CHRISTUS Santa Rosa Hospital

2827 Babcock Rd.

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

christus

CHRISTUS Santa Rosa Overview

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

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

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

Neuroscience Articles

  • Brain study hints at how fibromyalgia works

    By Kathryn Doyle

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  • Docs urge action to stop young drivers' texting

    By Janice Neumann

    NEW YORK (Reuters Health) - Texting while driving could be contributing to thousands of car crashes, especially among teens, and the American College of Preventive Medicine (ACPM) wants policy makers, doctors and parents to do something about it.

    Texting by novice drivers raises the chances of an accident almost four-fold, the authors of a new position statement point out. But they say new laws, combined with public education, could help eradicate this unnecessary risk on the roadways.

    "I was surprised that statistically the risks, given the little hard data we have, are comparable or worse than those of individuals who are driving under the influence," said Dr. Kevin Sherin, director of the Florida Department of Health in Orange County and lead author of the recommendations published in the American Journal of Preventive Medicine.

    The new recommendations focus on teens because they text or Internet browse nearly twice as much as adults. A recent study found that drivers with less than two years' experience are eight times more likely to crash if they use a cell phone, and seven times more likely if they reach for a cell phone (see Reuters Health story of January 1, 2014, here: http://bit.ly/19F1LID).

    Their risk of crashing increases 3.9 times by sending or receiving texts or using the Internet while driving, the same study found. Of drivers under 20 years old, 11 percent involved in fatal vehicle crashes said they were distracted and nearly one in five said those distractions came from using a cell phone.

    Distractions played a role in 17 percent of motor vehicle crashes in 2011 and 3,331 deaths, according to the National Highway Traffic Safety Administration. Cell phones were involved in 12 percent of the deaths.

    "I have personally observed my teens sending texts and admitting they were driving . . . despite my safety warnings and my own public health, preventive medicine and public safety awareness and special knowledge," said Sherin, whose children are now in their 20s.

    "It certainly did make me interested in effecting (change in) state and national policy," said Sherin, who also teaches at the Florida State University College of Medicine and the University of Central Florida College of Medicine in Tallahassee.

    The recommendations include state bans against texting and driving, public relations campaigns about the dangers, beefed up penalties for violations and educating future drivers when they apply for licenses. Primary care doctors and parents should also work at explaining the dangers of texting while driving to adolescents, starting at age 15, the authors say.

    They added that more research is needed on the role of texting in distracted driving, and on effective educational tools, ad campaigns and how best to counsel patients against it.

    According to the Governors Highway Safety Administration, 14 states have banned handheld cell phone use for all drivers, 38 states and Washington, D.C. prohibit cell phone use for new drivers, 20 states and D.C. prohibit cell phone use for school bus drivers and 44 states have banned texting while driving. Some states use primary enforcement laws for the infractions and others secondary enforcement laws.

    "I personally think the penalties for texting and driving should be as harsh as those for driving under the influence," Sherin said. "The risks are similar.

    Television ads in after-school time slots (like the ads against drugs and alcohol) could highlight the dangers of texting while driving for teens, the ACPM committee said.

    Dr. Linda Hill, clinical professor in the Department of Family and Preventive Medicine at the University of California, San Diego, told Reuters Health she agrees with the recommendations but thinks they should have also focused on the dangers of hands-free and hand-held cell phone use while driving. Hill was not involved in the recommendations, though she is a member of the ACPM.

    Employers also need to be involved since they often expect employees to answer their phones, even while driving, said Hill, who studies distracted driving and has launched several driver safety programs, including one for businesses.

    In a 2011-2012 survey of 5,000 college students in California, Hill found 90 percent were texting and 90 percent talking on the phone while driving. The survey also found that 50 percent sent texts while driving on the freeway.

    "We thought that was pretty scary," Hill said. "What shocked us was that 46 percent of the kids thought they were capable of distracted driving but thought only 8 percent of other drivers were."

    That unwarranted self-confidence in multitaskers is common, according to Zhen Joyce Wang at the Center for Cognitive and Brain Sciences, The Ohio State University. She told Reuters Health that texting while driving can be particularly dangerous.

    "It is because the capacities demanded by the tasks are more than what a person can typically afford," said Wang, who has published several studies on distracted driving. "We found both behavioral and eye movement (indicating visual attention) evidence that suggest texting and driving could be more dangerous than making phone calls while driving," Wang said in an email.

    SOURCE: http://bit.ly/1uHC58a American Journal of Preventive Medicine, published online Sept. 10, 2014.

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

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

    By Shereen Lehman

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    By Shereen Lehman

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  • Secure Italian military lab to grow medical marijuana

    By Steve Scherer

    ROME (Reuters) - Italy said on Thursday it would grow medical marijuana at a secure military lab outside Florence and distribute it through pharmacies to slash costs and make it more easily available to the sick.

    The use of medical marijuana or cannabis derivatives to treat patients has been legal in Italy since 2007, but only a few dozen people took it through the national healthcare system in 2013 because of its prohibitive cost.

    The military lab produces so-called "orphan" drugs no longer made by large pharmaceutical companies that are needed to treat rare diseases, Defense Minister Roberta Pinotti said after signing an agreement with Health Minister Beatrice Lorenzin.

    "The institute already produces some medicines," Pinotti said, explaining the unusual case of tasking the military to grow pot. "And we can guarantee security conditions."

    Lorenzin said she wanted to "debunk all the cultural or ideological myths" about using certain drugs in healthcare.

    "We already allow the use of drugs in medical treatment that are opiate or cocaine derivatives, and now we'll use cannabis," she told reporters.

    "Recreational drug use is harmful. But cannabis can be used to help treat certain pathologies or alleviate pain," she said.

    Possessing, selling and growing marijuana are illegal in Italy, which now imports all of its medical supplies of the drug, mostly from the Netherlands.

    Tax and transportation more than double the cost, with the retail price reaching almost 38 euros ($49) per gram, Dr. Francesco Crestani, an anesthesiologist and president of Italy's Association for Therapeutic Cannabis, told Reuters.

    PILOT PROJECT

    While several Italian regions have drafted laws aimed at cutting the cost of medical marijuana for people suffering from pathologies like cancer or multiple sclerosis, they have run into fierce opposition.

    Many argue that allowing the use of marijuana, even by the sick, sends the wrong message to teenagers, whose use of the drug is growing. One in four between the age of 15 and 19 has smoked it last year, a parliamentary report said this week.

    Italy's choice to keep tight control of the production of marijuana contrasts with developments in the United States, where almost half the 50 states allow sick people to grow their own, or in some states to buy it from dispensaries.

    The agreement, which the ministers described as a "pilot project", should result in the medicines being delivered to pharmacies by the end of 2015, Lorenzin said.

    Private pharmaceutical companies will not be able to produce medical marijuana "given the delicacy of this issue," she said.

    Each of Italy's 20 regional governments will establish the exact cost of the medicine to patients, Lorenzin added, but the retail cost of medical marijuana in Italy should be "more than halved."

    "This is a positive step," said therapeutic cannabis proponent Crestani, adding he hopes production is not delayed by bureaucratic snags.

    Due to the costs, most sick people who want marijuana have been buying it from the local drug dealer, Crestani said.

    "It's not safe to buy it on the street because there is no control over how it is produced. And the more you can cut the cost of the medicine, the better it is for the patient."

Oncology Articles

  • Angelina Jolie surgery sparks surge in female cancer tests-study

    By Laura Onita

    LONDON (Thomson Reuters Foundation) - Hollywood star Angelina Jolie's decision to make public her double mastectomy more than doubled the number of women in Britain seeking to have genetic breast cancer tests, according to a study released on Friday.

    Jolie, 39, who has become a high-profile human rights campaign, announced her surgery in May last year, saying she acted after testing positive for a mutation of the BRCA1 gene that significantly increases the risk of breast cancer.

    She said she was going public with news of her surgery as she hoped her story would inspire other women to fight the life-threatening disease.

    Researchers studied 21 clinics and regional genetic centers and found there were 4,847 referrals for testing in June and July last year compared to 1,981 in the same period of 2012.

    The study of the so-called "Angelina effect", published online in the journal Breast Cancer Research, credited Jolie's glamorous appearance and relationship with Hollywood actor Brad Pitt for helping to lessen women's fears about surgery.

    "Angelina Jolie ... is likely to have had a bigger impact than other celebrity announcements, possibly due to her image as glamorous and strong woman," researcher Gareth Evans of the charity Genesis Breast Cancer Prevention said in a statement.

    "This may have lessened patients' fears about a loss of sexual identity post-preventative surgery and encouraged those who had not previously engaged with health services to consider genetic testing."

    "These high-profile cases often mean that more women are inclined to contact centers such as Genesis - and other family history clinics - so that they can be tested for the mutation early and take the necessary steps to prevent themselves from developing the disease," he continued.

    "Of course, in some cases this may mean a risk-reducing mastectomy, however cancer preventing drugs, such as tamoxifen, and certain lifestyle changes like a healthy diet and more exercise, are also options which many women may consider."

    Breast cancer is the most common cancer in women worldwide. The World Health Organization estimated that more than 521,000 women died of breast cancer in 2012.

    Oscar-winning Jolie has in recent years drawn nearly as much attention for her globe-trotting work on behalf of refugees and victims of sexual violence in conflicts as for her acting.

    Jolie was named a Goodwill Ambassador for the UNHCR in 2001 and promoted to be Special Envoy to High Commissioner Antonio Guterres in 2012. Since 2012 she has also led a campaign against sexual violence in conflict zones.

    SOURCE: http://bit.ly/1u5z5nc Breast Cancer Research, September 18, 2014.

  • Many think of dermatology as superficial: survey

    By Madeline Kennedy

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  • Secure Italian military lab to grow medical marijuana

    By Steve Scherer

    ROME (Reuters) - Italy said on Thursday it would grow medical marijuana at a secure military lab outside Florence and distribute it through pharmacies to slash costs and make it more easily available to the sick.

    The use of medical marijuana or cannabis derivatives to treat patients has been legal in Italy since 2007, but only a few dozen people took it through the national healthcare system in 2013 because of its prohibitive cost.

    The military lab produces so-called "orphan" drugs no longer made by large pharmaceutical companies that are needed to treat rare diseases, Defense Minister Roberta Pinotti said after signing an agreement with Health Minister Beatrice Lorenzin.

    "The institute already produces some medicines," Pinotti said, explaining the unusual case of tasking the military to grow pot. "And we can guarantee security conditions."

    Lorenzin said she wanted to "debunk all the cultural or ideological myths" about using certain drugs in healthcare.

    "We already allow the use of drugs in medical treatment that are opiate or cocaine derivatives, and now we'll use cannabis," she told reporters.

    "Recreational drug use is harmful. But cannabis can be used to help treat certain pathologies or alleviate pain," she said.

    Possessing, selling and growing marijuana are illegal in Italy, which now imports all of its medical supplies of the drug, mostly from the Netherlands.

    Tax and transportation more than double the cost, with the retail price reaching almost 38 euros ($49) per gram, Dr. Francesco Crestani, an anesthesiologist and president of Italy's Association for Therapeutic Cannabis, told Reuters.

    PILOT PROJECT

    While several Italian regions have drafted laws aimed at cutting the cost of medical marijuana for people suffering from pathologies like cancer or multiple sclerosis, they have run into fierce opposition.

    Many argue that allowing the use of marijuana, even by the sick, sends the wrong message to teenagers, whose use of the drug is growing. One in four between the age of 15 and 19 has smoked it last year, a parliamentary report said this week.

    Italy's choice to keep tight control of the production of marijuana contrasts with developments in the United States, where almost half the 50 states allow sick people to grow their own, or in some states to buy it from dispensaries.

    The agreement, which the ministers described as a "pilot project", should result in the medicines being delivered to pharmacies by the end of 2015, Lorenzin said.

    Private pharmaceutical companies will not be able to produce medical marijuana "given the delicacy of this issue," she said.

    Each of Italy's 20 regional governments will establish the exact cost of the medicine to patients, Lorenzin added, but the retail cost of medical marijuana in Italy should be "more than halved."

    "This is a positive step," said therapeutic cannabis proponent Crestani, adding he hopes production is not delayed by bureaucratic snags.

    Due to the costs, most sick people who want marijuana have been buying it from the local drug dealer, Crestani said.

    "It's not safe to buy it on the street because there is no control over how it is produced. And the more you can cut the cost of the medicine, the better it is for the patient."

  • Stoners get high on love with marijuana dating sites

    By Mary Papenfuss

    SAN FRANCISCO (Reuters) - Dinner and a movie make for a typical date night but dinner followed by a joint could raise some eyebrows or be a turn-off despite increasing acceptance of marijuana use across the United States.

    So now, tuned-in stoners and users of medical pot are turning on to dating websites that cater exclusively to tokers or, at the very least, the "cannabis friendly" to avoid experiencing what they describe as all-too-frequent shock and rejection on the dating circuit.

    That has worked out well for a Vietnam War veteran from Michigan who works in the automotive industry and smokes to deal with the pain caused by chemotherapy treatment for hepatitis C.

    Larry, who asked to be identified only by his given name because of the legal issues surrounding marijuana use, says he is "very much enjoying" dating a woman he met on the dating website 420singles.net. The site name corresponds to a numerical code widely recognized within the cannabis subculture as a symbol for all things marijuana.

    "She lives near me but we wouldn't know about our shared medical marijuana use if we hadn't connected on the site because no one discusses pot smoking in my circles," he said.

    Larry's go-to website, with nearly 23,000 members, was the brainchild of 28-year-old California entrepreneur and self-described stoner Ryan Moxon of Marin County. About three years ago he dreamed up the idea for the site while yearning for the girl of his dreams: one who smokes pot.

    Membership is concentrated on the U.S. West Coast but also includes international smokers and has ballooned since voters in Washington state and Colorado opted to legalize recreational marijuana use in 2012.

    Voters in Oregon, Alaska and the District of Columbia will vote in November on the issue, and the New York Times in July called for the repeal of the federal ban on marijuana for those over the age of 21.

    "It's suddenly much cooler to come out as a toker," Moxon said of his site, which he says eliminates awkwardness about smoking.

    A newer website launched several months ago "aims to connect those with a passion for cannabis," said Miguel Lozano of Los Angeles, founder of My420mate.com with some 6,200 members.

    POTENTIAL INVESTORS

    Lozano, a medical marijuana user who enjoys pot to ease sports injury pain, is eager to counter the image that cannabis lovers are "merely hippies," he says.

    "There's a stereotype that pot smokers are lazy, isolated and lonely. They're not," he said. "They're the life of the party, they're often professionals and ambitious business people, and they make good partners."

    Lozano and Moxon are hoping their sites will become ad magnets for the burgeoning number of legal marijuana dispensaries and related products. Both sites already have drawn interest from potential investors, they say.

    Legal pot sales alone are expected to reach $10 billion by 2018, according to The ArcView Group, a marijuana industry investment company in San Francisco. Sales of pot-related products, from dope-infused health bars to cannabis-laced sexual lubricant, are among products expected to skyrocket.

    Another man, from Missouri, is dating a woman he met on Lozano's site. He classifies himself as a "recreational to daily" pot smoker. His new love interest smokes less but "she's totally cool with that," said the man, who asked that he be identified only by his given name, Corey, because marijuana use is illegal in his state.

    Although it's important to Corey that a date shares or is tolerant of his pot use, he believes would-be partners also have the personality he relates to.

    "Smokers come from all walks of life but they tend to chill back," he says. "When I go out with buddies who get wasted on alcohol, it can be embarrassing. With my cannabis-smoking pals, we relax and let the creativity unroll."

  • Venezuelan cartoonist says fired for health satire

    By Andrew Cawthorne

    CARACAS (Reuters) - A Venezuelan cartoonist said she was fired from her newspaper for a caricature that used the late socialist leader Hugo Chavez's signature to satirize the state of healthcare.

    "I was informed of my sacking from El Universal over this caricature and my awkward attitude over graphic satire," veteran cartoonist Rayma Suprani said via Twitter late on Wednesday.

    There was no confirmation from the newspaper.

    The cartoon, which ran on El Universal's editorial page on Wednesday, showed a normal-looking electrocardiogram under the heading "health" with another one merging Chavez's signature into a flat-lining heartbeat line under a title "health in Venezuela."

    The cartoon touched on two hugely sensitive subjects in Venezuela: the legacy of Chavez, the former president who ruled for 14 years before his death from cancer in 2013, and the socialist government's management of the health system.

    Supporters say Chavez transformed healthcare for the poor via popular programs like 'Barrio Adentro' (Inside the Neighborhood) which set up a network of small health clinics staffed by Cuban medics that offered free treatment.

    Opposition supporters often acknowledge welfare advances under Chavez, but say they were patchy, and are highly critical of shortages of medicine and equipment due to Venezuela's economic crisis.

    One opposition leader, Henrique Capriles, paid public tribute to Rayma after the caricature affair and used it to take a jab at Chavez's successor President Nicolas Maduro.

    "You have masses of talent and the admiration of thousands - just what those in power lack," he said on Twitter.

    El Universal's traditionally virulent anti-government line has softened under new ownership this year, though critical stories and opinions still appear.

    El Universal representatives were unavailable for comment on Thursday. One newspaper employee, speaking on condition of anonymity, said the cartoonist was fired because her work had increasingly annoyed her bosses.

Orthopedic Articles

  • Brain study hints at how fibromyalgia works

    By Kathryn Doyle

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    By Shereen Lehman

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    By Shereen Lehman

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  • Salt and smoking may interact to raise RA risk

    By Shereen Lehman

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  • Chiropractic care may ease back-related leg pain

    By Shereen Lehman

    NEW YORK (Reuters Health) - People with leg pain related to back problems had more short-term relief if they received chiropractic care along with exercise and advice, rather than exercise and advice alone, a new study has found.

    Patients with back-related leg pain, such as sciatica, are usually treated with prescription medications, injections and surgery.

    Increasingly, spinal manipulative therapy by chiropractors, exercise and self-management are being recommended as low-risk strategies for back-related leg pain, but good research studies have been lacking, experts say.

    "Spinal manipulation combined with home exercise may be worth trying for those with back-related leg pain that has lasted more than four weeks," Gert Bronfort told Reuters Health in an email.

    Bronfort, who led the study, is a researcher with the Integrative Health and Wellbeing Research Program at the University of Minnesota in Minneapolis.

    "This combination resulted in advantages in pain reduction, disability, global improvement, satisfaction, medication use and general physical health status after 12 weeks," he said.

    Nine months after the treatment ended, patients who received chiropractic therapy were still doing better than the other group in terms of global improvement, medication use and satisfaction, he added.

    Bronfort said that about four out of five people will develop low back pain during their lifetime, and up to 40 percent of them will develop back-related leg pain.

    As reported in Annals of Internal Medicine, Bronfort and colleagues enrolled 192 adults with back pain that had been radiating into the leg for at least four weeks. Patients were recruited through newspaper advertisements, direct mail, and community posters.

    Half the patients received instructions for specific exercises to do at home plus simple pain management techniques. In addition, during the first 12 weeks, they visited a chiropractor up to 20 times for 10 to 20 minutes of spinal manipulation at each visit.

    Patients in the other group also received the instructions for exercises and pain management techniques. They too met with a chiropractor, exercise therapist, or personal trainer during the first 12 weeks, but for four one-hour sessions without spinal manipulation.

    The patients were asked to rate their pain at the beginning of the study, after the 12 weeks of treatments and again at the end of the year.

    At 12 weeks, 37 percent of the spinal manipulation group felt their pain was reduced by at least three-quarters, compared to 19 percent of those who received exercise and advice only.

    In addition, the patients who had spinal manipulation had higher scores for overall improvement and satisfaction.

    By the one-year follow-up, the no-manipulation group had caught up, and there was no longer a significant difference in pain relief. But the scores for overall improvement and satisfaction remained higher for the patients who received spinal manipulative therapy.

    "We actually find the outcomes of the home exercise alone group to be very interesting," Bronfort said.

    Almost half of these patients experienced a 50 percent reduction in leg pain symptoms in both the short (at 12 weeks) and long term (at 52 weeks), Bronfort said.

    "That's an important improvement and warrants future research," he said, "We look forward to investigating how home exercise alone may compare to usual medical treatment and/or no treatment at all."

    "This is a well-conducted study by a group of well-respected chiropractic researchers," Sidney Rubinstein told Reuters Health in an email.

    Rubinstein is a researcher with the Department of Health Sciences at the University of Amsterdam in The Netherlands. He wasn't involved in the study, but has recently published a paper analyzing previous studies on spinal manipulative therapy.

    "It is perhaps the only study of good methodological quality using a robust sample of patients which examines the additional benefit of spinal manipulative therapy in those with sub-acute or chronic back-related leg pain," Rubinstein said.

    Rubinstein said it would be necessary to conduct an economic evaluation to determine if the use of spinal manipulative therapy in addition to home exercises is worth the cost.

    "This of course, must be considered in light of alternatives for this condition, such as epidural steroid injections or surgery, which are not only much more costly but also associated with important (and serious) adverse events," he said.

    Bronfort said his team feels that as long as there are no serious medical complications, patients can focus on self-management strategies.

    "Try and keep moving . . . simple activities like taking short walks and changing positions frequently (both advised in the home exercise program) may be helpful," he said.

    But, he added, for people who have pain that is too severe for to deal with on their own, seeing a chiropractor, physical therapist, or osteopath who can use spinal manipulation might help relieve their pain - possibly without the use of medications.

    SOURCE: http://bit.ly/1s3PM2z Annals of Internal Medicine, online September 15, 2014.

Transplant Articles

  • Kidney patients know little about transplant benefits

    By Ronnie Cohen

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  • British Ebola survivor flies to United States for blood donation

    By Reuters Staff

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

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

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

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

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

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

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

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

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

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

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

Women’s Health Articles

  • Kidney patients know little about transplant benefits

    By Ronnie Cohen

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  • Brain study hints at how fibromyalgia works

    By Kathryn Doyle

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  • Angelina Jolie surgery sparks surge in female cancer tests-study

    By Laura Onita

    LONDON (Thomson Reuters Foundation) - Hollywood star Angelina Jolie's decision to make public her double mastectomy more than doubled the number of women in Britain seeking to have genetic breast cancer tests, according to a study released on Friday.

    Jolie, 39, who has become a high-profile human rights campaign, announced her surgery in May last year, saying she acted after testing positive for a mutation of the BRCA1 gene that significantly increases the risk of breast cancer.

    She said she was going public with news of her surgery as she hoped her story would inspire other women to fight the life-threatening disease.

    Researchers studied 21 clinics and regional genetic centers and found there were 4,847 referrals for testing in June and July last year compared to 1,981 in the same period of 2012.

    The study of the so-called "Angelina effect", published online in the journal Breast Cancer Research, credited Jolie's glamorous appearance and relationship with Hollywood actor Brad Pitt for helping to lessen women's fears about surgery.

    "Angelina Jolie ... is likely to have had a bigger impact than other celebrity announcements, possibly due to her image as glamorous and strong woman," researcher Gareth Evans of the charity Genesis Breast Cancer Prevention said in a statement.

    "This may have lessened patients' fears about a loss of sexual identity post-preventative surgery and encouraged those who had not previously engaged with health services to consider genetic testing."

    "These high-profile cases often mean that more women are inclined to contact centers such as Genesis - and other family history clinics - so that they can be tested for the mutation early and take the necessary steps to prevent themselves from developing the disease," he continued.

    "Of course, in some cases this may mean a risk-reducing mastectomy, however cancer preventing drugs, such as tamoxifen, and certain lifestyle changes like a healthy diet and more exercise, are also options which many women may consider."

    Breast cancer is the most common cancer in women worldwide. The World Health Organization estimated that more than 521,000 women died of breast cancer in 2012.

    Oscar-winning Jolie has in recent years drawn nearly as much attention for her globe-trotting work on behalf of refugees and victims of sexual violence in conflicts as for her acting.

    Jolie was named a Goodwill Ambassador for the UNHCR in 2001 and promoted to be Special Envoy to High Commissioner Antonio Guterres in 2012. Since 2012 she has also led a campaign against sexual violence in conflict zones.

    SOURCE: http://bit.ly/1u5z5nc Breast Cancer Research, September 18, 2014.

  • U.S. nutrition program for mothers, infants sees falling demand

    By Annika McGinnis

    WASHINGTON (Reuters) - A government nutrition program for pregnant mothers and small children has not kept pace with technology and U.S. poverty experts say its paper voucher system is driving low-income women away from the program when they need it most.

    The Special Supplemental Nutrition Program for Women, Infants and Children, known as WIC, has seen a sharp drop in participation since 2010, unlike food stamps and other anti-poverty programs that ballooned during the 2007-9 recession and the economic recovery that followed, government figures show.

    "WIC providers are tearing their hair, beating their chests, 'what are they doing wrong?'" said Laurie True, California WIC Association director.

    Poverty experts say the shrinking demand does not reflect less need. They are pushing for faster changes to an outdated, cumbersome distribution process they say stigmatizes recipients.

    Participants complain of customers "shaming" them in grocery lines, said Sarah Monje, California's Native American Health Center WIC director.

    "I can feel the aura: 'Oh my god, this girl is taking forever,'" said WIC recipient Marquel Davis of Austin, Texas.

    With a generation of Americans "used to getting everything on their smartphones," True said, WIC is still "stuck in the hands-on experience."

    "That doesn't make the program as attractive to people who may be on the borderlines, the working poor and very busy - most of our participants work at least one job," she said.

    Congress mandated in 2010 that WIC switch to electronic benefit cards by 2020. All but nine U.S. states still rely on paper vouchers that program directors say hold up grocery-store lines and embarrass mothers.

    Davis, 26, said it was a hassle trying to redeem her WIC checks before Texas switched to an electronic system several years ago. The program pays only for specified foods sold in certain quantities.

    "You've got to separate (your groceries) and make sure it's the right one, right size, and on top of that, you got to sign and they got to initial," Davis said. "It's just hectic, especially if you have a kid shopping with you and you're trying to get home."

    WIC gives low-income pregnant, post-partum or breastfeeding women and kids up to age five vouchers worth about $43 each month for formula and healthy foods that adhere to federal nutrition requirements, such as limiting added sugar in yogurt and mandating that bread include whole wheat flour.

    The program requires recipients to attend classes on eating well and breastfeeding.

    Though WIC grew fairly steadily since its inception in 1972, U.S. Department of Agriculture data shows it shrank 10.6 percent between fiscal year 2010 and May 2014.

    Staff members "don't have a sense of declining need in their communities," said analyst Zoe Neuberger of the Center on Budget and Policy Priorities, a poverty-focused think tank.

    Participants dropped from 9.2 million to 8.2 million from 2010 to May, decreasing in every state and the District of Columbia, according to USDA. In Georgia, caseload plummeted 46 percent since 2009.

    Conversely, food stamp enrollment skyrocketed from 28.2 million in 2008 to 47.6 million in 2013 under expansions in President Barack Obama's 2009 stimulus package, though it fell to 46.2 million in May after benefits expired last November.

    But the smaller, more targeted WIC started shrinking years earlier and to a greater extent relative to enrollment, USDA data shows.

    SOCIAL STIGMA

    The social stigma, always a factor for some people, was accentuated by a distribution system largely unchanged in four decades, directors said.

    Many women have switched to food stamps, which use a debit-like card but lack such WIC benefits as affording expensive baby formula, feeding children healthier food and learning workplace breastfeeding rights, directors said.

    Being required to attend WIC advising sessions every one to three months can be a problem for low-income workers.

    Those include illegal immigrants, who may be deterred over fear of an immigration crackdown, New York-based nonprofit Community Food Advocates co-founder Agnes Molnar said. The WIC program does not require proof of citizenship, though state or tribal residency is required.

    Michael Osur, who runs 18 WIC clinics in southern California's Riverside County, saw an almost 40 percent drop in the percentage of people requesting materials in Spanish from 2007 to 2013.

    Lingering effects from last October's government shutdown, when clinics shuttered or scraped by on reserve funds, also hurt WIC, National WIC Association CEO Douglas Greenaway said.

    If caseload continues to drop, Congress will cut funding and clinics will close, consolidate and limit overtime and weekend services, True said.

    In California, Osur was opening mobile neighborhood clinics, insisting many women were neglecting critical help.

    "I think the need is there," he said. "We've just got to find a way to reach them."

  • It's not a small world after all: world population will soar

    By Will Dunham

    WASHINGTON (Reuters) - Contrary to some earlier projections, the world's population will soar through the end of the 21st century thanks largely to sub-Saharan Africa's higher-than-expected birth rates, United Nations and other population experts said on Thursday.

    There is an 80 percent likelihood that the number of people on the planet, currently 7.2 billion, will increase to between 9.6 billion and 12.3 billion by 2100, the researchers said. They also saw an 80 percent probability that Africa's population will rise to between 3.5 billion and 5.1 billion by 2100 from about 1 billion today.

    The study, led by U.N. demographer Patrick Gerland and University of Washington statistician and sociologist Adrian Raftery and published online by the journal Science, foresees only a 30 percent chance that earth's population will stop rising this century.

    "Previous forecasts did indeed forecast a leveling off of the world population around 2050, and in some cases a decline," Raftery said.

    Raftery said the new projections arise from data that clearly establishes that birth rates in sub-Saharan Africa have not been decreasing as quickly as some experts had expected, a trend that was "not as clear when previous forecasts were made."

    Raftery said the researchers used data on population, fertility, mortality and migration from every country and then predicted future rates using new statistical models. Some of the figures, such as the median projection of the population hitting 10.9 billion by 2100, mirror a U.N. report published in 2013.

    U.N. demographer Gerland said sub-Saharan Africa countries already with big populations and high fertility levels are expected to drive population growth, including Nigeria, Tanzania, Democratic Republic of the Congo, Niger, Uganda, Ethiopia, Kenya, Zambia, Mozambique and Mali.

    The world's population reached 1 billion in the early 19th century, doubled to 2 billion in the 1920s and doubled again to 6 billion in the 1990s. It hit 7 billion in 2011.

    The findings underscore worries expressed for decades by some experts about a planet growing more crowded and humankind exhausting natural resources, struggling to produce enough food or cope with poverty and infectious diseases.

    Raftery said African nations could benefit by intensifying policies to lower fertility rates, with studies showing that greater access to contraceptives and more education for girls and women can be effective.

    The researchers projected that Asia's population, now 4.4 billion, will peak at around 5 billion people in 2050, then begin to decline. They forecast that the populations of North America, Europe and Latin America will stay below 1 billion each by 2100.

    Among the experts who had predicted the global population rise would peter out was a 2010 report by Austrian demographer Wolfgang Lutz. He forecast it likely would reach 8 billion to 10 billion by 2050 but "population stabilization and the onset of a decline are likely" in the second half of the century.

    SOURCE: http://bit.ly/Xq6URw Science, online September 18, 2014.