Two recent government reports on the nation's mental health system conclude there's need for "dramatic" overhaul. But in its September analysis an independent federal agency -- the National Council on Disability -- emphasizes among "root causes" of the crisis inadequate state and federal funding and access disparities in public and private insurance. An Oct. 29 analysis from President Bush's New Freedom Commission on Mental Health, on the other hand, has little to say about fiscal matters of any kind, although its authors note that the current system is "incapable of efficiently delivering and financing effective treatments." Both reports say that fragmentation of service delivery and fragmentation of responsibility for mental health care have worsened as the nation moved over the past five decades to deinstitutionalize mentally ill patients. "The movement away from institutions . was motivated by reformers' desire to bring services to people in their communities, " says the Commission. "The unintended consequence is that responsibility is scattered across levels of government and across multiple agencies." As is the case in many other parallel sections of the papers, the Council's analysis generally agrees but expands its comments to include the role of financing. "Community mental health services are generally no more expensive than institutional care, " says the group. "However, to shift a system from over-reliance on institutions to one that provides more appropriate and more effective community services and supports requires an investment in the community. Start-up costs, along with the need to ensure that people continue to receive care while new community options come on line, have hampered states' ability to ensure that resources follow individuals into the community." But "far from meeting these obligations" to develop community-based care systems and maintain transitional institution-based care during the changeover, state investments in mental health have decreased over the decades, according to the Council. "State-only appropriations for mental health services are significantly lower today adjusted for inflation and growth in population ; than they were in 1955." Both reports exhort Americans to end the stigma surrounding mental illness. The Commission analysis quotes President Bush's statement at the panel's April launch: "Americans must understand and send this message: mental disability is not a scandal -- it is an illness." But again, the Council report goes much further, finding that fiscal consequences of stigmatization have created some of the most serious barriers to care. "The underlying stigma surrounding mental illness has led to systemic inequality in all health care delivery. For example, the private sector refuses to insure individuals with a history of any mental health treatment, when they will insure an individual with more severe physical health care needs." The October report is an interim analysis from the president's Commission. In a concluding statement.
Was maintained at two years follow-up Table 1 ; . Of note, Caucasian patients n 322 ; experienced significantly worse GI symptoms preoperatively than African-American patients n 78 ; p 0.05 ; , but there was no difference observed postoperatively. Table. Mean GISS cluster scores SD for LRYGB patients pre- and post-operatively. Pre-Op 1 Year 2 Years N 400 177 82 Abdominal Pain 14.71 + 13.2 ; 14.4 + 13.6 ; 24.7 + 19.8 ; p-value Ref 0.0001 p-value na Ref 0.8 Irritable Bowel 19.8 + 14 ; 15.9 + 11 ; 13.9 + 10.3 ; p-value Ref 0.0005 0.0001 p-value na ref 0.1 GERD 40.5 + 21.6 ; 15.6 + 15.3 ; 21.1 + 16.2 ; p-value Ref 0.0001 p-value na Ref 0.01 Reflux 33.9 + 22.9 ; 8. + 11.8 ; 10.4 + 12.5 ; p-value Ref 0.0001 p-value na ref 0.45 Sleep Disturbance 47.3 + 28.6 ; 22.4 + 24.1 ; 32.6 + 27.5 ; p-value Ref 0.0001 p-value Na Ref 0.005 Dysphagia 13.9 + 21.5 ; 5.7 + 12.1 ; 9.0 + 15.5 ; p-value Ref 0.0001 0.02 p-value Na ref 0.1 Conclusion: Weight loss following LRYGBP significantly improves common GI complaints observed in obese patients. Intensity of symptoms normalized and improvement was sustained at 2 years follow-up. 33. PREGNANCY OUTCOMES AFTER GASTRIC BYPASS SURGERY. Tuoc N. Dao, MD, Joseph Kuhn, MD, Dale Ehmer MD, Tammy Fisher, RN, Todd M. McCarty, MD, Baylor University Medical Center, Houston, TX. Background: There are limited data to support the delay of pregnancy for the first year after gastric bypass surgery. The purpose of this study is to compare outcomes of patients who become pregnant within the first year after surgery. Methods: A retrospective review was performed to identify patients who became pregnant after their gastric bypass surgery from 2001-2004. Data sources included medical records and telephone interview. Results: Of 2, 423 patients who had undergone bariatric surgery from 2001-2004 nineteen patients became pregnant within the first postoperative year. The average patient age at pregnancy was 31 y range 25-39 ; , and the average BMI was 34 range 25-50 ; . There were 15 live births 35-40 weeks ; , 3 miscarriages, and 1 ectopic pregnancy. Nutritional deficiencies included one patient with anemia that improved with supplements. Average weight change during pregnancy was a 4 pound weight gain range loss of 70 lbs to gain of 31 lbs ; . The average fetal birth weight was 2, 943 grams range 1, 786-3, 940 ; . No congenital defects were seen. Problems during pregnancy included transient preterm labor n 1, pregnancy induced hypertension n 1, placental abruption resulting in emergent caesarean section n 1, and bed rest n 1. No problems related to the bypass surgery were seen. Conclusion: The course of pregnancy within the first year after weight loss surgery did not carry any significant episodes of and cyproheptadine. Implantable Cardioverter-Defibrillators. Devices called Implantable cardioverter-defibrillators ICDs ; , which are sometimes combined with pacemakers, may be effective for preventing arrhythmias in heart failure patients. Studies have found them effective in preventing sudden death from severe rhythm disturbances in patients with weakened hearts from previous arrhythmias and in patients with genetic hypertrophic cardiomyopathy. They have also shown limited benefits in improving exercise capacity and quality of life and slowing the progression of heart failure!