Methodist Specialty and Transplant Hospital
Methodist Children’s Hospital
Methodist Heart Hospital
Methodist Healthcare Hospitals
Methodist Healthcare Hospitals, 800.333.7333 (Toll Free) | www.sahealth.com
University Health System
4502 Medical Drive, San Antonio, TX 78229
210.358.4000 | www.universityhealthsystem.com
St. Luke’s Baptist Hospital
7930 Floyd Curl Dr., San Antonio, TX 78229
210.297.5000 | www.baptisthealthsystem.com
Women’s health services are dedicated to treating women’s unique biological and physiological needs. Obstetrics, gynecology and family planning are areas of focus in women’s health. Women’s services cover a wide range of services, from annual procedures like PAP tests, to mammograms, urinary tract care, menopause, birth plans and delivery. The leading causes of death in women are heart disease, cancer and stroke. Other major health conditions women suffer from are diabetes, Alzheimer’s disease and chronic lower respiratory diseases. Healthy lifestyle choices, such as eating healthy and physical activity, reduce women’s health risks.
Women can find a full continuum of mother and baby care at the South Texas Medical Center. Our institutions offer state-of-the-art labor and delivery rooms designed with women and children in mind. Additional women’s services available at our institutions include breast cancer diagnoses and treatment, pregnancy testing, mammograms and all the non-invasive procedures performed using daVinci Gynecologic Surgery systems. Robotically assisted gynecologic surgeries include, but are not limited to, the treatment for cervical and uterine cancer, uterine fibroids, endometriosis, uterine prolapse and menorrhaiga or excessive bleeding.
Institutions at the South Texas Medical Center offering women services take a family-centered approach to maternity care and offer a comprehensive range of obstetrical and gynecological services. Our institutions are also equipped with neonatal intensive care units to care for mothers experiencing special or high-risk deliveries.
Women’s Health Articles
Exercise may prevent excess weight gain during pregnancy
By Shereen Lehman
(Reuters Health) - Moderate exercise is encouraged during pregnancy for plenty of reasons, but it may also help women avoid gaining too much weight, say UK researchers.
They reviewed studies since the 1990s looking at whether exercise alone helps prevent excess weight gain during pregnancy, and found that it does, or helps with weight loss after delivery, and found that it doesn't.
They also found a total of only five solid studies on those questions.
"There isn't enough research being conducted regarding the effects of exercise on gestational weight gain or postpartum weight loss," said Dr. Kirsty Elliot-Sale of the Sport, Health and Performance Enhancement Research Group at Nottingham Trent University, who led the review.
"Of those few good - as defined by appropriate research design - studies, exercise seems to be an effective tool during pregnancy to limit excessive gestational weight gain but so far exercise (walking) has not been shown to be effective for postpartum weight loss," Elliot-Sale told Reuters Health by email.
The U.S. Institute of Medicine advises women who are normal weight before they get pregnant to gain 25 to 35 pounds during their pregnancy. Women who are overweight should gain from 15 to 25 pounds, and obese women should gain from 11 to 20 pounds, according to IOM guidelines.
Elliot-Sale said that weight gain exceeding the appropriate amount has implications for both mothers and infants. It also contributes to postpartum weight retention and ultimately, if unchecked, a higher risk of obesity.
Elliot-Sale added that it's an area of research that urgently needs to be discussed and addressed.
"Women should be supported and guided during this potentially overwhelming time and losing pregnancy-related weight should be made easier and not overtake this special time," she said.
Elliot-Sale and colleagues reviewed the results of three research studies that compared exercise programs to regular care, or to other types of interventions during pregnancy, and two studies done during the year following pregnancy.
The researchers found that, on average, women who exercised during their pregnancies gained about five pounds less than their counterparts who didn't exercise.
There were no differences in weight loss after pregnancy between women who exercised and those who didn't, according to the results in the British Journal of Sports Medicine.
Elliot-Sale said she still believes that exercise is the answer, which is why she's now conducting studies on weight loss after pregnancy.
"Obviously, physical activity should be paired with good nutritional practices; however women should be cautioned not to overly restrict dietary energy intake whilst breastfeeding," Elliot-Sale said.
"I love it and my niche happens to be women and heart disease and trying to get the OB/GYNs to take more of an active role in managing women's comprehensive health," said Dr. Mary Rosser.
"I think the more we see in the literature studies like this, the more awareness it raises, not only on the patients' part, but I'm talking about the providers' part as well," said Rosser, an obstetrician/gynecologist at Montefiore Medical Center in New York.
Rosser, who was not involved in the review, said the fact that only five studies were available highlights the need for more research.
"I think that that's just more evidence that we need more randomized control trials to look at this issue, and it just increases our awareness," she said.
Rosser said that excessive weight gain during pregnancy and weight retention between pregnancies is becoming more common. She added that doctors are seeing more women who are overweight before ever getting pregnant.
Excessive weight gain could increase the risk of more complicated pregnancies, preeclampsia and gestational diabetes, she noted.
"We also have now seen in the literature that women who have these problems during pregnancy are at up to five times greater risk of having cardiovascular disease in their lifetime," Rosser said.
Rosser said that women who exercise before pregnancy are more likely to work out during pregnancy, but it's not too late to start an exercise program during pregnancy.
"We have to educate women that it's okay to exercise during pregnancy," she said.
Rosser advises women to talk to their obstetricians and ask about what kinds of activities are safe.
"I am a fan of brisk walking, and if you have no other complications I think that's very helpful," she said. "And also psychologically it helps everyone to exercise."
SOURCE: http://bmj.co/1yXEL1I British Journal of Sports Medicine, online November 18, 2014.
U.S. Supreme Court Justice Ginsburg released from hospital
By Reuters Staff
WASHINGTON (Reuters) - U.S. Supreme Court Justice Ruth Bader Ginsburg, the oldest member of the nine-justice court, was released from a Washington hospital on Thursday after undergoing a heart procedure, a court statement said.
Ginsburg, 81, had a stent placed in her right coronary artery at MedStar Washington Hospital Center on Wednesday to improve blood flow after she reported discomfort following routine exercise.
"Justice Ginsburg was released from the hospital this morning," court spokeswoman Kathleen Arberg said in a statement.
Ginsburg, appointed by President Bill Clinton in 1993, is the most senior liberal justice on the conservative-leaning court. As such, she is often the lead dissenting voice when the court is split 5-4.
She has survived serious bouts with cancer in 1999 and 2009.
In a July interview with Reuters, Ginsburg said she did not intend to leave the bench in the near future unless her health changed. She said she underwent regular medical check-ups for cancer and worked out twice a week with a personal trainer.
"Thank goodness I haven't slowed down," Ginsburg said at the time.
FDA regs highlight harms of indoor tanning
By Roxanne Nelson
(Reuters Health) - Early in 2014, the United States Food and Drug Administration moved tanning lamps into a new category of "moderately harmful" medical devices, and with good reason, researchers say.
In a review of the evidence that indoor tanning does damage, and has no health benefits, the study authors point out that the new rules will force device manufacturers and salons to do more to protect users.
"We feel that this is a very positive move by the FDA," said Dr. Henry Lim, chairman of dermatology at Henry Ford Medical Center in Detroit, Michigan, and senior author of the review. "There is a lot of evidence that early and frequent use of tanning beds increases the risk of skin cancer."
Among the new requirements is that all sunlamps have a "black box warning label" that says they shouldn't be used by people under age 18, Lim's team writes.
This is the strictest warning that the FDA puts on products, and it is used when there is reasonable evidence of a serious hazard, Kim and his coauthors point out in the Journal of the American Academy of Dermatology.
"The new regulations don't ban the use of tanning beds for children and teens," Lim cautioned. "That will be up to the discretion of the salons."
However, the FDA guidelines will probably prompt more states to enact legislation, Lim told Reuters Health. Currently, 41 states including the District of Columbia have some type of regulation in place, such as requiring parental consent.
Several states have completely banned indoor tanning for minors, as has Brazil. In July, Hawaii became the 10th state to do so, joining Vermont, California, Illinois, Louisiana, Minnesota, Oregon, Nevada, Texas and Washington.
"Earlier exposure to indoor tanning is associated with a greater risk for developing basal cell carcinoma at a young age," said Margaret Karagas, director of the Children's Environmental Health and Disease Prevention Research Center at Dartmouth University in Hanover, New Hampshire.
"The new FDA regulations reinforce the science that teens and young adults may be especially vulnerable to developing skin cancer if they use tanning beds," said Karagas. She was not involved in the review but recently published a study showing that a high proportion of patients with early-onset basal cell carcinoma had used indoor tanning.
Basal cell carcinoma is the most common type of skin cancer. While it is not as dangerous as other types, it can be very destructive and disfiguring.
However, Lim's team also points to studies that found people who were exposed to tanning beds before the age of 35 years had a significantly higher risk of developing melanoma, the deadliest type of skin cancer.
In their report, the researchers review the science of how skin's exposure to ultraviolet light from tanning beds, or the sun, causes the DNA damage that can lead to cancer. "Tanning is a clinical manifestation of cellular stress," they emphasize.
"Moreover, the common misconception that tanned skin offers protection from future UV radiation is proved false as there is no biochemical mechanism restricting further mutagenesis upon subsequent exposure," they write.
The study team covers evidence that use of tanning beds can be addictive in the same way as a drug. And they point out that the devices primarily emit UV-A light, which is less effective at inducing skin to make vitamin D than UV-B, so there's no argument for a health benefit there.
It's uncertain how much of an effect these new regulations will have on tanning bed users, Lim's team says.
Nearly 30 million Americans use tanning beds each year, and more than 2 million of them are teenagers, according to the American Academy of Dermatology.
Regular and heavy users are at the greatest risk, the authors note. More than 1 million people are estimated to use tanning salons each day in the U.S., indicating many repeat users. And about 70 percent of users are girls and young women between the ages of 16 and 29 years old.
These data are the most troubling, they write, since young women are known to be the most at-risk population for developing melanoma associated with the use of tanning beds.
"Pediatricians should counsel parents and patients about the risks of using tanning beds," Karagas said.
Lim's team hopes their review will be used by doctors as a resource for doing just that.
SOURCE: http://bit.ly/1prBRCr Journal of the American Academy of Dermatology, online November 11, 2014.
Cigarette smoking by U.S. adults reaches record low - CDC
By David Beasley
ATLANTA (Reuters) - Cigarette smoking among U.S. adults last year touched its lowest on record, a drop spurred by higher prices, smoke-free policies and anti-smoking campaigns, the Centers for Disease Control and Prevention said on Wednesday.
About 17.8 percent of American adults smoked cigarettes in 2013, down from 20.9 percent in 2005 and 42.4 percent in 1965, when the U.S. government began keeping records on smoking, the federal health agency said.
While the continuing decline is encouraging, Brian King, a senior scientific advisor with the CDC's Office on Smoking and Health, said the rate is not on track to meet the federal goal of cutting adult cigarette smoking to 12 percent by 2020.
"We need to accelerate the magnitude of the decline," he said.
Tobacco use remains the leading cause of preventable disease in the United States, causing 480,000 premature deaths annually, according to the CDC.
In addition to the overall decline in adult smokers, those who continue to smoke daily are cutting back, the CDC study found. U.S. smokers consumed an average of 14.2 cigarettes per day in 2013, down from 16.7 in 2005.
The CDC said increased access to medications and programs that help smokers quit also have contributed to the drop in smoking rates.
The U.S. Midwest has the highest adult cigarette smoking rate, and the West has the lowest, according to the study in the agency's Morbidity and Mortality Weekly Report.
Lesbians, gays and bisexual adults smoke about 50 percent more cigarettes than heterosexual people, the report said.
The agency also expressed concern over the increased use of electronic cigarettes - battery-powered cartridges that produce a nicotine-laced vapor for the "smoker" to inhale - and hookahs, or water pipes.
The use of e-cigarettes by high school students tripled from 2011 to 2013 to 4.5 percent, according to a CDC survey released last week.
The potential risks and benefits of e-cigarettes are subject to a fierce debate, with a lack of long-term scientific evidence on their safety.
SOURCE: http://1.usa.gov/1vmlQya Morbidity and Mortality Weekly Report, November 28, 2014.
Celiac disease showing up in many forms and at all ages
By Janice Neumann
(Reuters Health) - A classical set of celiac disease symptoms no longer reflects the profile of most newly-diagnosed patients, according to a new study from Italy.
Instead, doctors need to take other symptoms into account and consider the possibility of celiac disease, even when patients don't fit the old image of the condition, researchers say.
"It's been a gradual phenomenon since the 1970s that fewer people are presenting with the classical diarrhea and more with non-classical or silent presentation, both in adults and children," said Dr. Peter Green, who wasn't involved in the study.
"We don't actually know why one person has diarrhea and another presents with abdominal pain or osteoporosis," said Green, director of the Celiac Disease Center at Columbia University in New York.
Dr. Umberto Volta and his coauthors write in the journal BMC Gastroenterology that just 15 years ago, celiac disease was still thought of mainly as a rare pediatric food intolerance, whose most common signs were diarrhea and intestinal damage that was diagnosed through a biopsy.
The disease is now known to be an autoimmune disorder, caused by an inability to tolerate the gluten protein in wheat, barley and rye.
Eating gluten typically causes inflammation of the intestinal lining in people with celiac disease and makes it hard to absorb nutrients.
Research shows that more than 1 percent of people worldwide have the disease, but most may not know it, the authors of the study note. The diagnosis is based on a blood test for signs of the abnormal immune response, such as antibodies, as well as biopsy in some cases.
With his colleagues, Volta, a professor of medicine at the University of Bologna in Italy and vice president of the Ethical Committee at St. Orsola-Malpighi University Hospital, looked at the celiac patients diagnosed over the course of 15 years at that hospital.
The study involved 770 patients, 599 of them female, diagnosed between 1998 and 2007. Nearly half were diagnosed during the first 10 years of the study period and the rest in the last five years, indicating a steep rise in rates of diagnosis.
Among all the patients, 610 people, or 79 percent, had symptoms when they were diagnosed. But most of their problems were not the typical diarrhea and weight loss, but rather "non-classical" issues like bloating, osteoporosis and anemia. Diarrhea was a symptom in just 27 percent of patients.
Indeed, classical symptoms became less common over the years, decreasing from 47 percent of patients during the first 10 years to 13 percent in the last five. Meanwhile, other problems, as well as a lack of any significant related illness, increased by more than 86 percent.
"The most striking change in clinical presentation of celiac disease over time has been the decrease of diarrhea as the leading symptom and the progressive increase of other non-classical gastrointestinal symptoms (such as constipation, bloating and alternate bowel habits as well as gastro-esophageal reflux, nausea, vomiting and dyspepsia)," Volta said in an e-mail to Reuters Health.
"A high proportion of celiac disease patients did not show any gastrointestinal symptom, but they displayed extra-intestinal manifestations such as iron-deficiency anemia, unexplained osteoporosis, abnormalities of liver-function tests and recurrent miscarriages," he said.
The most common illness associated with celiac was thyroid disease. Only half the patients had severe intestinal damage, and 25 percent had partial damage.
In later years, more patients were diagnosed through blood tests. That may be one factor accounting for the changing pattern of typical symptoms, Volta said, because the patients were diagnosed earlier, before gluten had done its damage.
"The effects of gluten weren't as severe yet," Volta said. "The story of celiac disease has been radically changed by the discovery celiac disease-related antibodies, which identify plenty of unsuspected cases."
Green agreed that testing has vastly improved diagnosis of the disease. He said that in the United Kingdom, anyone with iron deficiency or migraine is tested for celiac disease.
While most celiac specialists understand the varied symptoms, other physicians might not, he said. Green pointed out that in the United States, only 17 percent of people with the disease are actually diagnosed.
"Anyone can have celiac disease, it's common and underdiagnosed," said Green. "The message we want to get out is if you think you've got celiac disease, don't just go on a gluten-free diet, test for it."
Volta said he hoped the study reminded doctors about the many problems that can signal celiac disease.
"I hope doctors keep in mind that celiac disease is a very frequent food intolerance, which should be investigated not only in patients with diarrhea and overt malabsorption, but also in people (with other symptoms)," Volta said.
"The treatment by gluten-free diet improves the quality of life in symptomatic patients and prevents complications in all celiac disease patients including those without symptoms," he said.
SOURCE: http://bit.ly/1ATNpT3 BMC Gastroenterology, Nov. 18, 2014.