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works007 · 发表于 2005-6-21 11:41:00

<H2>Half of us suffer from mental illness, survey finds 
<H4>Most patients do not receive adequate care</H4>
<DIV align=center>By William J. Cromie Harvard News Office About half of all the people in the United States will develop one or more mental disorders in their lifetimes, according to the latest national survey. During any year, one of every four people in this country fits the definition of "mentally ill." </DIV>
Most of these disorders are mild, the census-like survey found. Mild or severe, most of them start before or during adolescence, and most patients wait years for treatment or go untreated. Even when treatment is available, it is not likely to be very good. 
"It has been a decade since the last national survey of mental health in this country was taken," says Ronald Kessler, a professor of health care policy at Harvard Medical School, who directed both surveys. "Many important advances have been made in terms of new medications, public attitudes, and financing of treatment. Because of this, treatment has increased dramatically. We were hoping to see a decrease in disorder prevalence, but we did not. Also, quality of treatment was found to be low." 
Four articles in the June issue of Archives of General Psychiatry and one in the June 16 issue of the New England Journal of Medicine report survey results. A key finding is that those who did receive health care often did not get treatment consistent with even minimum accepted standards. Only about 13 percent of patients with mental health problems received adequate care. 
The researchers were struck and disappointed to learn that many people turn to nonmedical treatments without proven benefit. About one out of three patients relied on sources such as spiritual advisers and Internet groups. "You wouldn't rely on your priest for treatment if you had breast cancer," commented Thomas Insel, director of the National Institute of Mental Health, major supporter of the $20 million survey. 

<H3 align=center>Anxiety, mood swings, impulse control</H3>

The survey covered four types of mental illnesses. Anxiety disorders, such as panic, phobia, and post-traumatic stress, turned out to be the largest category. About 30 percent of people in the United States experience high enough anxiety at some time in their lives to meet the definition of being mentally disordered. 
Mood problems, such as major depression and manic depression, come next, accounting for almost 20 percent of mental problems. Over a one-year period, almost half of people in this category (45 percent) had severe problems. 
Lack of impulse control, such as defiance, hyperactivity, and explosive behavior, ranks next, involving about one in every four of the population over a lifetime. 
Abuse of and dependence on alcohol and drugs affect about 15 percent of people, with alcohol abuse accounting for most of this category. 
Young people are hard hit. Most of the mental illness in this country starts early. Anxiety disorders usually begin by age 14. Most mood problems start by age 20-25. While arthritis, diabetes, and heart disease are the chronic diseases of the elderly, mental illness is the chronic disorder of young people in our nation. 
Although problems that begin in childhood are often more serious than those starting in adulthood, they do not receive the most timely attention. Researchers think that this is because adults are not aware of the distress unless symptoms are extreme. The survey also found that men experience longer delays and lower rates of treatment than women. Minorities generally encounter longer delays than whites. The waits sometime stretch from years into decades. 
"Given the enormous personal and societal burdens of mental disorders, these observations should lead us to direct a greater part of our thinking about mental health interventions to children," says Kessler. "We should focus on early interventions aimed at preventing progression of primary disorders and the onset of multiple disorders." 
Kessler is referring to what experts call co-morbidity, the simultaneous occurrence of two or more disorders, such as depression and drug abuse. It's a huge problem. Almost half of mentally ill people carry the burden of two or more disorders. Such findings "highlight the importance of integrating treatments, of treating the people, instead of the disorder," notes Kathleen Merikangas of the National Institute of Mental Health. 

<H3 align=center>Is it really that bad? </H3>

Is it as bad as it sounds? 
Decisions to classify someone as mentally ill are based on guidelines agreed upon by federal agencies and private organizations of psychiatrists. In the national survey, some 300 interviewers trained in these guidelines knocked on the doors of 9,282 households in 34 states between February 2001 and April 2003. They asked specific questions about anxieties, phobias, moods, impulse control, alcohol, and drug use. Did interviewees avoid other people? Did the interviewees spend most of their day in bed or at a bar? 
Critics of the guidelines and conclusions based upon them worry that definitions of mental illnesses keep expanding to cover more and more situations. One psychiatrist complains that, "We'll soon have a syndrome for short, fat Irish guys with a Boston accent, and I'll be mentally ill." 
Kessler does not defend the system of guidelines, but he sticks by the results of the survey. "No one would be surprised to find that 99.9 percent of the population has had a physical illness sometime in their life," he points out. "Physical illnesses are often mild and short-lived; the same is true of what we call mental illnesses. But what our study shows is that these disorders have an impact on Americans as common as physical maladies such as diabetes and heart disease." if anything you do not understand, pls. let me know! and i will try my best to satisfy you!</H2>

dony · 发表于 2005-6-22 15:33:00

where do you get them

works007 · 发表于 2005-6-22 19:28:00

thanks for your attention!
i have these material from the Harvard university's webside![em05][em05]

[此贴子已经被作者于2005-6-22 19:31:28编辑过]

works007 · 发表于 2005-6-22 19:32:00

Dony,are you from Xiamen?

malifa0989 · 发表于 2005-6-22 19:55:00

I like it

works007 · 发表于 2005-6-27 16:01:00

<CENTER>
<H2>Risk of sudden cardiac death is highest in the early period following a heart attack</H2>
<H4>New research is needed to identify therapies and strategies to protect patients during this vulnerable time</H4></CENTER>
 
Even with modern medical treatment, patients who have experienced a heart attack remain at increased risk for sudden death after they are discharged from the hospital. In an effort to better understand who to treat and when, researchers at Brigham and Women's Hospital (BWH), in collaboration with an international research team, studied sudden death in 14,609 men and women who'd had a heart attack and were enrolled in the VALIANT Trial (Valsartan in Acute Myocardial Infarction Trial). 
The researchers found that the risk of sudden death was highest in the first 30 days following a heart attack, and that the risk declined rapidly with time. The risk of sudden death was particularly high in patients with reduced left ventricular (main heart pump) function. Researchers also found, unexpectedly, that patients with better left ventricular function were also at increased risk of dying suddenly during this early period. These findings suggest that new treatments focused on patients in that highest risk period could lead to a substantial saving of lives after a heart attack. Details are in the June 23 issue of the New England Journal of Medicine. 
According to lead author Scott D. Solomon, director of noninvasive cardiology at BWH, it is important to better understand the threshold of risk. "This study confirms that patients who have a decreased left ventricular ejection fraction after heart attack are at high risk of sudden death in the early period after an event. However, we also found that even patients with better cardiac function were also at risk during the early period. Although this risk of dying suddenly due to heart rhythm disturbances is greatest in the first few days after a heart attack - usually when the patient is in the hospital - we found that a substantial number of patients die suddenly and unexpectedly after hospital discharge. 
"As we discharge patients earlier and earlier after heart attack, we need to consider this risk. While we currently have good long-term therapies for patients at high risk for sudden death - notably implantable defibrillators - the fact that this risk is very high early on, then declines, would support the development of short-term strategies that might lead to savings lives during this particularly high risk period." 
Researchers studied 14,609 patients, between December 1998 and June 2001 who were enrolled in the VALIANT Trial - men and women with a median age of 67 years - with left ventricular dysfunction, heart failure, or both after heart attack to assess the incidence and timing of sudden unexpected death in relation to left ventricular ejection fraction. Causes of death were classified as non-cardiovascular or cardiovascular, and cardiovascular deaths were further classified as sudden or due to heart attack, heart failure, stroke, or other cardiovascular causes. 
Of the 14,609 patients studied, 1,067 died suddenly or were resuscitated following a cardiac arrest (median time after heart attack was 180 days). The risk of sudden death or cardiac arrest was highest in the first 30 days after heart attack. Indeed, during the first month, the rate of sudden death or cardiac arrest was 1.4 percent per month, and dropped to one-tenth that after two years. Furthermore, the majority of patients who died suddenly during the first 30 days did so after hospital discharge. Those with lower left ventricular ejection fraction (more impaired heart function), diabetes, and hypertension had a higher risk of sudden death or cardiac arrest. 
According to the researchers, these data indicate that the risk of sudden death changes dynamically after a heart attack, and that even patients with higher ejection fraction may be at risk during this early period. Current guidelines recommend implantation of a defibrillator for patients with significantly reduced left ventricular function after a heart attack, but not until at least 30 days after the event. During this period, many patients who remain at high risk are unprotected. 
"We need to consider therapies and strategies, even short-term bridging strategies, that could protect patients during this early vulnerable period following a heart attack." said Solomon. 
This research was supported by a grant from Novartis Pharmaceuticals.

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