Indian Medicine

NEW YORK (Reuters Health) - Drivers age 70 or older seem to benefit from a driver education program that addresses common errors of older drivers, such as not following traffic signals, following too closely, making poor left turns, and inappropriately changing lanes.

"Older drivers who received classroom and on-road training significantly improved their performance on road tests and written tests compared to controls who did not receive the training," said study chief Dr. Richard A. Marottoli of Yale University School of Medicine, New Haven, Connecticut.

The number of older drivers is expected to increase significantly in the coming years and motor vehicle crashes are among the top causes of accidental injury and death among people age 65 and older.

Marottoli and colleagues randomly assigned 126 drivers, 70 years or older, who had poor or fair performance on driving tests to no intervention (the control group) or to 8 hours of classroom driver education based in part on the AAA Driver Improvement Program, plus 2 hours of behind-the-wheel training.

The investigators report in The Journal of Gerontology that subjects who completed the driver re-education course showed statistically significant improvement in their written test and post-course road test.

The level of improvement seen in the on-road test was equal a 9.5-percent decrease in crash risk, Marottoli and colleagues estimate.

Overall, the subjects in the driver education group reported that they enjoyed the sessions and found the content beneficial to their driving practices.

Elderly individuals who lose their ability to drive are at increased risk of depression and isolation. "Our findings are encouraging," Marottoli told Reuters Health, "demonstrating that a relatively easy to implement intervention can enhance driving performance, potentially prolonging safe driving years, and help maintain activity levels and out-of-home mobility."

SOURCE: The Journal of Gerontology, October 2007.

Copyright © 2007 Reuters Limited.

NEW YORK (Reuters Health) - Eleven percent of U.S. men say they've carried on more than one sexual relationship at a time during the past year -- a practice that may facilitate transmission of HIV, according to researchers.

Using data from a government health survey of nearly 5,000 U.S. men, 11 percent said they had at least two sexual partners during the same time period during the last year.

Of concern, was these men were also more likely to say their female partners were not monogamous either, and said they drank and used drugs during sex. In addition, men with multiple female partners were more likely than monogamous men to have had sex with another man.

All of these behaviors raise the risk of contracting HIV and other sexually transmitted diseases (STDs). African-American and Hispanic men, who bear a disproportionate share of U.S. HIV cases, were two to three times more likely than whites to have concurrent sex partners.

"This study sheds light on the epidemic of heterosexually transmitted HIV in the U.S. -- especially among African Americans and Hispanics," Dr. Adaora A. Adimora, the study's lead author, told Reuters Health.

She and her colleagues at the University of North Carolina, Chapel Hill report the findings in the American Journal of Public Health.

The results are based on a 2002 federal government survey that included 4,928 men between the ages of 15 and 44. Among the 11 percent of men who'd had more than one sex partner at a time in the past year, most said they'd had only female partners.

While it's known that a high number of lifetime sexual partners is a risk factor for STDs and HIV, having these relationships at the same time may be especially risky. If one person becomes infected with an STD, he or she can rapidly pass it on, before becoming aware of his or her own infection.

"People -- especially women -- need to avoid partnerships with people who have other partners," Adimora said, adding that this is especially true for black and Hispanic women.

As always, she noted, people need to use condoms every time they have sex.

SOURCE: American Journal of Public Health, December 2007.

Copyright © 2007 Reuters Limited.

NEW YORK (Reuters Health) - Among depressed U.S. military veterans, young white men have the highest risk of suicide, the results of a large VA study suggest.

Using government data for more than 800,000 veterans who were treated for depression between1999 and 2004, the investigators found that the overall suicide risk was 7 to 8 times higher compared with that in the general population.

Male veterans had roughly three times the rate of suicide as female veterans did, while younger veterans -- those ages 18 to 44 -- had a higher suicide rate than their older counterparts. Men who were 65 years or older had the second highest risk, while the lowest risk was seen among men between the ages of 45 and 64 years old.

The study also found that white veterans were much more likely to commit suicide than all other racial groups -- with a rate more than three times that of African-American vets.

Overall, the number of veterans who committed suicide during the 5-year study was on par with the rates among men in the general population suffering from depression. Of the 807,694 depressed veterans in the study, 1,683 -- or 0.2 percent -- killed themselves.

The results pinpoint those vets who might have a particular risk of developing suicidal tendencies, according to the study authors, led by Dr. Kara Zivin of the Department of Veterans Affairs and the University of Michigan in Ann Arbor.

This will become increasingly important as more and more soldiers return from Iraq and Afghanistan, Zivin and her associates note in their study, published in the American Journal of Public Health.

Along with race, age and sex, other factors were linked with suicide risk. Veterans who admitted to substance abuse were at increased suicide risk, while those with service-related disabilities were actually at lower risk than vets without such injuries. Similarly, and somewhat surprisingly, veterans with post-traumatic stress disorder (PTSD) were less likely to commit suicide than those without the disorder.

The various reasons for these links cannot be discerned from this study, according to Zivin's team. In the case of the PTSD findings, they speculate, it's possible that these veterans benefited from more-intense psychiatric care, which in turn lowered their suicide risk.

However, more studies are needed to figure out why certain factors seem to predispose some veterans to a higher suicide risk.

For now, Zivin and her colleagues conclude, the current findings point to particular groups of vets who, for whatever reason, may be at greatest risk.

"These findings can assist clinicians and policy makers in determining which veterans to more closely monitor for signs and symptoms of potential suicidal behavior and which subgroups might be targeted first in systematic efforts to reduce suicide," the researchers conclude.

SOURCE: American Journal of Public Health, December 2007.

Copyright © 2007 Reuters Limited.

NEW YORK (Reuters Health) - Routine testing for HIV recommended by the Centers for Disease Control and Prevention (CDC) appears to be inconsistent with laws in many states, according to findings published in the medical journal PLoS ONE.

CDC recommends routine HIV testing for all Americans between 13 and 64 years old. This would eliminate previous requirements for written consent and pretest counseling, Dr. Leslie E. Wolf, who is currently at Georgia State University College of Law, Atlanta, and colleagues note.

However, they point out that "this approach may conflict with state requirements." In fact, most states have laws that require specific consent. Fourteen require written informed consent and 19 require oral consent. Eleven states require pretest counseling.

Because of such legislation, "the majority of states would need to amend their laws to permit routine HIV testing." For example, states that require disclosures of specific information during pretest counseling or the informed consent process "would need either to eliminate those disclosures or make them recommendations, rather than requirements."

However, the team found that "despite strong public health recommendations" to facilitate testing, "the trend in states that have amended their laws since 2004 has been to reaffirm requirements for pretest counseling and consent."

Given the continued stigma surrounding HIV, the investigators add, it is likely that a reasonable patient standard for informed consent "would require more information about HIV testing than is currently contemplated under the CDC's recommendations."

Wolf told Reuters Health: "We think a balance can be struck so that we can increase testing among those who are unaware of their status without losing the opportunity to engage in education about HIV and prevention."

"But," she noted, "we need a better understanding of what's happening in the states when they consider changing testing laws."

SOURCE: PLoS ONE, October 2007.

Copyright © 2007 Reuters Limited.

NEW YORK (Reuters Health) - Based on findings from a Dutch study, patients with venous leg ulcers need to be encouraged to comply with compression therapy and to be more active.

"In 70 percent of all patients with leg ulcers, ulceration is caused by venous insufficiency," Dr. Maud M. Heinen and colleagues write in the Archives of Dermatology. "Physical activity and adherence to compression therapy are two vital factors in decreasing wound healing time and preventing wound recurrence."

Heinen, of Radboud University Nijmegen Medical Center and associates, recruited 150 patients with leg ulcers to take part in a study to assess their physical activity, amount of walking, and adherence to compression therapy. The participants wore an accelerometer for a week and were then interviewed in the outpatient clinic.

Overall, the patients' level of moderately strenuous activity was low compared with that of the general Dutch population and 35 percent of the patients "did not have a 10-minute walk even once a week," the investigators found.

Furthermore, exercises for the lower legs were performed by only 35 percent of patients and only 39 percent fully complied with compression therapy.

"Patients should be encouraged to enhance physical activity that aims to activate the calf muscle pump," Heinen's team points out. Patients should also be urged to comply better with compression bandage or stocking treatments.

Factors associated with better patient compliance and strategies to enhance adherence and physical activity levels should be further explored, the researchers note.

SOURCE: Archives of Dermatology, October 2007.

Copyright © 2007 Reuters Limited.