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Heart patients should be regularly screened for signs of depression, the American Heart Association recommended Monday.

Depression is about three times more common in heart attack survivors and those hospitalized with heart problems than the general population, according to the recommendations published in the journal Circulation. The authors said only about half of heart doctors say they treat depression in their patients — and not all those diagnosed with depression are treated.

“I think we could reduce considerable suffering and improve outcomes,” by screening, said Erika Froelicher, professor of nursing at the University of California, San Francisco. “I know we can do more.”

While there’s no direct evidence that heart patients who are screened fare better, depression can result in poorer outcomes and a poorer quality of life, the panel said. Depressed patients may skip their medications, not change their diet or exercise or take part in rehabilitation programs, they said.

Anyone from cardiologists to nurses to primary care doctors can and should be involved in determining whether a patient is depressed, said Froelicher, who was co-chair of the panel that wrote the recommendations.

The panel suggests that heart patients be screened by first asking two standard questions: In the past two weeks, have you had little interest or pleasure in doing things? Have you felt down, depressed or hopeless?

If the patient answers yes to one or both, a questionnaire is recommended to determine if the patient is depressed and the severity. If depression is indicated, the patient may need to see a professional qualified in treating depression, the panel said, adding that treatment options include antidepressants, seeing a psychotherapist and exercise.

“Some physicians are qualified to treat it — others may be more comfortable referring the problem to a qualified mental health professional,” Froelicher said.

Psychiatrist Michelle Riba said the statement’s emphasis on frequent screening is important.

“What you want to see in a particular patient is how they do over time,” said Riba, past president of the American Psychiatric Association, which has endorsed the heart association’s recommendations.

One doctor said screening isn’t enough; patients need close monitoring to make sure they get help.

“A lot of patients with depression don’t follow up on it,” said Dr. Mary Whooley, a professor of medicine at the University of California, San Francisco, who was not on the panel.

Barbara Forman, 62, struggled with depression after her double bypass about five years ago. She said she spent most of her time at her Englewood, Ohio, home sitting in her chair, frequently crying for no reason. When she did get out, she was often winded, even from a walk up a sidewalk to deliver cupcakes to her grandchild’s classroom.

“I’m thinking, is this the way it’s going to be for the rest of my life? Since I’ve had a heart event, is my life over?” she said. “It also made me afraid to do things. I didn’t know how a heart attack felt. I would think, ‘Is this a heart attack?’”

A couple of months after she got home she called Mended Hearts, a group affiliated with the heart association that provides support to heart patients, and talked to someone who let her know depression was common in heart patients.

Her family doctor sent her to a psychologist, and after some initial reluctance, she started taking an antidepressant. That, along with starting a walking routine and volunteering with Mended Hearts and the heart association, improved her outlook.

“You can’t sit in your house and just vegetate,” she said. “Over the last 18 months to two years — It’s really gotten better.”

In the small rural village of Eshisiru in Western Kenya, hundreds of women in colourful dresses, many of them surrounded by a gaggle of children, queue patiently in the midday sun. These women are not waiting to draw water from a borehole or to buy food. Instead, they are waiting to be tested for HIV - something that campaigners say is virtually unheard of in Africa.The concept behind the programme that has brought people out in such numbers is very simple: Giving away a long-lasting insecticide-treated mosquito net, a water filter and condoms in exchange for taking the test.

‘The response has been overwhelming,’ says Peter Cleary, communications director of Vestergaard Frandsen, the private company providing the free pack and funding the testing. ‘Over 10,000 people showed up on the first day; on the second day we had almost as many.’

The project, run in cooperation with the Kenyan Ministry of Health and other non-governmental organisations, aims to test 43,000 sexually active people aged 15-49 across Lurambi District.

At the moment, less than 20 percent of Kenyans know their HIV status and there are an estimated 1.2 million HIV-infected Kenyans who do not know they carry the virus.

You don’t have to be a health worker to deduce a person ignorant of his or her status is more likely to spread the disease, and most of the people taking the test acknowledge this.

‘It is important to be tested because if people know their status they are going to change their behaviour,’ says 30-year-old Sarah Mukoshi, who queued for over two hours before receiving her pack.

However, those involved in running the project - many of whom have taken part in previous, less successful testing campaigns for various diseases - are in no doubt the real reason people have turned out is the freebies.

‘They are all saying they came to be tested, but you have to ask yourself why there is such a difference in turnout now,’ says Louis da Gama of Global Health Advocates.

Even experienced campaigners like da Gama are surprised by the demand, but the desire to get a hold of a free mosquito net is perfectly understandable given that malaria is one of the top killers in Africa.

Around 90 percent of the one million deaths from malaria each year occur in Africa, largely due to the lack of preventative measures.

In Kenya, only 52 percent of all children sleep under a mosquito net. The figure for pregnant women is 37 percent.

Considering that according to World Health Organization figures, diarrhoea accounts for up to 7.7 percent of all deaths in Africa, the water filter also is a major draw.

So attractive is the free pack that even frail old men and women, not exactly a high risk group for HIV/AIDS, have been showing up to be tested.

Part of the apparent success is also down to holding the testing in a central location, thus encouraging everyone to come at the same time and overcoming the stigma of individual testing.

‘Because people are coming in big numbers, nobody is embarrassed,’ says Christine Amboya, 23, as she is queuing together with her neighbours.

For those who do test positive, counselling is immediately available to help deal with the blow of being diagnosed HIV positive.

‘Most people come expecting to be negative because they don’t feel sick and are still able to work,’ says Beatrice Awino, manager of the Eshisiru testing site.

‘They are distraught when they find out they are positive.’

Also important is the fact that machines are located at many of the sites to test people’s CD4 count - the marker which determines the need to begin anti-retroviral treatment.

At Eshisiru alone, 40 people tested positive out of 650 in the first two days - slightly below the estimated national infection rate.

Of those 40 people, eight had to be put on to anti-retrovirals - made available in advance by the Kenyan Ministry of Health - immediately.

However, as successful as the testing programme appears to be in the early stages, it still has to be rolled out across Kenya to help the East African nation meet its goal of having 80 percent of all adults know their HIV status by 2010.

Vestergaard Frandsen is only funding the initial 43,000 tests, but from the level of interest being shown in the project, the money to take the project nationwide should not be long in coming.

Premier Wen Jiabao promised to improve Chinese food safety amid a widening scandal over tainted milk that has sickened more than 50,000 children. Wen, speaking at the World Economic Forum in the port city of Tianjin on Saturday, did not announce new initiatives but promised that the government would work to instill business ethics after a string of product safety disasters. “We plan not only to revitalize the food industry and the milk powder industry, we will try to ensure that all China-made products are safe for consumers and consumers can buy with assurance,” Wen said. The latest scandal erupted this month after the industrial chemical melamine, which is used to make plastics and fertilizer, was found in milk powder and linked to kidney stones in children.

The chemical was also found in liquid milk, yogurt and other products. Four deaths have been blamed on the bad milk, and some 54,000 children have developed kidney stones or other illnesses after drinking the contaminated baby formula.

Authorities say suppliers might have added melamine, which is rich in nitrogen, to watered-down milk to deceive quality tests for protein. The incident “has revealed to us that in the process of development, the government should pay more attention to business ethics and social morality,” Wen said.

He also defended the handling of the crisis by Beijing, which has in the past been accused of reluctance to come clean in situations that could potentially embarrass the Communist leadership. “When this kind of problem of food safety occurs, we do not cover it up,” Wen said.

“We face it candidly and have taken bold moves to address it. I think this has laid a good foundation for resolving problems.

” Also Saturday, a welfare group said almost a dozen Chinese orphans have been sickened by the tainted milk. The children, who live in orphanages around the country, are being treated for kidney stones at hospitals after drinking Sanlu brand powdered milk, the Half the Sky Foundation said on its Web site.

“All orphanages using identified tainted brands have changed to either fresh milk or to a brand that has been identified as safe,” said Jenny Bowen, executive director of the Berkeley, California-based group that provides services, supplies and work crews to 41 Chinese orphanages. Health experts say ingesting a small amount of melamine poses no danger, but in larger doses, the chemical can cause kidney stones and lead to kidney failure.

A combative Health Minister Anbumani Ramadoss, who has lost his battle with the government on legalising homosexuality, says India should wake up to the growing global acceptance of gays as this would ensure ‘an effective fight against AIDS’.'I would like to help gays come overground for an effective fight against AIDS. The world over gays are being accepted. We too need to move on,’ Ramadoss told IANS in an interview.

During the interview, he also spoke of the launch in two months of a Rs.7.5-billion National Emergency and Trauma Programme that will eventually see 20,000 ambulances across the country immediately responding to highway accidents, and of the National Nutrition Mission that aims to eliminate malnutrition by 2015.

According to the minister, he was aware of the social opposition to his demand to de-criminalize men having sex with men (MSM) but this was ‘a very serious issue from the AIDS-control point of view.

The National AIDS Control Programme, which is in Phase III (2007-2012), was being ‘adversely impacted because it is difficult to reach out to the gay population of the country. According to estimates, in India there are 2.46 million men who have sex with men. We know the HIV infection status of only 50 percent of these men. Eighty-six percent of HIV infection is through the sex route, which includes MSM and transgender,’ the minister pointed out.

He lamented that because of Section 377 of the Indian Penal Code that bans unnatural sex, a doctor could be arrested for treating a gay and a health worker could also be arrested for advising MSM about HIV infection.

‘Imagine the problem this means when it comes to our fight to contain HIV infection. While I fully support protecting children against sexual abuse and treating pedophiles as criminals,I would like to help gays come overground for an effective fight against AIDS.’

Answering a question on continued deaths due to malnutrition, Ramadoss said that for the last one year, the health ministry and the women and child development ministry had been working on the National Nutrition Mission that aims to eliminate malnutrition by 2015.

‘The programme will be rolled out shortly. The prime minister is very concerned about this problem and had three detailed discussions with us on the programme. In India, there is malnutrition because of poverty and also because of indulgence in the wrong sort of food. To tackle this, we will launch before December 2008 the National School Health Programme which will ensure that schoolgoing children are screened for eye and nose diseases, are taught about HIV, environment and a good diet,’ the minister stated.

Queried on the steps being taken to raise the standard of care and medical assistance provided in hospitals and government health centres, the minister said the Rs.7.5 billion National Emergency and Trauma Programme would be rolled out in two months.

‘Under this initiative, we will set up trauma centres on the country’s highways. There will be a telephone booth every five km to report a health emergency. At every 50 km, there will be a fully loaded ambulance on standby.

‘A basic trauma centre will be established every 100 km while there will be a super specialty trauma centre every 500 km. Existing facilities will be used to provide these services. We hope to cover the entire highways in the next two years.

‘We will soon also have an all-India emergency toll free number (108) that will alert ambulances of any emergency. Already there are 15-25 ambulances under this in states that have rolled out the programme (Gujarat, Andhra Pradesh and Uttarakhand). Ten other states have signed an MoU to avail of this facility. In three years, we expect a fleet of 20,000 ambulances to operate under this programme.’