So how do you know if you or your children have H1N1 flu or if your symptoms are severe enough to require medical treatment? The latest way is a free interactive website from The American Medical Association (AMA), built with partners Microsoft and personal health record provider Healthy Circles. The website offers information about seasonal and H1N1 flu and gives advice on when to seek professional help. The site asks a series of questions about a patient’s symptoms and history, and then lets the patient know if they need to see a doctor. But unlike other self-assessment flu sites, this website also allows doctors to communicate with patients and will eventually permit doctors to prescribe routine medications online.

Using information based on the latest CDC flu guidelines, the site helps patients determine the severity of their flu symptoms and, if they choose, share that information with a physician on a forum similar to that of Facebook. Physicians are then able to use tools on the site to monitor their patients’ symptoms, and manage patient flow within their respective practices.

“It’s basically Facebook for health care,” said Dr. James Mault, Chief Executive Officer of Healthy Circles, which developed the Web site. “I think that may help in a small way in reducing the worried well and the worried not-so-sick who are overwhelming our system right now.” And the site complies with medical privacy laws, he said.

Dr. Mary Anne McCaffree, a pediatrician from Oklahoma City and member of the AMA board, says that with both the seasonal flu and the H1N1 virus circulating, doctor’s offices are already seeing much more traffic than normal. “This resource allows patients to access their symptoms and determine when to seek care for themselves or their loved ones,” she said. “To prevent the spread of influenza, this site also helps determine when it is safe for those who have been sick to return to work or school.”

Colorado is the first state to adopt the technology, which will link government health sites in Colorado directly to the AMA site. “As part of Colorado’s dedication to healthcare technology, we are proud to be the first state in the nation to support this new online tool for Colorado families and healthcare professionals,” said Governor Bill Ritter. “This new tool will play a critical role in helping to reduce demands on our healthcare system.”

McCaffree said the site is the first step in a larger AMA initiative that will provide additional online tools for patients and doctors. As those tools are developed, new conditions outside of the flu will be added to a larger “umbrella portal.”

The patients were followed for a median of about seven to nine years, during which time there were 3,049 deaths among those with CD, 2,967 among those with inflammation, and 183 among the latent CD group. When the data was compared to records of the Swedish Total Population Register, all three groups had a higher risk of death than a matched control group; a 35 percent increased risk for those with latent CD, a 39 percent increased risk for those with CD, and a 72 percent increased risk for those with inflammation.

The risk of death was highest in the first year of follow-up, with latent CD associated with a 1.8-fold increased risk of death, CD with a 2.8-fold increase, and inflammation with a 4.7-fold increase. After the first year of follow-up, these figures decreased. The risk of death also decreased with age at diagnosis, with risk being higher for those diagnosed before age 20. “In conclusion, we found increased (risks) for death in individuals with biopsy-verified celiac disease, inflammation, and latent celiac disease, although absolute risks were small. Individuals undergoing small-intestinal biopsy in childhood had increased (risks) for death. Cardiovascular disease and malignancy were the main causes of death in celiac disease,” the authors write.

Jonas Ludvigsson, the study’s lead author and an associate professor of pediatrics at Orebro University Hospital, Sweden proposed several explanations for the increased mortality rates, including “malnutrition of energy and vitamins and chronic inflammation.” He said the higher risk in those with inflammation may because they weren’t told to follow a gluten-free diet, which often leads to normalization of the disease.

In an accompanying editorial, Dr. Peter H.R. Green, director of the Celiac Disease Center at Columbia University College of Physicians and Surgeons in New York, writes that the study provides important information on the risks associated with CD and raises the importance of doctors diagnosing the disease. “Until recently, gluten sensitivity has received little attention in the traditional medical literature, although there is increasing evidence for its presence in patients with various neurological disorders and psychiatric problems. The study by Ludvigsson and colleagues reinforces the importance of celiac disease as a diagnosis that should be sought by physicians. It also suggests that more attention should be given to the lesser degrees of intestinal inflammation and gluten sensitivity.”

According to the Celiac Sprue Association, about 1 of every 133 people has CD, but only about 3 percent have been diagnosed. Strict adherence to a gluten-free diet remains the only treatment for the disease, which can be very challenging since gluten can be found in everything from breakfast cereals and prepared luncheon meats to lip balms and lotions. Ingestion of gluten in any form can trigger CD to become active