the general population, 58.4 percent of deaths were from non-cardiovascular causes, 40.4 percent were from cardiovascular causes, and 1.2 percent were from unknown causes.

The overall all-cause death rate was higher among patients on dialysis, according to the report published in the Oct. 28 issue of the Journal of the American Medical Association.

“In particular, non-cardiovascular mortality rates were higher than cardiovascular mortality rates in patients starting dialysis,” wrote Dinanda J. de Jager, of the Leiden University Medical Center in the Netherlands, and colleagues. “These results suggest that excess mortality in patients receiving dialysis is not specifically the result of increased cardiovascular deaths.”

The researchers concluded that “cardiovascular and non-cardiovascular mortality are equally increased during the first three years of dialysis, compared with the general population. This implies that the importance of non-cardiovascular mortality in patients receiving dialysis has generally been underestimated. Therefore, research should focus more on methods to prevent non-cardiovascular mortality.”

Children and teens who take medicines for conditions such as schizophrenia, bipolar disorder and autism tend to put on a substantial amount of weight, a new study finds.

The worry is that excessive weight gain and other metabolic changes in childhood can place kids at risk for chronic health problems as adults. Some of these medicines, collectively known as “atypical antipsychotics,” have been linked to increased blood-fat levels.

“We are very much afraid that this will lead to diabetes and metabolic syndrome,” said study author Dr. Christoph Correll, medical director of the Recognition and Prevention program at the Zucker Hillside Hospital in Glen Oaks, N.Y.

The study, reported in the Oct. 28 issue of the Journal of the American Medical Association, is the largest analysis of its kind, Correll said.

Jeanette M. Jerrell, a professor of neuropsychiatry at the University of South Carolina School of Medicine in Columbia, is the co-author of a similar study published last year in the Archives of Pediatrics and Adolescent Medicine.

“We found that obesity/weight gain, type 2 diabetes mellitus and cardiovascular conditions were more prevalent in the treated cohort,” she noted.

Her study also found that kids taking multiple antipsychotics were at significantly higher risk for obesity/weight gain, type 2 diabetes, abnormal blood-fat levels and cardiovascular problems.

“This new study is important because it draws further attention to the safety profile of antipsychotics in young populations, and the critical need for expanding the evidence base to guide clinical decisions,” she said.

Concerns about the safety of atypical antipsychotics are not new. In 2003, the U.S. Food and Drug Administration ordered manufacturers of these drugs to add a warning about the risk for hyperglycemia and diabetes.

What’s more, a 2008 report in The Lancet suggested that some of these drugs — sometimes called “second-generation” antipsychotics — may be no better than older, “first-generation” medicines. The authors concluded that each drug must be weighed individually based on its efficacy and side effects.

Correll’s study was designed to assess the safety and effectiveness of the newer class of drugs in youth. His team followed 272 patients, aged 4 to 19, who were taking an antipsychotic for the first time. Patients were being treated for mood spectrum, schizophrenia spectrum or aggressive behavior spectrum disorders.

Fifteen pediatric patients who refused to participate or discontinued their antipsychotic medication within four weeks of starting served as a control group.

The study focused on four antipsychotics commonly prescribed to children: aripiprazole (Abilify), olanzapine (Zyprexa), quetiapine (Seroquel) and risperidone (Risperdal).

After nearly 11 weeks, the treated kids gained an average of 18.7 pounds on Zyprexa, 13.4 pounds on Seroquel, 11.7 pounds on Risperdal and 9.7 pounds on Abilify, while the control group gained less than half a pound. Between 10 percent and 36 percent became overweight or obese during the treatment period, according to the study.

“In these kids that we studied, there was rapid and dramatic weight gain, more than has been described before,” said Correll, who is also a scientist in the Center for Psychiatric Neuroscience at the Feinstein Institute for Medical Research in Manhasset, N.Y.

Use of each drug was linked to wider bellies and increased “fat mass” — the proportion of the body comprised of fat.

The drugs had varying effects on metabolic levels. Zyprexa and Seroquel users experienced significant adverse changes in total cholesterol and trigylcerides. Risperdal use resulted in a significant increase in triglycerides. Abilify, however, appeared “metabolically neutral,” Correll said.

“Some of these kids are maintained on these medications for many years if not indefinitely, so it’s definitely a concern,” said Ronald T. Brown, dean and professor of public health at Temple University Health Sciences Center in Philadelphia. “For children who really don’t absolutely need these drugs, they need to be doing more behavioral approaches in psychotherapy.”

In an accompanying editorial, Drs. Christopher K. Varley and Jon McClellan of Seattle Children’s Hospital concluded that large, independently funded studies are needed to establish the long-term safety and benefit of these drugs in children.

“Until those data are available, consideration of less risky treatment interventions and scrupulous attention to metabolic parameters in children and adolescents who receive atypical antipsychotic medications are essential,” they wrote.

Correll, in fact, is currently involved in a longer-term follow-up study to assess the health effects of these drugs in children over an extended period of time.

For now, he advises clinicians and families to carefully weigh the risks and benefits of the medications against the risk of the illness, and to consider other pharmaceutical and non-pharmaceutical options. It’s also important to teach children about healthy lifestyles and to closely monitor kids’ weight, lipid levels and blood glucose, he said.