Latin Academy pupil dies meningitis eyed

A 12-year-old Boston Latin Academy student died yesterday after being hospitalized over the weekend with a probable case of bacterial meningitis, health officials said last night.


Staff members from the Boston Public Health Commission plan to be at the school today to help counsel students and faculty.


Health officials say a relatively small number of students and faculty at the school are at risk of infection from the seventh-grade student, who was not identified because of patient confidentiality.


At this difficult time, our hearts ache for the family and friends of this young student,’’ Mayor Thomas M. Menino said. “We mourn her loss and join with the Boston Latin Academy in this hour of grief.’’


Superintendent Carol R. Johnson said the school community sends “our most sincere condolences to those who loved her.’’


“We have assembled a team of counselors who are ready to work with the Boston Latin Academy community in the difficult days ahead,’’ Johnson said.


School officials worked with staff from the health commission to identify individuals who may have been in close contact with the student and, “out of an abundance of caution, are advising that they go see their doctor,’’ said Matthew Wilder, School Department spokesman.


Dr. Anita Barry, director of the Infectious Disease Bureau at the Public Health Commission, said agency officials estimate that fewer than 50 students and faculty had close enough contact with the 12-year-old girl to be at risk.


The germ that causes meningitis spreads through contact with saliva, such as by kissing or sharing a water bottle, or by a cough, Barry said. The infection causes an inflammation of the brain and spinal cord.


School officials notified students and their families about the student and her illness over the weekend.


Dr. Helen W. Boucher of Tufts Medical Center said yesterday bacterial meningitis is the most serious form of meningitis.


“Some forms of bacterial meningitis are contagious, but it really depends on the type of bacteria and how close the contact is,” Boucher said. “We usually only worry about close contacts such as family members and roommates. Anyone who is worried and had potential contact should speak to either the school nurse or their own doctor.”


Schools spokesman Matthew Wilder said the school spent yesterday working with the Boston Public Health Commission to identify any students or faculty members who had prolonged close contact with the student and advised them to seek medical attention.


Health officials estimate there have been fewer than 10 cases of bacterial meningitis this year in the Boston area.


Bacterial meningitis is an infection of the lining of the brain and spinal cord. Symptoms include fever, headache, stiff neck and/or neck pain, nausea and vomiting, a rash, confusion and drowsiness.

Charla Nash, mauled by chimp, faces public

A woman whose face and hands were ripped off in a horrifying attack by a pet chimpanzee has showed the incredible results of her face transplant surgery.
Charla Nash, a 56-year-old single mother from Stamford, Connecticut, nearly died after the mauling two years ago.
She had tried to catch her boss' pet chimp Travis after he escaped – but the 14-year-old male ape turned on her and tore off her hands, nose, lips and eyelids.


Six months ago, Ms Nash underwent a 20-hour operation which left her with a new face, prosthetic eyes and new hands.
Although a serious infection meant the hands had to be removed, she can now smell again, eat solid food – and says her new face ’has really given me a life back’.


I’ve had people tell me I’m beautiful and nobody ever told me I was beautiful before,’ she told the Today show.
Of the family who donated the face of their loved one, she said: ‘Words can’t even say enough. It’s really given me a life back. It’s such a wonderful thing. I cannot thank them enough.'


She told Today that a little girl approached her on the first day she went out without a veil and said hello.
'That didn't happen before,' she said. 'It was nice. The little girl was saying 'Hi' to me...I'm not scaring anybody.'
Ms Nash’s doctors say her face will not resemble the donor’s and will instead mould to her own bone structure.
‘What we have seen is that the face almost blends in and becomes the patient’s own to the point that a regular person passing by will not even be able to tell,’ Dr. Bohdan Pomahac, from Brigham and Women’s Hospital, told the Today Show.


“I’ve had people tell me I’m beautiful,” Nash told “Today” interviewer Meredith Vieira. “And they were not telling me I was beautiful before.”


Nash said she recently visited a store with her brother and was heartened when a young girl said hello to her.


“It was nice,” she explained.


“I looked like I’ve got eyes and everything ... I’m not scaring anybody.”


Nash was brutally attacked by her friend’s pet chimp, Travis, in Stamford, Conn., in February 2009.


The animal nearly killed the 57-year-old mother, ripping off her face and both her hands and leaving her permanently blind.


After years of rehabilitation, Nash recently underwent ground-breaking surgery at Boston’s Brigham and Women's Hospital, where doctors replaced her face and both hands.


Medical complications forced doctors to remove the hands shortly after they were attached, but they may attempt the transplant again within the year.


“I found out later on that they — I had hands and they removed them," Nash told Vieira.


“And it didn't really bother me because I was too sick to worry about that, you know? … And then later on, I was disappointed that, you know, I had them and they're gone again.


“But I'm hoping, you know, for in the future, that it can be done again.”


Nash is now able to chew food and smell again and her daughter, Briana, said she feels like she’s starting to get her mother back.


“She looks similar,” she said.


“I mean the nose is very similar. I’m still waiting for the underlying bone structure to take some shape on her cheeks.

UN reports global drop in HIV infections

We are on the verge of a significant breakthrough in the AIDS response,”said Michel Sidibe, executive director of UNAIDS. “New HIV infections continue to fall and more people than ever are starting treatment,” he noted.


About half of those eligible for treatment are now receiving it, with the most dramatic improvement in access seen in sub-Saharan Africa, which recorded a 20 per cent jump in people undergoing treatment between 2009 and 2010.


As a result of better access to healthcare, the number of AIDS-related deaths were also falling, said UNAIDS, the UN agency spearheading the international campaign against the disease.


In 2010, 1.8 million deaths were linked to AIDS, down from a peak of 2.2 million last seen in 2006.


“An estimated 700,000 AIDS-related deaths were estimated to have been averted in 2010 alone,” added the UN agency.


Not only is treatment helping to prevent new AIDS-related deaths but it is also contributing to a drop in new HIV infections.


Patients undergoing care were less likely to infect others, as prevention programmes coupled with treatments were proving effective.


Modelling data suggests that “the number of new HIV infections is 30 to 50 per cent lower now than it would have been in the absence of universal access to treatment for eligible people living with HIV.”In Namibia for instance, where treatment access reached an all-time high of 90 per cent and condom use rose to 75 per cent among men, the combined impact contributed to a 60 per cent drop in new infections by 2010, noted UNAIDS.


The UN agency added that the full preventive impact of treatment was likely to be seen in the next five years, as more countries reach high levels of treatment coverage.


“The massive increases in the numbers of people receiving treatment in South Africa between 2009 and 2010, for example, are likely to be reflected in substantially fewer new infections in the near future,” it said.


UNAIDS assessed that even if the AIDS epidemic is not over, “the end may be in sight if countries invest smartly.””In the next five years, smart investments can propel the AIDS response towards achieving the vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths,” it said.


However, the turning point is coming at a time when industrialised nations’
public budgets are being squeezed and translating to less international funding
for the AIDS response.


There've been rises which have been particularly noticeable in Victoria and Queensland. New South Wales is pretty steady and the numbers are much smaller in the other states but there have been some rises.


So all in all it adds up to a picture of just over a 1,000 a year which is not good enough.


Both Queensland and Western Australia reported their highest rates of HIV diagnosis last year with 5.3 and 4.2 per cent of every 100,000 people testing positive respectively.


Of the 21,500 people living with HIV in Australia, NAPWA estimates that 70 per cent are receiving anti-retroviral treatment. That's fewer people than in sub-Saharan African countries like Botswana and Rwanda which have achieved access to treatment rates of more than 80 per cent.


Well firstly I'd just caution that we don't have a lot of data on the number of people on treatment in Australia. It's not that strong. We think it's about 70 per cent but it could be percentages either way.


Given the new developments which we have in Australia, we've got much better and better drugs, they're more tolerated and also the fact that science is now telling us that much earlier treatment is probably the way to go, I think we need to get messages out there to people with HIV and indeed health professionals that they should think again about earlier treatment.


Mr Whittaker says rising infection rates could be a symptom of fatigue among agencies working to combat the virus.


Well this year marks 30 years of AIDS. Thirty years since AIDS was first reported and of course what you have to do with education and prevention programs is keep them going and that's hard to sustain over 30 years.


But I think we've got an opportunity now to really revitalise and even revolutionise our approach to prevention in Australia because we've got new science and new information which we can utilise to drive down the rate of new infections.


But Mr Whittaker says despite these advances, Australia will have to work hard to meet UN goals to scale up treatment and decrease the number of sexual transmissions of HIV to 50 per cent by 2015.


Well Australia played a pivotal role in negotiating that declaration of commitment which the UNAIDS and UN are following. So people are looking at Australia to set a strong example.


The spokesman for the National Association of People Living with HIV and AIDS Bill Whittaker ending Jessicah Mendes's report.

Gilead Moves to Top Rivals With $11 Billion Deal

Gilead Sciences Inc.'s agreement to pay nearly $11 billion to acquire tiny Pharmasset Inc. is a dramatic illustration of the market potential—and public-health challenges—involved in the battle against the hepatitis C virus.


Pharmasset, a Princeton, N.J., company with just over 80 employees and no commercial products, is developing a compound that Gilead and analysts say is on track to be part of the first all-oral regimen for treating hepatitis C. Experts say that gives it a distinct advantage over current treatments in the potentially huge U.S. and global markets for such drugs.


Gilead, which has a blockbuster franchise for medicines that treat HIV, the virus that causes AIDS, is betting that Monday's $137-a-share deal will help it become similarly dominant in hepatitis C. Market-research firm Decision Resources estimates the global hepatitis C market will hit $16 billion in 2015, up from just $1.7 billion in 2010.


The purchase price represents a nearly 89% premium to Pharmasset's closing price Friday, putting it in the rarified ranks of Bristol-Myers Squibb Co.'s $2.1 billion purchase of Medarex and its novel cancer drug in 2009, which carried a 90.5% premium.


In 4 p.m. trading Monday on the Nasdaq Stock Market, Pharmasset shares were up 85% at $134.14.


An estimated four million Americans have hepatitis C, but only about a million of them have been diagnosed. Most victims go untreated rather than endure weekly injections of interferon and twice-daily ribavirin pills—a combination with harsh side effects—for as long as a year. Only about 50% of those treated are cured of the potentially fatal blood-borne virus.


Globally, some 170 million people are thought to have hepatitis C, which can be transmitted sexually, as well as by shared needles and at tattoo parlors. It can cause cirrhosis of the liver, and is the chief reason in the U.S. for liver transplants.


Our own nucleotide clearly doesn't have a profile to allow it to go forward,” he said. “The products that they have, while just entering Phase 3, I think have a high degree of predictability, in terms of how they will perform.


‘‘So we made a very difficult decision to do an acquisition which is much larger than we typically like to do, but one that we felt was very important for the company,'' Milligan said.


Three stages of testing are generally required for U.S. regulatory approval of a new drug.


Hepatitis C is a viral infection that can lead to swelling of the liver. As many as 170 million people globally carry the virus, which is transmitted through exposure to infected blood, and more than 350,000 die from related illnesses each year, according to the Geneva-based World Health Organization.


Current $3 Billion Market


The hepatitis C market is currently about $3 billion worldwide, Andrew Berens, a senior health-care analyst with Bloomberg Industries, in Skillman, New Jersey, said in a telephone interview.


Earlier this year, Merck & Co. and Vertex Pharmaceuticals Inc. won approval for the first new therapies for hepatitis C in almost a decade. Companies including Inhibitex Inc. and Achillion Pharmaceuticals Inc. are also racing to develop medicines for the virus.


Erik Gordon, a business professor at the University of Michigan, also questioned the price of the Gilead's proposed acquisition.


‘‘Gilead is paying too much, paying all in cash, borrowing money to do it, diluting earnings for three or more years -- to get a drug candidate or two in an area that was supposedly a core strength at Gilead,'' Gordon wrote in an e-mail. ‘‘You can do a lot of research for $11 billion.''


The purchase, which gives Gilead three potential treatments for chronic HCV now in development by Pharmasset, is five times bigger than the company's 2006 deal for Myogen Inc. for $2.2 billion, according to Bloomberg data.


HIV Medicines


Gilead sells Atripla, Truvada and Viread, medicines for HIV that generated $2.9 billion, $2.7 billion and $732 million in 2010 revenue, respectively. The company had $7.9 billion in sales last year. Gilead's experience with HIV treatment regimens will help bring the hepatitis C drugs through clinical development, Chief Executive Officer John Martin said.


Pharmasset reported data on PSI-7977 earlier this month, showing that 40 patients who received the therapy were responsive after 12 weeks. About half the patients had been followed up to 24 weeks, and all were cured. There were no significant adverse events. The drug was tested in combination with ribavirin, a medication currently used in treating the disease, in patients with hepatitis C genotypes 2 and 3. Genotype 1 is most common and hardest to treat.


Roche Holding AG, based in Basel, Switzerland, agreed in October to buy Anadys Pharmaceuticals Inc., another maker of experimental medicines for hepatitis C, for about $230 million.


‘‘We see continued consolidation in the space, potentially including Achillion, which will report important proof-of- efficacy data by year-end and is actively exploring strategic opportunities,” Edward Tenthoff, an analyst with Piper Jaffray & Co., wrote yesterday in a research note.


Achillion CEO Michael Kishbauch said Nov. 17 that his company based in New Haven, Connecticut, is in “advanced discussions” with potential partners or acquirers. The hepatitis C market may be worth $20 billion by 2020, Kishbauch said in an interview.

Be selective about breast cancer screening, women told

Clinical breast exams are no longer routinely recommended for women at average risk of breast cancer, according to new Canadian guidelines.


That's the main change in Monday's updated guidelines from the Canadian Task Force on Preventive Health Care.


An analysis also found routine mammography, self-examinations and MRIs had no significant benefit for women aged 40 to 49.


The task force also warned there was potential for harm from over-diagnosis and unnecessary biopsy, particularly for younger women.


"We're trying to reframe this set of guidelines away from a prescriptive approach, which makes a one-size-fits-all recommendation for women based on their age, and change it into a discussion between a woman and her doctor about the potential risks, about the potential benefits, and allow each woman to make a decision that's right for her," said Dr. Marcello Tonelli, the chair of the task force and a professor at the University of Alberta's Department of Medicine, in Edmonton.


P.O.V.
Do you support the idea of less screening for some women? Have your say.


The guidelines cover women up to age 74 who are at average risk, meaning they have:


No previous breast cancer.
No history of breast cancer in a first-degree relative such as a mother or sister.
No known mutations in the BRCA1 or BRCA2 genes.
No previous exposure to radiation of the chest wall.
The new guidelines also recommended a change in how often screening mammograms should be offered for women 50 to 74 — from every two years to every two to three years.


As before, there was no evidence that routine breast self-examination in women with no symptoms of breast cancer reduces the risk of death, the panelists concluded in the Canadian Medical Association Journal.


The Canadian Task Force on Preventive Health Care says that women in their 40s do not need regular mammograms, while women aged 50 to 74 can wait longer between exams - from every other year, to every two to three years.


"We're not trying to come across as saying that breast cancer screening with mammography is not useful," said Dr. Marcello Tonelli, chairman of the task force and associate professor in the department of medicine at the University of Alberta.


"We think it is a potentially useful tool in the fight against cancer. But it's important for women to be informed about the risks and benefits - to know that both are present, that it's not all benefit and to realize, when they make that assessment, the magnitude of what they're talking about.


"If you look at the numbers, you are much more likely to have a false positive result than you are to have your life saved by screening," Tonel-li said. "It's a real benefit, but com-pared with the risk of false positives, it's relatively small."


In some cases false positives can lead to women having part or all of their breasts removed when, in fact, they do not have cancer.


It is the first time the guidelines - published this week in the Canadian Medical Association Journal - have been updated in a decade, and with-in moments of their release dissenting voices emerged.


Critics accused the panel of relying on data from older studies that used now obsolete equipment to under-estimate the benefits of screening.


"People are gradually switching to digital mammography which is better than film at finding cancer - but even places still using film, the film is considerably better than it was in the '60s, '70s and '80s, when all these old trials were done," said Dr. Paula Gordon, a clinical professor of radiology at the University of B.C. and chairwoman of the Canadian Breast Cancer Foundation's B.C./Yukon region early detection working group.


She said the overall reduction of breast cancer deaths from mammography "could be easily in the range of 30 per cent.



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George W. Bush to Raise Cancer Awareness in Africa

DALLAS — Former President George W. Bush will travel to Africa next month to raise awareness about cervical and breast cancer, an effort he calls a “natural extension” of a program launched during his presidency that helps fight AIDS on the continent.


Bush, former first lady Laura Bush and officials with the George W. Bush Institute are heading to Tanzania, Zambia and Ethiopia from Dec. 1 through Dec. 5, where they’ll visit clinics and meet with governmental and health care leaders.


We believe it’s in our nation’s interest to deal with disease and set priorities and save lives,” Bush told The Associated Press.


In 2003, Bush launched the U.S. President’s Emergency Plan for AIDS Relief, or PEPFAR, to expand AIDS prevention, treatment and support programs in countries hit hard by the epidemic.


The new program, called the Pink Ribbon Red Ribbon initiative, seeks to expand the availability of cervical cancer screening and treatment and breast care education in sub-Saharan Africa and Latin America.


Bush said existing AIDS clinics will be used to screen and treat cervical cancer, which is four to five times more common among those living with HIV than those who don’t have the virus. Last year, 3.2 million people received antiretroviral treatments as a result of PEPFAR.


The initiative is a partnership among several organizations, including the Bush Institute, PEPFAR and the United Nations’ program on HIV and AIDS. Its goal is to reduce deaths by 25 percent in five years among women screened and treated through the initiative.


“We want to show what works and hopefully others across the continent of Africa will join us,’” Bush said.


Dr. Eric G. Bing, director of global health at the Bush Institute, said it’s often more difficult for African women to reveal they have cancer of the reproductive organs than to reveal they have HIV. There are more support groups and treatment available for HIV than cancer, he said.


“There’s silence around cancer for many of these communities and in many of these nations. And that’s one of the things that we hope to change,” Bing said.


Bush moved to Dallas after leaving office in 2009. The George W. Bush Presidential Center, which is set to be completed in 2013 on the campus of Southern Methodist University, will include his presidential library and the already-operating policy institute. Besides global health, the institute focuses on education reform, human freedom and economic growth.


Bush's policy institute is one of the organizations that announced this fall the Pink Ribbon Red Ribbon initiative to expand the availability of cervical cancer screening and treatment and breast care education in sub-Saharan Africa and Latin America.




Bush and former first lady Laura Bush will travel next month to Tanzania, Zambia and Ethiopia, meeting with governmental and health care leaders.


Bush tells The Associated Press it's in the nation's best interest to "deal with disease and set priorities and save lives."


He says it's a "natural extension" of the U.S. President's Emergency Plan for AIDS Relief, which he launched in 2003.



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Low BMI Associated With High 30-Day Postsurgical Mortality

Surgical patients with a body mass index at the lower end of the normal range were more likely to die within 30 days of the procedure than those in the moderately overweight range, researchers found.


Compared with patients with a BMI of 26.3 to 29.6, those with a value below 23.1 had a significantly higher risk of death (adjusted OR 1.40, 95% CI 1.25 to 1.58), according to an analysis of 189,533 surgeries performed in 2005 and 2006 and recorded in the National Surgical Quality Improvement Program (NSQIP) database.


Patients with higher BMI values above 23.1 -- including the morbidly obese -- had about the same risk of 30-day mortality as the moderately overweight, George J. Stukenborg, PhD, of the University of Virginia in Charlottesville, and colleagues, reported online in Archives of Surgery.


But for some individual types of surgeries, obesity was associated with increased mortality, the researchers found.


"These individual types of procedures include procedures with which the general surgeon should have definite experience: colorectal resection, colostomy formation, cholecystectomy, hernia repair, mastectomy, and wound debridement," Stukenborg and colleagues wrote.


NSQIP data in the study were extracted from medical records at 183 participating hospitals. Those with low volumes reported all cases performed each year whereas high-volume hospitals reported the first 40 consecutive cases for 42 eight-day cycles each year.


Patients in the study were categorized into BMI quintiles, with values of less than 23.1 being the lowest and those above 35.2 being the highest. For the overall 30-day mortality risk calculation, the middle quintile -- 26.3 to 29.6 -- served as the reference.


BMI values of 20 to 25 are considered normal. A value of 30 is the standard threshold separating overweight from frank obesity.


Odds ratios for 30-day mortality in the two lowest and two highest quintiles were adjusted for procedure type and baseline mortality risk. The latter is a standard part of the NSQIP data and is calculated from more than 30 patient variables including sociodemographic factors, comorbidities, and preoperative laboratory values such as serum albumin and white blood cell count.


Data reported for the years 2005 and 2006 were analyzed from 183 sites included in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database of general and vascular surgery. Of the189,533 patients reviewed in the evaluation, 3245 (1.7%) died within 30 days of surgery.


Measures of patient BMI were divided into nonstandard quintiles specific to the NSQIP study population. Baseline differences in overall existing mortality risk were evaluated for each patient, using the NSQIP probability of 30-day mortality risk score, which draws on more than 30 demographic variables as well as comorbidity factors and preoperative lab values. In addition, data were assessed to calculate the effect on patient mortality risk contributed by each of 45 independently evaluated categories of principal operating procedure.


The latter analysis found that the top 3 procedural categories associated with high 30-day mortality (compared with laparoscopy as a middle-range reference procedure responsible for 2% of the patient deaths) were exploratory laparotomy (13.9% of patient deaths), lower-extremity amputations (8.1%), and small bowel resection (7.9%). On the safer end of the procedural scale, 19 types of surgery each were associated with 1% or fewer of the patient deaths.


The authors also found notable interactions between BMI and some procedural categories, indicating that the link between BMI and mortality was statistically different for those categories than for patients who underwent laparoscopy. These findings suggest that the interaction between BMI and mortality plays a role within certain categories of surgery that may be classified as high risk or low risk, relative to laparoscopy.


Compared with the reference procedure, statistically significant (P < .05) differences in mortality odds were found for colostomies (AOR, 1.09; P = .009), wound debridement (AOR, 1.68; P = .002), ileostomy (AOR, 1.56; P = .008), musculoskeletal procedures (AOR, 0.49; P = .03), endarterectomy of head/neck vasculature (AOR, 0.55; P = .002), upper gastrointestinal procedures (AOR, 0.42; P < .001), cholecystectomy (AOR, 0.27; P = .04), and mastectomy (AOR, 0.05; P = .001).


"There is increasing evidence and supportive literature that obesity affects the practice of surgery in the United States and worldwide," explain the authors. "Reports to date have shown that, at the very least, complication rates and hospital resources have been affected by procedures on obese patients." The American College of Surgeons NSQIP database, used in the current study, "allows for the evaluation of a larger number of patients and for the examination of more specific types of procedures." The researchers conclude that "BMI is a significant predictor of mortality within 30 days of surgery, even after adjusting for the contribution to mortality risk made by type of surgery and for a specific patient's overall expected risk of death. Patients with a BMI of less than 23.1 demonstrated a significant increased risk of death.

Latinos fall 2nd Minority Victims to Diabetes

Do your children always feel hungry and thirsty but continue to lose weight? Be careful, as they may suffer from diabetes mellitus (DM) type-1 — a rare and difficult-to-treat diabetes commonly called “juvenile diabetes”.


Non-communicable diseases, including diabetes mellitus, have now appeared as a major health problem in Indonesia. The increased number of well-trained pediatricians and non-specialist physicians on diabetes care unexpectedly reveals that the number of Indonesian people suffering from DM type-1 is much higher than the figures that are currently reported.


Aditya Suryansyah, an endocrinologist from Pediatric Endocrinology Working Unit at the Jakarta-chapter of the Indonesian Pediatricians Association (IDAI Jaya), said on Friday that insufficient attention had been paid to children living with DM type-1, even though it is a relatively rare diabetes condition which is
difficult to treat.


Most diabetes occurring in children are type-2 diabetes. Unlike the DM type-2, which was commonly caused by poor living conditions, an unhealthy diet and sedentary lifestyles, the DM type-1 came from pancreatic damages, he said.


“Children suffering from type-1 diabetes need to take insulin, enabling better control of their blood sugar levels. The problem is, measures taken to bring blood glucose levels down sometimes work in different ways,” Aditya told a press briefing at the Health Ministry office.


According to the IDAI Jaya, Indonesia has now only 33 endocrine pediatricians. A two-year survey carried out by the association’s pediatric endocrinology unit during the period between 2008 and 2010 showed that 674 people in Indonesia suffered from the DM type-1 whereas only 156 type-1 diabetic victims were revealed in the beginning of the survey in 2008.


Surveys held by the Health Ministry conclude that about 5.7 percent of Indonesian people suffer from diabetes. According to a diagnosis conducted by health workers, about 1.1 percent of the country’s population suffers from the lifelong disease caused by high levels of blood glucose. This means that about 8 million Indonesian people are living with diabetes.


Tjandra Yoga Aditama, Health Ministry director general of disease control and environmental health, said that more effort was needed to tackle type-1 diabetes, as incidents continued to increase. “The number of people with type-1 diabetes is not that high [compared with type-2 diabetes]. Still, we need to pay more attention to dealing with the disease because it can cause a heavy burden to public health,” he said.


The type-1 diabetes, or often referred to as “juvenile diabetes”, is a form of diabetes mellitus that results from damaged insulin-producing beta cells of the pancreas. Shortages of insulin will lead to increased blood glucose. As a result, people with type-1 diabetes usually feel thirsty and hungry, although their body weight continues to decline. They also will experience excessive urination.


According to SJC Public Health, 8.7 percent of residents live with diabetes in the County; therefore, 59,621 residents out of 685,306 have developed diabetes. The report notes that 4 out of 5 of adult cases are adult onset type 2 diabetes —a preventable chronic disease.


While both nationally and locally, the Latino population follow the leading Non-Hispanic African American minority who suffers from the highest death rate caused by diabetes. Throughout the United States, 10.8 percent of non-Hispanic African Americans have Diabetes and Latinos are close with 10.6 percent. Among Hispanics/Latinos, diabetes prevalence rates 11.9 percent for Mexican-Americans, 12.6 percent for Puerto Ricans and are 8.2 percent for Cubans.


Diabetes, also called Diabetes mellitus, is a chronic illness that is characterized by a group of metabolic diseases in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced.


There are three types of Diabetes, Type 1 and 2 are incurable yet manageable. Type 1, also called Juvenile Diabetes begins in childhood and is caused by the body’s inability to produce insulin and Type 2, is caused by environmental factors that result in insulin resistance. The 3rd is gestational diabetes which is pregnancy onset and thus usually disappears after childbirth.


According to the American Diabetes Association, Diabetes often goes undiagnosed because many of its symptoms seem harmless:


Type 1 diabetes symptoms
• Frequent urination
• Unusual thirst
• Extreme hunger
• Unusual weight loss
• Extreme fatigue and irritability


Type 2 diabetes symptoms*
Any of the type 1 symptoms
Frequent infections
Blurred vision
Cuts/bruises that are slow to heal
Tingling/numbness in the hands/feet
Recurring skin, gum or bladder infections


Often people with type 2 diabetes have no symptoms.


“Studies have shown that type 2 diabetes can be prevented or delayed. Thirty minutes a day, five days a week, of moderate physical activity (such as brisk walking) and a 7% reduction in body weight (or about 15 pounds if you weigh 200 pounds) can help lower your risk for type 2 diabetes,” commented Mayer-Davis. “In addition, many diabetes complications, whether you have type 1 or type 2, can be prevented or delayed with exercise and healthy eating and keeping blood glucose levels as close to normal as possible.”

Can Orange County Do Better Than Laura's Law?

The July death of a schizophrenic homeless man after an altercation with Fullerton Police has focused attention on care for the mentally ill. Orange County supervisors might now adopt “Laura’s Law” so clinic workers can go into the streets to treat the mentally ill. Laura’s Law is in effect only in Nevada County, east of Sacramento. Officials there say it’s humane and cost-effective.


A metal detector and a uniformed guard greet visitors at the door of the Nevada County Behavioral Health Department. Security in the otherwise folksy lobby wasn’t always so tight, but 10 years ago, a severely mentally ill patient shot up the department’s front office and a restaurant nearby. He killed three people — among them 19-year-old Laura Wilcox, a mental health clinic volunteer on winter break from college.


"In January of 2001 our daughter was working at the Nevada County behavior health clinic, and she never came home that day," says Nick Wilcox, Laura's father.


Scott Harlan Thorpe was her killer — 41 years old at the time, suffering from severe delusions. He also refused medication to control those delusions. His family and the mental health system couldn’t do anything.


"We came to realize that this rampage shooting was really triggered by deficiencies in the mental health system," Nick Wilcox says. "So not being able to do anything about our daughter because she was dead, we tried to work on correcting the system."


The result? Laura’s Law, which allows counties, if they choose, to require medical treatment for a unique segment of the mentally ill community. It applies only to patients with severe mental illness and a history of multiple hospitalizations or jail time. The law lets a judge order such patients into “assisted outpatient treatment.”


"If we didn’t have assisted outpatient treatment, the only way you can really intervene with seriously mentally ill people who refuse treatment is to wait until something horrible happens," says Michael Heggarty, Nevada County's behavioral health director, "and then you can use involuntarily hospitalization or incarceration. But that’s a terrible outcome to have to wait for."


What’s more, says Heggarty, for every dollar spent on Laura’s Law, Nevada County saves $1.81 because fewer people end up in jail or in a mental hospital. Still, Heggarty says he was skeptical about the need.


"Part of my ignorance at the time was not really understanding fully the number of people that are seriously mentally ill," Heggarty says, "and because of their mental illness ... refuse to be in treatment because they don’t consider themselves to be sick."


Debra understands. She’s the mother of a 30-year-old schizophrenic son. She talked about him but wouldn’t give her last name.


"Truthfully, it’s like living on a roller coaster from hell," Debra says. "When he’s on medications he’s stable and he’s a joy to live with." And when he’s not, verbal and physical aggression overtakes him.


At Friday's Homeless Commission hearing, supporters and opponents of the law echoed arguments that have been made since the mid-1990s, when the state Legislature first began considering a law to help severely mentally ill people without violating their rights.
County mental health officials emphasized costs at Friday's meeting, and Ron Thomas, father of Kelly Thomas, reacted: "What I hear a lot is money. It's always about the money. … Let's start taking care of some of the people."
Those in favor of the law, primarily parents or siblings of adults with severe mental illness, recounted events in which current law kept them from coming to the aid of their relatives.
"God dammit, I want people to be mad like I was," said Jennifer Hoff. Her mentally ill son turned 18 in March and now is living on the streets in Santa Ana because he's not taking prescribed medications, she said. Current law prevents her from getting help for her son, she complained.
Once someone turns 18, they may make their own medical decisions. One of the most challenging effects of schizophrenia and some other illnesses is that those who are seriously ill have no sense there is anything wrong. They frequently refuse to take medications.
Federal privacy laws and existing state laws make it difficult for parents, relatives or friends to work with doctors on behalf of the ailing adult, speakers said.
But advocates for the rights of mentally ill people worry that new laws or local adoption of Laura's Law could mean mentally ill adults will receive treatment against their will, even if forced medication isn't allowed.
"My body belongs to me," said Charmaine Asher. Laura's Law is "a slippery slope of civil rights violations," she said.
In an effort to protect those rights, Laura's Law requires that the person have a history of not complying with prescribed medical treatment. That failure must have been a factor in the adult being sent to a hospital, prison or jail at least twice within the past 36 months.
The law also stipulates that if the mentally ill person wasn't in jail or hospitalized, he or she must have threatened or attempted serious violent behavior to themselves or others within the past four years.
The person also must have been offered the chance to voluntarily participate in a local treatment plan but continued to refuse, according to the law. Conditions must also be deteriorating "substantially" and require outpatient treatment to prevent persons becoming a danger to themselves or others or unable to care for themselves.
In addition, they must be found to be likely to benefit from the outpatient treatment.
County mental health officials did not go into much detail about how a locally adopted program might work. Most of the discussion involved costs and whether such a program would qualify for state mental health bond funds. Nevada and Los Angeles counties are using state money for their programs.
Nevada County officials have said Laura's Law saved taxpayers money, mainly because the costs of housing mentally ill people in jails and treating them in emergency rooms were substantially reduced after the county's adoption of Laura's Law.
Despite Nevada County's experience, Orange County officials made no mention of savings, only potential increased costs and other difficulties.
Supporters of Laura's Law say Orange County officials are reluctant to implement it because, once a treatment plan is approved by the courts, judges would hold the county accountable for following through and providing the treatment as well as keeping in contact with the patient.
The reliability of Orange County's estimates is uncertain. In October, Orange County mental health officials estimated Laura's Law would cost $6.1 million a year to care for about 120 patients.
Officials in San Diego County, which is almost identical to Orange County in population, say they could handle nearly five times as many severely mentally ill adults at about one-third of Orange County's cost estimate.

California court's pension ruling could reach far

Health benefits for government retirees may not be eliminated if state and local governments had clearly promised workers those benefits, the California Supreme Court ruled in an Orange County case Monday.


The unanimous ruling is expected to make it more difficult for state and local governments to shave costs by cutting health benefits to retirees if elected officials in previous years made it clear that those benefits would last a lifetime.


The state high court decided that retired Orange County employees may be able to show they had an implied contract that prevented the county from changing a healthcare plan in a way that caused the premiums of many retirees to skyrocket.


"Under California law, a vested right to health benefits for retired county employees can be implied under certain circumstances from a county ordinance or resolution," Justice Marvin R. Baxter wrote for the court.


Retirees sued Orange County in 2007 after it revamped the health benefit program to save money. A federal trial court sided with the county. An appeals court, which is now considering the case, asked the California Supreme Court to clarify state law in the case.


"This decision says that when you are in the process of doing public employee pension reform, you have to respect the rights of current retirees," said Ernest Galvan, a lawyer who represented more than 5,000 Orange County retirees and their family members.


"If you promised them a particular benefit when they were working and promised that would be part of their retirement, then that is a promise you have to keep."


But lawyers for cities and counties said they were pleased the court established a hurdle for showing that such promises were made.


"The good news for cities and counties is that the court made it clear that you need very strong evidence that the [elected officials] intended to create a lifetime benefit," said Jonathan V. Holtzman, who represented associations of California cities and counties.


Arthur A. Hartinger, who represented Orange County, said the county changed the health insurance plan to ensure it could survive.


Courts should be cautious and require strong evidence before finding an implicit promise to maintain health coverage, making sure that neither the supervisors nor the public "will be blindsided by unexpected obligations," said Justice Marvin Baxter in Monday's decision. But he rejected the county's attempt to bar all such lawsuits.


The court's cautionary language should help local governments defend against retiree suits, but the ruling still leaves them exposed to "extensive litigation," said Jonathan Holtzman, a lawyer for statewide associations of cities and counties.


"It's another hurdle that public agencies will have to address as they attempt to get their benefit costs under control," he said.


The court interpreted California law at the request of a federal appeals court that is considering a challenge by 5,400 Orange County retirees and survivors to an increase in their health insurance premiums in 2008.


County officials had approved the change while negotiating a pay raise with employee unions, who did not represent the retirees. Ernest Galvan, a lawyer for the former county workers, said county officials estimated the premium increase would cost each retiree or their family an average of $3,000 per year, a figure disputed by Arthur Hartinger, the county's lawyer.


Similar disputes are arising elsewhere in California as financially stressed local governments confront increasing pension and health care costs.


Jeffrey Lewis, a lawyer for nearly 1,400 retirees in Sonoma County, said the ruling should revive their lawsuit over county supervisors' decision to reduce its contribution to their health care premiums to $500 a month over a five-year period, starting in 2009.


The county had paid between 85 and 100 percent of the premiums since 1964, contributing $1,000 or more in some cases, Lewis said. In a November 2010 ruling, U.S. District Judge Claudia Wilken said the reduction would have a "devastating impact" on retirees with limited incomes but did not violate any express promise by the Board of Supervisors.


Lewis said he is also preparing a suit on behalf of retirees in Contra Costa County, where supervisors last year barred future increases in the county's contribution to former employees' health benefits.