The Concept, the Future Confluence of Electronic Mohs Mapping (EMM) with Electronic Medical Record (EMR) and Electronic Health Record (EHR)

Author and Disclosures

Ulysses L. Labilles, DMD, MHT

In his 12th year as Mohs histopathology supervisor and member of Dr. Christine Brown’s Skin Cancer Team in Dallas Texas-Uly as everybody call he is responsible in all facets of Mohs histotechnology, as well as pulling pre, intra, and postoperative values needed for Mohs operative summaries. He is also responsible in managing “Photo EMR” needed in pre-operative planning, patient education, and intra- and post-operative references. He currently developed a modified rapid immunohistochemistry protocol for frozen sections.

Disclosure: Uly Labilles has no financial relationships with Apple, Google, or with any company who develops Android based tablets and touch screens.

INTRODUCTION

The prestigious commonality of Bill Gates, Steve Jobs, Steve Ballmer, Scott McNealy, and Eric Schmidt is not that all five of these IT industry gurus were born between 1954 and 1956, but the epitome of work ethics and dedication. I just cannot help but wonder what will be Steve Jobs’ plan for the next iPad upgrade. From patient monitoring units, to blood pressure machines and operating room displays, tablets and touch screens are being integrated into an ever-expanding list of medical devices. Before we explore its future in fully-integrated healthcare e-support systems, let me discuss the basic definition of EMR and EHR. Conceding the fact that Electronic Medical Record (EMR) and Electronic Health Record (EHR) are often used interchangeably-these terms are completely different in concept and definitions. EHRs are reliant on EMRs being in place, both are prized for its crucial role in improving patient safety, quality and efficiency of patient care and reducing healthcare delivery costs. EMRs will never reach its full potential without interoperable EHRs in place. It is important to establish clinical information transaction standards that can be easily adopted by the different EMR application architectures now available. Until we open and expand the limited environments of existing EHR, the meaningful confluence of the concept of EMM and EMR will be a challenging endeavor.

Understanding the Difference between EMR and EHR

While qualified physicians already receiving incentive payments as high as $18,000; it is important to understand the difference between EMR and EHR to reduce confusion. EMR is the source of data for EHR, the legal record created in hospitals and ambulatory environments. The EHR represents the ability to easily share medical information among patients/consumers, healthcare providers, employers, and/or payers/insurers, including the government and its agencies. Patients’ information follows the stakeholders through various modalities of care engaged. HIMSS Analytics defined EMR and EHR as follows:

Electronic Medical Record is an application environment composed of the clinical data repository, clinical decision support, controlled medical vocabulary, order entry, computerized provider order entry, pharmacy, and clinical documentation applications. This environment supports the patient’s electronic medical record across inpatient and outpatient environments, and is used by healthcare practitioners to document, monitor, and manage health care delivery within a care delivery organization (CDO). The data in the EMR is the legal record of what happened to the patient during their encounter at the CDO and is owned by the CDO.

Electronic Health Record is owned by the patient and has patient input and access that spans episodes of care across multiple CDOs within a community, region, or state. It is a subset of each care delivery organization’s EMR, presently assumed to be summaries like ASTM’s Continuity of Care Record (CCR) or HL7’s Continuity of Care Document (CCD). ASTM International (ASTM) is originally known as the American Society for Testing and Materials, while Health Level Seven (HL7) is an all-volunteer, non-profit organization involved in development of international healthcare informatics interoperability standards. In the US, EHR will ride on the proposed National Health Information Network (NHIN). The EHR can be established only if the electronic medical records of the various CDOs have evolved to a level that can create and support a robust exchange of information between stakeholders within a community or region.

Replacing the Physicians Old Clipboard

While Apple’s Windows-based competitors running in Android OS is catching up, the day is not far of where a tablet like iPad becomes a healthcare provider’s primary portal into the spectrum of their health IT system. The tablets will be replacing the old physician’s clipboard. Outpatient practices already running a Mac-based EMR, an iPad interface will be a perfect upgrade. Development of apps that will allow patients to fill out registration, medical history, and other forms on the iPad. Could the iPad become the new e-sidekick of healthcare providers? There will be challenges, but the opportunities are exciting. The next generation of iPad will integrate with MacPractice EMR to manage schedules, view patient records, and enter clinical notes, and perhaps reciprocal consultation between physicians, surgeons and doctors in other field of Medicine and Research. Apple’s Face Time Protocol will not only the new video telephony solution for telemedicine, but also could expand its capabilities to link specialties like Mohs Surgery-bridging the surgeon, pathologist and histotechnologist into one seamless body. The new iPad 2 with its built in front facing VGA camera and a 720P HD rear facing camera will give the possibility of EMR/EHR FaceTime to healthcare. Handwriting functionality and dictation are among the challenges that need to be met, as well as developing EMR/EHR integrated apps like in microscopy and diagnostic imaging that Electronic Mohs Mapping (EMM) being part of its bundle. Just think about a fully integrated system which allows you to collaborate with your colleagues when developing or trying out a new protocol. For example, clinicians could easily exchange side by side comparisons using split sampling correlations between melanoma H & E slides and slides stained with a new immunohistochemistry protocol for validation. While Steve Jobs may already have the timeline for the coming upgrade of iPad replacing the old physician’s clipboard, Android are focused to replace Windows CE and Linux in medical devices. The Android platform is built on the Linux OS by providing a full-featured embedded system framework that is easy to use without the additional cost. Android is being adopted by companies in many industries for devices that require embedded operating systems. The medical industry has taken notice of Android since it is based on Linux. Linux is already a well established system in the medical industry. Medical industry has taken notice of Android’s future into Class I and II medical devices, taking note its known risk to FDA-regulated devices.

References
1. Electronic Medical Records vs. Electronic Health Records: Yes, There Is a Difference
Dave Garets and Mike Davis
2. From Meaningful Use to Meaningful Care
William F. Bria, II, MD; Michael B. Blackman, MD, MBA; Geeta Nayyar, MD, MBA
3. Apple iPad and Electronic Medical Records-Could it replace the Physicians Clipboard?, Satish Misra, MD, 04 February 2010
4. Android + Touch Screens=Future of Medical Devices, Tech Girl, 02 March 2011
5. IQMax Releases Healthcare Dictation App IQSpeak for Android OS, EMR and EHR News, 18 February 2011

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June 4, 2011. Medical, Points to Ponder, Science, Technology. Leave a comment.

Hexter Elementary received Healthier US Nutrition Challenge Award

There were 154 Dallas ISD schools that received awards in the HealthierUS Nutrition Challenge.
Dallas ISD had the most schools awarded in a single school district in the HealthierUS School Challenge. A ceremony on Wednesday, May 25, 2011, included student performances; principals exercising; appearances by Dr. Janey Thornton, USDA deputy undersecretary for Food, Nutrition and Consumer Services and Texas Department of Agriculture commissioner Todd Staples; and Dallas ISD officials.

May 25, 2011. Tags: . Health. Leave a comment.

Sentinel Node Biopsy Not Useful for Many With Cutaneous Melanoma

Sentinel lymph node biopsy (SLNB) is variably useful for melanoma patients with localized disease and clinically negative nodes if they have tumors of intermediate thickness, but is not useful for those with thin or thick tumors, according to a new analysis of published research.

Dr. Arthur R. Rhodes of Rush University in Chicago found no survival benefit for lymphatic mapping with SLNB, with therapeutic lymph node dissection (TLND) for positive nodes.

However, SLNB is still being recommended for patients with cutaneous melanoma based on questionable, “optimistic” interpretations of secondary outcomes from the Multi-center Selective Lymphadenectomy Trial (MSLT), according to a report in a December 20 online publication of the Archives of Dermatology.

“A clinical test that accurately predicts patient outcome for localized primary invasive CM (cutaneous melanoma) would be invaluable,” Dr. Rhodes writes. “In practice, SLNB is being used worldwide for this purpose.”

To better understand the predictive value of SLNB for patients with primary, invasive cutaneous melanoma with no clinically apparent lymphatic spread, Dr. Rhodes performed a Bayesian analysis of all informative studies including at least 50 patients to test the sensitivity and specificity of SLNB result for melanoma-related death.

Two reports included patients with tumors of intermediate thickness (1 to 4 millimeters). The risk of death due to melanoma for node-positive cases ranged from 26.2% to 31.6% in these patients, and 9.7% to 15.6% for node-negative cases.

The four reports including information on patients who had tumors measuring less than 1 millimeter thick found the same risk of death with node-positive and node-negative patients, ranging from 0% to 0.6%. One report included patients with tumors at least 4 millimeters thick, and found 32.5% of node-positive cases and 30.1% of node-negative cases died.

A separate analysis of 19 series of patients with any tumor thickness found the risk of melanoma-related death was 0% to 47.8% for node-positive patients and 0% to 13.3% for node-negative cases.

There is no current evidence that the procedure, or TLND for positive nodes, will improve disease-specific or overall survival, according to Dr. Rhodes. “If SLNB is being offered to obtain prognostic information, patients need to be informed how SLNB status will be used to predict cutaneous melanoma -related mortality and guide treatment options,” he concludes.

Arch Dermatol. Posted online December 20, 2010.

Reuters Health Information © 2011

Prognostic Usefulness of Sentinel Lymph Node Biopsy for Patients Who Have Clinically Node Negative, Localized, Primary Invasive Cutaneous Melanoma
A Bayesian Analysis Using Informative Published Reports

Arthur R. Rhodes, MD, MPH
Arch Dermatol. Published online December 20, 2010. doi:10.1001/archdermatol.2010.371

Objective To assess the prognostic value of sentinel lymph node biopsy status for patients with localized, clinically node negative, primary invasive cutaneous melanoma.

Design Predictive value of positive or negative sentinel lymph node biopsy (SLNB) results for melanoma-related death, using raw numbers from informative publications.

Setting and Participants Reports comprising 50 patients with cutaneous melanoma who had undergone SLNB, based on PubMed search (January 1, 1993, through June 3, 2010).

Main Outcome Measure Melanoma-related death.

Results. For the 2 informative reports of patients with tumors of intermediate thickness (1-4 mm), risk of melanoma-related death ranged from 26.2% to 31.6% for node-positive cases and from 9.7% to 15.6% for node-negative cases. Based on 4 informative reports of patients with thin tumors (1 mm), risk of melanoma-related death ranged from 0% to 0.6% for both node-positive and node-negative cases. For the single informative report of patients with thick tumors (4 mm), risk of melanoma-related death was 32.5% for node-positive cases and 30.1% for node-negative cases. For 19 informative case series with any tumor thickness, risk of melanoma-related death ranged from 0% to 47.8% for node-positive cases and from 0% to 13.3% for node-negative cases.

January 19, 2011. Tags: , , , , , , . Health. Leave a comment.

Obama: The Time To Embrace Clean Energy Is Now

President Obama meets with BP executives Wednesday for the first time since the company’s deep-water oil well in the Gulf of Mexico blew up eight weeks ago.

A new government estimate says the runaway well is spitting out up to 60,000 barrels of oil every day. That’s two or three times as much as BP has been able to capture each day.

In his first use of the Oval Office to address the nation, Obama promised to clean up the oil-soaked area, restore the Gulf environment and compensate people whose jobs have dried up because of the spill. He also used the Gulf Coast disaster to renew his push for cleaner forms of energy.

Obama likened the oil spill to an ongoing epidemic that the country will be battling for months or years to come. But beyond treating the symptoms of oil-stained beaches and out-of-work fishermen, he also wants the country to come to grips with what he regards as the underlying disease: a longstanding dependence on fossil fuels.

“The tragedy unfolding on our coast is the most painful and powerful reminder yet that the time to embrace a clean energy future is now,” Obama said.

The House of Representatives already has passed sweeping legislation to promote clean energy and curb greenhouse gases. But a similar bill in the Senate — authored by Democrat John Kerry and Independent Joe Lieberman — has been blocked by filibuster threats, and would need support from at least one Republican to have a chance.

So far, that vote is not there. Obama acknowledged that this month in a speech at Carnegie Mellon University.

“The votes may not be there right now, but I intend to find them in the coming months. I will continue to make the case for a clean energy future wherever and whenever I can,” he said.

Environmentalists have been urging the president to make that case more aggressively, saying Americans are eager for ambitious energy and climate legislation — even if it raises the price of a gallon of gas.

Recent polls have supported that notion, including one released this week by the Pew Research Center and one from the League of Conservation Voters that said two out of three voters feel this way.

League President Gene Karpinski said the BP spill should be the “final wake-up call.”

“Band-Aids are not enough,” Karpinski added. “We need to move in an entirely new direction and begin to reduce our dependence on oil. And that’s why Congress needs to pass a comprehensive bill.”

Supporters argue that cleaner alternative sources of energy will flourish in the U.S. only if buyers and sellers of traditional fossil fuels have to pay a price for the greenhouse gases those fuels produce.

Sens. Kerry and Lieberman insist that price need not be prohibitive to be effective. On Tuesday, Lieberman touted a new EPA estimate saying his bill would cost the average family less than $150 a year.

“Is the American household willing to pay less than $1 a day so we don’t have to buy oil from foreign countries, so we can create millions of new jobs, so we can clean up our environment? I think the answer is going to be yes,” Lieberman said.

That may be the answer for Democrats and Independents. But in the League of Conservation Voters’ survey, Republican voters were more likely to oppose an energy and climate bill. And Republican lawmakers decry the proposal as a “job-killing energy tax.”

In his speech Tuesday night, Obama said the nation can’t afford not to change its energy mix. But he left the door open to supporting less ambitious energy legislation — like the bill put forward by Sen. Richard Lugar (R-IN), which promotes efficiency but does not include a carbon tax or limits on greenhouse gases.

“All of these approaches have merit and deserve a fair hearing in the months ahead,” Obama said. “But the one approach I will not accept is inaction. The one answer I will not settle for is the idea that this challenge is somehow too big and too difficult to meet.”

The president noted that Americans’ huge appetite for oil is what pushed companies like BP to drill in ever deeper, riskier waters.

The millions of barrels of oil now fouling the Gulf of Mexico would have powered the U.S. economy for less than four hours.

By SCOTT HORSLEY
http://www.wbur.org/npr/127874185

June 16, 2010. Just personal and important. Leave a comment.

FDA Seizes Tainted Chinese Honey After Sen. Schumer Raises Fuss

Just two days after Sen. Charles Schumer urged the FDA to issue an official definition for honey because he claimed Chinese exporters are skirting food standards, the agency announced the seizure of 64 drums of contaminated Chinese honey.

Hmmmm. “The FDA took this action because of the potential serious public health effects of this product,” said Michael Chappell, the FDA’s acting associate commissioner for regulatory affairs, in a press release. The honey contained chloramphenicol, a potent antibiotic that can cause anemia, and isn’t supposed to be in food.

Coincidence or not, Schumer’s got a “bee in his bonnet” over honey imports, says the Wall Street Journal.

The bulk honey that federal marshals seized was imported by Sweet Works Inc., of Monterey Bay, Calif. The company got it from — you guessed it — a Chinese company. It was then sold to Alfred L. Wolff, Inc., a raw material supplier, which stored it in a Philadelphia warehouse where federal marshals found it. The antibiotic chloramphenicol isn’t allowed

The estimated haul? $32,000 worth of the sweet stuff. FDA is still checking it out.

The agency declined to provide any details about the seizure, or even whether such actions are common. The companies involved didn’t immediately respond to inquiries.

But the buzz over how governements should handle honey imports is a long and storied one.

Schumer says that if the FDA set a honey standard, it would be easier for the government to take action against imports that don’t meet them. And, he says, Chinese importers are getting around dumping duties by shipping honey through other countries or labeling their products differently.

In fact, a Taiwanese executive was arrested on such charges in March.

“I am calling on the federal government to issue a stinging rebuke to these practices, and once again level the playing field,” he says in a June 9 letter to FDA.

But trade groups representing importers may see it more as a move to protect New York’s prominent spot in the domestic market than anything else.

This isn’t the first time food safety and trade have collided.

In fact, it’s not even the first time this week. The catfish are jumping in Arkansas over whether Sen. Blanche Lincoln (D-AR) can push the USDA forward on an inspection rule some trade groups say is disguised as a way to keep catfish imports out.

UPDATE: Shortly after we published our post, Sen. Schumer’s office issued a press release, calling this tainted honey case “only the tip of the iceberg.”

And, he’s threatening legislation to give U.S. Customs more authority to crack down on “honey laundering.”

by April Fulton
 [Copyright 2010 National Public Radio]

I found the following story on my NPR iPhone App:
http://www.npr.org/blogs/health/2010/06/11/127764536/honey-tainted-with-antibiotic-seized-in-philadelphia?sc=17&f=1128

June 14, 2010. Health. Leave a comment.

Thank You for the Yellow

 

My dear Miss Behne thank you for the yellow
For it made me a better kid a day after, just a bit mellow
School year is over; I’ll miss your flash cards, your sweet hello
My dear Miss Behne thank you for the yellow

Remember Your Sweet Ones from Uly Labilles on Vimeo.

June 4, 2010. 1, Just personal and important. Leave a comment.

How The Tax Bill Would Affect Health Care Programs

Caught up in the congressional politics swirling around a pending tax bill are proposals that affect health care for newly laid-off workers as well as Medicare and Medicaid patients.

On the table: two proposals to extend — once again —a “fix” of Medicare payments to doctors and subsidies for COBRA health insurance, the federal program that allows laid-off workers to stay on their employer’s health insurance. Without action by the end of the month, the newly unemployed would have to pay the entire cost of continuing their health insurance and doctors could see their Medicare payments slashed by 21 percent.

And the legislation would also continue the extra federal payments to help hard-pressed state Medicaid programs.

The tax “extenders” bill extends unemployment benefits, a number of popular tax cuts and funds small business loan programs.

Congress is considering several solutions on the COBRA, Medicaid and Medicare payment issues and the House is expected to act early next week.

Doc Fix

In 1997, Congress put in place the Sustainable Growth Rate formula to set Medicare’s physician payments and curb the growth in health care costs. Based on the formula, whenever physician costs grew faster than the economy, doctors’ Medicare reimbursements would be reduced. However, every time – except once in 2003 – when this scenario has played out, lawmakers have intervened to delay the unpopular cuts.

Here are some of the options being considered:

— A deal crafted by Democratic leaders and announced Thursday that would include a fix to payment rates for three years. Specifically, it would allow increases to the payment rates through 2011. In 2012 and 2013, rates would keep pace with Medicare’s growth and an extra allowance would go to primary care doctors. The Congressional Budget Office is estimating how much this fix will cost. It could be considered by the House early next week.

— A five-year, $88.5 billion plan that would give doctors scheduled pay increases. This was initially popular among some House Democrats but has less traction in the Senate and among some moderates because of the cost.

— A delay of the 21 percent cut until the end of the year.

— Or, a one-month delay in the cuts. Congress opted for such a short-term fix on April 15.

The political dilemma is that members on both sides of the aisle are increasingly skittish about adding to the deficit in a year that has already been marked by lots of spending. And the powerful American Medical Association has steadfastly opposed shorter-term fixes, instead calling for a permanent solution.

Dr. James Rohack, president of the AMA, said in a release Thursday that a three-year fix would “provide temporary stability” for seniors and their physicians, but that the AMA is disappointed that Congress again won’t permanently fix the physician payment formula. “Achieving full repeal of the payment formula is apparently not feasible at this time, and Congress could have permanently solved this problem five years ago at a cost of $49 billion, less than the price of the short-term remedy now under consideration in Congress.”

The Congressional Budget Office has estimated the cost of the permanent fix to be $276 billion through 2020.

COBRA

Congress has extended the COBRA subsidies for unemployed workers four times since February 2009.

Under COBRA, laid-off workers can stay on their employer’s health insurance, usually for as long as 18 months. But the former employee has to pay all the costs, something that is often cost-prohibitive. The COBRA benefits subsidy pays 65 percent of the insurance premium costs for laid-off workers for 15 months.

The last extension of this subsidy was in April, for a month, and pending legislation would make it available to people laid off through the end of the year, at a cost of $7.8 billion. If Congress doesn’t act, those laid off on or after June 1 would have to bear the full cost of their COBRA coverage.

Although a popular provision, the COBRA subsidy extension is caught up in the politics about government spending.

Judy Conti, federal advocacy coordinator for the National Employment Law Projects, says she sees COBRA being extended for as long as high unemployment rates continue, but she thinks it’ll be a tough fight to keep the subsidy going into next year, saying there are some lawmakers “who think that we’ve done enough and that this is it and no more,” she said. “But I don’t think that’s going to win the day.”

Medicaid Funding Boost For States

With states facing a double recession whammy of less revenue and more demand for health care services, Congress included extra money to Medicaid programs in the federal stimulus package beginning in February 2009. Before the stimulus, the federal government’s share of Medicaid costs was between 50 and 76 percent (depending on the per capita income of the state). With the stimulus, the federal match increased to between 61 and 84 percent of all Medicaid spending. The higher matching rate was originally slated to expire at the end of 2010, but the bill would extend the higher rates until June 30, 2011, at a cost of $24 billion.

The timing was crucial, according to Robin Rudowitz, the associate director for the Kaiser Commission on Medicaid and the Uninsured. “When we asked them last year, states reported that the [stimulus funding] was a total lifeline to balance their budgets. While states still did make some cuts and restrictions, they overwhelmingly reported that things would have been a lot worse” without the funds, she said. (KHN is a program of the Kaiser Family Foundation.)

The timing on the extension could be helpful to states as well. Forty-six states end their fiscal year June 30th, so if the extra federal “match” ends this year, they could face the heavier Medicaid burden just halfway through their fiscal year.

This story was produced through collaboration between NPR and Kaiser Health News (KHN), an editorially independent news service and a program of the Kaiser Family Foundation, a nonpartisan health care policy organization that isn’t affiliated with Kaiser Permanente.

by Andrew Villega
Kaiser Health News

Copyright 2010 Kaiser Health News

I found the following story on my NPR iPhone App:
http://www.npr.org/templates/story/story.php?storyId=127088854&sc=17&f=1128

May 26, 2010. Health. Leave a comment.

New Bill Delays Medicare Pay Cut Until 2014, Provides Raises in Interim

Congressional Democrats today unveiled the outline of a bill that would delay a 21% cut in Medicare reimbursement to physicians until 2014 and increase rates for the rest of 2010 as well as 2011.

Reimbursement rates would not decrease in 2012 and 2013, and they could increase even more in those years if the growth of Medicare spending on physician services is “within reasonable limits,” according to a summary of the legislation released by Sen. Max Baucus (D-MT) and Rep. Sander Levin (D-MI). Rate increases would be higher for primary and preventive care.

The bill summary states that rates would return to “current law levels” in 2014, meaning that they would be subject to Medicare’s sustainable growth rate formula for setting physician reimbursement, which triggered this year’s pay cut, set for June 1. Based on the scenario sketched out in the bill summary, when the proposed law expires in 2014, physicians could see their Medicare reimbursement drop by more than 30%, according to the Congressional Budget Office.

No exact figures for any rate increases before 2014 appeared in the bill summary. Sen. Baucus and Rep. Levin have said they will release the full text of the bill later today. Sen. Baucus chairs the Senate Finance Committee, ans Rep. Levin chairs the House Ways and Means Committee.

These provisions on Medicare reimbursement are part of a larger bill that would extend unemployment compensation benefits and a hodgepodge of tax breaks, including tax credits for COBRA health insurance premiums. It also would raise billions of dollars in revenue by closing certain tax loopholes.

By: Robert Lowes

Medscape Medical News © 2010 Medscape, LLC

May 20, 2010. Health. Leave a comment.

Addicted to Tanning

Addiction to Indoor Tanning: Relation to Anxiety, Depression, and Substance Abuse
Mosher CE, Danoff-Burg S
Arch Dermatol. 2010;146:412-417

Dermatologists like to compare recreational indoor tanning with smoking, and with good reason. Both are acquired behaviors linked to the development of life-threatening malignancies (malignant melanoma and lung cancer, respectively). Moreover, both represent risk factors that, at least superficially, appear to be completely avoidable. No one can alter his or her genetic make-up, but why not just quit smoking or tanning?

Smoking, of course, is hard to quit because it is a substance-related disorder (SRD) — an addictive behavior that is characterized by behavioral and physiologic dependency. Recently, Warthan and others have asserted that the same holds true for ultraviolet light tanning.[1,2] Now, Mosher and Danoff-Burg present compelling evidence that, for a significant subset of young adults, indoor tanning may indeed be more of an addiction than a choice.

How is an SRD defined? Mosher and Danoff-Burg used 2 well-established SRD measures: the 4-item CAGE (“Cut down, Annoyed, Guilty, Eye-opener”) questionnaire that is commonly used to screen for alcoholism, and a tanning-specific modification of the 7 SRD criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). Both screening tests were self-administered by 421 college student volunteers (67.5% women; 93% between 18 and 21 years old) recruited from a university in the northeastern United States during the fall of 2006.

Of this cross-sectional pool, 237 participants (56.3%) reported that they had tanned indoors at least once in the past, and 229 of these completed their questionnaires. Participants who reported a long-term history of indoor tanning visited tanning salons a mean of 23 times during the previous year. Not surprisingly, habitual tanners were far more likely to meet criteria for addiction to tanning than were nontanners or sporadic tanners. Intriguingly, tanning “addicts” were also more likely to report symptoms of anxiety and substance abuse.

Specifically:

Among the 229 study participants who had used indoor tanning salons, roughly one third met SRD criteria for addiction (30.6% met CAGE criteria; 39.3% met DSM-IV-TR criteria).
Students who met criteria for indoor tanning addiction reported greater symptoms of anxiety than those who did not meet the criteria.
Students who met criteria for addiction to indoor tanning or addictive tendencies also reported greater alcohol and marijuana use during the previous month than those who did not meet the criteria.
Almost half (42%) of students who met the criteria for addiction to indoor tanning reported the use of at least 2 substances (eg, alcohol, marijuana, cocaine, amphetamines, or opiates) during the previous month; in contrast, only 16% of students who reported never tanning indoors and 16.8% of students who tanned indoors without meeting criteria for addiction reported this level of substance abuse.
In this study, tobacco use and depression did not correlate with tanning addiction status.
Variables, such as sex, age, and skin phototype, did not appear to correlate with tanning addiction status.
Viewpoint
Evidence linking excessive ultraviolet exposure to both malignant melanoma and nonmelanoma skin cancer is now irrefutable.[3,4] In addition, habitual tanning causes premature skin aging and photodamage (dyspigmentation, skin laxity, and rhytids) and can exacerbate pigment disorders, such as melasma and postinflammatory hyperpigmentation. Although knowledge of these harmful effects has become more widespread over the past decade, the use of indoor tanning facilities is more popular than ever, especially among young adults.[5]

How can this alarming paradox be explained? Mosher and Danoff-Burg propose that habitual indoor tanning may, in some cases, be best characterized as an SRD. Indeed, roughly one third of the college students whom they surveyed met both CAGE and DSM-IV-TR criteria for addiction to ultraviolet tanning. This subgroup also showed a greater proclivity to substance abuse and anxiety, suggesting that habitual tanning may be a predictor of other addictive behaviors, such as alcoholism and cigarette smoking.[6]

Most internists have encountered patients with end-stage emphysema or terminal lung cancer who, in some cases, die quite literally with a cigarette in hand. In a similar manner, most dermatologists have patients who, despite having a diagnosis of malignant melanoma, still won’t give up their weekly trips to the tanning salon. How can this self-destructive behavior be explained? In a word: addiction. As Mosher and Danoff-Burg and others have noted, many people who habitually tan would have a hard time kicking the habit, even if properly motivated to do so.

Armed with this new knowledge, clinicians should view habitual indoor tanning for what it is: a risky, potentially addictive behavior that is reinforced by a wide range of cultural, social, and psychological factors. In this context, conquering this popular and growing addiction will require more than a few stern words of warning delivered at the end of a routine skin examination.
By: Graeme M. Lipper, MD
References
Warthan MM, Uchida T, Wagner RF Jr. UV tanning as a type of substance-related disorder. Arch Dermatol. 2005;141:963-966. Abstract
Poorsattar SP, Hornung RL. UV light abuse and high-risk tanning behavior among undergraduate college students. J Am Acad Dermatol. 2007;56:375-379. Abstract
Karagas MR, Stannard VA, Mott LA, Slattery MJ, Spencer SK, Weinstock MA. Use of tanning devices and risk of basal call and squamous cell cancers. J Natl Cancer Inst. 2002;94:224-226. Abstract
Gallagher RP, Spinelli JJ, Lee TK. Tanning beds, sunlamps, and risk of cutaneous malignant melanoma. Cancer Epidemiol Biomarkers Prev. 2005;14:562-566. Abstract
Robinson JK, Kim J, Rosenbaum S, Ortiz S. Indoor tanning knowledge, attitudes, and behavior among young adults from 1988-2007. Arch Dermatol. 2008;144:484-488. Abstract
Heckman CJ, Egleston BL, Wilson DB, Ingersoll SK. A preliminary investigation of the predictors of tanning dependence. Am J Health Behav. 2008;32:451-464. Abstract

May 20, 2010. Health. Leave a comment.

Pledge to stop mother-to-baby HIV spread

A campaign is being launched to try to enlist public support to ensure no more children are born with HIV by 2015.

It is the work of the Global Fund, which uses donations from governments to fight HIV, TB and malaria.

The Born HIV Free campaign comes at a critical time, with the fund seeking donations of up to $20bn over the next three years.

It recognises this will be a battle, as governments deal with the aftermath of the Greek financial crisis.
HIV can be passed from mother to child during pregnancy, labour or breast-feeding.

This type of transmission has been almost wiped out in countries such as the UK, because pregnant women who test positive for the virus that causes AIDS can be treated with drugs.

Other measures – such as giving birth by caesarian section – help stop HIV being transmitted to the baby.

But in developing countries, 430,000 children are born with HIV every year.

International effort

The Global Fund already channels more than half of international resources used to prevent mothers passing on HIV.

It believes that the goal of ending this type of HIV transmission by 2015 is achievable – if governments feel they can pledge money with the support of their electorates.

Its executive director, Professor Michel Kazatchkine, said: “We can win this battle against Aids if we get the funding we require.

“This campaign is intended to encourage people to sign up in support of the Global Fund, and to show their leaders that there is strong public support to continue and increase funding for its mission.”

Endorsement

The campaign has been overseen by the French first lady, Carla Bruni-Sarkozy, who is an ambassador for the Global Fund.

Her voice urges people to lend their support in a series of films, with music by Amy Winehouse and U2, which are being promoted on the internet.

The logo has adapted the visual imagery of the red ribbon – long associated with AIDS awareness – to symbolise a mother and child.

The US is the biggest donor to the Global Fund. The UK has pledged or contributed $1.1bn since the fund began in 2002. France is the largest European contributor.

The next round of donations will be confirmed at a crucial meeting in October, chaired by the UN secretary-general Ban Ki-moon.

Insiders at the Global Fund are waiting to hear how the new coalition government in the UK will respond to the request for commitments.

They say they have previously had “promising noises” from the Conservatives and Liberal Democrats on global health issues.

The editor of the Lancet medical journal, Dr Richard Horton, said: “An early indication that our government will support the Global Fund is really important.

“It’s something that has worked – because the money has been spent on drug treatment and bed nets.

“Another pressing issue is taking a serious look at the Department for International Development.

“There is genuine concern that a lot of money has been spent on development aid – without always getting a clear return.

“There needs to be accountability at this time of financial stringency.”

By Jane Dreaper
Health correspondent, BBC News

May 19, 2010. Uncategorized. Leave a comment.

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