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

7979 Wurzbach Rd
San Antonio, TX 78229
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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

Neuroscience Articles

  • Mom's iron intake may be important for autism risk: study

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Iron intake during pregnancy might be associated with autism risk in the infant, a new study suggests.

    Researchers found that moms of kids with autism were less likely to remember taking iron supplements before and during pregnancy than other moms. That alone is not enough to prove a link, however.

    "Even though we found an association, it's just an association and needs to be replicated," said lead author Dr. Rebecca J. Schmidt.

    "If this is replicated, it will reinforce that women should be following current specific recommendations for iron intake before they get pregnant, during pregnancy and during breastfeeding," said Schmidt, who worked on the study in the department of public health sciences at the School of Medicine at the University of California, Davis.

    Folic acid, or vitamin B, deficiency has also been linked to autism risk. Both folic acid and iron are involved in fetal brain development and are usually included in prenatal vitamins, but this is the first time research has focused specifically on iron intake and later autism risk, the authors write.

    For the new study, Schmidt and her coauthors interviewed mothers in California with children ages two to five about any multivitamins, prenatal vitamins or supplements the mothers were taking before, during and after pregnancy.

    The researchers also asked about fortified cereals and other dietary sources of iron.

    They compared moms of 520 children diagnosed with an autism spectrum disorder and mothers of 346 kids with typical development.

    Moms in the typical development group were more likely to report taking iron-specific supplements, and they had higher average daily intakes, the researchers reported in the American Journal of Epidemiology.

    Prenatal vitamins were the biggest source of iron for mothers in both groups, accounting for about 30 to 32 milligrams. The rest of the iron came mostly from iron supplements, which reportedly were used by about 31 percent of women with typically developing kids and about 25 percent of mothers of kids with autism.

    Overall, based on researchers' estimates of daily iron intakes, moms in the typical development group got 57 milligrams of iron per day, on average, compared to 51 milligrams per day for moms in the autism group.

    But the moms in both groups were generally getting above the recommended amount of iron, the researchers pointed out.

    Typically an adult woman in her reproductive years should get 18 milligrams of iron daily, according to the Institute of Medicine.

    During pregnancy, about half of women become iron deficient, so it's recommended they boost up to 27 mg per day, and get at least nine mg daily while breastfeeding, Schmidt told Reuters Health by phone.

    If the results of this study can be reproduced in other studies, it might mean that the current recommendations for pregnant or breastfeeding women are too low, the authors write.

    According to the Institute of Medicine tables, the tolerable upper intake level for adult men and women is 45 milligrams per day, but other studies have found that pregnant women in the U.S. generally get about 48 milligrams per day from supplements.

    Too much iron from supplements can be toxic, Schmidt warned, but for iron in the diet from fortified cereals, beans, red meat and dark chocolate, there is no toxicity level.

    "I think most women know they're supposed to take a prenatal vitamin during and before pregnancy but not all women know why they're taking it," she said.

    Some prenatal vitamins include iron, but others, like the popular gummy vitamins, do not. Iron can cause nausea, so some prenatal vitamins leave it out for the woman to take separately at night before bed, she said.

    "Most women in America just don't get quite enough iron from the diet," Schmidt said.

    Since the new study only compared moms from two groups and asked them all to remember what they had been doing two to five years earlier, there is room for another explanation, she said. Lower levels of iron may not have caused autism for the kids. But iron and later autism were related somehow.

    The association was especially important for women who were over age 35 and who had metabolic conditions like diabetes and obesity. That could be because as women age they start to metabolize iron differently, Schmidt said.

    "The data here are very strong and internally consistent," said Dr. Philip J. Landrigan, who was not part of the new study.

    Landrigan directs the Children's Environmental Health Center at the Icahn School of Medicine at Mount Sinai in New York.

    Women who are pregnant should be sure to take iron in addition to folic acid, he told Reuters Health by phone.

    Iron deficiency is very common in the population, and the autism rate has been rising fast in recent years, and the two might be connected, he said.

    "I'm sure it's not the whole story, because iron deficiency has been around a long time," he said.

    The study adds to the growing body of evidence that non-genetic risk factors can contribute to autism risk and showed that combinations of factors, like maternal age and metabolic conditions, don't just add together, but seem to have a significantly bigger impact on risk, said Cindy Lawler, chief of the Genes, Environment, and Health Branch at the National Institutes of Environmental Health Sciences in Research Triangle Park, North Carolina.

    "The best advice for mothers right now is to get individual guidance on nutrition and supplement use from their physicians," she told Reuters Health by email.

    SOURCE: http://bit.ly/Y1WPuS American Journal of Epidemiology, online September 22, 2014.

  • Mexican state likely to change marijuana law this year, says ex-president

    By Dave Graham and Ana Isabel Martinez

    MEXICO CITY (Reuters) - A Mexican state could approve medicinal use of marijuana by the end of this year, paving the way for further steps toward legalizing the drug, former Mexican President Vicente Fox said on Monday.

    Political pressure inside Mexico to liberalize its stance on marijuana has been rising since the U.S. states of Washington and Colorado legalized possession and sale of the drug for recreational use in 2012.

    In July, opposition lawmakers in the western state of Jalisco put forward a plan to change local drug laws, including permitting the use of marijuana for medicinal purposes.

    To win support for the plan, the lawmakers from the leftist Party of the Democratic Revolution (PRD) organized an ongoing survey to gauge public opinion, which so far has shown a clear majority in favor of allowing medical marijuana.

    Fox, who became a strong advocate for legalization after he left office in 2006, said Jalisco, a traditionally conservative state, was making "rapid progress" with the proposal.

    "I think it will probably be approved before the year is over," he told reporters in Mexico City at an event to discuss an energy forum in his home state of Guanajuato next month.

    Marijuana, along with contraband such as cocaine and crystal meth, has been a major source of income for violent drug cartels responsible for tens of thousands of deaths in Mexico.

    The PRD needs support from President Enrique Pena Nieto's Institutional Revolutionary Party (PRI) to secure a majority in Jalisco's congress, and Enrique Velazquez, one of the lawmakers behind the plan, said nearly half the local PRI deputies had already said they would back legalizing medicinal marijuana.

    Much would depend on PRI state governor Aristoteles Sandoval and Velazquez was hopeful he would back the plan, which followed a similar proposal for the capital still under discussion.

    "I talked to (Sandoval) 10 days ago, and he was receptive to the idea," Velazquez told Reuters.

    In June, Pena Nieto himself hinted that he was open to adopting a more liberal stance on marijuana, saying that Mexico and the United States could not pursue diverging policies on the issue.

    In 2009, Mexico made it legal to carry up to 5 grams (0.18 ounce) of marijuana, 500 milligrams (0.018 ounce) of cocaine and tiny amounts of heroin and methamphetamines.

    However, advocates of reform say more must be done to cut crime, and Fox said there could be no turning back.

    "The path towards legalizing drugs is irreversible," he said. "Prohibition must be replaced by regulation."

  • U.S. agency moves to end sex bias in biomedical research

    By Will Dunham

    WASHINGTON (Reuters) - The U.S. National Institutes of Health began putting in place on Tuesday its new policy aimed at ending long-standing sex bias in biomedical research favoring male lab animals and cells in the pivotal studies that are done before human clinical trials.

    The NIH, the U.S. government's medical research agency, said it had approved about $10 million in funds to supplement grants already given to 82 recipients from various universities and hospitals to expand studies to better explore possible sex differences in numerous types of medical conditions.

    Research has shown that men and women sometimes experience diseases differently and respond to treatments differently. Before new medicines or treatments can be tried on people in clinical trials, they are tested on animals or cells in a lab in so-called preclinical studies.

    An over-reliance on male lab animals like mice and rats and male cells in lab dishes in such research has obscured important sex differences that could guide future studies involving human subjects, leading to flawed findings, according to the NIH.

    "We think it's an important change and a meaningful change," Dr. Janine Clayton, director of the NIH Office of Research on Women's Health, said of the new policy.

    "It is designed to be a catalyst for considering sex as a fundamental variable in research," Clayton added. "We're asking one simple question: What effect does sex have in the context of your research?"

    The researchers who received the supplemental grant money are working on studies involving human and non-human subjects looking at matters including immunology, cardiovascular physiology, neural circuitry and behavioral health, the NIH said.

    Under the new policy, first announced in May, researchers seeking NIH grants will have to report their plans for balancing male and female cells and animals in preclinical studies, with only "rigorously defined exceptions."

    The U.S. Congress two decades ago required the NIH to include women in research it funded that involved human subjects. Before that, some clinical trials simply excluded women, leading to findings that failed to account for important sex differences.

  • What makes hospital patients turn violent?

    By Shereen Lehman

    NEW YORK (Reuters Health) - It's common for patients to come into a hospital with injuries, but too often they're the ones inflicting injury on nurses, technicians and security guards, according to a new study.

    Researchers analyzed incident reports of patient violence to identify the situations most likely to lead to a physical conflict, in the hope of training hospital staff to avert the attacks.

    "This study is contributing to knowledge about how we can develop (patient violence) prevention," Judith Arnetz told Reuters Health. "This is a project that is very much in collaboration with hospital stakeholders and that means both labor and management," said Arnetz, a researcher with the Wayne State University School of Medicine in Detroit who led the new study.

    "Compared with workers in other industries, hospital workers have high rates of non-fatal workplace assault injuries," Arnetz and her colleagues write in the Journal of Advanced Nursing.

    Among hospital workers, nurses, mental health professionals and security staff are most at risk, they point out, but hospitals' efforts to reduce workplace violence are hampered by a lack of information about the reasons violence flares.

    To learn more about what triggers patient violence, Arnetz and her colleagues looked at electronic reports of patient-to-employee violence during a one-year period in a Midwestern hospital system that includes a pediatric hospital, a rehabilitation hospital and five specialty hospitals.

    The system has 15,000 employees, two of the hospitals are located in the suburbs and five are in cities. Employees are required to report details of all adverse incidents in a centralized computer reporting system.

    A total of 214 incidents of patient violence were entered over the year, with 90 percent involving physical violence directed toward employees. Nurses reported about 40 percent of the incidents. Another 16 percent were reported by security staff and 14 percent by nursing assistants called patient care associates.

    Incidents happened at all seven hospitals, "ranging from eight at a suburban specialty hospital to 64 at an inner city acute care hospital," according to the authors.

    "In order to know what's happening you really do have to look at incident reports," Arnetz said. "After reading and rereading all of these incidents we came up with what we saw as three main themes or categories."

    The study team further broke those patterns down into sub-themes, which were very specific types of situations that represented risk situations for violence.

    Within the first overall category of patient behavior and characteristics, which accounted for 40 percent of incidents, the researchers identified cognitive impairment (such as dementia or intoxication) and times when patients were demanding to leave as recurring sub-themes in the incident reports.

    For example, one registered nurse recounted, "I was sitting at bedside of a confused patient. She had been laying down, got up quickly and punched me in the left side of the face." A patient care associate also reported, "Was comforting confused patient and he put his hand around my neck and tried to choke me."

    A psychiatric social worker entered, "Patient was at the nurses' station demanding discharge, abruptly started striking at me, hitting and scratching my face and neck."

    A second category of incidents was related to delivering care and tended to happen when workers were in close proximity to patients, such as using needles and otherwise causing discomfort, or physically moving patients from one place to another.

    For example, a registered nurse wrote, "Patient needed lab work drawn and became very hostile, aggressive and violent with staff. He was verbally abusive with profanity and physically abusive by hitting, biting, scratching and pushing. Attempted to grab patient's arm to prevent him from hitting the ER (emergency room) tech who was drawing his blood and the patient hit me in the left side of my face . . . patient hit my eye, ear, cheek and head. Patient then tried to bite me, but could only get my clothing."

    And a patient care associate entered, "Employee was hooking up tube feeding, patient got agitated and kicked employee in the face."

    The third category, dubbed situational events, involved transitions such as admission or discharge, use of restraints, redirecting patients back to their beds or hospital rooms and intervening with a violent patient.

    A patient care associate wrote, "I was trying to keep the patient from leaving the room and going to the elevator by standing in front of her room door. She got mad and scratched my face. I grabbed her hands to keep her from scratching me again and then she bit my thumb."

    And a security guard's supervisor wrote, "Security officer was injured while attempting to control patient. Patient was disruptive and threatening medical staff. Security officer was kicked to the chest area by patient while attempting to place her in a wheelchair."

    "I think each of these subthemes are specific enough that it would be possible to educate staff to be aware of the risk situations," Arnetz said. "I think that is the importance of this study."

    Arnetz said another general theme that emerged from the analysis was that healthcare workers were often taken by surprise by the patient outbursts.

    "It may be that staff are missing signals, or they need to be educated so that they know that these things could happen," she said.

    SOURCE: http://bit.ly/1wg3mxD Journal of Advanced Nursing, online August 4, 2014.

  • Brain study hints at how fibromyalgia works

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Brain scans show that people with the pain disorder fibromyalgia react differently to what others would consider non-painful sights and sounds, new research suggests.

    The small new study provides clues to what might be going wrong in the nervous system of people with fibromyalgia, along with possible new approaches to alleviating their pain.

    "If we understand the mechanism, we may come up with new and potentially better forms of treatment," said lead author Marina López-Solà of the department of Psychology and Neuroscience at the University of Colorado, Boulder.

    Fibromyalgia, which patients experience as widespread muscle pain and fatigue, affects as many as five million Americans, most commonly middle-aged women, according to the U.S. Department of Health and Human Services.

    Its cause is unknown and there is no cure, but medications can treat the symptoms.

    The new results suggest not only that fibromyalgia is related to greater processing of pain-related signals, but also potentially to a misprocessing of other types of non-painful sensory signals that may be important to address during treatment, Lopez-Sola told Reuters Health by email.

    She and her team used "functional magnetic resonance imaging," which measures blood flow changes in the brain, to assess brain responses among 35 women with fibromyalgia and 25 similar women without the disorder.

    The fibromyalgia patients were more sensitive to non-painful stimulation compared to people without the disorder, they report in Arthritis and Rheumatism.

    Researchers showed the subjects some colors, played some tones and asked subjects to perform very simple motor tasks at the same time, like touching the tip of the right thumb with another finger.

    Areas of the brain's cortex primarily responsible for processing visual, auditory and motor signals were significantly activated in the healthy comparison group, but not in the fibromyalgia group.

    However, other brain regions that are not relevant for primary processing were activated in fibromyalgia sufferers but not in healthy controls.

    What seems to be happening is that the brains of fibromyalgia patients are under-processing certain forms of sensory information at the first stages of processing, but are also amplifying the signal at a later level of sensory integration of multiple sensory inputs, Lopez-Sola said.

    "When you are in pain, it is probable that you are more concentrated on your own pain than on the tasks you have to pay attention to," said Dr. Pedro Montoya of the Research Institute on Health Sciences at the Universitat Illes Balears in Palma de Mallorca, Spain, who was not part of the new study.

    "For me, these findings provide further support for the idea that psychological strategies aimed at changing the focus of attention from the body to external cues could be useful for these patients," Montoya said.

    There were only a small number of people involved in the study, and the researchers did not account for other mental health conditions the participants may have had, both factors that limit the results, said Dr. Winfried Hauser, associate professor of Psychosomatic Medicine at Technische Universitat Munchen in Germany.

    People with fibromyalgia often also have conditions like depression, so some people believe the disorder has a mental basis, said Michael E. Geisser, professor in the department of physical medicine and rehabilitation at the University of Michigan in Ann Arbor.

    But evidence for a neuro-anatomical basis for fibromyalgia is growing, said Geisser, who was not part of the new study.

    "There is increasing evidence that fibromyalgia is not just a pain condition," he told Reuters Health by email. "More recent research done on persons with fibromyalgia, such as the research by Lopez-Sola and colleagues, suggests that persons with fibromyalgia suffer from a central processing deficit of multiple types of sensory stimuli, not just pain."

    "It's as if the volume control for sensation in persons with fibromyalgia is turned up, or louder, for many types of sensation compared to persons without the disorder," he said.

    That might help explain why many people with fibromyalgia also often suffer from fatigue, cognitive problems or mood disturbance, Geisser said.

    Currently, people with the disorder can take anticonvulsant medications, such as pregabalin (Lyrica), and antidepressants such as duloxetine (Cymbalta) and milnacipran (Savella), which have been FDA approved for treating fibromyalgia.

    Further research to improve understanding of where there are problems in the brain for people with the disorder could lead to the development of new treatments, Geisser said.

    For example, it would be interesting to see if a treatment targeted at dampening response in an area of the brain that "overreacted" in this study helped to treat fibromyalgia symptoms, he said.

    SOURCE: http://bit.ly/1mbOikg Arthritis and Rheumatism, online September 15, 2014.

Oncology Articles

  • CEO to step down of Livestrong group founded by cyclist Armstrong

    By Jon Herskovitz

    AUSTIN, Texas (Reuters) - The CEO of the Livestrong cancer foundation started by disgraced cyclist Lance Armstrong announced his resignation on Tuesday after a tenure in which the organization went from a being global brand to losing millions after Armstrong's doping scandal.

    Doug Ulman, who helped develop the foundation that aids cancer patients and helped steer it through the scandals brought about by revelations of Armstrong's doping, said he will join Ohio State University's Comprehensive Cancer Center.

    "I am very proud and thankful for the progress we achieved together, advancing the fight against cancer and embracing a mission of service to survivors, their families and friends," Ulman said in a posting on the Livestrong foundation's website.

    Ulman started a fund for young adults after overcoming chondrosarcoma, a cancer that attacks bones and cartilage, when he was a college student and joined Livestrong 14 years ago. He will stay with Livestrong until the end of the year and did not give an indication as to who would take over for him.

    The Livestrong Foundation, which started an international trend about a decade ago with the yellow silicone bracelets bearing its name, has seen its net revenue fall by 63 percent from $52.5 million in 2005 to $19.5 million last year.

    The group gained global recognition when Armstrong won the Tour de France seven straight times between 1999 and 2005. But Armstrong, whose battle against cancer made him a hero to millions, was stripped of his Tour de France victories and banned for life from racing in 2012 by the U.S. Anti-Doping Agency after it accused him in a report of engineering one of the most sophisticated doping schemes in sports.

    He severed official ties to Livestrong in November 2012 and admitted to doping in a January 2013 television interview with celebrity host Oprah Winfrey.

    Ulman has said in media interviews the foundation would survive the scandal and serve its purpose of helping cancer patients and survivors.

  • Mexican state likely to change marijuana law this year, says ex-president

    By Dave Graham and Ana Isabel Martinez

    MEXICO CITY (Reuters) - A Mexican state could approve medicinal use of marijuana by the end of this year, paving the way for further steps toward legalizing the drug, former Mexican President Vicente Fox said on Monday.

    Political pressure inside Mexico to liberalize its stance on marijuana has been rising since the U.S. states of Washington and Colorado legalized possession and sale of the drug for recreational use in 2012.

    In July, opposition lawmakers in the western state of Jalisco put forward a plan to change local drug laws, including permitting the use of marijuana for medicinal purposes.

    To win support for the plan, the lawmakers from the leftist Party of the Democratic Revolution (PRD) organized an ongoing survey to gauge public opinion, which so far has shown a clear majority in favor of allowing medical marijuana.

    Fox, who became a strong advocate for legalization after he left office in 2006, said Jalisco, a traditionally conservative state, was making "rapid progress" with the proposal.

    "I think it will probably be approved before the year is over," he told reporters in Mexico City at an event to discuss an energy forum in his home state of Guanajuato next month.

    Marijuana, along with contraband such as cocaine and crystal meth, has been a major source of income for violent drug cartels responsible for tens of thousands of deaths in Mexico.

    The PRD needs support from President Enrique Pena Nieto's Institutional Revolutionary Party (PRI) to secure a majority in Jalisco's congress, and Enrique Velazquez, one of the lawmakers behind the plan, said nearly half the local PRI deputies had already said they would back legalizing medicinal marijuana.

    Much would depend on PRI state governor Aristoteles Sandoval and Velazquez was hopeful he would back the plan, which followed a similar proposal for the capital still under discussion.

    "I talked to (Sandoval) 10 days ago, and he was receptive to the idea," Velazquez told Reuters.

    In June, Pena Nieto himself hinted that he was open to adopting a more liberal stance on marijuana, saying that Mexico and the United States could not pursue diverging policies on the issue.

    In 2009, Mexico made it legal to carry up to 5 grams (0.18 ounce) of marijuana, 500 milligrams (0.018 ounce) of cocaine and tiny amounts of heroin and methamphetamines.

    However, advocates of reform say more must be done to cut crime, and Fox said there could be no turning back.

    "The path towards legalizing drugs is irreversible," he said. "Prohibition must be replaced by regulation."

  • More patients could wear regular clothing in hospital: study

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Although doctors say many patients in hospitals could be wearing their own clothing below the waist, and most want to, a majority still don't, according to a small Canadian study.

    That could have an important effect on patient dignity, the authors suggest.

    Dr. Todd C. Lee, who participated in the research, said he was struck by how bizarre it was to see one of his patients leave the ward briefly to attend to business wearing a suit, and then return and don an undignified open-backed hospital gown again.

    "Clearly he was capable of wearing normal clothes - it was our system and its expectations (and perhaps his preconceived notion of them) that led to him awkwardly strutting down the hall in that fashion," Lee told Reuters Health in an email.

    "Since then, I have always believed that patients should be encouraged to wear their own clothing if it is appropriate," he said. "It is interesting in that most times I have ever suggested it to my patients, they usually take to the idea quite quickly."

    Lee is a doctor in the division of general internal medicine at McGill University Health Center in Montreal, Quebec.

    For the study, he and his colleagues noted whether or not patients entering six clinical teaching units at five hospitals in Canada on the same day were wearing any garments below the waist, other than underwear or a diaper.

    They also asked the attending doctors if each patient would be allowed to wear garments like pants if they wanted to.

    Of the 127 patients entering the units that day, doctors said that 57 would be eligible to wear pants, but only 14 of those were doing so, Lee and his team reported in a research letter in JAMA Internal Medicine.

    Some patients weren't eligible to wear regular clothes below the waist because they had wounds or catheters. In other cases, patients were too immobile, too incontinent, too confused, or too ill to wear such attire, given the available nursing resources.

    At one center, researchers also asked 17 patients who were eligible to wear pants but were not doing so if they would like to, and 13 said yes.

    "Our study, which was small, suggested that probably more than one in two patients could have been wearing their own clothing, but were not," Lee said. "On some units that proportion will be higher, on others lower."

    In certain circumstances, gowns do have practical advantages, making physical examinations easier for doctors, and making laundering and disinfecting easier for those caring for patients with frequent urinary or fecal incontinence, he said.

    But as others have suggested, taking away a patient's clothes and forcing them to adopt the familiar hospital gown may cause additional emotional trauma to some patients, he said.

    "I think all patients should therefore have the option to wear their own clothing if it is clinically reasonable to do so," Lee said. "Clothing worn needs to be hygienic, able to be laundered, and shouldn't preclude the examination of patients or the performing of medically necessary acts."

    Patients should be prepared to change into the hospital gown for procedures or examinations, which require them, he said.

    One way to address the problem would be for a Canadian or American company to design updated 'functional fashions' for the hospital that are easy to put on, easy to take off, easy to launder, and that facilitated examinations and tests, but preserve more dignity for the patient, he said. Until then, the base option may be for patients to ask for their own clothes and see if it would be an option.

    "Much as I think patients should politely ask all health care practitioners who see them in the hospital to wash their hands, I think they should also ask, if they are interested in doing so, if they can wear their own clothing," Lee said. "To my mind, there is no harm in asking politely."

    SOURCE: http://bit.ly/1emvR3n JAMA Internal Medicine, September 22, 2014.

  • Study of smoking cancer patients fuels e-cigarette debate

    By Kate Kelland

    LONDON (Reuters) - The fierce debate over whether e-cigarettes can help people quit smoking took another twist on Monday as a research paper on their use by cancer patients was criticized as flawed.

    The study of cancer patients who smoke found that those using e-cigarettes as well as tobacco cigarettes were more nicotine dependent and equally or less likely to have quit than those who didn't use e-cigarettes.

    The scientists behind the research, which was published online September 22 in Cancer, the journal of the American Cancer Society, said their results raised doubts about whether e-cigarettes had any benefit in helping cancer patients to give up smoking.

    But that conclusion was questioned by other tobacco and addiction researchers, who said the selection of patients for the study had given it an inherent bias.

    The uptake of e-cigarettes, which use battery-powered cartridges to produce a nicotine-laced vapour for the "smoker" to inhale, has rocketed in the past two years, but there is fierce debate about their potential risks and benefits.

    Because they are new, there is a lack of long-term scientific evidence on their safety. Some experts fear they could lead to nicotine addiction and be a gateway to tobacco smoking, while others say they have enormous potential to help millions of smokers around the world to quit.

    What few studies there are give a mixed picture, with some concluding that e-cigarettes can help people give up a deadly tobacco habit, while others suggest they may carry health risks of their own.

    A World Health Organization (WHO) report last month called for stiff regulation of e-cigarettes as well as bans on indoor use, advertising and sales to minors.

    But that report itself was also criticised by experts who said it contained errors, misinterpretations and misrepresentations.

    For the Cancer journal study, researchers led by Jamie Ostroff of the Memorial Sloan Kettering Cancer Center in New York City studied 1,074 cancer patients who smoked and who were enrolled between 2012 and 2013 in a tobacco treatment program at a cancer center.

    They found a three-fold increase in e-cigarette use from 2012 to 2013 - rising from 10.6 percent to 38.5 percent.

    At enrollment onto the program, the researchers' analysis found, the e-cigarette users were more nicotine dependent than non-users, had more prior quit attempts, and were more likely to be diagnosed with lung or head and neck cancers.

    By the end of the study period, the researchers said, e-cigarette users were just as likely as non-users of e-cigarettes to be smoking.

    But Robert West, director of tobacco research at University College London, said the study was not able to assess whether or not for cancer patients who smoke, using an e-cigarette to try and quit is beneficial, "because the sample could consist of e-cigarette users who had already failed in a quit attempt, so all those who would have succeeded already would be ruled out."

    Peter Hajek, director of the Tobacco Dependence Research Unit at Queen Mary, University of London, agreed that the study's data did not justify the conclusions.

    "The authors followed up smokers who tried e-cigarettes but did not stop smoking, and excluded smokers who tried e-cigarettes and stopped smoking," he said.

    "Like smokers who fail with any method, these were highly dependent smokers who found quitting difficult. The authors concluded that e-cigarette (use) was not helpful, but that would be true for any treatment however effective if only treatment failures were evaluated."

    SOURCE: http://bit.ly/1qntnWk

    Cancer 2014.

  • CORRECTED-Many think of dermatology as superficial: survey

    (Corrects affiliations of Dr. Armstrong in para 2 and Dr. Edison in para 10.)

    By Madeline Kennedy

    NEW YORK (Reuters Health) - The public has some misconceptions about what dermatologists actually do, according to a recent U.S. survey.

    "Overall, 46 percent of the participants thought that we spend the majority of our time managing skin cancer and 27 percent thought that we spend the majority of our time doing cosmetic procedures," said Dr. April Armstrong of the University of Colorado Denver in Aurora, Colorado, the study's senior author.

    The results show a lack of understanding of the day-to-day realities of dermatology, the researchers say, and that misperception could affect whether people get needed care for skin diseases or if adequate funding goes to dermatology research.

    According to a 2007 workforce survey, only 10 percent of a dermatologist's work involves cosmetic procedures and the remaining 90 percent is made up of surgery and managing medical conditions, Armstrong and her team point out in the Journal of the American Academy of Dermatology.

    For their own study, Armstrong and her colleagues asked a sample of more than 800 people across the United States what they think dermatologists spend most of their time doing.

    They also asked participants how important they consider dermatology to be, how much dermatologists earn and how many hours they work, as compared to other types of doctors.

    The respondents felt that cardiologists and primary care physicians have "more critical" professions than dermatologists and that plastic surgery is less important. Most people chose the same hierarchy when asked how difficult the job of a dermatologist was, with only plastic surgery rated as easier.

    The respondents were correct in certain of their perceptions, including the number of hours worked per week by different types of doctors and the average incomes in the various fields.

    Dermatologists tend to work fewer hours than the other specialties, though they report seeing a larger number of patients, according to the study team. Dermatologists also earn less than cardiologists and plastic surgeons but more than primary care physicians, the researchers say.

    Dr. Karen Edison, chair of the Department of Dermatology at the University of Missouri Heath Care in Columbia, Missouri, agreed that there are some misconceptions about her field. She told Reuters Health in a phone call that, "While we certainly have expertise and in fact pioneered many of the most popular cosmetic procedures, most of what we do is medical and surgical dermatology."

    According to the American Academy of Dermatology, dermatologists diagnose and treat over 3,000 diseases, ranging from skin cancer to eczema to bacterial infections.

    "In addition to the common dermatological conditions which are acne, rosacea, and psoriasis, dermatologists also manage a number of very complex medical dermatological conditions such as blistering diseases, pemphigus or pemphigoids, and a number of cutaneous infections that I think the public is not quite aware of," Armstrong said.

    "Misconceptions about dermatology may discourage patients with severe skin disease who need our expertise to seek care in settings that are not prepared to deliver high quality dermatology care and services," she added.

    "We also do quite a bit of primary care in dermatology," Edison said. "We talk to patients not only about the need for sun protection, but we talk to them about their smoking, about their diet and exercise, many of us look at a patient as an entire person because the general health of a patient really affects the health of their skin."

    Armstrong and her colleagues write that media emphasis on cosmetic innovations likely contributes to the public's confusion about what dermatologists really do.

    Edison places some of the responsibility with dermatologists as well. "We have also played a part, by in some areas not participating as fully as we perhaps should with the greater house of medicine or the wider medical community," she said.

    Armstrong emphasized that it's important for dermatologists to find ways to speak to the public about their profession.

    "The key message," Armstrong said, "is that there are gaps in the public understanding of the profession, of dermatologists' expertise and what we spend the majority of our time doing, and I think there can be educational efforts there to close the gap."

    SOURCE: http://bit.ly/1o6rpdq Journal of the American Academy of Dermatology, online August 28, 2014.

Orthopedic Articles

  • Brain study hints at how fibromyalgia works

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Brain scans show that people with the pain disorder fibromyalgia react differently to what others would consider non-painful sights and sounds, new research suggests.

    The small new study provides clues to what might be going wrong in the nervous system of people with fibromyalgia, along with possible new approaches to alleviating their pain.

    "If we understand the mechanism, we may come up with new and potentially better forms of treatment," said lead author Marina López-Solà of the department of Psychology and Neuroscience at the University of Colorado, Boulder.

    Fibromyalgia, which patients experience as widespread muscle pain and fatigue, affects as many as five million Americans, most commonly middle-aged women, according to the U.S. Department of Health and Human Services.

    Its cause is unknown and there is no cure, but medications can treat the symptoms.

    The new results suggest not only that fibromyalgia is related to greater processing of pain-related signals, but also potentially to a misprocessing of other types of non-painful sensory signals that may be important to address during treatment, Lopez-Sola told Reuters Health by email.

    She and her team used "functional magnetic resonance imaging," which measures blood flow changes in the brain, to assess brain responses among 35 women with fibromyalgia and 25 similar women without the disorder.

    The fibromyalgia patients were more sensitive to non-painful stimulation compared to people without the disorder, they report in Arthritis and Rheumatism.

    Researchers showed the subjects some colors, played some tones and asked subjects to perform very simple motor tasks at the same time, like touching the tip of the right thumb with another finger.

    Areas of the brain's cortex primarily responsible for processing visual, auditory and motor signals were significantly activated in the healthy comparison group, but not in the fibromyalgia group.

    However, other brain regions that are not relevant for primary processing were activated in fibromyalgia sufferers but not in healthy controls.

    What seems to be happening is that the brains of fibromyalgia patients are under-processing certain forms of sensory information at the first stages of processing, but are also amplifying the signal at a later level of sensory integration of multiple sensory inputs, Lopez-Sola said.

    "When you are in pain, it is probable that you are more concentrated on your own pain than on the tasks you have to pay attention to," said Dr. Pedro Montoya of the Research Institute on Health Sciences at the Universitat Illes Balears in Palma de Mallorca, Spain, who was not part of the new study.

    "For me, these findings provide further support for the idea that psychological strategies aimed at changing the focus of attention from the body to external cues could be useful for these patients," Montoya said.

    There were only a small number of people involved in the study, and the researchers did not account for other mental health conditions the participants may have had, both factors that limit the results, said Dr. Winfried Hauser, associate professor of Psychosomatic Medicine at Technische Universitat Munchen in Germany.

    People with fibromyalgia often also have conditions like depression, so some people believe the disorder has a mental basis, said Michael E. Geisser, professor in the department of physical medicine and rehabilitation at the University of Michigan in Ann Arbor.

    But evidence for a neuro-anatomical basis for fibromyalgia is growing, said Geisser, who was not part of the new study.

    "There is increasing evidence that fibromyalgia is not just a pain condition," he told Reuters Health by email. "More recent research done on persons with fibromyalgia, such as the research by Lopez-Sola and colleagues, suggests that persons with fibromyalgia suffer from a central processing deficit of multiple types of sensory stimuli, not just pain."

    "It's as if the volume control for sensation in persons with fibromyalgia is turned up, or louder, for many types of sensation compared to persons without the disorder," he said.

    That might help explain why many people with fibromyalgia also often suffer from fatigue, cognitive problems or mood disturbance, Geisser said.

    Currently, people with the disorder can take anticonvulsant medications, such as pregabalin (Lyrica), and antidepressants such as duloxetine (Cymbalta) and milnacipran (Savella), which have been FDA approved for treating fibromyalgia.

    Further research to improve understanding of where there are problems in the brain for people with the disorder could lead to the development of new treatments, Geisser said.

    For example, it would be interesting to see if a treatment targeted at dampening response in an area of the brain that "overreacted" in this study helped to treat fibromyalgia symptoms, he said.

    SOURCE: http://bit.ly/1mbOikg Arthritis and Rheumatism, online September 15, 2014.

  • REFILE-Falls indoors may signal frailty, linked to shorter survival

    (corrects third paragraph to say study was led by Bailly)

    By Shereen Lehman

    NEW YORK (Reuters Health) - Women in their eighties who fell indoors, rather than outdoors or from a height like a ladder, died sooner than their peers, a new French study finds.

    Indoor falls could be an indicator of frailty and a sign that protective measures should be taken, say the authors.

    The study was led by Sebastien Bailly, a researcher with Hospices Civils de Lyon in France. He and his coauthors write in the journal Maturitas, "The mean survival time of women with inside falls was nearly 1.6 years shorter than that of women with other falling profiles."

    Bailly and his colleagues studied 4,574 women who were over the age of 74 when they joined the study, could walk by themselves and were not living in institutional settings.

    The researchers called the women every four months for the first four years of the study to find out if they had fallen at some time during the previous week and where.

    The study team distinguished among falls by their location, whether they were due to inattention or to an environmental obstacle, and how serious the resulting injuries were.

    Along these lines, they classified the falls as environmental falls, such as slipping or tripping on something outdoors, falls from a height like a ladder or stairs, and inside or outside falls in general.

    Looking at information on 329 women who had fallen the week before the phone call follow-ups, the researchers found that 26 percent were so-called environmental falls, 19 percent were outside falls, 43 percent were inside falls and 12 percent were falls from height.

    The study team followed up again after another 13 years and found that 269 women had died. And those who had fallen indoors had an average survival time of 7.6 years, compared with 9.2 years for women who had any other type of fall.

    Separate from the type of falls women had, the researchers also found that women with advanced age, signs of frailty, slow walking speeds and comorbidities - that is, other health conditions - also had shorter survival times.

    However, women with frailties, for example, "who experienced outside falls or falls from height had no increased mortality despite more serious injuries," the researchers note.

    "Among community-dwelling women, some fall more frequently than others," the study team concludes. "These women should draw the caregivers' attention because their falls may be indicators of frailty. Non-injurious falls are also of concern because women experiencing this type of fall may suffer from unfavourable underlying conditions and be at risk of short survival."

    "The study is very well done," Dr. Kathleen Walsh told Reuters Health. "It has been shown in prior studies that for indoor falls the mortality tends to be worse, and longevity is diminished," said Walsh, who was not involved in the French research.

    Walsh, a geriatric and emergency medicine specialist at the University of Wisconsin Hospital in Madison, said there are different reasons that people fall inside and one of the questions that would be have been interesting to ask was how much time the patients were spending indoors or outdoors.

    "In general, people who fall inside have to stay inside for a reason and that's because of comorbidities - they're not super active and may not be active for different reasons," she said.

    But, Walsh said, family members shouldn't panic and tell their elderly loved ones that they need to move into assisted living after they've had a fall.

    "Because if you panic without having things evaluated by the physician that person will probably not tell you again when they have fallen," she said. "Staying calm is the number one thing."

    Walsh also said that physicians should ask their elderly patients if they have fallen within the previous year. If they have fallen, the doctors should find out what the patient remembers about the fall and if it was caused by certain movements, or if the patient could get up after the fall.

    "The red flags are, did they pass out before they fell," she said. "It's all in the history, if you take a good history you can usually figure things out."

    Walsh said that family members help to prevent falls by doing things like removing rugs and putting bars in bathrooms. In addition, she suggests elderly patients take classes to improve their balance and strength, such as the Stepping On class (http://www.steppingon.com).

    "Stepping is usually held at a local hospital or senior center and it's all about things that you can do while you're washing dishes or doing odds and ends around the house so you don't have to go to the physical therapist," she said.

    SOURCE: http://bit.ly/1oHXLKv Maturitas, online August 4, 2014.

  • REFILE-Falls indoors may signal frailty, linked to shorter survival

    (corrects third paragraph to say study was led by Bailly)

    By Shereen Lehman

    NEW YORK (Reuters Health) - Women in their eighties who fell indoors, rather than outdoors or from a height like a ladder, died sooner than their peers, a new French study finds.

    Indoor falls could be an indicator of frailty and a sign that protective measures should be taken, say the authors.

    The study was led by Sebastien Bailly, a researcher with Hospices Civils de Lyon in France. He and his coauthors write in the journal Maturitas, "The mean survival time of women with inside falls was nearly 1.6 years shorter than that of women with other falling profiles."

    Bailly and his colleagues studied 4,574 women who were over the age of 74 when they joined the study, could walk by themselves and were not living in institutional settings.

    The researchers called the women every four months for the first four years of the study to find out if they had fallen at some time during the previous week and where.

    The study team distinguished among falls by their location, whether they were due to inattention or to an environmental obstacle, and how serious the resulting injuries were.

    Along these lines, they classified the falls as environmental falls, such as slipping or tripping on something outdoors, falls from a height like a ladder or stairs, and inside or outside falls in general.

    Looking at information on 329 women who had fallen the week before the phone call follow-ups, the researchers found that 26 percent were so-called environmental falls, 19 percent were outside falls, 43 percent were inside falls and 12 percent were falls from height.

    The study team followed up again after another 13 years and found that 269 women had died. And those who had fallen indoors had an average survival time of 7.6 years, compared with 9.2 years for women who had any other type of fall.

    Separate from the type of falls women had, the researchers also found that women with advanced age, signs of frailty, slow walking speeds and comorbidities - that is, other health conditions - also had shorter survival times.

    However, women with frailties, for example, "who experienced outside falls or falls from height had no increased mortality despite more serious injuries," the researchers note.

    "Among community-dwelling women, some fall more frequently than others," the study team concludes. "These women should draw the caregivers' attention because their falls may be indicators of frailty. Non-injurious falls are also of concern because women experiencing this type of fall may suffer from unfavourable underlying conditions and be at risk of short survival."

    "The study is very well done," Dr. Kathleen Walsh told Reuters Health. "It has been shown in prior studies that for indoor falls the mortality tends to be worse, and longevity is diminished," said Walsh, who was not involved in the French research.

    Walsh, a geriatric and emergency medicine specialist at the University of Wisconsin Hospital in Madison, said there are different reasons that people fall inside and one of the questions that would be have been interesting to ask was how much time the patients were spending indoors or outdoors.

    "In general, people who fall inside have to stay inside for a reason and that's because of comorbidities - they're not super active and may not be active for different reasons," she said.

    But, Walsh said, family members shouldn't panic and tell their elderly loved ones that they need to move into assisted living after they've had a fall.

    "Because if you panic without having things evaluated by the physician that person will probably not tell you again when they have fallen," she said. "Staying calm is the number one thing."

    Walsh also said that physicians should ask their elderly patients if they have fallen within the previous year. If they have fallen, the doctors should find out what the patient remembers about the fall and if it was caused by certain movements, or if the patient could get up after the fall.

    "The red flags are, did they pass out before they fell," she said. "It's all in the history, if you take a good history you can usually figure things out."

    Walsh said that family members help to prevent falls by doing things like removing rugs and putting bars in bathrooms. In addition, she suggests elderly patients take classes to improve their balance and strength, such as the Stepping On class (http://www.steppingon.com).

    "Stepping is usually held at a local hospital or senior center and it's all about things that you can do while you're washing dishes or doing odds and ends around the house so you don't have to go to the physical therapist," she said.

    SOURCE: http://bit.ly/1oHXLKv Maturitas, online August 4, 2014.

  • Salt and smoking may interact to raise RA risk

    By Shereen Lehman

    NEW YORK (Reuters Health) - Eating a diet high in salt may increase the risk of rheumatoid arthritis among smokers, according to a large study from Sweden.

    Researchers set out to see if a salty diet might be linked to the onset of RA, but found a connection only among smokers - who were more than twice as likely as anyone with a low-salt diet to develop the condition.

    "Although we could not confirm our original hypothesis, we were surprised by the large influence of sodium intake on smoking as a risk factor," Björn Sundström told Reuters Health in an email.

    "Smoking is a strong risk factor for developing rheumatoid arthritis, and this risk is further amplified by less than ideal food habits with high sodium intake," said Sundström, a researcher in the departments of public health and clinical medicine at Umea University who led the new study.

    Rheumatoid arthritis is a chronic disease that causes pain and swelling in the joints. About 1.5 million Americans, three-quarters of them women, have been diagnosed with the condition, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

    The cause of rheumatoid arthritis isn't known, but it results from a person's own immune system attacking joint tissues. Genetics and lifestyle factors, such as smoking, hormone and cholesterol levels and obesity, have all been identified as risk factors.

    Previous laboratory research on animals and human cells also suggests sodium may provoke inflammatory molecules that are often elevated in people several years before RA appears, the authors write in the journal Rheumatology.

    To see if there is a link between sodium in the diet and risk for developing RA, Sundström and colleagues looked at health records and lifestyle information for almost 100,000 participants in a screening and intervention program that began in 1991 in Vasterbotton County in northern Sweden.

    The study team identified 386 cases of people who developed rheumatoid arthritis by 2011. Then for each case, they identified five participants who were similar in age and sex, but did not develop disease, for comparison.

    The researchers accounted for dietary habits, education, cholesterol and triglyceride levels, weight and other factors for all the participants and found no significant associations between sodium in the diet and who went on to develop RA.

    But when they looked just at smokers, they found those who consumed the most sodium were 2.26 times as likely as smokers who consumed the least sodium to develop RA.

    Smokers who consumed the least sodium had similar risk to nonsmokers in the study, leading the researchers to conclude that smoking and heavy sodium intake interact somehow to promote RA.

    "Ideally, these results needs to be repeated in an independent population," Sundström, said.

    More research is also needed to identify the biological pathways through which sodium intake can affect smoking as a risk factor, he said.

    "The study provides the first evidence in rheumatoid arthritis that sodium intake may influence risk for onset of the disease," Dr. Lars Klareskog told Reuters Health in an email.

    Klareskog, a rheumatologist and researcher at the Karolinska Institute and Karolinska University Hospital in Stockholm, was not involved in the study.

    "In addition, the study demonstrates that the impact of high salt diet is restricted to individuals who smoke," he said.

    Klareskog noted that smoking is an important risk factor for rheumatoid arthritis.

    "The contribution of smoking to risk for rheumatoid arthritis overall is such that 25 percent of all rheumatoid arthritis in our country, Sweden, would not have happened without smoking," he said. One third of all cases with the more severe form of rheumatoid arthritis would not have happened without smoking, he added.

    The present study suggests that reducing salt intake may be added to this list of lifestyle advice for avoiding rheumatoid arthritis, Klareskog said.

    "Confirmatory studies are, however, needed before recommendations on salt intake can be made to the public as ways to protect against getting rheumatoid arthritis," he said.

    SOURCE: http://bit.ly/1piaEeE Rheumatology, online September 10, 2014.

Transplant Articles

  • Kidney patients know little about transplant benefits

    By Ronnie Cohen

    NEW YORK (Reuters Health) - In a new study, the vast majority of kidney failure patients told researchers they saw no need for a kidney transplant because they were doing fine on dialysis - but the researchers say these patients might not realize how much a transplant could help them.

    "Nobody is doing fine on dialysis to the point where a transplant wouldn't be better for them," senior author Dr. Dorry Segev told Reuters Health. "Transplantation is the better form of renal replacement."

    A kidney transplant doubles a recipient's life expectancy, said Segev, a transplant surgeon at the Johns Hopkins Hospital in Baltimore, Maryland.

    His group's study, published in the Clinical Journal of the American Society of Nephrology, showed a gap in dialysis patients' knowledge about the benefits of transplants over dialysis, Segev said.

    Researchers surveyed 348 patients being treated at 26 Baltimore-area freestanding dialysis centers, asking whether a dozen potential concerns constituted reasons they would not pursue a transplant. The average age was 56 and half the patients had been on dialysis for at least two months.

    Overall, more than 68 percent of the patients told researchers "I'm doing fine on dialysis."

    The older the patient, the more likely they were to report feeling fine on dialysis, the study found.

    Less educated patients were more likely to report being content with dialysis than those with higher degrees, the study found.

    Almost a quarter of patients had not seen a nephrologist (a doctor who specializes in kidney disease) before starting dialysis - and these people were almost twice as likely to report that no one had discussed a possible transplant with them.

    Nearly 30 percent of participants reported feeling uncomfortable asking a friend or relative to donate a kidney, the study found. The authors say such reluctance to ask friends and relatives to donate kidneys is consistent with prior studies.

    Also consistent with prior studies, the researchers found that women tended to be more fearful about transplants than men, with 26 percent of women saying they feared a transplant compared to less than eight percent of the men.

    Women do just as well after a transplant as men, if not better, Segev said. "That's another area where we need to work on education and assurance," he said.

    In sum, he said, the study points to a lack of education for renal-failure patients about the benefits of kidney transplants.

    "This is another set of evidence that we have a problem in how well we are educating people at the time of their kidney disease," he said. "We really need to find a better way to educate people about transplantation."

    Jesse Schold agreed. He has done similar research at the Cleveland Clinic but was not involved with the current study.

    "The preponderance of research shows that transplantation doubles life expectancy, improves quality of life and reduces healthcare costs," he told Reuters Health.

    "It's certainly interesting and to most people would be relatively startling" to realize how many patients aren't pursuing transplantation because they say they're doing fine, he said.

    "Given the overwhelming evidence that transplantation is a better treatment modality, it certainly suggests that more education may be appropriate."

    Schold stressed the need for patients suffering from renal failure to see nephrologists and learn about transplants soon after they are diagnosed with renal problems.

    Prior research found that kidney-disease patients who are African-American or lack private health insurance are less likely to be matched with donor organs before they need dialysis (see Reuters Health story of January 31, 2013 here: http://reut.rs/1tKdUU2).

    Almost 66 percent of the current study participants were African-American. Some 24 percent of them reported feeling uncomfortable asking someone to donate a kidney, compared to 41 percent of other participants.

    Americans who receive kidneys from unrelated live donors tend to be white, highly educated and live in wealthier neighborhoods, according to an earlier study (see Reuters Health story of April 9, 2012 here: http://reut.rs/ZoGvFw).

    A kidney is one of the few organs people can give away and go on to live a healthy life.

    Since the 1990s, advances in immune-suppression have made it safer to receive an organ from someone who's not a relative. Less-invasive surgical techniques also make it easier to donate.

    SOURCE: http://bit.ly/1uzgihR Clinical Journal of the American Society of Nephrology, online September 11, 2014.

  • British Ebola survivor flies to United States for blood donation

    By Reuters Staff

    (Reuters) - A British man who survived Ebola after being treated in London has flown to the United States to try to help another patient suffering from the virus, the Foreign Office in the United Kingdom said on Thursday.

    Media reports said William Pooley planned to donate his blood, which likely contains protective antibodies that could help fight the disease, for an emergency transfusion to an Ebola patient in Atlanta.

    An American doctor who worked for the World Health Organization is being treated at Emory University Hospital in Atlanta after he became infected with Ebola in Sierra Leone.

    A spokesman for the Emory hospital would not confirm on Thursday whether the doctor, who has not been named, will be getting blood donated from the British man, citing patient privacy laws.

    There are two Ebola patients being treated in the United States. A spokesman for the Nebraska hospital where another American is receiving care for the virus said the British man was not headed to that facility.

    Pooley, 29, contracted the disease while working as a volunteer nurse in Sierra Leone. He was discharged earlier this month from a special isolation unit at the Royal Free Hospital in London after 10 days of treatment with the experimental ZMapp drug.

    London's Evening Standard newspaper said Pooley and the doctor he is hoping to help were reported to be close friends after working together at the Ebola treatment center in Kenema, Sierra Leone.

    The pair has the same blood type, which made Pooley the perfect donor, the newspaper said.

    There is no proven cure for Ebola, a deadly virus that was discovered nearly 40 years ago in the forests of central Africa. The worst-ever outbreak on record of the virus, which has killed at least 2,630 people in West Africa, has triggered a scramble to develop the first drug or vaccine to treat it.

    Earlier this month at the University of Nebraska Medical Center in Omaha, Dr. Rick Sacra received a plasma infusion from another American Ebola survivor, Dr. Kent Brantly. Brantly's blood likely contained protective antibodies that doctors said could help buy Sacra some time while his body worked to fight off the infection.

    Brantly's blood type also turned out to be a match for his friend and fellow missionary Sacra.

Women’s Health Articles

  • Emergency contraception may not be available to all young men

    By Andrew M. Seaman

    NEW YORK (Reuters Health) - Young men often run into difficulties when they attempt to buy the morning-after pill for their partners, a new study suggests.

    Researchers report in the journal Contraception that in about one in every five attempts, young men in New York City were not able to buy the drug that can prevent pregnancy up to five days after unprotected sex.

    "We give a significant amount of lip service for men to be responsible in the couple and there are a number of ways for them to do that," Dr. David Bell told Reuters Health. "In this case, if the condom breaks, they can do that by getting emergency contraception for their partner."

    People should make sure they aren't putting up additional barriers that prevent men from taking a responsible role within the relationship, Bell said.

    Bell, the study's lead author, is from Columbia University's Mailman School of Public Health. He's also the medical director for the Young Men's Clinic, part of New York Presbyterian Hospital's Family Planning Clinic.

    "In my conversations with a number of young men, they would say 'I would try to go get emergency contraception from the pharmacy and they asked me to get my partner's ID or any woman off the street,'" he said. "It was in the back of my mind about how real were these barriers."

    Currently, any person of any age can buy the morning-after pill - often sold as Plan B One-Step and Next Choice one dose - without a prescription at U.S. drugstores.

    When the study was conducted in July 2012, U.S. law restricted access to the morning-after pill without a prescription to men and women 17 years old and older.

    For the new study, the researchers sent three male mystery shoppers - ages 19, 25 and 28 - to 158 pharmacies in the Washington Heights, East Harlem and Upper East Side neighborhoods of New York City.

    Overall, the mystery shoppers were able to purchase the medication at 128 of the pharmacies.

    Of the 30 pharmacies where the mystery shoppers couldn't access the drug, 22 required the male to bring either a female or her ID with him. The other eight pharmacies said they didn't have the medication in stock.

    Most of the people working at the pharmacies did give the mystery shoppers accurate information about the medication's effectiveness. One worker incorrectly told a shopper that the medication would cause an abortion. Another worker incorrectly told a shopper it would cause birth defects.

    The findings don't necessarily hold true for other parts of the country, Bell said.

    "Although New York City is particularly liberal and would have better access, given this is the situation in New York City, I would speculate that there is probably more of an issue in other parts of the country that we haven't studied," he said.

    In New York City, Bell added, it's fairly easy for men who are turned away at one pharmacy to go to another.

    "I obviously can't speak to smaller towns where there may be only one pharmacy," he said.

    Bell said a possible next step for the research is to do the experiment again to see if things have changed since there are now no age restrictions on over-the-counter access to the morning-after pill.

    SOURCE: http://bit.ly/1qr1Kvw Contraception, October issue(online June 27), 2014.

  • Mom's iron intake may be important for autism risk: study

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Iron intake during pregnancy might be associated with autism risk in the infant, a new study suggests.

    Researchers found that moms of kids with autism were less likely to remember taking iron supplements before and during pregnancy than other moms. That alone is not enough to prove a link, however.

    "Even though we found an association, it's just an association and needs to be replicated," said lead author Dr. Rebecca J. Schmidt.

    "If this is replicated, it will reinforce that women should be following current specific recommendations for iron intake before they get pregnant, during pregnancy and during breastfeeding," said Schmidt, who worked on the study in the department of public health sciences at the School of Medicine at the University of California, Davis.

    Folic acid, or vitamin B, deficiency has also been linked to autism risk. Both folic acid and iron are involved in fetal brain development and are usually included in prenatal vitamins, but this is the first time research has focused specifically on iron intake and later autism risk, the authors write.

    For the new study, Schmidt and her coauthors interviewed mothers in California with children ages two to five about any multivitamins, prenatal vitamins or supplements the mothers were taking before, during and after pregnancy.

    The researchers also asked about fortified cereals and other dietary sources of iron.

    They compared moms of 520 children diagnosed with an autism spectrum disorder and mothers of 346 kids with typical development.

    Moms in the typical development group were more likely to report taking iron-specific supplements, and they had higher average daily intakes, the researchers reported in the American Journal of Epidemiology.

    Prenatal vitamins were the biggest source of iron for mothers in both groups, accounting for about 30 to 32 milligrams. The rest of the iron came mostly from iron supplements, which reportedly were used by about 31 percent of women with typically developing kids and about 25 percent of mothers of kids with autism.

    Overall, based on researchers' estimates of daily iron intakes, moms in the typical development group got 57 milligrams of iron per day, on average, compared to 51 milligrams per day for moms in the autism group.

    But the moms in both groups were generally getting above the recommended amount of iron, the researchers pointed out.

    Typically an adult woman in her reproductive years should get 18 milligrams of iron daily, according to the Institute of Medicine.

    During pregnancy, about half of women become iron deficient, so it's recommended they boost up to 27 mg per day, and get at least nine mg daily while breastfeeding, Schmidt told Reuters Health by phone.

    If the results of this study can be reproduced in other studies, it might mean that the current recommendations for pregnant or breastfeeding women are too low, the authors write.

    According to the Institute of Medicine tables, the tolerable upper intake level for adult men and women is 45 milligrams per day, but other studies have found that pregnant women in the U.S. generally get about 48 milligrams per day from supplements.

    Too much iron from supplements can be toxic, Schmidt warned, but for iron in the diet from fortified cereals, beans, red meat and dark chocolate, there is no toxicity level.

    "I think most women know they're supposed to take a prenatal vitamin during and before pregnancy but not all women know why they're taking it," she said.

    Some prenatal vitamins include iron, but others, like the popular gummy vitamins, do not. Iron can cause nausea, so some prenatal vitamins leave it out for the woman to take separately at night before bed, she said.

    "Most women in America just don't get quite enough iron from the diet," Schmidt said.

    Since the new study only compared moms from two groups and asked them all to remember what they had been doing two to five years earlier, there is room for another explanation, she said. Lower levels of iron may not have caused autism for the kids. But iron and later autism were related somehow.

    The association was especially important for women who were over age 35 and who had metabolic conditions like diabetes and obesity. That could be because as women age they start to metabolize iron differently, Schmidt said.

    "The data here are very strong and internally consistent," said Dr. Philip J. Landrigan, who was not part of the new study.

    Landrigan directs the Children's Environmental Health Center at the Icahn School of Medicine at Mount Sinai in New York.

    Women who are pregnant should be sure to take iron in addition to folic acid, he told Reuters Health by phone.

    Iron deficiency is very common in the population, and the autism rate has been rising fast in recent years, and the two might be connected, he said.

    "I'm sure it's not the whole story, because iron deficiency has been around a long time," he said.

    The study adds to the growing body of evidence that non-genetic risk factors can contribute to autism risk and showed that combinations of factors, like maternal age and metabolic conditions, don't just add together, but seem to have a significantly bigger impact on risk, said Cindy Lawler, chief of the Genes, Environment, and Health Branch at the National Institutes of Environmental Health Sciences in Research Triangle Park, North Carolina.

    "The best advice for mothers right now is to get individual guidance on nutrition and supplement use from their physicians," she told Reuters Health by email.

    SOURCE: http://bit.ly/Y1WPuS American Journal of Epidemiology, online September 22, 2014.

  • Test young women for gonorrhea and Chlamydia, experts say

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Sexually active women under age 24 and older women at risk, like those who are pregnant, should be tested for the sexually transmitted diseases (STDs) Chlamydia and gonorrhea, according to new recommendations from the U.S. Preventive Services Task Force.

    Those are the most common STDs in the country, with more than 1.4 million reported cases of Chlamydia in 2012 alone, the government-backed Task Force wrote in a guideline published online in Annals of Internal Medicine.

    It is important to screen for these infections because they usually don't cause symptoms for women, but can be dangerous if left untreated, the authors wrote.

    "Chlamydia is the most common reportable disease in the United States and gonorrhea is the second most common," said Hayley Mark of the Johns Hopkins School of Nursing in Baltimore, Maryland, who isn't a member of the Task Force.

    "Both are a major cause of genital tract infections and untreated have substantial implications for women including ectopic pregnancy, infertility and chronic pelvic pain," she told Reuters Health by email.

    The Centers for Disease Control and Prevention (CDC) estimate that more than 800,000 people contract gonorrhea in the U.S. each year, and fewer than half of these infections are diagnosed and reported.

    The USPSTF recommendation does not include men because there was not enough evidence to recommend for or against screening, the authors said.

    "Sexually transmitted infections in men are usually symptomatic, which generally leads to earlier diagnosis and treatment, and these infections are less like to result in long term health complications for men," said Dr. Kirsten Bibbins-Domingo, Task Force co-vice chair and a general internist at San Francisco General Hospital.

    Most new Chlamydia and gonorrhea infections happen among women aged 20 to 24. People with new or multiple sex partners, who use condoms inconsistently or who exchange sex for money or drugs are also at high risk.

    The USPSTF recommends screening for the infections with nucleic acid amplification tests (NAATs) at primary care visits for young women and older women with extra risk factors at least once, and then again if a woman's sexual history changes to include risk factors.

    These tests, which are very sensitive and specific, require a urine sample for men and a vaginal swab for women, Mark said.

    Antibiotics can treat the infections, but gonorrhea is resistant to all but one class of antibiotics - cephalosporins - and even the effectiveness of that drug is dwindling, she said.

    "There are antibiotic treatments that are safe to use in pregnant women, and it is important for pregnant women to get treated, to prevent passing an infection on to her baby before and during the baby's birth," said Dr. Rachel Gorwitz, medical epidemiologist in the Division of STD Prevention in the CDC.

    Prompt treatment is important for infected women and also for their sex partners, she told Reuters Health by email.

    In the same issue of Annals of Internal Medicine, the USPSTF also published a recommendation that doctors should offer or refer patients to high-intensity behavioral counseling if they have a current or recurring STD or engage in risky sexual practices, and for all sexually active adolescents.

    Counseling involves providing basic information about the infections and how they're passed from person to person, assessing an individual patient's risk, providing education about condom use, and teaching ways to communicate with partners about safe sex.

    Previous research has shown that when adults or adolescents spend at least two hours talking about these issues with a counselor, including hands-on practice with condoms, condom use increases and STD cases decrease.

    Less-intensive counseling did not affect outcomes, however.

    "These types of interventions are generally not feasible in a typical primary care visit, but they could be feasible in an integrated care setting that included a behavior specialist who was trained to provide sexual risk-reduction counseling," the authors write.

    SOURCES: http://bit.ly/1qpWMiT, http://bit.ly/1rix43C Annals of Internal Medicine, online September 22, 2014.

  • U.S. agency moves to end sex bias in biomedical research

    By Will Dunham

    WASHINGTON (Reuters) - The U.S. National Institutes of Health began putting in place on Tuesday its new policy aimed at ending long-standing sex bias in biomedical research favoring male lab animals and cells in the pivotal studies that are done before human clinical trials.

    The NIH, the U.S. government's medical research agency, said it had approved about $10 million in funds to supplement grants already given to 82 recipients from various universities and hospitals to expand studies to better explore possible sex differences in numerous types of medical conditions.

    Research has shown that men and women sometimes experience diseases differently and respond to treatments differently. Before new medicines or treatments can be tried on people in clinical trials, they are tested on animals or cells in a lab in so-called preclinical studies.

    An over-reliance on male lab animals like mice and rats and male cells in lab dishes in such research has obscured important sex differences that could guide future studies involving human subjects, leading to flawed findings, according to the NIH.

    "We think it's an important change and a meaningful change," Dr. Janine Clayton, director of the NIH Office of Research on Women's Health, said of the new policy.

    "It is designed to be a catalyst for considering sex as a fundamental variable in research," Clayton added. "We're asking one simple question: What effect does sex have in the context of your research?"

    The researchers who received the supplemental grant money are working on studies involving human and non-human subjects looking at matters including immunology, cardiovascular physiology, neural circuitry and behavioral health, the NIH said.

    Under the new policy, first announced in May, researchers seeking NIH grants will have to report their plans for balancing male and female cells and animals in preclinical studies, with only "rigorously defined exceptions."

    The U.S. Congress two decades ago required the NIH to include women in research it funded that involved human subjects. Before that, some clinical trials simply excluded women, leading to findings that failed to account for important sex differences.

  • More patients could wear regular clothing in hospital: study

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Although doctors say many patients in hospitals could be wearing their own clothing below the waist, and most want to, a majority still don't, according to a small Canadian study.

    That could have an important effect on patient dignity, the authors suggest.

    Dr. Todd C. Lee, who participated in the research, said he was struck by how bizarre it was to see one of his patients leave the ward briefly to attend to business wearing a suit, and then return and don an undignified open-backed hospital gown again.

    "Clearly he was capable of wearing normal clothes - it was our system and its expectations (and perhaps his preconceived notion of them) that led to him awkwardly strutting down the hall in that fashion," Lee told Reuters Health in an email.

    "Since then, I have always believed that patients should be encouraged to wear their own clothing if it is appropriate," he said. "It is interesting in that most times I have ever suggested it to my patients, they usually take to the idea quite quickly."

    Lee is a doctor in the division of general internal medicine at McGill University Health Center in Montreal, Quebec.

    For the study, he and his colleagues noted whether or not patients entering six clinical teaching units at five hospitals in Canada on the same day were wearing any garments below the waist, other than underwear or a diaper.

    They also asked the attending doctors if each patient would be allowed to wear garments like pants if they wanted to.

    Of the 127 patients entering the units that day, doctors said that 57 would be eligible to wear pants, but only 14 of those were doing so, Lee and his team reported in a research letter in JAMA Internal Medicine.

    Some patients weren't eligible to wear regular clothes below the waist because they had wounds or catheters. In other cases, patients were too immobile, too incontinent, too confused, or too ill to wear such attire, given the available nursing resources.

    At one center, researchers also asked 17 patients who were eligible to wear pants but were not doing so if they would like to, and 13 said yes.

    "Our study, which was small, suggested that probably more than one in two patients could have been wearing their own clothing, but were not," Lee said. "On some units that proportion will be higher, on others lower."

    In certain circumstances, gowns do have practical advantages, making physical examinations easier for doctors, and making laundering and disinfecting easier for those caring for patients with frequent urinary or fecal incontinence, he said.

    But as others have suggested, taking away a patient's clothes and forcing them to adopt the familiar hospital gown may cause additional emotional trauma to some patients, he said.

    "I think all patients should therefore have the option to wear their own clothing if it is clinically reasonable to do so," Lee said. "Clothing worn needs to be hygienic, able to be laundered, and shouldn't preclude the examination of patients or the performing of medically necessary acts."

    Patients should be prepared to change into the hospital gown for procedures or examinations, which require them, he said.

    One way to address the problem would be for a Canadian or American company to design updated 'functional fashions' for the hospital that are easy to put on, easy to take off, easy to launder, and that facilitated examinations and tests, but preserve more dignity for the patient, he said. Until then, the base option may be for patients to ask for their own clothes and see if it would be an option.

    "Much as I think patients should politely ask all health care practitioners who see them in the hospital to wash their hands, I think they should also ask, if they are interested in doing so, if they can wear their own clothing," Lee said. "To my mind, there is no harm in asking politely."

    SOURCE: http://bit.ly/1emvR3n JAMA Internal Medicine, September 22, 2014.