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Autism study downplays genetics as primary cause
Environmental factors may be more important than previously thought in determining whether a child develops autism, says a study of twins published online in July by the Archives of General Psychiatry. The findings shake up prior assumptions that genetics were largely the culprit behind the neurodevelopmental disorder, now estimated to affect 1% of the population. The study, believed to be the largest of its kind, looked at 192 pairs of identical and fraternal twins, in which at least one child in each pair had strict autism or a milder autism spectrum disorder. Researchers drew on records from the California Dept. of Developmental Services. They found that shared environmental factors -- prenatal and early postnatal experiences common to both twins, such as parental age, low birth weight or multiple births -- accounted for 55% of strict autism and 58% of more broadly defined ASD cases. Genetic heritability accounted for 37% of autism and 38% of ASD cases. By contrast, earl [Read more]
California budget includes Medicaid doctor pay cut and patient co-pays
California lawmakers adopted an annual budget by the June deadline for the first time in five years, but they will have to amend it if judges or federal officials reject a 10% Medicaid physician pay cut in the budget, among other policy changes that require federal approval. California Gov. Jerry Brown, who signed the $88 billion fiscal 2012 budget on June 30, said the measure reduces the state's general fund spending to its lowest level as a percentage of state economic growth since 1973. "This is a huge step forward. But California's long-term stability depends on our willingness to continue to pay down debt and live within our means." California physicians opposed the Medicaid rate and access reductions in the budget, according to the California Medical Assn. These include a double-digit Medicaid pay cut in a state that already has one of the five-lowest Medicaid pay rates in the country, according to Lisa Folberg, vice president of medical and regulatory policy for the associ [Read more]
Personality disorder criteria revised in new diagnosis manual
Draft criteria for identifying and diagnosing personality disorders in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders simplifies the number of conditions and allows for a greater variety of impairment levels. The proposed recommendations follow the receipt of more than 8,000 public comments on the DSM-5 in 2010. The comments concerned all aspects of the DSM-5, not just personality disorders. Comments relevant to issues managed by the 11-member Personality and Personality Disorders Work Group led it to return narcissistic personality disorder to the list of disorder types after removing it in an earlier draft. The group also simplified and streamlined the process of assessing personality disorders. The goal of the new criteria is to maximize their utility to clinicians and benefit to patients, according to the American Psychiatric Assn. "Our proposed criteria get away from the idea that personality pathology is just a group of disorders," said [Read more]
Appeals court rules individual mandate unconstitutional
The 11th U.S. Circuit Court of Appeals has ruled that Congress exceeded its authority by requiring all Americans to purchase health insurance as part of the health system reform law. In a 2-1 decision issued Aug. 12, the federal appeals court said the law's individual mandate cannot be sustained "as a valid exercise of Congress' power to regulate activities that substantially affect interstate commerce." The mandate requires individuals to obtain health coverage starting in 2014 or pay a penalty. "This economic mandate represents a wholly novel and potentially unbounded assertion of congressional authority: the ability to compel Americans to purchase an expensive health insurance product they have elected not to buy, and to make them re-purchase that insurance product every month for their entire lives," the appellate panel said. The case stems from a lawsuit filed by Florida and more than 24 other states challenging the Patient Protection and Affordable Care Act. A lower c [Read more]
New COPD guidelines aim to manage patients better
New guidelines for chronic obstructive pulmonary disease recommend that physicians use spirometry to diagnose airflow obstruction in patients with respiratory symptoms such as wheezing, shortness of breath and chronic cough. The screen, however, should not be performed in asymptomatic people, because it could lead to unnecessary testing and increased health care costs, among other things. Doctors also are urged to be alert for respiratory symptoms in patients who smoke, because cigarette smoking is the leading cause of COPD, according to the National Heart, Lung and Blood Institute. They should talk to such patients about the harms of smoking and help them quit the habit, said lead guidelines author Amir Qaseem, MD, PhD. Long-term exposure to other lung irritants, such as air pollution, chemical fumes and dust, also might contribute to developing the disease, the institute said. The recommendations, published in the Aug. 2 issue of Annals of Internal Medicine, were developed b [Read more]
Illinois law prohibits sex offenders from practicing medicine
Physicians and other health care professionals convicted of a sex crime, forcible felony or patient battery will be prohibited from practicing in Illinois under a new state law. Gov. Pat Quinn signed House Bill 1271 into law July 21. It mandates that the licenses of physicians, dentists, nurses, optometrists, physical therapists and other health professionals convicted of such crimes be immediately and permanently revoked without a hearing by the Illinois Department of Professional Regulation. Those with convictions in other states who apply for Illinois medical licenses will be denied. "We must stand up strong against the violence and crime that destroys communities," Quinn said. "Whether they are at the doctor's office or in the streets of their own neighborhood, families and citizens should feel safe and protected." The Illinois State Medical Society applauded the law, which it supported in the Legislature, said society President Wayne V. Polek, MD, an anesthesiologist f [Read more]
CT scans rise fourfold in EDs, but hospitalizations fall by half
Computed tomography use in U.S. emergency departments more than quadrupled between 1996 and 2007, but newly published data from more than 350,000 patient visits show that hospital admissions after a scan in the ED fell by more than half. In light of concerns about potential cumulative radiation dose due to the skyrocketing use of medical imaging, the information sheds light on how CT scans may benefit patients, said Keith E. Kocher, MD, MPH, lead author of the study published online Aug. 12 in Annals of Emergency Medicine. "There are a lot of questions to ask about the exploding use of CT scans in the ED, and one of the things you want to know is whether this is changing patient outcomes," said Dr. Kocher, clinical instructor of emergency medicine at the University of Michigan Medical School. "It appears there's an association between the rate of CT scans going up and physicians being more likely to discharge patients home than [there] used to be." So, for example, a patient w [Read more]
Diabetes app found helpful in managing condition
A randomized controlled trial in the U.S. of a mobile app's effectiveness at improving health outcomes found that patients who used a mobile health application to help manage their diabetes had better outcomes than those using traditional means. The mobile app studied in the trial was WellDoc's DiabetesManager, an FDA-cleared application that collects data, analyzes it and provides real-time patient coaching. The application also allows physicians to create their own rules about what data are sent to them to help deliver personalized feedback and care plans. The study, conducted by the University of Maryland School of Medicine and released online before its scheduled publication in the September issue of Diabetes Care, found a mean decline in A1C levels of 1.9% among those who used the mobile tool over a year, compared with 0.7% among those receiving traditional care. The study was funded by WellDoc, CareFirst Blue Cross/Blue Shield of Maryland, Sprint, LifeScan and the Universit [Read more]
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