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A Healthy Mind Can Help Fight HIV
 FRIDAY, June 20 (HealthDay News) -- Stress and depression may make a great difference in the health of people infected with HIV, according to three new reviews of the data on the subject.
Scientists haven't yet proved that personal attitude and mental health directly affect the progress of HIV infection and AIDS. But the research strongly points to a link, said Dr. Gail Ironson, lead author of the one of the reviews.
"We've got enough studies with people followed over time (to show) that it's not a fluke. You can see how consistent the evidence is," said Ironson, professor of psychology and psychiatry at the University of Miami.
Researchers have long tried to understand the link between people's emotional lives and the progression of HIV. Many HIV patients have histories of depression, stress and trauma that could potentially affect their physical health.
The reviews examining these issues were published in the June edition of the journal Psychosomatic Medicine.
In her review, Ironson and a co-author looked at a number of studies examining the effect of factors such as social support, personality and spirituality.
"Psychological states do predict whether you're going to stay healthy longer or whether your disease is going to progress faster," Ironson concluded.
According to one measure of the strength of the immune system, depressed people become susceptible to disease at twice the rate of other patients, she said.
Jane Leserman, professor of psychiatry at the University of North Carolina, found similar results in her review of studies between 1990 and July 2007.
Psychological problems can contribute to worsening health in a variety of ways, such as making it less likely that patients will take their medications as directed, Leserman explained. On the other hand, research suggests that "enhancing stress management can have protective effects in terms of the immune system," she said.
It may sound obvious that stress and depression make people sicker. But "people want the proof, and we're providing the evidence," Leserman said. "Without that evidence, I don't think HIV researchers would really take it that seriously."
Another study in the journal suggests that interventions that improve mental health might also boost the immune health of HIV-infected people. Adam Carrico of the University of California, San Francisco, and Michael Antoni, of the University of Miami, reviewed 14 studies on the subject conducted between 1987 and 2007. They write that, "psychological interventions represent a viable adjuvant treatment that can assist patients with improving psychological adjustment and potentially enhancing immune status."
According to Leserman, researchers could definitively link mental issues to physical health by launching what's known as the "gold standard" of research -- a randomized, double-blind study. Hypothetically, researchers could track two randomly chosen groups of HIV patients, some whom are depressed and stressed and others who aren't.
But such a study would require researchers to not let the depressed patients be treated for mental problems, which is ethically and practically not possible. Both Leserman and Ironson believe that it is crucial to boost the health of HIV patients by helping them deal with the mental challenges they face outside of their disease.
"We should not give up on these people," Leserman said. "We should work with them to try to improve their lives."
Ironson put it this way: "I would encourage patients to view the glass as half full instead of half empty. There's scientific evidence that that [good mental health] is related to slower disease progression."
More information
There's more on HIV/AIDS at the Foundation for AIDS Research  .
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Study Ties Herpes Virus to Emerging Form of Diabetes
 TUESDAY, June 17 (HealthDay News) -- A link appears to exist between a herpes virus and an atypical form of type 2 diabetes in persons from sub-Saharan Africa, according to a new study.
Researchers in France, writing in the June 18 issue of the Journal of the American Medical Association , noted a possible tie between the presence of antibodies for the virus human herpesvirus 8 (HHV-8) and ketosis-prone type 2 diabetes mellitus (DM-2). Ketosis occurs when ketone bodies, byproducts of fat metabolism, build up in body tissues and fluids.
DM-2 has emerged as a common form of diabetes in African populations since 1987, and from 30 percent to 60 percent of adults in sub-Saharan Africa have markers of HHV-8 infection.
The study, which looked at 187 black African diabetics patients, found HHV-8 antibodies in nearly 88 percent of those in the group with ketosis-prone DM-2, while they were found in only 15 percent of those with non-ketotic DM-2 and 40 percent of the control participants.
"Our preliminary study shows a strong link between ketosis-prone DM-2 phenotype and markers of HHV-8 infection," the authors wrote. "Patients with ketosis-prone DM-2 have a very high prevalence of HHV-8 infection, whereas patients with non-ketotic DM-2 have a much lower prevalence of HHV-8 infection when compared with the background population."
The authors called for more studies to try to replicate the results in other populations and longitudinal studies to understand the significance of the findings.
More information
The American Diabetes Association has more about diabetes .
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Repeat Teen Self-Cutters Likely to Engage in Risky Sex
 FRIDAY, June 13 (HealthDay News) -- Children who are frequent self-cutters are more likely to engage in risky sexual behavior, a new study says.
People who have cut themselves at least three times used condoms less often during sex, were more likely to share cutting instruments and had less self-restraint in general than teens who only cut themselves once or twice, according to the report in the June issue of the Journal of Developmental & Behavioral Pediatrics.
"The associations between frequent cutting, sexual risk and low self-restraint provide clues to the forces that underlie this repeated behavior and point us in the right direction for future research to better understand this troubling and self-destructive phenomenon," lead study author Dr. Larry K. Brown, of the Bradley Hasbro Children's Research Center, said in a prepared statement.
The findings came from analyzing questionnaires completed by more than 100 children, ages 11 to 18, with a history of cutting who were in intensive psychiatric treatment programs. None of the participants reported having HIV infection. Approximately 39 percent engaged in frequent cutting, and nearly three-quarters of these frequent cutters were girls.
Just 39 percent of frequent cutters who were sexually active said they used condoms consistently in the past 90 days -- nearly half that of infrequent cutters. Frequent cutters were four times more likely to share their cutting instruments than the other cutters.
"Although it appears that infrequent cutters are more 'experimental' and more like their peers who do not cut, teens who cut themselves frequently should be referred for additional psychiatric evaluation to address their sexual risk behaviors and minimize their HIV risk," Brown said.
More information
The Nemours Foundation has more about cutting .
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Malpractice Premiums, Rate of C-Sections Rise Together
 MONDAY, May 5 (HealthDay News) -- As medical malpractice premiums increase, so do the rates of Caesarean sections, new research shows.
The study provides a small snapshot of the association, drawing on data from the University of Connecticut Health Center in Farmington. The findings, while not national in scope, could further fuel the debate about whether higher malpractice rates boost the C-section rates, or visa versa.
"When I compared the malpractice rates to C-section rates prior to 1999, both were declining at a similar rate," says study author Dr. Jeffrey V. Spencer, a maternal-fetal medicine fellow at UConn. From 1999 to 2005, however, both were increasing.
The study was scheduled to be presented Monday at the American Society of Obstetricians and Gynecologists annual meeting, in New Orleans.
Spencer and his team reviewed the center's perinatal database from 1991 to 2005, noting how many vaginal deliveries and how many C-sections took place. They got the average malpractice rates from the primary carrier at their institution and adjusted them for inflation over the years.
"I can't say one led to the other or vice-versa," Spencer said. But he speculates the medical malpractice rates are driving up the C-section rates. "The theory is, doctors are practicing more defensive medicine. Maybe doctors are fearful of litigation,'' he added, perhaps likely to decide on a C-section at the first sign of any potential problems.
In all, 23 percent (15,021) of the 64,767 deliveries studied were C-sections. Spencer's team also looked at first and repeat C-sections and compared those with the average malpractice premiums by year and found a relationship between increased malpractice rates and both first and repeat C-sections.
In a second study, Spencer and his colleagues looked at the impact of increasing malpractice rates on what is known as "operative vaginal deliveries" -- delivering a child by forceps or vacuum They found that 16 percent (10,299) of the 64,767 deliveries were this type. From 1991 to 2005, average malpractice rates increased from $50,345 to $126,806.
The rates for malpractice rose, he said, even though both types of vaginal deliveries declined. Forceps deliveries declined from 11 percent to less than 1 percent, and vacuum deliveries went from 17.2 percent to 6.2 percent.
Nationwide, C-section deliveries accounted for 30.2 percent of all deliveries in 2005, according to the U.S. Centers for Disease Control and Prevention, a record high for the nation. In 1996, in comparison, 20.7 percent of deliveries were by C-section.
Another expert said the findings are nothing new.
"These two papers do nothing more than substantiate what we already know," said Dr. Marsden Wagner, a perinatologist and former director of Women's and Children's Health for the World Health Organization.
One of the reasons for what Wagner refers to as the "scandalous " rate for C-section is that "doctors are afraid of litigation."
"Any physician who picks up a scalpel and does major abdominal surgery, which is what a C-section is, because that doctor is afraid of litigation, is not practicing medicine but is practicing fear and greed," he said.
"The increasing C-section rate has not decreased the amount of litigation," Wagner said. "So their attempt to avoid litigation by doing C-section is not working."
Spencer agreed. "The only thing to my knowledge that has changed or lowered malpractice rates are states having legislation to place caps on malpractice settlements."
More information
To learn more about C-sections, visit the National Institutes of Health.
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