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View Article  Abuse, HIV Raise Women's Suicide Risk
HealthSCOUT (Mar 28, 04:35 PM)  MONDAY, March 28 (HealthDay News) -- HIV infection and abusive relationships are especially tough on women, with a new study showing greatly increased risks for depression and suicide attempts in women afflicted with both these problems.

"Health care and service providers who interact with women who may be HIV-positive or are in an abusive relationship should routinely look for mental health issues, such as suicidal thoughts. It may be the case that crisis intervention is needed to help women in these situations," study lead author Andrea C. Gielen, deputy director of the Center for Injury Research and Policy at Johns Hopkins Bloomberg School of Public Health, said in a prepared statement.

Reporting in the March/April issue of the journal Women's Health Issues, the researchers examined data on more than 600 women and found that abused women were four times more likely than non-abused women to have thought about suicide.

The study also found that, among women with HIV, those who were recently diagnosed thought about suicide more frequently.

Overall, 31 percent of the 611 women in the study reported contemplating suicide and 16 percent reported having attempted suicide. Half of the study participants reported problems with depression and 26 percent reported problems with anxiety.

The combination of HIV infection and a history of abuse appears especially troublesome for affected women, according to the researchers. They report that nearly three-quarters (72 percent) of abused, HIV-positive women reported problems with depression, compared with 24 percent of non-abused, HIV-negative women.

Abused, HIV-positive women were seven times more likely to report problems with depression, 4.9 times more likely to have problems with anxiety, 3.6 times more likely to have thought about suicide and 12.5 times more likely to have attempted suicide compared to uninfected women with no history of abuse.

"Given that suicide is the fourth leading cause of death for women ages 15 to 44, there is a need for further research on risk and opportunities for prevention," Gielen said.

More information

The National Mental Health Association has more about suicide.

SOURCE: Johns Hopkins Bloomberg School of Public Health, news release, March 22, 2005~SUIC~~AIDS~~DEPR~~WMEN~~DOMV~

View Article  Cannabis: We'Ve Known the Risks for Years.
 

A Special Report: Cannabis: We'Ve Known the Risks for Years. So Why is Clarke Rethinking Now?

Independent on Sunday, The (Mar 20, 09:19 AM)  Charles Clarke's second thoughts on cannabis are puzzling. The two studies, from Holland and New Zealand - which apparently prompted the Home Secretary's rethink - suggest that regular use of the drug increases the risk of psychosis in vulnerable people.

But they merely confirm what was already known about the drug. They increase the weight of evidence against cannabis, but they do not point to a higher order of risk.

It has been known for a century that heavy doses of cannabis induce hallucinations. The drug stimulates the brain to increase the production of the chemical dopamine, an excess of which is the hallmark of schizophrenia.

Any drug that increases the release of dopamine will therefore worsen the symptoms of schizophrenia. What has been unclear is whether cannabis only triggers psychotic attacks in someone who is already ill, or can cause schizophrenia to develop in someone who was previously well.

At least five studies published before the Government downgraded cannabis from Class B to Class C last year had shown people who used cannabis were at higher risk of mental illness. Research in Sweden and the Netherlands revealed that regular consumers were up to six times more likely to have psychotic episodes than non-users.

What appears to have alarmed Mr Clarke is the latest finding by a team of Dutch researchers from Maastricht University, published in the British Medical Journal last December, which showed that frequent users of cannabis who were psychologically vulnerable to its effects were at high risk of suffering a psychotic episode needing hospital treatment.

Up to 10 per cent of adults - about four million people in Britain - are estimated to have a tendency to paranoid thoughts or grandiose delusions, and could be tipped into psychosis by the drug. The researchers led by Professor Jim van Os studied 2,437 young people aged 14 to 24. They found half of those who smoked cannabis regularly and had a pre-existing risk of psychosis developed psychotic symptoms over the four-year period of the study.

The finding prompted British experts to warn that the growth of cannabis smoking among schoolchildren could trigger an epidemic of psychosis.

Professor Robin Murray of the Institute of Psychiatry said: "It may be to do with how early you start. The earlier it is, the greater the risk." Surveys suggest the average age at which people start smoking cannabis has come down since the 1970s. In the UK, two out of five 15-year-olds say they have tried cannabis, more than anywhere else in Europe.

Further evidence confirming the Dutch findings has now come from New Zealand, the second study cited by Mr Clarke, where a survey of 1,000 young people has found that those who used cannabis every day were nearly twice as likely to suffer psychotic symptoms as non- users.

Daily users were between 60 and 80 per cent more likely to experience symptoms such as hearing voices, paranoid thoughts and feelings of isolation. Professor Jim Fergusson of Otago University, who led the study published in the international journal Addiction, told the New Zealand Herald: "These are not huge increases in risk and nor should they be, because cannabis is by no means the only thing that will determine if you suffer these symptoms."

He added that the debate over cannabis had become polarised between those who believed it caused serious harm and those who argued it was harmless and should be legalised. "I think the truth lies somewhere in the middle," he said.

Cannabis is still widely accepted to be less damaging than the Class A drugs heroin and cocaine - and less damaging than the legal drug tobacco.

View Article  A Conversation About Hospital Financial Woes
Journal of Business; Spokane (Mar 07, 01:57 AM)  Editor's note: The following transcript reflects a conversation between Melissa Ahern, an associate professor in health policy and administration at Washington State University at Spokane, and Ryland "Skip" Davis, Sacred Heart Medical Center's CEO, about the financial squeeze some hospitals are experiencing and related health-care issues.

Ahern: Skip, what are the major issues facing hospitals right now?

Davis: What we know from national data is that about onethird of hospitals are doing well, one-third are breaking even, and one- third are losing money Unfortunately, here in Spokane, we're not in the one-third of the hospitals doing well. Government (Medicare and Medicaid) is our biggest payerrepresenting about 65 percent of our total business. Basically, the cost and demand for government health care is greater than the government's willingness to pay. This forces us to subsidize Medicare and Medicaid patients. We've always done that historically, but our state's deficit results in continued rollbacks in terms of what and how much is covered. This is all compounded by an ever-increasing drug formulary and rising prices for those drugs, technology, labor costs, and liability costs. Medicare faces the same issue.

Ahern: So here we are again in an era of health-care inflation rising costs and prices at a time when more and more people are aging and need additional health care. One of the big drivers of health-care costs has always been the constant growth of medical technology - new drugs, new procedures, and new equipment. Davis: New technologies, such as stents, defibrillators, and ventricular- assist devices (VADs), are examples of technologies that are very expensive. Defibrillators and pacemakers are getting more sophisticated and costly now. VADs, which help augment diseased heart function, are in hot demand, but are very costly. In fact, Sacred Heart surgeons just performed two of the first implantable VAD procedures in the country. Reimbursements for these technologies aren't keeping up with their costs, and yet the demand is growing.

Ahern: What about the issue of technology being costeffective? Do we adopt technologies that are not costeffective?

Davis: The issue with technology is that it always opens up new possibilities and therefore always introduces new costs. MRI is a very effective diagnostic tool that is costly, but enables much more effective treatment. Endoscopes cost money, but they enable excising polyps before they become cancerous. Knee operations used to involve a six-week hospital stay with a cast. Now, total knee replacements involve a fourday stay. My wife had both knees replaced. Before the surgeries, she couldn't walk across the street. Now she can go hiking and is pain-free. So there's no question that many of these technologies are cost-effective from the point of view of the additional quality of life that they confer. The pace of changing technology has quickened.

Ahern: Economists who are studying the health-care economy and the overall economy see that resources over the next decade are probably going to be more scarce, due to scarce energy resources, and due to a rapidly aging population that needs more health care. Do you think that Medicare and Medicaid reimbursements are going to continue to shrink?

Davis: Yes, I foresee continued potential rollbacks in reimbursement. Rollbacks began under the Clinton administration. There is a rollback provision in the new Medicare drug law. On top of that, our state has a $1.8 billion deficit, and there is tremendous demand for funds from higher education, K-12 education, and other social issues that need attention. So health care is in a fairly long line for funding. Federal and state governments are trying to control health care costs, and trying to force efficiencies. Meanwhile, we'll soon need to be able to provide significantly more healthcare services to accommodate the aging baby boomers. The demand continues to exceed our ability to pay for care under our existing system.

Ahern: Unfortunately, the healthcare system is broken in some key ways. Culprits include fragmentation (which results in inefficiency and poor quality), not enough focus on preventive care, payment systems with perverse incentives, and no clear consumer responsibility for costs. Is there a way to fix part of this sooner rather than later? What do we address first?

Davis: Both the government and consumers are unrealistic about health care. Over the last 40 to 50 years, we've developed a mentality that we are entitled to what we want, when we want it, no matter how much it costs. We are not on a sustainable course to be able to offer the same menu of services we've offered in the past. We've got to ask ourselves some difficult questions, such as how much our society wants to spend on the last stages of life.

Ahern: The issue of medical malpractice is currently being raised in the Washington state Legislature and in other states as one that drives up healthcare costs. Conjoined with this issue is the issue of quality in health care and medical errors.

Davis: We have a public expectation that if anything goes wrong, we turn to attorneys. However, these are risks in any given population. For example, there is a statistically documented occurrence of particular types of problems with babies who are born that have nothing to do with errors on the part of doctors or hospitals, but attorneys and patients sue anyway. Sacred Heart has a primary focus on quality and safety, and there is increasingly complementary technology that takes human error out of the equation. We are aggressively pursuing new ways to make care safe.

Ahern: What is a good example of that?

Davis: With technology, bar coding for pharmaceuticals eliminates substantial errors. A number of drugs have very similar names, so taking the writing out of prescribing drugs makes a significant difference. We were early adopters of a computer-assisted pharmacy system that cross-checks drug administration with patient, order, drug, and time, and alerts us to potential errors.

Ahern: It seems like an electronic medical record (EMR) would reduce errors. Having a record that moves with the patient from outpatient to inpatient, from city to city, would eliminate all of the confusion that comes from poor communication about what care the patient has had and needs to have next. Where are we on the EMR?

Davis: We have been moving along on that here in Spokane and are ahead of 99 percent of the rest of the country. We've digitized lab results, and whatever physicians do in the hospital can be electronically. transferred to their offices. Over 600 of our physicians have Palm Pilot devices for use. When they make rounds, they can see patient location, lab, X-ray, and progress notes. Prompting devices for physicians enable them to use time more efficiently in caring for patients. We can send digitized images (X- rays, MRIs, etc.) electronically throughout a network of 35 hospitals.

Ahern: One new initiative that is being touted by the Washington Department of Health is called Bridges to Excellence. That program is designed to help providers move toward increased electronic patient monitoring and also toward pay-for-performance. Providers are paid for quality, and are able to better produce quality because they know exactly how their patients are doing through the electronic-monitoring system.

Davis: That system works if the data is consistent and accurate. Hospitals have differences in patient acuity. Sacred Heart takes more seriously ill heart patients, so we will probably have a somewhat higher mortality rate, compared to an institution that takes less seriously ill heart patients. But good measurement and making those measures available to the public is important for both providers and patients in improving quality. The managerial process must demand accountability. And when we make mistakes, we should admit it, and indicate what steps are being taken to make sure it doesn't happen again. We are making substantial progress.

Ahern: So, if you could redesign the health-care system, what would you do?

Davis: I think the answer lies in publicprivate partnerships. National risk pools can help produce a more actuarially-sound pricing basis. States and employers can work together to come up with innovative approaches to provide some healthinsurance coverage for employees. Tax dollars will continue to have to take care of our low-income vulnerable citizens. Care should be consistent and similar across the country. The Dartmouth Atlas shows that it is currently inconsistent and there is a wide variability in treatments geographically for the same diseases. There needs to be a universal package of care available to everyone. And, consumers need to be responsible for some initial amount of care to be better connected to the economics of health-care decisions.

Copyright Northwest Business Press Inc. Feb 10, 2005

View Article  What You Need to Know About Living Wills
Scripps Howard (Mar 22, 06:35 PM)  Despite extraordinary intervention by Congress and the president in the tragic case of Terri Schiavo, she is a reminder once again of how important it is to make your wishes known for end-of-life care regardless of age.

Schiavo was just 26 years old when a heart stoppage caused severe brain damage 15 years ago, prompting a protracted legal battle between her husband and parents over whether to remove her feeding tube.

Of the 2 million Americans who die each year, 70 percent will do so after the decision is made to forgo life-sustaining treatment, yet the Schiavo case begs the question again: How will you and your family write that final act?

Q: How do I make my wishes known?

A: Start with a living will or other written instructions that describe the treatment you want if you cannot decide yourself. Discuss the instructions with your family, friends and physician, and designate someone you trust to carry out your wishes.

All 50 states and the District of Columbia have laws covering living wills and documents designating a proxy to act for you in a medical crisis. The Supreme Court recognized the right to state your end-of-life wishes in the 1990 case of Nancy Cruzan, who spent seven years on life support when a 1983 car wreck left her comatose at age 25.

Q: What conditions can I specify?

A: You can describe the quality of life you would want, or offer alternatives: How would you want to be treated if illness or accident leaves you in a coma or a persistent vegetative state? Under what conditions would you want to be put on a ventilator? A feeding tube? Antibiotics? Resuscitated if you die?

The case of Karen Ann Quinlan, left comatose by a drug overdose at age 21, brought the issue to national attention in 1976. Her parents gave a New Jersey court permission to take her off a ventilator but allowed nutrition and hydration to continue until her death nine years later.

Q: Will a living will guarantee that my wishes are followed?

A: Maybe, maybe not. The specifics of your condition, the available technology and large and small decisions made along the way typically affect your medical prognosis and appropriate treatment.

However, patients nearing death often draft a detailed written "advance directive" spelling out treatment. Someone with terminal cancer, for instance, may request chemotherapy but reject a respirator.

Health care professionals also may not honor your wishes. A study of 117 doctors published in the Archives of Internal Medicine last July found that physicians didn't follow advance directives 65 percent of the time under hypothetical scenarios for seriously ill patients.

Q: I'm afraid to surrender control of my treatment.

A: As long as you're competent, no one can override you, and you retain the right to change your instructions.

Still, designate someone you trust over 18 to act for you if you can't act for yourself. Generally, your next of kin decide the course of treatment, so a wife typically decides for a husband and a husband for a wife as Florida courts held in the Schiavo case.

Q: Can I trust my spouse or children to do what I want if it's too painful for them?

A: Ask them. A family member may be too emotionally torn to do what you want or understand what's important to you.

But whomever you choose, pick a health-care proxy who will advocate your case. In fact University of Michigan researchers Angela Fagelin and Carl Schneider contend in a recent Hastings Center Report that your proxy choice is far more important than a living will, which works in theory but may fail in practice when end-of-life decisions change radically as a patient's health declines and can't cover all contingencies.

Also, don't wait until disaster strikes to notify your proxy and discuss life-and-death issues.

Should you be the proxy, be prepared to demand the same medical updates the patient would receive and to confer with the medical team, discuss treatment options, and request consultations and second opinions.

Q: Where do I get the forms?

A: The federal Patient Self-Determination Act requires that all health care providers supply patients with the documents required by state law. Advance directives generally must be witnessed by two people (not your proxy) and may require a notary.

On the Net:

www.partnershipforcaring.org has all 50 states' forms.

www.healthdirectives.org will scan in your documents into its database and provide a wallet alert card for $18.

(Reach Mary Deibel at deibelm(at)shns.com)

© 2004 Scripps Howard News Service.

All Rights Reserved.

View Article  Ventures That Can't Be Taken on Trust
Daily Mail; London (UK) (Mar 23, 06:49 PM)  IT'S GOT all the telltale signs of a disaster waiting to happen: big tax perks, complicated investments and frenetic marketing by financial advisers.

This time the product is the venture capital trust - but like technology funds, precipice bonds and zero dividend preference shares before them, they are attracting investors who cannot afford to have their fingers burnt.

On the surface, venture capital trusts (VCTs) look like a win- win situation, offering 40pc tax relief on the investment plus tax- free growth and income so long as the shares are held for at least three years. VCTs raise a few million pounds by issuing shares to investors and put the money into fledgling businesses. Shareholders share the profits and the losses.

But there's more than one sting in the tail and the unwary investor could easily be hurt. These are very high-risk schemes, yet some VCTs allow minimum investments of just Pounds 1,000, which is bound to attract some people who cannot afford to lose money.

City watchdog the Financial Services Authority has become concerned that small investors could be tempted by the tax breaks and lock up money they can ill afford to lose.

VCTs have a number of key problems that should persuade small investors to steer clear: YOU must leave your money in them for three years for the tax break to stay intact - but most experts suggest you should really expect to leave your money for ten years.

THEIR shares can be very difficult to trade and most, if they can be sold, go for 15pc to 30pc less than the value of the assets they hold.

THE tax relief only applies on the initial purchase of the shares - so if you want to sell them the buyer won't get tax relief, which undermines their value.

SOME VCTs are being set up by companies with no experience of this style of investment.

WHILE some offer to buy your shares back at a small discount which would give you around 88pc of their true value, this guarantee is only as strong as the company which makes it - and some VCTs are being launched by potentially here-today-gonetomorrow companies.

Ben Yearsley, of independent financial adviser Hargreaves Lansdown, has scrutinised 45 VCTs launched this year. He says: 'There are ten to 15 I would not touch with a bargepole. Only a quarter to a third of them are worthwhile investments.

'I have suggested to these trusts that the minimum investment should be Pounds 5,000, but some are as low as Pounds 1,000.

These are long-term investments of at least seven to ten years and people who cannot afford to tie their money up that long should not buy purely on the back of a tax break.' The FSA is publishing warning guidelines on its internet site at www.fsa.gov.uk. It is also contacting financial advisers to make sure they are following the rules on advised sales and it is checking the activities of those launching VCTs.

Specifically it is looking at direct mail being sent to people, to check it highlights the risks prominently enough, and checking that they are targeting the right type of investor - that is those wealthy enough to consider VCTs.

It will also be looking at material sent to IFAs and press advertising.

"FSA spokesman Rob McIvor says: 'If they are targeting people with Pounds 250,000 of liquid assets that is one thing, but if they are sending material to small investors that is another thing entirely.

'VCTs are supposed to have 70pc of their money in what the Inland Revenue calls qualifying investments - these are usually start-up or fledgling ventures.

'The other 30 pc was generally put into something much less risky such as cash or bonds, but we are now seeing VCTs putting this into areas such as emerging markets or derivatives, which is pushing up the risk levels enormously.' The message is clear. By all means invest in VCTs if you can afford to lose all or most of the money if things go wrong.

But make sure you read all of the material carefully and understand fully what you are getting into. If in any doubt, go to an independent financial adviser and pay them to advise you.

t.hazell@dailymail.co.uk

View Article  Understanding Business
New Straits Times (Mar 20, 11:09 PM)  THE world has become a global marketplace.

As students explore the world of business and the opportunities and

challenges it presents, it is vital that they do so with an appreciation

of the impact of the global marketplace and international trade.

Through business courses, students will develop a fundamental

understanding of the global economy. They will come to appreciate the

impact that a business can have on their lives and communities today and

on the careers and opportunities they are considering for the future.

As students develop a better understanding of international business,

more options are available to them, allowing them more latitude to apply

their business skills.

Everyone plays a role in the process of marketing. Every product bought

and sold, as well as every service rendered or received, represents the

culmination of the marketing process.

Students will learn about the techniques and strategies used by

businesses to identify and reach potential consumers of their products

and to influence sales.

The dynamic nature of the marketing function ensures that products are

constantly improved to meet customers' expectations and that pricing

policies are responsive and effective.

No product sells itself, therefore, marketing is definitely an area of

business that is highly influenced by new and innovative strategies.

A business studies programme will build a strong foundation for those

who wish to move on to further study and train in specialised areas such

as management, international business, marketing, accounting, information

technology, computer applications, or entrepreneurship.

At Olympia College, students can get a free counselling guide on

courses daily. Call any of its counsellors for more information at

03-20503688 (Kuala Lumpur), 03-7955 8868 (Petaling Jaya), 04- 6584868

(Penang), 07-2233868 (Johor Baru), 09-5177868 (Kuantan) or 05- 2433868

(Ipoh).

You can also email raffles@olympia.edu.my

View Article  To Help Small Business Thrive, Keep Tax Cuts Alive
 

To Help Small Business Thrive, Keep Tax Cuts Alive, Nation's Largest Taxpayer Group Says

U.S. Newswire (Mar 02, 11:58 AM)  WASHINGTON, March 2 /U.S. Newswire/ -- Expiring federal tax cuts, nagging state-level tax increases, and looming proposals to boost payroll taxes constitute a triple threat to small businesses: that's the warning the 350,000-member National Taxpayers Union (NTU) gave to policymakers at a forum sponsored by the Small Business & Entrepreneurship Council.

"Small businesses could be locked out of a prosperous future unless the tax cuts of the last four years are locked in," said NTU President John Berthoud, who served as a Speaker at the Council's event. "The income tax rate reductions, phase-out of the death tax, and numerous other recently-enacted provisions have fueled America's economic recovery, for which the small business sector has provided the most horsepower."

Berthoud, who holds a Ph.D. in Political Economy from Yale University, noted that approximately two-thirds of all personal income tax returns in the top bracket report at least some earnings from a small business, making the recent reductions in this and other personal tax brackets a vital component of relief for sole proprietorships and other small firms. He also cited results from NTU's 2004 study of Tax Code complexity, which found that a decade of tinkering with federal tax laws has added a billion extra hours to the annual paperwork burdens on American taxpayers, including small businesses.

"Here today, gone tomorrow tax provisions have contributed greatly to the planning headaches of small businesses," Berthoud said. "A steadily growing economy depends on a solid low-tax structure that businesses can confidently plan around in years to come."

Berthoud also cautioned that ill-advised tax hikes from state governments could prove catastrophic to the small business sector. "In their hunt for new revenue to squander, state lawmakers have disguised tax increases as licensing fees, loophole closures, or temporary surcharges, but the result is the same - businesses and their employees are starved to fatten government's coffers," he said.

Additionally, Berthoud observed that lifting the cap on earnings subject to Social Security taxes "could hit sole proprietors with a one-two punch to their pocketbooks," in the form of a marginal tax rate increase of over 12 percent. High- earning employees of small businesses would likely see a direct tax bite as well as a loss of future wage increases, while other workers might forfeit their jobs entirely as business owners struggle to shoulder the heavier tax load.

"Until the Tax Code is scrapped in favor of a simpler system, the bottom line for businesses may depend on making the recent tax cuts permanent and avoiding punitive increases in other federal and state taxes," Berthoud concluded.

NTU is a non-partisan citizen group working for lower taxes and smaller government. Note: Further tax policy research, including NTU's tax complexity study, is available at http://www.ntu.org.

http://www.usnewswire.com

View Article  Tides of Change
Fort Worth Star-Telegram (Fort Worth, Texas) (Mar 21, 09:50 AM)  Mar. 20--FORT WORTH -- On most days, Paul Williams sits on a bar stool on his porch, a Shiner beer at hand, waving at the passing cars as the western sun glints off the water.

Shoes are optional, but fishing is not. He knows when the catfish are biting.

"Life on the lake is good," he said, a smile turning up his thick handlebar mustache.

Williams, a handyman-for-hire around Lake Worth, lives in 720 square feet on a tiny lot that sits 30 paces from the water's edge. If he's not fixing plumbing or fishing, he's using a metal detector at the swimming beaches.

He is one of the reasons Lake Worth has never been confused with the more upscale Eagle Mountain Lake, even though both stretch up the northwestern side of Tarrant County. Folks at Lake Worth are proud of the distinction.

But the colorful characters, bizarre mythologies and quirky history -- a goat man, a boardwalk, a castle -- that define the lake may eventually yield to the same suburbanization and gentrification that have transformed other areas of Tarrant County.

The reason, simply put, is the land.

After almost a century, the city is loosening its grip on the land and selling it to the homeowners, and at generous prices.

It's what the homeowners have wanted. After years of leasing their lakefront land, they suddenly own valuable property on the water just 15 minutes from downtown.

But that newfound value may force a good number of them off the lake.

Joe Waller, 59, who has lived on the lake for more than 20 years, said the houses there are all distinctive -- not remotely alike. The same could be said for the people.

"The area on the lake is improving fast," he said. "Property values have escalated extraordinarily quickly. Houses and land are selling for higher prices.

"But I like Lake Worth because it is eclectic. I like the different kinds of people who live there. We're losing a lot of the real characters. They're getting priced out by the taxes on the property."

Few places around Tarrant County have as lively a history as Lake Worth.

The lake, which the city began filling in 1914, is one of the state's oldest man-made reservoirs and still provides a third of the water supply for Fort Worth.

At least a dozen city parks line the shore, from the expansive Nature Center and Refuge to tiny Camp Joy.

An 80-year-old castle stands watch over a portion of the shoreline. But another lake icon has passed into history, a fella named Catfish Charlie, who once ruled the roost at a dive called Nova's Shady Grove.

The lake was also the site of a gruesome murder spree in 1982, when Larry Keith Robison killed his housemate and four people next door. Five years later, an F-4 Phantom coming in for a landing at what was then Carswell Air Force Base crashed in the lake, killing the pilot and the weapons officer.

"Lake Worth became so much a part of the identity of the city," said Quentin McGown, a Fort Worth lawyer and historian. "The Sunday drive around the lake was a regular part of early life. Later, it became the ultimate site for urban legends.

"I don't know how many cities have their own goat man, but not very many."

Not long after the lake was filled, people started to build on its shores. Most used the simplest brick or clapboard construction.

The city formalized the building boom by signing long-term leases with people, thus retaining ownership of the land. It was an arrangement unique in Tarrant County.

It stayed that way until the early 1990s, with the city eventually hoping to buy people out and make the entire lake parkland.

"I just realized that it wasn't going to work," said Bill Meadows, who was then the city councilman for the area. "It was a nice idea, but it was going to cost us tens of millions of dollars to buy all these improvements around the lake.

"The other dynamic," Meadows said, "was that they were leaning on their City Council person, saying 'We want to own.' "

For more than a decade, the process of transferring the property has crept along in frustrating fits and starts.

But in recent years, the change has sped up. More than a third of the 600 lakefront properties are now in private hands. And the majority of the other homeowners have an agreement with the city to buy.

Property values, meanwhile, have shot skyward. The total value of residential lots around the lake soared 76 percent from 2002 to 2003, as the Tarrant Appraisal District began making large-scale adjustments.

Owning the property has, in most people's views, improved things for the residents, even if it leaves them to wonder what the place will look like in another generation.

"If you own your property, you take more pride in it," said Waller, who was among the first at the lake to purchase his property. "Once people have a chance to buy their own property, they have more security. They invest more in it."

Oh, the days when people flocked to Casino Beach. Thousands came, tens of thousands really, in the 1920s and '30s.

Some came for the Thriller, a state-of-the-art roller coaster that climbed all the way to 72 feet. Some came to stroll the boardwalk, just like in Atlantic City, N.J.

Some put on their tuxedos and ball gowns to dance in the 31,000-square-foot ballroom, where Tommy Dorsey and Duke Ellington played to huge crowds, as Jacksboro Highway flourished as a gambling destination.

Many more came just to play on a beach with real sand during hot summers without air conditioning.

By the 1940s, Casino Beach was fading as a destination. In 1973, with the boardwalk and amusement park long gone, a wrecking ball finished off the ballroom.

One more Lake Worth memory, gone.

For 14 years, Jerry Swanson leased 7.5 acres from the city and ran the Lake Worth Marina along with a restaurant and some docks.

About two years ago, Swanson, 69, decided he wanted to retire, so he tried to sell everything but the 1.2 acres on which he lived.

"Nobody wanted to buy a marina on leased land," he said.

Eventually, the city bought it from him, as the lease required, and demolished the buildings. Swanson bought the property his house sat on for $29,000. A year later, that land was valued at $128,000.

"They sell you the land for cheap," he said. "As soon as you buy it, TAD slam-dunks you with a big tax bill. We're on a fixed income. We're having a terrible time trying to keep up with the taxes."

Fortunately for the residents, the appraisal district ruled that the land did not constitute new improvements, and the annual taxable increase was capped at 10 percent.

Shelly Harper, who has lived at the lake for 15 years and is president of the East Lake Worth Neighborhood Association, watched her property value shoot from zero to $96,000 the year she bought her land on Cahoba Drive for $20,000.

That kind of sticker shock happened throughout the neighborhood.

"I went and protested, but it did absolutely no good," she said.

The Tarrant Appraisal District said the waterfront lots are worth at least $80,000, some much more, depending on their view and access.

That's what people get when they sell the lots privately, said Randy Armstrong, director of residential appraisal.

"It's all based on sales, every bit of it," Armstrong said. "The appraisal district does not make them up. The market determines property values."

That much Armstrong and Harper agree on.

"It has definitely enhanced the opportunities for people around here to sell," Harper said.

In the 1920s, Samuel E. and Elizabeth Whiting turned an 1860s stone farmhouse into one of the most out-of-place residences ever built in Fort Worth.

A castle. A turret. A tower. Thick walls and rich woodwork. Stained-glass windows. Built on the lake's southern shore, the castle bore the legendary name of Inverness, a famous castle in Scotland and the home of Macbeth in Shakespeare's play.

Most people, though, called it the Whiting Castle.

When the couple moved out in the 1950s, actor James Stewart briefly moved in for the filming of Strategic Air Command. But the house never found owners like the Whitings.

By the 1990s, it had been stripped of many of its valuables, graffiti left in their place. The city sold the property in 2000.

The ominous-looking structure is now protected by razor wire and signs warning that the police are watching.

Just down the road, at a place called Admiral's Point, were cozy cottages used as guest houses by the castle's owners. They were bulldozed when the castle was sold by the city; three big new houses were built in their place.

John Miles and his wife live in one of them.

"We had been looking for lake property," he said. "Eagle Mountain is more expensive than we wanted to pay. Arlington is too far. Here, so many of the houses are run-down and so old, we had to give it a lot of thought."

The view from his back yard is gorgeous, and it's certainly no hassle to drive to work at nearby Lockheed Martin. But the telephone service is awful, he said, and they can't get DSL service.

"There was a lot of stuff we should have checked into before," he said.

Miles is optimistic that the area will continue to improve, that the current owners will upgrade their properties or that new owners will move in.

"There's a good tax base out there if we can get some nicer houses in the area," he said.

But development tops many residents' list of concerns.

They have watched the explosive commercial growth along Jacksboro Highway. They have voiced their worries about traffic from the new Brewer High School planned for Silver Creek Road, a two-lane thoroughfare that feeds into Loop 820.

As new homes begin to spring up near the lake, residents are pushing the city to require large lots to avoid crowded neighborhoods.

Part of the concern, they say, is based on traffic congestion, but some is environmentally based. The city's comprehensive plan calls for low-density development and less concrete around watersheds such as Lake Worth.

"We're not trying to stop development around the lake," Waller said. "That will happen regardless. We're trying to control the shape and look of development."

For more than 20 years, residents have also pressed their concerns about the depth of the lake. Lake Worth is only a few feet deep in places because of decades of sedimentation.

They watched, rather insulted, as local leaders snagged quick federal approval for $110 million to help build Town Lake downtown, wondering why the city can't find money for a lake it already owns.

"It's a public lake, but because it is so shallow, it is dangerous to go boating or skiing," Waller said. "From a safety and a recreational standpoint, the entire city would benefit from its dredging."

The city is working with the Army Corps of Engineers on a study to "environmentally restore" portions of the lake, particularly where Silver and Lone Oak creeks flow in on the western side, said Paul Bounds, the water department's Lake Worth coordinator.

"That's more limited than dredging the whole lake," Bounds said. "We're not talking about increasing the depth of the entire lake."

Nothing terrified the residents of northwest Fort Worth more during the summer of 1969 than the Lake Worth Monster.

The monster apparently lived on Greer Island, off the shore of the Nature Center, and took to hurling tires and attacking cars and generally provoking panic.

More than 100 people reported seeing him that summer. Star-Telegram stories quoting baffled authorities led to ever-greater numbers of gun-toting would-be monster killers roaming the lake's shores.

The monster was described as a 7-footer with a heck of a foot. One footprint was reported to be 16 inches long and 8 inches wide.

He was hairy and believed to be half-man, half-goat.

But he apparently disappeared as quickly as he came. He hasn't been seen since.

Williams, the handyman, pays $55 a month for his lease, an admittedly sweet deal for the luxury of walking barefoot to his boat dock to throw a line in the water.

He's lived at the lake since 1983 and knows many of the other long-timers and their quirky houses. He's now on a stretch of Watercress Road that the city plans on keeping because the houses sit too close to the road, creating problems with rights of way, officials said.

Not that it matters much to Williams anyway. Even if he could come up with the money to buy the land, the taxes would eat him up.

"It makes more sense financially for me to stay with the lease," he said. "I'll stay here as long as I can."

Gracey Tune, the sister of famed Broadway dancer Tommy Tune, has much the same feeling.

She's lived on the lake since 1979. She chose Lake Worth because of its people.

"We looked at two-thirds of the houses on Lake Worth when I first moved out here," said Tune, who runs a neighborhood art and dance studio in Fort Worth. "A lot of those people are gone. I've seen more of the change in the last few years.

"Now I look across the lake and say, 'When did that house go up?' "

After renting all those years, Tune bought a 1940s-era house on Mosque Point in December. She doesn't own the land because she missed the chance to pay the affordable price from the city. The market price, her only option now, is at least $100,000.

But, like Williams on the other side of the water, she will stay as long she can.

"We had these neighborhood bars that you walked to, and people would bring their food in and we would tell stories," Tune said. "I met a man who made his own wild grape wine out of the vines out there. The memories are so rich for me.

"There aren't any places like that anymore."

Staff writer Jeff Claassen and news researcher Marcia Melton contributed to this report.

MOST LAND ALONG LAKE WILL BE SOLD TO RESIDENTS

Almost all the residents living along the shore of Lake Worth have signed an agreement with the city that gives them the right to purchase their leased land at 2001 appraised values.

When the proper infrastructure -- including sewer service -- is on each tract, the city puts the land up for sale, said Doug Rademaker, who oversees real property management for the city.

The city has taken in $3.4 million from the sale of 238 properties. An additional 320 properties remain to be sold, Rademaker said.

About 40 of the leases won't change hands because running water and sewer to the areas is too expensive or because there are access issues, he said.

"We'll continue to honor the leases, but we won't be able to sell," Rademaker said.

The money from the sales is deposited into the Lake Worth Infrastructure Fund.

Only one area -- around Love Circle -- has not received water or sewer services, according to Paul Bounds, the water department's Lake Worth coordinator.

The city hired an appraiser in 2001 to set values on the property, but the prices remain far below the market. That's not a problem, Rademaker said.

"Since the city had a long-term relationship with the residents, we thought it was in our best interest to convey the property to them," he said.

--Chris Vaughn

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