Most people have at least one person in their lives they consider "difficult." This is the co-worker, in-law, neighbor or friend who's bullying, controlling, hypercritical or so anxious they can't make a decision.

Interactions with them can be challenging, frustrating, even perilous, depending on the role they play in your life. A new book, "Difficult Personalities," by Helen McGrath, a clinical psychologist and adjunct university professor in Melbourne, Australia, and writer Hazel Edwards, offers advice on managing this kind of behavior in other people -- and in yourself.

The authors share insights into what's behind various personality traits, typical behavior, positive aspects of the types and practical strategies you can use to deal with them or cope with your own tendencies.

Their approach changes depending on the behavior. With worriers and perfectionists, they suggest offering understanding, empathy and a reality check. With inflexible and over-controlling people they suggest an assertive, rational and sometimes reassuring manner. They describe pragmatic ways to confront and defuse (or avoid) negative, bossy or "superior" people. And for dealing with bullies, con artists and sociopaths, they focus on concrete steps to identify the behaviors and protect yourself.

But for the most part, McGrath and Edwards advise an approach toward other people -- and ourselves -- that is respectful and compassionate, recognizing that we all have flaws and annoying traits. To that end, they include chapters on getting on top of anxiety, practicing rational thinking, managing anger, negotiating conflict and maintaining strong romantic partnerships.

They base much of their material, they say, on the "Diagnostic and Statistical Manual of Mental Disorders," the widely used American Psychiatric Assn. reference book. They also draw on the Myers-Briggs Type Indicator psychological test to discuss ways to manage differences between introverts and extroverts, thinkers and feelers, and planners and "optionizers." 

-- Anne Colby

Photo: "Difficult Personalities," Helen McGrath and Hazel Edwards, the Experiment, $14.95

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Use of antidepressants has gone up over the years, but those with Type 2 diabetes may be taking more than the general public.

That's what researchers discovered in a longitudinal study of people with and without diabetes who were part of a Finnish study. They looked at antidepressant use among 493 people who developed Type 2 diabetes as well as a group of 2,450 people without the disease, which acted as a control. Those findings were compared with antidepressant use among 748 people who developed cancer along with 3,730 who did not. The use of antidepressants was tracked for four years before a diagnosis of diabetes or cancer as well as four years after, and for the same number of years for the control groups.

Among the diabetics and non-diabetics, antidepressant use showed the same general rise during the eight years, which researchers believe is consistent with general antidepressant use. But antidepressant usage among those with Type 2 diabetes was twice that of non-diabetics over the study period. Also, antidepressant use among diabetics spiked temporarily during the year people were diagnosed.

Antidepressant use among those with and without cancer showed the same gradual increase until cancer diagnosis, when use among cancer patients rose significantly. That use continued to decline slightly after that among cancer patients, but stayed much higher compared with those without cancer.

Researchers believe the numbers show that diabetes diagnosis may not have an enduring effect on depression risk, and that the brief spike after diagnosis could represent a real increase in depression risk.

As for why antidepressant use was higher in diabetics before diagnosis, the study authors float a few theories, including the fact that depression could increase the risk of Type 2 diabetes, since common depression symptoms are eating more--especially fat- and sugar-laden foods--and exercising less.

The study was published online this week in the journal Diabetes Care.

-- Jeannine Stein

Photo credit: Joe Raedle / Getty Images

The flu may move its victims -- to stay in bed, to resolve to get a flu shot next year, to curse the (probably young and sniffly) family member who gave it to them  -- but it also moves, in a way, itself. From west to east, to be exact.

Researchers have known that flu season traditionally occurs in winter, and from year to year they've had a pretty good idea of which strains will be dominant. But predicting the path of illness has been difficult. So researchers at Tufts University attempted to establish a pattern for flu outbreaks' timing and intensity.

They analyzed older adults' hospitalization records for the 1991 through 2004 flu seasons. (This means the new H1N1 strain was not part of the equation.) And they found that flu seasons typically peaked first in the Western states and later in Eastern states. Nevada, Utah and California led the way; Rhode Island, New Hampshire and Maine wrapped things up.

So, you may ask? It's all about prevention, the researchers say.

Or as they put it: "Understanding the geographical patterns of influenza spread and utilizing multiple parameters for predictive modeling are essential for guiding prevention efforts."

Here's the full study of flu movement, published Thursday in PLoS One. (Don't forget to check out the map.)

-- Tami Dennis

Photo: This year's seasonal flu shot will target the new H1N1 strain and two other strains.

Credit: Bloomberg

Perhaps it was the big check you wrote out yesterday. Or the scramble to get to the post office to get said check postmarked in time. Perhaps it's the endless demands of jobs and family. Maybe it's just become a way of life.

If you're stressed, then you've got a reason to have a celebratory cocktail today: April 16 is National Stress Awareness Day.

Oh, wait. National Stress Awareness Day was established in 1982 and has been sponsored yearly by the Health Resource Network, a nonprofit health organization, to encourage healthy ways of dealing with stress.

All right, forget the cocktail. Perhaps a nice walk in the mountains -- or around the parking lot -- instead? Perhaps you should slip into a meditation class between those endless meetings or errands? Or maybe just meditate briefly about the future prospect of learning to meditate. That ought to help. 

In fact, the entire month of April has been designated stress awareness month. But April 16 is a special day on our yearly stress-ometer, the more so this year because everybody's going all tea-party about paying taxes.

Guess who's got ideas on what to do on National Stress Awareness Day? La-Z Boy, maker of the eponymous recliners. They suggest you elevate your feet and get some lumbar support. The Ski Channel also has some ideas that involve elevating your entire body to a higher altitude and coming down -- really fast.

Just so we're clear on this, stress -- in particular chronic stress -- is bad for your health. It's pretty clearly linked to elevated blood pressure and incidence of stroke, it can wreak havoc with your memory and, if you deal with it poorly, can raise your risk of depression -- a new article in Nature Neuroscience recently looked at this link. And then there's the grinding and clenching of teeth. A recent article in BioMedCentral's open access publication Head and Face Medicine found that grinding and clenching of the teeth at night is largely the result of poorly managed stress.

So, be sure to put "celebrate Stress Awareness Day -- healthily" on your to-do list.

--Melissa Healy

Existing drugs used to treat depression and other mood disorders might be useful to limit brain damage following a stroke because they promote the growth of new nerve cells in the brain, according to a study in mice. The research is tantalizing because drugs that are known to spur nerve growth are already available and because there are few other options to mitigate the effects of stroke once brain damage has occurred.

Researchers at the Buck Institute for Age Research in Novato, Calif., compared stroke size and recovery in mice who were genetically altered and treated to either grow or not grow new neurons prior to stroke. The strokes in the animals that did not grow new neurons were 30% larger. The mice that did grow new neurons -- called neurogenesis -- showed improvement in motor function following the stroke.

It's not known exactly how new neurons improve stroke outcome. But the lead author of the study, Dr. David Greenberg, said in a news release: "Assuming that neurogenesis is also beneficial in humans, drugs approved by the FDA for other purposes and already shown to promote new neuron growth in rodents might be worth studying as a potential treatment for stroke in humans."

Studies still need to be conducted in humans. And, Greenberg cautions, people who have suffered strokes should not treat themselves with antidepressants or lithium without medical advice.

Further research will examine the effects of drugs that produce new nerve growth in other brain diseases, such as Parkinson's, Alzheimer's and Huntington's diseases.

The study is published online this week in the Proceedings of the National Academy of Sciences.

-- Shari Roan

Photo credit: Advanced Cell Technology Inc.

Food-borne illnesses are proving to be stubborn -- unsurprisingly so, perhaps -- but that's not to say there aren't some small bright spots in the latest report from the federal Centers for Disease Control and Prevention.

In 2009, the federal government had especially hoped to reduce incidence of four food-borne diseases -- campylobacter, listeria, salmonella and E. coli O157. Of those four, gains were made only against the E. coli strain.

Shigella wasn't on the most-wanted list, but it took a hit too. Hey, a bonus.

The data are preliminary, based on disease surveillance in 10 states (including California), but they do offer a snapshot of where we stand, at least in relation to food-borne threats.

Want some numbers from the report? Here's a taste:

In 2009, a total of 17,468 laboratory-confirmed cases of infection were identified. The number of reported infections and incidence per 100,000 population, by pathogen, were as follows: Salmonella (7,039; 15.19), Campylobacter (6,033; 13.02), Shigella (1,849; 3.99), Cryptosporidium (1,325; 2.86), STEC O157 (459; 0.99), STEC non-O157 (264; 0.57), Vibrio (160; 0.35), Listeria (158; 0.34), Yersinia (150; 0.32), and Cyclospora (31; 0.07).

For a more thorough picture, you'll need comparison numbers. You can head over to the full food-borne diseases report at the CDC site. That report, "Preliminary FoodNet Data on the Incidence of Infection with Pathogens Transmitted Commonly Through Food --- 10 States, 2009," was released Thursday in the CDC's Morbidity and Mortality Weekly Report.

Those who feel reassured by the numbers above probably weren't among the 15.19 out of 100,000 diagnosed with salmonella.

Here's general information on food-borne illnesses from the CDC, plus an L.A. Times article, The science of salmonella, that illustrates the difficulties of combating these tiny, sometimes deadly, foes. It begins:

This is salmonella's world. We're just living in it.

The bacterium appeared on the planet millions of years before humans, and scientists are certain it will outlast us too. It's practically guaranteed that salmonella will keep finding its way into the food supply despite the best efforts of producers and regulators.

-- Tami Dennis

Photo: Wash the produce thoroughly, cook the meat thoroughly -- and don't cross-contaminate during preparation. Oh, and be sure to chill the leftovers. All good advice, all from the CDC at the above link.

Credit: Associated Press

Childhood obesity campaigns such as First Lady Michelle Obama's "Let's Move" program are good, but they may not be enough to truly stem the tide of obesity, according to a perspective article published online Wednesday in the New England Journal of Medicine.

There's no doubt that school and home interventions focusing on nutrition and exercise are helpful, and more attention is being paid to improving school lunches and encouraging physical activity. But some studies show that those efforts may be too little too late, say the paper's authors, Janet Wojcicki and Dr. Melvin B. Heyman of the department of pediatrics at UC San Francisco, who make a strong case that more importance needs to be placed on pregnancy and infancy.

Too many overweight and obese children are exhibiting ill effects such as high blood pressure and early signs of heart disease by the time they're in school. And that doesn't bode well for later years. "[P]revention must start as early as possible," the authors wrote, "since school-age children already have an unacceptably high prevalence of obesity and associated medical conditions." This topic was covered in depth by Times health writer Shari Roan.

Issues that should be targeted include excessive maternal weight gain, smoking during pregnancy and truncated breast feeding. "Studies have shown," the authors wrote, "that early interventions can potentially prevent the development of obesity in school-age children, along with associated health conditions."

Wojcicki and Heyman point out that attempts are being made to address this critical period, such as stop-smoking campaigns and the Institute of Medicine's stricter guidelines for pregnancy weight gain for obese women. But they add, "The Let's Move campaign could synchronize its efforts more directly with these existing campaigns and try to ensure that the IOM recommendations are more widely known and followed by pregnant women."

-- Jeannine Stein

Photo credit: Viktor Drachev / AFP/Getty Images

Surely, improved hospital safety would lead to fewer malpractice claims, yes? Perhaps, perhaps not. We've had little evidence either way. Enter the Rand Corp.

Researchers there have offered up their analysis of the connection, based on California's experiences. They say that a county with a decrease of 10 adverse events would see 3.7 fewer malpractice claims. Similary, an increase of 10 events would suggest 3.7 more malpractice claims.

From the Rand report's conclusion:

Arguments about the merits of statutory tort intervention will surely continue in the future,
but to the extent that improved safety performance can be shown to have a demonstrable
impact on malpractice claims, that offers another focal point for policymakers in seeking to
address the malpractice crisis. Based on the results of the current study, we would suggest that that focal point may be more immediately relevant than has previously been recognized.

Here's the full report: Is Better Patient Safety Associated with Less Malpractice Activity? Evidence from California. For a shorter version, go to the summary.

-- Tami Dennis

Not too long ago, a discussion about cancer treatment was largely limited to drugs and surgery. The Wellness Community helped broaden that discussion.

It was founded in 1982 by the husband of Harriet Benjamin, who had been diagnosed with breast cancer, and it emphasized the social and emotional needs of cancer patients.

Benjamin died earlier this month in Marina del Rey. Her obituary is published in Thursday's Los Angeles Times. Harold Benjamin died in 2004.

The Wellness Community has since become the Cancer Support Community. Says Cancer Support Community President Kim Thiboldeaux in Thursday's article: "It was a brave and bold move for her years ago to decide she was going to be very public about her own cancer experience. She did not want people to face cancer alone."

What a legacy. 

-- Tami Dennis

Photos: Harold and Harriet Benjamin.

Borderline personality disorder has long been considered one of the toughest psychiatric disorders to resolve. There have been many questions about how to best treat the condition, which is marked by unstable relationships, unhappiness, mood changes, impulsive behavior and poor decision-making.

Advances in understanding and treating the condition have been made in recent years, however. And a new study offers hope that recovery, although challenging, can be long-lasting.

Many Zanarini of McLean Hospital in Massachusetts studied 290 hospitalized patients with BPD over 10 years. Half of the patients recovered from the disorder after 10 years of follow-up. Recovery was defined as at least two years without symptoms and both social and vocational functioning. Overall, 93% of patients achieved a remission of symptoms lasting at least two years and 86% for at least four years.

The research suggests that while it may be difficult to achieve recovery, once recovery has been attained it appears to last. While many treatments focus on symptoms, therapy should include work on improving relationships and functioning in the workplace, areas that vastly boost the odds of long-term recovery, the authors said.

The study is published online Thursday in The American Journal of Psychiatry.

-- Shari Roan

Photo credit: Wesley Allsbrook  /  For the Times

Back when Viagra was first marketed, some sexual health experts suggested that it might work in women as well as men, providing a pharmacological aid for women with low levels of arousal (sometimes termed "female sexual dysfunction" or "female sexual arousal disorder").

But it hasn't worked that well in women -- suggesting there's something about arousal in male versus female parts that differs physiologically. (It does help some women: A 2008 study, for example, showed women on antidepressants who had sagging libidos were helped some by the little blue pill.)

Now scientists at Pfizer -- the company that discovered Viagra's sexual effects by chance while searching for a treatment for high blood pressure and angina -- say they've taken an important step in finding such a drug.

You can read about their findings, published in the British Journal of Pharmacology, in a news release titled "Towards Treating Female Sexual Dysfunction: Research Reveals Secrets of Female Sexual Arousal."

Or if you need calming down after all this sizzly sex talk, check out the research paper "UK-414,495, a selective inhibitor of neutralendopeptidase, potentiates pelvic nerve-stimulated increases in female genital blood flow in the anaesthetized rabbit."

A rabbit. The last animal in the world needing help in the breeding department, but that's biomedical research for you.

The crux of what the scientists found seems to be this: 

A drug called UK-414,495 enhanced blood flow to the vagina and clitoris when the pelvic nerve of the rabbit was stimulated. (Yes, it appears that rabbits have clitorises.) This seems to work because the drug blocks the destruction of a key nerve chemical, VIP, that helps dilate blood vessels. So it hangs around for longer to do its job.

The scientists say that the research is still in its very early stages. But two things have them encouraged: The enhanced dilation of blood vessels didn't happen all over the body (you wouldn't want that--you want the effect to be somewhat specific) and it only happened when the pelvic nerve was stimulated.

Anyway, Pfizer says this particular drug isn't suitable for development, but the finding may pave the way for other drugs that might be more useful. One reason Viagra has only mixed results in women may be that nitric oxide, the chemical that's affected by Viagra and that is centrally involved in male erections, isn't as major a player as VIP in vaginal engorgement.

The scientists also do note that "the translation of results obtained in the rabbit to humans is currently unknown, especially when one considers that the link between blood flow and subjective arousal remains controversial." They add that there are some studies suggesting some women with arousal disorders are helped by enhanced blood flow to the genitals, however.

But -- here's another but -- in the case of the most-studied drug, Viagra, "normal sexual desire appears to be critical" for it to work.

Despite some breathless news reports that a female Viagra may be just around the corner, it seems there's a lot more research to be done before that happens.

-- Rosie Mestel

Photo: Viagra, lots of it. Will Pfizer soon have an analogous pink pill for women?

Credit: AFP/GETTY IMAGES

Deaths of women during childbirth dropped by a startling 35% from 1980 to 2008, from more than half a million yearly to 343,000, according to a new analysis reported online this week in the journal Lancet.

Or maybe not, depending on whom you listen to. The report, coming on the eve of a major New York City conference on maternal health, has provoked widesrpead criticism and confusion, as well as conflicting media reports.

The new report, by researchers from the University of Washington and the University of Queensland in Australia, is startling because most previous studies, including a United Nations report released only two years ago, have indicated that the rate has remained fairly steady at about half a million, with only modest improvements in some areas. But the new report by Dr. Christopher Murray of Washington and his colleagues suggests that the rate has been dropping by an average of about 1.4% per year since 1980. If they are correct, that is very good news because it means that countries are making a concerted effort to reduce maternal deaths.

But an analysis released about the same time by a group called Countdown to 2015 — so-named because two of the United Nations' Millennium Development Goals for 2015 include significant reductions in both maternal and child deaths before that year — says its own analysis shows that 350,000 to 500,000 women still die in childbirth each year, with the number probably at the higher end of the range.

Overlaying the dispute on numbers is a political disagreement, fueled by that most contentious of topics: money.  Countdown to 2015 and other groups say that an additional $16 billion in donor funds over the $4 billion currently received will be required by 2015 to help meet the development goals. But good news about a reduction in mortality might put a crimp in their plans. Typically, when success is being achieved in any public health area, there is less urgency to donate new funds to continue the effort. Thus, the editor of the Lancet, Dr. Richard Horton, noted in an editorial that he had been pressured by some — as yet unnamed — maternal health advocates to delay publication of Murray's report until September, after the end of the current fundraising season.

Murray and his colleagues say they are confident in their figures because they have compiled a lot more data than has been possible before, from vital registration data, censuses, surveys and autopsy studies. Using this data, they have generated a maternal mortality ratio (MMR) for each country, as well as for the world as a whole. An MMR is the number of women who die during childbirth for every 100,000 live births.  Globally, the MMR fell from 422 in 1980 to 251 in 2008, they reported. The highest MMR was 1,575 in Afghanistan, while the lowest was four in Italy. The U.S. ranked 39th worldwide, with an MMR of 17.

More than 80% of all maternal deaths were concentrated in 21 countries in 2008, while 50% were in only six countries: India, Nigeria, Pakistan, Afghanistan, Ethiopia and the Democratic Republic of the Congo. Despite Murray's observed reduction in maternal mortality, the team concluded that only 23 countries were on track to achieve their target of lowering MMR by 75% between 1990 and 2015. Among those doing the best are Egypt, China, Ecuador and Bolivia.

Among developed countries, the U.S., Canada and Denmark have been trending in the opposite direction, according to the study. The MMR in the United States has increased from 12 in 1990 to 17 in 2008, a 42% increase. Part of the increase may be due to changes in the way such deaths are reported, the authors concluded, but that does not explain why deaths here are occurring at double the rate of in Britain, triple the rate in Australia and four times the rate in Italy.

The analysis found that nearly one in five deaths in 2008, a total of 61,400, were associated with HIV infections. The high incidence of HIV in sub-Saharan Africa is a major reason why many countries there are having difficulty lowering their MMR.

Some possible solutions to the problem of maternal deaths are simple "if the will and the funds are present," said Dr. Flavia Bustreo, director of the Partnership for Maternal, Newborn & Child Health, a group of more than 300 organizations that plays a major role in Countdown to 2015.  For example, if women were to go to clinics with trained staff or midwives and proper equipment, an estimated 50% of mothers and newborns could be saved, she said. If mothers received adequate prenatal care, up to two-thirds of them could be rescued. 

Reducing stigma linked to childbirth and deaths is also important. In many parts of Southeast Asia, for example, childbirth is considered dirty and women are forced to deliver in cowsheds, where they must remain for a month. Cords are often cut with dirty tools, leading to infections. Babies with pneumonia do not get antibiotics. And families know that many mothers and babies will die, so they simply accept it and do not report it.

"Millions of babies die without people realizing it can be different," said Dr. Joy Lawn of Saving Newborn Lives/Save the Children. "This is not high tech. Up to 3 million newborns can be saved each year with simple approaches" like using clean tools, providing antibiotics to treat pneumonia and kangaroo care, where the mother acts as an incubator for her preterm infant.

For some other coverage of the subject, see the New York Times here, the Washington Post here and a Columbia Review of Journalism analysis of the story here.

— Thomas H. Maugh II

Aspirin may seem too old-fashioned to be effective against headaches as severe as migraines, but that doesn't appear to be the case.

In a review of previous studies, researchers at the Cochrane Library found that 1,000 milligrams of good old-fashioned salicylic acid works fairly well at easing migraine pain.

For 1 in 4 people, it takes away the pain completely in two hours. For 1 in 2 people, it reduces the pain to mild or better. In fact, the medicine cabinet staple works about as well as the prescription drug sumatriptan at controlling the headaches.

An anti-nausea drug, specifically metoclopramide, can ease that roiling feeling that often accompanies migraines, the researchers add.

Here's the review summary.

And here's information on sumatriptan (brand name Imitrex), metoclopramide (Reglan) and aspirin  (Bayer, Bufferin among others), all from RxList.

Plus, a good overview of migraines from MedicineNet and a summary of migraine treatment from the American Headache Society.

-- Tami Dennis

Photo illustration credit: Gary Friedman / Los Angeles Times

No doubt you know about the X Games, but you've probably never heard of the Extremity Games. Like the X Games, events include extreme sports such as motocross and skateboarding. But this extreme competition is only for disabled athletes who have lost a limb or have limb differences.

The Extremity Games started in 2006, and in addition to motocross and skateboarding, sports include wakeboarding, rock climbing, kayaking, mountain biking and martial arts. In May there's a motocross elite competition in Michigan; the main event is in June in Texas; and in September the wakeboarding elite competition takes place in Florida. The games are organized by the Athletes With Disabilities Network, which is a subsidiary of Easter Seals-Michigan.

Chris Ridgway is a motocross racer from Apple Valley who competes in both the Extremity Games as well as in adaptive events for disabled athletes in the X Games. Ridgway, who was profiled on the Outposts blog in 2009, elected to have his left leg amputated below the knee in 2002 after suffering substantial injuries while doing motocross (he's been competing since the early 1990s). Before the amputation he used a wheelchair and endured tremendous pain. Although he says he's not in this to be an inspiration to others, he is by default. "This is the hand I was dealt," he says, "and I've just got to deal with it. I'm pretty sure the other athletes feel the same way."

Of his fellow Extremity Gamers, Ridgway says: "They have the most amazing stories that would literally make you cringe, but at the same time they're not saying, 'Woe is me, I'm down in the dumps.' They work hard and they still go through a lot of pain, but they're doing what they want to do. It's the whole atmosphere around the games that I really love."

He treats the Extremity Games no differently from any other competition. For his first event in 2007 he quit his job and trained intensely for seven months so he could come away with the gold medal. And he did. He now has three golds.

"I'm not special," he says. "Anybody can do this."

Ridgway, who wears a prosthetic leg while racing, recommends that those attending the upcoming Extremity Games talk to the competitors: "It's a story about never giving up," he says. "I can't stand people in my life who are quitters, and that's why I like the athletes in the Extremity Games. They just keep trying."

-- Jeannine Stein

Photo: Chris Ridgway on his motorbike during a practice. Credit: Steve Cox

Despite the now well-known and far-reaching effects of smoking, more than one-fifth of Americans still smoke. Why?

For many, it may be hard to quit because they also have depression. According to government statistics released Tuesday, 43% of adult smokers age 20 and older have depression. Among men ages 40 to 54, a whopping 55% of those who smoke have depression. Among women ages 20 to 39 who smoke, 50% have depression.

The report, drawn from the National Health and Nutrition Examination Surveys of 2005 through 2008, also found depressed smokers are heavier smokers. Depressed people were more likely to smoke within five minutes of awakening and to smoke more than one pack of cigarettes a day. Twenty-eight percent of adult smokers with depression smoked more than a pack a day, which is almost twice the rate for adult smokers without depression.

Smokers with depression were also much less likely to have tried quitting. However, other studies have demonstrated that smokers with depression can succeed with intensive treatment. These treatments usually include therapies for help with depression and smoking cessation.

The report was published by the National Center for Health Statistics. Information on smoking cessation for people with depression can be found on the government website Smokefree.

-- Shari Roan

Photo: Kirk McCoy  /  Los Angeles Times

The heel-stick test commonly used for screening newborns for a variety of genetic disorders is not a good way to test for cytomegalovirus infections, the most common nongenetic cause of hearing loss, researchers reported Tuesday. About 20,000 to 30,000 infants in the U.S. are born with cytomegalovirus (CMV) infections acquired from their mother each year, and about 10% to 15% of them go on to develop hearing loss. Detection of the virus at birth could sharply reduce the infections, which often have no symptoms, and researchers had high hopes for the heel-stick test, which is already widely used. In it, a needle is used to prick the infant's heel, producing a drop of blood that is absorbed onto a filter paper and dried. A variety of tests can then be run on the dried blood.

The only accurate way now to identify a CMV infection is to culture a urine or saliva specimen to look for the virus. But that is cumbersome, time-consuming and relatively expensive. Researchers had hoped that it would be possible to use DNA screening techniques to look for the viral genes in the blood obtained by heel sticks.

To test this possibility a team of researchers headed by Dr. Suresh B. Boppana of the University of Alabama at Birmingham screened blood samples from the university and six other institutions. Among 29,448 babies screen with the conventional culture technique, the team reported in the Journal of the American Medical Assn., they found 91 cases of congenital CMV infections. Subsequent diagnoses by the infant's own doctors found that 92 had the virus, for a detection rate of nearly 100%. In contrast, among 11,422 infants screened with a DNA assay, they identified only 28.3% of infections. Among another 9,026 infants who were given what researchers hoped would be a more sensitive DNA assay, the team identified only 34.4% of infections.

"These results have major public health implications because they indicate that such methods, as currently performed, will not be suitable for the mass screening of newborns for congenital CMV infections," they wrote. Researchers will now have to look elsewhere for a suitable test.

-- Thomas H. Maugh II

For the health-obsessed (and considering what Americans spend on healthcare, in some ways we are indeed health-obsessed), what could be better than a leisurely perusal of one's healthcare records? Always-perusable healthcare records.

Electronic health and medical records make that possible -- and folks who use them seem to take more control of their healthcare, suggests a new survey from the California HealthCare Foundation.

Among other things, the records let patients double-check the information within and help them feel they know more about their own health.

Here's the full California HealthCare Foundation report.

Of course, as the study points out, only about 7% of American adults have used the things. But it might not be a stretch to say those numbers will rise. (Californians seem fonder of them than most Americans, the data shows.)

As for what Americans spend on healthcare, that would be about $7,681 per resident in 2008, according to the Kaiser Family Foundation. (Check out the pie chart on how that breaks down.)

-- Tami Dennis

Photo: Medical records are daunting enough; paper versions can be overwhelming. Credit: Bloomberg News

Two years ago, the U.S. Food and Drug Administration published information showing that people taking anticonvulsant medications, drugs used to treat epilepsy, have twice the risk of suicidal behavior and suicidal thoughts. A study published Tuesday in the Journal of the American Medical Assn. confirms that finding and identifies a handful of medications that appear to carry the most risk.

Researchers led by a team from Brigham and Women's Hospital in Boston, analyzed data from almost 300,000 people who had begun taking an anticonvulsant. They recorded reports of suicide, attempted suicide or violent deaths in the first 60 days of use. The patients were ages 15 or older. The study found an increased risk of suicidal acts and violent deaths for the drugs gabapentin, lamotrigine, oxcarbazepine, tiagabine and valproate when compared with a standard anticonvulsant, topiramate. For example, there were 5.6 cases of attempted or completed suicide per 1,000 person-years among gabapentin users, 10 cases per 1,000 person-years among oxcarbazepine users and 14.1 cases per 1,000 person-year among tiagabine users compared with topiramate users. The increased risk began about 14 days after the start of treatment.

No one knows why certain anticonvulsants increase the risk of suicidal behavior, however, they are known to produce mood and behavior changes. The FDA requires anticonvulsant drug products to carry a label with information about the suicide risk. Perhaps a stronger warning, such as black box warning on the medication, is warranted. Certain anticonvulsants such as gabapentin have soared in popularity in recent years, often used off-label for psychiatric disorders and various pain conditions. The drugs may be effective to treat disorders other than epilepsy, but they are not without risk.

-- Shari Roan

The Food and Drug Administration said Tuesday it is taking a long-expected step and phasing out the production and sale of asthma inhalers using chlorofluorocarbons as a propellant. The chlorofluorocarbons, commonly known as CFCs, were once widely used in a variety of applications, especially as refrigerants, because of their inertness, but they have been shown to damage the Earth's ozone layer, which protects life from the damaging effects of the sun's ultraviolet rays. Most uses of the chemicals have already been abandoned. Medical devices employing them are among the last to be affected.

Four of the seven devices using CFCs are no longer being made, but they are being banned to prevent their reintroduction. The rest will be forbidden after the end of 2013. Patients using inhalers will be able to buy alternative inhalers containing the same drugs but using different propellents — most notably hydrofluoroalkane, which is destroyed in the atmosphere before it can reach the ozone layer.

The devices that are no longer being made and whose sale will be forbidden after June 14 are:

• Tilade Inhaler, made by King Pharmaceuticals
• Alupent Inhalation Aerosol, made by Boehringer Ingelheim Pharmaceuticals
• Azmacort Inhalation Aerosol, made by Abbott Laboratories
• Intal Inhaler, made by King Pharmaceuticals

The three products whose sale will be permitted until Dec. 31, 2013, are:

• Aerobid Inhaler System, made by Forest Laboratories
• Combivent Inhalation Aerosol, made by Boehringer Ingelheim Pharmaceuticals
• Maxair Autohaler, made by Graceway Pharmaceuticals

The agency cautioned against buying any of the banned products over the Internet because they are often mislabeled or do not contain effective ingredients.

Information on inhalers that do not use CFCs can be found here.

— Thomas H. Maugh II

Taking the car keys away from an aging parent or spouse whose mental faculties are slipping is one of the most difficult decisions a loved one confronts. But sometimes, it must be done. And knowing what checklist neurologists use might help both to back up your judgment and take some of the sting out of the decision for all parties.

Fortunately, the American Academy of Neurology has just issued new practice parameters for physicians that take account of the most recent findings on cognitive impairment and driving. This is the group's first update of the document in a decade.

Among patients who have recently been diagnosed with mild dementia, 76% can still pass an on-road driving test. Clearly, some with mild dementia can continue for some time to drive safely, but not all.  

The stakes for guessing which ones should not are high. But "there is no test result or historical feature which accurately quantifies driving risk," the academy says. The neurologist's most useful tool for gauging dementia is called the mini-mental state exam, but a patient's score on that test alone is not a good predictor of an older driver's ability to drive safely.

The academy recommends that, beyond a patient's performance on the mini-mental state exam, a physician should consider the patient's past driving record, his or her level of aggressiveness and impulsiveness, and whether the patient acknowledges avoidance in his or her driving patterns -- reporting, for instance, that he stays away from driving on highways or at night. When the driver acknowledges such avoidance behavior, that's a more useful clue than when she doesn't; some patients don't respond to declining driving performance by scaling back.

In the same vein, eliciting a caregiver's view of a patient's driving safety is most useful to a physician in cases where the caregiver rates the patient's driving as marginal or unsafe. Recent research suggests that caregivers routinely overestimate the driving performance of a loved one with dementia -- a fact that loved ones should consider when they begin to have doubts. 

And taking a patient's word for it is clearly not useful. The practice guidelines took note of research finding that in a group of patients with mild Alzheimer's disease, 94% identified themselves as safe drivers, while only 41% could actually pass an on-road driving test. Another study found of drivers diagnosed with mild Alzheimer's found that all of those who had failed the on-road driving exam had rated themselves as good drivers. 

Sadly, there are no proven interventions -- classes, medications, strategies -- that can reduce driving risk for those with dementia. One study suggested that requiring those over 85 years of age to come in and apply for a license in person reduced fatal crashes among this population.

Are you facing this difficult decision? Here's a very useful article on the subject, and here's a state-by-state list of alternative transportation available to seniors and patients with disabilities.

-- Melissa Healy