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Doctors Talk Frankly About What Encourages And Impedes Early Diagnosis Of Alzheimer's
A doctor"s positive attitude to Alzheimer"s diagnosis and their trusting, personal relationships with local dementia support service providers are powerful enablers for early diagnosis of Alzheimer"s, according to new research reported at the Alzheimer"s Association 2009 International Conference on Alzheimer"s Disease (ICAD 2009) in Vienna.
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Federal Funding Should Be Available For Abortion Services, Opinion Piece Says
"The current debate over government funding for abortion in the health care plan is a reminder of how we have failed poor women," Frances Kissling writes in a Salon opinion piece. According to Kissling, the 32-year-old Hyde Amendment, which prohibits federal funding for abortion services, has played a large role in denying impoverished women access to the procedure. "Restoring those funds has not been a top priority for pro-choice advocates, who sadly concluded that because the public does not care about poor women and is actually hostile to poor women who have sex and become pregnant, it would be futile to put too much capital into reversing Hyde," Kissling writes.However, "we have an opportunity to make amends" by reversing the Hyde Amendment and restoring federal funding for abortion services, according to Kissling. "But the portents are not promising," she writes, adding that a group of "pro-life" Democrats in the House in a recent letter to House Speaker Nancy Pelosi (D-Calif.) "laid down the first major antiabortion challenge to health care reform." In addition, the Obama administration "has refused to rule out including abortion in the health care package, but President Obama is already signaling that the status quo on abortion is likely to endure," Kissling writes."The longer it takes to pass a plan, the more momentum against including coverage for abortion -- and possibly contraception -- will build," Kissling writes, adding that "there is a good chance there will be limits on government funding for abortions in the health care package, if not outright exclusion." A compromise being considered by the House Energy and Commerce Committee would not prohibit or require private insurers offering government plans from covering abortions but would prohibit the use of federal funds to pay for them. "Whether this would result in a reduction of coverage in such plans is unclear, but it is possible," she continues."The timing is critical. The need is great, and growing," Kissling writes, adding, "If abortion services are excluded from the health care reform package, the number of women who will not be able to afford abortions is bound to rise and the number of unwanted children will increase." Kissling concludes, "One hears over and over again that we all agree that the health care system is broken; the status quo is not acceptable. The status quo on coverage for abortion is especially unacceptable" (Kissling, Salon, 7/27).
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Veterans Affairs Provides Underused Monthly Pension Benefit While Medicaid Receives Increased Attention
Medicaid receives increased attention while an underused, special monthly pension benefit called Aid and Attendance can help veterans, and spouses, with assisted living.
Public Health

New Treatment Option For Patients With Chronic Hepatitis C

A new combination therapy of daily consensus interferon (CIFN) and ribavirin is effective for some people with chronic hepatitis C (HCV) who do not respond to standard therapy. The treatment works particularly well in interferon-sensitive patients who have lower fibrosis scores, according to a new study in the June issue of Hepatology, a journal published by John Wiley & Sons on behalf of the American Association for the Study of Liver Diseases (AASLD). The article is also available online at Wiley Interscience. Nearly half of all HCV patients do not respond to the standard therapy of pegylated interferon and ribavirin. They remain at risk for developing life-threatening liver disease. So far, other alternative therapies have not been particularly successful in these nonresponders. One new treatment with the potential to help patients with persistent HCV involves high doses of daily consensus interferon (CIFN) combined with ribavirin. Researchers, led by Bruce Bacon of St. Louis University, conducted a multicenter trial to examine the efficacy, tolerability and safety of this approach. The researchers studied 487 patients whose HCV had not responded to initial treatment with standard therapy. Many had characteristics that generally bode poorly for treatment response. Nearly all had HCV genotype 1; 80 percent had not responded strongly to their previous treatment; 68 percent had high baseline levels of the virus in their blood; 60 percent had advanced liver disease; and about 20 percent were African-American. These factors have all been shown to reduce rates of sustained viral response after treatment. The patients were divided into three groups. Two would receive the new therapy at different doses, and the third would receive no therapy. After 24 weeks, the control group was stratified into one of the treatment arms. Ultimately, 245 of the patients received 9 mcg of CIFN daily along with ribavirin, and 242 others took 15 mcg of CIFN daily along with ribavirin. After 24 weeks, patients with detectable HCV RNA were considered non-responders and stopped the therapy. Responders continued taking their therapy up through week 48, and were then followed-up through week 72. If HCV RNA was detected between weeks 48 and 72, the patient was classified as a relapser. Nearly 7 percent of the patients taking 9 mcg of CIBN, and 10.7 percent of those taking 15 mcg, achieved a sustained viral response. The rates were even higher among patients who had responded better to the standard therapy and among those who had lower baseline fibrosis scores. "The best response rate, 31.6 percent, was observed in noncirrhotic patients who had a partial virologic response with a greater than 2-log10 decline in HCV RNA during their previous course of peg-IFN treatment," the authors report. While adverse events were common, most patients continued their treatment in spite of them. Common side effects were neutropenia, fatigue, leucopenia, depression, nausea, muscle pain, lymphopenia and anemia. "The present study demonstrated that some patients with chronic hepatitis C who have failed to respond to treatment with peg-IFN and RBV can be successfully retreated with daily CIFN and RBV," the authors conclude. "The greatest SVR rate during retreatment in the present study was observed in F0-F3 patients who had a partial virologic response during their prior course of treatment." Article: "Retreating Chronic Hepatitis C with Daily Interferon Alfacon-1/Ribavirin after Nonresponse to Pegylated Interferon/Ribavirin: DIRECT Results." Bacon, Bruce R.; Shiffman, Mitchell; Mendes, Flavia; Ghalib, Reem; Hassanein, Tarek; Morelli, Giuseppe; Joshi, Shobha; Rothstein, Kenneth; Kwo, Paul; Gitlin, Norman. Hepatology; June 2009. Sean Wagner Wiley-Blackwell


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