The Cancer Therapy & Research Center at the UT Health Science Center San Antonio

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Cancer Therapy & Research Center at UTHSC

The Cancer Therapy & Research Center at the UT Health Science Center San Antonio Overview

It’s all about research, prevention and treatment at the The Cancer Therapy & Research Center (CTRC) at the UT Health Science Center San Antonio. As one of the world’s premier cancer research and treatment centers, the CTRC provides total patient care, ground-breaking research, state-of-the-art technology and multidisciplinary services to help patients fight cancer – and win.

Although the CTRC is one of the elite academic cancer centers in the country, it focuses on the patient as much as it does on the disease. It is one of only four cancer centers in Texas to be named a National Cancer Institute (NCI) Designated Cancer Center and conducts one of the largest oncology Phase I clinical drug programs in the world.

Services at the CTRC include medical oncology, radiation oncology, surgical oncology, outpatient surgery, Phase I/II/III clinical trials, imaging services, psychology, pre-clinical and clinical research, cancer prevention and education classes and a variety of groups to help patients find all the help they may need. Some of the specialized serviced include on-cite cancer screening, disease specific clinics specializing in sarcoma, geriatric oncology, gastrointestinal oncology, thoracic oncology, breast health, prostate oncology, neuro-oncology, Intensity Modulated Radiation Therapy (IMRT), high dose rate (HDR) brachytherapy and more.

UT Medicine Cancer Therapy and Research Center Featured Video

Cardiovascular Articles

  • Weekday heart attacks still getting quicker treatment at hospitals

    By Kathryn Doyle

    NEW YORK (Reuters Health) - People who arrive at the hospital with a heart attack during business hours are more likely to survive than those who show up on weeknights, weekends or holidays, according to a new study.

    Rates of death in the hospital are very low overall, at just over 4 percent, the researchers found. But some life-saving treatments can take longer to get to patients during off hours, which makes care less than optimal, they write.

    It was actually surprising how similar quality of care seemed to be for working hours and after hours in the hospital, and even for balloon angioplasty, there was only a difference of 16 minutes, said study author Dr. Jorge F. Saucedo of the NorthShore University Health System in Evanston, Illinois.

    In the most severe heart attacks, a blood vessel in the heart is completely blocked. Using a catheter to thread a balloon into the blocked artery can immediately restore blood flow.

    In the new study, which included more than 50,000 severe heart attacks between 2007 and 2010 in the U.S., patients who arrived at the hospital during work hours took an average of 56 minutes to have angioplasty, the balloon procedure. For those who arrived on nights or weekends, the average wait time was 72 minutes.

    Both times fall within the American Heart Association's recommendation of no more than 90 minutes wait for angioplasty. The time to patients getting imaging or medication was the same for both groups, according to the results in Circulation: Cardiovascular Quality and Outcomes.

    When the researchers adjusted for a variety of patient characteristics, they found those who arrived at the hospital during off hours were about 13 percent more likely to die from any cause.

    The proportion of patients who had angioplasty within the recommended 90 minutes was 89 percent during the weekdays and 79 percent during off hours.

    All in all, the numbers are better than in past studies, the authors note in their report, and in most categories there were no differences in treatment based on when patients arrived at the hospital.

    Management of these severe heart attacks seems to have improved greatly over the past several years, said Dr. Rodrigo Estévez-Loureiro of the interventional cardiology unit at Complejo Asistencial Universitario de León in Spain.

    "Differences observed in (door to balloon) times, although statistically significant, are not clinically relevant between off and on-hours," Estévez-Loureiro, who was not involved in the new study, told Reuters Health by email.

    A 16-minute delay likely will not influence overall mortality from the heart attacks he said.

    "Also surprising was the very low in- hospital mortality for both groups," Saucedo told Reuters Health.

    The hospital catheterization laboratory, where angioplasties are performed, is fully staffed during the day but most hospitals in the U.S. do not staff the lab after hours, he said. When a heart attack patient arrives on a night or weekend, staff members are paged and have to drive to the hospital from their homes.

    To make angioplasty wait times equal day and night, catheterization labs would have to be fully staffed 24-hours per day, but currently the financial and logistical costs would be too high to recommend that, Saucedo said by email.

    Patients may have waited longer to come to the hospital with heart attack symptoms in the middle of the night, which might have contributed to the increased risk of death, he noted. All things considered, the management and outcomes for people with severe heart attacks after hours was very good.

    One takeaway message for patients, he said, is to come to the hospital as soon as you have symptoms of a heart attack, including tightness of the chest, excess sweating, weakness and light-headedness.

    Estévez-Loureiro recommended calling an ambulance to get to the hospital, since medical personnel may be able to verify if you are having a heart attack on the way and start administering treatment and call the catheterization lab en route.

    SOURCE: http://bit.ly/XaY6j7 Circulation: Cardiovascular Quality and Outcomes, online July 29, 2014.

  • Short jogs linked to lower risk of death from heart disease

    By Kathryn Doyle

    NEW YORK (Reuters Health) - People who run in their spare time, even if it's not very fast or very far, tend to have a lower risk of dying from heart disease or from any cause than non-runners, according to a new study.

    The study was large but was observational, meaning the researchers asked participants about their running habits rather than randomly assigning them to running and non-running groups. So they cannot conclude that running, and not other differences between participants, was responsible for the lower risks.

    It's difficult to use more rigorous randomized controlled trials to look at outcomes like death, because that takes so long to track, said lead author Duck-chul Lee, from the College of Human Sciences at Iowa State University in Ames.

    He said the current study is the largest on this topic, but it would still be useful to conduct randomized trials to look at the effects of running on blood pressure and cholesterol, for instance.

    The researchers studied more than 55,000 generally healthy adults between ages 18 and 100. Participants answered questions about their physical activity habits over the past three months, including running speed, duration and frequency. Some were not runners at all; the rest were divided into five groups based on how much they ran each week.

    The researchers then tracked the participants using their medical records for an average of 15 years.

    About 3,400 people died during that time, including roughly 1,200 from cardiovascular causes, including heart disease and stroke.

    At the start, runners were more often male, younger and leaner. Compared to non-runners, people who ran at all were 30 percent less likely to die during the study period and 45 percent less likely to die from cardiovascular disease.

    Runners had a reduced risk of death even if they ran for less than 51 minutes or less than six miles per week, and even if they ran at a pace slower than six miles per hour, according to results published in the Journal of the American College of Cardiology.

    "I think the findings are very encouraging since the study suggests that you don't necessarily have to aim for a marathon in order to obtain the health benefits of physical activity," said Dr. Kasper Andersen of Uppsala University Hospital in Sweden.

    Andersen was not involved in the new study.

    "I guess you can interpret this as every time you go running you are putting savings in your own health bank - an investment that gives you a longer life," he told Reuters Health by email.

    Running was linked to better health regardless of sex, age, smoking status or weight, the researchers found. Runners had life expectancies three years longer than non-runners, on average.

    "The (World Health Organization) guidelines recommend at least 75 minutes per week of vigorous aerobic activity such as running," Lee told Reuters Health in an email. "However, we found mortality benefits in runners who ran even as little as 30 to 60 minutes per week."

    There haven't been as many studies on the benefits of vigorous activity as there have been for moderate activity, he said.

    "As far as recommending that people go for short jogs everyday, I do think this is something we could recommend, although with a couple caveats," said Andrea Chomistek, from the School of Public Health at Indiana University Bloomington.

    "For individuals who are currently inactive, they should probably start with walking and ease into running," she told Reuters Health in an email. "For inactive individuals who are older or have medical issues, they may want to check in with their physician before starting a running program, although walking is just fine."

    Finding a running buddy can be good motivation, Chomistek said.

    "If you know that someone is counting on you to show up, you'll be more likely to go," she said. "And longer runs are definitely more fun if you have company."

    SOURCE: http://bit.ly/1nND4lC Journal of the American College of Cardiology, online July 28, 2014.

  • Dementia patients more likely to get pacemakers: study

    By Andrew M. Seaman

    NEW YORK (Reuters Health) - People with dementia are more likely to get pacemakers than people without any cognitive impairment, according to a new study.

    The study can't explain why people with dementia are more likely to get the devices, which help control irregular heart rhythms, according to the lead author.

    "It may be completely appropriate," Nicole Fowler said. "There may be something that we haven't been able to measure that makes people with dementia need them more."

    Alternatively, she told Reuters Health that the difference could represent family members or doctors choosing more aggressive treatment for people with dementia.

    Fowler worked on the new study while at the University of Pittsburgh School of Medicine. She's now affiliated with the Indiana University Center for Aging Research in Indianapolis.

    She and her colleagues write in a research letter in JAMA Internal Medicine that people with dementia and a lesser form of thinking and memory trouble known as mild cognitive impairment can also have heart problems.

    People with dementia, their family members and their doctors should weigh the risks and benefits of using pacemakers, they add.

    For the new study, the researchers analyzed data on 16,245 people seen at 33 Alzheimer's Disease Centers from September 2005 through December 2011.

    At their first visit to the centers, about 46 percent of people had no evidence of dementia. Another 21 percent had mild cognitive impairment and 33 percent had dementia.

    Over the course of the study, four people out of every 1,000 who didn't have signs of dementia at their first visit received a pacemaker each year. The rate increased to 4.7 per 1,000 people among those with mild cognitive impairment and 6.5 per 1,000 people among those with dementia.

    The researchers found that people with dementia were 60 percent more likely to receive a pacemaker than those without dementia after taking into account their age, sex, race, location, heart health, blood pressure, stroke risk and cognitive decline during the study.

    They write that the findings are counter to expectations that people with serious and often fatal conditions might be treated less aggressively.

    Additional studies will be required to find out exactly why people with dementia are more likely to receive pacemakers, Fowler said.

    "Medical decisions for patients with dementia are really hard," she said. "We know from the data that families really struggle to make medical decisions . . . It's important to find out what are some of the things patients and families need to support their decision making."

    SOURCE: http://bit.ly/1qHE3Wz JAMA Internal Medicine, online July 28, 2014.

  • Drugs to increase "good" cholesterol may not cut deaths

    By Andrew M. Seaman

    NEW YORK (Reuters Health) - Drugs that have been investigated to increase so-called "good" cholesterol may not prevent deaths, heart attacks or strokes as many hoped, according to a new analysis.

    Due to limitations in existing studies and ongoing experiments involving these and other drugs, researchers not involved with the analysis caution that it's too early to give up on medications that increase high-density lipoprotein (HDL) cholesterol, however.

    "In the time before statins were available, there were several pieces of evidence that HDL-raising drugs reduce cardiovascular events, but since the time statins have been used there is now evidence that HDL-targeted therapies don't do anything to decrease mortality," said Dr. Darrel Francis, the study's senior author from Imperial College London.

    Unlike low-density lipoprotein (LDL), which is the so-called "bad" cholesterol that piles up in blood vessels, HDL is considered good because it's thought to chip away LDL cholesterol.

    People with low HDL levels and high LDL levels are known to be at an increased risk of death, the researchers write in the journal The BMJ.

    Drugs known as statins - such as Pfizer's Lipitor - that lower LDL have been found to be effective at reducing deaths. Attention has turned to the development of drugs that increase levels of HDL to achieve added benefits.

    Francis and his colleagues examined the results of 39 randomized controlled trials - the gold standard in medical research - that evaluated the use of three drugs known as niacin, fibrates and cholesterylester transfer protein (CETP) inhibitors.

    While the drugs differ in how they work, all three increase the amount of HDL cholesterol in the body.

    Overall, the drugs did not reduce the number of deaths from any cause or deaths from heart disease before or after statins became common.

    Before statins, fibrates reduced heart attacks and niacin reduced heart attacks and strokes. After statins, the benefit from the two HDL-increasing drugs disappeared.

    The researchers write that the simple idea that a drug that raises HDL levels should also decrease the number of heart attacks and strokes may not be correct.

    "Even if HDL is carrying cholesterol away from the coronary arteries, that doesn't mean that any therapy that raises HDL is automatically protective," Francis said. "After all, the therapy could just be blocking cholesterol traveling on HDL from exiting."

    But a closer look should be given to specific groups of patients before researchers abandon work on drugs targeting HDL cholesterol levels, cautioned Dr. Leonard Kritharides in an editorial accompanying the new study.

    Kritharides, the head of cardiology at Concord Repatriation General Hospital in Sydney, Australia, said other research has suggested there may be a benefit among people with low HDL cholesterol and high triglycerides, which is another type of fat in blood.

    "The possibility of important benefits for some patients should not be dismissed too lightly," he wrote.

    Dr. Steven Nissen, the chair of cardiovascular medicine at the Cleveland Clinic in Ohio, also said the studies included in the analysis had limitations and there are more studies on HDL-increasing drugs underway.

    "I think the science here hasn't been fully worked out and the only way to answer it is with randomized controlled trials and that's what a number of people are doing," said Nissen, who wasn't involved with the new study. He is the head of a trial for a CETP inhibitor from Eli Lilly.

    "If every study underway fails, we'll have to give up on HDL at some point," he said, adding that researchers aren't there yet.

    "What we don't need here is to prejudge ongoing research," Nissen said.

    SOURCE: http://bit.ly/1o0aGXw and http://bit.ly/1zcpif4 The BMJ, July 18, 2014.

  • Checking pulse could help detect risk of a second stroke

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Stroke patients and their families can be taught to monitor the patient's pulse and detect irregular heartbeats that might lead to another stroke, according to a new study.

    Of people who have a stroke, 40 percent will suffer another one within the next 10 years, said lead author Dr. Bernd Kallmunzer of the Department of Neurology at Universitätsklinikum Erlangen in Germany.

    Taking a pulse reading can detect atrial fibrillation, a leading source of blood clots that travel to the brain and cause stroke. Detecting atrial fibrillation is important because the patient can be treated with anti-clotting medications to reduce the risk of another stroke or death, Kallmünzer told Reuters Health by email.

    Atrial fibrillation is when the two upper chambers of the heart contract very rapidly and irregularly. At first, this irregularity occurs in episodes, then the heartbeat returns to normal rhythm and may not cause any symptoms.

    There's no treatment for the fibrillation itself, but the longer a person's pulse is monitored, for example by an electronic sensor, the greater the odds of detecting fibrillation events and starting clot prevention, the authors write in the journal Neurology.

    However, not everyone has access to or can afford high-tech monitoring, so the study team tested how accurately patients and their families could detect fibrillation just by taking a pulse.

    The study included 256 patients who had suffered a first stroke and were treated at the authors' stroke unit in Germany in late 2012 or early 2013. While still hospitalized, the patients and in some cases also their relatives were taught to take pulse readings from the radial artery in the left wrist.

    The patients and families were also given printed instruction materials and a stopwatch.

    During the half-hour tutorial, patients were taught to use the stopwatch to measure pulse rate and to recognize a normal pulse sensation and an irregular sensation that may indicate atrial fibrillation.

    Atrial fibrillation feels like a 'stumbling' rhythm and may be faster than 100 beats per minute or slower than 50, Kallmünzer said. A normal heartbeat is rhythmic and regular and only changes slightly on inhale and exhale.

    The patients were then hooked up to an electrical heart monitor and the screen was covered. A healthcare professional, the patient and the patient's family all attempted to take a pulse reading.

    According to the electrical heart monitor, 172 of the patients had normal heart rhythms and 57 had atrial fibrillations - the rest had another kind of abnormal rhythm. The researchers analyzed how often wrist pulse readings achieved the same result as the electrical heart monitor.

    Almost 90 percent of the patients who were mentally able did complete a pulse reading on themselves, and correctly detected 54 percent of the atrial fibrillations. Health care providers detected 97 percent of atrial fibrillations.

    Only six patients who thought their heart rates were irregular were incorrect. A false-positive rate that low is encouraging, the authors write.

    Among patients with atrial fibrillation whose family members took the tutorial, relatives detected the irregular beats 77 percent of the time by taking the patient's pulse.

    When atrial fibrillation is detected, medication can reduce the risk of a second stroke by 60 to 70 percent in comparison to not treating patients, according to Rolf Wachter of Universitatsmedizin Gottingen in Germany.

    "This is, I would say, one of the most effective therapies in medicine," he told Reuters Health in an email.

    Wachter, who was not part of the new study, researches heart conditions like atrial fibrillation.

    "We do not specifically know whether the approach in this paper is really the best approach. Other methods, including using a machine to monitor heart rhythm, might be better at detecting fibrillations, but they haven't been compared to each other in a trial," he said.

    "In general, taking your pulse is easy, harmless and free from side effects. Therefore anyone can try to do it," Kallmünzer said. "In stroke patients with very severe disability, family members, friends or nurses can do the measurements for the patient."

    The risk of a second stroke is highest during the months after the first one, but currently researchers do not know exactly how long this kind of pulse monitoring should go on, he said.

    If you're not sure how to take your pulse or that of a family member or how often you should check, ask your doctor, he said.

    "Health care professionals, doctors and nurses have outstanding experience in this technique and will be glad to give instructions."

    SOURCE: http://bit.ly/WC2Azb Neurology, online July 23, 2014.

Comprehensive Rehabilitation Articles

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Emergency News

  • Weekday heart attacks still getting quicker treatment at hospitals

    By Kathryn Doyle

    NEW YORK (Reuters Health) - People who arrive at the hospital with a heart attack during business hours are more likely to survive than those who show up on weeknights, weekends or holidays, according to a new study.

    Rates of death in the hospital are very low overall, at just over 4 percent, the researchers found. But some life-saving treatments can take longer to get to patients during off hours, which makes care less than optimal, they write.

    It was actually surprising how similar quality of care seemed to be for working hours and after hours in the hospital, and even for balloon angioplasty, there was only a difference of 16 minutes, said study author Dr. Jorge F. Saucedo of the NorthShore University Health System in Evanston, Illinois.

    In the most severe heart attacks, a blood vessel in the heart is completely blocked. Using a catheter to thread a balloon into the blocked artery can immediately restore blood flow.

    In the new study, which included more than 50,000 severe heart attacks between 2007 and 2010 in the U.S., patients who arrived at the hospital during work hours took an average of 56 minutes to have angioplasty, the balloon procedure. For those who arrived on nights or weekends, the average wait time was 72 minutes.

    Both times fall within the American Heart Association's recommendation of no more than 90 minutes wait for angioplasty. The time to patients getting imaging or medication was the same for both groups, according to the results in Circulation: Cardiovascular Quality and Outcomes.

    When the researchers adjusted for a variety of patient characteristics, they found those who arrived at the hospital during off hours were about 13 percent more likely to die from any cause.

    The proportion of patients who had angioplasty within the recommended 90 minutes was 89 percent during the weekdays and 79 percent during off hours.

    All in all, the numbers are better than in past studies, the authors note in their report, and in most categories there were no differences in treatment based on when patients arrived at the hospital.

    Management of these severe heart attacks seems to have improved greatly over the past several years, said Dr. Rodrigo Estévez-Loureiro of the interventional cardiology unit at Complejo Asistencial Universitario de León in Spain.

    "Differences observed in (door to balloon) times, although statistically significant, are not clinically relevant between off and on-hours," Estévez-Loureiro, who was not involved in the new study, told Reuters Health by email.

    A 16-minute delay likely will not influence overall mortality from the heart attacks he said.

    "Also surprising was the very low in- hospital mortality for both groups," Saucedo told Reuters Health.

    The hospital catheterization laboratory, where angioplasties are performed, is fully staffed during the day but most hospitals in the U.S. do not staff the lab after hours, he said. When a heart attack patient arrives on a night or weekend, staff members are paged and have to drive to the hospital from their homes.

    To make angioplasty wait times equal day and night, catheterization labs would have to be fully staffed 24-hours per day, but currently the financial and logistical costs would be too high to recommend that, Saucedo said by email.

    Patients may have waited longer to come to the hospital with heart attack symptoms in the middle of the night, which might have contributed to the increased risk of death, he noted. All things considered, the management and outcomes for people with severe heart attacks after hours was very good.

    One takeaway message for patients, he said, is to come to the hospital as soon as you have symptoms of a heart attack, including tightness of the chest, excess sweating, weakness and light-headedness.

    Estévez-Loureiro recommended calling an ambulance to get to the hospital, since medical personnel may be able to verify if you are having a heart attack on the way and start administering treatment and call the catheterization lab en route.

    SOURCE: http://bit.ly/XaY6j7 Circulation: Cardiovascular Quality and Outcomes, online July 29, 2014.

  • Tools for planning end of life care are varied, untested: study

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Many tools exist to help introduce people to the subject of advanced care planning, but they vary widely in what they offer and how accessible they are, according to a new research review.

    The authors found the tools that are most readily available often have not been vetted by formal studies, and the ones that have are often not accessible to the public or are specific to certain diseases.

    "Decision aids" have proliferated in many areas of medicine but have yet to really take off in the area of advanced directives, though they have a lot of potential to help doctors and patients, said Dr. Benjamin H. Levi of Penn State College of Medicine in Hershey, Pennsylvania.

    Levi was not one of the authors of the new paper in the Annals of Internal Medicine, but he did review it for the journal.

    Advance care planning helps seriously ill patients think through their treatment goals and informs care choices for the future in case they cannot express their wishes.

    Less than half of severely or terminally ill patients have an advance directive in their medical record, according to the study authors, and past research has found doctors are only correct 65 percent of the time in predicting what intensive care a patient would want.

    Some patients prioritize living longer, whereas others may not wish to be kept alive when meaningful recovery or a particular quality of life is no longer possible, write the authors, led by Mary Butler of the Minnesota Evidence-based Practice Center at the University of Minnesota School of Public Health in Minneapolis.

    One common "advanced directive" is a do not resuscitate order, but the directives can be much more nuanced than that, taking into account religion, spirituality and philosophical outlook, they note.

    It can take more than an hour to have that kind of conversation with your doctor, Levi said, time many doctors can't devote to one patient.

    "For something like advanced care planning it's way outside the experience of most people, they don't know how to word their preferences," Levi said. "The decision aid can be very useful as a stand-alone or as springboard to that conversation with your doctor."

    Decision aids, some of which actually function as legally binding final directives, should not be a substitute for talking to your doctor, though, he told Reuters Health.

    As the study notes, those aids that exist can be printed leaflets, videos or interactive sites, some of which work to introduce any person, healthy or sick, to the idea of an advance directive. Others are tailored specifically to certain long-term illnesses.

    The existing studies on these aids have not been uniform and there has not been a side-by-side comparison of the different types to see which are best, Levi said. The new research review did not attempt to do that either, rather it just accumulates the existing studies in one place, Butler and her coauthors write.

    "You can't use this article to choose one," Levi said.

    Dr. Linda L. Emanuel, director of the Buehler Center on Aging, Health & Society at Northwestern University Feinberg School of Medicine in Chicago, agreed.

    "We have no idea how to assess what's a good decision aid," Emanuel told Reuters Health by phone.

    "First of all, these decisions are assessed as good bad or indifferent in real time, and 'maybe I regret my decision but I don't know how another decision would make me feel.'"

    But there are certain criteria anyone can use to assess whether an aid might be useful, she said. It should be understandable and accessible for patients and should communicate with their healthcare teams in a useful way.

    Patients should remember that they have a federally protected right to have their preferences honored no matter how they communicate them, even verbally, she said.

    "I think there's really only one product out there that I think is good and I would recommend, it has a website that people can go to and have an interactive experience," she said, referring to PREPARE, an interactive website for families navigating medical decision making, run by the University of California.

    Emanuel also recommended The Conversation Project as "a good resource for familiarizing yourself with advanced care planning and seeing what people are talking about in the area."

    The experts agreed that advanced care planning is important and the best advice right now is to do a little exploring, try a few different decision aids and see what works for you.

    "I believe strongly that these decision tools can be helpful for folks and that they should try one or more different ones to see what works," said Dr. Michael Green of Penn State College of Medicine in Hershey. He and Levi helped develop "Making Your Wishes Known," one of the interactive web tools included in the review.

    "I think everybody should explore this, not just sick people," Green told Reuters Health. "If someone is sick and comes to the hospital, the default position is to do everything."

    "In many cases that's the right call, but in some cases it's not and what a shame and a waste and a tragedy if people undergo unnecessary unwanted treatment because there is no directive," Levi said.

    SOURCE: http://bit.ly/UzEcfY Annals of Internal Medicine, online July 29, 2014.

  • Dozens of ill Keith Urban fans treated at concert near Boston

    By Reuters Staff

    BOSTON (Reuters) - Forty-six music fans were treated for mostly alcohol-related medical problems at Australian country singer Keith Urban's concert outside Boston on Saturday night, local officials said.

    Fire and emergency medical personnel dealt with dozens of ill fans during the show at an outdoor arena in Mansfield, Massachusetts, about 25 miles south of Boston, the town's police and fire departments said in a joint statement on Sunday.

    Some 22 people were transported to area hospitals, mostly for alcohol-related illness, and more than 50 people were taken into protective custody by police, who noted that the large number of people needing treatment prompted authorities to call in ambulances from five nearby communities.

    "Last evening's Keith Urban concert was not anticipated to present with the volume of issues handled," officials said in the statement.

    The incident came a month after dozens of people were taken to hospitals for drug and alcohol-related illnesses at a house music concert at Boston's TD Garden.

    Urban, a Grammy winner who is married to Oscar-winning actress Nicole Kidman, was tapped last month to return as a judge on Fox's television singing competition "American Idol."

  • U.N. warns of alarming malnutrition rates in Somali capital

    By Reuters Staff

    MOGADISHU (Reuters) - The United Nations has reported alarming rates of malnutrition in the Somali capital where aid agencies cannot meet the needs of 350,000 people due to insufficient funds, drought and conflict.

    The U.N. Office for the Coordination of Humanitarian Affairs (OCHA) said the Somali government had compared the situation to the run-up to a 2011 famine that killed 260,000 people.

    The United Nations has sought to improve its early warning mechanisms after its failure to spot indications of crisis in 2010 was blamed for the scale of the famine that followed in a nation torn apart by years of conflict.

    "Alarming rates of malnutrition have been observed among displaced communities in Mogadishu," OCHA said in a report released over the weekend, citing a study by a unit of the U.N. Food and Agricultural Organization.

    It said aid agencies were unable to meet the needs of 350,000 people who had fled to Mogadishu, saying the aid organizations faced a shortage of funds and violence in the capital that could restrict deliveries.

    Al Shabaab rebels, seeking to topple the Western-backed government and impose their own strict interpretation of Islam, have staged a series of attacks in Mogadishu during the Muslim fasting month of Ramadan, which ends this week.

    "The humanitarian community is mobilizing resources to address the serious situation, but the significant shortfall in funding for humanitarian activities has undermined the capacity to respond," OCHA said of the challenges in Mogadishu.

    Because of drought and continued conflict, it said food shortages were expected to worsen in areas mainly in the south and southeast of Somalia.

    Earlier this year, African Union forces launched a new drive to push al Shabaab militants out of other towns and cities. Many people fled their homes in the fighting. Officials have said aid convoys sometimes struggled to reach newly retaken towns.

    A U.N. emergency fund had allocated more than $21 million to support humanitarian work in Somalia, including funding a campaign to combat an outbreak of measles, OCHA said.

    Overall, OCHA said it had raised less than a third of the $933 million required for its relief work in 2014, which ranges from food provision to health work and basic education.

  • India battles to contain "brain fever" as deaths reach almost 570

    By Nita Bhalla

    NEW DELHI (Thomson Reuters Foundation) - Almost 570 people in India have died after contracting encephalitis, commonly known as "brain fever", health authorities said on Friday, warning the death toll may rise with more people still at risk.

    Outbreaks of Acute Encephalitis Syndrome and Japanese Encephalitis are common every year in India, especially during the monsoon season, and claim hundreds of lives.

    But this year, major outbreaks - usually most prevalent in the northern states of Uttar Pradesh and Bihar - have spread to regions such as West Bengal and Assam further east and north, killing 568 people.

    In West Bengal, where at least 111 people have died from both strains, a senior health official said authorities were taking emergency steps to contain the outbreak.

    "We have sounded an alert in seven districts and canceled the leave of all health department officials," West Bengal's Health Services Director B.R. Satpathy told the Thomson Reuters Foundation.

    The health department has set up clinics across affected areas and is trying to prevent breeding of mosquitoes by fogging, especially around pig farms, where there is a high risk of contracting the virus.

    Encephalitis is an inflammation of the brain, caused by any one of a number of viruses, says the World Health Organization. Symptoms include high fever, vomiting and, in severe cases, seizures, paralysis and coma. Infants and elderly people are particularly vulnerable.

    It is most often caused by eating or drinking contaminated food or water, from mosquito or other insect bites or through breathing in respiratory droplets from an infected person.

    Outbreaks of the virus tend to occur in poor, flood-hit areas, where monsoons have left pools of stagnant water, allowing mosquitoes to breed and infect villagers.

    Floods also lead to the contamination of clean water sources such as wells, leaving many people with no option but to use the same dirty water for both drinking and sanitation.

    Health Minister Harsh Vardhan said last month that he was distressed at the "runaway conquest of encephalitis" and ordered the vaccination of all children in vulnerable states and the provision of dedicated hospital beds.

    In 2012, the government launched a national program to prevent and control the virus, including expanded vaccinations, strengthened surveillance and improved access to safe drinking water and sanitation.

    There were 1,273 deaths due to encephalitis in 2013 compared to 440 deaths from malaria and 193 from dengue, according to government statistics.

Surgery Articles

  • Inquiry finds "indications" of organ harvesting in Kosovo conflict

    By Julia Fioretti

    BRUSSELS (Reuters) - An EU-led inquiry found "compelling indications" that Kosovo Albanian guerrillas extracted body organs from Serb captives during the 1998-99 war and sold them, but the practice was not widespread and there was not enough evidence for a trial, the lead investigator said on Tuesday.

    After a three-year investigation, the EU-led task force said there was, however enough evidence to prosecute former leaders of the Kosovo Liberation Army (KLA) for war crimes against the ethnic Serb and Roma populations of Kosovo during the conflict.

    The investigation was prompted by a 2011 report by Council of Europe member Dick Marty that accused senior KLA commanders of involvement in the smuggling of Serb prisoners into northern Albania and the removal of their organs for sale.

    Prime Minister Hashim Thaci, himself a former KLA leader who was named in Marty's report, has dismissed the accusations as an attempt to tarnish the Kosovo Albanian fight for independence.

    U.S. prosecutor John Clint Williamson, who led the investigation, said there was no evidence of widespread organ harvesting, but that the crime had occurred a number of times.

    "There are compelling indications that this practice did occur on a very limited scale and that a small number of individuals were killed for the purpose of extracting and trafficking their organs," he told journalists.

    Other crimes perpetrated by senior KLA members, such as unlawful killings and forced disappearances, amounted to the ethnic cleansing of large portions of the Serb and Roma populations, and there was enough evidence to prosecute, Williamson said.

    DARK CLOUD

    The task force will file its indictment against former KLA leaders for war crimes once an ad hoc tribunal has been set up by the European Union and Kosovo, something Williamson said would happen next year. He did not name the people likely to be indicted.

    Prime Minister Thaci said in a statement the government would continue cooperating with the task force.

    "The government of the Republic of Kosovo appreciates the completion of the ambassador Williamson's work, which is an important step to determine potential individual responsibility and gives an end to the claims of the unfounded charges."

    Serbia's counter-insurgency campaign of 1998 and 1999 eventually drew in NATO, which bombed for 78 days to drive out Serbian forces behind the killings of Kosovo Albanian civilians. Around 10,000 Albanians and just over 2,000 Serbs are believed to have been killed during and immediately after the war.

    Kosovo declared independence in 2008 but the EU still plays a guiding role in policing and justice, particularly cases of war crimes.

    Efforts to investigate alleged war crimes committed by the guerrillas have run up against widespread intimidation in a small country where clan loyalties run deep and former KLA rebels are revered as heroes.

    Williamson condemned what he called "active efforts" to undermine the investigation.

    "As long as a few powerful people continue to thwart investigations into their own criminality, the people of Kosovo as a whole pay the price as this leaves a dark cloud over the country."

  • Alabama man claims penis was amputated by mistake

    By Jonathan Kaminsky

    (Reuters) - An Alabama man who went in to a hospital last month for a circumcision awoke after surgery to find his penis had been amputated, his lawyer said on Thursday.

    Johnny Lee Banks Jr., 56, said in a lawsuit filed in state court earlier this week that no one at the Princeton Baptist Medical Center in Birmingham, Alabama, had told him why it had been necessary to remove his penis.

    "My client is devastated," said Banks' attorney John Graves.

    Banks, who is married and does not work due to a disability, did not recall the precise date of the incident but believed it occurred in June, his attorney said.

    A spokeswoman for the hospital's parent company said in a statement that Banks' allegations were without merit.

    "We intend to defend all counts aggressively," Kate DeWitt Darden, spokeswoman for Baptist Health System, said in a statement.

    The lawsuit does not specify a monetary value of the damages.

    Named as defendants in the lawsuit are the hospital, the Simon-Williamson Clinic, Urology Centers of Alabama and two doctors, Graves said.

    Representatives for the Simon-Williamson Clinic and the Urology Centers of Alabama did not immediately respond to requests for comment.

  • Robot bladder surgery fails to deliver fewer complications

    By Gene Emery

    NEW YORK (Reuters Health) - Using robotic techniques to remove a cancerous bladder doesn't reduce the risk of complications compared with conventional "open" surgery, according to a new comparison of 118 patients conducted by surgeons at the Memorial Sloan Kettering Cancer Center in New York.

    The study, detailed in the New England Journal of Medicine, marks the first ongoing comparison of the risks and benefits of the two techniques. Past studies concluded that the robotic technique meant less time in the hospital and fewer complications but they were done by looking back at the records of already-treated patients.

    "There's been a lot of hype surrounding robots and it's been hard to gain perspective," said Dr. Vincent Laudone, one of the coauthors.

    Dr. Jennifer Yates, director of minimally invasive urology at the University of Massachusetts Medical School, who was not involved in the test, told Reuters Health that the findings will give surgeons pause because they're going to be surprised by the results.

    Robots have shown to be so valuable for prostate removal, many surgeons were convinced that a similar benefit would appear when they were used for bladder removal, she said. "They're going to say, 'Hey, I'm kinda surprised by this.' They're also going to be encouraged that the complication rate was comparable."

    "Bottom line: It looks like it was pretty much a wash," Laudone told Reuters Health. For patients, it means "if you're going to a surgeon who is experienced in traditional surgery and recommends traditional surgery, that's a reasonable recommendation."

    He estimated that perhaps 25 percent of bladder cancer removals, known as radical cystectomies, are currently done with robots.

    The study also found that patients who underwent conventional surgery spent about 28 percent less time in the operating room. They experienced more blood loss - about 5 ounces more - but "with that amount, we wouldn't expect to see any significant side effect," Laudone said.

    "These results highlight the need for randomized trials to inform the benefits and risks of new surgical technologies before widespread implementation," he and his colleagues concluded.

    About 67,000 bladder tumors are discovered in the U.S. each year and one quarter of them require bladder removal.

    The new study involved patients who needed both the bladder and nearby lymph nodes extracted. The men also lost their prostate and the women lost their ovaries, fallopian tubes, uterus and related organs. Even when a $2 million robot was used, conventional surgery was employed to redirect urine to the intestine.

    With robot-assisted surgery, 22 percent of the 60 patients had at least one serious complication within the first 90 days. A complication was regarded as serious if it required further surgery, intubation or major rehabilitation. The rate was essentially the same - 21 percent - with traditional surgery.

    When the researchers included lesser complications, such as those requiring intravenous medicine or blood transfusion, the risk was 62 percent with robot-assisted surgery versus 66 percent with open surgery.

    The average length of hospital stay was eight days for both groups.

    But the patients in the robot group spent two hours longer in the operating room. The average time was 5 hours 29 minutes with conventional surgery and 7 hours 36 minutes with robotic assistance.

    Both Laudone and Yates said that time difference is expected to shrink as doctors become more adept at working with robots.

    "It's an evolving technology and we're evolving in our learning to use the robot," Laudone said. "We're getting better as robotic surgeons, so operating time is diminishing. With prostate surgery, the same thing was true. Now, in some cases, doing it with the robot is faster. So the time difference is something I think will disappear with more experience."

    Yates cautioned that "this was a small study and I think it needs to be fleshed out with larger numbers. And you have to remember that Sloan Kettering is one of the more prominent high-volume institutions in the country. Whether this is generalizable to other institutions remains to be seen."

    SOURCE: http://bit.ly/1wN4FCQ New England Journal of Medicine, online July 23, 2014.

Neonatal Articles

  • Evidence suggests babies in womb start learning earlier than thought: study

    By Barbara Liston

    ORLANDO, Fla. (Reuters) - Babies in the womb show evidence of learning by their 34th week, three weeks earlier than previously thought, new research has found.

    "It really pushed the envelope" in terms of how early babies begin to learn, lead researcher Charlene Krueger, associate professor at the University of Florida's College of Nursing, said on Thursday.

    The study, published in the journal Infant Behavior and Development, followed 32 women from their 28th through 38th weeks of pregnancy in an investigation to pinpoint when the ability to learn emerges.

    Krueger had the women repeat three times out loud a set 15-second nursery rhyme, and do it twice a day for six weeks. The selected rhyme was previously unknown to the mothers.

    The fetuses' heart rates were monitored at 32, 33 and 34 weeks as they listened to a recording of a female stranger recite the rhyme.

    By the 34th week, Krueger said, the heart rates of the tested fetuses showed an overall slight decline while listening to the recording, compared with a control group of fetuses whose heart rates slightly accelerated while listening to a recording of a new nursery rhyme.

    Krueger said a decelerating heartbeat has long been associated with a fetus recognizing something familiar, compared with an accelerated heartbeat response to a novel sound or experience.

    "We cautiously concluded, because it was not statistically significant, that learning emerged by 34 weeks gestational age," she said.

    At that point, the mothers stopped reciting the rhyme to their babies who were tested again at 36 and 38 weeks.

    "At 38 weeks we confidently concluded the fetus could remember the rhythm of that nursery rhyme, which was four weeks after the mother stopped reciting the rhyme," Krueger said.

    "The deeper and more prolonged response (at 38 weeks), the more confident I felt that learning had gone on," she said.

    Krueger said the findings have implications for the care of pre-term babies in neonatal units. She said she next wants to experiment with placing recordings of the mothers' voices in the babies' cribs so they will benefit from positive impacts of their mothers' voices.

    "What it really shows is how sophisticated the interaction is between a mother and her infant," she said.

    SOURCE: http://bit.ly/1lEBzAl Infant Behavior and Development, May 2014.

  • HIV-positive women in Central America pressured to sterilize

    By Katie Nguyen

    MELBOURNE (Thomson Reuters Foundation) - HIV-positive women in Central America are being pressured to undergo sterilization by prejudiced health workers and misled about the risk of the virus being transmitted to their unborn children, a study has found.

    A survey of 285 women living with HIV in El Salvador, Honduras, Mexico and Nicaragua found that 23 percent of them had faced pressure from doctors and nurses to be sterilized.

    The rate ranged from 20 percent in Nicaragua to 28 percent in Mexico, according to research by the Mesoamerican Coalition for the Reproductive Rights of Women with HIV and the Women and Health Initiative of Harvard School of Public Health.

    The consistency of the rate over a large geographical area pointed to a "systematic pattern" of pressure and coercion, said Harvard School of Public Health research fellow Tamil Kendall.

    "It's really unthinkable that women living with HIV are being pressured and forced into sterilization when treatment almost eliminates the possibility of the mother-to-child transmission... and also provides options for safer conception and pregnancy," said Kendall, who presented the research at an international conference on AIDS in Melbourne on Wednesday.

    "In this day and age there is no reason why women living with HIV can't safely exercise their reproductive rights," she told Thomson Reuters Foundation, adding that it was likely the attitude of many health workers reflected the stigma towards HIV in the societies they came from.

    UNKNOWINGLY STERILIZED

    An estimated 17.7 million women worldwide had the human immunodeficiency virus (HIV) that causes AIDS in 2012, according to the World Health Organization (WHO).

    Citing U.N. figures, Kendall said there were 59,300 women living with HIV in Mexico, El Salvador, Honduras and Nicaragua in 2012.

    The study said pregnant HIV-positive women - whose status was known to health workers - were almost eight times more likely to report an experience of pressure or coercion to sterilize than women with HIV who were not pregnant.

    In one "particularly horrific" case, Kendall said a Mexican woman was sterilized without her knowledge while under anaesthetic for a Cesarean section. When she woke up, her thumb had been dipped in ink so it could be used on a consent form.

    In another case, a young Salvadoran said nurses threatened to deny her a Cesarean unless she signed up to be sterilized.

    Health workers often fed women misinformation as a way of coercing them, said Kendall, who has carried out research on women living with HIV in Latin America for more than a decade.

    "Women are told that if they have another pregnancy that either they will die or their children will almost surely acquire HIV and die," she said.

    "Healthcare providers use these kinds of high pressure tactics to force them into sterilization, and this is simply scientifically untrue."

    Without treatment, the likelihood of a HIV-positive mother transmitting HIV to her child during pregnancy, labor, delivery or through breastfeeding ranges from 15 percent to 45 percent, WHO says. With the right antiretroviral treatment, the transmission rate can be reduced to below 5 percent.

    The women surveyed in Central America came from rich and poor, rural and urban backgrounds. Women of indigenous and African descent were also represented.

    Yet neither their ethnicity, nor economic or social status were significant in indicating whether they were likely to be pressured to sterilize, Kendall said.

    "That reinforces the idea that what is actually driving this is discrimination around HIV itself," she said.

  • Using a nicotine patch during pregnancy tied to higher ADHD risk

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Smoking during pregnancy has been linked to a higher chance of the child having attention-deficit/hyperactivity disorder (ADHD), and a new study suggests women who use nicotine replacement products may also have children with an elevated risk.

    That doesn't necessarily mean that nicotine causes ADHD, the authors note.

    For instance, it could be that women dependent on nicotine are more likely to have ADHD symptoms themselves, said senior author Dr. Carsten Obel, from Aarhus University in Denmark. The children of women who use nicotine replacement products to quit smoking may be at risk of ADHD because of genes or their family environment, he told Reuters Health by email.

    For the new study, the researchers analyzed information from Danish databases on more than 80,000 children born between 1996 and 2002.

    Mothers were interviewed while pregnant and asked if they currently smoked, used nicotine replacement products including gum, patches or sprays or had quit smoking before pregnancy without nicotine replacement. They also reported whether their husbands were current smokers.

    The researchers then followed the children through 2011 and noted hospital diagnoses of ADHD or use of medication for the disorder. Roughly two percent of children in the study were diagnosed with ADHD.

    Compared to children with nonsmoking parents, kids with two smoking parents were 83 percent more likely to develop ADHD, according to results published in Pediatrics.

    Having a mother who smoked during pregnancy seemed to be a stronger predictor of ADHD risk than having a father who smoked.

    Mothers who used nicotine replacement products had children with an increased risk of ADHD similar to the increase associated with smoking.

    At this point, it is too soon to estimate how important nicotine exposure might be for ADHD risk, Obel said.

    Mothers who had quit smoking and those who used nicotine replacement products both tended to have babies with higher, healthier birth weights than current smokers, he noted. Smoking during pregnancy is known to be associated with a lower birth weight for the baby.

    "The nicotine patch doesn't decrease birth weight, which has been used as a target measure for a long, long time," said Yoko Nomura, who studies central nervous system development at The City University of New York's Queens College.

    "We can't say the nicotine patch is useless because birth weight is so associated with many different illnesses," Nomura told Reuters Health. She was not part of the new study.

    For most people, the risk of ADHD is very small to begin with, she said.

    As of 2011, 11 percent of U.S. kids ages four to 17 had been diagnosed with ADHD, according to the Centers for Disease Control and Prevention.

    Many factors can influence the risk of ADHD, and most of the important predictors are genetic, Nomura said.

    "In order to prevent the non-genetic component of ADHD, we need to understand how smoking increases risk, and this doesn't help us learn more about that," she said.

    Parents reporting their own smoking habits may not be very reliable, given the social pressure to quit during pregnancy, she noted.

    "We have a long way to go before we can even conclude anything," Nomura said.

    "The best advice will at this point probably be to try to stop smoking without use of nicotine replacement and preferably before getting pregnant," Obel said. "If this is not possible nicotine replacement is, based on the birth weight results, preferable in comparison with continuing to smoke."

    For women who struggle to quit, even just cutting down on the number of cigarettes per day is a step in the right direction, Nomura said.

    SOURCE: http://bit.ly/1nP7FcE Pediatrics, online July 21, 2014.

Neuroscience Articles

  • U.S. lawyer groups launch effort to prevent elder financial fraud

    By Michael Leibel

    NEW YORK (Reuters) - Lawyers will have access to training on identifying elderly clients who have fallen prey to financial scams under a continuing education program introduced Tuesday by the American Bar Association and two investor protection groups.

    The program will teach lawyers how to spot signs of cognitive impairment, identify possible cases of investment exploitation and report these suspected instances to the appropriate authorities.

    Sponsored by the ABA along with the Investor Protection Trust and the Investor Protection Institute, two nonprofit organizations devoted to investor education and protection, the new program is called the Elder Investment Fraud and Financial Exploitation Prevention Program Legal.

    Roughly one in five older Americans has been victimized by financial scams which cost them some $2.9 billion a year, according to studies from the Investor Protection Trust and MetLife Inc. Dementia caused by old age and other types of brain damage can make people more vulnerable to financial exploitation.

    "Our goal is to improve the communication among legal professionals, older Americans, adult children and state securities regulators in order to head off financial swindles before the damage is done," Don Blandin, president and chief executive of IPT, said in a press release announcing the program.

    Attorneys may not realize that they can get into trouble themselves if they don't recognize the signs of a scam, said Lori Stiegel, project director at the ABA.

    "A lawyer who is ignorant of (elder investment fraud and financial exploitation) and fails to recognize its signs may unwittingly participate in victimizing the client... and as a result may face professional discipline and liability for malpractice," Stiegel said in the release.

    When the three groups surveyed 674 practicing attorneys it found 91.4 percent considered elder financial fraud to be a "very serious" or "somewhat serious" problem, and 88.6 percent said they would participate in a program designed to prevent this exploitation.

    Other organizations plan to create resources to help financial professionals diagnose mental acuity in their clients. The North American Securities Administrators Association is developing guidelines for how brokerages can protect vulnerable clients. The Securities Industry and Financial Markets Association is also pushing for similar changes.

  • NCAA agrees to settle head injury suit for $70 million

    By Mary Wisniewski

    CHICAGO (Reuters) - The NCAA has agreed to settle a head injury lawsuit by providing $70 million for concussion testing and diagnosis of current and former student athletes in a move expected to change the way such injuries are handled at colleges nationwide, according to court documents filed in Chicago on Tuesday.

    The class-action agreement, if approved by a federal judge and class members, applies to student athletes in all sports who have played at NCAA member schools at any time in the past until 50 years in the future.

    The settlement does not include bodily injury claims, which plaintiff's attorney Steve Berman said should be handled on an individual basis. He said the settlement is aimed at protecting student athletes on the field.

    "The whole goal of my clients is to change the way the NCAA handles concussions," Berman said. "We're very hopeful this will cut down on the number of concussions and people returning to play too early."

    A hearing on the NCAA agreement is scheduled for 2 p.m. CDT (1900 GMT) in Chicago but U.S. District Judge John Lee is not expected to make a decision on whether to grant the settlement preliminary approval until sometime in August, Berman said.

    The danger of concussions and other head injuries has received increased attention in college and professional sports in recent years. A settlement between the National Football League and thousands of former players, who contend the league played down the risk of concussions, was granted preliminary approval by a federal judge earlier this month.

  • Short jogs linked to lower risk of death from heart disease

    By Kathryn Doyle

    NEW YORK (Reuters Health) - People who run in their spare time, even if it's not very fast or very far, tend to have a lower risk of dying from heart disease or from any cause than non-runners, according to a new study.

    The study was large but was observational, meaning the researchers asked participants about their running habits rather than randomly assigning them to running and non-running groups. So they cannot conclude that running, and not other differences between participants, was responsible for the lower risks.

    It's difficult to use more rigorous randomized controlled trials to look at outcomes like death, because that takes so long to track, said lead author Duck-chul Lee, from the College of Human Sciences at Iowa State University in Ames.

    He said the current study is the largest on this topic, but it would still be useful to conduct randomized trials to look at the effects of running on blood pressure and cholesterol, for instance.

    The researchers studied more than 55,000 generally healthy adults between ages 18 and 100. Participants answered questions about their physical activity habits over the past three months, including running speed, duration and frequency. Some were not runners at all; the rest were divided into five groups based on how much they ran each week.

    The researchers then tracked the participants using their medical records for an average of 15 years.

    About 3,400 people died during that time, including roughly 1,200 from cardiovascular causes, including heart disease and stroke.

    At the start, runners were more often male, younger and leaner. Compared to non-runners, people who ran at all were 30 percent less likely to die during the study period and 45 percent less likely to die from cardiovascular disease.

    Runners had a reduced risk of death even if they ran for less than 51 minutes or less than six miles per week, and even if they ran at a pace slower than six miles per hour, according to results published in the Journal of the American College of Cardiology.

    "I think the findings are very encouraging since the study suggests that you don't necessarily have to aim for a marathon in order to obtain the health benefits of physical activity," said Dr. Kasper Andersen of Uppsala University Hospital in Sweden.

    Andersen was not involved in the new study.

    "I guess you can interpret this as every time you go running you are putting savings in your own health bank - an investment that gives you a longer life," he told Reuters Health by email.

    Running was linked to better health regardless of sex, age, smoking status or weight, the researchers found. Runners had life expectancies three years longer than non-runners, on average.

    "The (World Health Organization) guidelines recommend at least 75 minutes per week of vigorous aerobic activity such as running," Lee told Reuters Health in an email. "However, we found mortality benefits in runners who ran even as little as 30 to 60 minutes per week."

    There haven't been as many studies on the benefits of vigorous activity as there have been for moderate activity, he said.

    "As far as recommending that people go for short jogs everyday, I do think this is something we could recommend, although with a couple caveats," said Andrea Chomistek, from the School of Public Health at Indiana University Bloomington.

    "For individuals who are currently inactive, they should probably start with walking and ease into running," she told Reuters Health in an email. "For inactive individuals who are older or have medical issues, they may want to check in with their physician before starting a running program, although walking is just fine."

    Finding a running buddy can be good motivation, Chomistek said.

    "If you know that someone is counting on you to show up, you'll be more likely to go," she said. "And longer runs are definitely more fun if you have company."

    SOURCE: http://bit.ly/1nND4lC Journal of the American College of Cardiology, online July 28, 2014.

  • Dementia patients more likely to get pacemakers: study

    By Andrew M. Seaman

    NEW YORK (Reuters Health) - People with dementia are more likely to get pacemakers than people without any cognitive impairment, according to a new study.

    The study can't explain why people with dementia are more likely to get the devices, which help control irregular heart rhythms, according to the lead author.

    "It may be completely appropriate," Nicole Fowler said. "There may be something that we haven't been able to measure that makes people with dementia need them more."

    Alternatively, she told Reuters Health that the difference could represent family members or doctors choosing more aggressive treatment for people with dementia.

    Fowler worked on the new study while at the University of Pittsburgh School of Medicine. She's now affiliated with the Indiana University Center for Aging Research in Indianapolis.

    She and her colleagues write in a research letter in JAMA Internal Medicine that people with dementia and a lesser form of thinking and memory trouble known as mild cognitive impairment can also have heart problems.

    People with dementia, their family members and their doctors should weigh the risks and benefits of using pacemakers, they add.

    For the new study, the researchers analyzed data on 16,245 people seen at 33 Alzheimer's Disease Centers from September 2005 through December 2011.

    At their first visit to the centers, about 46 percent of people had no evidence of dementia. Another 21 percent had mild cognitive impairment and 33 percent had dementia.

    Over the course of the study, four people out of every 1,000 who didn't have signs of dementia at their first visit received a pacemaker each year. The rate increased to 4.7 per 1,000 people among those with mild cognitive impairment and 6.5 per 1,000 people among those with dementia.

    The researchers found that people with dementia were 60 percent more likely to receive a pacemaker than those without dementia after taking into account their age, sex, race, location, heart health, blood pressure, stroke risk and cognitive decline during the study.

    They write that the findings are counter to expectations that people with serious and often fatal conditions might be treated less aggressively.

    Additional studies will be required to find out exactly why people with dementia are more likely to receive pacemakers, Fowler said.

    "Medical decisions for patients with dementia are really hard," she said. "We know from the data that families really struggle to make medical decisions . . . It's important to find out what are some of the things patients and families need to support their decision making."

    SOURCE: http://bit.ly/1qHE3Wz JAMA Internal Medicine, online July 28, 2014.

  • Drugs to increase "good" cholesterol may not cut deaths

    By Andrew M. Seaman

    NEW YORK (Reuters Health) - Drugs that have been investigated to increase so-called "good" cholesterol may not prevent deaths, heart attacks or strokes as many hoped, according to a new analysis.

    Due to limitations in existing studies and ongoing experiments involving these and other drugs, researchers not involved with the analysis caution that it's too early to give up on medications that increase high-density lipoprotein (HDL) cholesterol, however.

    "In the time before statins were available, there were several pieces of evidence that HDL-raising drugs reduce cardiovascular events, but since the time statins have been used there is now evidence that HDL-targeted therapies don't do anything to decrease mortality," said Dr. Darrel Francis, the study's senior author from Imperial College London.

    Unlike low-density lipoprotein (LDL), which is the so-called "bad" cholesterol that piles up in blood vessels, HDL is considered good because it's thought to chip away LDL cholesterol.

    People with low HDL levels and high LDL levels are known to be at an increased risk of death, the researchers write in the journal The BMJ.

    Drugs known as statins - such as Pfizer's Lipitor - that lower LDL have been found to be effective at reducing deaths. Attention has turned to the development of drugs that increase levels of HDL to achieve added benefits.

    Francis and his colleagues examined the results of 39 randomized controlled trials - the gold standard in medical research - that evaluated the use of three drugs known as niacin, fibrates and cholesterylester transfer protein (CETP) inhibitors.

    While the drugs differ in how they work, all three increase the amount of HDL cholesterol in the body.

    Overall, the drugs did not reduce the number of deaths from any cause or deaths from heart disease before or after statins became common.

    Before statins, fibrates reduced heart attacks and niacin reduced heart attacks and strokes. After statins, the benefit from the two HDL-increasing drugs disappeared.

    The researchers write that the simple idea that a drug that raises HDL levels should also decrease the number of heart attacks and strokes may not be correct.

    "Even if HDL is carrying cholesterol away from the coronary arteries, that doesn't mean that any therapy that raises HDL is automatically protective," Francis said. "After all, the therapy could just be blocking cholesterol traveling on HDL from exiting."

    But a closer look should be given to specific groups of patients before researchers abandon work on drugs targeting HDL cholesterol levels, cautioned Dr. Leonard Kritharides in an editorial accompanying the new study.

    Kritharides, the head of cardiology at Concord Repatriation General Hospital in Sydney, Australia, said other research has suggested there may be a benefit among people with low HDL cholesterol and high triglycerides, which is another type of fat in blood.

    "The possibility of important benefits for some patients should not be dismissed too lightly," he wrote.

    Dr. Steven Nissen, the chair of cardiovascular medicine at the Cleveland Clinic in Ohio, also said the studies included in the analysis had limitations and there are more studies on HDL-increasing drugs underway.

    "I think the science here hasn't been fully worked out and the only way to answer it is with randomized controlled trials and that's what a number of people are doing," said Nissen, who wasn't involved with the new study. He is the head of a trial for a CETP inhibitor from Eli Lilly.

    "If every study underway fails, we'll have to give up on HDL at some point," he said, adding that researchers aren't there yet.

    "What we don't need here is to prejudge ongoing research," Nissen said.

    SOURCE: http://bit.ly/1o0aGXw and http://bit.ly/1zcpif4 The BMJ, July 18, 2014.

Oncology Articles

  • Too few U.S. youth getting vaccine for sexually transmitted virus -CDC

    By David Beasley

    ATLANTA (Reuters) - More U.S. adolescents are receiving vaccines against the sexually transmitted virus that causes cervical and other types of cancer but vaccination rates for the infection remain too low, federal health officials said on Thursday.

    In 2013, 37.6 percent of girls ages 13-17 got the recommended three doses of the vaccine against human papillomavirus (HPV), the Centers for Disease Control and Prevention said.

    That was up from 33.4 percent in 2012 but far short of the CDC's goal of an 80 percent vaccination rate, data showed.

    "It's frustrating to report almost the same HPV vaccination coverage levels among girls for another year," said Dr. Anne Schuchat, assistant surgeon general and director of the CDC's National Center for Immunization and Respiratory Diseases.

    The percentage of boys receiving all three doses of the vaccine more than doubled, increasing to 13.9 percent in 2013 from 6.8 percent in 2012, according to data from the CDC's National Immunization Survey of teens.

    Though the CDC recommends the HPV vaccine for all 11-year-old and 12-year-old boys and girls, the 2013 study found that doctors had not recommended it to one third of girls and more than half of boys.

    HPV is the most common sexually transmitted infection, with 79 million U.S. residents currently infected and 14 million new cases every year, according to the health agency.

    The virus can cause cervical, vaginal, penile anal and throat cancers. Each year, about 4,000 women in the United States die of cervical cancer, the CDC said.

    "Pre-teens need HPV vaccine today to be protected from HPV cancers tomorrow," Schuchat said.

    Parents cited a lack of knowledge about the vaccine and safety concerns as reasons for not having their children vaccinated, the CDC said.

    The vaccine is safe, the CDC said. About 67 million doses have been distributed since it became available in 2006 for girls and 2009 for boys and no serious safety concerns have been linked to HPV vaccination, the agency said.

    SOURCE: http://1.usa.gov/1rdFRT9 Morbidity and Mortality Weekly Report, online July 24, 2014.

  • Robot bladder surgery fails to deliver fewer complications

    By Gene Emery

    NEW YORK (Reuters Health) - Using robotic techniques to remove a cancerous bladder doesn't reduce the risk of complications compared with conventional "open" surgery, according to a new comparison of 118 patients conducted by surgeons at the Memorial Sloan Kettering Cancer Center in New York.

    The study, detailed in the New England Journal of Medicine, marks the first ongoing comparison of the risks and benefits of the two techniques. Past studies concluded that the robotic technique meant less time in the hospital and fewer complications but they were done by looking back at the records of already-treated patients.

    "There's been a lot of hype surrounding robots and it's been hard to gain perspective," said Dr. Vincent Laudone, one of the coauthors.

    Dr. Jennifer Yates, director of minimally invasive urology at the University of Massachusetts Medical School, who was not involved in the test, told Reuters Health that the findings will give surgeons pause because they're going to be surprised by the results.

    Robots have shown to be so valuable for prostate removal, many surgeons were convinced that a similar benefit would appear when they were used for bladder removal, she said. "They're going to say, 'Hey, I'm kinda surprised by this.' They're also going to be encouraged that the complication rate was comparable."

    "Bottom line: It looks like it was pretty much a wash," Laudone told Reuters Health. For patients, it means "if you're going to a surgeon who is experienced in traditional surgery and recommends traditional surgery, that's a reasonable recommendation."

    He estimated that perhaps 25 percent of bladder cancer removals, known as radical cystectomies, are currently done with robots.

    The study also found that patients who underwent conventional surgery spent about 28 percent less time in the operating room. They experienced more blood loss - about 5 ounces more - but "with that amount, we wouldn't expect to see any significant side effect," Laudone said.

    "These results highlight the need for randomized trials to inform the benefits and risks of new surgical technologies before widespread implementation," he and his colleagues concluded.

    About 67,000 bladder tumors are discovered in the U.S. each year and one quarter of them require bladder removal.

    The new study involved patients who needed both the bladder and nearby lymph nodes extracted. The men also lost their prostate and the women lost their ovaries, fallopian tubes, uterus and related organs. Even when a $2 million robot was used, conventional surgery was employed to redirect urine to the intestine.

    With robot-assisted surgery, 22 percent of the 60 patients had at least one serious complication within the first 90 days. A complication was regarded as serious if it required further surgery, intubation or major rehabilitation. The rate was essentially the same - 21 percent - with traditional surgery.

    When the researchers included lesser complications, such as those requiring intravenous medicine or blood transfusion, the risk was 62 percent with robot-assisted surgery versus 66 percent with open surgery.

    The average length of hospital stay was eight days for both groups.

    But the patients in the robot group spent two hours longer in the operating room. The average time was 5 hours 29 minutes with conventional surgery and 7 hours 36 minutes with robotic assistance.

    Both Laudone and Yates said that time difference is expected to shrink as doctors become more adept at working with robots.

    "It's an evolving technology and we're evolving in our learning to use the robot," Laudone said. "We're getting better as robotic surgeons, so operating time is diminishing. With prostate surgery, the same thing was true. Now, in some cases, doing it with the robot is faster. So the time difference is something I think will disappear with more experience."

    Yates cautioned that "this was a small study and I think it needs to be fleshed out with larger numbers. And you have to remember that Sloan Kettering is one of the more prominent high-volume institutions in the country. Whether this is generalizable to other institutions remains to be seen."

    SOURCE: http://bit.ly/1wN4FCQ New England Journal of Medicine, online July 23, 2014.

Orthopedic Articles

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Transplant Articles

  • Inquiry finds "indications" of organ harvesting in Kosovo conflict

    By Julia Fioretti

    BRUSSELS (Reuters) - An EU-led inquiry found "compelling indications" that Kosovo Albanian guerrillas extracted body organs from Serb captives during the 1998-99 war and sold them, but the practice was not widespread and there was not enough evidence for a trial, the lead investigator said on Tuesday.

    After a three-year investigation, the EU-led task force said there was, however enough evidence to prosecute former leaders of the Kosovo Liberation Army (KLA) for war crimes against the ethnic Serb and Roma populations of Kosovo during the conflict.

    The investigation was prompted by a 2011 report by Council of Europe member Dick Marty that accused senior KLA commanders of involvement in the smuggling of Serb prisoners into northern Albania and the removal of their organs for sale.

    Prime Minister Hashim Thaci, himself a former KLA leader who was named in Marty's report, has dismissed the accusations as an attempt to tarnish the Kosovo Albanian fight for independence.

    U.S. prosecutor John Clint Williamson, who led the investigation, said there was no evidence of widespread organ harvesting, but that the crime had occurred a number of times.

    "There are compelling indications that this practice did occur on a very limited scale and that a small number of individuals were killed for the purpose of extracting and trafficking their organs," he told journalists.

    Other crimes perpetrated by senior KLA members, such as unlawful killings and forced disappearances, amounted to the ethnic cleansing of large portions of the Serb and Roma populations, and there was enough evidence to prosecute, Williamson said.

    DARK CLOUD

    The task force will file its indictment against former KLA leaders for war crimes once an ad hoc tribunal has been set up by the European Union and Kosovo, something Williamson said would happen next year. He did not name the people likely to be indicted.

    Prime Minister Thaci said in a statement the government would continue cooperating with the task force.

    "The government of the Republic of Kosovo appreciates the completion of the ambassador Williamson's work, which is an important step to determine potential individual responsibility and gives an end to the claims of the unfounded charges."

    Serbia's counter-insurgency campaign of 1998 and 1999 eventually drew in NATO, which bombed for 78 days to drive out Serbian forces behind the killings of Kosovo Albanian civilians. Around 10,000 Albanians and just over 2,000 Serbs are believed to have been killed during and immediately after the war.

    Kosovo declared independence in 2008 but the EU still plays a guiding role in policing and justice, particularly cases of war crimes.

    Efforts to investigate alleged war crimes committed by the guerrillas have run up against widespread intimidation in a small country where clan loyalties run deep and former KLA rebels are revered as heroes.

    Williamson condemned what he called "active efforts" to undermine the investigation.

    "As long as a few powerful people continue to thwart investigations into their own criminality, the people of Kosovo as a whole pay the price as this leaves a dark cloud over the country."

  • Doctors more likely than public to sign up for organ donation: study

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Doctors are almost twice as likely as the general public to be registered organ donors, according to a study of Canadian physicians.

    "A common myth is that physicians won't work as hard to save the lives of patients if they know they are registered for organ donation," said lead author Alvin Ho-ting Li.

    These results demonstrate that, as registered donors, physicians are more confident in the donation and transplantation system than most other people, he told Reuters Health by email.

    "These findings can help dispel that myth," said Li, of Western University in London, Ontario, who worked on the study.

    Li and his team used cross-referenced data on 15,000 active physicians in Ontario in 2013 and 60,000 residents similar in age, sex, income and residential neighborhood with an organ donor registry.

    More than 43 percent of the doctors were registered organ donors, compared to 30 percent of their matched comparison group and 24 percent of the general public in Ontario, according to the results in JAMA.

    Doctors who were younger, female or living in a rural community were more likely to be registered.

    "Many physicians see the ramifications of the organ donation shortage first hand in their patients, so they may be more motivated to contribute to the shortage if possible," said Dr. Claire Wakefield of Sydney Children's Hospital in Randwick, Australia, who was not part of the new study.

    Performing many medical procedures may also make the prospect of organ donation less intimidating for doctors, she told Reuters Health by email.

    "I think the Canadian findings are likely to be reflective of the situation in industrialized countries with universal health care coverage, which doesn't include the U.S." said Susan E. Morgan, director of the Center for Communication, Culture, and Change at the University of Miami in Coral Gables, Florida.

    "Although we all expect doctors to know everything health-related, they really don't," Morgan, who was not involved in the study, told Reuters Health by email. "They're regular people who are influenced by the dominant norms in their culture, just like everyone else."

    Although Morgan has worked on public education campaigns for organ donation in the U.S., she said she was surprised there weren't more physician organ donors in Ontario.

    Many Americans are still uneasy about organ donation due to lack of information, she said.

    "We have a truly excellent system in this country that does quite well when it comes to protecting potential donors," Morgan said.

    Doctors and other medical staff have no control over whether someone can become a donor, which is determined by various medical criteria, nor over who will receive those organs, she said.

    "The medical personnel who work very, very hard to save the lives of people who are gravely injured or dying are not the same people who do organ transplants - and they don't even work with people who are on the transplant waiting list," she said. "These are very different medical specialties."

    Currently almost 123,000 people in the U.S. are waiting for an organ transplant, most commonly for a kidney or liver, according to the Organ Procurement and Transplantation Network.

    "We hope that these results will generate further discussion and awareness, and encourage everyone to sign up for organ and tissue donation," Li said.

    SOURCE: http://bit.ly/1nax5Hh JAMA, online July 16, 2014.

Women’s Health Articles

  • Evidence suggests babies in womb start learning earlier than thought: study

    By Barbara Liston

    ORLANDO, Fla. (Reuters) - Babies in the womb show evidence of learning by their 34th week, three weeks earlier than previously thought, new research has found.

    "It really pushed the envelope" in terms of how early babies begin to learn, lead researcher Charlene Krueger, associate professor at the University of Florida's College of Nursing, said on Thursday.

    The study, published in the journal Infant Behavior and Development, followed 32 women from their 28th through 38th weeks of pregnancy in an investigation to pinpoint when the ability to learn emerges.

    Krueger had the women repeat three times out loud a set 15-second nursery rhyme, and do it twice a day for six weeks. The selected rhyme was previously unknown to the mothers.

    The fetuses' heart rates were monitored at 32, 33 and 34 weeks as they listened to a recording of a female stranger recite the rhyme.

    By the 34th week, Krueger said, the heart rates of the tested fetuses showed an overall slight decline while listening to the recording, compared with a control group of fetuses whose heart rates slightly accelerated while listening to a recording of a new nursery rhyme.

    Krueger said a decelerating heartbeat has long been associated with a fetus recognizing something familiar, compared with an accelerated heartbeat response to a novel sound or experience.

    "We cautiously concluded, because it was not statistically significant, that learning emerged by 34 weeks gestational age," she said.

    At that point, the mothers stopped reciting the rhyme to their babies who were tested again at 36 and 38 weeks.

    "At 38 weeks we confidently concluded the fetus could remember the rhythm of that nursery rhyme, which was four weeks after the mother stopped reciting the rhyme," Krueger said.

    "The deeper and more prolonged response (at 38 weeks), the more confident I felt that learning had gone on," she said.

    Krueger said the findings have implications for the care of pre-term babies in neonatal units. She said she next wants to experiment with placing recordings of the mothers' voices in the babies' cribs so they will benefit from positive impacts of their mothers' voices.

    "What it really shows is how sophisticated the interaction is between a mother and her infant," she said.

    SOURCE: http://bit.ly/1lEBzAl Infant Behavior and Development, May 2014.

  • REFILE-Traumatic childhood events more common among military volunteers

    (change to coding, no change to article text)

    By Andrew M. Seaman

    NEW YORK (Reuters Health) - People who served in the military tend to have experienced more traumatic childhood events, such as being abused or living with an alcohol-dependant parent, than people who are not veterans, according to a new study.

    In particular, men who volunteered for the military were more than twice as likely as men without military experience to report at least one adverse event in childhood, which supports a theory that people may use the military to escape from dysfunctional home lives, the researchers write in JAMA Psychiatry.

    "It may be a sign of resilience," John Blosnich said. "They may recognize the military offers training, education and advancement. Our next step is to look at whether or not these adverse childhood experiences are related to their health outcomes."

    Blosnich is the study's lead author and a researcher at the Center for Health Equity Research and Promotion at the Veterans Affairs Pittsburgh Healthcare System.

    Adverse childhood events include a range of negative experiences that have been linked to lifelong consequences such as post-traumatic stress disorder, drug and alcohol abuse, attempted suicide and shortened life expectancy.

    If past research suggesting some people may join the military to escape personal problems is true, Blosnich and his colleagues write, adverse childhood experiences may be more common among current and former military members.

    That has implications for the current healthcare needs of military personnel and veterans, the authors point out. And, because past trauma may make a person more vulnerable to developing post-traumatic stress disorder after a new adverse event like combat exposure, it suggests elevated risks for poor mental health in the affected soldiers.

    To get a sense of how common adverse childhood experiences are among people who served in the military, the researchers analyzed responses to a survey conducted in 10 U.S. states and the District of Columbia by the Centers for Disease Control and Prevention in 2010.

    The survey included questions about 11 adverse childhood experiences, including living with a person with a mental illness, living with a person abusing alcohol or drugs, living with someone who was in jail, going through parental divorce, being physically or verbally abused and being sexually abused.

    Over 60,000 people, including more than 7,500 with a military history, took the survey and were included in the analysis. The study team distinguished between those who served in the all-volunteer military after 1973 and those who served before 1973, during the draft.

    Overall, men who served in the army during the all-volunteer era had more adverse experiences in all 11 categories than those without a history of military service.

    That was especially true for sexual abuse with 11 percent of those from the volunteer-era reporting being touched sexually, compared to about 5 percent of non-military people.

    Those who served in the volunteer military were also about twice as likely to report childhood experiences of being forced to touch someone sexually and being forced to have sex.

    People from the volunteer military were also more likely to report adverse experiences from four of the 11 categories, compared to people without a history of military service.

    Having had an increasing number of adverse experiences is important, the researchers write, because the number is tied to the severity of poor health outcomes later on.

    There were far fewer differences among men who were drafted into the military, female veterans and people who never served in the military.

    In the draft era, the researchers note, men without adverse experiences entering the military would have diluted the effect of volunteers.

    Women may not demonstrate the same patterns because female survivors of adverse experiences - especially victims of sexual abuse - may not see the military as an escape, they add.

    It's impossible to know whether those who reported more adverse childhood experiences joined the military because of them or had poorer health as adults, Blosnich said, because the survey didn't ask those questions.

    "I think we just need to know more about this and how it may or may not operate within military health in order to know where to go from here," he said.

    SOURCE: http://bit.ly/1nxhBvE JAMA Psychiatry, online July 23, 2014.

  • REFILE-Traumatic childhood events more common among military volunteers

    (change to coding, no change to article text)

    By Andrew M. Seaman

    NEW YORK (Reuters Health) - People who served in the military tend to have experienced more traumatic childhood events, such as being abused or living with an alcohol-dependant parent, than people who are not veterans, according to a new study.

    In particular, men who volunteered for the military were more than twice as likely as men without military experience to report at least one adverse event in childhood, which supports a theory that people may use the military to escape from dysfunctional home lives, the researchers write in JAMA Psychiatry.

    "It may be a sign of resilience," John Blosnich said. "They may recognize the military offers training, education and advancement. Our next step is to look at whether or not these adverse childhood experiences are related to their health outcomes."

    Blosnich is the study's lead author and a researcher at the Center for Health Equity Research and Promotion at the Veterans Affairs Pittsburgh Healthcare System.

    Adverse childhood events include a range of negative experiences that have been linked to lifelong consequences such as post-traumatic stress disorder, drug and alcohol abuse, attempted suicide and shortened life expectancy.

    If past research suggesting some people may join the military to escape personal problems is true, Blosnich and his colleagues write, adverse childhood experiences may be more common among current and former military members.

    That has implications for the current healthcare needs of military personnel and veterans, the authors point out. And, because past trauma may make a person more vulnerable to developing post-traumatic stress disorder after a new adverse event like combat exposure, it suggests elevated risks for poor mental health in the affected soldiers.

    To get a sense of how common adverse childhood experiences are among people who served in the military, the researchers analyzed responses to a survey conducted in 10 U.S. states and the District of Columbia by the Centers for Disease Control and Prevention in 2010.

    The survey included questions about 11 adverse childhood experiences, including living with a person with a mental illness, living with a person abusing alcohol or drugs, living with someone who was in jail, going through parental divorce, being physically or verbally abused and being sexually abused.

    Over 60,000 people, including more than 7,500 with a military history, took the survey and were included in the analysis. The study team distinguished between those who served in the all-volunteer military after 1973 and those who served before 1973, during the draft.

    Overall, men who served in the army during the all-volunteer era had more adverse experiences in all 11 categories than those without a history of military service.

    That was especially true for sexual abuse with 11 percent of those from the volunteer-era reporting being touched sexually, compared to about 5 percent of non-military people.

    Those who served in the volunteer military were also about twice as likely to report childhood experiences of being forced to touch someone sexually and being forced to have sex.

    People from the volunteer military were also more likely to report adverse experiences from four of the 11 categories, compared to people without a history of military service.

    Having had an increasing number of adverse experiences is important, the researchers write, because the number is tied to the severity of poor health outcomes later on.

    There were far fewer differences among men who were drafted into the military, female veterans and people who never served in the military.

    In the draft era, the researchers note, men without adverse experiences entering the military would have diluted the effect of volunteers.

    Women may not demonstrate the same patterns because female survivors of adverse experiences - especially victims of sexual abuse - may not see the military as an escape, they add.

    It's impossible to know whether those who reported more adverse childhood experiences joined the military because of them or had poorer health as adults, Blosnich said, because the survey didn't ask those questions.

    "I think we just need to know more about this and how it may or may not operate within military health in order to know where to go from here," he said.

    SOURCE: http://bit.ly/1nxhBvE JAMA Psychiatry, online July 23, 2014.

  • EU finds 'morning after pills' work, regardless of a woman's weight

    By Reuters Staff

    LONDON (Reuters) - Emergency contraceptives, known as the "morning after pill," remain suitable for all women who need them, regardless of a woman's weight, European regulators said on Thursday.

    The European Medicines Agency had questioned whether the contraceptives worked as effectively in women weighing more than 75 kg (165 lbs), but its experts concluded that the benefits of using them outweighed the risks.

    While some clinical studies suggested a reduced effectiveness in women with high bodyweight, others found no such connection and the agency decided there was not enough evidence to conclude with any certainty that there was a risk.

    The European review looked at the effectiveness of Takeda's Norlevo and Bayer's Levonelle, containing levonorgestrel, and HR Pharma's ellaOne, containing ulipristal acetate.

    "Women should be reassured that regardless of their body weight, emergency contraceptives can still be used to prevent unintended pregnancy," said Sarah Branch, of Britain's drugs watchdog the Medicines and Healthcare products Regulatory Agency.

  • Peer-led stress reduction may help mothers of kids with autism

    By Shereen Lehman

    NEW YORK (Reuters Health) - Programs teaching "mindfulness" and "positive psychology" both helped mothers of children with autism and other mental-development disabilities to reduce their stress, anxiety and depression, according to a new study.

    Most services for such families focus on the disabled child, researchers say, but improving the mental health of parents is likely to make them better caregivers and that, in turn, could improve their child's development.

    "There are literally decades of studies that have described the high levels of stress and distress, anxiety and depressive symptoms that moms and dads of children with developmental disabilities suffer, and I didn't want to describe anymore, I wanted to do something about it," said Elizabeth Dykens, who led the new study.

    "So this is really for parents - it was for their mental health and wellbeing, for their own adult development," said Dykens, an associate director of the Vanderbilt Kennedy Center for Research on Human Development in Nashville, Tennessee.

    "And I think that's what really sets it apart from the traditional interventions that are much more child oriented," she told Reuters Health.

    Past research has found that cognitive behavioral therapies, such as Mindfulness Based Stress Reduction and so-called positive psychology, are effective at reducing symptoms of stress, anxiety and even depression, Dykens and her colleagues write in the journal Pediatrics.

    Those two approaches have also been shown to lend themselves to group programs and to being delivered by non-professionals who have undergone the therapy themselves and been thoroughly trained to help peers, the authors add.

    For their study, Dykens and her colleagues enrolled 243 mothers of children with autism or other neurodevelopmental disabilities and randomly assigned them to groups that would receive either the mindfulness training or a positive psychology program called Positive Adult Development (PAD).

    "Mindfulness basically helps people focus on the present moment in a non-judgmental way, and it does that through deep belly breathing, gentle movements like yoga or qigong and meditation," Dykens said.

    She said the PAD group was more focused on thoughts, including practicing gratitude and forgiveness and defining one's own strengths.

    "Things that would counteract the anger or disappointment or feelings of guilt or sadness families often experience as they try to deal with the kids' challenging behavior and also work with the systems that are involved in providing care," she said.

    Four peer mentors, who were themselves mothers of children with developmental disabilities, had gone through the therapies and been trained to lead the groups under the supervision of a social worker.

    Both programs consisted of hour-and-a-half weekly sessions for six weeks. Psychological questionnaires were used to assess the participating mothers a total of six times before, during and up to six months after treatment.

    At the start, about 85 percent of the participating mothers had significantly elevated levels of stress, 48 percent were clinically depressed and 41 percent had anxiety disorders.

    By the end of six weeks, both groups showed significant reductions in stress, depression and anxiety levels, with sharp drops starting after just two weeks. In addition, both groups reported improved sleep and life satisfaction.

    Mothers in the mindfulness group had greater improvements in anxiety, depression, sleep and wellbeing and stronger responses in the categories of anxiety and depression, compared to the women in the positive psychology program during that time.

    The researchers speculate that may be because of the immediacy of physical relaxation promoted by the mindfulness approach. But over the longer follow-up period, mothers in the positive psychology group reported greater reductions in depression and improvements in life satisfaction compared to the mindfulness group, the researchers note.

    They acknowledge the study had some limitations because it compared two active interventions without using a comparison group that got no treatment.

    But, the study team writes, "untreated mothers of offspring with disabilities do not necessarily become less depressed over time." If anything, research shows they experience more health and mental health problems with age, the authors say.

    Dr. Eric Hollander told Reuters Health that despite its limitations, the study was large enough to show some interesting results.

    "It's pretty hard to show significant differences between active interventions but nevertheless the study did show some hints or suggestions of differences in terms of the type of interventions," he said.

    Hollander, who was not involved in the study, directs the Compulsive, Impulsive and Autism Spectrum Disorder Program at Montefiore Medical Center in New York.

    He said this is an important area for research because "families with children with autism spectrum disorder have higher caregiver burden than any other disorder."

    "I think the idea of using parents or peers to run these interventions is a good one because I think that families will identify with people who've been through the process," he said. "And it does bring down the cost."

    Dykens said that parents looking for this type of help could find books on mindfulness practice and there are some community mental health centers that offer help as well.

    Mindfulness Based Stress Reduction is a program originally developed for severely ill patients coping with pain, but is now offered more widely and parents can search online for psychotherapists, meditation centers and other health and wellness centers that may offer the course.

    Dykens added that joining parent groups and searching for local chapters of specific advocacy groups, such as the Autism Society and the National Down Syndrome Society, might also help parents.

    SOURCE: http://bit.ly/1rofAmY Pediatrics, online July 21, 2014.