Deadly Meningitis Cases Worry Gay Community

By Randy Dotinga
HealthDay Reporter

TUESDAY, April 23 (HealthDay News) -- A series of bacterial meningitis cases in Southern California and New York City, resulting in the deaths of several gay men, have set the gay community on edge. However, preliminary tests suggest the cases on each coast aren't connected.

Health activists became concerned in Los Angeles after a 33-year-old gay attorney from West Hollywood suddenly became ill from meningitis and died on April 13. The AIDS Healthcare Foundation, which advocates for health for gay men, initially criticized local health officials for not pushing for vaccinations. However, "we don't think it's part of an outbreak or due to him being a gay man," said Dr. Wayne Chen, the organization's acting chief of medicine.

Still, the Los Angeles County's public health department is offering meningitis vaccinations for free for those who are poor or uninsured.

In New York City, health officials are recommending that certain groups of gay and bisexual men, along with certain visitors to the city, get vaccinated against meningitis.

According to Los Angeles County health officials, four cases of meningitis in gay or bisexual men have been confirmed in the region since December, including one 30-year-old who died of meningitis in Los Angeles, and another man of the same age who died in the San Diego area, both in December, according to news reports.

The officials say the four Los Angeles cases in gay and bisexual men don't appear to be "highly related" to those elsewhere in Southern California or in New York City.

In New York City, officials have noted more than 20 meningitis cases since 2010 in gay or bisexual men; seven of the men died. The city recommends vaccinations for any HIV-infected gay or bisexual men and those who have had close or intimate contact with men they met via websites, apps or at bars or parties. Visitors who have been to the city since Sept. 1 and engaged in these types of activities should get vaccinated too, city officials added.

Meningitis is transmitted through close contact with an infected person and kills, often quickly, by causing the lining around the brain to swell. It commonly spreads through places where people live closely together, such as dorms and military housing.

Meningitis hasn't previously been connected to gay men in particular, Chen said.

Many people have the bacteria that cause meningitis in their nasal passages, but the germs often don't cause problems, said infectious disease specialist Dr. William Schaffner, chair of the department of preventive medicine at Vanderbilt University Medical Center. "They can carry these bacteria for long periods of time and transmit them to other people without being aware of the process."

The germs can create a mild illness at first that can quickly turn deadly, especially if the bacteria gets into the bloodstream, he said.

"You feel kind of punky, and you maybe have a sore throat," Schaffner said. "You lose your appetite, you get drowsy. Then you can slip into a coma."

Antibiotics effectively treat bacterial meningitis, he said, but they must be given quickly. That's why people should seek medical care if they suffer from symptoms like stiff neck, high fever (beyond 100.1 degrees Fahrenheit) or severe headache, he said.

Meningitis vaccines cost about $100, Chen said, and can cause side effects that are similar to those possible in people who get flu vaccines. The vaccines work against most strains of meningitis, Schaffner said, and take 10 to 14 days to become effective.

Copyright © 2013 HealthDay. All rights reserved. SOURCES: William Schaffner, M.D., professor and chair, department of preventive medicine, Vanderbilt University Medical Center, Nashville, Tenn.; Wayne Chen, M.D., acting chief, medicine, AIDS Healthcare Foundation, Los Angeles

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Community Gardening May Reap Body Weight Benefit

FRIDAY, April 19 (HealthDay News) -- People with plots in community gardens are less likely to be overweight or obese than those who don't garden, a new study suggests.

"It has been shown previously that community gardens can provide a variety of social and nutritional benefits to neighborhoods," study author Cathleen Zick, a professor of family and consumer studies at the University of Utah, said in a university news release. "But until now, we did not have data to show a measurable health benefit for those who use the gardens."

She and her colleagues looked at the body-mass index (BMI) of 198 community gardeners in Salt Lake City and compared them to non-gardening neighbors. BMI is a measurement of body fat based on height and weight.

The BMI of female community gardeners was an average 1.84 points lower than their neighbors, a difference of 11 pounds for a 5-foot-5 woman. The BMI of male community gardeners was 2.36 points lower than their neighbors, a difference of 16 pounds for a man at 5 feet 10 inches.

Compared to nongardeners, the likelihood of being overweight or obese was 62 percent lower for male gardeners and 46 percent lower for female gardeners, according to the study appearing online April 18 in the American Journal of Public Health.

The researchers also found that gardeners had lower BMIs than their same-sex siblings. The average BMI was 1.88 lower for female community gardeners compared to their sisters and 1.33 lower for male community gardeners compared to their brothers.

There was no difference in BMI or the risk of being overweight between married gardeners and their spouses. That is not surprising because spouses would likely help out with gardening and benefit from eating the healthy foods produced in the garden, the study authors noted.

These findings support "the idea that community gardens are a valuable neighborhood asset that can promote healthier living. That could be of interest to urban planners, public health officials and others focused on designing new neighborhoods and revitalizing old ones," Zick said.

But while "these data are intriguing," she noted, "they were drawn from participants in a single community gardening organization in Salt Lake City and may not apply broadly until more research is done."

And although the study found an association between gardening and lower BMI, it did not prove a cause-and-effect relationship.

-- Robert Preidt
Copyright © 2013 HealthDay. All rights reserved. SOURCE: University of Utah, news release, April 18, 2013

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Guideline Changes Have Asperger's Community on Edge

By Lisa Esposito
HealthDay Reporter

THURSDAY, April 18 (HealthDay News) -- People with Asperger's syndrome -- mild autism with normal or sometimes superior verbal ability and intelligence -- are at a crossroads: Their diagnosis is about to disappear.

In 1994, Asperger's was recognized as its own disorder in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-4). For some people, realizing that they fit into the Asperger's diagnosis was a "eureka" moment of sorts.

In mid-May, however, the American Psychiatric Association (APA) will unveil the latest edition of the diagnostic manual. In the DSM-5, the Asperger's term will not exist -- and many people with Asperger's are upset.

Hallmark symptoms -- significant impairment in work and social functioning, inability to understand nonverbal communication, repetitive behaviors and restricted routines -- will be folded into the term "autism spectrum disorders," ranging from the mildest to most severe autism.

The APA says that with the change, diagnosis will become more accurate and consistent.

"The intent was that it would make diagnosis more straightforward," said Catherine Lord, a member of the APA group that updated the diagnoses. "They're not necessarily different disorders because, at least biologically, nobody can differentiate Asperger's from autism."

"One of the good things that the idea of Asperger's syndrome did was make people aware that somebody can have quite significant social deficits but be a very intelligent person," said Lord, director of the Center for Autism and the Developing Brain at New York-Presbyterian Hospital. "The goal of our committee is not to lose those people but to say they can be recognized within this broader concept of autism spectrum disorders."

But many with Asperger's believe they will fall off the spectrum and lose access to needed services. And they fear that their very identity is at stake.

Some people with Asperger's syndrome "formed their first identity of normality within the group," said Liane Holliday Willey, senior editor of the Autism Spectrum Quarterly and an autism consultant in Grand Rapids, Mich. She has Asperger's.

So does Brian King, an Illinois-based relationship coach and licensed clinical social worker. With the change, he said, "people who have embraced the Asperger's label are now thinking, 'I have an Asperger's support group. I call myself an Aspie. If you take that from me, who am I?'"

It's not clear how many people have Asperger's. Estimates vary anywhere from three in every 1,000 to one in every 200 people. But experts say the impact of the change will be widespread.

In the United States, DSM diagnoses are closely aligned with health insurance billing. Internationally, governments and social agencies use the manual to approve funding for services and research.

"[The DSM] has repercussions throughout the world, especially the English-speaking world," said Tony Attwood, an adjunct professor at the Minds & Hearts clinic in Brisbane, Australia.

"I think the banning of the term Asperger's syndrome is too premature," Attwood said. "They're very upset [in Australia]. So they have to explain to, for example, employers, that they are now to be called autistic and have mild autism."

In October, APA member Lord published a study that found only about 10 percent of children would lose their autism diagnosis under the new criteria. Attwood, however, said estimates of people who will lose funding eligibility range anywhere from 10 percent to 75 percent.

King said people who are not obviously struggling may lose out.

"If there is some kid in college who's an intellectual juggernaut -- they can pass socially, who can think his or her way through social situations -- but is so in need of services on campus, in need of accommodations, that's the person I'm worried about," King said. "The one who, underneath it all, is suffering, but is so good at passing that they're off the radar of a lot of diagnosticians."

For children with Asperger's, early intervention, which includes parent training, is considered ideal. One question is whether early intervention will be easier or harder to obtain under the new criteria.

"In California, for example, if you have an Asperger's diagnosis, you are not eligible for the autism services as a young child," Lord said. But Attwood said he's concerned that with the change, "parents may not be eligible for early intervention services before the child goes to school."

Lord said a family "must be ready if they meet someone who doesn't understand the new criteria to be able to say, 'Look, one principle is a lack of social reciprocity. And even though my son is 12 years old and very bright and does go to school and does love his teacher and does take turns well, he still really struggles with ... understanding what a friend is even though he has play dates and does do things.'"

Eric Lipshaw, 21, a student at Oakland University in Rochester, Mich., is "110 percent" against the diagnosis change.

"I get disability support services, assistance on campus," Lipshaw said. "They give me a scribe for my handwriting -- that's illegible. They have note-takers and anything else we need."

Some job seekers with Asperger's turn to agencies that specialize in people with disabilities. Other adults need social security benefits or residential services. Some will lose these services along with the Asperger's diagnosis, Attwood said.

Karen Rodman, president and founder of Families of Adults Affected with Asperger's Syndrome, said although the Asperger's listing in DSM-4 was inadequate it was better than not using the term at all.

Rodman, whose husband has Asperger's and Tourette syndrome, said people with the diagnosis and their family caregivers already have unmet needs for assistance that will only get worse with the change.

One undercurrent in the debate has been the suspicion that the change was made to cut costs. Attwood and King both said that although that might or might not have been an intention, it will be an effect.

"The medical insurance companies and other agencies will save money," Attwood said. "I can't say that this has been the driving force of the change; all I know is that this is the highly probable outcome. With fewer people being diagnosed, it's going to be less expensive for the agencies that support such individuals -- either government or private."

Some people with Asperger's may fit under "social communication disorder" in the new DSM-5.

The manual also is adding "sensory sensitivity" to the autism spectrum criterion. This involves extreme sensitivity to a person's environment, including the touch of other people, the sensation of the clothing they wear, and sights, smells and sounds around them. Attwood praised this addition.

"The ultimate impact of the DSM is going to be wait-and-see," King said. "It's a guideline, not an absolute end-all and be-all of how to treat this. A clinician can use their own judgment based on their own experience."

Copyright © 2013 HealthDay. All rights reserved. SOURCES: Catherine Lord, Ph.D., director, Center for Autism and the Developing Brain, New York-Presbyterian Hospital/Weill Cornell Medical College, New York City; Liane Holliday Willey, senior editor, Autism Spectrum Quarterly, and autism consultant, Grand Rapids, Mich.; Brian R. King, L.C.S.W., relationship coach, Illinois; Tony Attwood, adjunct professor, Minds & Hearts Clinic, Brisbane, Australia; Eric Lipshaw, college student, Oakland University, Rochester, Mich.; Karen Rodman, president and founder, Families of Adults Affected With Asperger's Syndrome

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