CHRISTUS Santa Rosa Hospital

2827 Babcock Rd.

San Antonio, TX 78229
P 210.705.6300
www.christussantarosa.org

christus

CHRISTUS Santa Rosa Overview

Conveniently located in the South Texas Medical Center, CHRISTUS Santa Rosa Hospital – Medical Center is the preferred acute care destination for patients and physicians throughout South Texas. The campus features a broad, unique range of inpatient and outpatient clinical services, centered around a modern 178-bed Hospital.

Rounding out the comprehensive medical services offered on the hospital campus are five medical office buildings housing numerous physician offices, highly trained staff and physicians dedicated to the care of elderly patients, specialized diagnostic and treatment services for patients with digestive diseases, outpatient rehabilitation services, wound care and hyperbaric oxygen treatment, and the CHRISTUS Transplant Institute.

CHRISTUS Santa Rosa Hospital – Medical Center brings together state-of-the-art equipment, knowledgeable staff and physicians, and extensive educational support in order to provide holistic treatment in a safe, family-centered environment for all patients.

Cardiovascular Articles

  • With high blood pressure, light to moderate drinking may protect heart

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Drinking alcohol has been tied in the past to a higher risk of high blood pressure, but in a new analysis of past studies, researchers found that a drink or two a day seemed to protect even those with hypertension from heart disease and death.

    People with high blood pressure who have never been drinkers shouldn't start now based on the evidence from studies like these, said senior author Qi-Qiang He of the School of Public Health/Global Health Institute at Wuhan University in China.

    Observational studies only include data on what people do in their lives and what happens to them, and can't say for sure that one action, like drinking alcohol, causes a particular result.

    The new meta-analysis combines the data from nine previous studies involving a total of nearly 400,000 people with high blood pressure. In all of the studies, alcohol consumption, including wine, beer and spirits, was recorded, as were cases of heart disease, stroke, heart failure and death from any cause.

    The researchers divided the participants into four groups: occasional or never drinkers, those who drank about 10 grams (about a third of an ounce) of ethanol - pure alcohol - per day, and those who drank 20 or 30 grams of ethanol per day.

    In the U.S., a five-ounce glass of wine, a 12-ounce bottle of beer and a 1.5-ounce shot of liquor each contain about 14 grams of alcohol.

    Overall, He's team found that cardiovascular disease, heart attacks, strokes and other risks went down as alcohol consumption went up, according to the results published in Mayo Clinic Proceedings.

    This study included relatively few heavy drinkers, and other studies have found that the heart risk decline disappears for very heavy drinkers or binge drinkers, the authors caution.

    For all causes of death, the risk was lowest among those who drank between eight and 10 grams of alcohol per day, and the risk was higher for those who drank more or did not drink at all. Light to moderate drinkers were about 18 percent less likely to die over the course of a study than people who did not drink.

    "This was firstly found true in people with normal blood pressure," He told Reuters Health by email.

    In the general population, some studies suggest that alcohol consumption might enhance heart rate variability or keep plaque from building up inside arteries, but the mechanism is still not clear, He said.

    If anything, beneficial effects of alcohol should be even more pronounced for people without high blood pressure, said Dr. Franz H. Messerli a cardiology expert at the Icahn School of Medicine at Mount Sinai in New York.

    "One to 2 drinks daily is said to be the goldilocks amount of alcohol," Messerli told Reuters Health by email.

    But even these small amounts of alcohol have been associated with an increased risk for high blood pressure, he said.

    "We don't know whether moderate drinking is truly cardioprotective or if it is merely a marker of a healthy lifestyle," Messerli said.

    Moderate alcohol drinkers also tend to be part of the healthiest subset of the social landscape, he said.

    "Non-drinkers are usually older, eat a less healthy diet and exercise less than moderate drinkers," he noted.

    Messerli agreed that the study results should not be taken as encouragement for non-drinkers to take up drinking.

    Suggesting that people start having a few drinks here and there to reduce their risk of various heart problems may actually lead to binge drinking which increases the risk of stroke, Messerli said.

    SOURCE: http://bit.ly/1vSuiUa Mayo Clinic Proceedings, online August 1, 2014.

  • Amgen seeks U.S. approval of new cholesterol-fighting drug

    By Reuters Staff

    (Reuters) - Amgen Inc said on Thursday it applied to U.S. health regulators to sell its cholesterol fighter, evolocumab, becoming the first company to seek approval of a medicine from a closely watched new class of potent heart drugs.

    Amgen is racing with Regeneron Inc to bring to market the potentially lucrative new drugs aimed at patients unable to tolerate widely used statins, and those who cannot sufficiently lower cholesterol despite use of statins, such as Pfizer Inc's Lipitor, or other medicines.

    The injectable drugs work by blocking a naturally occurring protein called PCSK9 that prevents the liver from removing LDL cholesterol, the "bad" cholesterol, from the bloodstream.

    In large clinical trials, evolocumab cut LDL levels by more than 50 percent even in patients already taking other cholesterol medicines.

    Analysts have forecast multibillion-dollar sales for the new biotech drugs, if they demonstrate an ability to significantly reduce heart attacks and deaths in larger ongoing trials, as statins have.

    While Amgen was the first to file for U.S. approval of a PCSK9 inhibitor, Regeneron and French partner Sanofi have an ace up their sleeve that could enable them to catch up or even reach the market first with their drug, alirocumab.

    In late July, the companies said they paid $67.5 million to acquire a special voucher from BioMarin Pharmaceutical Inc that could assure alirocumab an expedited six-month U.S. regulatory review, rather than the standard 10 months.

    Pfizer Inc is also developing a PCSK9 inhibitor, but is behind Amgen and Regeneron.

    Amgen is expected to submit approval applications for evolocumab to regulators in Europe and other markets in the coming months.

  • Self management may reduce blood pressure: study

    By Andrew M. Seaman

    NEW YORK (Reuters Health) - Even people at significant risk for heart attacks and strokes can take an active role in reducing their own high blood pressure, by measuring it themselves and adjusting their medications, according to a new study from the UK.

    Researchers found that patients who closely monitored their own blood pressure and medications, using detailed instructions from their doctors, lowered their readings more than patients who relied on their healthcare providers to take periodic readings and make medication changes.

    "We've previously done a study with a group of people with uncomplicated hypertension (or high blood pressure)," said Dr. Richard McManus, the report's lead author. "We wanted to see if that intervention would also work with people with greater coronary heart disease and in the elderly."

    The intervention consisted of patients creating a detailed plan with their doctor, measuring their own blood pressure daily and adjusting their medications according to their blood pressure readings and instructions in the plan.

    This new approach resulted in better management and lower blood pressure after a year, in part because doctors tend to be reluctant to change medications based on blood pressure readings recorded at a single healthcare visit, the researchers suggest.

    Healthcare providers don't always act on readings that are above target, McManus said.

    He and his colleague write in JAMA that other studies have found self monitoring of blood pressure may result in lower readings and many people in the UK already monitor their own blood pressure.

    For the new study, the researchers enrolled 552 patients with high blood pressure and a history of other significant health problems, such as strokes, heart attacks, diabetes and kidney disease. The patients were recruited from 59 doctors' offices in the UK and participated in the trial between 2011 and 2013.

    Normal blood pressure is considered to be a systolic (the top number) reading of 120 millimeters of mercury (mmHg) or less and a diastolic (the bottom number) of 80 mmHg or less, according to the U.S. National Institutes of Health.

    High blood pressure is usually defined as a systolic reading above 140 mmHg and a diastolic reading of 90m mmHg or more. Any reading between the normal and high categories is considered to be "prehypertension."

    Half of the patients were assigned to take part in the intervention and the other half were assigned to receive usual care, which consisted of periodic visits to their doctors for blood pressure readings and medication adjustment.

    At the beginning of the study, the participants in each group had an average blood pressure reading of about 144 mmHg over about 80 mmHg.

    Among patients in the self-management group, the number and types of medications taken tended to increase, so that after 12 months, they were taking, on average, 3.3 doses of medication a day compared to 2.6 in the usual care group.

    After 12 months, the systolic reading fell in both groups, but significantly more among those who took their own readings and managed their own medications.

    People in the usual care group saw their average systolic reading fall to about 138 mmHg after one year, compared to 128 mmHg among those in the intervention group.

    "These differences in blood pressure that were observed in this study were quite substantial," said Dr. Steven Nissen, chairman of the Robert and Suzanne Tomsich Department of Cardiovascular Medicine located on the main campus of Cleveland Clinic in Ohio.

    Any reduction in blood pressure of more than 2 or 3 mmHg is a noticeable difference, said Nissen, who wasn't involved in the new study but coauthored a commentary on it in the journal.

    While the results can't prove whether those in the intervention group went on to have fewer strokes and heart attacks, Nissen said lower blood pressure is tied to better long-term outcomes.

    He cautioned that not every person with blood pressure problems will be able to handle their own readings or medication management.

    "It just means you can't go into every community and expect every patient to have the sophistication and means to follow this type of algorithm," Nissen said.

    He added that people have difficulty controlling their blood pressure for a variety of reasons - not just that doctors won't adjust medication during office visits.

    For example, Nissen said, people in the U.S. may also have trouble accessing healthcare and affording prescriptions. He said self treatment is a potential option, however.

    "There are a lot of people out there with high blood pressure - a significant number of them (are) still above targeted readings despite treatment," McManus said. "This is an intervention that could be used in those people."

    He cautioned, however, that people need to talk with their doctors about this type of blood pressure management and should not attempt it on their own.

    SOURCE: http://bit.ly/1lwkHSh and http://bit.ly/1opxQqO JAMA, online August 26, 2014.

  • CORRECTED-Travel with medications, medical devices can be daunting

    (In paragraph 14, clarifies Dr. Bauer's comment)

    By Kathryn Doyle

    NEW YORK (Reuters Health) - For international travelers who need to carry medical devices and medications with them, it's not easy to find out the travel requirements at their destinations, and embassies in general aren't much help, according to a new study.

    "The problem is known to exist but has not previously been published as we have," said lead author Moses Mutie of the Faculty of Health at the University of Canberra in Bruce, Australia.

    "Most embassies focus on trade and tourism," Mutie told Reuters Health by email. "Health issues are not often a priority."

    The Australian researchers considered the situation of a traveler from their own country going to one of 25 other countries popular with Australian tourists, including destinations in Africa, the Americas, Europe, Southeast Asia and the Western Pacific.

    The researchers explored embassy and consular websites looking for the quantities and different types of medication allowed in the country for personal use, required documentation, customs information and details about travelling with medical equipment.

    They also sent a standardized email to each embassy asking those same questions.

    Two weeks later, 11 embassies had responded, two of which forwarded the questions to the Pharmacy Board of the home country but did not respond further, the authors report in Travel Medicine and Infectious Disease.

    Of the eight countries that did respond, their recommendations varied widely, and tended to be much more strict than the recommendations of the International Narcotics Control Board (INCB), an independent body implementing United Nations Drug Control Conventions.

    According to the INCB recommendations for individual travelers, you should carry a copy of the prescription, but there are no other certifications or requirements for less than 20 doses of any medication, or less than a 30-day supply of narcotics or psychotropics, such as Ambien or Haldol.

    Many embassies, however, said all drugs required special certification of ownership and personal use, beyond a valid prescription. In some countries, a visitor is required to consult a local clinician to validate ongoing need for the medication.

    Some countries warn that if authorities are in doubt, they have the right to deny entry or confiscate the medications, the authors write.

    Drugs on Schedule I of the U.S. Controlled Substances Act, including hallucinogens or stimulants with no medical use, like THC or cocaine, can never be brought across national borders.

    Neither the embassy and consular websites nor the email responses addressed medical equipment.

    The lack of information for travelers offered by local embassies may sometimes indicate a lack of suitable regulations in destination countries, or that no one knows where to find them, said Dr. Irmgard Bauer of the Division of Tropical Health and Medicine at James Cook University in Townsville, Australia, who was not part of the study. She called the situation a "huge mess."

    Patients should turn to their treating doctor and a travel clinic, with both having the obligation to find out what is required, she told Reuters Health by email.

    "Travellers on longer trips could also be referred to a colleague in the country of destination to continue treatment and prescribe the medication," she said. "In some cases, it may mean that travel cannot happen."

    Specific outcomes for a traveler with too much medication or not enough documentation depend on the country, its law, and the person working at customs that day, Bauer said.

    "With narcotics, an arrest is not unlikely," she said. "In some countries, this will not be pleasant."

    The situation can be toughest for last minute travelers, Mutie said, but ideally there will be sufficient time to search for information ahead of time and talk to your doctor, who should be the principal source of the required information.

    Dr. Natasha Hochberg, an infectious disease physician at Boston University School of Public Health, suggested "that international travelers with chronic medical conditions seek care at least 4 to 6 weeks in advance of travel at a travel clinic to address issues related to bringing medications overseas but also to address the need for immunizations and prophylactic medication and to discuss health-promoting topics."

    Hochberg, who was not involved in the new study, added, "Travelers bringing medication overseas should bring the medication in their carry-on luggage to prevent possible loss in checked baggage, keep it in the original bottle that the medication came in, take enough to last for their trip as well as some extra in case of changes to the itinerary, and have adequate documentation including the original prescription and possibly a signed letter on travel clinic letterhead."

    For medical devices, Mutie suggests planning ahead and checking with the airline. Airlines, he notes, have published clear medical clearance guidelines in this area.

    In future, embassy websites should be designed with the user in mind, since embassies are established to provide a service, he said.

    SOURCE: http://bit.ly/1lfNmeb Travel Medicine and Infectious Disease, August 6, 2014.

  • CORRECTED-Travel with medications, medical devices can be daunting

    (In paragraph 14, clarifies Dr. Bauer's comment)

    By Kathryn Doyle

    NEW YORK (Reuters Health) - For international travelers who need to carry medical devices and medications with them, it's not easy to find out the travel requirements at their destinations, and embassies in general aren't much help, according to a new study.

    "The problem is known to exist but has not previously been published as we have," said lead author Moses Mutie of the Faculty of Health at the University of Canberra in Bruce, Australia.

    "Most embassies focus on trade and tourism," Mutie told Reuters Health by email. "Health issues are not often a priority."

    The Australian researchers considered the situation of a traveler from their own country going to one of 25 other countries popular with Australian tourists, including destinations in Africa, the Americas, Europe, Southeast Asia and the Western Pacific.

    The researchers explored embassy and consular websites looking for the quantities and different types of medication allowed in the country for personal use, required documentation, customs information and details about travelling with medical equipment.

    They also sent a standardized email to each embassy asking those same questions.

    Two weeks later, 11 embassies had responded, two of which forwarded the questions to the Pharmacy Board of the home country but did not respond further, the authors report in Travel Medicine and Infectious Disease.

    Of the eight countries that did respond, their recommendations varied widely, and tended to be much more strict than the recommendations of the International Narcotics Control Board (INCB), an independent body implementing United Nations Drug Control Conventions.

    According to the INCB recommendations for individual travelers, you should carry a copy of the prescription, but there are no other certifications or requirements for less than 20 doses of any medication, or less than a 30-day supply of narcotics or psychotropics, such as Ambien or Haldol.

    Many embassies, however, said all drugs required special certification of ownership and personal use, beyond a valid prescription. In some countries, a visitor is required to consult a local clinician to validate ongoing need for the medication.

    Some countries warn that if authorities are in doubt, they have the right to deny entry or confiscate the medications, the authors write.

    Drugs on Schedule I of the U.S. Controlled Substances Act, including hallucinogens or stimulants with no medical use, like THC or cocaine, can never be brought across national borders.

    Neither the embassy and consular websites nor the email responses addressed medical equipment.

    The lack of information for travelers offered by local embassies may sometimes indicate a lack of suitable regulations in destination countries, or that no one knows where to find them, said Dr. Irmgard Bauer of the Division of Tropical Health and Medicine at James Cook University in Townsville, Australia, who was not part of the study. She called the situation a "huge mess."

    Patients should turn to their treating doctor and a travel clinic, with both having the obligation to find out what is required, she told Reuters Health by email.

    "Travellers on longer trips could also be referred to a colleague in the country of destination to continue treatment and prescribe the medication," she said. "In some cases, it may mean that travel cannot happen."

    Specific outcomes for a traveler with too much medication or not enough documentation depend on the country, its law, and the person working at customs that day, Bauer said.

    "With narcotics, an arrest is not unlikely," she said. "In some countries, this will not be pleasant."

    The situation can be toughest for last minute travelers, Mutie said, but ideally there will be sufficient time to search for information ahead of time and talk to your doctor, who should be the principal source of the required information.

    Dr. Natasha Hochberg, an infectious disease physician at Boston University School of Public Health, suggested "that international travelers with chronic medical conditions seek care at least 4 to 6 weeks in advance of travel at a travel clinic to address issues related to bringing medications overseas but also to address the need for immunizations and prophylactic medication and to discuss health-promoting topics."

    Hochberg, who was not involved in the new study, added, "Travelers bringing medication overseas should bring the medication in their carry-on luggage to prevent possible loss in checked baggage, keep it in the original bottle that the medication came in, take enough to last for their trip as well as some extra in case of changes to the itinerary, and have adequate documentation including the original prescription and possibly a signed letter on travel clinic letterhead."

    For medical devices, Mutie suggests planning ahead and checking with the airline. Airlines, he notes, have published clear medical clearance guidelines in this area.

    In future, embassy websites should be designed with the user in mind, since embassies are established to provide a service, he said.

    SOURCE: http://bit.ly/1lfNmeb Travel Medicine and Infectious Disease, August 6, 2014.

Comprehensive Rehabilitation Articles

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Emergency News

  • West Africa Ebola outbreak could infect 20,000 people, WHO says

    By Stephanie Nebehay and Tim Cocks

    GENEVA/LAGOS (Reuters) - The Ebola epidemic in West Africa could infect more than 20,000 people, the U.N. health agency said on Thursday, warning that an international effort costing almost half a billion dollars is needed to overcome the outbreak.

    As the World Health Organization (WHO) announced its strategic plan for combatting the virus, GlaxoSmithKline said an experimental Ebola vaccine is being fast-tracked into human studies and it plans to produce up to 10,000 doses for emergency deployment if the results are good.

    The WHO estimates it will take six to nine months to halt the Ebola epidemic in West Africa, while Nigeria said on Thursday that a doctor involved in treating the Liberian-American who brought the disease to the country had died in Port Harcourt, Africa's largest energy hub, although the cause had yet to be confirmed.

    So far 3,069 cases have been reported in the outbreak but the WHO said the actual number in Guinea, Sierra Leone, Liberia and Nigeria could already be two to four times higher.

    "This is not a West Africa issue. This is a global health security issue," Bruce Aylward, the WHO's Assistant Director-General for Polio, Emergencies and Country Collaboration, told reporters in Geneva.

    With a fatality rate of 52 percent, the death toll stood at 1,552 as of Aug. 26. That is nearly as high as the total from all recorded outbreaks since Ebola was discovered in what is now Democratic Republic of Congo in 1976.

    The figures do not include deaths from a separate Ebola outbreak announced at the weekend in Congo, which has been identified as a different strain of the virus.

    Aylward said tackling the epidemic would cost an estimated $490 million, involving thousands of local staff and 750 international experts. "It is a big operation. We are talking (about) well over 12,000 people operating over multiple geographies and high-risk circumstances. It is an expensive operation," he said.

    The operation marks a major ramping up of the response by the WHO, which had been accused by some aid agencies of reacting too slowly to the outbreak.

    A wider United Nations -led plan being launched by the end of September is expected to provide support for the secondary effects of the outbreak on food security, water, sanitation, primary and secondary healthcare and education, the WHO said.

    EXPERIMENTAL DRUGS

    Early this month, the WHO called the current Ebola outbreak an "international health emergency." Concerns that the disease could spread beyond West Africa have led to the use of drugs still under development for the treatment of a handful of cases.

    Two American health workers, who contracted Ebola while treating patients in Liberia, received an experimental therapy called ZMapp, a cocktail of antibodies made by tiny California biotech Mapp Biopharmaceutical. They recovered and were released from hospital last week.

    The virus has already killed an unprecedented number of health workers and is still being spread in a many places, the agency said. About 40 percent of the cases have occurred within the past 21 days, WHO statistics showed.

    Previous Ebola outbreaks have mainly occurred in isolated areas of Central Africa. However the current epidemic has spread to three West African capitals and Lagos, Africa's biggest city. The WHO said special attention would need to be given to stopping transmission in capital cities and major ports.

    Authorities in Nigeria announced the death in Port Harcourt, the oil industry hub of Africa's largest crude exporter, of one of the doctors who treated Patrick Sawyer, a U.S. citizen who died in Lagos after flying in from Liberia last month.

    Health Ministry spokesman Dan Nwomeh wrote in his Twitter feed that 70 people who had been in contact with Sawyer were now under observation in the town. Aylward said the deceased doctor had not yet been confirmed as being infected with Ebola.

    According to new figures released on Thursday, Nigeria has recorded 17 cases, including six deaths, from Ebola, since Sawyer collapsed upon arrival at Lagos airport in late July.

    AID EFFORT CHOKED OFF

    The Lagos case contributed to the decision by a number of airlines to halt services to Ebola-affected countries. Air France said on Wednesday it had suspended flights to Sierra Leone on the advice of the French government.

    The WHO has advised against travel bans and border closures, which some countries in the region have also implemented, saying they risked creating food and supply shortages.

    "We assume current airline limitations will stop within the next couple of weeks. This is absolutely vital," Aylward said. "Right now the aid effort risks being choked off."

    West African health ministers meeting in Ghana on Thursday echoed the WHO's concerns and called for the reopening of borders and an end to flight bans.

  • West Africa Ebola outbreak could infect 20,000 people, WHO says

    By Stephanie Nebehay and Tim Cocks

    GENEVA/LAGOS (Reuters) - The Ebola epidemic in West Africa could infect more than 20,000 people, the U.N. health agency said on Thursday, warning that an international effort costing almost half a billion dollars is needed to overcome the outbreak.

    As the World Health Organization (WHO) announced its strategic plan for combatting the virus, GlaxoSmithKline said an experimental Ebola vaccine is being fast-tracked into human studies and it plans to produce up to 10,000 doses for emergency deployment if the results are good.

    The WHO estimates it will take six to nine months to halt the Ebola epidemic in West Africa, while Nigeria said on Thursday that a doctor involved in treating the Liberian-American who brought the disease to the country had died in Port Harcourt, Africa's largest energy hub, although the cause had yet to be confirmed.

    So far 3,069 cases have been reported in the outbreak but the WHO said the actual number in Guinea, Sierra Leone, Liberia and Nigeria could already be two to four times higher.

    "This is not a West Africa issue. This is a global health security issue," Bruce Aylward, the WHO's Assistant Director-General for Polio, Emergencies and Country Collaboration, told reporters in Geneva.

    With a fatality rate of 52 percent, the death toll stood at 1,552 as of Aug. 26. That is nearly as high as the total from all recorded outbreaks since Ebola was discovered in what is now Democratic Republic of Congo in 1976.

    The figures do not include deaths from a separate Ebola outbreak announced at the weekend in Congo, which has been identified as a different strain of the virus.

    Aylward said tackling the epidemic would cost an estimated $490 million, involving thousands of local staff and 750 international experts. "It is a big operation. We are talking (about) well over 12,000 people operating over multiple geographies and high-risk circumstances. It is an expensive operation," he said.

    The operation marks a major ramping up of the response by the WHO, which had been accused by some aid agencies of reacting too slowly to the outbreak.

    A wider United Nations -led plan being launched by the end of September is expected to provide support for the secondary effects of the outbreak on food security, water, sanitation, primary and secondary healthcare and education, the WHO said.

    EXPERIMENTAL DRUGS

    Early this month, the WHO called the current Ebola outbreak an "international health emergency." Concerns that the disease could spread beyond West Africa have led to the use of drugs still under development for the treatment of a handful of cases.

    Two American health workers, who contracted Ebola while treating patients in Liberia, received an experimental therapy called ZMapp, a cocktail of antibodies made by tiny California biotech Mapp Biopharmaceutical. They recovered and were released from hospital last week.

    The virus has already killed an unprecedented number of health workers and is still being spread in a many places, the agency said. About 40 percent of the cases have occurred within the past 21 days, WHO statistics showed.

    Previous Ebola outbreaks have mainly occurred in isolated areas of Central Africa. However the current epidemic has spread to three West African capitals and Lagos, Africa's biggest city. The WHO said special attention would need to be given to stopping transmission in capital cities and major ports.

    Authorities in Nigeria announced the death in Port Harcourt, the oil industry hub of Africa's largest crude exporter, of one of the doctors who treated Patrick Sawyer, a U.S. citizen who died in Lagos after flying in from Liberia last month.

    Health Ministry spokesman Dan Nwomeh wrote in his Twitter feed that 70 people who had been in contact with Sawyer were now under observation in the town. Aylward said the deceased doctor had not yet been confirmed as being infected with Ebola.

    According to new figures released on Thursday, Nigeria has recorded 17 cases, including six deaths, from Ebola, since Sawyer collapsed upon arrival at Lagos airport in late July.

    AID EFFORT CHOKED OFF

    The Lagos case contributed to the decision by a number of airlines to halt services to Ebola-affected countries. Air France said on Wednesday it had suspended flights to Sierra Leone on the advice of the French government.

    The WHO has advised against travel bans and border closures, which some countries in the region have also implemented, saying they risked creating food and supply shortages.

    "We assume current airline limitations will stop within the next couple of weeks. This is absolutely vital," Aylward said. "Right now the aid effort risks being choked off."

    West African health ministers meeting in Ghana on Thursday echoed the WHO's concerns and called for the reopening of borders and an end to flight bans.

  • West Africa Ebola outbreak could infect 20,000 people, WHO says

    By Stephanie Nebehay and Tim Cocks

    GENEVA/LAGOS (Reuters) - The Ebola epidemic in West Africa could infect more than 20,000 people, the U.N. health agency said on Thursday, warning that an international effort costing almost half a billion dollars is needed to overcome the outbreak.

    As the World Health Organization (WHO) announced its strategic plan for combatting the virus, GlaxoSmithKline said an experimental Ebola vaccine is being fast-tracked into human studies and it plans to produce up to 10,000 doses for emergency deployment if the results are good.

    The WHO estimates it will take six to nine months to halt the Ebola epidemic in West Africa, while Nigeria said on Thursday that a doctor involved in treating the Liberian-American who brought the disease to the country had died in Port Harcourt, Africa's largest energy hub, although the cause had yet to be confirmed.

    So far 3,069 cases have been reported in the outbreak but the WHO said the actual number in Guinea, Sierra Leone, Liberia and Nigeria could already be two to four times higher.

    "This is not a West Africa issue. This is a global health security issue," Bruce Aylward, the WHO's Assistant Director-General for Polio, Emergencies and Country Collaboration, told reporters in Geneva.

    With a fatality rate of 52 percent, the death toll stood at 1,552 as of Aug. 26. That is nearly as high as the total from all recorded outbreaks since Ebola was discovered in what is now Democratic Republic of Congo in 1976.

    The figures do not include deaths from a separate Ebola outbreak announced at the weekend in Congo, which has been identified as a different strain of the virus.

    Aylward said tackling the epidemic would cost an estimated $490 million, involving thousands of local staff and 750 international experts. "It is a big operation. We are talking (about) well over 12,000 people operating over multiple geographies and high-risk circumstances. It is an expensive operation," he said.

    The operation marks a major ramping up of the response by the WHO, which had been accused by some aid agencies of reacting too slowly to the outbreak.

    A wider United Nations -led plan being launched by the end of September is expected to provide support for the secondary effects of the outbreak on food security, water, sanitation, primary and secondary healthcare and education, the WHO said.

    EXPERIMENTAL DRUGS

    Early this month, the WHO called the current Ebola outbreak an "international health emergency." Concerns that the disease could spread beyond West Africa have led to the use of drugs still under development for the treatment of a handful of cases.

    Two American health workers, who contracted Ebola while treating patients in Liberia, received an experimental therapy called ZMapp, a cocktail of antibodies made by tiny California biotech Mapp Biopharmaceutical. They recovered and were released from hospital last week.

    The virus has already killed an unprecedented number of health workers and is still being spread in a many places, the agency said. About 40 percent of the cases have occurred within the past 21 days, WHO statistics showed.

    Previous Ebola outbreaks have mainly occurred in isolated areas of Central Africa. However the current epidemic has spread to three West African capitals and Lagos, Africa's biggest city. The WHO said special attention would need to be given to stopping transmission in capital cities and major ports.

    Authorities in Nigeria announced the death in Port Harcourt, the oil industry hub of Africa's largest crude exporter, of one of the doctors who treated Patrick Sawyer, a U.S. citizen who died in Lagos after flying in from Liberia last month.

    Health Ministry spokesman Dan Nwomeh wrote in his Twitter feed that 70 people who had been in contact with Sawyer were now under observation in the town. Aylward said the deceased doctor had not yet been confirmed as being infected with Ebola.

    According to new figures released on Thursday, Nigeria has recorded 17 cases, including six deaths, from Ebola, since Sawyer collapsed upon arrival at Lagos airport in late July.

    AID EFFORT CHOKED OFF

    The Lagos case contributed to the decision by a number of airlines to halt services to Ebola-affected countries. Air France said on Wednesday it had suspended flights to Sierra Leone on the advice of the French government.

    The WHO has advised against travel bans and border closures, which some countries in the region have also implemented, saying they risked creating food and supply shortages.

    "We assume current airline limitations will stop within the next couple of weeks. This is absolutely vital," Aylward said. "Right now the aid effort risks being choked off."

    West African health ministers meeting in Ghana on Thursday echoed the WHO's concerns and called for the reopening of borders and an end to flight bans.

Surgery Articles

  • Robotic prostate removal tied to surgical changes, costs

    By Andrew M. Seaman

    NEW YORK (Reuters Health) - The introduction of robotic surgery for prostate cancer may have led to changes in the number of surgeons performing prostate removals and in the overall cost, according to a new study.

    With the technology being used more widely, fewer doctors are performing the procedure and the overall cost of prostate removal has gone up, researchers found.

    While studies examining the benefits and potential harms of robotic surgery have produced mixed results, the researchers write in BJU International that there is little information on how the innovation influenced prostate removal in the U.S.

    "We knew by anecdotal reports as well as the scientific literature that it had become relatively widespread but we didn't know how that had been done," said Dr. Steven Chang, the study's lead author from Harvard Medical School, Brigham and Women's Hospital and the Dana-Farber Cancer Institute in Boston.

    Robotic-assisted radical prostatectomy, which is the removal of the prostate with the help of a robot, began after U.S. regulators approved Intuitive Surgical, Inc.'s da Vinci Surgical System in 2000.

    Before that, surgeons would remove the prostate through a relatively large incision in so-called open surgery - or through a small incision with the help of a camera, in laparoscopic surgery.

    For the new study, the researchers used data on nearly 490,000 men who had their prostates removed between 2003 and 2010. Of those, 338,448 had open or laparoscopic surgery and 150,921 had robotic-assisted surgery.

    Overall, there was a dramatic increase in the number of prostate removals with the new technology. The proportion of surgeons doing at least half of their prostate removals with the robot increased from 0.7 percent in 2003 to about 42 percent by 2010.

    Surgeons who had been doing more than 24 prostate removals each year were the most likely to start using the new technology.

    The researchers also found that the number of surgeons performing prostate removals decreased during the study period from about 10,000 to 8,200.

    Chang said the finding that fewer surgeons are performing the procedure is likely because the ones who were only doing a few every year decided to stop altogether.

    "It was fairly obvious that the people who adopted this technology had a higher volume per year than people who did not adopt this technology," he said.

    "We have seen a concentration of da Vinci use among high volume surgeons, which we think is a positive for the healthcare system," said Dave Rosa, the executive vice president and chief scientific officer of Intuitive Surgical, Inc., in a statement emailed to Reuters Health.

    "Da Vinci use for radical prostatectomy has been shown to have clinical advantages over open prostatectomy in most of the dozens of comparative clinical studies published," Rosa added.

    The current study was not designed to analyze which type of surgery is safer or leads to fewer complications, Chang said.

    "I don't think anyone really knows that answer and I don't know if that study will ever be done," Dr. Jeff Karnes, who was not involved with the new study, told Reuters Health.

    When it comes to prostate removal, the surgeon's experience is likely more important than whether it's done with or without a robot, said Karnes, an urologist from the Mayo Clinic in Rochester, Minnesota.

    Chang and his colleagues also found that the introduction of the new technology was tied to an increase in overall U.S. spending on prostate removals.

    They write that the increase in cost is likely related to an increased number of prostate removals and increased cost for each procedure.

    Robotic-assisted prostate removals cost more than open surgeries throughout the study but the researchers found that the cost of the older surgical methods also increased toward the end of the study.

    They can't say, based on their data, why the cost of open or laparoscopic surgeries began to increase, but they suggest it may be due to slower surgeons continuing to use open surgeon or innovations in open surgery that drove the price up.

    Alternatively, Karnes said it could also be a result of riskier prostate removals, which take more time, needing open surgery.

    Intuitive Surgical, Inc.'s Rosa said a thorough study would take into account overall societal costs in an economic analysis. Those costs include how the patients faired after the procedure.

    "Costs can be calculated very differently in economic studies depending on the methodology used," he said.

    Chang said a goal in the future would be to do a more thorough cost analysis that includes more indirect costs.

    Overall, Karnes said he is not surprised by the results of the study.

    "We know that when a hospital acquires the technology the number of robot procedures go up in that hospital," he said.

    For patients faced with prostate removal, he said it's likely best to make a decision on open or robotic-assisted surgery based on the surgeon's experience and performance.

    SOURCE: http://bit.ly/1luyDMz BJU International, online August 26, 2014.

  • Second D.C.-area man stricken with flesh-eating bacteria -media

    By John Clarke and Ian Simpson

    Aug 22 () - (Reuters) - A flesh-eating bacterial disease has infected another Washington, D.C.-area man, local media reported on Thursday, just days after a man was released from a hospital following a near-deadly bout with the germ.

    Joe Wood of Stafford, Virginia, said he was swimming in the Potomac River near the town of Callao earlier this month when a scratch on his left leg became infected with vibrio vulnificus, an aggressive bacteria that feeds on flesh, Washington D.C.'s WTOP radio reported.

    Wood was admitted to the Mary Washington Hospital in Fredericksburg on July 5 where an infectious disease specialist performed skin graft surgery on Tuesday, the report said. Doctors told the radio station that Wood would likely survive.

    The report could not be immediately confirmed as the hospital did not return repeated calls by a Reuters reporter on Thursday.

    The news comes just days after a 66-year-old Maryland man was released from a hospital after nearly losing a leg and his life to the flesh-eating bacterial infection that he contracted in Chesapeake Bay earlier in the month.

    The bacterial strain causes severe illness characterized by fever and chills, septic shock and lesions. Symptoms include vomiting and diarrhea.

    Vibrio cases are on the rise in the region. In a 2009 study, the Chesapeake Bay Foundation found that the increase in infections was linked to pollution and unusually hot summers.

    In Maryland, the number of all vibrio cases, including the strain that afflicted the two men, reached 57 last year, a 10-year high, according to the Maryland Department of Health and Mental Hygiene.

    Virginia had eight vibrio vulnificus cases last year, according to the Virginia Department of Health. There have been 27 cases involving vibrio species overall so far this year.

    Nationwide, there are as many as 95 cases of vibrio vulnificus infections each year, 35 of which result in death, according to CDC statistics.

  • Men, substance users less likely to have weight-loss surgery

    By Ronnie Cohen

    NEW YORK (Reuters Health) - A one-size-fits-all approach to weight-loss surgery may be keeping obese men, substance users and older people out of the operating room, a new study suggests.

    The study analyzed data from a Canadian program intended to encourage obese people to undergo weight-loss surgery. More than half the patients dropped-out without having the operation, researchers found.

    Men, smokers, drinkers, drug users and people age 60 and older were the most likely to quit the program before having the operation, senior author Dr. Fayez Quereshy from the University of Toronto in Ontario told Reuters Health in a telephone interview.

    More than one-third of U.S. adults are obese and cost an estimated $147 billion a year in medical care, according to the Centers for Disease Control and Prevention.

    Weight loss operations, formally known as bariatric surgery, are known to cut obesity-related disease and healthcare costs. Prior research has shown they result in substantial weight loss and can reverse the course of some related diseases (see Reuters story of December 24, 2013 here: http://reut.rs/1BDFesE).

    In some studies, the surgery has been more effective in helping obese people shed weight than diet, exercise, therapy and drugs (see Reuters story of October 31, 2013 here: http://reut.rs/1z2YCLN).

    The operations reduce the size of the stomach so patients can eat only small amounts of food. Doctors recommend the procedures for people who are severely obese or moderately obese with serious weight-related health problems.

    But while bariatric surgery is becoming increasingly popular, the drop-out rate has also been growing, the authors write in the Journal of the American College of Surgeons.

    In the current study, they examined the records of 1,664 patients referred to the bariatric-surgery program between 2008 and 2011. Patients ranged in age from 19 to 80, with an average age of 48. They waited an average of nearly 15 months to have the surgery, the authors write.

    Body mass index (BMI), a ratio of weight to height, was higher than 40 in nearly nine of every ten people. A BMI of 40 would be roughly equivalent, for example, to a height of 5 foot 2 inches (157 cm) and a weight of 218 pounds (99 kg), or a height of 6 feet (183 cm) and a weight of 294 pounds (133 kg).

    About one in every 13 people had a BMI above 60, roughly equivalent to a height of 5 foot 2 inches and a weight of 330 pounds (150 kg),

    Most patients - 74 percent - referred to the program were women. Men were not only less likely to be referred, they were also nearly half as likely to undergo the surgery.

    Heavier patients were more likely to have the operation and older patients (i.e., those over 60) were less likely, the study found.

    Distance from home to the program appeared to have no impact on attrition.

    Smokers, drinkers and other substance users were more likely to quit before surgery. The study did not determine if they left the program on their own or were refused treatment. Substance abusers must demonstrate prolonged abstinence to be eligible for weight-loss surgery, the authors write.

    Knowing which patients are dropping out should help administrators tailor future bariatric-surgery services, Quereshy said.

    The best way to most efficiently move more patients through the system, he believes, would be to tailor the care for certain groups of people. For example, he suggested, patients with limited social networks should be connected to social workers early on.

    "In environments where resources are scarce and obesity-related complications carry a significant cost burden and patient complications, we need to think of novel ways to reduce wait times, patient dropouts and disappointments while improving satisfaction," Quereshy said.

    Bariatric surgeon Dr. Erik Dutson, from the University of California, Los Angeles, said the study's message rings just as true in America as it does in Canada. He was not involved with the current study.

    "If we are going to continue to look at bariatric surgery as the gold standard for weight loss, then we should keep our eyes open about preemptively anticipating problems with patients and make special care considerations for certain subgroups," Dutson said.

    Bariatric surgery is not risk-free. Gastric-bypass operations, for example, carry the risk of blood clots, breathing problems, heart attacks, strokes, infections and allergic reactions to anesthesia, according to the National Institutes of Health.

    Still, Dutson believes that bariatric surgery is the safest way to reduce obesity and prevent related complications, such as diabetes. He described the operation as safer than a gall bladder removal.

    "It's ironically safer to undergo an operation than to not undergo an operation," he said.

    SOURCE: http://bit.ly/1p7pDN9 Journal of the American College of Surgeons, online August 11, 2014.

Neonatal Articles

  • Calorie goals, support may help limit pregnancy weight gain

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Compared to obese expectant mothers without special care, those given individualized calorie goals and weekly group meetings gained less weight during pregnancy and had fewer oversized newborns in a new study.

    "More than half of women in the U.S. start out their pregnancies overweight or obese, and approximately half of all pregnant women gain too much weight during pregnancy, which can lead to increasing overweight and obesity," said lead author Dr. Kimberly K. Vesco of the Center for Health Research at Kaiser Permanente, Northwest, in Portland, Oregon.

    "Women who gain too much weight during pregnancy may retain some of that extra weight and enter their next pregnancy at a higher weight than their prior pregnancy, which can increase their risk for pregnancy complications such as gestational diabetes, high blood pressure, babies that are too big and cesarean section," Vesco, a board-certified obstetrician-gynecologist, told Reuters Health by email.

    The U.S. Institute of Medicine (IOM), a government advisory body, has issued guidelines for healthy amounts of weight gain during pregnancy, although they remain controversial (see Reuters Health story of November 17, 2010, here: http://reut.rs/1AXzmJz).

    The guidelines suggest that normal-weight women gain around 25 pounds during pregnancy, but that obese women limit their weight gain to between 11 and 20 pounds.

    For the new study, rather than giving obese women the IOM target range, Vesco's team asked 114 of them to try to maintain their weight at the start of the study, which was early in pregnancy, and assumed the women would gain a little weight anyway.

    Vesco and her team divided the participants, who were all obese and at least seven weeks pregnant when recruited into the study, into two groups. Women in one group received a single advice session from a dietician with general information about eating a healthy diet during pregnancy and usual care for the rest of their pregnancies.

    The second group attended two individualized counseling sessions where the dietician gave each woman tailored diet and physical activity guidelines, recommending at least 30 minutes of moderate activity each day, geared toward helping them gain no more than three percent of their current body weight throughout pregnancy.

    For a 200-pound woman, that would mean gaining no more than six pounds.

    Once they had their individual goals, the women started attending weekly 90-minute group sessions covering topics including nutrition, exercise and behavioral change. They were also given a goal for physical activity in the next week. The women kept food and activity journals and tracked their weight each week.

    By week 34 of pregnancy, women in the weight-control group had gained an average of 11 pounds and women in the comparison group had gained 18.5 pounds.

    By two weeks after giving birth, moms in the weight control group were an average of almost six pounds lighter than when they enrolled in the study, whereas in the comparison group moms were an average of 2.6 pounds heavier.

    Nine percent of babies born to mothers in the weight-control group were large for their gestational age - which increases the risk of birth injury and infant low blood sugar - compared to 26 percent of babies in the other group, according to the results published in the journal Obesity.

    "A common misconception during pregnancy is that women need to eat for two," Vesco said. "That's just not true. Most pregnant women need no extra calories in the first trimester and only 200-300 extra calories in the second and third trimesters," she said.

    "Our study found that limited or no weight gain may be beneficial for mom and baby, but we still need larger studies to confirm these findings before the IOM guidelines can change," Vesco said.

    Doctors can help women control their pregnancy weight by weighing them, calculating their body mass index and giving them weight-gain targets for pregnancy, said Dr. Alexis Shub, a senior lecturer in the Department of Obstetrics and Gynaecology at the University of Melbourne in Australia.

    "In our own research we have found that many obese women do not recognise that they are obese, and many overestimate the appropriate weight gain for pregnancy - so education by health care professionals is very important," she told Reuters Health by email.

    "It is laudable that research is taking place to answer questions that affect so many women and babies that we see every day in clinical practice, and that managing weight gain for these women may have a long term role in their own health and the health of their children," said Shub, who was not involved in the study.

    But, she noted, more than 1000 women declined to be in the trial, so those that participated were highly motivated. A less motivated group would likely have been less successful, she said.

    Most women, not just those who are obese, can benefit from setting a weight gain goal and following a healthy eating plan, Vesco said.

    Implementing this approach, with 90-minute weekly meetings and behavioral specialists, could be done in the real world but it would require ongoing resources and commitment from a health plan, and it's unclear how much it would cost, she said.

    "Women who are obese when they get pregnant should talk to their practitioner and together set their weight gain goals," Vesco said. "They can seek dietary advice from their practitioner or a dietician."

    SOURCE: http://bit.ly/XVvpam Obesity, online August 28, 2014.

  • Fishery mislabeling could mean more mercury than buyers bargain for

    By Janice Neumann

    NEW YORK (Reuters Health) - That Chilean sea bass from the local grocery store could have twice the methylmercury that's expected - if it comes from a region other than indicated on the label, a new study says.

    While fish certified by the Marine Stewardship Council (MSC) is generally considered safe, seafood from regions with high levels of contamination are not. And researchers studying samples from U.S. retail stores found that many fish are indeed the species they are claimed to be, but not from the region claimed.

    "Chilean sea bass is already known to sometimes have high mercury levels," lead author Peter Marko, of the University of Hawai'i at Manoa, Honolulu, told Reuters Health.

    "If women are pregnant or nursing, they probably shouldn't buy that fish, to be safe," he said.

    Past research has found that fish sold in retail markets is not always the species it's advertised to be. And that even within a given species, mercury levels can vary widely.

    Methylmercury, the type of mercury found in fish, is an organic compound that can be absorbed into living tissue.

    Pregnant and nursing women and kids have been advised by the U.S. Food and Drug Administration to avoid shark, tilefish, swordfish and King Mackerel because these species have a mean mercury level of 0.73 to 1.45 parts per million. The FDA's limit for mercury in fish for human consumption is 1.0 ppm.

    Normally, the mercury content of Chilean sea bass, also known as Patagonian toothfish, is 0.35 ppm, according to the FDA.

    In the current study, published in the journal PLOS One, researchers used sea bass tissue samples from retailers in 10 U.S. states. They measured the total amount of mercury in 25 of the MSC-certified and 13 of the uncertified Chilean sea bass samples.

    They found that fish labeled as certified had less than half the mercury (0.35 ppm) of uncertified fish (0.89 ppm).

    But when the researchers excluded the fish that actually belonged to other species and were not genetically sea bass, they found no significant difference in the mercury levels of certified and uncertified fish.

    "We then said, 'that can't be because certified is supposed to come from South Georgia, where the mercury level is low, why do we see such a difference in mercury?'" said Marko, referring to a fishery area close to the South Pole and known to have less mercury contamination than fish from waters off South American. "It's these fishery stock substitutions," he said.

    The researchers tested the DNA of the fish and found those from outside the MSC-certified South Georgia/Shag Rocks fishery had twice as much mercury (0.63 ppm) as those genetically confirmed to be South Georgia stock (0.31 ppm).

    "Regular mercury exposure is potentially dangerous to developing nervous systems, so this and other studies like it are of greatest concern to pregnant women, children, and women planning on having children," Marko said in an e-mail.

    "Our study demonstrates that accurate labeling of seafood - not just with respect to what species but also what country or region the seafood came from - is essential to consumers, particularly in the aforementioned demographic, to make informed choices at the seafood counter," he said.

    Marko pointed out that fish from South American waters can have two-to-three times as much mercury as fish from MSC-certified regions.

    Roberta White, professor and chair of Environmental Health at Boston University School of Public Health, who was not involved in the study, told Reuters Health in a phone interview the findings were another reminder that consumers need to be careful when purchasing fish.

    "What's really disturbing is how do people choose to eat fish that are safe?" said White, who has studied the effects of industrial pollutants on the brain.

    "Everybody wants people to eat fish because it is good for the brain and heart, but we also don't want them to be poisoning their children because they're pregnant," she said.

    White said future studies needed to focus on different species of fish and the genetics within species, as well as variations in neurotoxicants. Other contaminants in fish could also pose a health danger, including Polychlorinated Biphenyls (PCBs), which are synthetic organic chemicals, organic tin and different pesticides, she said.

    "As this article points out, sometimes you think something is safe because of the way it's labeled and maybe it isn't, but that's true of all our food," White said.

    "This is where you have to start, the simple stuff," White said. "I think what's important about the study is the public health message that we need to be careful about this and figure it out," said White.

    SOURCE: http://bit.ly/1vBpKRH PLOS One, online August 5, 2014.

  • U.S. to propose birth control exception for religious companies -source

    By Caroline Humer

    (Reuters) - The Obama administration will ensure access to birth control coverage for employees of closely-held companies that object to contraception on religious grounds, proposing a new accommodation to health benefits mandated by the Affordable Care Act, a source familiar with the plan said on Friday.

    The move follows a Supreme Court ruling in June that allowed certain for-profit companies to refuse to cover contraceptives due to the religious beliefs of their owners.

    President Barack Obama's healthcare reform law requires companies to provide free birth control coverage as a preventive service included in their health plans.

    The U.S. Department of Health and Human Services had already provided an exception to non-profit groups with religious affiliations, such as certain universities or hospitals, in 2013. The exception requires insurers to cover the cost of birth control for employees of such organizations, separate from the benefits paid for by the employers.

    On Friday, it was expected to propose an extension of that rule to closely-held companies in rules published in the Federal Register, the source said.

    The rule is in direct response to the Supreme Court ruling in favor of Hobby Lobby Stores Ltd, a family-owned chain of craft stores, and Conestoga Wood Specialties Corp of Pennsylvania. The two companies combined employ nearly 14,000 people. The accommodation is expected to impact at nearly 50 additional companies who have filed similar lawsuits.

    At the time, the justices ruled that for-profit companies can make claims under a 1993 federal law called the Religious Freedom Restoration Act that was enacted to protect religious liberty. They had suggested that the government could extend the accommodation made for non-profit groups.

    HHS also proposed on Friday an interim rule for non-profits to lay out additional ways that these companies can provide notice to the government in writing of their religious objections to providing contraception coverage.

    The interim rule for non-profits is largely in response to a Supreme Court order in July, issued days after the Hobby Lobby ruling, that gave a temporary exemption to a Christian college in Illinois. It had said that the initial process for informing insurers of their religious standing also violated their beliefs.

Neuroscience Articles

  • With high blood pressure, light to moderate drinking may protect heart

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Drinking alcohol has been tied in the past to a higher risk of high blood pressure, but in a new analysis of past studies, researchers found that a drink or two a day seemed to protect even those with hypertension from heart disease and death.

    People with high blood pressure who have never been drinkers shouldn't start now based on the evidence from studies like these, said senior author Qi-Qiang He of the School of Public Health/Global Health Institute at Wuhan University in China.

    Observational studies only include data on what people do in their lives and what happens to them, and can't say for sure that one action, like drinking alcohol, causes a particular result.

    The new meta-analysis combines the data from nine previous studies involving a total of nearly 400,000 people with high blood pressure. In all of the studies, alcohol consumption, including wine, beer and spirits, was recorded, as were cases of heart disease, stroke, heart failure and death from any cause.

    The researchers divided the participants into four groups: occasional or never drinkers, those who drank about 10 grams (about a third of an ounce) of ethanol - pure alcohol - per day, and those who drank 20 or 30 grams of ethanol per day.

    In the U.S., a five-ounce glass of wine, a 12-ounce bottle of beer and a 1.5-ounce shot of liquor each contain about 14 grams of alcohol.

    Overall, He's team found that cardiovascular disease, heart attacks, strokes and other risks went down as alcohol consumption went up, according to the results published in Mayo Clinic Proceedings.

    This study included relatively few heavy drinkers, and other studies have found that the heart risk decline disappears for very heavy drinkers or binge drinkers, the authors caution.

    For all causes of death, the risk was lowest among those who drank between eight and 10 grams of alcohol per day, and the risk was higher for those who drank more or did not drink at all. Light to moderate drinkers were about 18 percent less likely to die over the course of a study than people who did not drink.

    "This was firstly found true in people with normal blood pressure," He told Reuters Health by email.

    In the general population, some studies suggest that alcohol consumption might enhance heart rate variability or keep plaque from building up inside arteries, but the mechanism is still not clear, He said.

    If anything, beneficial effects of alcohol should be even more pronounced for people without high blood pressure, said Dr. Franz H. Messerli a cardiology expert at the Icahn School of Medicine at Mount Sinai in New York.

    "One to 2 drinks daily is said to be the goldilocks amount of alcohol," Messerli told Reuters Health by email.

    But even these small amounts of alcohol have been associated with an increased risk for high blood pressure, he said.

    "We don't know whether moderate drinking is truly cardioprotective or if it is merely a marker of a healthy lifestyle," Messerli said.

    Moderate alcohol drinkers also tend to be part of the healthiest subset of the social landscape, he said.

    "Non-drinkers are usually older, eat a less healthy diet and exercise less than moderate drinkers," he noted.

    Messerli agreed that the study results should not be taken as encouragement for non-drinkers to take up drinking.

    Suggesting that people start having a few drinks here and there to reduce their risk of various heart problems may actually lead to binge drinking which increases the risk of stroke, Messerli said.

    SOURCE: http://bit.ly/1vSuiUa Mayo Clinic Proceedings, online August 1, 2014.

  • German Green's ice bucket challenge lights up dope debate

    By Reuters Staff

    BERLIN (Reuters) - A German Greens party leader has taken the "ice bucket" charity challenge to a new high, standing next to a marijuana plant while dousing himself with water in a tacit call for the legalization of cannabis.

    Cem Oezdemir is one of many public figures and ordinary citizens around the world to take the challenge - pouring a bucket of ice water over one's head to raise funds to fight Amyotrophic Lateral Sclerosis (ALS).

    But Oezdemir, whose party supports legalizing the drug for adults, acknowledged that the waist-high plant by his side in a video filmed on a Berlin rooftop was indeed a "subtle political statement."

    "Yes, it is a cannabis plant," Oezedmir told the Essen-based Westdeutsche Allgemeine Zeitung (WAZ) after speculation about the plant gripped social media.

    "In a free society it should be up to each individual person to decide whether they want to consume cannabis and take the associated risks," he told the newspaper.

    Possession, cultivation and consumption of cannabis is illegal in Germany although carrying small amounts is tolerated. In July, a court ruled that seriously ill patients could cultivate their own.

  • Fishery mislabeling could mean more mercury than buyers bargain for

    By Janice Neumann

    NEW YORK (Reuters Health) - That Chilean sea bass from the local grocery store could have twice the methylmercury that's expected - if it comes from a region other than indicated on the label, a new study says.

    While fish certified by the Marine Stewardship Council (MSC) is generally considered safe, seafood from regions with high levels of contamination are not. And researchers studying samples from U.S. retail stores found that many fish are indeed the species they are claimed to be, but not from the region claimed.

    "Chilean sea bass is already known to sometimes have high mercury levels," lead author Peter Marko, of the University of Hawai'i at Manoa, Honolulu, told Reuters Health.

    "If women are pregnant or nursing, they probably shouldn't buy that fish, to be safe," he said.

    Past research has found that fish sold in retail markets is not always the species it's advertised to be. And that even within a given species, mercury levels can vary widely.

    Methylmercury, the type of mercury found in fish, is an organic compound that can be absorbed into living tissue.

    Pregnant and nursing women and kids have been advised by the U.S. Food and Drug Administration to avoid shark, tilefish, swordfish and King Mackerel because these species have a mean mercury level of 0.73 to 1.45 parts per million. The FDA's limit for mercury in fish for human consumption is 1.0 ppm.

    Normally, the mercury content of Chilean sea bass, also known as Patagonian toothfish, is 0.35 ppm, according to the FDA.

    In the current study, published in the journal PLOS One, researchers used sea bass tissue samples from retailers in 10 U.S. states. They measured the total amount of mercury in 25 of the MSC-certified and 13 of the uncertified Chilean sea bass samples.

    They found that fish labeled as certified had less than half the mercury (0.35 ppm) of uncertified fish (0.89 ppm).

    But when the researchers excluded the fish that actually belonged to other species and were not genetically sea bass, they found no significant difference in the mercury levels of certified and uncertified fish.

    "We then said, 'that can't be because certified is supposed to come from South Georgia, where the mercury level is low, why do we see such a difference in mercury?'" said Marko, referring to a fishery area close to the South Pole and known to have less mercury contamination than fish from waters off South American. "It's these fishery stock substitutions," he said.

    The researchers tested the DNA of the fish and found those from outside the MSC-certified South Georgia/Shag Rocks fishery had twice as much mercury (0.63 ppm) as those genetically confirmed to be South Georgia stock (0.31 ppm).

    "Regular mercury exposure is potentially dangerous to developing nervous systems, so this and other studies like it are of greatest concern to pregnant women, children, and women planning on having children," Marko said in an e-mail.

    "Our study demonstrates that accurate labeling of seafood - not just with respect to what species but also what country or region the seafood came from - is essential to consumers, particularly in the aforementioned demographic, to make informed choices at the seafood counter," he said.

    Marko pointed out that fish from South American waters can have two-to-three times as much mercury as fish from MSC-certified regions.

    Roberta White, professor and chair of Environmental Health at Boston University School of Public Health, who was not involved in the study, told Reuters Health in a phone interview the findings were another reminder that consumers need to be careful when purchasing fish.

    "What's really disturbing is how do people choose to eat fish that are safe?" said White, who has studied the effects of industrial pollutants on the brain.

    "Everybody wants people to eat fish because it is good for the brain and heart, but we also don't want them to be poisoning their children because they're pregnant," she said.

    White said future studies needed to focus on different species of fish and the genetics within species, as well as variations in neurotoxicants. Other contaminants in fish could also pose a health danger, including Polychlorinated Biphenyls (PCBs), which are synthetic organic chemicals, organic tin and different pesticides, she said.

    "As this article points out, sometimes you think something is safe because of the way it's labeled and maybe it isn't, but that's true of all our food," White said.

    "This is where you have to start, the simple stuff," White said. "I think what's important about the study is the public health message that we need to be careful about this and figure it out," said White.

    SOURCE: http://bit.ly/1vBpKRH PLOS One, online August 5, 2014.

  • Self management may reduce blood pressure: study

    By Andrew M. Seaman

    NEW YORK (Reuters Health) - Even people at significant risk for heart attacks and strokes can take an active role in reducing their own high blood pressure, by measuring it themselves and adjusting their medications, according to a new study from the UK.

    Researchers found that patients who closely monitored their own blood pressure and medications, using detailed instructions from their doctors, lowered their readings more than patients who relied on their healthcare providers to take periodic readings and make medication changes.

    "We've previously done a study with a group of people with uncomplicated hypertension (or high blood pressure)," said Dr. Richard McManus, the report's lead author. "We wanted to see if that intervention would also work with people with greater coronary heart disease and in the elderly."

    The intervention consisted of patients creating a detailed plan with their doctor, measuring their own blood pressure daily and adjusting their medications according to their blood pressure readings and instructions in the plan.

    This new approach resulted in better management and lower blood pressure after a year, in part because doctors tend to be reluctant to change medications based on blood pressure readings recorded at a single healthcare visit, the researchers suggest.

    Healthcare providers don't always act on readings that are above target, McManus said.

    He and his colleague write in JAMA that other studies have found self monitoring of blood pressure may result in lower readings and many people in the UK already monitor their own blood pressure.

    For the new study, the researchers enrolled 552 patients with high blood pressure and a history of other significant health problems, such as strokes, heart attacks, diabetes and kidney disease. The patients were recruited from 59 doctors' offices in the UK and participated in the trial between 2011 and 2013.

    Normal blood pressure is considered to be a systolic (the top number) reading of 120 millimeters of mercury (mmHg) or less and a diastolic (the bottom number) of 80 mmHg or less, according to the U.S. National Institutes of Health.

    High blood pressure is usually defined as a systolic reading above 140 mmHg and a diastolic reading of 90m mmHg or more. Any reading between the normal and high categories is considered to be "prehypertension."

    Half of the patients were assigned to take part in the intervention and the other half were assigned to receive usual care, which consisted of periodic visits to their doctors for blood pressure readings and medication adjustment.

    At the beginning of the study, the participants in each group had an average blood pressure reading of about 144 mmHg over about 80 mmHg.

    Among patients in the self-management group, the number and types of medications taken tended to increase, so that after 12 months, they were taking, on average, 3.3 doses of medication a day compared to 2.6 in the usual care group.

    After 12 months, the systolic reading fell in both groups, but significantly more among those who took their own readings and managed their own medications.

    People in the usual care group saw their average systolic reading fall to about 138 mmHg after one year, compared to 128 mmHg among those in the intervention group.

    "These differences in blood pressure that were observed in this study were quite substantial," said Dr. Steven Nissen, chairman of the Robert and Suzanne Tomsich Department of Cardiovascular Medicine located on the main campus of Cleveland Clinic in Ohio.

    Any reduction in blood pressure of more than 2 or 3 mmHg is a noticeable difference, said Nissen, who wasn't involved in the new study but coauthored a commentary on it in the journal.

    While the results can't prove whether those in the intervention group went on to have fewer strokes and heart attacks, Nissen said lower blood pressure is tied to better long-term outcomes.

    He cautioned that not every person with blood pressure problems will be able to handle their own readings or medication management.

    "It just means you can't go into every community and expect every patient to have the sophistication and means to follow this type of algorithm," Nissen said.

    He added that people have difficulty controlling their blood pressure for a variety of reasons - not just that doctors won't adjust medication during office visits.

    For example, Nissen said, people in the U.S. may also have trouble accessing healthcare and affording prescriptions. He said self treatment is a potential option, however.

    "There are a lot of people out there with high blood pressure - a significant number of them (are) still above targeted readings despite treatment," McManus said. "This is an intervention that could be used in those people."

    He cautioned, however, that people need to talk with their doctors about this type of blood pressure management and should not attempt it on their own.

    SOURCE: http://bit.ly/1lwkHSh and http://bit.ly/1opxQqO JAMA, online August 26, 2014.

  • Tricking memory in lab animals stokes hope for PTSD

    By Sharon Begley

    NEW YORK (Reuters) - The frailty of remembrance might have an upside: When a memory is recalled, two research teams reported on Wednesday, it can be erased or rewired so that a painful recollection is physically linked in the brain to joy and a once-happy memory to pain.

    While lab rodents were used in the research, it adds to growing evidence that the malleability of memory might be exploited to treat disorders such as post-traumatic stress.

    In both studies, scientists focused on a phenomenon called reconsolidation. Discovered in the 1990s, it refers to the fact that when a memory is retrieved, its physical manifestation in the brain is so "labile," or changeable, that it can be altered. False memories can form, and the associated emotions can flip.

    "Recalling a memory is not like playing a tape recorder," said Susumu Tonegawa of the Massachusetts Institute of Technology, who led one of the studies. "It's a creative process."

    The MIT team decided to see how creative. They gave male mice a small electric shock when the animals wandered into one part of a cage, creating a memory linking that place to pain. In a different part, mice got to cavort with females, so they remembered that spot quite fondly.

    The mice had been engineered so specific brain neurons could be activated with light, a technique called optogenetics. Using lasers, the scientists reactivated the where, what and when of the memories, which are encoded in the hippocampus.

    While the shock memory was active and labile, the mice got to play with females. While the memory of socializing was active, they got a shock.

    That changed brain wiring, the scientists reported in the journal Nature. The memory of the shock became physically connected to neurons encoding pleasure; the memory of socializing connected to neurons encoding fear.

    "We could switch the mouse's memory from positive emotions to negative, and negative to positive," Tonegawa told reporters.

    More research is needed before anything similar could be used in people, MIT's Roger Redondo said, "but the circuits appear to be very similar" as in mice.

    In a separate study, researchers at Boston's McLean Hospital also exploited the malleability of reactivated memories to erase them completely.

    After training rats that a flash of light precedes a shock, the researchers turned on the light, reactivating the memory. They immediately gave the animals xenon gas, an anesthetic that blocks molecules involved in memory formation.

    That apparently jammed the machinery needed for memory reconsolidation, psychologist Edward Meloni and colleagues reported in the journal PLOS One: The rats forgot that light precedes a shock. Similarly trained rats not given xenon remembered just fine.

    Psychologist Elizabeth Phelps of New York University called both studies "interesting advances."

    But clear ethical issues involved in manipulating human memory remain, even for therapeutic purposes.

    "I think we are still a long way from translating this research to good clinical interventions," since memories that contribute to PTSD are "likely much more complex" than in mice and rats, Phelps said.

    SOURCE: http://bit.ly/1nDWhBE Nature and http://bit.ly/1tVYoEU PLOS One, online August 27, 2014.

Oncology Articles

  • UK cancer drug fund gets extra 160 million pounds

    By Reuters Staff

    LONDON (Reuters) - A fund that helps patients receive cancer medicines not routinely paid for by Britain's state health service is to get an extra 160 million pounds ($265 million), although the government is also taking a tougher line on prices.

    The Cancer Drugs Fund will negotiate with the pharmaceutical industry on cost "to ensure best value" for the National Health Service (NHS) in England, the Department of Health said on Thursday.

    The fund, which was set up four years ago, is being extended to 2016 and will be increased to 280 million pounds a year from 200 million.

    The funding increase follows a number of controversial decisions by the National Institute for Health and Care Excellence (NICE), the country's cost-effectiveness watchdog, to block payment for some cancer drugs.

    Patients in England who cannot get such cancer drugs on the NHS can apply to the Cancer Drugs Fund to cover the costs.

    Alongside the injection of new funds to help patients, two new drugs have also been identified that will be added to the fund. These are Astellas and Medivation's Xtandi for prostate cancer, and Celgene's Revlimid for a new group of patients with myelodysplastic syndrome, a rare blood condition.

  • Robotic prostate removal tied to surgical changes, costs

    By Andrew M. Seaman

    NEW YORK (Reuters Health) - The introduction of robotic surgery for prostate cancer may have led to changes in the number of surgeons performing prostate removals and in the overall cost, according to a new study.

    With the technology being used more widely, fewer doctors are performing the procedure and the overall cost of prostate removal has gone up, researchers found.

    While studies examining the benefits and potential harms of robotic surgery have produced mixed results, the researchers write in BJU International that there is little information on how the innovation influenced prostate removal in the U.S.

    "We knew by anecdotal reports as well as the scientific literature that it had become relatively widespread but we didn't know how that had been done," said Dr. Steven Chang, the study's lead author from Harvard Medical School, Brigham and Women's Hospital and the Dana-Farber Cancer Institute in Boston.

    Robotic-assisted radical prostatectomy, which is the removal of the prostate with the help of a robot, began after U.S. regulators approved Intuitive Surgical, Inc.'s da Vinci Surgical System in 2000.

    Before that, surgeons would remove the prostate through a relatively large incision in so-called open surgery - or through a small incision with the help of a camera, in laparoscopic surgery.

    For the new study, the researchers used data on nearly 490,000 men who had their prostates removed between 2003 and 2010. Of those, 338,448 had open or laparoscopic surgery and 150,921 had robotic-assisted surgery.

    Overall, there was a dramatic increase in the number of prostate removals with the new technology. The proportion of surgeons doing at least half of their prostate removals with the robot increased from 0.7 percent in 2003 to about 42 percent by 2010.

    Surgeons who had been doing more than 24 prostate removals each year were the most likely to start using the new technology.

    The researchers also found that the number of surgeons performing prostate removals decreased during the study period from about 10,000 to 8,200.

    Chang said the finding that fewer surgeons are performing the procedure is likely because the ones who were only doing a few every year decided to stop altogether.

    "It was fairly obvious that the people who adopted this technology had a higher volume per year than people who did not adopt this technology," he said.

    "We have seen a concentration of da Vinci use among high volume surgeons, which we think is a positive for the healthcare system," said Dave Rosa, the executive vice president and chief scientific officer of Intuitive Surgical, Inc., in a statement emailed to Reuters Health.

    "Da Vinci use for radical prostatectomy has been shown to have clinical advantages over open prostatectomy in most of the dozens of comparative clinical studies published," Rosa added.

    The current study was not designed to analyze which type of surgery is safer or leads to fewer complications, Chang said.

    "I don't think anyone really knows that answer and I don't know if that study will ever be done," Dr. Jeff Karnes, who was not involved with the new study, told Reuters Health.

    When it comes to prostate removal, the surgeon's experience is likely more important than whether it's done with or without a robot, said Karnes, an urologist from the Mayo Clinic in Rochester, Minnesota.

    Chang and his colleagues also found that the introduction of the new technology was tied to an increase in overall U.S. spending on prostate removals.

    They write that the increase in cost is likely related to an increased number of prostate removals and increased cost for each procedure.

    Robotic-assisted prostate removals cost more than open surgeries throughout the study but the researchers found that the cost of the older surgical methods also increased toward the end of the study.

    They can't say, based on their data, why the cost of open or laparoscopic surgeries began to increase, but they suggest it may be due to slower surgeons continuing to use open surgeon or innovations in open surgery that drove the price up.

    Alternatively, Karnes said it could also be a result of riskier prostate removals, which take more time, needing open surgery.

    Intuitive Surgical, Inc.'s Rosa said a thorough study would take into account overall societal costs in an economic analysis. Those costs include how the patients faired after the procedure.

    "Costs can be calculated very differently in economic studies depending on the methodology used," he said.

    Chang said a goal in the future would be to do a more thorough cost analysis that includes more indirect costs.

    Overall, Karnes said he is not surprised by the results of the study.

    "We know that when a hospital acquires the technology the number of robot procedures go up in that hospital," he said.

    For patients faced with prostate removal, he said it's likely best to make a decision on open or robotic-assisted surgery based on the surgeon's experience and performance.

    SOURCE: http://bit.ly/1luyDMz BJU International, online August 26, 2014.

  • Medicaid payouts for office visits may influence cancer screening: study

    By Kathryn Doyle

    NEW YORK (Reuters Health) - In states where Medicaid pays doctors higher fees for office visits, Medicaid beneficiaries are more likely to be screened for breast, cervical or colorectal cancer, according to a new study.

    "States tend to vary in their reimbursement rates for different types of medical care services; some states may have low reimbursements for certain services and higher reimbursements for others," said lead author Dr. Michael T. Halpern of the Division of Health Services and Social Policy Research at RTI International at Washington, D.C.

    Medicaid, a health insurance program for low-income individuals, is jointly funded by the federal government and the individual states. Each state establishes its own coverage and reimbursement policies.

    Unexpectedly, states' reimbursement rates for specific screening tests weren't always associated with an increase in screening rates, Halpern and his team found.

    There is no reason to believe that reimbursing more for a certain test would lead to that test being used less, so there's probably something else going on to explain that relationship, which was specifically true for Pap tests, Halpern told Reuters Health by email.

    Researchers analyzed Medicaid data from 2007 for 46 states and the District of Columbia.

    In states with higher payments for office visits, cancer screenings were more common. But higher payments for the screenings themselves did not always mean the screenings were performed more often, according to results published in the journal Cancer.

    Nationwide, the median Medicaid reimbursement for an office visit is $37. (In other words, half the states pay doctors less than that.) The median Medicaid reimbursement was $24 for a Pap test, which can detect early cervical cancer, and $271 for a colonoscopy.

    These tests are all recommended for the age group of the people in the study, but since some of the tests are not recommended yearly and the study only includes data from 2007, it was not clear whether the Medicaid beneficiaries were receiving guideline-based screening, Halpern said.

    State by state, when screening test reimbursement rose by 20 percent, the odds of receiving a colonoscopy increased by 1.6 percent, the odds of getting a Pap test decreased by 0.8 percent, and a mammogram might be more or less likely depending on the type and location of the screening order.

    But when reimbursement for an office visit rose by 20 percent, so did screening rates, by 2 to 8 percent.

    "Many primary care physicians do not accept Medicaid patients or are able to provide care only to limited numbers of Medicaid beneficiaries, potentially due to low reimbursements for office visits," Halpern said. "By increasing Medicaid reimbursements for primary care physician office visits, more physicians may be able to provide care for Medicaid beneficiaries, thus increasing their likelihood of receive cancer screenings."

    For screenings like colonoscopy and mammography, the primary care doctor refers the patient to another provider for those tests, so the amount Medicaid reimburses for the tests generally doesn't have a financial benefit for the referring physician, he said.

    "The finding with higher Medicaid office fees is noteworthy, because it means that higher fees open physicians' doors to Medicaid patients and that is the first step to getting patients the care they need," said Stephen Zuckerman, senior fellow and co-director of the Health Policy Center of the Urban Institute. "Cancer screening is only on part of that."

    Doctors' time is limited, and economic incentives matter to them, Zuckerman told Reuters Health by email.

    "In a system with many payers, that means that it makes sense for physicians to see patients for whom they receive better compensation before they see other patients," he said.

    Fees are not the only incentives in scheduling patients, but they do play an important role, he said.

    "Since office visit fees have the most consistent relationship to receipt of cancer screening, it would be important to make sure those fees are sufficient to get Medicaid patients appropriate access to primary care services," Zuckerman said.

    SOURCE: http://bit.ly/1tOc4l9 Cancer, online August 25, 2014.

  • Prescription painkiller deaths fall in medical marijuana states

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Researchers aren't sure why, but in the 23 U.S. states where medical marijuana has been legalized, deaths from opioid overdoses have decreased by almost 25 percent, according to a new analysis.

    "Most of the discussion on medical marijuana has been about its effect on individuals in terms of reducing pain or other symptoms," said lead author Dr. Marcus Bachhuber in an email to Reuters Health. "The unique contribution of our study is the finding that medical marijuana laws and policies may have a broader impact on public health."

    California, Oregon and Washington first legalized medical marijuana before 1999, with 10 more following suit between then and 2010, the time period of the analysis. Another 10 states and Washington, D.C. adopted similar laws since 2010.

    For the study, Bachhuber, of the Philadelphia Veterans Affairs Medical Center and the University of Pennsylvania, and his colleagues used state-level death certificate data for all 50 states between 1999 and 2010.

    In states with a medical marijuana law, overdose deaths from opioids like morphine, oxycodone and heroin decreased by an average of 20 percent after one year, 25 percent by two years and up to 33 percent by years five and six compared to what would have been expected, according to results in JAMA Internal Medicine.

    Meanwhile, opioid overdose deaths across the country increased dramatically, from 4,030 in 1999 to 16,651 in 2010, according to the Centers for Disease Control and Prevention (CDC). Three of every four of those deaths involved prescription pain medications.

    Of those who die from prescription opioid overdoses, 60 percent have a legitimate prescription from a single doctor, the CDC also reports.

    Medical marijuana, where legal, is most often approved for treating pain conditions, making it an option in addition to or instead of prescription painkillers, Bachhuber and his coauthors wrote.

    In Colorado, where recreational growth, possession and consumption of pot has been legal since 2012 and a buzzing industry for the first half of 2014, use among teens seems not to have increased (see Reuters story of July 29, 2014 here: http://reut.rs/1o040NI).

    Medical marijuana laws seem to be linked with higher rates of marijuana use among adults, Bachhuber said, but results are mixed for teens.

    But the full scope of risks, and benefits, of medical marijuana is still unknown, he said.

    "I think medical providers struggle in figuring out what conditions medical marijuana could be used for, who would benefit from it, how effective it is and who might have side effects; some doctors would even say there is no scientifically proven, valid, medical use of marijuana," Bachhuber said. "More studies about the risks and benefits of medical marijuana are needed to help guide us in clinical practice."

    Marie J. Hayes of the University of Maine in Orno co-wrote an accompanying commentary in the journal.

    "Generally healthcare providers feel very strongly that medical marijuana may not be the way to go," she told Reuters Health. "There is the risk of smoke, the worry about whether that is carcinogenic but people so far haven't been able to prove that."

    There may be a risk that legal medical marijuana will make the drug more accessible for kids and smoking may impair driving or carry other risks, she said.

    "But we're already developing Oxycontin and Vicodin and teens are getting their hands on it," she said.

    If legalizing medical marijuana does help tackle the problem of painkiller deaths, that will be very significant, she said.

    "Because opioid mortality is such a tremendously significant health crisis now, we have to do something and figure out what's going on," Hayes said.

    The efforts states currently make to combat these deaths, like prescription monitoring programs, have been relatively ineffectual, she said.

    "Everything we're doing is having no effect, except for in the states that have implemented medical marijuana laws," Hayes said.

    People who overdose on opioids likely became addicted to it and are also battling other psychological problems, she said. Marijuana, which is not itself without risks, is arguably less addictive and almost impossible to overdose on compared to opioids, Hayes said.

    Adults consuming marijuana don't show up in the emergency room with an overdose, she said. "But," she added, "we don't put it in Rite Aid because we're confused by it as a society."

    SOURCE: http://bit.ly/1pYZf8d JAMA Internal Medicine, August 25, 2014

  • Mammography false alarms linked with later tumor risk

    By Ronnie Cohen

    NEW YORK (Reuters Health) - Women whose screening mammograms produce false alarms have a heightened risk of being diagnosed with breast cancer years later, but the reason remains mysterious, researchers say.

    An increased risk of breast cancer among women with a "false positive" mammogram has been reported before. What's new about this study is that the authors tried to figure out how much, if any, of the extra risk is simply due to doctors missing the cancer the first time they investigated the worrisome mammogram findings.

    But mistakes from doctors missing cancers explained only a small percentage of the increased risk, according to lead author My von Euler-Chelpin, an epidemiologist from the University of Copenhagen in Denmark.

    She told Reuters Health in a telephone interview that she could not explain most of the increased risk of later breast cancer in women with false-positive mammograms. (A mammogram is considered false positive when it suggests possible breast cancer but additional screenings or a biopsy fails to find it.)

    Of more than 58,000 Danish women who had mammography between 1991 and 2005, her study identified 4,743 women with suspicious findings that were eventually declared negative.

    By 2008, 295 of those 4,743 women had been diagnosed with breast cancer, von Euler-Chelpin and colleagues reported in Cancer Epidemiology.

    Radiologists reread the original mammograms and found that doctors had actually missed the cancer in 72 of the 295 women, for a false-negative rate of 1.5 percent. Even after taking those missed cancers into account, however, the researchers found that women with false-positive mammograms were still 27 percent more likely to be diagnosed with breast cancer years later, compared to women with only negative test results.

    The risk was slightly higher in women who had surgical biopsies that turned out to be negative.

    Von Euler-Chelpin thinks a smaller percentage of American women would have an elevated risk for breast cancer after a false-positive test because the U.S. has a higher rate of false positives than Denmark. The risk of a false-positive test over 10 mammograms ranges from 58 percent to 77 percent in the U.S., while it is around 16 percent in Denmark, the study says.

    Dr. Michael Alvarado, a breast cancer surgeon from the University of California, San Francisco, agreed that the risk of being diagnosed with breast cancer after a false positive mammogram is probably lower in the U.S. than in Denmark.

    "It's hard to translate the data to the U.S. population because we have such a different screening program, we tend to biopsy everything, and we're much more aggressive," he told Reuters Health. Alvarado was not involved in the current study.

    "Is there some inherent biology of the breast that makes it suspicious and it puts you at higher risk? I don't think anyone knows what it is," he said.

    Alvarado wondered if women who get false-positive mammograms should be followed more closely by their doctors, or if false-positive patients should be screened differently.

    Von Euler-Chelpin told Reuters Health the excess rate of breast cancer among women who have had false-positive mammograms points to the need to personalize screening programs for women - and Dr. Karla Kerlikowske agreed.

    Kerlikowske, from the University of California, San Francisco, is developing a risk calculator app to guide women in deciding how often to get mammograms. The calculator considers a range of factors, including age, race, previous breast cancer, family history and breast density. Kerlikowske was not involved in the current study.

    Although having had a false-positive mammogram is associated with a woman's breast cancer risk, Kerlikowske points out that the actual risk of being diagnosed with breast cancer remains low.

    The average five-year breast cancer risk for a 50-year-old white woman with no prior family history of breast cancer is 1.25 percent, the calculator shows. It ranges from less than 1 percent, to 2.70 percent, depending upon breast density, for the same woman with a history of a prior breast biopsy, regardless of whether the biopsy was positive or negative.

    "The absolute risk is still small," Kerlikowske said. "To me, it just says, now you have this risk factor, and you have to consider it with other risk factors."

    Von Euler-Chelpin agrees.

    "This paper is one little step on the way of trying to identify high-risk groups," she said. "The goal is to find more personalized screening programs for women."

    The American Cancer Society recommends that women be screened for breast cancer every year they are in good health starting at age 40. But a growing number of researchers have questioned the benefits of annual mammograms, and since 2009 the government-backed United States Preventive Services Task Force has recommended that screening be done every two years and be generally restricted to women aged 50 to 74.

    Women in Denmark between the ages 50 to 69 are invited to have screening mammograms every other year, Von Euler-Chelpin said.

    Getting a mammogram every other year instead of annually did not increase the risk of advanced breast cancer in women ages 50 to 74, according to a study Kerlikowske published last year (see Reuters story of March 18, 2013 here: http://reut.rs/1w7CMuh).

    The recommendation to reduce the frequency and delay the start of mammography screening was based on research showing the risk of false-positive results - which needlessly expose women to the anguish of a possible breast cancer diagnosis and the ordeal of further testing - outweighed the benefits of detecting cancers earlier.

    SOURCE: http://bit.ly/1wALk81 Cancer Epidemiology, online July 14, 2014.

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Women’s Health Articles

  • Calorie goals, support may help limit pregnancy weight gain

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Compared to obese expectant mothers without special care, those given individualized calorie goals and weekly group meetings gained less weight during pregnancy and had fewer oversized newborns in a new study.

    "More than half of women in the U.S. start out their pregnancies overweight or obese, and approximately half of all pregnant women gain too much weight during pregnancy, which can lead to increasing overweight and obesity," said lead author Dr. Kimberly K. Vesco of the Center for Health Research at Kaiser Permanente, Northwest, in Portland, Oregon.

    "Women who gain too much weight during pregnancy may retain some of that extra weight and enter their next pregnancy at a higher weight than their prior pregnancy, which can increase their risk for pregnancy complications such as gestational diabetes, high blood pressure, babies that are too big and cesarean section," Vesco, a board-certified obstetrician-gynecologist, told Reuters Health by email.

    The U.S. Institute of Medicine (IOM), a government advisory body, has issued guidelines for healthy amounts of weight gain during pregnancy, although they remain controversial (see Reuters Health story of November 17, 2010, here: http://reut.rs/1AXzmJz).

    The guidelines suggest that normal-weight women gain around 25 pounds during pregnancy, but that obese women limit their weight gain to between 11 and 20 pounds.

    For the new study, rather than giving obese women the IOM target range, Vesco's team asked 114 of them to try to maintain their weight at the start of the study, which was early in pregnancy, and assumed the women would gain a little weight anyway.

    Vesco and her team divided the participants, who were all obese and at least seven weeks pregnant when recruited into the study, into two groups. Women in one group received a single advice session from a dietician with general information about eating a healthy diet during pregnancy and usual care for the rest of their pregnancies.

    The second group attended two individualized counseling sessions where the dietician gave each woman tailored diet and physical activity guidelines, recommending at least 30 minutes of moderate activity each day, geared toward helping them gain no more than three percent of their current body weight throughout pregnancy.

    For a 200-pound woman, that would mean gaining no more than six pounds.

    Once they had their individual goals, the women started attending weekly 90-minute group sessions covering topics including nutrition, exercise and behavioral change. They were also given a goal for physical activity in the next week. The women kept food and activity journals and tracked their weight each week.

    By week 34 of pregnancy, women in the weight-control group had gained an average of 11 pounds and women in the comparison group had gained 18.5 pounds.

    By two weeks after giving birth, moms in the weight control group were an average of almost six pounds lighter than when they enrolled in the study, whereas in the comparison group moms were an average of 2.6 pounds heavier.

    Nine percent of babies born to mothers in the weight-control group were large for their gestational age - which increases the risk of birth injury and infant low blood sugar - compared to 26 percent of babies in the other group, according to the results published in the journal Obesity.

    "A common misconception during pregnancy is that women need to eat for two," Vesco said. "That's just not true. Most pregnant women need no extra calories in the first trimester and only 200-300 extra calories in the second and third trimesters," she said.

    "Our study found that limited or no weight gain may be beneficial for mom and baby, but we still need larger studies to confirm these findings before the IOM guidelines can change," Vesco said.

    Doctors can help women control their pregnancy weight by weighing them, calculating their body mass index and giving them weight-gain targets for pregnancy, said Dr. Alexis Shub, a senior lecturer in the Department of Obstetrics and Gynaecology at the University of Melbourne in Australia.

    "In our own research we have found that many obese women do not recognise that they are obese, and many overestimate the appropriate weight gain for pregnancy - so education by health care professionals is very important," she told Reuters Health by email.

    "It is laudable that research is taking place to answer questions that affect so many women and babies that we see every day in clinical practice, and that managing weight gain for these women may have a long term role in their own health and the health of their children," said Shub, who was not involved in the study.

    But, she noted, more than 1000 women declined to be in the trial, so those that participated were highly motivated. A less motivated group would likely have been less successful, she said.

    Most women, not just those who are obese, can benefit from setting a weight gain goal and following a healthy eating plan, Vesco said.

    Implementing this approach, with 90-minute weekly meetings and behavioral specialists, could be done in the real world but it would require ongoing resources and commitment from a health plan, and it's unclear how much it would cost, she said.

    "Women who are obese when they get pregnant should talk to their practitioner and together set their weight gain goals," Vesco said. "They can seek dietary advice from their practitioner or a dietician."

    SOURCE: http://bit.ly/XVvpam Obesity, online August 28, 2014.

  • Fishery mislabeling could mean more mercury than buyers bargain for

    By Janice Neumann

    NEW YORK (Reuters Health) - That Chilean sea bass from the local grocery store could have twice the methylmercury that's expected - if it comes from a region other than indicated on the label, a new study says.

    While fish certified by the Marine Stewardship Council (MSC) is generally considered safe, seafood from regions with high levels of contamination are not. And researchers studying samples from U.S. retail stores found that many fish are indeed the species they are claimed to be, but not from the region claimed.

    "Chilean sea bass is already known to sometimes have high mercury levels," lead author Peter Marko, of the University of Hawai'i at Manoa, Honolulu, told Reuters Health.

    "If women are pregnant or nursing, they probably shouldn't buy that fish, to be safe," he said.

    Past research has found that fish sold in retail markets is not always the species it's advertised to be. And that even within a given species, mercury levels can vary widely.

    Methylmercury, the type of mercury found in fish, is an organic compound that can be absorbed into living tissue.

    Pregnant and nursing women and kids have been advised by the U.S. Food and Drug Administration to avoid shark, tilefish, swordfish and King Mackerel because these species have a mean mercury level of 0.73 to 1.45 parts per million. The FDA's limit for mercury in fish for human consumption is 1.0 ppm.

    Normally, the mercury content of Chilean sea bass, also known as Patagonian toothfish, is 0.35 ppm, according to the FDA.

    In the current study, published in the journal PLOS One, researchers used sea bass tissue samples from retailers in 10 U.S. states. They measured the total amount of mercury in 25 of the MSC-certified and 13 of the uncertified Chilean sea bass samples.

    They found that fish labeled as certified had less than half the mercury (0.35 ppm) of uncertified fish (0.89 ppm).

    But when the researchers excluded the fish that actually belonged to other species and were not genetically sea bass, they found no significant difference in the mercury levels of certified and uncertified fish.

    "We then said, 'that can't be because certified is supposed to come from South Georgia, where the mercury level is low, why do we see such a difference in mercury?'" said Marko, referring to a fishery area close to the South Pole and known to have less mercury contamination than fish from waters off South American. "It's these fishery stock substitutions," he said.

    The researchers tested the DNA of the fish and found those from outside the MSC-certified South Georgia/Shag Rocks fishery had twice as much mercury (0.63 ppm) as those genetically confirmed to be South Georgia stock (0.31 ppm).

    "Regular mercury exposure is potentially dangerous to developing nervous systems, so this and other studies like it are of greatest concern to pregnant women, children, and women planning on having children," Marko said in an e-mail.

    "Our study demonstrates that accurate labeling of seafood - not just with respect to what species but also what country or region the seafood came from - is essential to consumers, particularly in the aforementioned demographic, to make informed choices at the seafood counter," he said.

    Marko pointed out that fish from South American waters can have two-to-three times as much mercury as fish from MSC-certified regions.

    Roberta White, professor and chair of Environmental Health at Boston University School of Public Health, who was not involved in the study, told Reuters Health in a phone interview the findings were another reminder that consumers need to be careful when purchasing fish.

    "What's really disturbing is how do people choose to eat fish that are safe?" said White, who has studied the effects of industrial pollutants on the brain.

    "Everybody wants people to eat fish because it is good for the brain and heart, but we also don't want them to be poisoning their children because they're pregnant," she said.

    White said future studies needed to focus on different species of fish and the genetics within species, as well as variations in neurotoxicants. Other contaminants in fish could also pose a health danger, including Polychlorinated Biphenyls (PCBs), which are synthetic organic chemicals, organic tin and different pesticides, she said.

    "As this article points out, sometimes you think something is safe because of the way it's labeled and maybe it isn't, but that's true of all our food," White said.

    "This is where you have to start, the simple stuff," White said. "I think what's important about the study is the public health message that we need to be careful about this and figure it out," said White.

    SOURCE: http://bit.ly/1vBpKRH PLOS One, online August 5, 2014.

  • Death certificates would reflect gender identity under California bill

    By Reuters Staff

    SACRAMENTO, Calif. (Reuters) - Death certificates in California would be changed to reflect the gender identity of people at the time of their death rather than their sex at birth under a bill passed by lawmakers on Wednesday, the latest effort by the state to further the rights of transgender residents.

    The bill, which passed the state senate on Wednesday and has already passed the state assembly, must now go back to the assembly for final approval of amendments before it is sent to Democratic Governor Jerry Brown to be signed and become law.

    It is one of several measures aimed at furthering the family rights of LGBT Californians passed this session, including a measure allowing same-sex couples to be listed as mother, father or parent on a child's birth certificate.

    "Once we are deceased, we are often at the mercy of others to treat us with dignity," said California Assembly Speaker Toni Atkins, a Democrat from San Diego. "The very least we can do is ensure individuals are given basic human dignity by honoring their authentic selves when they pass so that more pain is not inflicted upon grieving loved ones or the community."

    Under the bill, an official filling out a death certificate would have to respect evidence that the deceased person had changed gender identity, including health records showing treatment for gender transition, court approval for a name change, an advanced healthcare directive or other documents.

    Last year, the legislature passed other laws protecting transgender rights, including one that allows minors to participate in school athletics and use restrooms in accordance with their chosen gender.

  • Shift work linked to greater diabetes risk

    By Shereen Lehman

    NEW YORK (Reuters Health) - People who work night shifts, or constantly changing shifts are more likely to develop type 2 diabetes compared to non-shift workers, suggests a new analysis of previous studies.

    The risk was highest for men and people who worked rotating shifts, but the reasons for those differences remain unclear, researchers say.

    "Shift work is very common in modern society," the study's senior author Zuxun Lu told Reuters Health in an email.

    "Over the past decades, a few epidemiological studies have assessed the association between shift work and the risk of diabetes mellitus with the inconsistent results," said Lu, a researcher at Tongji Medical College, Huazhong University of Science and Technology in Wuhan, China.

    The lack of a definitive summary of previous results prompted Lu's team to assess what's known, they write in the journal Occupational and Environmental Medicine.

    About 15 million Americans are shift workers, according to the U.S. Centers for Disease Control and Prevention. And diabetes affects about 30 million Americans, or about 9 percent of the total population.

    Lu and colleagues combined and re-analyzed the data from 12 previous studies that looked at the association between shift work and chances of developing diabetes. The studies included a total of 226,652 participants and 14,595 people with diabetes.

    The studies were published between 1983 and 2013. Six of the studies were conducted in Japan, with two each from the U.S. and Sweden and one each from Belgium and China.

    Shift work includes working nights, evenings, rotating shifts or irregular shifts - anything other than working typical daytime hours, the authors note.

    Based on their analysis, the risk of diabetes was increased by 9 percent overall for shift workers, compared to people who had never been exposed to shift work.

    Male shift workers had a 28 percent greater risk of developing diabetes than their female counterparts. And people who worked rotating shifts had a 42 percent greater risk of diabetes compared to non-shift workers.

    It's not known how long the participants in those studies had been shift workers, which limits the authors' ability to interpret their results.

    The new analysis doesn't prove that shift work causes diabetes or explain how it might do so, they acknowledge.

    "More prospective cohort studies with long follow-up periods are warranted to replicate our findings and reveal the underlying biological mechanism," Lu said.

    He speculated that shift work may interfere with eating and sleeping patterns and disrupt circadian rhythms.

    "Some studies have shown that insufficient sleep and poor sleep quality may develop and exacerbate insulin resistance," Lu said.

    Insulin resistance is a condition in which the body doesn't use insulin properly to process blood sugar. It's also sometimes called "pre-diabetes."

    In addition, previous studies show that shift work is associated with weight gain, increase in appetite and body fat, which are major risk factors for diabetes Lu and his coauthors write.

    "The overall literature in this subject right now has been fairly convincing that there is in fact an association between a misalignment of circadian rhythm and risk for diabetes," Dr. Peter Butler told Reuters Health.

    Butler directs the Larry L. Hillblom Islet Research Center at the David Geffen School of Medicine at the University of California, Los Angeles.

    Butler, who was not involved in the study, said he wasn't surprised that the authors found rotating shifts tended to have more of an effect. "If your circadian rhythms aren't synchronized, it's not at all surprising that bad things would happen.".

    But, Butler said, it's not a problem for most people and that most people on night shifts don't get diabetes.

    "Probably about 20 percent of us are vulnerable for diabetes, and what I think probably happens is the people who get diabetes in relation to shift work are the ones who were vulnerable to getting diabetes anyway," he said.

    "It's not like if you are one of the 80 percent who's lucky enough to not be vulnerable and you go on shift work you are now going to get diabetes - it's more a question if you are one of the unlucky ones who are predisposed to diabetes, then shift work may nudge you over that fence," Butler added.

    He said avoiding rotating shifts might be a good idea for people who have a strong family history of diabetes. But people who are at risk and have to work rotating shifts can still reduce the likelihood that they'll get diabetes.

    "You can counter the risks for diabetes," he said. "There are many risks that come into play and circadian misalignment is just one risk, but if you counter that by regular exercise and good diet, you'd reduce that risk very substantially."

    SOURCE: http://bit.ly/1s4yYnh Occupational and Environmental Medicine, online July 16, 2014.

  • Medicaid payouts for office visits may influence cancer screening: study

    By Kathryn Doyle

    NEW YORK (Reuters Health) - In states where Medicaid pays doctors higher fees for office visits, Medicaid beneficiaries are more likely to be screened for breast, cervical or colorectal cancer, according to a new study.

    "States tend to vary in their reimbursement rates for different types of medical care services; some states may have low reimbursements for certain services and higher reimbursements for others," said lead author Dr. Michael T. Halpern of the Division of Health Services and Social Policy Research at RTI International at Washington, D.C.

    Medicaid, a health insurance program for low-income individuals, is jointly funded by the federal government and the individual states. Each state establishes its own coverage and reimbursement policies.

    Unexpectedly, states' reimbursement rates for specific screening tests weren't always associated with an increase in screening rates, Halpern and his team found.

    There is no reason to believe that reimbursing more for a certain test would lead to that test being used less, so there's probably something else going on to explain that relationship, which was specifically true for Pap tests, Halpern told Reuters Health by email.

    Researchers analyzed Medicaid data from 2007 for 46 states and the District of Columbia.

    In states with higher payments for office visits, cancer screenings were more common. But higher payments for the screenings themselves did not always mean the screenings were performed more often, according to results published in the journal Cancer.

    Nationwide, the median Medicaid reimbursement for an office visit is $37. (In other words, half the states pay doctors less than that.) The median Medicaid reimbursement was $24 for a Pap test, which can detect early cervical cancer, and $271 for a colonoscopy.

    These tests are all recommended for the age group of the people in the study, but since some of the tests are not recommended yearly and the study only includes data from 2007, it was not clear whether the Medicaid beneficiaries were receiving guideline-based screening, Halpern said.

    State by state, when screening test reimbursement rose by 20 percent, the odds of receiving a colonoscopy increased by 1.6 percent, the odds of getting a Pap test decreased by 0.8 percent, and a mammogram might be more or less likely depending on the type and location of the screening order.

    But when reimbursement for an office visit rose by 20 percent, so did screening rates, by 2 to 8 percent.

    "Many primary care physicians do not accept Medicaid patients or are able to provide care only to limited numbers of Medicaid beneficiaries, potentially due to low reimbursements for office visits," Halpern said. "By increasing Medicaid reimbursements for primary care physician office visits, more physicians may be able to provide care for Medicaid beneficiaries, thus increasing their likelihood of receive cancer screenings."

    For screenings like colonoscopy and mammography, the primary care doctor refers the patient to another provider for those tests, so the amount Medicaid reimburses for the tests generally doesn't have a financial benefit for the referring physician, he said.

    "The finding with higher Medicaid office fees is noteworthy, because it means that higher fees open physicians' doors to Medicaid patients and that is the first step to getting patients the care they need," said Stephen Zuckerman, senior fellow and co-director of the Health Policy Center of the Urban Institute. "Cancer screening is only on part of that."

    Doctors' time is limited, and economic incentives matter to them, Zuckerman told Reuters Health by email.

    "In a system with many payers, that means that it makes sense for physicians to see patients for whom they receive better compensation before they see other patients," he said.

    Fees are not the only incentives in scheduling patients, but they do play an important role, he said.

    "Since office visit fees have the most consistent relationship to receipt of cancer screening, it would be important to make sure those fees are sufficient to get Medicaid patients appropriate access to primary care services," Zuckerman said.

    SOURCE: http://bit.ly/1tOc4l9 Cancer, online August 25, 2014.