Methodist Healthcare Ministries

4507 Medical Drive
San Antonio, TX 78229
P 210.692.0234 | Toll-Free 1.800.959.6673
www.mhm.org

mhm

Methodist Healthcare Ministries Overview

Methodist Healthcare Ministries (MHM) is a private, faith-based, not-for-profit organization dedicated to providing medical, dental and health-related human services to low-income families and the uninsured in South Texas. The mission of the organization is “Serving Humanity to Honor God” by improving the physical, mental and spiritual health of those least served in the Southwest Texas Conference area of The United Methodist Church. MHM is one-half owner of the Methodist Healthcare System – the largest healthcare system in South Texas.

These services include primary care medical and dental clinics, support services like counseling, case management and social services, family wellness and parenting programs, and church-based community nursing programs.

MHM also works with similarly-focused organizations and state government in developing more socially conscious public policy. The purpose is to change legislative perspectives and policies so that the root of the problems of the underserved are addressed for the long term. In addition, MHM provides financial support to established organizations that are already effectively fulfilling the needs of the underserved in local communities through programs and services that they already operate.

MHM Featured Video

Cardiovascular Articles

  • Probiotics might help lower blood pressure

    By Krystnell Storr

    NEW YORK (Reuters Health) - Regularly consuming probiotics, or the "good" bacteria found in yogurt, milk and cheese, may help control blood pressure, according to a new review of past studies.

    Researchers found that consuming the proper amount of probiotics over at least two months appeared to modestly lower blood pressure.

    "I do not think the general public understands how probiotics might be beneficial to health at this stage," said Jing Sun, who worked on the study at the Griffith University School of Medicine and Griffith Health Institute in Queensland, Australia.

    "The challenge to us is to convince patients and clinicians to accept the product in daily life," Sun said.

    Past studies have shown probiotics can have a positive effect on blood sugar, cholesterol and certain hormones - all of which can impact blood flow, she noted.

    The new findings do not mean people should replace their blood pressure medication with probiotics and it is still unclear which strain or combination of strains might work best.

    The American Heart Association considers normal blood pressure to be a systolic reading of less than 120 millimeters of mercury (mm Hg) and a diastolic reading of less than 80 mm Hg. High blood pressure starts at 140/90 mm Hg and increases a person's risk of heart disease, stroke, kidney disorders and other health problems.

    For some people with high blood pressure the only effective treatment has been medication, but that means costs and possible side effects.

    The new review, published in the journal Hypertension, combined the results of nine studies that randomly assigned participants to take probiotics or not. Seven of the trials were double-blind, meaning neither the participants nor the experimenters knew who received probiotics and who received a probiotic-free placebo until the end of the study. The different strains of probiotics were delivered in products like yogurt and milk.

    The studies included a total of almost 550 people.

    The researchers found that on average, probiotic consumption lowered systolic blood pressure (the top number) by 3.56 mm Hg and diastolic blood pressure (the bottom number) by 2.38 mm Hg, compared to a placebo or no treatment.

    Getting at least 100 billion colony-forming units of probiotics each day, the amount in a carton of some yogurts, seemed to be necessary for significant blood pressure improvements. And no change in blood pressure was seen among participants who were given probiotics for less than eight weeks.

    The researchers noted that the effect of probiotics was strongest among people who already had elevated blood pressure.

    Lori Hoolihan, a researcher at the Dairy Council of California in Irvine who was not involved in the analysis, called probiotics a "functional food."

    She said the review is a step in the right direction.

    "Randomized clinical trials are the gold standard in research and they had a strict criteria for choosing the studies and they actually looked at human trials which are stronger than animal trials," she said.

    "They used real foods that had probiotics at realistic levels, they didn't use supplements or wacky chemical concoctions that no one has heard of. They used foods on the market so you and I could go into the market and pick (them) up," she added.

    "Americans don't like to think about bacteria so it's hard for people to embrace it but there are good and bad bacteria and there is no avoiding them. Our gut is home to many bacteria and if bumping up the amount of good bacteria can optimize health and prevent chronic diseases then that's a good thing," Hoolihan said.

    The price of probiotic supplements varies, but a 30-day supply from the drugstore may cost about $30.

    Dr. Shira Doron, who has studied probiotics at Tufts Medical Center in Boston, said that because probiotics only seemed to have an effect under certain conditions in specific groups of patients, it's hard to know how to make recommendations to patients at this time.

    What's more, she said, "The fact that each study within this meta-analysis was done using a different probiotic or combination of probiotics means that I as a physician am completely unable to say to my patient, 'Go out and buy probiotic X. It was shown to be effective in clinical trials.'"

    "We know no two probiotics act alike," Doron explained. "One simply cannot extrapolate from a study of one probiotic that another strain or even another dose or another source - dairy product, capsule, sachet, etc. - will work."

    "I don't think this is 'ready for prime time' yet, as they say. That being said, probiotics might help, and generally don't hurt, except perhaps your wallet, so if someone with high blood pressure wants to try probiotics as an adjunct to their regular blood pressure medication, I say go for it," she said.

    SOURCE: http://bit.ly/1kLRX1U Hypertension, online July 21, 2014.

  • Medication errors may be common after hospital discharge

    By Krystnell Storr

    NEW YORK (Reuters Health) - More than half of heart patients in a new U.S. study made mistakes taking their medications or misunderstood instructions given to them after being discharged from the hospital.

    Those with the lowest "health literacy" were among the most likely to make the risky errors, highlighting the importance of healthcare professionals making sure their instructions are clear and of patients being sure they understand what they need to do after they get home, the study authors say.

    "Some errors have the potential to be harmful to patients," said lead author Dr. Amanda Mixon, a hospitalist with the VA Tennessee Valley Healthcare System in Nashville.

    "Thousands of patients are discharged home with medications every day. Knowing which patients are at risk of medication errors after patients go home can help inpatient providers counsel patients about their medications before they go home," added Mixon, who is also affiliated with Vanderbilt University.

    Past research suggests that an individual's health literacy, the ability to interpret and act on health information, is a strong predictor of whether they will correctly follow instructions for their own care (see Reuters Health article of October 25, 2013, here: http://reut.rs/UdH55N).

    Overall, 20 to 30 percent of prescriptions are never filled, and 50 percent are not continued as prescribed, according to the U.S. Centers for Disease Control and Prevention.

    To assess what factors might influence whether heart patients will follow their care instructions correctly after leaving the hospital, Mixon's team recruited 471 people hospitalized for heart failure, heart attacks and related conditions, then discharged from the hospital.

    The participants' average age was 59 and just under half were women. Every participant took a seven-minute health literacy test to gauge their understanding of health information as well as a short numeracy test to measure basic math skills.

    The researchers contacted the patients by telephone two to three days after they left the hospital and compared the medications on the discharge list from their doctors to what the patients said they were taking.

    When someone said they were taking a medication not on the list, or forgot to mention one that was on the list, it was counted as an error. If a patient didn't know the purpose, dose or frequency of a medication, it was classified as a misunderstanding.

    Failure to refill a prescription, discontinuing use of a medication against a healthcare professional's orders or not being aware of a medication were also counted as errors.

    More than half - 242 of the 471 patients - had at least one discrepancy between the medications they reported taking, and the ones on their discharge list. Over a quarter left out one or more medications on their list and more than a third were taking something that wasn't on the list. And 59 percent of patients had a misunderstanding of the purpose, dose or frequency of their medications.

    Participants who scored highest on the math skills test were about 23 percent less likely than those who scored lowest to add or omit medications, the researchers report in Mayo Clinic Proceedings.

    People with the highest health literacy scores were about 16 percent less likely to make an error compared to those who scored lowest. And women were about 40 percent less likely than men to make a mistake.

    Single people were almost 70 percent more likely than people who were married to make errors. Older age and worse cognitive function also predicted higher odds of having an error.

    "It's a powerful study in that it helps to define some of the things we assume, but haven't been able to fully understand," said Dr. Benjamin Brooke, a surgeon and professor at the University of Utah School of Medicine in Salt Lake City, who was not involved in the study.

    "I think this says that we need to do a better job of understanding a patient at the time of discharge, what are their risks of having a post discharge adverse event," he told Reuters Health.

    In healthcare, "there's a lot of moving parts and it's difficult to make sure they all move in tandem," he noted. "A patient may see a doctor for 20 years and then end up seeing another one who does not know their medical history as well. But this is a global issue. There's a lot of errors that occur when we leave the hospital."

    He favors the idea of a brief health literacy test that might identify patients most likely to have trouble following treatment instructions after discharge. "Whether it's a quick streamlined tool that nurses or anyone part of the medical team can administer, it's something that might be feasible," he said.

    "The main thing is, we need to be aware of the problem and the study points out some of the things we need to focus on more closely," he said.

    Mixon said that for patients who have low health literacy or numeracy, healthcare providers need to be especially careful in counseling them about their medications at hospital discharge.

    She added that patients can also be proactive and assertive by asking a healthcare professional to carefully review the medications they are required to take at home, making sure to ask questions about previously prescribed medications and whether or not they should be continued.

    SOURCE: http://bit.ly/1jQCCm1 Mayo Clinic Proceedings, online July 03, 2014.

  • Healthy living may slow early dementia: study

    By Andrew M. Seaman

    NEW YORK (Reuters Health) - A program that emphasizes healthy eating, brain and social engagement, physical activity and heart health may slow dementia among people at risk for Alzheimer's disease, says a new preliminary report from Sweden.

    The findings can't guarantee that healthy living will prevent Alzheimer's disease but they add to growing evidence that suggests overall health is tied to dementia risk.

    "This is really hard evidence that we can do something for brain health," said Dr. Miia Kivipelto, the study's lead author, from the Karolinska Institute in Stockholm.

    The findings also show that it's not too late to help brain health since the participants were all at risk for Alzheimer's disease, Kivipelto added.

    She and her colleagues presented their findings at the Alzheimer's Association International Conference in Copenhagen, Denmark.

    An estimated 35.6 million people are living with dementia worldwide, according to the World Health Organization. Alzheimer's disease is the most common form of dementia.

    Another study presented at the same conference also suggested that controlling certain risk factors, such as high blood pressure, obesity and diabetes, may reduce the worldwide prevalence of Alzheimer's by almost a third.

    People with Alzheimer's experience memory loss, which worsens with time. The disease leads to problems with decision making and an inability to perform daily tasks. Eventually, the complications from Alzheimer's disease lead to death.

    Alzheimer's is the sixth leading cause of death in the U.S., according to the Centers for Disease Control and Prevention. About 5.3 million Americans have the disease.

    For the new study, the researchers recruited 1,260 Finnish adults between the ages of 60 and 77 years to take part in the two-year trial.

    All of the participants scored above a cutoff point on a list of lifestyle risk factors for cognitive impairment and Alzheimer's, and on a neurological test, all had cognitive performance that was average or slightly below average for their age.

    The participants were randomly assigned to a group that received basic health advice or a group that took part in a multi-component program targeting diet, exercise, heart health and brain and social engagement.

    The multi-component intervention was delivered during a series of group sessions over the course of the study.

    After two years, the researchers found the group that just got basic health advice experienced substantially more cognitive decline than the program participants.

    "We saw about a 40 percent difference between the intervention and the control groups," Kivipelto said. "It was clear the intervention group improved from baseline."

    She said the difference was robust but it's difficult to say whether the participants experienced a noticeable difference. A longer trial that's in the works will have to look at the real-world effect on people who stick with the program and whether the intervention prevents Alzheimer's.

    "I think the evidence is that this delays onset for people who don't have it," said Dr. Sam Gandy, who was not involved in the new study. "For people that do, it slows the progression. Whether it completely protects everyone, I would doubt it. Maybe there are people who have a mildly increased risk and this could prevent it."

    Gandy directs the Center for Cognitive Health at Mount Sinai Hospital in New York City.

    Kivipelto cautioned that a healthy lifestyle is no guarantee that a person won't develop Alzheimer's.

    "We know that there are people who get other diseases even if they're living in a healthy way," Kivipelto said. "We don't want to label anybody who has Alzheimer's that 'this is because of your life.'"

    Still, she said, it's not too early to recommend interventions that target diet, exercise, heart health and brain and social engagement. Many of those interventions also target other chronic health conditions.

    "It's not too early," she said. "We've already had observational studies showing the same thing."

    Gandy said he already gives his patients and their caregivers similar advice.

    "I tell them both that these are the most important things they can do to keep their brains healthy," he said.

  • U.S. strokes, stroke deaths decreased over past decades

    By Andrew M. Seaman

    NEW YORK (Reuters Health) - The number of Americans having strokes and the number dying following strokes decreased over the past 20 years, according to a new study.

    The declines in strokes and improvements in survival were similar between blacks, whites, men and women, according to the researchers.

    "Stroke is still the fourth leading cause of death and the leading cause of disability in the U.S. but we're doing better," said Dr. Josef Coresh, the study's senior author from the Johns Hopkins Bloomberg School of Public Health in Baltimore.

    More than 795,000 people in the U.S. have a stroke each year, according to the Centers for Disease Control and Prevention, and about 130,000 die as a result.

    The vast majority of strokes are ischemic strokes, which occur when blood flow to the brain is blocked. About 10 percent of strokes, known as hemorrhagic stokes, are caused by leaking blood vessels.

    Coresh and his colleagues write in JAMA, the journal of the American Medical Association, that some studies have reported a decline in stroke rates.

    Whether that decline has been consistent among people of all races and among both men and women is still up for debate, however.

    For example, some studies from the U.S. and UK found that strokes decreased among whites but not blacks, who are already known to be at greater risk of stroke than whites.

    To learn more, the researchers analyzed data from a long-term study of 15,792 people in four areas of the U.S. The participants were between 45 and 64 years old when they entered the study between 1987 and 1989.

    The authors restricted the current analysis to 14,357 people who had not had a stroke when they entered the study. They found 1,051 participants had a stroke by 2011 and 58 percent of those people died during the study period.

    Over a given 10-year period, the stroke rate decreased by about one stroke per 1,000 people per year. That drop was similar between black and white participants, and between men and women.

    Coresh noted that blacks were still at a greater risk for strokes than whites, because they had a higher rate of strokes to begin with.

    "I think it's very good that we're seeing decreases among African Americans as well because there is a concern of health disparities," Coresh said.

    When the researchers divided participants by age, they found stroke rates only decreased among those ages 65 and older, however.

    The chance of dying after having a stroke also fell during the study. Over a 10-year period, the number of deaths per 100 strokes dropped by eight. That decrease was particularly prevalent among the youngest study participants and was similar for both sexes and races.

    Coresh said the decline in strokes and improvement in survival may be attributable to better control of risk factors - particularly high blood pressure, also known as hypertension - as well as increased smoking cessation and diabetes control.

    "I think we've been working on hypertension awareness, treatment and control for 40 years now," he said. "Largely it's a story of success but as (with) many things in health it's never done. We need to keep doing better and better."

    In an editorial accompanying the new study, Drs. Ralph Sacco and Chuanhui Dong from the University of Miami Miller School of Medicine's Department of Neurology write that there is still considerable work to be done to lower stroke rates in the U.S.

    "Greater improvements in brain health, especially with controllable risk factors such as diet, exercise, smoking, and obesity, among younger segments of the population are required to reduce the risk of stroke and enhance the chance of successful cognitive aging for all adults," they write.

    SOURCE: http://bit.ly/UabphF and http://bit.ly/1r4lbi9 JAMA, online July 15, 2014.

  • Gene therapy creates 'biological pacemaker' cells for the heart

    By Will Dunham

    WASHINGTON (Reuters) - Researchers have succeeded in turning ordinary cardiac muscle cells into specialized ones that deliver a steady heartbeat using a gene therapy procedure they predict could become an alternative to implanted electronic pacemakers.

    A study published on Wednesday involved pigs with a condition called heart block that makes their hearts beat too slowly. By injecting a human gene into a tiny region of the heart's pumping chambers roughly the size of a peppercorn, the researchers reprogrammed heart muscle cells into a type of cell that emits electrical impulses to drive the beating heart.

    In doing so, cardiologists at Cedars-Sinai Heart Institute in Los Angeles created "biological pacemaker" cells that restored a normal heart rate in the pigs. The procedure achieved the same result as implanting an electronic pacemaker that sends electrical pulses to the heart if it beats too slowly or skips a beat.

    "This development heralds a new era of gene therapy where genes are used not only to correct a deficiency disorder but actually to convert one type of cell into another to treat disease," Dr. Eduardo Marbán, director of the Cedars-Sinai Heart Institute and leader of the research team, told reporters.

    The researchers noted that pig hearts are very similar to human hearts. Dr. Eugenio Cingolani, director of the institute's Cardiogenetics-Familial Arrhythmia Clinic, said "if all goes well" in further animal studies examining the procedure's long-term effectiveness and safety, "we hope to be able to begin trials in humans within three years."

    The researchers envision using the procedure initially to help people with heart rhythm disorders who cannot use a pacemaker because of device-related complications like an infection or in fetuses in the womb with congenital heart block.

    Such fetuses cannot have a pacemaker implanted and risk severe heart failure often resulting in stillbirth. The researchers hope to develop an injection-based treatment to deliver the gene therapy to these developing babies.

    They said down the road the procedure might be used in a broader patient population as a realistic alternative to the pacemaker. Marbán said about 2 percent of pacemakers lead to an infection requiring treatment. In the United States alone, about 300,000 people get pacemakers annually.

    "Rather than having to undergo implantation with a metallic device that needs to be replaced regularly and can fail or become infected, patients may someday be able to undergo a single gene injection and be cured of the slow heart rhythm forever," Cingolani said.

    Using a minimally invasive catheter procedure, the researchers injected pigs that had complete heart block with a gene called TBX18 that is responsible for a protein that makes the heart keep the right rhythm. On the second day after the gene was injected, the pigs developed a faster, more normal heartbeat that lasted for the rest of the 14-day experiment.

    The researchers used a common type of virus called an adenovirus to introduce the gene into the pigs but expressed confidence the virus poses minimal risk.

    The research appears in the journal Science Translational Medicine.

    SOURCE: http://bit.ly/1mVg1mT Science Translational Medicine, online July 16, 2014.

Comprehensive Rehabilitation Articles

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Emergency News

  • Life-threatening reactions to diet drug on the rise in the UK

    By Shereen Lehman

    NEW YORK (Reuters Health) - Use of a diet drug known as DNP has been linked to five deaths in the UK since 2007, according to a new report.

    The compound, also known as 2,4-Dinitrophenol, is a synthetic chemical originally used in the manufacturing of dyes, wood preservatives, explosives and pesticides.

    DNP was developed as a weight-loss drug in the 1930s before being banned in the U.S. in 1938 after reports of severe toxic reactions, researchers note. Still, the compound remains in use, sold online in bulk powder.

    "DNP is a so called 'fat burning' product used by body builders and as a weight loss aid - it prevents energy being stored as fat, but instead this is released as heat," senior author Dr. Simon Thomas told Reuters Health in an email. "The effect is an increase in body temperature and this can damage the body's cells, e.g. in muscle, kidney and brain."

    Thomas directs the National Poisons Information Service (NPIS) in Newcastle upon Tyne, UK.

    He said DNP can cause fever, nausea or vomiting, skin discoloration or rash, breathing difficulties, abdominal pain, agitation and headache. Those could progress to confusion, seizures, kidney failure, muscle damage and bone marrow failure.

    "DNP is sold via the Internet and so we don't have good data on how many people use it," Thomas said. "Our research, however, has shown increasing numbers of people in the UK presenting with adverse clinical effects after DNP use, suggesting that increasing numbers of people have been using the chemical."

    For the new study, Thomas and his colleagues analyzed data from a phone enquiry service run by the NPIS for UK health professionals seeking information and advice about the management of people with suspected poisoning.

    Between 2007 and 2013, they found there were 39 phone calls relating to 30 different exposures to DNP involving 27 men and three women.

    Twenty-two of those exposures were reported in 2013. Only three were reported from 2007 to 2011.

    Ten of the poisoning episodes were classified as minor, 12 were moderate and five were severe. Severity information was not available for three patients.

    Five of the cases resulted in deaths - one in 2008, one in 2012 and three in 2013, according to findings published in the Emergency Medicine Journal.

    "DNP is a hazardous substance not fit for human consumption," Thomas said. "It can cause severe toxic effects that can result in death."

    The effects are also unpredictable, he added. Some people use DNP for a while without any apparent problems and then suddenly develop side effects.

    "The higher the dose used, the greater the risk of severe toxic effects, but no dose is safe," Thomas said. He and his colleagues have seen serious side effects in people using the doses recommended by websites that sell the compound.

    Dr. Edward Boyer agreed that DNP is a dangerous chemical and shouldn't be used as medication.

    Boyer is an emergency medicine physician and toxicology expert at the University of Massachusetts Medical School in Worcester. He wasn't involved in the study.

    He said the reason DNP is dangerous has to do with how the body manages energy.

    "There's a world of chemical reactions that go on inside your body and every time a chemical reaction occurs it releases heat," he told Reuters Health. "Your body takes some of that heat and normally turns it back into other chemical reactions which lead to molecules that you can use for additional energy - it's just a way of being efficient."

    Dinitrophenol breaks that cycle so instead of taking the heat that's produced from one reaction and turning it into other forms of useful energy, the body just produces more heat, Boyer said.

    Too much of that heat production, he said, and "you wind up literally baking yourself to death."

    SOURCE: http://bit.ly/1sBv0as Emergency Medicine Journal, online June 23, 2014.

  • Life-threatening reactions to diet drug on the rise in the UK

    By Shereen Lehman

    NEW YORK (Reuters Health) - Use of a diet drug known as DNP has been linked to five deaths in the UK since 2007, according to a new report.

    The compound, also known as 2,4-Dinitrophenol, is a synthetic chemical originally used in the manufacturing of dyes, wood preservatives, explosives and pesticides.

    DNP was developed as a weight-loss drug in the 1930s before being banned in the U.S. in 1938 after reports of severe toxic reactions, researchers note. Still, the compound remains in use, sold online in bulk powder.

    "DNP is a so called 'fat burning' product used by body builders and as a weight loss aid - it prevents energy being stored as fat, but instead this is released as heat," senior author Dr. Simon Thomas told Reuters Health in an email. "The effect is an increase in body temperature and this can damage the body's cells, e.g. in muscle, kidney and brain."

    Thomas directs the National Poisons Information Service (NPIS) in Newcastle upon Tyne, UK.

    He said DNP can cause fever, nausea or vomiting, skin discoloration or rash, breathing difficulties, abdominal pain, agitation and headache. Those could progress to confusion, seizures, kidney failure, muscle damage and bone marrow failure.

    "DNP is sold via the Internet and so we don't have good data on how many people use it," Thomas said. "Our research, however, has shown increasing numbers of people in the UK presenting with adverse clinical effects after DNP use, suggesting that increasing numbers of people have been using the chemical."

    For the new study, Thomas and his colleagues analyzed data from a phone enquiry service run by the NPIS for UK health professionals seeking information and advice about the management of people with suspected poisoning.

    Between 2007 and 2013, they found there were 39 phone calls relating to 30 different exposures to DNP involving 27 men and three women.

    Twenty-two of those exposures were reported in 2013. Only three were reported from 2007 to 2011.

    Ten of the poisoning episodes were classified as minor, 12 were moderate and five were severe. Severity information was not available for three patients.

    Five of the cases resulted in deaths - one in 2008, one in 2012 and three in 2013, according to findings published in the Emergency Medicine Journal.

    "DNP is a hazardous substance not fit for human consumption," Thomas said. "It can cause severe toxic effects that can result in death."

    The effects are also unpredictable, he added. Some people use DNP for a while without any apparent problems and then suddenly develop side effects.

    "The higher the dose used, the greater the risk of severe toxic effects, but no dose is safe," Thomas said. He and his colleagues have seen serious side effects in people using the doses recommended by websites that sell the compound.

    Dr. Edward Boyer agreed that DNP is a dangerous chemical and shouldn't be used as medication.

    Boyer is an emergency medicine physician and toxicology expert at the University of Massachusetts Medical School in Worcester. He wasn't involved in the study.

    He said the reason DNP is dangerous has to do with how the body manages energy.

    "There's a world of chemical reactions that go on inside your body and every time a chemical reaction occurs it releases heat," he told Reuters Health. "Your body takes some of that heat and normally turns it back into other chemical reactions which lead to molecules that you can use for additional energy - it's just a way of being efficient."

    Dinitrophenol breaks that cycle so instead of taking the heat that's produced from one reaction and turning it into other forms of useful energy, the body just produces more heat, Boyer said.

    Too much of that heat production, he said, and "you wind up literally baking yourself to death."

    SOURCE: http://bit.ly/1sBv0as Emergency Medicine Journal, online June 23, 2014.

  • Life-threatening reactions to diet drug on the rise in the UK

    By Shereen Lehman

    NEW YORK (Reuters Health) - Use of a diet drug known as DNP has been linked to five deaths in the UK since 2007, according to a new report.

    The compound, also known as 2,4-Dinitrophenol, is a synthetic chemical originally used in the manufacturing of dyes, wood preservatives, explosives and pesticides.

    DNP was developed as a weight-loss drug in the 1930s before being banned in the U.S. in 1938 after reports of severe toxic reactions, researchers note. Still, the compound remains in use, sold online in bulk powder.

    "DNP is a so called 'fat burning' product used by body builders and as a weight loss aid - it prevents energy being stored as fat, but instead this is released as heat," senior author Dr. Simon Thomas told Reuters Health in an email. "The effect is an increase in body temperature and this can damage the body's cells, e.g. in muscle, kidney and brain."

    Thomas directs the National Poisons Information Service (NPIS) in Newcastle upon Tyne, UK.

    He said DNP can cause fever, nausea or vomiting, skin discoloration or rash, breathing difficulties, abdominal pain, agitation and headache. Those could progress to confusion, seizures, kidney failure, muscle damage and bone marrow failure.

    "DNP is sold via the Internet and so we don't have good data on how many people use it," Thomas said. "Our research, however, has shown increasing numbers of people in the UK presenting with adverse clinical effects after DNP use, suggesting that increasing numbers of people have been using the chemical."

    For the new study, Thomas and his colleagues analyzed data from a phone enquiry service run by the NPIS for UK health professionals seeking information and advice about the management of people with suspected poisoning.

    Between 2007 and 2013, they found there were 39 phone calls relating to 30 different exposures to DNP involving 27 men and three women.

    Twenty-two of those exposures were reported in 2013. Only three were reported from 2007 to 2011.

    Ten of the poisoning episodes were classified as minor, 12 were moderate and five were severe. Severity information was not available for three patients.

    Five of the cases resulted in deaths - one in 2008, one in 2012 and three in 2013, according to findings published in the Emergency Medicine Journal.

    "DNP is a hazardous substance not fit for human consumption," Thomas said. "It can cause severe toxic effects that can result in death."

    The effects are also unpredictable, he added. Some people use DNP for a while without any apparent problems and then suddenly develop side effects.

    "The higher the dose used, the greater the risk of severe toxic effects, but no dose is safe," Thomas said. He and his colleagues have seen serious side effects in people using the doses recommended by websites that sell the compound.

    Dr. Edward Boyer agreed that DNP is a dangerous chemical and shouldn't be used as medication.

    Boyer is an emergency medicine physician and toxicology expert at the University of Massachusetts Medical School in Worcester. He wasn't involved in the study.

    He said the reason DNP is dangerous has to do with how the body manages energy.

    "There's a world of chemical reactions that go on inside your body and every time a chemical reaction occurs it releases heat," he told Reuters Health. "Your body takes some of that heat and normally turns it back into other chemical reactions which lead to molecules that you can use for additional energy - it's just a way of being efficient."

    Dinitrophenol breaks that cycle so instead of taking the heat that's produced from one reaction and turning it into other forms of useful energy, the body just produces more heat, Boyer said.

    Too much of that heat production, he said, and "you wind up literally baking yourself to death."

    SOURCE: http://bit.ly/1sBv0as Emergency Medicine Journal, online June 23, 2014.

Surgery Articles

  • Fourth bacterial infection death reported at South Carolina hospital

    By Harriet McLeod

    CHARLESTON, S.C. (Reuters) - A patient who contracted a rare bacterial infection during surgery at a South Carolina hospital died last week, bringing the total deaths to four since the outbreak was first suspected in May, a hospital spokeswoman said on Tuesday.

    The four dead are among 15 patients infected by Mycobacterium abscessus during surgery at Greenville Memorial Hospital, spokeswoman Sandy Dees said.

    Hospital officials cited tap water as the likely origin of the bacteria.

    "Although we use sterile water in or near the surgical sterile field, even something as seemingly safe as pre-surgery hand washing may have contributed," said Dr. Robert Mobley Jr., the hospital's medical director of quality. "At this time, we have not been able to find any single cause or process as the trigger for the outbreak."

    Mycobacterium abscessus is commonly found in soil, water and dust, but rarely causes infection in healthy people, hospital officials said.

    Infection is usually caused by injections of contaminated substances or by invasive medical procedures using contaminated equipment or material, according to the U.S. Centers for Disease Control and Prevention.

    Mycobacterium abscessus associated with healthcare can cause infections of the skin and soft tissues under the skin or lung infections in people with chronic lung diseases, the CDC said.

    The first patient tested positive for the infection in March, and two of the infected surgical patients remained hospitalized, Dees said. All the infected patients had serious underlying medical conditions, she said.

    After an investigation assisted by the CDC and South Carolina's health agency, the hospital has started using new operating room procedures, including filtering water and flushing scrub sinks, Dees said.

  • Pregnancy doesn't drive women doctors out of surgical training

    By Ronnie Cohen

    NEW YORK (Reuters Health) - A new study disputes a common stereotype that women who become pregnant during surgical training often drop out of those training programs.

    Researchers led by Dr. Erin G. Brown of the University of California, Davis found that neither women nor men who had children born during their school's surgical residency program were more likely to quit than residents who did not have children during training.

    Brown told Reuters Health the idea for the study came to her when she was pregnant with her daughter, now one and a half years old, during her surgical residency.

    "Things are changing. It's not an overnight change. It's a slow, steady culture change away from the old boys' club mentality that women who have children during training aren't going to cut it," she said.

    "This study shows that surgical residents who have children during training are just as good," she added.

    General surgical residency programs last five years and are known for being rigorous.

    For the new study, Brown and her colleagues reviewed records on 85 residents enrolled in the University of California, Davis general surgery residency program from 1999 to 2009.

    Forty-nine of the residents were men, and the average age of all residents entering the program was almost 28 years. Overall attrition was about 19 percent, with 16 residents leaving the program.

    A similar proportion of male and female residents left the training program.

    Of the 85 residents, 25 had children born during training.

    Among female residents in particular, 25 percent had children during training and took an average maternity leave of 10 weeks. One of those women left the training program. One woman extended her residency training by two weeks, but the other women who had babies while in training completed the program on time.

    Residents with children born during the program treated a similar number of patients and were equally likely to pass their boards as those who did not have children, according to findings published in JAMA Surgery.

    In an accompanying commentary, Dr. Jeffrey Gauvin, director of the surgical training program at Santa Barbara Cottage Hospital in California, applauded the study but questioned its applicability to smaller programs like his own.

    Davis has "a deep bullpen from which a program director can call in reserves when someone is on leave," he writes. "This may be a very different scenario for small or midsized programs that have very limited - if any - reserves."

    Gauvin formerly directed the surgical residency program at the University of California, Davis.

    Brown acknowledged that smaller programs could face greater challenges in accommodating surgical residents during maternity leave. She is currently compiling data from surgical residency programs of various sizes across the nation to see if the results of the Davis study hold.

    "These are very motivated women who know what they want, and they're able to manage the stress of parenting and training and don't deviate from their career goals," Brown said.

    Women comprised just seven percent of U.S. medical school graduates in 1965, according to the Association of American Medical Colleges. Today that rate hovers near 50 percent.

    But a majority of surgical residents continue to be male, Dr. Nina Shapiro told Reuters Health.

    Shapiro, a professor of head and neck surgery at the University of California, Los Angeles, was not involved in the current study. She said she has watched life change for pregnant surgical residents since she began her training in 1991.

    "Because there's been an increase in the number of women, the climate has by default changed," she said. "There's a huge difference in 20 years."

    "The women going into surgery are very keenly watching those ahead of them. If women are showing they can have babies and be successful, I think other women are going to follow. It's really inspiring for women going into these training programs."

    Shapiro is married to another physician, and they have two young children.

    "Is it a perfect life?" she asked. "There are many days I can't see my kids. For the most part, I make it work. I never miss a school event, a big event in my kids' lives. I don't miss too many small events. I do a lot of homework. I know a lot of fifth-grade math."

    SOURCE: http://bit.ly/1n1S0L8 and http://bit.ly/1nk9sMq JAMA Surgery, online July 16, 2014.

  • Some kidney donors struggle to buy life insurance: study

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Although people who have donated a kidney have passed a rigorous battery of tests and tend to be healthier than the average person, many report difficulty getting or changing health or life insurance policies after the surgery, according to a new study.

    "These are the healthiest people in the nation, they've undergone more health screening scrutiny than anybody else for any process," said senior author Dr. Dorry L. Segev. "We only allow the healthiest people to do this."

    Segev is an abdominal transplant surgeon at Johns Hopkins University School of Medicine in Baltimore, Maryland, where the study took place.

    "The thought that somebody who has perfectly normal kidney function will have to fight with their insurance company is troubling," he told Reuters Health.

    He and his coauthors surveyed over 1,000 people who had donated a kidney at their hospital between 1970 and 2011.

    Of the almost 400 donors who reported getting or changing health insurance after donation, seven percent had difficulties. Some of them were denied coverage and others were told donating a kidney was a preexisting condition.

    Almost 200 people had changed or initiated life insurance, and 25 percent reported similar trouble, according to results published in the American Journal of Transplantation.

    "Insurance companies who are supposed to be making predictions about people's insurability are totally misinterpreting this particular medical scenario," Segev said.

    One of the tenets of the Affordable Care Act (ACA) is that insurers can't take preexisting conditions, like diseases and disabilities or things they interpret as a disease or disability, including kidney donation, into account when offering or pricing health insurance plans.

    "The health insurance thing hopefully will be attenuated by the ACA but life insurance will not," Segev said.

    The study leaves unexplored many factors that might be important in determining whether people get accepted or charged higher premiums, said Steven Weisbart, chief economist at the Insurance Information Institute in New York.

    Importantly, the researchers did not compare this group of kidney donors with a similar group of non-donors to see if they encountered more problems than the comparison group, he told Reuters Health.

    "There's nothing here about how long after donation the effort to change or buy life insurance took place," Weisbart said. "If it was a long time they are much older, and there could be many factors to their health."

    "The life insurance market is enormous and quite varied," he said. Some companies may be concerned about the impact of going down to one kidney and might choose to reject an applicant, but another company might accept the same person without an increased premium, he said. Kidney donors should shop around for life insurance.

    There is quite a bit of evidence that even living with only one kidney, donors are healthier and less likely to have kidney problems than the general public, according to Dr. Hassan N. Ibrahim, medical director of the Kidney Transplant Program at the University of Minnesota Medical School in Minneapolis.

    "Kidney donors live as long if not longer than others," Ibrahim, who was not part of the new study, told Reuters Health.

    Data to that effect have been published in Sweden, Japan and the U.S., he said.

    "This is an American issue, not a European, not a Canadian issue," Ibrahim said.

    In Canada it takes donors longer to get a quote on their insurance but premiums are never raised and insurance is never denied, he said.

    This particular study found higher rates of insurance difficulties than most others have found, he said. That may be because 20 percent of the donors in this group had high blood pressure or diabetes, which may have influenced their insurability.

    Ibrahim suspects that between one and two percent of donors actually have problems getting or changing insurance, but even one percent of 5,000 donors per year is concerning, he said.

    "It's certainly an important social issue," Ibrahim said. "Almost a third of people who would not consider donation are afraid of costs and insurance coverage."

    A group in the Philippines offers free insurance coverage for life for a kidney donor and the donor's family, he noted, which incentivizes donation.

    "We need to remove disincentives to donation in the U.S.," Ibrahim said.

    Kidney recipients' insurance covers the entirety of the transplant cost. Having health or life insurance in place before the transplant may help donors avoid some struggle, but they could still need to change insurance at some point, Segev noted.

    "For people who have donated kidneys the message is, remember that you are healthy," he said. "Call your transplant center and get us in touch with your insurance company so we can educate them."

    "None of this should be construed as a reason to not donate," he said.

    SOURCE: http://bit.ly/1t35hEe American Journal of Transplantation, online July 16, 2014.

Neonatal Articles

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

    By Kathryn Doyle

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  • Pregnancy doesn't drive women doctors out of surgical training

    By Ronnie Cohen

    NEW YORK (Reuters Health) - A new study disputes a common stereotype that women who become pregnant during surgical training often drop out of those training programs.

    Researchers led by Dr. Erin G. Brown of the University of California, Davis found that neither women nor men who had children born during their school's surgical residency program were more likely to quit than residents who did not have children during training.

    Brown told Reuters Health the idea for the study came to her when she was pregnant with her daughter, now one and a half years old, during her surgical residency.

    "Things are changing. It's not an overnight change. It's a slow, steady culture change away from the old boys' club mentality that women who have children during training aren't going to cut it," she said.

    "This study shows that surgical residents who have children during training are just as good," she added.

    General surgical residency programs last five years and are known for being rigorous.

    For the new study, Brown and her colleagues reviewed records on 85 residents enrolled in the University of California, Davis general surgery residency program from 1999 to 2009.

    Forty-nine of the residents were men, and the average age of all residents entering the program was almost 28 years. Overall attrition was about 19 percent, with 16 residents leaving the program.

    A similar proportion of male and female residents left the training program.

    Of the 85 residents, 25 had children born during training.

    Among female residents in particular, 25 percent had children during training and took an average maternity leave of 10 weeks. One of those women left the training program. One woman extended her residency training by two weeks, but the other women who had babies while in training completed the program on time.

    Residents with children born during the program treated a similar number of patients and were equally likely to pass their boards as those who did not have children, according to findings published in JAMA Surgery.

    In an accompanying commentary, Dr. Jeffrey Gauvin, director of the surgical training program at Santa Barbara Cottage Hospital in California, applauded the study but questioned its applicability to smaller programs like his own.

    Davis has "a deep bullpen from which a program director can call in reserves when someone is on leave," he writes. "This may be a very different scenario for small or midsized programs that have very limited - if any - reserves."

    Gauvin formerly directed the surgical residency program at the University of California, Davis.

    Brown acknowledged that smaller programs could face greater challenges in accommodating surgical residents during maternity leave. She is currently compiling data from surgical residency programs of various sizes across the nation to see if the results of the Davis study hold.

    "These are very motivated women who know what they want, and they're able to manage the stress of parenting and training and don't deviate from their career goals," Brown said.

    Women comprised just seven percent of U.S. medical school graduates in 1965, according to the Association of American Medical Colleges. Today that rate hovers near 50 percent.

    But a majority of surgical residents continue to be male, Dr. Nina Shapiro told Reuters Health.

    Shapiro, a professor of head and neck surgery at the University of California, Los Angeles, was not involved in the current study. She said she has watched life change for pregnant surgical residents since she began her training in 1991.

    "Because there's been an increase in the number of women, the climate has by default changed," she said. "There's a huge difference in 20 years."

    "The women going into surgery are very keenly watching those ahead of them. If women are showing they can have babies and be successful, I think other women are going to follow. It's really inspiring for women going into these training programs."

    Shapiro is married to another physician, and they have two young children.

    "Is it a perfect life?" she asked. "There are many days I can't see my kids. For the most part, I make it work. I never miss a school event, a big event in my kids' lives. I don't miss too many small events. I do a lot of homework. I know a lot of fifth-grade math."

    SOURCE: http://bit.ly/1n1S0L8 and http://bit.ly/1nk9sMq JAMA Surgery, online July 16, 2014.

  • India faces crisis over dwindling numbers of girls, U.N. says

    By Nita Bhalla

    NEW DELHI (Thomson Reuters Foundation) - The dwindling numbers of Indian girls, caused by the illegal abortion of millions of babies, has reached "emergency proportions", fueling an increase in crimes such as kidnapping and trafficking, the United Nations warned on Tuesday.

    Despite laws that ban expectant parents from running tests to determine the gender of unborn children, female feticide remains a common practice in parts of India, where a preference for sons runs deep.

    "It is tragically ironic that the one who creates life is herself denied the right to be born," said Lakshmi Puri, deputy executive director of U.N. Women, at the launch of a new study on sex ratios and gender-biased sex selection.

    India's traditionally male-dominated culture views sons as assets - breadwinners who will provide for the family, carry on the family name and perform the last rites for their parents, an important ritual in many faiths.

    Girls, however, are often seen as a liability, with families having to dig deep for a substantial dowry to ensure a desirable match. In a culture that views pre-marital sex as bringing shame to the girl's family, parents also worry about their safety.

    India's 2011 census showed that while the overall female-to-male ratio has improved marginally since the last census a decade ago, fewer girls were born than boys and the number of girls younger than six plummeted for the fifth straight decade.

    "The sharply declining child-sex ratio in India has reached emergency proportions and urgent action must be taken to alleviate this crisis," Puri added.

    A May 2011 study in British medical journal the Lancet found that up to 12 million Indian girls were aborted over the last three decades, resulting in a skewed child sex ratio of 918 girls to every 1,000 boys in 2011, versus 962 in 1981.

    Activists blame ultrasonography for the rise in abortions, saying the technology is used for sex determination.

    But the crime is tough to check, they add, resulting in few convictions. There were 221 cases of feticide reported in 2013, up from 210 in 2012, the National Crime Records Bureau says.

    U.N. officials said India's economic and social progress had failed in the area of sex selection, and the unbalanced sex ratio was contributing to crimes such as rape, abduction and trafficking.

    The entire social structure will have to change, with a battle waged against the root causes of a preference for sons, said Lise Grande, the U.N. resident coordinator in India.

    "This may be one of the hardest, most difficult struggles India faces, but it is arguably one of its most important," she added.

  • Babies of anxious mothers more likely to cry excessively: study

    By Shereen Lehman

    NEW YORK (Reuters Health) - Women with anxiety disorders may be more likely to have babies who cry excessively, suggests a new German study.

    Researchers already know that the children of women with anxiety disorders are more prone to develop anxiety themselves, according to Johanna Petzoldt. She led the current study at the Institute of Clinical Psychology and Psychotherapy at Dresden University of Technology.

    "We found a relationship between maternal anxiety disorders prior to, during and after pregnancy, thus, mothers with prior anxiety disorders might represent a specific risk group for having an infant that will cry excessively," Petzoldt told Reuters Health in an email.

    "Early identification and monitoring of mothers with prior anxiety disorders could be an opportunity to support mother-infant dyads at risk," she said.

    For the new study, Petzoldt and her colleagues enrolled 286 women who were early in their pregnancies.

    The women were 28 years old, on average. About 63 percent of them were unmarried and 59 percent were pregnant for the first time.

    At the beginning of the study, the researchers asked the women about any depressive or anxiety symptoms they had and when those symptoms started. Then they checked in with the women every other month until their babies were four months old and again one year later.

    In the interviews that took place after the babies were born, 29 mothers reported that their infants cried excessively. Excessive crying was defined as crying that lasts three or more hours per day, at least three days per week for a duration of three weeks or longer.

    The researchers found that women who had an anxiety disorder before becoming pregnant were more likely to have a baby that cried excessively compared with women without an anxiety disorder.

    That was also the case when including women who developed an anxiety disorder during pregnancy or after giving birth, according to results published in the Archives of Disease in Childhood.

    Unlike in previous studies, the researchers did not find a clear association between maternal depression and excessive crying among infants.

    The study doesn't prove women's anxiety caused their babies to cry more - only that there was a link between the two. And the reasons for the association still aren't clear.

    More research is needed to learn more about maternal anxiety and depression and infant crying, Petzoldt said.

    "Women can have anxiety or depression during pregnancy and it can have negative consequences for the baby," psychiatrist Dr. Ariela Frieder told Reuters Health.

    "It's very important to take an active stance to treat it. That can change the outcome and can really help the baby to do better," she said.

    Frieder, from the Department of Obstetrics and Gynecology and Women's Health at Montefiore Medical Center in New York, wasn't involved in the new study.

    She said women who are pregnant and believe they may have anxiety should tell their OB/GYN and the doctor can refer them to the appropriate mental health professionals. Talk therapy could be one option for treatment.

    In an editorial published with the study, Dr. Harriet Hiscock said there is no doubt that a mother's mood can impact her baby's behavior and vice versa.

    Hiscock, from the University of Melbourne in Australia, agreed that more research is needed to confirm the current findings.

    But in the meantime, she wrote that doctors can talk to women about anxiety and its perceived impact on their parenting style and on their infant, as long as professional support is available if needed.

    "This needs to be done sensitively as the last thing we need to do is add to a mother's 'day of worry' by blaming her for her infant's crying," Hiscock wrote.

    SOURCE: http://bit.ly/U6yS3l and http://bit.ly/1q3FnCP Archives of Disease in Childhood, online June 27, 2014.

  • Preemies treated in high-volume neonatal units more likely to survive

    By Ronnie Cohen

    NEW YORK (Reuters Health) - Babies born very early stand a better chance of surviving if they are treated in neonatal hospital units that see a large number of premature infants, a new study shows.

    The British study included babies born before 33 weeks of pregnancy who were admitted for extra care. Full term is considered 39 to 40 weeks.

    "The first hours of these babies' lives can be crucial, which means it is essential to give them expert care at this time," said lead author Sam Watson, from the University of Warwick's Medical School and Department of Economics in Coventry, in a news release.

    The analysis confirms results of a 2010 U.S. study led by Dr. Judith Chung, a maternal-fetal medicine specialist at the University of California, Irvine.

    "The best outcomes for high-risk infants occur in hospitals with the highest volume," Chung, who was not involved in the British study, told Reuters Health.

    "If you're at an increased risk of premature delivery, you should deliver at a higher level, high-volume hospital," she said.

    For the new study, the researchers analyzed data from 20,554 very premature infants delivered at 165 hospitals with neonatal units across the UK. About 4.5 percent of them died in the hospital.

    Infants were 32 percent less likely to die if they were admitted to high-volume neonatal units compared to low-volume units, the researchers found.

    The earliest preemies, those born before 27 weeks of pregnancy, benefited the most from high-volume units, Watson told Reuters Health.

    Those babies had half the odds of dying when they were treated in neonatal units that handle a high number of premature births, compared to low-volume units, the study published in BMJ Open found.

    "The effect we observe is mainly being driven by the infants born at less than 27 weeks," Watson said.

    "It would be most important to deliver the youngest fetuses at the highest volume hospital," Chung said.

    Unfortunately, doctors often cannot predict premature births. But expectant mothers who go into labor prematurely sometimes can and should be transferred, Chung said.

    Why babies are more likely to survive in hospitals that deliver more preemies remains an open question, but researchers suspect clinical experience is key.

    "It could be a case of the physicians in the high-volume units have more experience and are more skilled," Watson said. "It is also possible that economies of scale play a role, in that the larger and busier units have more resources to invest in technology and facilities."

    Chung likened doctors working in neonatal units with a high volume of preemies to cardiac surgeons who perform the highest number of heart surgeries.

    "The assumption is it's probably experience," she said. "If you do more of them, you're better."

    Neonatologist Dr. Valencia Walker described the study results as "intuitive."

    "Anything we get a chance to perfect, we will get better and better at it if we have the resources to do it," she told Reuters Health.

    Walker, from the David Geffen School of Medicine at UCLA in Los Angeles, was not involved in the current study.

    She pointed out that systems to determine where pregnant women deliver their babies in England and the U.S. differ significantly.

    In 2003, the UK created a model of networked, regionalized units to facilitate the transfer of premature babies to higher care neonatal units. The current study highlights advantages of the system but also raises concerns about the possible result of smaller neonatal units closing, Watson said.

    Walker said the U.S. has far fewer neonatal intensive care units and a different set of considerations and restrictions regarding transferring patients. In Southern California, for example, traffic can at times render transfers impossible.

    Worldwide, 15 million of the 135 million babies born in 2010 were premature - defined as before 37 weeks of pregnancy - and 1.1 million died, according to a United Nations report (see Reuters story of May 2, 2012 here: http://reut.rs/1oYW0fp). Since 1995, the average rate of premature births has doubled to 6 percent in developed countries, the report found.

    Nutrition, maternal age, smoking, alcohol, obesity and diabetes have all been implicated in premature births.

    SOURCE: http://bit.ly/1oVSOkH BMJ Open, online July 7, 2014.

Neuroscience Articles

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

    By Kathryn Doyle

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  • Exercise may slow physical and mental decline after menopause

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Women who exercise regularly after menopause tend to maintain their physical strength and mental acuity longer than those who don't, according to a new review of past studies that found exercise that gets the heart rate up is best.

    "We found that all the studies showed that physical activity was associated with decreased rates of cognitive decline and that even becoming active in later life as opposed to a lifetime of physical activity still lowered the risk compared to those who were inactive," said Debra Anderson.

    Anderson worked on the study at the Institute of Health and Biomedical Innovation of the Queensland University of Technology in Kelvin Grove, Australia.

    She and her team reviewed 21 studies published between 2009 and 2014 assessing exercise or leisure time physical activity among women ages 65 and older. Ten were randomized controlled trials, the most rigorous kind of study, in which women were randomly assigned to different exercise programs or to no program.

    Some studies involved structured group exercise programs aimed at hitting certain heart rates and energy expenditures while others involved balance and strength training programs or yoga classes.

    Higher physical activity levels were always linked to slower physical decline and better fitness. Exercise generally seemed to preserve brain health, too, although the studies didn't agree on the strength of that association. Some concluded that a woman's brain function at age 50 largely predicted her mental faculties at ages 60 and 70, while others found that mental decline was strongly linked to being sedentary, the authors write in Maturitas.

    "We found that moderate to vigorous exercise is better than mild and gentle exercise," Anderson told Reuters Health in an email. "There was a dose response in moderate to vigorous exercise which showed more was progressively better."

    Current guidelines call for older adults to get the equivalent of 30 minutes of moderate exercise five times per week. But doctors might consider "prescribing" more intense exercise to older women, the authors suggest.

    "Based on our findings we feel this should be 30 to 45 minutes of moderate to vigorous activity at least five times per week for midlife and older women," Anderson said.

    Previously, older women have been encouraged to keep their exercise moderate, but now it seems very important that women exercise to a point where they cannot finish a sentence while exercising and breathe hard and sweat, she said.

    "I would encourage someone who has not exercised at this intensity before to see a general practitioner for a referral to an accredited exercise physiologist to talk with them on how to build up to this level," she added.

    The idea that breaking a sweat helps the brain is not new, said Selena Bartlett, a neuroscientist at Queensland University of Technology. She was not involved in the new study, but collaborates with Anderson on activity and cognition research.

    It's not clear exactly how exercise helps the brain, Bartlett told Reuters Health.

    "One thing we absolutely know is it builds muscle and strengthens the skeletal frame, and also brings oxygen and blood flow to the brain," she said.

    Keeping active helps make aging easier for everyone, not just postmenopausal women, Bartlett said, but that group might derive particular benefit. Estrogen levels decrease during menopause, and the hormone has a role in preserving brain cells and forming new memories.

    "Especially for postmenopausal women, the intensity matters for brain and body health," Bartlett said.

    SOURCE: http://bit.ly/WlzOm8 Maturitas, online June 20, 2014.

  • Polio still threatens Middle East after Syria, Iraq cases: U.N.

    By Stephanie Nebehay

    GENEVA (Reuters) - Thirty-six children in Syria and two in Iraq have been paralyzed by polio since October, and the risk of the virus spreading further in the Middle East remains high, U.N. aid agencies said on Tuesday.

    A crippling and incurable disease, polio erupted in October in the northeast province of Deir al-Zor, marking Syria's first outbreak since 1999. The two cases recorded in Iraq this year were in Iraqi children living in the Baghdad area.

    A polio vaccination campaign reached a record 25 million children in seven countries of the Middle East between December and June, but aid agencies need to go back to them again for follow-up shots in a second phase planned from August, the World Health Organization and U.N. Children's Fund (UNICEF) said.

    The ideal is to vaccinate every child between three and six times, but many of the 3 million children in Syria cannot be reached even once, the agencies said.

    "It is now even more imperative to reach every child multiple times, and to do whatever we can to vaccinate children we could not reach in previous rounds," UNICEF regional director for the Middle East and North Africa Maria Calivis said in the report, "Outbreak in the Middle East - War in Syria opens the Door to an Old Enemy".

    Children in Syria are at greatest risk as routine immunization has been disrupted and many health centers are severely damaged after more than three years of conflict, it said. Nearly three million Syrian refugees, including many health workers, have fled to neighboring countries.

    All but one of the 36 known polio cases in Syria were recorded last year, according to the WHO. Most were in Deir al-Zor, but others were in Aleppo, Idlib, Hama and Hassakeh.

    Polio invades the nervous system and can cause irreversible paralysis within hours.

    "Right now we estimate that there are 765,000 children inside Syria who live in areas that are hard to reach. And as long as we don't get full and regular access to these children, the chances of polio spreading further will continue to exist," UNICEF spokeswoman Juliette Touma told a news briefing.

    The government of President Bashar al-Assad and rebel groups have supported vaccination, WHO spokeswoman Sona Bari said.

    "We had tremendous cooperation across lines, both opposition groups and the government are very committed to have polio vaccination for their children," Bari told Reuters.

    "There has been good coverage. It is really where active fighting is going on where it is hard to reach children and do any humanitarian work. Phase two is about reaching those hard to reach children," she said.

    A U.N. Security Council resolution last week authorized convoys into rebel-held areas without Syrian government consent at four border crossings from Turkey, Iraq and Jordan. The mechanism is still being set up and convoys have yet to roll.

    "We hope that resolution 2165 will allow us to reach some of the children that we have not reached. We have pre-positioned supplies in warehouses in Turkey and in Jordan," Touma said.

  • Illinois legalizes medical marijuana for children with seizures

    By Reuters Staff

    (Reuters) - Illinois children and adults with epilepsy will soon be allowed to use marijuana to ease their symptoms under a law signed on Sunday by Democratic Governor Pat Quinn, the latest in a series of measures loosening restrictions on cannabis by U.S. states.

    The move to add epilepsy and other seizure disorders to the list of conditions legal to treat with marijuana or its extracts comes as numerous states have made medical use of the drug legal. Two states, Colorado and Washington, have legalized its recreational use.

    "This new law will help alleviate the suffering of many adults and children across the state," Quinn said in a statement. "Epilepsy is a debilitating condition, and this much-needed relief will help to reduce some of its symptoms for those who endure seizures."

    The Illinois law, which takes effect in January, would allow children who experience seizures to be treated with non-smokable forms of cannabis, as long as they have permission from a parent.

    "I have a 14-year-old constituent by the name of Hugh who lives with epilepsy," said Republican state lawmaker Jim Durkin, who co-sponsored the new law. "His parents, Bob and Kelly, want to provide their son with as much relief as possible. Unfortunately, traditional medications and methods have not worked."

    The state is putting the final touches on a broader medical marijuana plan, a tightly regulated program whose regulations were finalized just last week.

    Residents will be allowed to apply for permission to use the drug to treat medical conditions in September, and the full program is expected to be up and running early next year, Quinn spokeswoman Katie Hickey said on Sunday.

  • Medication errors may be common after hospital discharge

    By Krystnell Storr

    NEW YORK (Reuters Health) - More than half of heart patients in a new U.S. study made mistakes taking their medications or misunderstood instructions given to them after being discharged from the hospital.

    Those with the lowest "health literacy" were among the most likely to make the risky errors, highlighting the importance of healthcare professionals making sure their instructions are clear and of patients being sure they understand what they need to do after they get home, the study authors say.

    "Some errors have the potential to be harmful to patients," said lead author Dr. Amanda Mixon, a hospitalist with the VA Tennessee Valley Healthcare System in Nashville.

    "Thousands of patients are discharged home with medications every day. Knowing which patients are at risk of medication errors after patients go home can help inpatient providers counsel patients about their medications before they go home," added Mixon, who is also affiliated with Vanderbilt University.

    Past research suggests that an individual's health literacy, the ability to interpret and act on health information, is a strong predictor of whether they will correctly follow instructions for their own care (see Reuters Health article of October 25, 2013, here: http://reut.rs/UdH55N).

    Overall, 20 to 30 percent of prescriptions are never filled, and 50 percent are not continued as prescribed, according to the U.S. Centers for Disease Control and Prevention.

    To assess what factors might influence whether heart patients will follow their care instructions correctly after leaving the hospital, Mixon's team recruited 471 people hospitalized for heart failure, heart attacks and related conditions, then discharged from the hospital.

    The participants' average age was 59 and just under half were women. Every participant took a seven-minute health literacy test to gauge their understanding of health information as well as a short numeracy test to measure basic math skills.

    The researchers contacted the patients by telephone two to three days after they left the hospital and compared the medications on the discharge list from their doctors to what the patients said they were taking.

    When someone said they were taking a medication not on the list, or forgot to mention one that was on the list, it was counted as an error. If a patient didn't know the purpose, dose or frequency of a medication, it was classified as a misunderstanding.

    Failure to refill a prescription, discontinuing use of a medication against a healthcare professional's orders or not being aware of a medication were also counted as errors.

    More than half - 242 of the 471 patients - had at least one discrepancy between the medications they reported taking, and the ones on their discharge list. Over a quarter left out one or more medications on their list and more than a third were taking something that wasn't on the list. And 59 percent of patients had a misunderstanding of the purpose, dose or frequency of their medications.

    Participants who scored highest on the math skills test were about 23 percent less likely than those who scored lowest to add or omit medications, the researchers report in Mayo Clinic Proceedings.

    People with the highest health literacy scores were about 16 percent less likely to make an error compared to those who scored lowest. And women were about 40 percent less likely than men to make a mistake.

    Single people were almost 70 percent more likely than people who were married to make errors. Older age and worse cognitive function also predicted higher odds of having an error.

    "It's a powerful study in that it helps to define some of the things we assume, but haven't been able to fully understand," said Dr. Benjamin Brooke, a surgeon and professor at the University of Utah School of Medicine in Salt Lake City, who was not involved in the study.

    "I think this says that we need to do a better job of understanding a patient at the time of discharge, what are their risks of having a post discharge adverse event," he told Reuters Health.

    In healthcare, "there's a lot of moving parts and it's difficult to make sure they all move in tandem," he noted. "A patient may see a doctor for 20 years and then end up seeing another one who does not know their medical history as well. But this is a global issue. There's a lot of errors that occur when we leave the hospital."

    He favors the idea of a brief health literacy test that might identify patients most likely to have trouble following treatment instructions after discharge. "Whether it's a quick streamlined tool that nurses or anyone part of the medical team can administer, it's something that might be feasible," he said.

    "The main thing is, we need to be aware of the problem and the study points out some of the things we need to focus on more closely," he said.

    Mixon said that for patients who have low health literacy or numeracy, healthcare providers need to be especially careful in counseling them about their medications at hospital discharge.

    She added that patients can also be proactive and assertive by asking a healthcare professional to carefully review the medications they are required to take at home, making sure to ask questions about previously prescribed medications and whether or not they should be continued.

    SOURCE: http://bit.ly/1jQCCm1 Mayo Clinic Proceedings, online July 03, 2014.

Oncology Articles

  • Florida jury awards record $23 billion against RJ Reynolds

    By Barbara Liston

    ORLANDO, Fla. (Reuters) - A Florida jury has awarded the widow of a chain smoker who died of lung cancer 18 years ago record punitive damages of more than $23 billion in her lawsuit against the R.J. Reynolds Tobacco Company, the nation's second-biggest cigarette maker.

    The judgment, returned on Friday night, was the largest in Florida history in a wrongful death lawsuit filed by a single plaintiff, according to Ryan Julison, a spokesman for the woman's lawyer, Chris Chestnut.

    Cynthia Robinson of the Florida Panhandle city of Pensacola sued the cigarette maker in 2008 over the death of her husband, Michael Johnson, claiming the company conspired to conceal the health dangers and addictive nature of its products.

    Johnson, a hotel shuttle bus driver who died of lung cancer in 1996 at age 36, smoked one to three packs a day for more than 20 years, starting at age 13, Chestnut said.

    "He couldn't quit. He was smoking the day he died," the lawyer told Reuters on Saturday.

    After a four-week trial and 11 hours of deliberations, the jury returned a verdict granting compensatory damages of $7.3 million to the widow and the couple's child, and $9.6 million to Johnson's son from a previous relationship.

    The same jury deliberated for another seven hours before awarding Robinson the additional sum of $23.6 billion in punitive damages, according to the verdict forms.

    Lawyers for the tobacco company, a unit of Reynolds American Inc whose brands include Camel, Kool, Winston and Pall Mall cigarettes, could not immediately be reached for comment.

    But J. Jeffery Raborn, vice president and assistant general counsel for R.J. Reynolds, said in a statement quoted by the New York Times that the company planned to challenge "this runaway verdict." Such industry appeals are often successful.

    Chestnut countered, "This wasn't a runaway jury, it was a courageous one."

    He said jurors appeared to have been swayed by evidence of the company's aggressive marketing of tobacco products, particularly promotions aimed at young people, and by its claims that it was Johnson's choice to smoke.

    "They lied to Congress, they lied to the public, they lied to smokers and tried to blamed the smoker," he said.

    Robinson's lawsuit originally was part of a large class-action litigation known as the "Engle case," filed in 1994 against tobacco companies.

    A jury in that case returned a verdict in 2000 in favor of the plaintiffs awarding $145 billion in punitive damages, which at the time was the largest such judgment in U.S. history.

    That award, however, was tossed out in 2006 by the Florida Supreme Court, which decertified the class, agreeing with a lower court that the group was too disparate and that each consumer had smoked for different reasons.

    But the court said the plaintiffs could file lawsuits individually. Robinson was one of them.

    The Florida high court also let stand the jury's findings that cigarettes are defective and cause disease, and that Big Tobacco was negligent, meaning those issues did not have to be re-litigated in future lawsuits.

    The U.S. Supreme Court last month declined to hear a series of tobacco company appeals, mainly from R.J. Reynolds, seeking to overturn Florida court judgments totaling more than $70 million.

  • Musicians On Call' bring music for the soul to patients' beds

    By Daniel Gaitan

    NEW YORK (Reuters Health) - Musicians On Call, a nonprofit providing live music to the seriously ill, hopes to aggressively expand to other major cities across the U.S. next year.

    For more than a decade, volunteer artists with Musicians On Call have given bedside performances to patients undergoing treatment or unable to leave their hospital beds.

    "It's a very tangible way to give back," Pete Griffin, president of Musicians On Call, told Reuters Health. "We are not music therapy, because that is its own medical profession. What we do is bring live music, and what a lot of research shows is that that does decrease patients' stress levels and lowers blood pressure." Family members may also benefit from seeing their loved ones enjoy a "moment of normalcy."

    Since 1999, Musician On Call volunteers have performed for more than 415,000 patients in hospitals, nursing homes and hospices - but only in a handful of states.

    Griffin said the organization hopes to aggressively grow throughout 2015 and expand beyond its seven "hubs" where most Music On Call programs are located: New York, Philadelphia, Baltimore, Washington, D.C., Miami, Nashville and Los Angeles.

    For hospitals without the bedside concert program, Musicians On Call provides a collection of albums.

    "We create 'music pharmacies.' We have supporters and record labels who donate CDs, and then hospitals go on our website and request a 'music pharmacy,' a box of 200 CDs and CD players for their patients to listen to," Griffin said. Nearly 800 hospitals have requested them.

    Dr. Melinda R. Ring, an assistant professor of clinical medicine at Northwestern University's Feinberg School of Medicine in Chicago, said she believes music helps provide the seriously ill a sense of peace.

    "Music touches us. Music has the ability to transform the mood that we're in, the way we're perceiving things," Ring told Reuters Health. "For somebody who has fears about death, pain or other end-of-life issues, listening to something that can bring them joy in the hospital doesn't necessarily change the outcome of what will happen, but it changes their experience."

    Loretta Downs, past president of the Chicago End-of-Life Care Coalition and a hospice volunteer, said she would like to see more medical centers supporting Musicians On Call.

    "Music is a form of reminiscence, and if a family member or a patient can request a song that brings back positive memories, it's a great thing," Downs told Reuters Health. "We want to remember the things that made us happy."

    Downs founded Chrysalis End-of-Life Inspirations, an effort aiming to equip hospitals and nursing homes with "Chrysalis Rooms," private spaces where seriously ill patients can gather with family and friends and listen to music, among other things.

    Many artists visiting hospitals through Musicians On Call find themselves playing requests for upbeat pop songs. Currently, the most popular request from young people is "Let It Go," the Oscar-winning anthem from the animated film "Frozen."

    "When we go into the children's hospitals, a lot of them know the Disney songs," Griffin added. "With the older populations, blues and classic rock are popular. Country music is popular around Nashville, rock in the Northeast."

    Singer and songwriter Kenli Mattus was one of the first artists to work with Musicians On Call.

    "I really enjoy giving patients what I think they want. For kids, I play nursery rhyme songs or make up songs on the spot, which they really like. When I play for adults, I play Frank Sinatra, soul or gospel." Mattus told Reuters Health. "When you go room-to-room and play for a handful of people, it's an incredible personal connection. It really inspires me and makes me feel like I'm doing something good for the world."

    Other notable artists who have performed with Musicians On Call include Pharrell Williams, Kelly Clarkson and Paulina Rubio.

  • HPV test better than Pap for assessing cervical cancer risk: study

    By Andrew M. Seaman

    NEW YORK (Reuters Health) - Testing for human papillomavirus (HPV) may be the best way to know whether a woman is at risk of developing cervical cancer in the near future, according to a new study.

    Negative HPV tests provided women with more reliable assurance that they wouldn't develop cancer or other abnormal cervical changes in the next three years, compared to traditional Pap tests, researchers report.

    "Primary HPV screening might be a viable alternative to Pap screening alone," said Julia Gage, the study's lead author from the National Institutes of Health's National Cancer Institute in Bethesda, Maryland.

    About 12,000 U.S. women were diagnosed with cervical cancer in 2010 and about 4,000 died from the disease, according to the Centers for Disease Control and Prevention. Roughly 91 percent of cervical cancers are thought to be caused by HPV.

    Pap smears, which require doctors to collect cells from the cervix to look for abnormalities, have traditionally been used to determine whether a woman is at risk of developing cancer in the near future.

    In 2012, the government-backed U.S. Preventive Services Task Force recommended women between ages 21 and 65 years be screened using a Pap test every three years and said those ages 30 to 65 years could instead opt for cotesting, which is a Pap test in combination with a HPV test, every five years.

    HPV is the most common sexually transmitted infection and affects both men and women. About 79 million people have the infection but most people don't know they're infected because symptoms are uncommon.

    HPV testing also requires doctors to collect cells like they would during a Pap test but the end result is whether the woman has the virus - not abnormal cells.

    "What we wanted to see is whether primary HPV screening could be a good alternative to Pap and compare it to cotesting," Gage said.

    For the new study, the researchers used data from over one million women who were between ages 30 and 64 years and screened for cervical cancer at Kaiser Permanente Northern California since 2003.

    The researchers followed women who had a negative Pap or HPV test to see whether they developed cervical cancer during the next three years. They also looked at how many women developed cervical cancer in the five years following cotesting.

    Overall, about 20 women out of 100,000 developed cervical cancer in the three years following a negative Pap test. That compared to 11 women out of 100,000 who developed the cancer during the three years after receiving a negative HPV test.

    About 14 women out of 100,000 developed cervical cancer in the five years following negative cotests, according to results published in the Journal of the National Cancer Institute.

    Gage said the findings were not surprising, since HPV is the cause of most cervical cancers.

    She cautioned that the results do not foreshadow the death of Pap smears. The tests may still have a role in monitoring whether women with HPV, who are at an increased risk of cancer, go on to develop abnormal cervical cells.

    "We always have to reconsider how we're screening patients and focus on the best way to screen for certain cancer," said Dr. Mario Leitao Jr., a gynecological surgeon at Memorial Sloan Kettering Cancer Center in New York City.

    "I think this is very interesting because instead of doing (Pap tests) every three years you could do HPV (tests) every three years," said Leitao, who was not involved with the new study.

    He said there will be a lot of variables in deciding which test is best for women.

    "The best way to do it is still to be determined but it's important they have some form of cervical cancer screening at least every three years," Leitao said.

    He added that women also have to be their own advocates and tell their doctors that they don't need Pap tests every year.

    "It shouldn't be done more frequently than every three years," he said.

    SOURCE: http://bit.ly/UckC33 Journal of the National Cancer Institute, online July 18, 2014.

  • Depression may keep some men from fighting prostate cancer

    By Shereen Lehman

    NEW YORK (Reuters Health) - Depression may be source of disparities in the treatment men get for prostate cancer, according to a new study.

    In the analysis, older men who were depressed before they got a prostate cancer diagnosis were more likely to have aggressive cancer, less likely to undergo the recommended treatment for their stage and type of disease and more likely to die.

    "We traditionally think of disparities in healthcare by race and socioeconomic status, but our research demonstrates that mental illness can also be a significant driver of treatment choice and outcomes in terms of prostate cancer," Dr. Jim Hu told Reuters Health in an email.

    Hu is director of robotic and minimally invasive surgery at the David Geffen School of Medicine at UCLA. He led the new study that was published in Journal of Clinical Oncology.

    According to the Centers for Disease Control and Prevention, almost 200,000 men were diagnosed with prostate cancer in the U.S. in 2010, and just under 30,000 men died from the disease that year.

    Past research has linked depression to a greater likelihood of getting less-aggressive treatment and to poorer survival in other cancers, including breast and liver cancers. But little is known about how depression might affect men's diagnosis and treatment for prostate cancer, Hu and his colleagues write.

    The researchers analyzed information from a large national database of Medicare patients, focusing on more than 40,000 men diagnosed with localized prostate cancer between 2004 and 2007 and observed through 2009.

    Of those, 1,894 men were also diagnosed with depression during the two years before their cancer was detected.

    "First, we found that men with prostate cancer who were older, lower income, with more medical (conditions), white or Hispanic (versus Black and Asian), unmarried, residing in nonmetropolitan areas were more likely to be depressed," Hu said.

    "In addition, depressed men were less likely to seek out definitive therapy (surgery or radiation) in contrast to non-depressed men," he said, which goes against the current guidelines for treating intermediate- and high-risk disease.

    After adjusting for differences in the men's tumor characteristics and the treatment they chose, the researchers found that depressed men had worse overall survival compared to men who were not depressed, Hu noted.

    Hu said he was surprised by the results because depressed men were more likely to see physicians in the two years before their prostate cancer diagnosis compared to non-depressed men - an average of 43 times versus 27 times, respectively.

    The team also found that depressed men were more likely to get so-called expectant management, which includes the use of hormones to decrease the aggressiveness of prostate cancer or no treatment at all, which is called "watchful waiting" or active surveillance.

    It's possible, Hu and his colleagues write, that depression makes men less interested in screening, leading to their cancers being diagnosed at a later stage, and makes them choose less aggressive treatment. The greater number of doctor visits might be focused on mental illness, leading to less attention toward cancer screening.

    These findings cannot prove there's a cause and effect at work, the authors caution. However, they suggest that physicians should take care to ensure prostate cancer patients are getting the mental health treatment they need so depression doesn't bias a patient's treatment choices and chances for survival.

    Dr. Behfar Ehdaie, a surgeon who specializes in prostate cancer at Memorial-Sloan Kettering Cancer Center in New York, said that mental health is an important aspect of prostate cancer care.

    Given the prevalence of depression in these men, survivorship in that light has been underreported in the literature, said Ehdaie, who was not involved in the study.

    "We know that men who are diagnosed with prostate cancer have an increased risk of suicide - this was shown in a Swedish study looking at men from Sweden," he told Reuters Health.

    "This adds more data from the United States, specifically looking at men age 67 and older, that also demonstrates that mental health should be assessed and be part of our prostate cancer care," he said.

    But Ehdaie emphasized that this study does not suggest the less aggressive approach of expectant management is associated with poor outcomes, or that depression increases the risk of dying from prostate cancer.

    "The endpoint evaluated is overall survival, and we do know that from previous studies, depression is associated with cardiovascular events, for example, which are also associated with increased risk of mortality," Ehdaie said.

    That distinction between deaths from prostate cancer or progression of the disease, and overall deaths from any cause is important, he added.

    Ehdaie said that future studies are needed to determine the impact of mental health issues on treatment decision making, especially in men with intermediate- or high-risk disease who appear not to be receiving the appropriate treatment.

    "As healthcare providers, we need to be aware of the greater risk for aggressive prostate cancer in depressed men," Hu said. "Additionally, depressed men may require special attention in light of the lower initiative to follow through with physician recommendations."

    Hu added that encouraging depressed men with prostate cancer to join prostate cancer support groups may help spur them to pursue recommended treatments.

    SOURCE: http://bit.ly/UdORwx Journal of Clinical Oncology, online July 7, 2014.

Orthopedic Articles

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Transplant Articles

  • Some kidney donors struggle to buy life insurance: study

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Although people who have donated a kidney have passed a rigorous battery of tests and tend to be healthier than the average person, many report difficulty getting or changing health or life insurance policies after the surgery, according to a new study.

    "These are the healthiest people in the nation, they've undergone more health screening scrutiny than anybody else for any process," said senior author Dr. Dorry L. Segev. "We only allow the healthiest people to do this."

    Segev is an abdominal transplant surgeon at Johns Hopkins University School of Medicine in Baltimore, Maryland, where the study took place.

    "The thought that somebody who has perfectly normal kidney function will have to fight with their insurance company is troubling," he told Reuters Health.

    He and his coauthors surveyed over 1,000 people who had donated a kidney at their hospital between 1970 and 2011.

    Of the almost 400 donors who reported getting or changing health insurance after donation, seven percent had difficulties. Some of them were denied coverage and others were told donating a kidney was a preexisting condition.

    Almost 200 people had changed or initiated life insurance, and 25 percent reported similar trouble, according to results published in the American Journal of Transplantation.

    "Insurance companies who are supposed to be making predictions about people's insurability are totally misinterpreting this particular medical scenario," Segev said.

    One of the tenets of the Affordable Care Act (ACA) is that insurers can't take preexisting conditions, like diseases and disabilities or things they interpret as a disease or disability, including kidney donation, into account when offering or pricing health insurance plans.

    "The health insurance thing hopefully will be attenuated by the ACA but life insurance will not," Segev said.

    The study leaves unexplored many factors that might be important in determining whether people get accepted or charged higher premiums, said Steven Weisbart, chief economist at the Insurance Information Institute in New York.

    Importantly, the researchers did not compare this group of kidney donors with a similar group of non-donors to see if they encountered more problems than the comparison group, he told Reuters Health.

    "There's nothing here about how long after donation the effort to change or buy life insurance took place," Weisbart said. "If it was a long time they are much older, and there could be many factors to their health."

    "The life insurance market is enormous and quite varied," he said. Some companies may be concerned about the impact of going down to one kidney and might choose to reject an applicant, but another company might accept the same person without an increased premium, he said. Kidney donors should shop around for life insurance.

    There is quite a bit of evidence that even living with only one kidney, donors are healthier and less likely to have kidney problems than the general public, according to Dr. Hassan N. Ibrahim, medical director of the Kidney Transplant Program at the University of Minnesota Medical School in Minneapolis.

    "Kidney donors live as long if not longer than others," Ibrahim, who was not part of the new study, told Reuters Health.

    Data to that effect have been published in Sweden, Japan and the U.S., he said.

    "This is an American issue, not a European, not a Canadian issue," Ibrahim said.

    In Canada it takes donors longer to get a quote on their insurance but premiums are never raised and insurance is never denied, he said.

    This particular study found higher rates of insurance difficulties than most others have found, he said. That may be because 20 percent of the donors in this group had high blood pressure or diabetes, which may have influenced their insurability.

    Ibrahim suspects that between one and two percent of donors actually have problems getting or changing insurance, but even one percent of 5,000 donors per year is concerning, he said.

    "It's certainly an important social issue," Ibrahim said. "Almost a third of people who would not consider donation are afraid of costs and insurance coverage."

    A group in the Philippines offers free insurance coverage for life for a kidney donor and the donor's family, he noted, which incentivizes donation.

    "We need to remove disincentives to donation in the U.S.," Ibrahim said.

    Kidney recipients' insurance covers the entirety of the transplant cost. Having health or life insurance in place before the transplant may help donors avoid some struggle, but they could still need to change insurance at some point, Segev noted.

    "For people who have donated kidneys the message is, remember that you are healthy," he said. "Call your transplant center and get us in touch with your insurance company so we can educate them."

    "None of this should be construed as a reason to not donate," he said.

    SOURCE: http://bit.ly/1t35hEe American Journal of Transplantation, online July 16, 2014.

  • Some kidney donors struggle to buy life insurance: study

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Although people who have donated a kidney have passed a rigorous battery of tests and tend to be healthier than the average person, many report difficulty getting or changing health or life insurance policies after the surgery, according to a new study.

    "These are the healthiest people in the nation, they've undergone more health screening scrutiny than anybody else for any process," said senior author Dr. Dorry L. Segev. "We only allow the healthiest people to do this."

    Segev is an abdominal transplant surgeon at Johns Hopkins University School of Medicine in Baltimore, Maryland, where the study took place.

    "The thought that somebody who has perfectly normal kidney function will have to fight with their insurance company is troubling," he told Reuters Health.

    He and his coauthors surveyed over 1,000 people who had donated a kidney at their hospital between 1970 and 2011.

    Of the almost 400 donors who reported getting or changing health insurance after donation, seven percent had difficulties. Some of them were denied coverage and others were told donating a kidney was a preexisting condition.

    Almost 200 people had changed or initiated life insurance, and 25 percent reported similar trouble, according to results published in the American Journal of Transplantation.

    "Insurance companies who are supposed to be making predictions about people's insurability are totally misinterpreting this particular medical scenario," Segev said.

    One of the tenets of the Affordable Care Act (ACA) is that insurers can't take preexisting conditions, like diseases and disabilities or things they interpret as a disease or disability, including kidney donation, into account when offering or pricing health insurance plans.

    "The health insurance thing hopefully will be attenuated by the ACA but life insurance will not," Segev said.

    The study leaves unexplored many factors that might be important in determining whether people get accepted or charged higher premiums, said Steven Weisbart, chief economist at the Insurance Information Institute in New York.

    Importantly, the researchers did not compare this group of kidney donors with a similar group of non-donors to see if they encountered more problems than the comparison group, he told Reuters Health.

    "There's nothing here about how long after donation the effort to change or buy life insurance took place," Weisbart said. "If it was a long time they are much older, and there could be many factors to their health."

    "The life insurance market is enormous and quite varied," he said. Some companies may be concerned about the impact of going down to one kidney and might choose to reject an applicant, but another company might accept the same person without an increased premium, he said. Kidney donors should shop around for life insurance.

    There is quite a bit of evidence that even living with only one kidney, donors are healthier and less likely to have kidney problems than the general public, according to Dr. Hassan N. Ibrahim, medical director of the Kidney Transplant Program at the University of Minnesota Medical School in Minneapolis.

    "Kidney donors live as long if not longer than others," Ibrahim, who was not part of the new study, told Reuters Health.

    Data to that effect have been published in Sweden, Japan and the U.S., he said.

    "This is an American issue, not a European, not a Canadian issue," Ibrahim said.

    In Canada it takes donors longer to get a quote on their insurance but premiums are never raised and insurance is never denied, he said.

    This particular study found higher rates of insurance difficulties than most others have found, he said. That may be because 20 percent of the donors in this group had high blood pressure or diabetes, which may have influenced their insurability.

    Ibrahim suspects that between one and two percent of donors actually have problems getting or changing insurance, but even one percent of 5,000 donors per year is concerning, he said.

    "It's certainly an important social issue," Ibrahim said. "Almost a third of people who would not consider donation are afraid of costs and insurance coverage."

    A group in the Philippines offers free insurance coverage for life for a kidney donor and the donor's family, he noted, which incentivizes donation.

    "We need to remove disincentives to donation in the U.S.," Ibrahim said.

    Kidney recipients' insurance covers the entirety of the transplant cost. Having health or life insurance in place before the transplant may help donors avoid some struggle, but they could still need to change insurance at some point, Segev noted.

    "For people who have donated kidneys the message is, remember that you are healthy," he said. "Call your transplant center and get us in touch with your insurance company so we can educate them."

    "None of this should be construed as a reason to not donate," he said.

    SOURCE: http://bit.ly/1t35hEe American Journal of Transplantation, online July 16, 2014.

  • Some kidney donors struggle to buy life insurance: study

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Although people who have donated a kidney have passed a rigorous battery of tests and tend to be healthier than the average person, many report difficulty getting or changing health or life insurance policies after the surgery, according to a new study.

    "These are the healthiest people in the nation, they've undergone more health screening scrutiny than anybody else for any process," said senior author Dr. Dorry L. Segev. "We only allow the healthiest people to do this."

    Segev is an abdominal transplant surgeon at Johns Hopkins University School of Medicine in Baltimore, Maryland, where the study took place.

    "The thought that somebody who has perfectly normal kidney function will have to fight with their insurance company is troubling," he told Reuters Health.

    He and his coauthors surveyed over 1,000 people who had donated a kidney at their hospital between 1970 and 2011.

    Of the almost 400 donors who reported getting or changing health insurance after donation, seven percent had difficulties. Some of them were denied coverage and others were told donating a kidney was a preexisting condition.

    Almost 200 people had changed or initiated life insurance, and 25 percent reported similar trouble, according to results published in the American Journal of Transplantation.

    "Insurance companies who are supposed to be making predictions about people's insurability are totally misinterpreting this particular medical scenario," Segev said.

    One of the tenets of the Affordable Care Act (ACA) is that insurers can't take preexisting conditions, like diseases and disabilities or things they interpret as a disease or disability, including kidney donation, into account when offering or pricing health insurance plans.

    "The health insurance thing hopefully will be attenuated by the ACA but life insurance will not," Segev said.

    The study leaves unexplored many factors that might be important in determining whether people get accepted or charged higher premiums, said Steven Weisbart, chief economist at the Insurance Information Institute in New York.

    Importantly, the researchers did not compare this group of kidney donors with a similar group of non-donors to see if they encountered more problems than the comparison group, he told Reuters Health.

    "There's nothing here about how long after donation the effort to change or buy life insurance took place," Weisbart said. "If it was a long time they are much older, and there could be many factors to their health."

    "The life insurance market is enormous and quite varied," he said. Some companies may be concerned about the impact of going down to one kidney and might choose to reject an applicant, but another company might accept the same person without an increased premium, he said. Kidney donors should shop around for life insurance.

    There is quite a bit of evidence that even living with only one kidney, donors are healthier and less likely to have kidney problems than the general public, according to Dr. Hassan N. Ibrahim, medical director of the Kidney Transplant Program at the University of Minnesota Medical School in Minneapolis.

    "Kidney donors live as long if not longer than others," Ibrahim, who was not part of the new study, told Reuters Health.

    Data to that effect have been published in Sweden, Japan and the U.S., he said.

    "This is an American issue, not a European, not a Canadian issue," Ibrahim said.

    In Canada it takes donors longer to get a quote on their insurance but premiums are never raised and insurance is never denied, he said.

    This particular study found higher rates of insurance difficulties than most others have found, he said. That may be because 20 percent of the donors in this group had high blood pressure or diabetes, which may have influenced their insurability.

    Ibrahim suspects that between one and two percent of donors actually have problems getting or changing insurance, but even one percent of 5,000 donors per year is concerning, he said.

    "It's certainly an important social issue," Ibrahim said. "Almost a third of people who would not consider donation are afraid of costs and insurance coverage."

    A group in the Philippines offers free insurance coverage for life for a kidney donor and the donor's family, he noted, which incentivizes donation.

    "We need to remove disincentives to donation in the U.S.," Ibrahim said.

    Kidney recipients' insurance covers the entirety of the transplant cost. Having health or life insurance in place before the transplant may help donors avoid some struggle, but they could still need to change insurance at some point, Segev noted.

    "For people who have donated kidneys the message is, remember that you are healthy," he said. "Call your transplant center and get us in touch with your insurance company so we can educate them."

    "None of this should be construed as a reason to not donate," he said.

    SOURCE: http://bit.ly/1t35hEe American Journal of Transplantation, online July 16, 2014.

Women’s Health Articles

  • Pregnancy doesn't drive women doctors out of surgical training

    By Ronnie Cohen

    NEW YORK (Reuters Health) - A new study disputes a common stereotype that women who become pregnant during surgical training often drop out of those training programs.

    Researchers led by Dr. Erin G. Brown of the University of California, Davis found that neither women nor men who had children born during their school's surgical residency program were more likely to quit than residents who did not have children during training.

    Brown told Reuters Health the idea for the study came to her when she was pregnant with her daughter, now one and a half years old, during her surgical residency.

    "Things are changing. It's not an overnight change. It's a slow, steady culture change away from the old boys' club mentality that women who have children during training aren't going to cut it," she said.

    "This study shows that surgical residents who have children during training are just as good," she added.

    General surgical residency programs last five years and are known for being rigorous.

    For the new study, Brown and her colleagues reviewed records on 85 residents enrolled in the University of California, Davis general surgery residency program from 1999 to 2009.

    Forty-nine of the residents were men, and the average age of all residents entering the program was almost 28 years. Overall attrition was about 19 percent, with 16 residents leaving the program.

    A similar proportion of male and female residents left the training program.

    Of the 85 residents, 25 had children born during training.

    Among female residents in particular, 25 percent had children during training and took an average maternity leave of 10 weeks. One of those women left the training program. One woman extended her residency training by two weeks, but the other women who had babies while in training completed the program on time.

    Residents with children born during the program treated a similar number of patients and were equally likely to pass their boards as those who did not have children, according to findings published in JAMA Surgery.

    In an accompanying commentary, Dr. Jeffrey Gauvin, director of the surgical training program at Santa Barbara Cottage Hospital in California, applauded the study but questioned its applicability to smaller programs like his own.

    Davis has "a deep bullpen from which a program director can call in reserves when someone is on leave," he writes. "This may be a very different scenario for small or midsized programs that have very limited - if any - reserves."

    Gauvin formerly directed the surgical residency program at the University of California, Davis.

    Brown acknowledged that smaller programs could face greater challenges in accommodating surgical residents during maternity leave. She is currently compiling data from surgical residency programs of various sizes across the nation to see if the results of the Davis study hold.

    "These are very motivated women who know what they want, and they're able to manage the stress of parenting and training and don't deviate from their career goals," Brown said.

    Women comprised just seven percent of U.S. medical school graduates in 1965, according to the Association of American Medical Colleges. Today that rate hovers near 50 percent.

    But a majority of surgical residents continue to be male, Dr. Nina Shapiro told Reuters Health.

    Shapiro, a professor of head and neck surgery at the University of California, Los Angeles, was not involved in the current study. She said she has watched life change for pregnant surgical residents since she began her training in 1991.

    "Because there's been an increase in the number of women, the climate has by default changed," she said. "There's a huge difference in 20 years."

    "The women going into surgery are very keenly watching those ahead of them. If women are showing they can have babies and be successful, I think other women are going to follow. It's really inspiring for women going into these training programs."

    Shapiro is married to another physician, and they have two young children.

    "Is it a perfect life?" she asked. "There are many days I can't see my kids. For the most part, I make it work. I never miss a school event, a big event in my kids' lives. I don't miss too many small events. I do a lot of homework. I know a lot of fifth-grade math."

    SOURCE: http://bit.ly/1n1S0L8 and http://bit.ly/1nk9sMq JAMA Surgery, online July 16, 2014.

  • Exercise may slow physical and mental decline after menopause

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Women who exercise regularly after menopause tend to maintain their physical strength and mental acuity longer than those who don't, according to a new review of past studies that found exercise that gets the heart rate up is best.

    "We found that all the studies showed that physical activity was associated with decreased rates of cognitive decline and that even becoming active in later life as opposed to a lifetime of physical activity still lowered the risk compared to those who were inactive," said Debra Anderson.

    Anderson worked on the study at the Institute of Health and Biomedical Innovation of the Queensland University of Technology in Kelvin Grove, Australia.

    She and her team reviewed 21 studies published between 2009 and 2014 assessing exercise or leisure time physical activity among women ages 65 and older. Ten were randomized controlled trials, the most rigorous kind of study, in which women were randomly assigned to different exercise programs or to no program.

    Some studies involved structured group exercise programs aimed at hitting certain heart rates and energy expenditures while others involved balance and strength training programs or yoga classes.

    Higher physical activity levels were always linked to slower physical decline and better fitness. Exercise generally seemed to preserve brain health, too, although the studies didn't agree on the strength of that association. Some concluded that a woman's brain function at age 50 largely predicted her mental faculties at ages 60 and 70, while others found that mental decline was strongly linked to being sedentary, the authors write in Maturitas.

    "We found that moderate to vigorous exercise is better than mild and gentle exercise," Anderson told Reuters Health in an email. "There was a dose response in moderate to vigorous exercise which showed more was progressively better."

    Current guidelines call for older adults to get the equivalent of 30 minutes of moderate exercise five times per week. But doctors might consider "prescribing" more intense exercise to older women, the authors suggest.

    "Based on our findings we feel this should be 30 to 45 minutes of moderate to vigorous activity at least five times per week for midlife and older women," Anderson said.

    Previously, older women have been encouraged to keep their exercise moderate, but now it seems very important that women exercise to a point where they cannot finish a sentence while exercising and breathe hard and sweat, she said.

    "I would encourage someone who has not exercised at this intensity before to see a general practitioner for a referral to an accredited exercise physiologist to talk with them on how to build up to this level," she added.

    The idea that breaking a sweat helps the brain is not new, said Selena Bartlett, a neuroscientist at Queensland University of Technology. She was not involved in the new study, but collaborates with Anderson on activity and cognition research.

    It's not clear exactly how exercise helps the brain, Bartlett told Reuters Health.

    "One thing we absolutely know is it builds muscle and strengthens the skeletal frame, and also brings oxygen and blood flow to the brain," she said.

    Keeping active helps make aging easier for everyone, not just postmenopausal women, Bartlett said, but that group might derive particular benefit. Estrogen levels decrease during menopause, and the hormone has a role in preserving brain cells and forming new memories.

    "Especially for postmenopausal women, the intensity matters for brain and body health," Bartlett said.

    SOURCE: http://bit.ly/WlzOm8 Maturitas, online June 20, 2014.

  • India faces crisis over dwindling numbers of girls, U.N. says

    By Nita Bhalla

    NEW DELHI (Thomson Reuters Foundation) - The dwindling numbers of Indian girls, caused by the illegal abortion of millions of babies, has reached "emergency proportions", fueling an increase in crimes such as kidnapping and trafficking, the United Nations warned on Tuesday.

    Despite laws that ban expectant parents from running tests to determine the gender of unborn children, female feticide remains a common practice in parts of India, where a preference for sons runs deep.

    "It is tragically ironic that the one who creates life is herself denied the right to be born," said Lakshmi Puri, deputy executive director of U.N. Women, at the launch of a new study on sex ratios and gender-biased sex selection.

    India's traditionally male-dominated culture views sons as assets - breadwinners who will provide for the family, carry on the family name and perform the last rites for their parents, an important ritual in many faiths.

    Girls, however, are often seen as a liability, with families having to dig deep for a substantial dowry to ensure a desirable match. In a culture that views pre-marital sex as bringing shame to the girl's family, parents also worry about their safety.

    India's 2011 census showed that while the overall female-to-male ratio has improved marginally since the last census a decade ago, fewer girls were born than boys and the number of girls younger than six plummeted for the fifth straight decade.

    "The sharply declining child-sex ratio in India has reached emergency proportions and urgent action must be taken to alleviate this crisis," Puri added.

    A May 2011 study in British medical journal the Lancet found that up to 12 million Indian girls were aborted over the last three decades, resulting in a skewed child sex ratio of 918 girls to every 1,000 boys in 2011, versus 962 in 1981.

    Activists blame ultrasonography for the rise in abortions, saying the technology is used for sex determination.

    But the crime is tough to check, they add, resulting in few convictions. There were 221 cases of feticide reported in 2013, up from 210 in 2012, the National Crime Records Bureau says.

    U.N. officials said India's economic and social progress had failed in the area of sex selection, and the unbalanced sex ratio was contributing to crimes such as rape, abduction and trafficking.

    The entire social structure will have to change, with a battle waged against the root causes of a preference for sons, said Lise Grande, the U.N. resident coordinator in India.

    "This may be one of the hardest, most difficult struggles India faces, but it is arguably one of its most important," she added.

  • Britain plans new measures to prevent female genital mutilation

    By Reuters Staff

    LONDON (Reuters) - Britain is to make it compulsory for teachers and health workers to report cases of female genital mutilation (FGM), Prime Minister David Cameron said on Tuesday.

    The government, which is hosting a London summit on FGM and forced marriage, will also announce a range of other measures aimed at bringing an end to both practices in Britain and abroad, Cameron's office said in a statement.

    This will include 1.4 million pounds ($2.4 million) of funding for an FGM prevention program in Britain, new laws that would see parents prosecuted if they fail to prevent their daughter undergoing FGM, and programs to prevent child and forced marriage in 12 developing countries.

    "I'll make reporting FGM mandatory for doctors, teachers and social workers. Let's end this abhorrent practice once and for all," Cameron said on Twitter.

    FGM, the partial or total removal of external female genitalia, is a tradition practiced widely in African and many Muslim countries and often justified as a means of suppressing a woman's sexual desire to prevent "immoral" behavior.

    Around 103,000 women aged between 15 and 49, and another 10,000 girls aged under 15 who have migrated to England and Wales are estimated to have undergone FGM, according to a report on Tuesday from City University London.

    Britain also plans an international charter calling for the eradication of FGM and forced marriage within a generation, and the government said Tuesday's summit, being attended by 500 delegates from 50 countries, would aim to secure new commitments from the private sector, faith leaders and governments.

    FGM has been a criminal offense in the UK since 1985 but new legislation in 2003 introduced a maximum prison sentence of 14 years. The 2003 act also made it an offense for British citizens to carry out or procure FGM abroad, even in countries where the practice is legal.

    Earlier this year a doctor became one of two men to face trial in the UK's first prosecution for FGM.

  • UK study estimates nearly 200,000 girls and women have had FGM or at risk

    By Emma Batha

    LONDON (Thomson Reuters Foundation) - Almost 200,000 women and girls living in England and Wales have undergone female genital mutilation (FGM) or are at risk of being cut, according to new estimates - a far higher number than previously thought.

    The figures were released on Monday on the eve of Girl Summit, an international conference in London aimed at tackling FGM and child marriage.

    An estimated 137,000 women and girls in England and Wales who were born in countries where FGM is prevalent have been cut, according to a report by rights group Equality Now and City University London.

    Experts also calculated that about 60,000 girls up to the age of 14 have been born in England and Wales to mothers who have had FGM, suggesting they may be at risk or have already been cut.

    Efua Dorkenoo, senior FGM adviser to Equality Now, said: ". . . the government needs to get a handle over this extreme abuse of the most vulnerable girls in our society by implementing a robust national plan to address the issue".

    FGM involves the partial or total removal of the external genitalia. In its most extreme form, known as infibulation, the girl's vaginal opening is also stitched or sealed.

    The ritual, done for cultural, traditional or religious reasons, can cause a host of serious physical and psychological problems. In some cases girls die during the procedure. FGM may also cause fatal complications during childbirth later in life.

    Up to now the government has relied on a 2007 study which estimated more than 20,000 girls were at high risk of FGM in England and Wales and 66,000 girls and women aged 15-49 had already undergone the practice. Recent migration patterns mean that these figures - based on 2001 census data - are out of date.

    Earlier this month a parliamentary committee issued a damning report which described the FGM crisis as "a national scandal" and called for an immediate plan to tackle it.

    Dorkenoo said professionals - like health workers, teachers and social workers - were crying out for clear guidance on how to identify and refer girls at risk.

    "There is no time to waste on platitudes as thousands of girls living in England and Wales are having their life blighted by this damaging practice," said Dorkenoo, who co-authored the report which is part-funded by the government.

    The survey combined FGM prevalence data from the 29 countries where it is most commonly practiced in Africa and the Middle East with information from the 2011 census about women who had migrated from those countries.

    Researchers will now calculate estimates for local areas to enable professionals to plan services to support women affected by FGM and protect their daughters.

    The World Health Organization estimates that globally 100 to 140 million girls and women have undergone FGM.