Saturday, August 31, 2013
Sunday, August 18, 2013
Wednesday, July 31, 2013
Fatigue in M.S.
by DR. KURT WOELLER on DECEMBER 5, 2012
Fatigue as defined by Webster’s medical dictionary is as follows:
- weariness or exhaustion from labor, exertion, or stress, and the temporary loss of power to respond induced in a sensory receptor or motor end organ by continued stimulation. Essentially, fatigue is the lack/loss of energy needed to maintain normal function – whether it is temporary or chronic.
According to estimates from the Centers for Disease Control approximately 25,000 million Americans suffer from severe fatigue (lasting longer than one month). We all experience fatigue from time to time, but the devastating problem of persistent fatigue is the inability to carry on normal daily activities essential for health, family and livelihood.
Fatigue is a significant problem in Multiple Sclerosis (MS).
What are the reasons for fatigue in MS?
Is fatigue in MS different than someone with classic Chronic Fatigue Syndrome or a person with another disease condition?
What can be done to help with fatigue in MS?
The list of medical problems that can lead to fatigue is quite lengthy. When a patient presents to a physician with complaint of fatigue the doctor will look for clinical signs of recent illness such as a virus. They may ask questions about sleep habits, diet, issues related to potential depression, unexpected loss of weight, and other associated complaints, such as weakness, headaches, etc. The doctor will usually perform some blood testing for thyroid function (a good reason everyone with MS should have their thyroid assessed via Thyroid Stimulating Hormone, Free T3 and Free T4 levels), anemia (either iron and/or vitamin B12 and folate), metabolic panel looking at electrolytes such as sodium, potassium, and chloride, blood sugar (to rule out hypoglycemia or diabetes), and a complete blood count (to evaluate immune function).
However, in MS a person’s fatigue is often not caused by anemia or blood sugar problems (although it is important to check).
The fatigue manifests at a much deeper level, in part from the cellular machinery called the mitochondria, as well as the associated immune dysfunction that defines the disease.
Mitochondria are our cells energy factories. They produce a tremendous amount of energy currency needed by the body, i.e. brain, heart, muscles to function properly.
Mitochondria receive nutrients from our diet, as well as oxygen from the air we breathe to burn fuel (proteins and fats) for energy production.
Deficits in certain nutrients like CoQ10 can leave the mitochondria vulnerable to malfunction.
Certain nutrients have been shown to help some people with fatigue such as L-Carnitine (helps to transport fat into the cell as a fuel source – 500mg to 1000mg daily), CoQ10 (supports the inner workings of the mitochondria – 200mg to 300mg daily), NADH (necessary for mitochondria activity – 5mg to 10mg daily), and Ribose (needed for energy production – 5g to 10 g daily).
Another possible link for fatigue in MS has to do with a deficiency of cyclic AMP (cAMP). cAMP is a cellular messenger responsible for a variety of functions such as stimulating myelin production (protective coating around nerve cells that is damaged in MS) and helping to maintain the blood brain barrier (damaged in MS which can lead to brain inflammation).
One brain structure responsible for cAMP production is the Pineal Gland. The pineal gland is best known for its role in sleep regulation through the production of melatonin. The pineal receives input from a chemical called Histamine 2 which has been found to be deficient in MS. Without adequate H2 people suffer many of the common problems seen in MS including fatigue, heat intolerance, digestive problems, symptoms of allergy, hormone imbalances, i.e. thyroid, poor sleep.
A therapy called Prokarin has shown benefit for many individuals with MS. Prokarin positively influences the histamine 2 system in the body with improvements in symptoms such as fatigue and weakness.
There is much to discuss with respects to these important biochemical systems and how they related to MS. I will discuss Prokarin therapy and other related topics seen in MS in future writings.
Dr. Kurt N. Woeller About the author: Dr. Kurt N. Woeller, D.O. is the medical director for Sunrise Complementary Medical Center in California, as well as two online patient-physician access websites – www.AskTheDoctor-MS.com and www.AutismActionPlan.com. He has been a complementary and integrative medical specialist since 1998 helping individuals with chronic illness including Multiple Sclerosis, Autism, Chronic Fatigue, Autoimmune Disorders, etc. who are interested in integrative (traditional and natural medicine) medical options for their condition. Dr. Woeller is available for Q&A’s regarding natural and complementary medicine options for Multiple Sclerosis at AskTheDoctor-MS. You can also learn more about Dr. Woeller’s consultation services, books, websites, etc. at Dr.Woeller.com.
Source: http://msrelief.com/2012/12/05/multiple-sclerosis-and-fatigue-why-are-you-so-tired/
All health and health-related information contained within this website are intended to be general in nature and does not reflect any and/or all treatment options. The web site is an educational tool and should not be used as a substitute for a visit with a health care professional.
Monday, July 29, 2013
Wednesday, July 17, 2013
The Crack-Up Book
by
Charles Barber
The Crack-Up Book
Posted: 06/26/2013 9:50 am
"In a real dark night of the soul, it is always three o'clock in the morning, day after day."
That is how F. Scott Fitzgerald described his mental state in a series of essays called
The Crack-Up, published in 1936, a few years before he died.
The Crack-Up was Fitzgerald's description of his own experience with depression and alcoholism, and obliquely, his wife Zelda's bipolar disorder.
Yet nowhere in the essays are such psychiatric terms used. Instead, Fitzgerald uses metaphor and poetry. He writes that he "cracked like an old plate," and lived in a state of emotional bankruptcy in a world of "dangerous mist" and "villainous feeling." He sums up the last, lost decade of his life: there had been "too much anger and too many tears."
Thankfully Fitzgerald was writing before the publication of the American Psychiatric Association's diagnostic manuals, the fifth edition of which, the DSM-5, was recently published. Had the DSMs existed, even a writer of Fitzgerald's stature would have been tempted to draw from symptom lists to describe his inner torment in The Crack-Up.
The DSMs have become victims of their own success. To be sure, the DSM-3, published in 1980, was a necessary step forward for the psychiatric world. Earlier manuals were steeped in unclear Freudianisms with little consistency in the language of even basic psychiatric diagnoses. Doctors, and perhaps more importantly, insurance companies, had no way to talk to one another. DSM-3 became quite unexpectedly a runaway success, a best seller. (The last version made $100 million for the APA.) But each successive edition seems to have gone haywire, adding over time, hundreds of new diagnoses. Which in turn has led to mass over-diagnosing and over-medicating.
A central problem is that the DSM's diagnoses are categorical, rather than dimensional. That is, to qualify for one of the 400 or so diagnoses in today's manual, one has to meet sharply drawn criteria. The DSMs have set up diagnosis as a light switch that is either on or off. But psychiatric conditions are not absolute and differ wildly in intensity from person to person. A dimensional perspective -- like that of a dimmer switch, as psychologist Simone Hoermann has put it -- more accurately reflects the realities of psychiatric suffering.
The result is a mass confusion between severe and persistent mental illness -- the truly mentally ill -- and the worried well. Millions of Americans are mistakenly walking around thinking they have a mental illness. One in ten of us in on antidepressants. Since the mass impact of the DSMs, psychiatry has been all off or on (mainly on), with no dimmers.
There are two ways out of this mess. The first is to ignore the DSM-5 entirely and wait until biological psychiatry can be used as a basis for a truly scientific diagnostic system. Thomas Insel, director of the National Institute of Mental Health, did as much recently when he said that NIMH would no longer use the DSM to guide research, favoring instead new categories based on neural circuits and cognitive functioning.
The second approach is to actually listen to patients as they tell their stories and describe what they are feeling. As William Osler, Canadian physician and a pioneer of modern medicine, said a century ago, "Listen to your patient. He is telling you the diagnosis." Besides, listening is good treatment. Research shows unequivocally that the more patients feel understood, the better their satisfaction with treatment. The better their satisfaction with care, the better their compliance and clinical outcomes.
I tell my students, if you want to learn about depression, don't read the DSM. Read The Crack-Up. If you want to understand grief, read Joan Didion's The Year of Magical Thinking. If you want to know about Post-Traumatic Stress Disorder, read Wilfred Owen's poetry about World War I. This is how Owen described shell-shocked soldiers (he was one himself) in "Mental Cases":
These are men whose minds the Dead have ravished
... their eyeballs shrink tormented
Back into their brains, because on their sense
Sunlight becomes a bloodsmear; night becomes blood-black ...
Until the biology catches up, we would do well to heed the lessons of the literary and, yes, psychiatric experts -- Fitzgerald and Owen: no categories, all dimension.
Source: http://www.huffingtonpost.com/charles-barber/the-crackup-book_b_3497782.html?utm_hp_ref=books&ir=Books
Charles Barber
The Crack-Up Book
Posted: 06/26/2013 9:50 am
"In a real dark night of the soul, it is always three o'clock in the morning, day after day."
That is how F. Scott Fitzgerald described his mental state in a series of essays called
The Crack-Up, published in 1936, a few years before he died.
The Crack-Up was Fitzgerald's description of his own experience with depression and alcoholism, and obliquely, his wife Zelda's bipolar disorder.
Yet nowhere in the essays are such psychiatric terms used. Instead, Fitzgerald uses metaphor and poetry. He writes that he "cracked like an old plate," and lived in a state of emotional bankruptcy in a world of "dangerous mist" and "villainous feeling." He sums up the last, lost decade of his life: there had been "too much anger and too many tears."
Thankfully Fitzgerald was writing before the publication of the American Psychiatric Association's diagnostic manuals, the fifth edition of which, the DSM-5, was recently published. Had the DSMs existed, even a writer of Fitzgerald's stature would have been tempted to draw from symptom lists to describe his inner torment in The Crack-Up.
The DSMs have become victims of their own success. To be sure, the DSM-3, published in 1980, was a necessary step forward for the psychiatric world. Earlier manuals were steeped in unclear Freudianisms with little consistency in the language of even basic psychiatric diagnoses. Doctors, and perhaps more importantly, insurance companies, had no way to talk to one another. DSM-3 became quite unexpectedly a runaway success, a best seller. (The last version made $100 million for the APA.) But each successive edition seems to have gone haywire, adding over time, hundreds of new diagnoses. Which in turn has led to mass over-diagnosing and over-medicating.
A central problem is that the DSM's diagnoses are categorical, rather than dimensional. That is, to qualify for one of the 400 or so diagnoses in today's manual, one has to meet sharply drawn criteria. The DSMs have set up diagnosis as a light switch that is either on or off. But psychiatric conditions are not absolute and differ wildly in intensity from person to person. A dimensional perspective -- like that of a dimmer switch, as psychologist Simone Hoermann has put it -- more accurately reflects the realities of psychiatric suffering.
The result is a mass confusion between severe and persistent mental illness -- the truly mentally ill -- and the worried well. Millions of Americans are mistakenly walking around thinking they have a mental illness. One in ten of us in on antidepressants. Since the mass impact of the DSMs, psychiatry has been all off or on (mainly on), with no dimmers.
There are two ways out of this mess. The first is to ignore the DSM-5 entirely and wait until biological psychiatry can be used as a basis for a truly scientific diagnostic system. Thomas Insel, director of the National Institute of Mental Health, did as much recently when he said that NIMH would no longer use the DSM to guide research, favoring instead new categories based on neural circuits and cognitive functioning.
The second approach is to actually listen to patients as they tell their stories and describe what they are feeling. As William Osler, Canadian physician and a pioneer of modern medicine, said a century ago, "Listen to your patient. He is telling you the diagnosis." Besides, listening is good treatment. Research shows unequivocally that the more patients feel understood, the better their satisfaction with treatment. The better their satisfaction with care, the better their compliance and clinical outcomes.
I tell my students, if you want to learn about depression, don't read the DSM. Read The Crack-Up. If you want to understand grief, read Joan Didion's The Year of Magical Thinking. If you want to know about Post-Traumatic Stress Disorder, read Wilfred Owen's poetry about World War I. This is how Owen described shell-shocked soldiers (he was one himself) in "Mental Cases":
These are men whose minds the Dead have ravished
... their eyeballs shrink tormented
Back into their brains, because on their sense
Sunlight becomes a bloodsmear; night becomes blood-black ...
Until the biology catches up, we would do well to heed the lessons of the literary and, yes, psychiatric experts -- Fitzgerald and Owen: no categories, all dimension.
Source: http://www.huffingtonpost.com/charles-barber/the-crackup-book_b_3497782.html?utm_hp_ref=books&ir=Books
Stem-Cell Transplants Erase HIV In Two Men
Stem-Cell Transplants Erase HIV In Two Men
Two cancer patients in Boston no longer show any evidence of HIV infection, researchers announce.
By Rose Pastore
Posted 07.03.2013
Atomic Model of an HIV Capsid Courtesy of TCBG-UIUC
Two men with HIV seem to have been cleared of the virus after receiving stem-cell transplants to treat their lymphoma, scientists announced Wednesday at an International AIDS Society conference in Kuala Lumpur. One of the men has now been off of antiretroviral therapy for 15 weeks; the other stopped taking HIV-suppressing drugs seven weeks ago.
Doctors have been unable to detect HIV infection in the two men since they received the stem-cell therapy, though it is too early to be certain that the virus has completely disappeared from their bodies, according to Timothy Henrich, a physician and researcher at Harvard Medical School and Brigham and Women's Hospital in Boston.
The cases of these two men differ from that of Timothy Ray Brown, the first person to be cured of HIV, in a significant way: The so-called Berlin patient received a bone-marrow transplant to treat leukemia in 2007, using stem cells from a donor with a rare genetic mutation that makes people resistant to HIV, Reuters reports. The stem cells transplanted into the two Boston patients did not have that genetic mutation.
These patients, one of whom was infected as an infant and the other during the early years of the AIDS epidemic, are also unlike the baby girl who was recently cured of HIV. The infant in Mississippi was treated with antiretroviral therapy hours after her birth, and her cure is considered a "functional cure" because, while the virus is no longer replicating in her body, some tests revealed...
Atomic Model of an HIV Capsid Courtesy of TCBG-UIUC
Two men with HIV seem to have been cleared of the virus after receiving stem-cell transplants to treat their lymphoma, scientists announced Wednesday at an International AIDS Society conference in Kuala Lumpur. One of the men has now been off of antiretroviral therapy for 15 weeks; the other stopped taking HIV-suppressing drugs seven weeks ago.
Doctors have been unable to detect HIV infection in the two men since they received the stem-cell therapy, though it is too early to be certain that the virus has completely disappeared from their bodies, according to Timothy Henrich, a physician and researcher at Harvard Medical School and Brigham and Women's Hospital in Boston.
The cases of these two men differ from that of Timothy Ray Brown, the first person to be cured of HIV, in a significant way: The so-called Berlin patient received a bone-marrow transplant to treat leukemia in 2007, using stem cells from a donor with a rare genetic mutation that makes people resistant to HIV, Reuters reports. The stem cells transplanted into the two Boston patients did not have that genetic mutation.
These patients, one of whom was infected as an infant and the other during the early years of the AIDS epidemic, are also unlike the baby girl who was recently cured of HIV. The infant in Mississippi was treated with antiretroviral therapy hours after her birth, and her cure is considered a "functional cure" because, while the virus is no longer replicating in her body, some tests revealed...
Sunday, July 14, 2013
Cancer - The Forbidden Cures
Massimo Mazzucco (born 20 July 1954 in Turin) is an Italian filmmaker who is known for producing documentary films such as The New American Century and Cancer -The Forbidden Cures.
Mazzucco is also the editor of luogocomune.net, an Italian news site known especially for discussing conspiracy theories regarding the September 11 WTC attacks.
http://en.wikipedia.org/wiki/Massimo_Mazzucco
Link: http://youtu.be/gWLrfNJICeM
Thursday, July 11, 2013
Saturday, June 29, 2013
Alcohol Addiction Relapse
Alcohol Addiction Relapse Might Be Thwarted By Turning Off Brain Trigger
By Jennifer O'Brien on June 23, 2013
Researchers at the Ernest Gallo Clinic and Research Center at UC San Francisco have been able to identify and deactivate a brain pathway linked to memories that cause alcohol cravings in rats, a finding that may one day lead to a treatment option for people who suffer from alcohol abuse disorders and other addictions.
.
In the study, researchers were able to prevent the addicted animals from seeking alcohol and drinking it, the equivalent of relapse.
“One of the main causes of relapse is craving, triggered by the memory by certain cues – like going into a bar, or the smell or taste of alcohol,” said lead author Segev Barak, PhD, at the time a postdoctoral fellow in the lab of co-senior author Dorit Ron, PhD, a Gallo Center investigator and UCSF professor of neurology.
“We learned that when rats were exposed to the smell or taste of alcohol, there was a small window of opportunity to target the area of the brain that reconsolidates the memory of the craving for alcohol and to weaken or even erase the memory, and thus the craving”he said.
The study, also supervised by co-senior author PatriciH. Janak, PhD, a Gallo Center investigator and UCSF professor of neurology, was published online on June 23 in Nature Neuroscience.
Neural Mechanism That Triggers Alcohol Memorya
In the first phase of the study, rats had the choice to freely drink water or alcohol over the course of seven weeks, and during this time developed a high preference for alcohol.
In the next phase, they had the opportunity to access alcohol for one hour a day, which they learned to do by pressing a lever. They were then put through a 10-day period of abstinence from alcohol.
Following this period, the animals were exposed for five minutes to just the smell and taste of alcohol, which cued them to remember how much they liked drinking it. The researchers then scanned the animals’ brains, and identified the neural mechanism responsible for the reactivation of the memory of the alcohol – a molecular pathway mediated by an enzyme known as mammalian target of rapamycin complex 1 (mTORC1).
They found that just a small drop of alcohol presented to the rats turned on the mTORC1 pathway specifically in a select region of the amygdala, a structure linked to emotional reactions and withdrawal from alcohol, and cortical regions involved in memory processing.
They further showed that once mTORC1 was activated, the alcohol-memory stabilized (reconsolidated) and the rats relapsed on the following days, meaning in this case, that they started again to push the lever to dispense more alcohol.
“The smell and taste of alcohol were such strong cues that we could target the memory specifically without impacting other memories, such as a craving for sugar,” said Barak, who added that the
In the first phase of the study, rats had the choice to freely drink water or alcohol over the course of seven weeks, and during this time developed a high preference for alcohol.
In the next phase, they had the opportunity to access alcohol for one hour a day, which they learned to do by pressing a lever. They were then put through a 10-day period of abstinence from alcohol.
Following this period, the animals were exposed for five minutes to just the smell and taste of alcohol, which cued them to remember how much they liked drinking it. The researchers then scanned the animals’ brains, and identified the neural mechanism responsible for the reactivation of the memory of the alcohol – a molecular pathway mediated by an enzyme known as mammalian target of rapamycin complex 1 (mTORC1).
They found that just a small drop of alcohol presented to the rats turned on the mTORC1 pathway specifically in a select region of the amygdala, a structure linked to emotional reactions and withdrawal from alcohol, and cortical regions involved in memory processing.
They further showed that once mTORC1 was activated, the alcohol-memory stabilized (reconsolidated) and the rats relapsed on the following days, meaning in this case, that they started again to push the lever to dispense more alcohol.
“The smell and taste of alcohol were such strong cues that we could target the memory specifically without impacting other memories, such as a craving for sugar,” said Barak, who added that the
Ron research group has been doing brain studies for many years and has never seen such a robust and specific activation in the brain.
Drug that Erases the Memory of Alcohol
In the next part of the study, the researchers set out to see if they could prevent the reconsolidation of the memory of alcohol by inhibiting mTORC1, thus preventing relapse.
When mTORC1 was inactivated using a drug called rapamycin, administered immediately after the exposure to the cue (smell, taste), there was no relapse to alcohol-seeking the next day.
Strikingly, drinking remained suppressed for up to 14 days, the end point of the study.
Strikingly, drinking remained suppressed for up to 14 days, the end point of the study.
These results suggest that rapamycin erased the memory of alcohol for a long period, said Ron.
The authors said the study is an important first step, but that more research is needed to determine how mTORC1 contributes to alcohol memory reconsolidation and whether turning off mTORC1 with rapamycin would prevent relapse for more than two weeks.
The authors also said it would be interesting to test if rapamycin, an FDA-approved drug currently used to prevent organ rejection after transplantation, or other mTORC1 inhibitors that are currently being developed in pharmaceutical companies, would prevent relapse in human alcoholics.
“One of the main problems in alcohol abuse disorders is relapse, and current treatment options are very limited.” Barak said.
The authors said the study is an important first step, but that more research is needed to determine how mTORC1 contributes to alcohol memory reconsolidation and whether turning off mTORC1 with rapamycin would prevent relapse for more than two weeks.
The authors also said it would be interesting to test if rapamycin, an FDA-approved drug currently used to prevent organ rejection after transplantation, or other mTORC1 inhibitors that are currently being developed in pharmaceutical companies, would prevent relapse in human alcoholics.
“One of the main problems in alcohol abuse disorders is relapse, and current treatment options are very limited.” Barak said.
“Even after detoxification and a period of rehabilitation, 70 to 80 percent of patients will relapse in the first several years. It is really thrilling that we were able to completely erase the memory of alcohol and prevent relapse in these animals. This could be a revolution in treatment approaches for addiction, in terms of erasing unwanted memories and thereby manipulating the brain triggers that are so problematic for people with addictions.”
The other co-authors of the paper are Feng Liu, PhD, Sami Ben Hamida, PhD, Quinn V. Yowell, BS, Jeremie Neasta, PhD, and Viktor Kharazia, PhD, all of the Gallo Center and UCSF Department of Neurology.
The study was supported by funds from the National Institute on Alcohol Abuse and Alcoholism and funds from the State of California for Medical Research on Alcohol and Substance Abuse administered through UCSF.
The UCSF-affiliated Ernest Gallo Clinic and Research Center is one of the world’s preeminent academic centers for the study of the biological basis of alcohol and substance use disorders. Gallo Center discoveries of potential molecular targets for the development of therapeutic medications are extended through preclinical and proof-of-concept clinical studies.
The other co-authors of the paper are Feng Liu, PhD, Sami Ben Hamida, PhD, Quinn V. Yowell, BS, Jeremie Neasta, PhD, and Viktor Kharazia, PhD, all of the Gallo Center and UCSF Department of Neurology.
The study was supported by funds from the National Institute on Alcohol Abuse and Alcoholism and funds from the State of California for Medical Research on Alcohol and Substance Abuse administered through UCSF.
The UCSF-affiliated Ernest Gallo Clinic and Research Center is one of the world’s preeminent academic centers for the study of the biological basis of alcohol and substance use disorders. Gallo Center discoveries of potential molecular targets for the development of therapeutic medications are extended through preclinical and proof-of-concept clinical studies.
Source: http://www.ucsf.edu/news/2013/06/107001/addiction-relapse-might-be-thwarted-turning-brain-trigger
WHO's pain ladder for adults
WHO's pain ladder for adults
WHO has developed a three-step "ladder" for cancer pain relief in adults.
If pain occurs, there should be prompt oral administration of drugs in the following order: nonopioids (aspirin and paracetamol); then, as necessary, mild opioids (codeine); then strong opioids such as morphine, until the patient is free of pain. To calm fears and anxiety, additional drugs – “adjuvants” – should be used. To maintain freedom from pain, drugs should be given “by the clock”, that is every 3-6 hours, rather than “on demand” This three-step approach of administering the right drug in the right dose at the right time is inexpensive and 80-90% effective. Surgical intervention on appropriate nerves may provide further pain relief if drugs are not wholly effective. In the case of cancer pain in children, WHO recommends a two step ladder. For further information see WHO Guidelines on the pharmacological treatment of persisting pain in children with medical illnesses at:
WHO guidelines on persisting pain in children
Source:
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One in three absences at work due to anxiety and stress
One in three absences at work due to anxiety and stress, official Government survey finds
Anxiety and stress are the most common reasons to be off work because of illness, accounting for more than a third of national absences, an official study has found.
Anxiety and stress are the most common reasons to be off work because of illness Photo: Alamy
By Christopher Hope, Senior Political Correspondent
10:00PM BST 26 Jun 2013
A major study of tens of thousands of individual GPs' sick notes found that 35 per cent of those surveyed were given for “mild to moderate mental health disorders”, such as depression, anxiety and stress.
The fit note replaced the sick note in April 2010 and was supposed to allow employees back more quickly by suggesting things they could do at work.
The fit note specifically allows doctors to state what tasks a patient can do at work rather than simply declare them unfit to work. The scheme was meant to help the Government tackle the annual £15billion sickness absence bill, saving £240million over the 10 years.
The notes are normally required by employers to provide evidence that they are sick on the seventh day of an employee's illness.
However employers have repeatedly said they were dissatisfied, saying the scheme has made little or no difference in helping employees return to work more quickly.
The unprecedented Government study examined 58,700 individual fit notes issued to 25,000 patients between October 2011 and January 2013.
It found that there is “some evidence that mild-to-moderate mental health disorders are a growing cause of sickness absence”.
It added that “the highest rates of fit notes being issued for mild-to-moderate mental health disorders were found in practices in the most socially deprived areas”.
The study also laid bare “significant variation” between doctors in the rate at which the notes were issued.
In one GP practice 23 per of all the notes that were issued were for “mild to moderate” disorders, compared to 54 per cent at another practice.
Half of the notes allowed patients to take up to a month off work, while a quarter were for between one month and three months.
Longer fit notes were generally issued for more severe disorders and illnesses. Just over one in 10 of those surveyed were pronounced “may be fit to work” by their GPs.
There was also a split between men and women, with male patients 72 per cent more likely to be given a long term sicknote lasting of more than four weeks.
Contrary to concerns from employers, the report found there was “some evidence that the introduction of the fit note is having a positive effect in reducing long-term sickness absence”.
Over the past five years the proportion of employers with no sickness absence among their workforce has increased from 40 per cent to 51 per cent of employers.
However employers have been reporting that longer-term absence is increasing because of surgery, back pain, stress, mental health and other problems.
A survey from the Engineering Employers Federation earlier this month said employers were blaming “the failure” of the fit note scheme on GPs.
The study found that only a quarter of 353 employers that the fit note scheme had resulted in employees being returned to work.
They reported that GPs were the second biggest barrier to helping somebody back to work, behind only the employees’ health condition.
The EEF said: “Medical professionals are still disengaged from the fit note process and need to be better engaged through effective training.”
A Department for Work and Pensions spokesman said: "Sickness absence is a burden to business, to the taxpayer and to the thousands of people who end up trapped on benefits when they could actually work.
"Supporting people with mental health problems to return to work more quickly will be an important part of the new independent health and work advisory service we are bringing in, which will save employers up to £160m a year in Statutory Sick Pay.”
Source: http://www.theglobeandmail.com/life/health-and-fitness/health/painkiller-diclofenac-risky-should-be-removed-from-market-researchers-say/article8508977/
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