Health Insurance Lead

ATLANTA (AP) -- The nation's obesity epidemic is exacting a heavy toll: The rate of new diabetes cases nearly doubled in the United States in the past 10 years, the government said Thursday. The highest rates were in the South, according to the first state-by-state review of new diagnoses. The worst was in West Virginia, where about 13 in 1,000 adults were diagnosed with the disease in 2005-07. The lowest was in Minnesota, where the rate was 5 in 1,000.

Nationally, the rate of new cases climbed from about 5 per 1,000 in the mid-1990s to 9 per 1,000 in the middle of this decade.

Roughly 90 percent of cases are Type 2 diabetes, the form linked to obesity.

The findings dovetail with trends seen in obesity and lack of exercise - two health measures where Southern states also rank at the bottom.

"It isn't surprising the problem is heaviest in the South - no pun intended," agreed Matt Petersen, who oversees data and statistics for the American Diabetes Association.

The study, led by Karen Kirtland of the Centers for Disease Control and Prevention, provides an up-to-date picture of where the disease is exploding. The information should be a big help as the government and health insurance companies decide where to focus prevention campaigns, Petersen said.

Diabetes was the nation's seventh-leading cause of death in 2006, according to the CDC. More than 23 million Americans have diabetes, and the number is rapidly growing. About 1.6 million new cases were diagnosed among adults last year.

Type 2 diabetics do not produce or use insulin, a hormone needed to convert sugar into energy. The illness can cause sugar to build up in the body, leading to complications such as heart disease, blindness, kidney failure and poor circulation that leads to foot amputations.

The study involved a random-digit-dialed survey of more than 260,000 adults. Participants were asked if they had ever been told by a doctor that they have diabetes, and when the diagnosis was made. The comparisons between 1995-97 and 2005-07 covered only the 33 states for which the CDC had complete data for both time periods.

The researchers had data for 40 states for the years 2005-07.

West Virginia, South Carolina, Alabama, Georgia, Texas and Tennessee had the highest rates, all at 11 cases per 1,000 or higher. Puerto Rico was about as high as West Virginia. Minnesota, Hawaii and Wyoming had the lowest rates.

It is not entirely clear why some states were worse than others. Older people, blacks and Hispanics tend to have higher rates of Type 2 diabetes, and the South has large concentrations of all three groups. However, West Virginia is overwhelmingly white.

The report asked about diagnosed diabetes only. Because an estimated one in four diabetics have not been diagnosed, the findings probably underestimate the problem, said Angela Liese, a diabetes researcher at the University of South Carolina.

The underestimates may be particularly bad in the rural South and other areas where patients have trouble getting health care, she noted.

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On the Net:

State-by-state rates: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5743a2.htm

© 2008 The Associated Press.

CHICAGO (AP) -- A popular antidepressant plus three months of psychotherapy dramatically helped children with anxiety disorders, the most common psychiatric illnesses in kids, the biggest study of its kind found.

The research also offers comfort to parents worried about putting their child on powerful drugs - therapy alone did a lot of good, too.

Combining the drug sertraline, available as a generic and under the brand name Zoloft, with therapy worked best. But each method alone also had big benefits, said Dr. John Walkup, lead author of the government-funded research. It's estimated that anxiety disorders affect as many as 20 percent of U.S. children and teens.

In many cases, symptoms almost disappeared in children previously so anxious that they wouldn't leave home, sleep alone, or hang out with friends, said Walkup, a Johns Hopkins Hospital psychiatrist.

"What we're saying is we've got three good treatments," he said.

Sertraline is among antidepressants linked with suicidal thoughts and behavior in children with depression.

In this study, only a handful of the more than 200 kids using it had suicide-related thoughts and there were no suicide attempts, Walkup said. Suicidal tendencies are more common in depression than in anxiety, he said.

Zoloft, mostly used to treat adult depression and anxiety, is approved for treating obsessive-compulsive disorder in kids, but not anxiety. Some doctors use it for that, however. And some smaller, less rigorous studies have suggested it and other antidepressants can help.

The new study, paid for by the National Institute of Mental Health, is the largest examining treatment of childhood anxiety disorders, said co-author Dr. John March of Duke University,

Dr. Thomas Insel, the institute's director, said the study provides strong evidence that combined treatment is "the gold standard," but that sertraline or therapy alone can be effective.

Dr. Sharon Hirsch, a University of Chicago psychiatrist not involved in the study, said it echoes benefits she's seen in her own young anxiety patients on both treatments. But she note that the study shows that therapy alone is also good news for parents who don't want to put their children on an antidepressant.

The study, published online in the New England Journal of Medicine, was scheduled for presentation Thursday at an American Academy of Child and Adolescent Psychiatry meeting in Chicago.

Several study authors reported receiving consulting fees or other compensation from drug companies, including antidepressant makers.

The study involved 488 children aged 7 to 17 treated at six centers around the country. They were randomly assigned to one of four 12-week treatments: up to 200 milligrams daily of sertraline; 14 hour-long sessions of psychotherapy alone; both treatments together; or dummy pills.

In the combined treatment group, 81 percent of children were much improved by three months, compared with 60 percent in the therapy-only group, 55 percent in the sertraline-only group, and 24 percent in the placebo group.

Improvement, measured on a psychiatric scale, meant that anxiety had lessened so much that kids could do things they'd refused to do before, such as sleep in their own beds, go to school and socialize.

There was only one serious "adverse event" considered possibly linked to treatment - worsening behavior in a child on drug treatment only.

While many kids have occasional fears or anxiousness, those with full-fledged anxiety disorders are almost paralyzed by these feelings. Three types of disorders were studied: separation anxiety, generalized anxiety and social phobia, Walkup said.

Affected kids may be so worried that something bad will happen to their parents that they repeatedly refuse to go to school. Or they'll be so afraid of thunderstorms that they get chronic stomachaches, even when it's not stormy. Those with social anxiety disorder may just seem shy, but they are so self-conscious that they won't seek out friends or take part in class so their grades suffer, Walkup said.

"These kids were really miserable at the start of the study," and many ended up "really happy," March said.

The therapy used in the study was cognitive behavior therapy, which emphasizes that thoughts can be irrational and cause troubling feelings. It encourages patients to focus on positive thinking that allows them to develop ways of confronting fearful situations.

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On the Net:

NEJM: http://www.nejm.org

National Institute of Mental Health: http://www.nimh.nih.gov

© 2008 The Associated Press.

LONDON (AP) -- In the race to build a better artificial heart, French scientists have turned to technology from satellites and airplanes to create a heart that they say responds better to the human body. So far, the new device, shown at a news conference in Paris on Monday, has only been tested in animals. Its makers hope it might one day help people survive without needing a human heart transplant.

American companies have already produced artificial hearts, and scientists in Japan and South Korea are also working on versions.

But the French artificial heart is the first to be able to determine its patients' needs and respond accordingly. And its maker is a subsidiary of the parent company of Airbus, the European Aeronautic Defense and Space Co., or EADS.

"It's the same principle in the airplane as in the body," said Patrick Coulombier, chief operating officer of Carmat, the manufacturer.

Coulombier said the same tiny sensors that measure air pressure and altitude in an airplane or satellite are also in the artificial heart, detecting things like the heart's pumping speed and the pressure on its walls.

That should allow the device to respond immediately if the patient needs more or less blood. The heart is expected to cost about $192,140. The most advanced U.S. artificial heart, made by the U.S. company Abiomed, sells for up to $250,000.

Abiomed was aware of the French project but declared itself ahead in the race.

"Our artificial heart has already been implanted in patients and is FDA-approved," said Aimee Maillett, a company spokeswoman. On average, Abiomed's heart has extended patients' lives by about five months.

Few details are available about the artificial hearts being developed in Japan and South Korea because the scientists have not published their work widely.

Previous artificial hearts have been unable to automatically vary their pumping speed. The French heart is also the most lifelike, with two pumps to send blood into the lungs and the rest of the body, just like a real heart. Past artificial hearts have only had one pump.

The heart was tested in sheep, in some cases for three to six months to see how the animals' bodies would adjust to the artificial organ. Researchers did not test how long it would keep the animals alive. Laboratory experiments tested the heart in various scenarios, including, for example, when a hypothetical patient was exercising and suddenly needed more blood.

"This could be a bases-loaded home run if it works," said Dr. Douglas Zipes, past president of the American College of Cardiology and professor of cardiology at Indiana University. Zipes was not linked to the French research.

The French model is made from natural materials including polymer and pig tissue, which have already been used in heart valves implanted into people.

Those have not caused any problems like rejection or clotting, commonly seen with artificial hearts or devices. That makes some doctors optimistic that a heart partially constructed from the same tissues could spare patients lifelong anti-rejection and anti-clotting medicines.

The artificial heart would initially be for patients who had suffered a massive heart attack or who had heart failure, but might eventually be used in patients were are not that sick. French doctors hope to start tests in humans in the next two years.

Heart disease is the world's top killer. According to the American Heart Association, about 2,200 heart transplants were performed in the U.S. in 2006, and the waiting list is long.

While previous artificial hearts have mainly acted to buy time until a real heart becomes available, Dr. Ottavio Alfieri, a professor of cardiac surgery at Raffaele University Hospital in Milan and spokesman for the European Society of Cardiology, said the French heart might work in the longer term.

Experts warned that many past attempts to replace the human heart have failed.

"Virtually all devices that have been implanted in humans, no matter how well designed, have been associated with unforeseen complications," said Dr. Tim Gardner, president of the American Heart Association.

"This is a high-risk area with a lot of problems," said Dr. Karl Swedberg, a cardiologist at the University of Gothenburg in Sweden. He doubted the new artificial heart could be used to alleviate the shortage in donors, since it was very expensive and would still require a major operation.

"An artificial heart is an interesting idea, but we should focus on the established treatments we already have," Swedberg said.

© 2008 The Associated Press.

NEW YORK (AP) -- Turning your clock back on Sunday may be good for your heart. Swedish researchers looked at 20 years of records and discovered that the number of heart attacks dipped on the Monday after clocks were set back an hour, possibly because people got an extra hour of sleep.

But moving clocks forward in the spring appeared to have the opposite effect. There were more heart attacks during the week after the start of daylight saving time, particularly on the first three days of the week.

"Sleep - through a variety of mechanisms - affects our cardiovascular health," said Dr. Lori Mosca, director of preventive cardiology at New York-Presbyterian Hospital, who was not involved in the research. The findings show that "sleep not only impacts how we feel, but it may also affect whether we develop heart disease or not."

The study was described in a letter published in Thursday's New England Journal of Medicine by Dr. Imre Janszky of the Karolinska Institute and Dr. Rickard Ljung of Sweden's National Board of Health and Welfare.

Janszky said he came up with the idea for the study after last spring's time change, when he was having problems adjusting.

"I was on the bus, quite sleepy, and I thought of this," said Janszky, who has done other research on sleep and health.

They took advantage of Sweden's comprehensive registry of heart attacks to see if the disruptions to sleep and the body's internal clock caused by a time change had any effect on heart attacks from 1987 to 2006. They compared the number of heart attacks on each of the seven days after the time shift with the corresponding day two weeks earlier and two weeks later.

Overall, in the week after "spring forward," there was a 5 percent increase in heart attacks, with a 6 percent bump on Monday and Wednesday and a 10 percent increase on Tuesday. In the week after "fall back," the number of heart attacks was about the same, except on Monday, which had a 5 percent decrease.

"The finding that the possibility of additional sleep seems to be protective on the first workday after the autumn shift is intriguing," the authors wrote.

Doctors have long known that Monday in general is the worst day for heart attacks, and they usually blame the stress of a new work week and increased activity. The Swedish researchers said their findings suggest that the minor loss of sleep that occurs at the end of ordinary weekends - with people going to bed later on Sunday and getting up early on Monday - might also be a contributing factor.

Last year, a study by American researchers found there were more pedestrian deaths during the evening rush hour in November than October as drivers and pedestrians adjust to the earlier darkness. They said the risk for pedestrians drops in the spring when clocks are set back and daylight comes earlier.

Daylight saving time in the United States ends this year at 2 a.m. Sunday. All states except Arizona and Hawaii will make the switch. Sweden and the rest of Europe turned back their clocks last weekend. More than 1.5 billion people worldwide live in countries that use daylight saving time, the researchers said.

Sweden has a moderate rate of heart attacks and is at a high latitude, but Janszky said he would expect roughly the same results elsewhere.

Sleep can affect the heart through changes in blood pressure, inflammation, blood clotting, blood sugar, cholesterol and blood vessels, Mosca said. She suggested that anxiety from changes in routine may also be a factor, in addition to loss of sleep.

Dr. Ronald Chervin, director of the University of Michigan's Sleep Disorders Center, said this is a "sleep-deprived society," and he advises taking advantage of Sunday's time change and getting an extra hour of sleep.

In the spring, he suggests gradually adjusting to the one-hour loss by going to bed and getting up 15 minutes earlier for a few days before the time change.

"We spend a third of our lives sleeping and people forget how much effect it has on overall health," he said.

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On the Net:

New England Journal: http://www.nejm.com

© 2008 The Associated Press.

WELLINGTON, New Zealand (AP) -- Doctors removed a tumor from an East Timorese baby that was almost one-third the child's body weight during a life-saving operation in New Zealand, officials said Thursday.

Surgeons cut out the 7.3-pound benign tumor on Sunday from the abdomen of 14-month-old Alex Gonzaga at Wellington Hospital, hospital spokeswoman Trish Lee said.

The boy weighed about 24 pounds before the surgery and is expected to make a full recovery with no long term consequences, Lee said.

Bill Day, president of the Port Nicholson Rotary Club that sponsored the project, said Alex was already eating, moving about and well on the way to recovery.

"He's looking good, he's standing up holding on to mum, smiling and playing with toys - throwing things on the floor - you wouldn't think there was anything wrong with him," he told The Associated Press.

Doctors expect the boy will be ready to go home in about 10 days.

His mother, Elisa Da Conceicao, said she was very happy with the operation and looking forward to breast-feeding her son again, Wellington's Dominion Post newspaper reported Wednesday.

The tumor originally was spotted by a doctor in impoverished East Timor and scanned on a visiting medical ship. The operation in New Zealand involved a surgical team of 10 doctors.

Surgical team leader Brendon Bowkett said Alex would have died if he had not had the operation, in which 10 surgions removed the huge tumor mass from crucial structures, including the urinary tract.

© 2008 The Associated Press.