CHRISTUS Santa Rosa Hospital

2827 Babcock Rd.

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

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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

  • Clockwork heart pacemaker does away with batteries

    By Ben Hirschler

    BARCELONA (Reuters) - Swiss engineers, famous for making the world's finest watches, are turning their hands to cardiology with a prototype battery-less pacemaker based on a self-winding wristwatch.

    Current pacemakers, which help the heart beat more regularly, offer a lifeline for many patients with cardiac problems but the need for battery power is a limiting factor, since replacing them requires a surgical intervention.

    Adrian Zurbuchen of the University of Bern's cardiovascular engineering group aims to get around the problem with his device, using automatic clockwork first developed for pocket watches by Swiss watchmaker Abraham-Louis Perrelet in 1777.

    In the same way that an automatic watch winds itself when it moves on the wrist, the clockwork pacemaker generates electrical current using the movement of heart muscle. To do this, it is stitched directly on to the pulsating heart.

    So far the experimental system has only been tested on pigs, Zurbuchen told the annual meeting of the European Society of Cardiology in Barcelona on Sunday. The animals hearts were successfully regulated to a steady 130 beats per minute.

    "This is a feasibility study. We have shown that it is possible to pace the heart using the power of its own motion," Zurbuchen said.

    The research is still at an early stage and there is, as yet, no schedule for human testing. Zurbuchen has also not discussed the idea with potential industrial partners but he said it was "probably a good time to look" for backers.

    Other researchers are investigating ways to get rid of batteries in pacemakers by transmitting power through the body from an external source - but the idea of using clockwork is novel.

    Automatic watches work because they have an eccentric weight that pivots when the wearer's arm moves. This rotation progressively winds a spring that then turns the watch mechanism. In the new Swiss pacemaker, the mechanical spring unwinds to spin an electrical micro-generator.

  • Low-carb diets may beat low-fat options for weight loss, heart health

    By Andrew M. Seaman

    A low-carbohydrate diet is better for losing weight and may also be better for lowering the risk of heart disease than a low-fat diet, according to a new study.

    While low-carb diets have outperformed other diets when it comes to weight loss, some researchers feared they might be worse for heart health because they tend to be high in fat.

    The new study shows that with proper nutritional counseling, people can lose more weight and lower their risk factors for heart disease on a low-carbohydrate diet, said the lead author, Dr. Lydia Bazzano of Tulane University in New Orleans.

    "This study shows if you are overweight and have cardiovascular disease risk factors and haven't had success on other diets, certainly a low-carbohydrate diet is worth a try," said Bazzano.

    Carbohydrates are found in food and include sugar, fiber and starches that give the body energy. Some carbs - like those in whole grains and fruits - are healthier than others - like those in white bread and other processed foods.

    Bazzano and her colleagues write in Annals of Internal Medicine that low-carb diets have become popular weight loss strategies in recent years. Studies on their effects on cardiovascular risk factors have produced mixed results, however.

    For the new study, she and her colleagues recruited 148 obese men and women between the ages of 22 and 75. None of the participants had heart disease or diabetes.

    Half were randomly assigned to follow a low-carbohydrate diet for a year, and the other half were assigned to a low-fat diet for a year. They were told to not change their physical activity throughout the trial.

    All participants attended regular meetings where they learned about portion control, healthy eating and overall nutrition. They were also offered one meal-replacement bar or shake per day.

    The only difference between the groups was the proportions of carbohydrate and fat in their diets.

    Those in the low-carbohydrate group were told to eat at no more than 40 grams of digestible carbohydrates per day. ("Digestible carbs" equals total carbs minus total fiber.)

    Those in the low-fat group were told not to get more than 30 percent of their daily energy from fat and no more than 55 percent of their daily energy from carbohydrates.

    Overall, about four of every five participants were still following the diets 12 months later.

    During that time, the researchers found, people on the low-carbohydrate diet lost more weight and more body fat than those on the low-fat diet.

    The difference in lost weight between the two groups would represent about eight additional pounds.

    Additionally, the researchers saw no increases in total cholesterol or "bad" LDL cholesterol between the two groups. Bazzano said that's good news since some thought a low-carbohydrate diet would increase cholesterol levels.

    Those in the low-carbohydrate group had lower levels of fat circulating in their blood and had lower scores on a measure often used to predict the risk of a heart attack or stroke within the next 10 years.

    "I thought that was a very striking finding," Bazzano said. She added that the score that predicts risk of future heart attacks and strokes was computed after the study was finished and is less reliable than the other risk factors they measured.

    Dr. David Jenkins, who wasn't involved in the study, told Reuters Health, "This doesn't look to me to say 'eat all the meats you want to lower your carbohydrates.' That's just one way to do it."

    Instead, Jenkins said, people in this study appeared to improve their overall diets. For example, they were eating foods with healthier fats, such as nuts and beans.

    He also said they seemed to eat more fiber and cut down on processed foods with more carbohydrates.

    "I think it's another testament to what one can do with a more plant-based diet using the right macronutrient profile," said Jenkins of the Department of Nutritional Sciences at the University of Toronto and the Keenan Research Centre at St. Michael's Hospital.

    Bazzano agreed that the overall diets improved among the participants and they were encouraged to eat healthier forms of protein like chicken, fish, nuts and beans.

    She also said her team is not sure why people on the low-carbohydrate diets lost more weight and had lower risk factors for heart disease after one year. It's not clear, she added,if there would still be a difference after a longer period.

    SOURCE: http://bit.ly/1qjI8OG Annals of Internal Medicine, online September 1, 2014.

  • U.S. startups get OK for smartphone-based heart tracking

    By Christina Farr

    SAN FRANCISCO (Reuters) - For a growing U.S. aging population, tracking heart health via a smartphone can mean the difference between life and death.

    This week, two Silicon Valley startups received a green-light from the U.S. Food and Drug Administration for mobile applications that monitor patients from home, a step forward for a nascent digital health industry that has pressed for more clarity from the agency on regulations.

    AliveCor said it received the FDA's approval to detect serious heart conditions in electrocardiogram (ECG) readings taken from a mobile device. The company says its newly-approved algorithm can detect atrial fibrillation, a form of cardiac arrhythmia that affects about one in four adults over the age of 40. If its smartphone-compatible heart-monitor device detects an abnormality, a physician could intervene before the patient experiences a stroke or other life-threatening event.

    The device fits most smartphones and rests on a patient's finger or chest to record an ECG.

    "Atrial fibrillation is very hard to identify," said Euan Thomson, AliveCor's chief executive. "A large group of people have it, but don't know they have it."

    Thomson said AliveCor can detect the condition and send the data to a cardiologist for review. The company plans to incorporate this algorithm into its application and make it available to consumers by September.

    In addition, startup Vital Connect received approval for a patch -- the "HealthPatch MD" -- that patients can attach to one of three areas on their chest and view their own biometric data on a mobile device.

    Sensors embedded in the band-aid sized patch track heart rate, pulse variability, respiratory rate, skin temperature, steps, "fall" detection and more.

    Valeska Schroeder, the company's vice president of product management, said the medical device will hit the market in the United States, and potentially also Canada and Europe, by the end of the year. Patients need a prescription to buy the device.

    What is unique about Vital Connect is that it puts the data in context, Schroeder explained. If a patient's heart rate spikes when they are lying flat in bed, that is typically a worrisome sign. But during exercise or a fall, it is a typical occurrence. If they opt in, physicians get notified when their patients hit or exceed set thresholds.

    Vital Connect first hit the headlines when Apple poached one of its senior executives, Ravi Narasimhan, as part of a larger effort to hire talent from the medical field.

    "We know we are working in a hot market," said Schroeder. "We know other firms are interested in making related products."

    These companies are taking different approaches, but they share the goal of helping doctors track patients remotely and take steps to prevent fatal outcomes. Data may also inform physicians about whether their patients should schedule an in-person or emergency room visit.

    According to the Centers for Disease Control, 129.8 million people visited the emergency room in 2010 and 13 percent of these visits resulted in hospital readmission.

    "By getting an intelligent device in the hands of a patient, we hope to fulfill the vision for mobile health," said Thomson.

  • 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.

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

  • Better education on breast reconstruction may be needed after cancer

    By Andrew M. Seaman

    NEW YORK (Reuters Health) - When it comes to deciding to have breast reconstruction after surgery for breast cancer, most women are generally satisfied with the decision-making process, a new study suggests.

    "Our findings generally were good news - women who wanted reconstruction got it, those who didn't were generally satisfied with the decision process," said Dr. Monica Morrow, the study's lead author from Memorial Sloan Kettering Cancer Center in New York City.

    The study findings also revealed misunderstandings on the part of some patients. For example, some women who didn't undergo breast reconstruction said they worried that the implants would interfere with cancer screenings later on, or that they feared the implants.

    "Our study points to specific topics doctors can address with patients - safety of implants, lack of interference with cancer detection by reconstruction that are of concern to patients," Morrow wrote in an email.

    She said that the study also indicates that many patients are focused on their cancer treatment at the time of diagnosis and not interested in reconstruction. That's fine, she said, as long as they are aware of the possibility of reconstruction later on.

    "There is no 'correct' rate of reconstruction," she added.

    Morrow and her colleagues write in JAMA Surgery that in the U.S., since passage of the Women's Health and Cancer Rights Act of 1998, women receive universal coverage for breast reconstruction after they have a breast removed.

    Despite the coverage for breast reconstruction, only about 25 to 35 percent of women opt for the procedure, they add.

    Some people, who are not patients or breast cancer doctors, have said this rate of reconstruction is low, Morrow said.

    To ensure that breast cancer patients understood their options, New York State passed a law in 2010 mandating that surgeons discuss breast reconstruction with them and provide information on insurance and availability.

    "The purpose of our study was to understand whether patients felt that they were adequately informed about reconstruction and to understand the reasons they chose not to undergo the procedure," she added. "Without such understanding, it is not possible to devise strategies to address the problem (if there actually is a problem)."

    For the study, she and her colleagues used data from cancer registries in Los Angeles and Detroit on 485 women who had a breast removed and were cancer free for four years.

    Overall, 222 women, or about 46 percent, eventually underwent breast reconstruction. About two-thirds of those women had it done at the same time their breast was removed; the other third had breast reconstruction later on.

    Only about 13 percent of women said they were dissatisfied with the decision process about whether or not to have breast reconstruction, the authors found.

    Black women were about three times more likely to report dissatisfaction, however.

    Women who were older, had other health problems and lower education levels were less likely to have breast reconstruction. Women who received chemotherapy as treatment were also less likely to have the surgery.

    Women without private health insurance were also less likely to have breast reconstruction, despite universal coverage.

    About half of the women who did not get reconstruction said they did not want additional surgery. About a third said reconstruction was not important and about 36 percent said they feared implants.

    About 24 percent of women were concerned the implants would interfere with future breast cancer screenings, but the researchers said past studies have not found evidence to support that concern.

    "What our study actually says is that laws such as the NY state law are addressing a non-problem," Morrow said. "Patients are informed about reconstruction, some just chose not to have it."

    She added that women who want to keep their breasts may choose lumpectomy, which removes less tissue than a complete mastectomy, and radiation instead of a total breast removal.

    "So, it is not particularly surprising that reconstruction isn't a priority for all women who chose to undergo mastectomy," she said.

    Also, Morrow said, it's difficult to educate patients in a time when they get information from many sources that may not be scientifically valid or perpetuate myths, such as implants being unsafe.

    She also said that it's worth knowing that many women in this study decided to have breast reconstruction later on.

    "During follow-up it is worth asking patients if they have developed an interest in reconstruction and want to see a plastic surgeon, and patients who choose not to have immediate reconstruction need to know that they haven't closed the door permanently," she added.

    SOURCE: http://bit.ly/1thODnx JAMA Surgery, online August 20, 2014.

  • 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.

Neonatal Articles

  • U.S. judge halts major part of Texas law restricting abortions

    By Reuters Staff

    AUSTIN, Texas (Reuters) - A U.S. judge struck down parts of a law seen as restricting abortions in Texas, saying in a decision on Friday that a provision requiring clinics to have certain hospital-like settings for surgeries was unconstitutional.

    "The act's ambulatory-surgical center requirement places an unconstitutional undue burden on women throughout Texas," U.S. District Judge Lee Yeakel said in his decision.

    The so-called ambulatory surgical center requirement was to have gone into effect on Sept. 1. It would require clinics to meet a set of buildings standards that abortion rights advocates said were unnecessary, especially when an abortion is medically induced.

    Advocacy groups who brought the suit, including Whole Women's Health, had argued the requirement was costly and had no medical benefit, seeing it as mostly intended to shut clinics that could not afford to make the changes.

    The state argued the requirement reduces complications and increases patient care when complications occur.

  • African-Americans may be getting inferior breastfeeding advice

    By Ronnie Cohen

    NEW YORK (Reuters Health) - Mothers who give birth in areas with higher concentrations of African-Americans are less likely to get breastfeeding support on maternity wards than mothers in other communities, a new study shows.

    Breastfeeding provides well-documented health benefits to infants and their mothers. But African-American women are about 16 percent less likely to nurse their newborns than white women, according to research from the Centers for Disease Control and Prevention (CDC).

    The study of 2,727 American hospitals and birth centers sought to uncover the reasons for the racial disparities.

    "What this study suggests is that hospital practices, not just women's choices, beliefs or values, contribute to the observed racial disparities in infant feeding," sociologist Elizabeth Armstrong told Reuters Health in an email.

    "Where a woman lives - and consequently gives birth - affects how her infant is nourished. Black babies and their mothers are less likely to start off in environments that support the optimal level of care for infant feeding and mother-baby bonding," she said.

    Armstrong, a professor at Princeton University in New Jersey, was not involved in the current study.

    The CDC researchers gathered data on optimal maternity care from hospitals and birth centers across the U.S. and compared areas with a higher percentage of black residents to areas with a lower percentage.

    Facilities in zip codes with more black residents were more likely to give tests to their staff on breastfeeding support, the researchers wrote in the CDC's Morbidity and Mortality Weekly Report.

    At the same time, maternity wards in areas with more African-Americans were less than half as likely to limit the use of breastfeeding supplements, such as formula. A 2006 report from the Government Accountability Office showed that when hospitals hand out free formula samples, mothers tend to breastfeed less.

    Hospitals in neighborhoods with more African-Americans were also 7 percent more likely to give newborns pacifiers, which can inhibit breastfeeding.

    And facilities in areas with higher concentrations of whites were nearly 14 percent more likely to promote early initiation of breastfeeding and nearly 12 percent more likely to work to keep newborns next to their mothers in the hospital. Both factors are known to promote breastfeeding.

    Hospitals in neighborhoods with more blacks were significantly less likely to offer breastfeeding support after mothers returned home.

    "This study shows the best support is not where it's most needed," Dr. Miriam Labbok told Reuters Health in a telephone interview. "If we could just change the hospital practices, I think we could have a lot more equity."

    A pediatrician, Labbok is the founding director of the Carolina Global Breastfeeding Institute at the University of North Carolina at Chapel Hill and was not involved in the current study.

    Lead author Jennifer Lind told Reuters Health that it's too early to understand the reasons for the racial differences.

    "Because this is the first stab or look into the whole issue, we really don't know why we're seeing these disparities," she said in a telephone interview. Lind is an epidemiologist with the CDC.

    "We found that hospital practices during childbirth have a major impact on whether a mother is able to start and continue breastfeeding," she said. "We think it's really important that all hospitals - regardless of where they're located - apply policies and practices proven to be supportive of breastfeeding so that more babies are able to reap the numerous benefits."

    Research has shown that breastfed babies, especially those fed just breast milk without any formula, are less likely to die of sudden infant death syndrome, or SIDS (see Reuters Health story of June 14, 2011 here: http://reut.rs/VPTRIv). African-American babies are more likely to die from SIDS, also known as "crib death."

    Breastfeeding also lowers babies' risk of infection, childhood obesity, asthma and type 2 diabetes, Lind said. Mothers who nurse their babies cut their chances of being diagnosed with breast and ovarian cancer, she said.

    The American Academy of Pediatrics recommends exclusive breastfeeding for six months and continued breastfeeding for another year while babies are introduced to complementary foods.

    In 2011, 79 percent of new American mothers started to breastfeed their infants, but fewer than half were still breastfeeding at six months, according to the CDC.

    Only 195 U.S. hospitals, accounting for 8 percent of all births, have earned the status of Baby Friendly, the gold standard for optimal maternity care established by the World Health Organization and UNICEF in 1991, Armstrong said.

    "I really think what we're seeing here is very much due to the fact that hospitals put up barriers," Labbok said. "I'd say this is a very good reflection of something that's wrong, and it needs to be fixed."

    She noted that African-American women continued to nurse their babies at higher rates than white women in the 1960s, when breastfeeding in the U.S. hit an all-time low.

    "In general, there has been this incorrect assumption that because you're black, you don't breastfeed, and that is just out and out wrong," Labbok said. "We've really got to strive for equity. This study shows very clearly that we have some work to do."

    SOURCE: http://1.usa.gov/1pRnjKa Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report, online August 22, 2014.

  • 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.

Neuroscience Articles

  • Low-carb diets may beat low-fat options for weight loss, heart health

    By Andrew M. Seaman

    A low-carbohydrate diet is better for losing weight and may also be better for lowering the risk of heart disease than a low-fat diet, according to a new study.

    While low-carb diets have outperformed other diets when it comes to weight loss, some researchers feared they might be worse for heart health because they tend to be high in fat.

    The new study shows that with proper nutritional counseling, people can lose more weight and lower their risk factors for heart disease on a low-carbohydrate diet, said the lead author, Dr. Lydia Bazzano of Tulane University in New Orleans.

    "This study shows if you are overweight and have cardiovascular disease risk factors and haven't had success on other diets, certainly a low-carbohydrate diet is worth a try," said Bazzano.

    Carbohydrates are found in food and include sugar, fiber and starches that give the body energy. Some carbs - like those in whole grains and fruits - are healthier than others - like those in white bread and other processed foods.

    Bazzano and her colleagues write in Annals of Internal Medicine that low-carb diets have become popular weight loss strategies in recent years. Studies on their effects on cardiovascular risk factors have produced mixed results, however.

    For the new study, she and her colleagues recruited 148 obese men and women between the ages of 22 and 75. None of the participants had heart disease or diabetes.

    Half were randomly assigned to follow a low-carbohydrate diet for a year, and the other half were assigned to a low-fat diet for a year. They were told to not change their physical activity throughout the trial.

    All participants attended regular meetings where they learned about portion control, healthy eating and overall nutrition. They were also offered one meal-replacement bar or shake per day.

    The only difference between the groups was the proportions of carbohydrate and fat in their diets.

    Those in the low-carbohydrate group were told to eat at no more than 40 grams of digestible carbohydrates per day. ("Digestible carbs" equals total carbs minus total fiber.)

    Those in the low-fat group were told not to get more than 30 percent of their daily energy from fat and no more than 55 percent of their daily energy from carbohydrates.

    Overall, about four of every five participants were still following the diets 12 months later.

    During that time, the researchers found, people on the low-carbohydrate diet lost more weight and more body fat than those on the low-fat diet.

    The difference in lost weight between the two groups would represent about eight additional pounds.

    Additionally, the researchers saw no increases in total cholesterol or "bad" LDL cholesterol between the two groups. Bazzano said that's good news since some thought a low-carbohydrate diet would increase cholesterol levels.

    Those in the low-carbohydrate group had lower levels of fat circulating in their blood and had lower scores on a measure often used to predict the risk of a heart attack or stroke within the next 10 years.

    "I thought that was a very striking finding," Bazzano said. She added that the score that predicts risk of future heart attacks and strokes was computed after the study was finished and is less reliable than the other risk factors they measured.

    Dr. David Jenkins, who wasn't involved in the study, told Reuters Health, "This doesn't look to me to say 'eat all the meats you want to lower your carbohydrates.' That's just one way to do it."

    Instead, Jenkins said, people in this study appeared to improve their overall diets. For example, they were eating foods with healthier fats, such as nuts and beans.

    He also said they seemed to eat more fiber and cut down on processed foods with more carbohydrates.

    "I think it's another testament to what one can do with a more plant-based diet using the right macronutrient profile," said Jenkins of the Department of Nutritional Sciences at the University of Toronto and the Keenan Research Centre at St. Michael's Hospital.

    Bazzano agreed that the overall diets improved among the participants and they were encouraged to eat healthier forms of protein like chicken, fish, nuts and beans.

    She also said her team is not sure why people on the low-carbohydrate diets lost more weight and had lower risk factors for heart disease after one year. It's not clear, she added,if there would still be a difference after a longer period.

    SOURCE: http://bit.ly/1qjI8OG Annals of Internal Medicine, online September 1, 2014.

  • Fears of addiction keep cancer patients from getting pain relief

    By Randi Belisomo

    NEW YORK (Reuters Health) - Fears of opioid abuse and addiction might be keeping patients with advanced cancer from getting enough pain medicine, researchers say.

    "At the end of life, we should feel comfortable providing whatever necessary to control pain," said Joel Hyatt, assistant regional director at Kaiser Permanente. Concerns about overdose and addiction, he told Reuters Health, should not prevent terminally ill patients from obtaining relief.

    Pain undertreatment is estimated to affect half of cancer patients, according to a recent report in the Journal of Clinical Oncology.

    Opioids, a type of narcotic, work in the spinal cord and brain to reduce the intensity of pain signals reaching the brain. The opioids hydrocodone (Vicodin), hydromorphone (Dilaudid) and oxycodone (Oxycontin, Percocet) are commonly prescribed painkillers. Hydrocodone is the most prescribed medication in the U.S., according to the International Narcotics Control Board.

    Opioid overuse and abuse are a widespread problem that gets lots of attention in the news media - and that may keep cancer patients and doctors from using them appropriately.

    "On one hand, we're told we overuse opioids," Hyatt said. "On the other, we're told we underuse them."

    Underuse worries Judith Paice, a pain specialist at Northwestern University Feinberg School of Medicine in Chicago. Part of the problem, she said, is that it's sometimes hard for patients to convey to doctors how severe the pain is.

    Most pain is controllable, she maintains; patients must describe symptoms, and physicians must seriously consider them.

    "All pain is real to the person experiencing it," Paice told Reuters Health. "But unlike infections we measure with blood samples, it doesn't have an objective marker."

    Doctors often ask patients to rate their pain on a 0 to 10 scale. But severity, experts say, should be described in more detail than that.

    "The zero to ten scale was a good beginning when introduced to quantify pain," said Paice. "Unfortunately, it's now a check in the box. It's another thing physicians ask, and patients feel frustrated because they don't feel doctors take it to the next step and work on their pain."

    She advises patients to elaborate. Diaries may help detail sites of pain, severity and factors prompting pain to worsen. "Whether it's when walking, coughing, sitting or lying flat, those give clues where pain comes from," she said. "What words describe it?" Adjectives could include aching, throbbing, tingling, burning, electrical or shooting.

    Narcotics are not the only option for treating pain. Patrick Fehling, a University of Colorado Hospital addiction psychiatrist, says anxiety often makes pain worse. In some cases, he told Reuters Health, pain should be treated with interdisciplinary counseling from social workers, clergy or psychologists. Research suggests complementary treatments such as massage and acupuncture may also be beneficial.

    "Patients might say, 'I have pain and would like it taken away,'" said Fehling. "But their experience might be they felt pain on a three out of ten level, and they wanted zero. That's not always realistic."

    Some populations are at particularly high risk for inadequate pain control. For example, research has shown that patients in minority care settings are three times more likely to receive undertreatment than those in non-minority settings. Sixty percent of African-American and 74 percent of Hispanic outpatients with cancer-related pain reported inadequate prescriptions.

    "This is a most vulnerable population," said Egidio Del Fabbro, a Virginia Commonwealth University palliative specialist. "To undertreat them is something we should avoid at all costs." Research cites unrelieved pain as the greatest fear among the terminally ill.

    While stigmas may be keeping doctors from prescribing adequate pain medication in certain patient populations, similar misconceptions may keep patients from seeking relief.

    "There is a stigma surrounding opioids, with morphine more than others," Paice said. Many people, she added, associate morphine with dying; they think it's only used in the final hours. In fact, she said, can be used anytime during cancer treatment to maintain mobility, appetite and quality of life.

    "Pain keeps patients from being able to enjoy whatever time they have left," Paice said.

    When time is precious, however, balancing relief and alertness is essential, Del Fabbro maintains. The sedative effects of opioids may be troubling.

    "Families want to recognize the loved one they know," he told Reuters Health. "What you get with excessive opioids is sedation, delirium, cognitive changes, and that's not the person they love. You want the best of both worlds. You want patients to be themselves and their pain controlled."

  • New test may predict worker hearing loss

    By Madeline Kennedy

    NEW YORK (Reuters Health) - Not everyone exposed to high noise levels at work experiences hearing loss as a result, and a new study suggests a simple test can predict which workers will be affected.

    Researchers caution that low accuracy in predicting who would not suffer hearing loss means the test shouldn't be used to select employees to work under high noise conditions.

    Nor should the test be used "to exclude workers from occupational noise exposure, but for improving counseling especially concerning use of hearing protectors and for a tighter schedule for hearing tests," said one of the study authors, Dr. Michael Kundi, at the Institute of Environmental Health in Vienna, Austria.

    In the study, the test did do a better job of predicting which workers would experience hearing loss than traditional risk factors like how long workers were exposed to noise and how often they wore hearing protection.

    Approximately 15 percent of Americans between the ages of 20 and 69 have hearing loss that is possibly caused by noise at work or during leisure activities, according to the National Institute on Deafness and Other Communication Disorders.

    According to the U.S. Occupational Safety and Health Administration (OSHA), 30 million Americans are exposed to hazardous noise levels at work.

    Researchers have long sought to understand differences in hearing loss experienced by people exposed to similar noise levels in the workplace. Studies at the authors' institute have found that variations in the inner ear's reaction to noise are partly responsible, meaning some people are more susceptible to hearing loss than others, likely due to genetics.

    One indicator of a person's susceptibility is how quickly the cells of the inner ear recover from noise exposure, which can be detected by measuring so-called temporary threshold shift (TTS) - a temporary hearing loss that's also known as aural fatigue or auditory fatigue.

    The TTS test exposes participants to frequencies between 200 and 500 Hertz at about 100 decibels. After the exposure, the researchers perform an audiogram at 4 kilohertz for at least 10 minutes.

    The magnitude of TTS after 2.5 minutes may indicate whether the person is more likely to suffer permanent noise-induced hearing loss, according to the authors.

    For their study, published in Occupational and Environmental Medicine, they followed 125 white, male teenage apprentices working as fitters and welders at a steel company in Austria.

    They measured the participants' hearing at the start of the apprenticeship in the morning hours, before workers were exposed to workplace noise. The study followed the apprentices, conducting hearing tests every three to five years for an average of 13 years.

    The study team found that 82 percent of the workers considered vulnerable to hearing loss based on the initial test did lose hearing over the years.

    When predicting who was not likely to experience hearing loss, however, the test was correct only 53 percent of the time.

    OSHA requires employers to implement a "hearing conservation program" when workers are exposed to noise of 85 decibels or more over an eight-hour shift. The rule requires "employers to measure noise levels, provide free annual hearing exams and free hearing protection, provide training, and conduct evaluations of the adequacy of the hearing protectors in use" (see: http://1.usa.gov/1vnyj2o).

    The current study suggests that such restrictions may be more effective for some workers than others, Kundi notes. Although he doesn't recommend the test be used to assign workers to noisy jobs or exclude them, the TTS test could identify people who are particularly vulnerable.

    The test is not expensive, he said, and can be done during regular occupational hearing tests. A person concerned about hearing loss could also get this test on his or her own. An ear, nose and throat specialist with an audiometer and a noise generator can perform it, Kundi said.

    "It would be premature to recommend this screening method for general use until these findings have been replicated by an independent group," said Dr. Robert Dobie, an ear specialist at the University of Texas Health Science Center in San Antonio. "Even then, its apparently poor performance (especially its low specificity) would dampen enthusiasm," Dobie told Reuters Health by email.

    Dobie, who was not involved in the study, also worries that "it might lead to inadequate prevention and counseling efforts for people who appeared - by this test - to be resistant to noise damage," he said. "At this point in time, it seems best to treat everyone as susceptible."

    For workers concerned about noise exposure, Dr. Hanns Moshammer, who led the Austrian study, said it's important to let the inner ear recover by reducing noise in activities outside of work.

    After a person has been exposed to loud noise, "for recovery, the cells need calm conditions for the rest of the day," he said. Increasingly, "recreational noise, games and loud music threaten our hearing faculty," he added, and advised that people exposed to noise at work avoid noisy leisure activities.

    Hans-Peter Hutter, senior author of the study, added in an email that "noise induced hearing loss (NIHL) represents a public health challenge as numbers are increasing - we think that our findings are a further step in the prevention of this health problem."

    SOURCE: bit.ly/1tlA284 Occupational & Environmental Medicine online July 25, 2014.

  • UK and French police hunt for seriously ill boy taken from hospital

    By Reuters Staff

    LONDON (Reuters) - British and French police launched a major hunt on Friday to find a seriously ill young boy taken from a hospital by his parents, saying that unless he was found quickly his life could be at risk.

    Ashya King, 5, who has a brain tumour, was removed from Southampton General Hospital in southern England by his mother, Naghemeh, and father, Brett, on Thursday afternoon and later, with his six siblings, the family boarded a ferry to France.

    "If we do not locate Ashya today there are serious concerns for his life," said Detective Superintendent Dick Pearson.

    "He is receiving constant medical care within the UK due to recent surgery and ongoing medical issues. Without this specialist, 24-hour care Ashya is at risk of additional health complications which place him at substantial risk."

    Police said the family were travelling in a grey Hyundai car while Ashya, who cannot communicate verbally and is immobile, was likely to be in a wheelchair or a stroller.

  • 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.

Oncology Articles

  • Better education on breast reconstruction may be needed after cancer

    By Andrew M. Seaman

    NEW YORK (Reuters Health) - When it comes to deciding to have breast reconstruction after surgery for breast cancer, most women are generally satisfied with the decision-making process, a new study suggests.

    "Our findings generally were good news - women who wanted reconstruction got it, those who didn't were generally satisfied with the decision process," said Dr. Monica Morrow, the study's lead author from Memorial Sloan Kettering Cancer Center in New York City.

    The study findings also revealed misunderstandings on the part of some patients. For example, some women who didn't undergo breast reconstruction said they worried that the implants would interfere with cancer screenings later on, or that they feared the implants.

    "Our study points to specific topics doctors can address with patients - safety of implants, lack of interference with cancer detection by reconstruction that are of concern to patients," Morrow wrote in an email.

    She said that the study also indicates that many patients are focused on their cancer treatment at the time of diagnosis and not interested in reconstruction. That's fine, she said, as long as they are aware of the possibility of reconstruction later on.

    "There is no 'correct' rate of reconstruction," she added.

    Morrow and her colleagues write in JAMA Surgery that in the U.S., since passage of the Women's Health and Cancer Rights Act of 1998, women receive universal coverage for breast reconstruction after they have a breast removed.

    Despite the coverage for breast reconstruction, only about 25 to 35 percent of women opt for the procedure, they add.

    Some people, who are not patients or breast cancer doctors, have said this rate of reconstruction is low, Morrow said.

    To ensure that breast cancer patients understood their options, New York State passed a law in 2010 mandating that surgeons discuss breast reconstruction with them and provide information on insurance and availability.

    "The purpose of our study was to understand whether patients felt that they were adequately informed about reconstruction and to understand the reasons they chose not to undergo the procedure," she added. "Without such understanding, it is not possible to devise strategies to address the problem (if there actually is a problem)."

    For the study, she and her colleagues used data from cancer registries in Los Angeles and Detroit on 485 women who had a breast removed and were cancer free for four years.

    Overall, 222 women, or about 46 percent, eventually underwent breast reconstruction. About two-thirds of those women had it done at the same time their breast was removed; the other third had breast reconstruction later on.

    Only about 13 percent of women said they were dissatisfied with the decision process about whether or not to have breast reconstruction, the authors found.

    Black women were about three times more likely to report dissatisfaction, however.

    Women who were older, had other health problems and lower education levels were less likely to have breast reconstruction. Women who received chemotherapy as treatment were also less likely to have the surgery.

    Women without private health insurance were also less likely to have breast reconstruction, despite universal coverage.

    About half of the women who did not get reconstruction said they did not want additional surgery. About a third said reconstruction was not important and about 36 percent said they feared implants.

    About 24 percent of women were concerned the implants would interfere with future breast cancer screenings, but the researchers said past studies have not found evidence to support that concern.

    "What our study actually says is that laws such as the NY state law are addressing a non-problem," Morrow said. "Patients are informed about reconstruction, some just chose not to have it."

    She added that women who want to keep their breasts may choose lumpectomy, which removes less tissue than a complete mastectomy, and radiation instead of a total breast removal.

    "So, it is not particularly surprising that reconstruction isn't a priority for all women who chose to undergo mastectomy," she said.

    Also, Morrow said, it's difficult to educate patients in a time when they get information from many sources that may not be scientifically valid or perpetuate myths, such as implants being unsafe.

    She also said that it's worth knowing that many women in this study decided to have breast reconstruction later on.

    "During follow-up it is worth asking patients if they have developed an interest in reconstruction and want to see a plastic surgeon, and patients who choose not to have immediate reconstruction need to know that they haven't closed the door permanently," she added.

    SOURCE: http://bit.ly/1thODnx JAMA Surgery, online August 20, 2014.

  • Fears of addiction keep cancer patients from getting pain relief

    By Randi Belisomo

    NEW YORK (Reuters Health) - Fears of opioid abuse and addiction might be keeping patients with advanced cancer from getting enough pain medicine, researchers say.

    "At the end of life, we should feel comfortable providing whatever necessary to control pain," said Joel Hyatt, assistant regional director at Kaiser Permanente. Concerns about overdose and addiction, he told Reuters Health, should not prevent terminally ill patients from obtaining relief.

    Pain undertreatment is estimated to affect half of cancer patients, according to a recent report in the Journal of Clinical Oncology.

    Opioids, a type of narcotic, work in the spinal cord and brain to reduce the intensity of pain signals reaching the brain. The opioids hydrocodone (Vicodin), hydromorphone (Dilaudid) and oxycodone (Oxycontin, Percocet) are commonly prescribed painkillers. Hydrocodone is the most prescribed medication in the U.S., according to the International Narcotics Control Board.

    Opioid overuse and abuse are a widespread problem that gets lots of attention in the news media - and that may keep cancer patients and doctors from using them appropriately.

    "On one hand, we're told we overuse opioids," Hyatt said. "On the other, we're told we underuse them."

    Underuse worries Judith Paice, a pain specialist at Northwestern University Feinberg School of Medicine in Chicago. Part of the problem, she said, is that it's sometimes hard for patients to convey to doctors how severe the pain is.

    Most pain is controllable, she maintains; patients must describe symptoms, and physicians must seriously consider them.

    "All pain is real to the person experiencing it," Paice told Reuters Health. "But unlike infections we measure with blood samples, it doesn't have an objective marker."

    Doctors often ask patients to rate their pain on a 0 to 10 scale. But severity, experts say, should be described in more detail than that.

    "The zero to ten scale was a good beginning when introduced to quantify pain," said Paice. "Unfortunately, it's now a check in the box. It's another thing physicians ask, and patients feel frustrated because they don't feel doctors take it to the next step and work on their pain."

    She advises patients to elaborate. Diaries may help detail sites of pain, severity and factors prompting pain to worsen. "Whether it's when walking, coughing, sitting or lying flat, those give clues where pain comes from," she said. "What words describe it?" Adjectives could include aching, throbbing, tingling, burning, electrical or shooting.

    Narcotics are not the only option for treating pain. Patrick Fehling, a University of Colorado Hospital addiction psychiatrist, says anxiety often makes pain worse. In some cases, he told Reuters Health, pain should be treated with interdisciplinary counseling from social workers, clergy or psychologists. Research suggests complementary treatments such as massage and acupuncture may also be beneficial.

    "Patients might say, 'I have pain and would like it taken away,'" said Fehling. "But their experience might be they felt pain on a three out of ten level, and they wanted zero. That's not always realistic."

    Some populations are at particularly high risk for inadequate pain control. For example, research has shown that patients in minority care settings are three times more likely to receive undertreatment than those in non-minority settings. Sixty percent of African-American and 74 percent of Hispanic outpatients with cancer-related pain reported inadequate prescriptions.

    "This is a most vulnerable population," said Egidio Del Fabbro, a Virginia Commonwealth University palliative specialist. "To undertreat them is something we should avoid at all costs." Research cites unrelieved pain as the greatest fear among the terminally ill.

    While stigmas may be keeping doctors from prescribing adequate pain medication in certain patient populations, similar misconceptions may keep patients from seeking relief.

    "There is a stigma surrounding opioids, with morphine more than others," Paice said. Many people, she added, associate morphine with dying; they think it's only used in the final hours. In fact, she said, can be used anytime during cancer treatment to maintain mobility, appetite and quality of life.

    "Pain keeps patients from being able to enjoy whatever time they have left," Paice said.

    When time is precious, however, balancing relief and alertness is essential, Del Fabbro maintains. The sedative effects of opioids may be troubling.

    "Families want to recognize the loved one they know," he told Reuters Health. "What you get with excessive opioids is sedation, delirium, cognitive changes, and that's not the person they love. You want the best of both worlds. You want patients to be themselves and their pain controlled."

  • 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.

Orthopedic Articles

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Women’s Health Articles

  • U.S. judge halts major part of Texas law restricting abortions

    By Reuters Staff

    AUSTIN, Texas (Reuters) - A U.S. judge struck down parts of a law seen as restricting abortions in Texas, saying in a decision on Friday that a provision requiring clinics to have certain hospital-like settings for surgeries was unconstitutional.

    "The act's ambulatory-surgical center requirement places an unconstitutional undue burden on women throughout Texas," U.S. District Judge Lee Yeakel said in his decision.

    The so-called ambulatory surgical center requirement was to have gone into effect on Sept. 1. It would require clinics to meet a set of buildings standards that abortion rights advocates said were unnecessary, especially when an abortion is medically induced.

    Advocacy groups who brought the suit, including Whole Women's Health, had argued the requirement was costly and had no medical benefit, seeing it as mostly intended to shut clinics that could not afford to make the changes.

    The state argued the requirement reduces complications and increases patient care when complications occur.

  • Better education on breast reconstruction may be needed after cancer

    By Andrew M. Seaman

    NEW YORK (Reuters Health) - When it comes to deciding to have breast reconstruction after surgery for breast cancer, most women are generally satisfied with the decision-making process, a new study suggests.

    "Our findings generally were good news - women who wanted reconstruction got it, those who didn't were generally satisfied with the decision process," said Dr. Monica Morrow, the study's lead author from Memorial Sloan Kettering Cancer Center in New York City.

    The study findings also revealed misunderstandings on the part of some patients. For example, some women who didn't undergo breast reconstruction said they worried that the implants would interfere with cancer screenings later on, or that they feared the implants.

    "Our study points to specific topics doctors can address with patients - safety of implants, lack of interference with cancer detection by reconstruction that are of concern to patients," Morrow wrote in an email.

    She said that the study also indicates that many patients are focused on their cancer treatment at the time of diagnosis and not interested in reconstruction. That's fine, she said, as long as they are aware of the possibility of reconstruction later on.

    "There is no 'correct' rate of reconstruction," she added.

    Morrow and her colleagues write in JAMA Surgery that in the U.S., since passage of the Women's Health and Cancer Rights Act of 1998, women receive universal coverage for breast reconstruction after they have a breast removed.

    Despite the coverage for breast reconstruction, only about 25 to 35 percent of women opt for the procedure, they add.

    Some people, who are not patients or breast cancer doctors, have said this rate of reconstruction is low, Morrow said.

    To ensure that breast cancer patients understood their options, New York State passed a law in 2010 mandating that surgeons discuss breast reconstruction with them and provide information on insurance and availability.

    "The purpose of our study was to understand whether patients felt that they were adequately informed about reconstruction and to understand the reasons they chose not to undergo the procedure," she added. "Without such understanding, it is not possible to devise strategies to address the problem (if there actually is a problem)."

    For the study, she and her colleagues used data from cancer registries in Los Angeles and Detroit on 485 women who had a breast removed and were cancer free for four years.

    Overall, 222 women, or about 46 percent, eventually underwent breast reconstruction. About two-thirds of those women had it done at the same time their breast was removed; the other third had breast reconstruction later on.

    Only about 13 percent of women said they were dissatisfied with the decision process about whether or not to have breast reconstruction, the authors found.

    Black women were about three times more likely to report dissatisfaction, however.

    Women who were older, had other health problems and lower education levels were less likely to have breast reconstruction. Women who received chemotherapy as treatment were also less likely to have the surgery.

    Women without private health insurance were also less likely to have breast reconstruction, despite universal coverage.

    About half of the women who did not get reconstruction said they did not want additional surgery. About a third said reconstruction was not important and about 36 percent said they feared implants.

    About 24 percent of women were concerned the implants would interfere with future breast cancer screenings, but the researchers said past studies have not found evidence to support that concern.

    "What our study actually says is that laws such as the NY state law are addressing a non-problem," Morrow said. "Patients are informed about reconstruction, some just chose not to have it."

    She added that women who want to keep their breasts may choose lumpectomy, which removes less tissue than a complete mastectomy, and radiation instead of a total breast removal.

    "So, it is not particularly surprising that reconstruction isn't a priority for all women who chose to undergo mastectomy," she said.

    Also, Morrow said, it's difficult to educate patients in a time when they get information from many sources that may not be scientifically valid or perpetuate myths, such as implants being unsafe.

    She also said that it's worth knowing that many women in this study decided to have breast reconstruction later on.

    "During follow-up it is worth asking patients if they have developed an interest in reconstruction and want to see a plastic surgeon, and patients who choose not to have immediate reconstruction need to know that they haven't closed the door permanently," she added.

    SOURCE: http://bit.ly/1thODnx JAMA Surgery, online August 20, 2014.

  • African-Americans may be getting inferior breastfeeding advice

    By Ronnie Cohen

    NEW YORK (Reuters Health) - Mothers who give birth in areas with higher concentrations of African-Americans are less likely to get breastfeeding support on maternity wards than mothers in other communities, a new study shows.

    Breastfeeding provides well-documented health benefits to infants and their mothers. But African-American women are about 16 percent less likely to nurse their newborns than white women, according to research from the Centers for Disease Control and Prevention (CDC).

    The study of 2,727 American hospitals and birth centers sought to uncover the reasons for the racial disparities.

    "What this study suggests is that hospital practices, not just women's choices, beliefs or values, contribute to the observed racial disparities in infant feeding," sociologist Elizabeth Armstrong told Reuters Health in an email.

    "Where a woman lives - and consequently gives birth - affects how her infant is nourished. Black babies and their mothers are less likely to start off in environments that support the optimal level of care for infant feeding and mother-baby bonding," she said.

    Armstrong, a professor at Princeton University in New Jersey, was not involved in the current study.

    The CDC researchers gathered data on optimal maternity care from hospitals and birth centers across the U.S. and compared areas with a higher percentage of black residents to areas with a lower percentage.

    Facilities in zip codes with more black residents were more likely to give tests to their staff on breastfeeding support, the researchers wrote in the CDC's Morbidity and Mortality Weekly Report.

    At the same time, maternity wards in areas with more African-Americans were less than half as likely to limit the use of breastfeeding supplements, such as formula. A 2006 report from the Government Accountability Office showed that when hospitals hand out free formula samples, mothers tend to breastfeed less.

    Hospitals in neighborhoods with more African-Americans were also 7 percent more likely to give newborns pacifiers, which can inhibit breastfeeding.

    And facilities in areas with higher concentrations of whites were nearly 14 percent more likely to promote early initiation of breastfeeding and nearly 12 percent more likely to work to keep newborns next to their mothers in the hospital. Both factors are known to promote breastfeeding.

    Hospitals in neighborhoods with more blacks were significantly less likely to offer breastfeeding support after mothers returned home.

    "This study shows the best support is not where it's most needed," Dr. Miriam Labbok told Reuters Health in a telephone interview. "If we could just change the hospital practices, I think we could have a lot more equity."

    A pediatrician, Labbok is the founding director of the Carolina Global Breastfeeding Institute at the University of North Carolina at Chapel Hill and was not involved in the current study.

    Lead author Jennifer Lind told Reuters Health that it's too early to understand the reasons for the racial differences.

    "Because this is the first stab or look into the whole issue, we really don't know why we're seeing these disparities," she said in a telephone interview. Lind is an epidemiologist with the CDC.

    "We found that hospital practices during childbirth have a major impact on whether a mother is able to start and continue breastfeeding," she said. "We think it's really important that all hospitals - regardless of where they're located - apply policies and practices proven to be supportive of breastfeeding so that more babies are able to reap the numerous benefits."

    Research has shown that breastfed babies, especially those fed just breast milk without any formula, are less likely to die of sudden infant death syndrome, or SIDS (see Reuters Health story of June 14, 2011 here: http://reut.rs/VPTRIv). African-American babies are more likely to die from SIDS, also known as "crib death."

    Breastfeeding also lowers babies' risk of infection, childhood obesity, asthma and type 2 diabetes, Lind said. Mothers who nurse their babies cut their chances of being diagnosed with breast and ovarian cancer, she said.

    The American Academy of Pediatrics recommends exclusive breastfeeding for six months and continued breastfeeding for another year while babies are introduced to complementary foods.

    In 2011, 79 percent of new American mothers started to breastfeed their infants, but fewer than half were still breastfeeding at six months, according to the CDC.

    Only 195 U.S. hospitals, accounting for 8 percent of all births, have earned the status of Baby Friendly, the gold standard for optimal maternity care established by the World Health Organization and UNICEF in 1991, Armstrong said.

    "I really think what we're seeing here is very much due to the fact that hospitals put up barriers," Labbok said. "I'd say this is a very good reflection of something that's wrong, and it needs to be fixed."

    She noted that African-American women continued to nurse their babies at higher rates than white women in the 1960s, when breastfeeding in the U.S. hit an all-time low.

    "In general, there has been this incorrect assumption that because you're black, you don't breastfeed, and that is just out and out wrong," Labbok said. "We've really got to strive for equity. This study shows very clearly that we have some work to do."

    SOURCE: http://1.usa.gov/1pRnjKa Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report, online August 22, 2014.

  • New test may predict worker hearing loss

    By Madeline Kennedy

    NEW YORK (Reuters Health) - Not everyone exposed to high noise levels at work experiences hearing loss as a result, and a new study suggests a simple test can predict which workers will be affected.

    Researchers caution that low accuracy in predicting who would not suffer hearing loss means the test shouldn't be used to select employees to work under high noise conditions.

    Nor should the test be used "to exclude workers from occupational noise exposure, but for improving counseling especially concerning use of hearing protectors and for a tighter schedule for hearing tests," said one of the study authors, Dr. Michael Kundi, at the Institute of Environmental Health in Vienna, Austria.

    In the study, the test did do a better job of predicting which workers would experience hearing loss than traditional risk factors like how long workers were exposed to noise and how often they wore hearing protection.

    Approximately 15 percent of Americans between the ages of 20 and 69 have hearing loss that is possibly caused by noise at work or during leisure activities, according to the National Institute on Deafness and Other Communication Disorders.

    According to the U.S. Occupational Safety and Health Administration (OSHA), 30 million Americans are exposed to hazardous noise levels at work.

    Researchers have long sought to understand differences in hearing loss experienced by people exposed to similar noise levels in the workplace. Studies at the authors' institute have found that variations in the inner ear's reaction to noise are partly responsible, meaning some people are more susceptible to hearing loss than others, likely due to genetics.

    One indicator of a person's susceptibility is how quickly the cells of the inner ear recover from noise exposure, which can be detected by measuring so-called temporary threshold shift (TTS) - a temporary hearing loss that's also known as aural fatigue or auditory fatigue.

    The TTS test exposes participants to frequencies between 200 and 500 Hertz at about 100 decibels. After the exposure, the researchers perform an audiogram at 4 kilohertz for at least 10 minutes.

    The magnitude of TTS after 2.5 minutes may indicate whether the person is more likely to suffer permanent noise-induced hearing loss, according to the authors.

    For their study, published in Occupational and Environmental Medicine, they followed 125 white, male teenage apprentices working as fitters and welders at a steel company in Austria.

    They measured the participants' hearing at the start of the apprenticeship in the morning hours, before workers were exposed to workplace noise. The study followed the apprentices, conducting hearing tests every three to five years for an average of 13 years.

    The study team found that 82 percent of the workers considered vulnerable to hearing loss based on the initial test did lose hearing over the years.

    When predicting who was not likely to experience hearing loss, however, the test was correct only 53 percent of the time.

    OSHA requires employers to implement a "hearing conservation program" when workers are exposed to noise of 85 decibels or more over an eight-hour shift. The rule requires "employers to measure noise levels, provide free annual hearing exams and free hearing protection, provide training, and conduct evaluations of the adequacy of the hearing protectors in use" (see: http://1.usa.gov/1vnyj2o).

    The current study suggests that such restrictions may be more effective for some workers than others, Kundi notes. Although he doesn't recommend the test be used to assign workers to noisy jobs or exclude them, the TTS test could identify people who are particularly vulnerable.

    The test is not expensive, he said, and can be done during regular occupational hearing tests. A person concerned about hearing loss could also get this test on his or her own. An ear, nose and throat specialist with an audiometer and a noise generator can perform it, Kundi said.

    "It would be premature to recommend this screening method for general use until these findings have been replicated by an independent group," said Dr. Robert Dobie, an ear specialist at the University of Texas Health Science Center in San Antonio. "Even then, its apparently poor performance (especially its low specificity) would dampen enthusiasm," Dobie told Reuters Health by email.

    Dobie, who was not involved in the study, also worries that "it might lead to inadequate prevention and counseling efforts for people who appeared - by this test - to be resistant to noise damage," he said. "At this point in time, it seems best to treat everyone as susceptible."

    For workers concerned about noise exposure, Dr. Hanns Moshammer, who led the Austrian study, said it's important to let the inner ear recover by reducing noise in activities outside of work.

    After a person has been exposed to loud noise, "for recovery, the cells need calm conditions for the rest of the day," he said. Increasingly, "recreational noise, games and loud music threaten our hearing faculty," he added, and advised that people exposed to noise at work avoid noisy leisure activities.

    Hans-Peter Hutter, senior author of the study, added in an email that "noise induced hearing loss (NIHL) represents a public health challenge as numbers are increasing - we think that our findings are a further step in the prevention of this health problem."

    SOURCE: bit.ly/1tlA284 Occupational & Environmental Medicine online July 25, 2014.

  • California passes 'yes-means-yes' campus sexual assault bill

    By Aaron Mendelson

    (Reuters) - Californian lawmakers passed a law on Thursday requiring universities to adopt "affirmative consent" language in their definitions of consensual sex, part of a nationwide drive to curb sexual assault on U.S. campuses.

    The measure, passed unanimously by the California State Senate, has been called the "yes-means-yes" bill. It defines sexual consent between people as "an affirmative, conscious and voluntary agreement to engage in sexual activity."

    The bill states that silence and a lack of resistance do not signify consent and that drugs or alcohol do not excuse unwanted sexual activity.

    Governor Jerry Brown must sign the bill into law by the end of September. If he does, it would mark the first time a U.S. state requires such language to be a central tenet of school sexual assault policies, said Claire Conlon, a spokeswoman for State Senator Kevin De Leon, who championed the legislation.

    Opponents of the bill say it is politically over-reaching and could push universities into little charted legal waters.

    The bill comes amid mounting pressure nationwide by lawmakers, activists and students on universities and colleges to curb sexual assaults on campuses and to reform investigations after allegations are made.

    The White House has declared sex crimes to be "epidemic" on U.S. college campuses, with one in five students falling victim to sex assault during their college years.

    Universities in California and beyond have already taken steps, including seeking to delineate whether consent has been given beyond 'no means no.'

    Harvard University said last month it had created an office to investigate all claims of sexual harassment or sex assault, and that it would lower its evidentiary standard of proof in weighing the cases.

    Under California's bill, state-funded colleges and universities must adopt strict policies regarding sexual assault, domestic violence, dating violence and stalking, among other actions in order to receive financial aid money.

    No college or university voiced opposition to the bill, Conlon said.

    The U.S. Department of Education in May released a list of 55 colleges -- including three in California -- under investigation to determine whether their handling of sex assaults and harassment violated federal laws put in place to ensure equal treatment in higher education.

    The Californian institutions on the list are University of California, Berkeley, Occidental College and the University of Southern California.