Methodist Specialty and Transplant Hospital
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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
U.S. judge halts major part of Texas law restricting abortions
By Reuters Staff
AUSTIN, Texas (Reuters) - A U.S. judge struck down parts of a law seen as restricting abortions in Texas, saying in a decision on Friday that a provision requiring clinics to have certain hospital-like settings for surgeries was unconstitutional.
"The act's ambulatory-surgical center requirement places an unconstitutional undue burden on women throughout Texas," U.S. District Judge Lee Yeakel said in his decision.
The so-called ambulatory surgical center requirement was to have gone into effect on Sept. 1. It would require clinics to meet a set of buildings standards that abortion rights advocates said were unnecessary, especially when an abortion is medically induced.
Advocacy groups who brought the suit, including Whole Women's Health, had argued the requirement was costly and had no medical benefit, seeing it as mostly intended to shut clinics that could not afford to make the changes.
The state argued the requirement reduces complications and increases patient care when complications occur.
Better education on breast reconstruction may be needed after cancer
By Andrew M. Seaman
NEW YORK (Reuters Health) - When it comes to deciding to have breast reconstruction after surgery for breast cancer, most women are generally satisfied with the decision-making process, a new study suggests.
"Our findings generally were good news - women who wanted reconstruction got it, those who didn't were generally satisfied with the decision process," said Dr. Monica Morrow, the study's lead author from Memorial Sloan Kettering Cancer Center in New York City.
The study findings also revealed misunderstandings on the part of some patients. For example, some women who didn't undergo breast reconstruction said they worried that the implants would interfere with cancer screenings later on, or that they feared the implants.
"Our study points to specific topics doctors can address with patients - safety of implants, lack of interference with cancer detection by reconstruction that are of concern to patients," Morrow wrote in an email.
She said that the study also indicates that many patients are focused on their cancer treatment at the time of diagnosis and not interested in reconstruction. That's fine, she said, as long as they are aware of the possibility of reconstruction later on.
"There is no 'correct' rate of reconstruction," she added.
Morrow and her colleagues write in JAMA Surgery that in the U.S., since passage of the Women's Health and Cancer Rights Act of 1998, women receive universal coverage for breast reconstruction after they have a breast removed.
Despite the coverage for breast reconstruction, only about 25 to 35 percent of women opt for the procedure, they add.
Some people, who are not patients or breast cancer doctors, have said this rate of reconstruction is low, Morrow said.
To ensure that breast cancer patients understood their options, New York State passed a law in 2010 mandating that surgeons discuss breast reconstruction with them and provide information on insurance and availability.
"The purpose of our study was to understand whether patients felt that they were adequately informed about reconstruction and to understand the reasons they chose not to undergo the procedure," she added. "Without such understanding, it is not possible to devise strategies to address the problem (if there actually is a problem)."
For the study, she and her colleagues used data from cancer registries in Los Angeles and Detroit on 485 women who had a breast removed and were cancer free for four years.
Overall, 222 women, or about 46 percent, eventually underwent breast reconstruction. About two-thirds of those women had it done at the same time their breast was removed; the other third had breast reconstruction later on.
Only about 13 percent of women said they were dissatisfied with the decision process about whether or not to have breast reconstruction, the authors found.
Black women were about three times more likely to report dissatisfaction, however.
Women who were older, had other health problems and lower education levels were less likely to have breast reconstruction. Women who received chemotherapy as treatment were also less likely to have the surgery.
Women without private health insurance were also less likely to have breast reconstruction, despite universal coverage.
About half of the women who did not get reconstruction said they did not want additional surgery. About a third said reconstruction was not important and about 36 percent said they feared implants.
About 24 percent of women were concerned the implants would interfere with future breast cancer screenings, but the researchers said past studies have not found evidence to support that concern.
"What our study actually says is that laws such as the NY state law are addressing a non-problem," Morrow said. "Patients are informed about reconstruction, some just chose not to have it."
She added that women who want to keep their breasts may choose lumpectomy, which removes less tissue than a complete mastectomy, and radiation instead of a total breast removal.
"So, it is not particularly surprising that reconstruction isn't a priority for all women who chose to undergo mastectomy," she said.
Also, Morrow said, it's difficult to educate patients in a time when they get information from many sources that may not be scientifically valid or perpetuate myths, such as implants being unsafe.
She also said that it's worth knowing that many women in this study decided to have breast reconstruction later on.
"During follow-up it is worth asking patients if they have developed an interest in reconstruction and want to see a plastic surgeon, and patients who choose not to have immediate reconstruction need to know that they haven't closed the door permanently," she added.
SOURCE: http://bit.ly/1thODnx JAMA Surgery, online August 20, 2014.
African-Americans may be getting inferior breastfeeding advice
By Ronnie Cohen
NEW YORK (Reuters Health) - Mothers who give birth in areas with higher concentrations of African-Americans are less likely to get breastfeeding support on maternity wards than mothers in other communities, a new study shows.
Breastfeeding provides well-documented health benefits to infants and their mothers. But African-American women are about 16 percent less likely to nurse their newborns than white women, according to research from the Centers for Disease Control and Prevention (CDC).
The study of 2,727 American hospitals and birth centers sought to uncover the reasons for the racial disparities.
"What this study suggests is that hospital practices, not just women's choices, beliefs or values, contribute to the observed racial disparities in infant feeding," sociologist Elizabeth Armstrong told Reuters Health in an email.
"Where a woman lives - and consequently gives birth - affects how her infant is nourished. Black babies and their mothers are less likely to start off in environments that support the optimal level of care for infant feeding and mother-baby bonding," she said.
Armstrong, a professor at Princeton University in New Jersey, was not involved in the current study.
The CDC researchers gathered data on optimal maternity care from hospitals and birth centers across the U.S. and compared areas with a higher percentage of black residents to areas with a lower percentage.
Facilities in zip codes with more black residents were more likely to give tests to their staff on breastfeeding support, the researchers wrote in the CDC's Morbidity and Mortality Weekly Report.
At the same time, maternity wards in areas with more African-Americans were less than half as likely to limit the use of breastfeeding supplements, such as formula. A 2006 report from the Government Accountability Office showed that when hospitals hand out free formula samples, mothers tend to breastfeed less.
Hospitals in neighborhoods with more African-Americans were also 7 percent more likely to give newborns pacifiers, which can inhibit breastfeeding.
And facilities in areas with higher concentrations of whites were nearly 14 percent more likely to promote early initiation of breastfeeding and nearly 12 percent more likely to work to keep newborns next to their mothers in the hospital. Both factors are known to promote breastfeeding.
Hospitals in neighborhoods with more blacks were significantly less likely to offer breastfeeding support after mothers returned home.
"This study shows the best support is not where it's most needed," Dr. Miriam Labbok told Reuters Health in a telephone interview. "If we could just change the hospital practices, I think we could have a lot more equity."
A pediatrician, Labbok is the founding director of the Carolina Global Breastfeeding Institute at the University of North Carolina at Chapel Hill and was not involved in the current study.
Lead author Jennifer Lind told Reuters Health that it's too early to understand the reasons for the racial differences.
"Because this is the first stab or look into the whole issue, we really don't know why we're seeing these disparities," she said in a telephone interview. Lind is an epidemiologist with the CDC.
"We found that hospital practices during childbirth have a major impact on whether a mother is able to start and continue breastfeeding," she said. "We think it's really important that all hospitals - regardless of where they're located - apply policies and practices proven to be supportive of breastfeeding so that more babies are able to reap the numerous benefits."
Research has shown that breastfed babies, especially those fed just breast milk without any formula, are less likely to die of sudden infant death syndrome, or SIDS (see Reuters Health story of June 14, 2011 here: http://reut.rs/VPTRIv). African-American babies are more likely to die from SIDS, also known as "crib death."
Breastfeeding also lowers babies' risk of infection, childhood obesity, asthma and type 2 diabetes, Lind said. Mothers who nurse their babies cut their chances of being diagnosed with breast and ovarian cancer, she said.
The American Academy of Pediatrics recommends exclusive breastfeeding for six months and continued breastfeeding for another year while babies are introduced to complementary foods.
In 2011, 79 percent of new American mothers started to breastfeed their infants, but fewer than half were still breastfeeding at six months, according to the CDC.
Only 195 U.S. hospitals, accounting for 8 percent of all births, have earned the status of Baby Friendly, the gold standard for optimal maternity care established by the World Health Organization and UNICEF in 1991, Armstrong said.
"I really think what we're seeing here is very much due to the fact that hospitals put up barriers," Labbok said. "I'd say this is a very good reflection of something that's wrong, and it needs to be fixed."
She noted that African-American women continued to nurse their babies at higher rates than white women in the 1960s, when breastfeeding in the U.S. hit an all-time low.
"In general, there has been this incorrect assumption that because you're black, you don't breastfeed, and that is just out and out wrong," Labbok said. "We've really got to strive for equity. This study shows very clearly that we have some work to do."
SOURCE: http://1.usa.gov/1pRnjKa Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report, online August 22, 2014.
New test may predict worker hearing loss
By Madeline Kennedy
NEW YORK (Reuters Health) - Not everyone exposed to high noise levels at work experiences hearing loss as a result, and a new study suggests a simple test can predict which workers will be affected.
Researchers caution that low accuracy in predicting who would not suffer hearing loss means the test shouldn't be used to select employees to work under high noise conditions.
Nor should the test be used "to exclude workers from occupational noise exposure, but for improving counseling especially concerning use of hearing protectors and for a tighter schedule for hearing tests," said one of the study authors, Dr. Michael Kundi, at the Institute of Environmental Health in Vienna, Austria.
In the study, the test did do a better job of predicting which workers would experience hearing loss than traditional risk factors like how long workers were exposed to noise and how often they wore hearing protection.
Approximately 15 percent of Americans between the ages of 20 and 69 have hearing loss that is possibly caused by noise at work or during leisure activities, according to the National Institute on Deafness and Other Communication Disorders.
According to the U.S. Occupational Safety and Health Administration (OSHA), 30 million Americans are exposed to hazardous noise levels at work.
Researchers have long sought to understand differences in hearing loss experienced by people exposed to similar noise levels in the workplace. Studies at the authors' institute have found that variations in the inner ear's reaction to noise are partly responsible, meaning some people are more susceptible to hearing loss than others, likely due to genetics.
One indicator of a person's susceptibility is how quickly the cells of the inner ear recover from noise exposure, which can be detected by measuring so-called temporary threshold shift (TTS) - a temporary hearing loss that's also known as aural fatigue or auditory fatigue.
The TTS test exposes participants to frequencies between 200 and 500 Hertz at about 100 decibels. After the exposure, the researchers perform an audiogram at 4 kilohertz for at least 10 minutes.
The magnitude of TTS after 2.5 minutes may indicate whether the person is more likely to suffer permanent noise-induced hearing loss, according to the authors.
For their study, published in Occupational and Environmental Medicine, they followed 125 white, male teenage apprentices working as fitters and welders at a steel company in Austria.
They measured the participants' hearing at the start of the apprenticeship in the morning hours, before workers were exposed to workplace noise. The study followed the apprentices, conducting hearing tests every three to five years for an average of 13 years.
The study team found that 82 percent of the workers considered vulnerable to hearing loss based on the initial test did lose hearing over the years.
When predicting who was not likely to experience hearing loss, however, the test was correct only 53 percent of the time.
OSHA requires employers to implement a "hearing conservation program" when workers are exposed to noise of 85 decibels or more over an eight-hour shift. The rule requires "employers to measure noise levels, provide free annual hearing exams and free hearing protection, provide training, and conduct evaluations of the adequacy of the hearing protectors in use" (see: http://1.usa.gov/1vnyj2o).
The current study suggests that such restrictions may be more effective for some workers than others, Kundi notes. Although he doesn't recommend the test be used to assign workers to noisy jobs or exclude them, the TTS test could identify people who are particularly vulnerable.
The test is not expensive, he said, and can be done during regular occupational hearing tests. A person concerned about hearing loss could also get this test on his or her own. An ear, nose and throat specialist with an audiometer and a noise generator can perform it, Kundi said.
"It would be premature to recommend this screening method for general use until these findings have been replicated by an independent group," said Dr. Robert Dobie, an ear specialist at the University of Texas Health Science Center in San Antonio. "Even then, its apparently poor performance (especially its low specificity) would dampen enthusiasm," Dobie told Reuters Health by email.
Dobie, who was not involved in the study, also worries that "it might lead to inadequate prevention and counseling efforts for people who appeared - by this test - to be resistant to noise damage," he said. "At this point in time, it seems best to treat everyone as susceptible."
For workers concerned about noise exposure, Dr. Hanns Moshammer, who led the Austrian study, said it's important to let the inner ear recover by reducing noise in activities outside of work.
After a person has been exposed to loud noise, "for recovery, the cells need calm conditions for the rest of the day," he said. Increasingly, "recreational noise, games and loud music threaten our hearing faculty," he added, and advised that people exposed to noise at work avoid noisy leisure activities.
Hans-Peter Hutter, senior author of the study, added in an email that "noise induced hearing loss (NIHL) represents a public health challenge as numbers are increasing - we think that our findings are a further step in the prevention of this health problem."
SOURCE: bit.ly/1tlA284 Occupational & Environmental Medicine online July 25, 2014.
California passes 'yes-means-yes' campus sexual assault bill
By Aaron Mendelson
(Reuters) - Californian lawmakers passed a law on Thursday requiring universities to adopt "affirmative consent" language in their definitions of consensual sex, part of a nationwide drive to curb sexual assault on U.S. campuses.
The measure, passed unanimously by the California State Senate, has been called the "yes-means-yes" bill. It defines sexual consent between people as "an affirmative, conscious and voluntary agreement to engage in sexual activity."
The bill states that silence and a lack of resistance do not signify consent and that drugs or alcohol do not excuse unwanted sexual activity.
Governor Jerry Brown must sign the bill into law by the end of September. If he does, it would mark the first time a U.S. state requires such language to be a central tenet of school sexual assault policies, said Claire Conlon, a spokeswoman for State Senator Kevin De Leon, who championed the legislation.
Opponents of the bill say it is politically over-reaching and could push universities into little charted legal waters.
The bill comes amid mounting pressure nationwide by lawmakers, activists and students on universities and colleges to curb sexual assaults on campuses and to reform investigations after allegations are made.
The White House has declared sex crimes to be "epidemic" on U.S. college campuses, with one in five students falling victim to sex assault during their college years.
Universities in California and beyond have already taken steps, including seeking to delineate whether consent has been given beyond 'no means no.'
Harvard University said last month it had created an office to investigate all claims of sexual harassment or sex assault, and that it would lower its evidentiary standard of proof in weighing the cases.
Under California's bill, state-funded colleges and universities must adopt strict policies regarding sexual assault, domestic violence, dating violence and stalking, among other actions in order to receive financial aid money.
No college or university voiced opposition to the bill, Conlon said.
The U.S. Department of Education in May released a list of 55 colleges -- including three in California -- under investigation to determine whether their handling of sex assaults and harassment violated federal laws put in place to ensure equal treatment in higher education.
The Californian institutions on the list are University of California, Berkeley, Occidental College and the University of Southern California.