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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_460"
                     title="Black Mothers at Increased Risk for Cardiomyopathy (CME/CE)"
                     score="0.014"
                     href="http://www.medpagetoday.com/Cardiology/Prevention/tb/18389?impressionId=1265808390146"
                     
      &lt;p&gt;African-American women have an increased risk of peripartum cardiomyopathy, researchers have found in a small, single-center Georgia study.&lt;/p&gt;
&lt;p&gt;Compared with healthy controls of other races, black women had a 15.7-fold increased risk of the dangerous heart condition (95% CI 3.5 to 70.6, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.001), Mindy B. Gentry, MD, of the Medical College of Georgia Cardiovascular Center in Augusta, and colleagues reported online in the &lt;em&gt;Journal of the American College of Cardiology&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;The researchers said that the findings &quot;could not be explained by several other factors,&quot; including hypertension and smoking.&lt;/p&gt;
&lt;p&gt;&quot;We are unable to determine in this study whether genetic factors of race, or other complex environmental, social, economic, or other factors that are linked to race, account for the increased risk,&quot; the researchers wrote.&lt;/p&gt;
&lt;p&gt;Peripartum cardiomyopathy is a major cause of heart failure and cardiovascular mortality among women of child-bearing age, and can occur in women without preexisting heart disease.&lt;/p&gt;
&lt;p&gt;However, its risk factors have not yet been established, the researchers said.&lt;/p&gt;
&lt;p&gt;So they conducted a single-center, case-control study involving 28 women diagnosed with peripartum cardiomyopathy. Each case was matched with three healthy controls: all delivered babies within the same month.&lt;/p&gt;
&lt;p&gt;The researchers found that case incidence was 24 in 100,000 deliveries for non-blacks and 340 in 100,000 for African Americans.&lt;/p&gt;
&lt;p&gt;That relationship remained significant in multivariate analyses, controlling for other factors (OR 31.5, 95% CI 3.6 to 277.6).&lt;/p&gt;
&lt;p&gt;Other significant risk factors included hypertension (OR 10.8, 95% CI 2.6 to 44.4), being unmarried (OR 4.2, 95% CI 1.4 to 12.3), and having had more than two previous pregnancies (OR 2.9, 95% CI 1.1 to 7.4).&lt;/p&gt;
&lt;p&gt;It wasn&apos;t significant in the univariate analysis, but smoking during pregnancy was a significant risk factor in the multivariate analysis, the researchers said.&lt;/p&gt;
&lt;p&gt;Yet in a stratified analysis, &quot;none of these risk factors could explain solely the increased risk for this disorder among African-American women,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;They noted that the frequency of cardiomyopathy was higher at their center than in previous reports, although it was comparable to the frequency in countries with more women of African descent (100 to 980 in 100,000 deliveries).&lt;/p&gt;
&lt;p&gt;&quot;These data and an analysis of previous reports provide strong, consistent evidence that the risk of peripartum cardiomyopathy is increased among women of African descent,&quot; they concluded. &quot;It is important to consider whether the increased risk is due to genetic factors, environmental factors, or both.&quot;&lt;/p&gt;
&lt;p&gt;The authors noted that the study was limited by a relatively small sample size.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The researchers reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_445"
                     title="Physician Charged in Michael Jackson Death"
                     score="0.014"
                     href="http://www.medpagetoday.com/EmergencyMedicine/EmergencyMedicine/tb/18368?impressionId=1265808390146"
                     
      &lt;p&gt;Conrad Robert Murray, MD, the physician attending Michael Jackson when the pop singer died of cardiac arrest last June, has been charged with involuntary manslaughter in Los Angeles.&lt;/p&gt;
&lt;p&gt;Murray was to be arraigned this afternoon. If convicted, he could receive a maximum prison term of four years.&lt;/p&gt;
&lt;p&gt;According to the L.A. County District Attorney&apos;s office, Murray &quot;did unlawfully, and without malice, kill Michael Joseph Jackson . . . in the commission of an unlawful act, not amounting to a felony; and in the commission of a lawful act which might have produced death, in an unlawful manner, and without due caution and circumspection.&quot;&lt;/p&gt;
&lt;p&gt;Witnesses said Murray was with Jackson when the 50-year-old singer collapsed at his rented home in Beverly Hills. Murray tried to revive Jackson there with CPR, then accompanied him to a hospital. Jackson was pronounced dead at the hospital without regaining consciousness.&lt;/p&gt;
&lt;p&gt;Subsequent statements from investigators indicated that Murry had injected Jackson with the anesthetic agent propofol earlier that day, apparently to help Jackson sleep.&lt;/p&gt;
&lt;p&gt;The singer had long complained of insomnia, according to news reports.&lt;/p&gt;
&lt;p&gt;After an autopsy, the Los Angeles county coroner&apos;s office &lt;a href=&quot;http://www.medpagetoday.com/ProductAlert/Prescriptions/15736&quot; mce_href=&quot;http://www.medpagetoday.com/ProductAlert/Prescriptions/15736&quot; target=&quot;_blank&quot;&gt;ruled in August&lt;/a&gt; that Jackson died of an overdose involving multiple drugs, including propofol and lorazepam (Ativan). Other drugs found in his system included midazolam, diazepam, lidocaine, and ephedrine.&lt;/p&gt;
&lt;p&gt;News reports indicated that other physicians besides Murray had prescribed drugs for Jackson. In addition to insomnia, the singer was believed to suffer from chronic pain related to burns suffered during the filming of a television commercial years earlier.&lt;/p&gt;
&lt;p&gt;The Reuters news service reported that Murray had told investigators he was not the first physician to give propofol to Jackson.&lt;/p&gt;
&lt;p&gt;In numerous public statements, Murray has maintained his innocence of wrongdoing.&lt;/p&gt;
&lt;p&gt;When Jackson died, he was about two weeks from beginning a series of 50 concerts in London, his first major performance effort in a decade. The posthumous concert film &quot;This Is It&quot; was filmed during rehearsals for the series.&lt;/p&gt;
&lt;p&gt;Although paparazzi photographs released in the months prior to his death portrayed the singer looking frail and gaunt  --  one showed him in a wheelchair  --  he appeared healthy in the film.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_401"
                     title="Perinatal HIV Infection Highest Among Blacks"
                     score="0.012"
                     href="http://www.medpagetoday.com/HIVAIDS/HIVAIDS/tb/18305?impressionId=1265808390146"
                     
      &lt;p&gt;The rate of mother-to-child HIV transmission among infants is 23 times higher for blacks than whites, the CDC reported.&lt;/p&gt;
&lt;p&gt;Although rates of perinatal HIV infection have fallen by more than 90% since the 1990s, racial and ethnic disparities not only remain but may be increasing, the agency said in the Feb. 5 issue of &lt;em&gt;Morbidity and Mortality Weekly Report&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;The finding comes from an analysis of surveillance data from the 34 states that have had confidential name-based reporting since at least December 2003, the agency said.&lt;/p&gt;
&lt;p&gt;In those states, from 2004 through 2007, the overall rate of diagnoses of perinatal HIV infection among children a year old or younger was 2.7 per 100,000, the agency said.&lt;/p&gt;
&lt;p&gt;But the rate among blacks was 12.3 per 100,000, compared with 2.0 for children who were Hispanic, 1.6 for those of other or multiple races, and 0.5 for white infants.&lt;/p&gt;
&lt;p&gt;Compared with the rate among white infants, the rate ratios were 23.1, 3.8, and 3.1 for black, Hispanic, and children of other or multiple races, respectively, the CDC said.&lt;/p&gt;
&lt;p&gt;On the positive side, rates fell significantly during the period for black and Hispanic children  --  from 14.8 to 10.2 per 100,000 for blacks and from 2.9 to 1.7 per 100,000 for Hispanics, the CDC found. The changes were significant at &lt;em&gt;P&lt;/em&gt;=0.003 and &lt;em&gt;P&lt;/em&gt;=0.04, respectively.&lt;/p&gt;
&lt;p&gt;There were no significant changes for white children and those of other or multiple races, the CDC said.&lt;/p&gt;
&lt;p&gt;During the study period, 69% of all children younger than 13 who were diagnosed with HIV were black, 16% were Hispanic, 11% were white, and 4% were of other or multiple races.&lt;/p&gt;
&lt;p&gt;The CDC said that racial and ethnic disparities in HIV/AIDS incidence among children have been known since 1981-1986, when 78% of children with AIDS were either black or Hispanic. Similar disparities have been seen in rates of perinatal HIV infection, the CDC said.&lt;/p&gt;
&lt;p&gt;The annual total of perinatal HIV infections has fallen about 90% since 1991, the agency said, but, despite that, 85% of reported infections during 2004-2007 were in children who were black or Hispanic.&lt;/p&gt;
&lt;p&gt;One limitation of the study, the CDC said, is that the data come from only 34 states and may not give a complete picture, especially since some areas with high AIDS morbidity  --  such as California and the District of Columbia  --  were left out.&lt;/p&gt;
&lt;p&gt;But, the agency argued, the findings in this report are &quot;consistent&quot; with disparities seen among people with AIDS from all 50 states.&lt;/p&gt;
&lt;p&gt;To eliminate perinatal HIV transmission, the CDC said all HIV-infected pregnant women must: &lt;ul&gt; &lt;li&gt;Be diagnosed before they get pregnant or soon after&lt;/li&gt; &lt;li&gt;Get prenatal care&lt;/li&gt; &lt;li&gt;Follow an antiretroviral regimen during pregnancy&lt;/li&gt; &lt;li&gt;Have a cesarean delivery at 38 weeks&apos; gestation if the virus has not been suppressed&lt;/li&gt; &lt;li&gt;Get antiretroviral medication during labor and delivery&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Antiretroviral medication also should be given to the newborns within the first hours after birth and for the first six weeks of life, the CDC said.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_380"
                     title="AMA Opens Site for Physicians Looking to Help Haiti"
                     score="0.011"
                     href="http://www.medpagetoday.com/EmergencyMedicine/EmergencyMedicine/tb/18271?impressionId=1265808390146"
                     
      &lt;p&gt;The AMA has launched a &lt;a href=&quot;http://www.ama-assn.org/go/haiti-volunteer&quot; mce_href=&quot;http://www.ama-assn.org/go/haiti-volunteer&quot; target=&quot;_blank&quot; title=&quot;AMA&amp;#8200;Haiti&amp;#8200;volunteer&amp;#8200;site&quot;&gt;Web site &lt;/a&gt;to help coordinate healthcare professionals who want to volunteer for the medical relief effort in Haiti.&lt;/p&gt;
&lt;p&gt;The site hosts a registry where volunteers can enter their names and contact information, credentials, and other relevant language and disaster relief skills.&lt;/p&gt;
&lt;p&gt;The registry will be used for aid to Haiti and in future disasters that may require volunteer physician support, the AMA said in a statement.&lt;/p&gt;
&lt;p&gt;The AMA site also contains a free online training program that offers potential volunteers insight into the clinical and public healthcare skills necessary to aid in the relief effort.&lt;/p&gt;
&lt;p&gt;The page was created at a time when the number of hospitalizations and new patients has started to decline, AMA president J. James Rohack, MD, noted, but &quot;the need for continued medical assistance is still significant.&quot;&lt;/p&gt;
&lt;p&gt;&quot;I encourage physicians to consider how they can help with this effort,&quot; he declared.&lt;/p&gt;
&lt;p&gt;Some observers have criticized the large volume of doctors swarming to the disaster-stricken nation, claiming the additional burden placed on already limited food, water, and housing resources comes at a time when engineers have not yet rebuilt the necessary housing and plumbing outlets.&lt;/p&gt;
&lt;p&gt;The Web site itself cautioned would-be volunteers that Haiti is still in desperate condition. &quot;Physicians must be prepared to provide care in a physically challenging, austere, resource-constrained environment. It is imperative that those involved in the relief effort be self-sufficient and are able to work independently,&quot; the site warned.&lt;/p&gt;
&lt;p&gt;The AMA publishes the journal &lt;em&gt;Disaster Medicine and Public Health Preparedness&lt;/em&gt;, which it said would serve as a valuable resource to potential volunteers.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_468"
                     title="DSM-V Draft Promises Big Changes in Some Psychiatric Diagnoses"
                     score="0.01"
                     href="http://www.medpagetoday.com/Psychiatry/GeneralPsychiatry/tb/18399?impressionId=1265808390146"
                     
      &lt;p&gt;Substantial changes are in the offing for the &quot;psychiatrist&apos;s bible,&quot; the Diagnostic and Statistical Manual of Mental Disorders, according to a draft of the forthcoming fifth edition.&lt;/p&gt;
&lt;p&gt;The American Psychiatric Association (APA) has posted the draft of DSM-V on a special Web site, &lt;a href=&quot;http://www.psych.org/dsmv.aspx&quot; mce_href=&quot;http://www.psych.org/dsmv.aspx&quot; target=&quot;_blank&quot;&gt;www.dsm5.org&lt;/a&gt;, to obtain comments from its members, other members of the mental health community, and the public.&lt;/p&gt;
&lt;p&gt;At a telephone press briefing before the draft&apos;s release, members of the APA team leading the DSM revision highlighted several substantial innovations they are proposing: &lt;ul&gt; &lt;li&gt;Recategorizing learning disorders, including creation of a single diagnostic category for autism and other socialization disorders, and replacing the controversial term &quot;mental retardation&quot; with &quot;intellectual disability&quot;&lt;/li&gt; &lt;li&gt;Eliminating &quot;substance abuse&quot; and &quot;substance dependence&quot; as disorders, to be replaced with a single &quot;addiction and related disorders&quot; category&lt;/li&gt; &lt;li&gt;Creating a &quot;behavioral addictions&quot; category that will include addictions to gambling but not to the Internet or sex&lt;/li&gt; &lt;li&gt;Offering a new assessment tool for suicide risk&lt;/li&gt; &lt;li&gt;Including a category of &quot;risk syndromes&quot; for psychosis and cognitive impairment, intended to capture mild versions of these conditions that do not always progress to full-blown psychotic disorders or dementia, but often do&lt;/li&gt; &lt;li&gt;Adding a new disorder in children, &quot;temper dysregulation with dysphoria,&quot; for persistent negative mood with bursts of rage&lt;/li&gt; &lt;li&gt;Revising criteria for some eating disorders, including creation of a separate &quot;binge eating disorder&quot; distinct from bulimia&lt;/li&gt; &lt;li&gt;Using &quot;dimensional assessments&quot; to account for severity of symptoms, especially those that appear in multiple diagnostic categories&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The APA will accept comments through April 20. The work groups managing the revision will consider them and make further changes as needed to the draft, said David Kupfer, MD, of the University of Pittsburgh, chairman of the DSM-V task force.&lt;/p&gt;
&lt;p&gt;The draft diagnostic criteria will then undergo two years of field testing. The final DSM-V is scheduled for release in May 2013, &lt;a href=&quot;http://www.medpagetoday.com/Psychiatry/GeneralPsychiatry/17482&quot; mce_href=&quot;http://www.medpagetoday.com/Psychiatry/GeneralPsychiatry/17482&quot; target=&quot;_blank&quot;&gt;a year later than originally planned&lt;/a&gt;.&lt;/p&gt;
&lt;p&gt;&lt;strong&gt;New Categories for Dyslexia, Autism&lt;/strong&gt;&lt;/p&gt;
&lt;p&gt;In the area of neurodevelopmental disorders, DSM-V will put dyslexia and dyscalculia  --  reflecting disabilities of reading and mathematics, respectively  --  into a new category of learning disabilities.&lt;/p&gt;
&lt;p&gt;Autism, Asperger&apos;s syndrome, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified will make up the new &quot;autism and related disorders&quot; category.&lt;/p&gt;
&lt;p&gt;The head of the APA&apos;s work group on substance-related disorders, Charles O&apos;Brien, MD, PhD, of the University of Pennsylvania, told reporters on the press call that substance dependence and abuse had no basis in the research on addictions.&lt;/p&gt;
&lt;p&gt;&quot;We unanimously agreed that . . . there really isn&apos;t evidence for an intermediate stage [short of addiction] that is now known as abuse,&quot; he said. Instead, there will be substance use disorders for each of the major types of drugs that cause problems, such as alcohol.&lt;/p&gt;
&lt;p&gt;He added that the term &quot;dependence&quot; was problematic as a psychiatric diagnosis because some types of physical dependence are &quot;completely normal&quot; for some medications, such as opioid painkillers.&lt;/p&gt;
&lt;p&gt;In fact, under the draft, DSM-V will include &quot;discontinuation syndromes&quot; to allow physicians to properly assess symptoms of withdrawal from psychoactive substances, including caffeine, O&apos;Brien said.&lt;/p&gt;
&lt;p&gt;He also said his work group had considered including sex and Internet addictions as disorders, but decided there was insufficient evidence to allow development of reliable diagnostic criteria for them.&lt;/p&gt;
&lt;p&gt;Consequently, gambling addiction is slated to be the only disorder formally listed in the behavioral addictions category.&lt;/p&gt;
&lt;p&gt;But O&apos;Brien added that, under current plans, sex and Internet addictions would be included in an appendix to DSM-V, intended to encourage additional research that could lead to their inclusion in future editions.&lt;/p&gt;
&lt;p&gt;Carole Lieberman, MD, a Beverly Hills, Calif., psychiatrist who appears frequently on television, regretted the omission of Internet addiction.&lt;/p&gt;
&lt;p&gt;Contacted for comment by &lt;em&gt;MedPage Today&lt;/em&gt; and ABC News, Lieberman said in an e-mail that behavioral addictions are a worthy category. &quot;But why would it not include &apos;Internet addiction,&apos;&quot; she wrote. &quot;Could it be that the psychiatrists involved do not want to acknowledge that their own Internet usage could meet the criteria for addiction?&quot;&lt;/p&gt;
&lt;p&gt;Lieberman added that compulsive shopping was another form of behavioral addiction that deserves recognition.&lt;/p&gt;
&lt;p&gt;&lt;strong&gt;Dimensional and Risk Assessments&lt;/strong&gt;&lt;/p&gt;
&lt;p&gt;APA leaders also emphasized the two new suicide risk assessment scales planned for DSM-V, one for adolescents and one for adults.&lt;/p&gt;
&lt;p&gt;David Shaffer, MD, of Columbia University, told reporters on the press call that suicide nearly always occurs in the context of some psychiatric disorder, but not always depression.&lt;/p&gt;
&lt;p&gt;The new risk assessment tools focus on risk factors such as impulsive behavior, heavy drinking, and chronic severe pain and illness.&lt;/p&gt;
&lt;p&gt;In DSM-IV, suicidal ideation is treated as a symptom of major depression and certain other disorders.&lt;/p&gt;
&lt;p&gt;Shaffer also explained the genesis of the proposed new childhood disorder, temper dysregulation with dysphoria (TDD).&lt;/p&gt;
&lt;p&gt;&quot;About 40% to 60% of the cases [seen by child psychiatrists] will be children who are doing things that other people don&apos;t want them to do,&quot; he said. Many of these are children who are &quot;stubborn and resistant and disobedient and moody.&quot;&lt;/p&gt;
&lt;p&gt;There is currently a recognized syndrome known as oppositional defiant disorder, but some children also display severe aggression and negative moods that go beyond mere stubbornness, according to Shaffer.&lt;/p&gt;
&lt;p&gt;Such children are often tagged as having juvenile bipolar disorder, but research has shown that the label is often inappropriate, since they usually do not qualify for a bipolar disorder diagnosis when they reach adulthood, although they remain dysfunctional. More often, these children are diagnosed as depressed when they become adults.&lt;/p&gt;
&lt;p&gt;He said the addition of TDD would better describe the severity and frequency of irritable behavior while also recognizing the mood disorder that goes with it.&lt;/p&gt;
&lt;p&gt;Another innovation in DSM-V will be the extensive use of so-called dimensional assessments. Whereas DSM-IV relied heavily on present-absent symptom checklists, the new edition will include severity scales for symptoms, such as anxiety or insomnia, that may appear to larger or smaller degrees in many different mental illnesses.&lt;/p&gt;
&lt;p&gt;Darrel Regier, MD, MPH, the APA&apos;s research director, said such checklists &quot;don&apos;t always fit the reality that someone with a mental disorder experiences.&quot; Often, a symptom like insomnia isn&apos;t on the checklist for a particular disorder, he said, &quot;but they can still affect patients&apos; lives and affect the treatment planning.&quot;&lt;/p&gt;
&lt;p&gt;Incorporating quantitative dimensional assessments should allow clinicians to develop treatment and response-monitoring plans better tailored to individual patients&apos; needs, Regier said.&lt;/p&gt;
&lt;p&gt;But Lieberman foresaw problems with the dimensional assessments. &quot;I don&apos;t think [they] will add anything but confusion,&quot; she said in an e-mail. &quot;As it is now, people don&apos;t really make use of the subcategories that there are to describe severity of symptoms. Instead, I see this as a tool that insurance companies could well co-opt to try to deny benefits.&quot;&lt;/p&gt;
&lt;p&gt;&lt;strong&gt;Gender Identity Disorder Stays&lt;/strong&gt;&lt;/p&gt;
&lt;p&gt;A closely watched issue in the DSM-V revision has been whether to change or do away with gender identity disorder, now listed in DSM-IV. At this point, the draft retains the designation but with some changes, officials said.&lt;/p&gt;
&lt;p&gt;People who consider themselves &quot;transgendered&quot; have long criticized DSM-IV and previous editions for labeling them with a mental disease when their problems, they believe, are purely somatic  --  that is, they have the wrong genitalia and hormonal balance.&lt;/p&gt;
&lt;p&gt;At the APA&apos;s annual meeting last May, members of the transgender community &lt;a href=&quot;http://www.medpagetoday.com/MeetingCoverage/APA/14270&quot; mce_href=&quot;http://www.medpagetoday.com/MeetingCoverage/APA/14270&quot; target=&quot;_blank&quot;&gt;made a case&lt;/a&gt; for dropping gender identity disorder from DSM-V, but keeping some kind of &quot;gender variance&quot; diagnosis as a medical condition. Such an approach would eliminate the stigma of a psychiatric diagnosis while leaving a pathway for third-party payment for gender transition treatments, they said.&lt;/p&gt;
&lt;p&gt;William Narrow, MD, the APA&apos;s research director for DSM-V, told reporters that the draft does remove the term &quot;disorder&quot; from the condition when applied to children, renaming it as &quot;gender incongruence.&quot;&lt;/p&gt;
&lt;p&gt;For adults, gender identity disorder will remain in DSM-V but with substantially altered diagnostic criteria, Narrow said.&lt;/p&gt;
&lt;p&gt;But APA officials said the organization planned more discussions with members of the transgender community.&lt;/p&gt;
&lt;p&gt;Kupfer, the DSM-V task force chairman, stressed that further changes in many diagnostic categories are likely following the comment period and field trials.&lt;/p&gt;
&lt;p&gt;Final revisions will be submitted in 2012 for approval by the APA&apos;s two governing bodies, the Assembly and the board of trustees.&lt;/p&gt;
&lt;p&gt;&lt;em&gt;This article was developed in collaboration with ABC News. &lt;/em&gt;&lt;img src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; mce_src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; alt=&quot;&quot;&gt;&lt;/p&gt;
    </recommendedItem>
</recommendedContent>
