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

  • CORRECTED-For diabetics, losing weight may delay kidney problems

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Healthy eating, staying active and losing weight are already recommended for people with type 2 diabetes, and new research suggests these steps may also delay or prevent chronic kidney disease.

    About 35 percent of U.S. adults with diabetes have some degree of kidney disease, and diabetes is the major cause of kidney failure and dialysis, according to the study's lead author Dr. William C. Knowler.

    "This result along with many others tends to reinforce the value of weight loss interventions and hopefully motivates people with diabetes to lose weight," said Knowler, who is chief of the Diabetes Epidemiology and Clinical Research Section of the National Institute of Diabetes and Digestive and Kidney Diseases in Phoenix, Arizona.

    He and his coauthors reexamined data from an existing study of lifestyle modifications for people with type 2 diabetes.

    For the original study, more than 5,000 overweight or obese Americans with type 2 diabetes ages 45 to 76 were divided into two groups. Half received diabetes support and education and the other half aimed to lose seven percent of their body weight through reduced calorie diets and increased physical activity.

    People were recruited for the study between 2001 and 2004. For the first year or so, the weight-loss group met regularly with dieticians, case managers and physical activity experts to stay on track toward their calorie, activity and weight-loss goals.

    The study continued, with encouragement to stick to diet and exercise programs, through 2012. As with many weight loss programs, the first year is the critical period for weight loss and later years are spent maintaining it, which can be difficult, Knowler said.

    At the one-year mark, the diet and exercise group had lost an average of 8.6 percent of their body weight, compared to less than one percent lost in the support-and-education group.

    Over the entire study period, people in the diet and exercise group were 31 percent less likely to develop very high risk chronic kidney disease, according to urine tests.

    The study's primary aim was to investigate the power of weight loss to reduce the risk of heart problems or stroke, and as the researchers published previously, no benefit was seen there.

    Knowler emphasized, however, that the weight loss program did improve the outlook for kidney disease and many other aspects of health, including depression, knee pain, urinary incontinence and heart rate recovery after exercise.

    Dr. Dick de Zeeuw writes in an accompanying editorial in The Lancet Diabetes and Endocrinology that he found the kidney-health benefit with no heart benefit difficult to reconcile.

    de Zeeuw, of the Department of Clinical Pharmacy and Pharmacology at the University of Groeningen in The Netherlands, also writes that using very high risk chronic kidney disease as the marker of success or failure in the study doesn't line up with what most trials like this would do if a drug were being tested instead of a lifestyle change.

    Nevertheless, these results reinforce the existing recommendation that people with type 2 diabetes should maintain a healthy weight, he told Reuters Health.

    "In one sense it doesn't add anything to existing recommendations because for overweight people, weight loss and increased activity are recommended already," Knowler said. "But we don't really put a lot of force behind that recommendation."

    For most people, telling them to lose weight and handing out some pamphlets is not enough, he said. This study indicates that an intense program of major behavioral change, including counseling, group session and mutual reinforcement can work.

    "Any approach that results in sustained weight loss should work just as well," Knowler said.

    SOURCE: http://bit.ly/1oRix03 The Lancet Diabetes and Endocrinology, online August 11, 2014.

  • For older women, working out may keep heart rates regular

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Physically active older women are less likely to suffer from atrial fibrillation, the most common form of irregular heartbeat, than less active women, according to a new U.S. study.

    Contrary to suggestions that exercise might raise the risk of abnormal heart rhythms, the analysis based on more than 80,000 postmenopausal women found the risk of atrial fibrillation was lowered by up to 44 percent with regular physical activity.

    "This is one of the reasons we ended up doing the study, we wanted to quell some of those concerns," said senior author Dr. Marco V. Perez of the Stanford Center for Inherited Cardiovascular Disease in California.

    "These are women not engaged in extreme forms of exercise, and what we found was that women who engaged in more exercise actually had a lower risk of AF," Perez told Reuters Health. "The more obese you were, the more you benefitted."

    Atrial fibrillation (AF), sometimes shortened to "AFib," affects more than 1 million U.S. women, and raises their risk of stroke and death even more than it does for men with the condition.

    Perez and his team analyzed data from the large, long-term Women's Health Initiative study. They focused on 81,317 postmenopausal women who had been followed over an average of 11 years.

    Using hospital records and Medicare claims, the researchers found that 9,792 of the women developed AF, at an average age of 63.

    Higher body mass index, a measure of weight relative to height, increased the risk for AF, as did lower levels of physical activity.

    Women who exercised an amount equivalent to five or six 30-minute walks per week or to more vigorous activity like biking twice a week, were 10 percent less likely to develop AF than sedentary women, the authors report in the Journal of the American Heart Association.

    "By the time you're 80, your risk of AFib is about 10 percent, so if you can decrease your risk by 10 percent that is significant," Perez said.

    Obese women were most likely to develop AF, but more physical activity reduced that risk. Obese, sedentary women's AF risk was 30 percent higher than that of a sedentary woman with normal BMI, and 44 percent higher than that of a normal-weight woman who exercised.

    But obese women who exercised had a 17 percent higher risk for AF than normal-weight women who exercised.

    There are other benefits as well, Perez said, since AF leads to hospitalizations and healthcare expenditures.

    Women who exercise more could also be doing other things that lower their risk of AF, but in the Women's Health Initiative data he and his team were able to account for education, income and other lifestyle factors, he said.

    "Physical activity in itself is known to help reduce cardiovascular risk factors, one of the most important of which is high blood pressure, a known mediator of risk of atrial fibrillation," said Dr. Usha B. Tedrow, director of the Clinical Cardiac Electrophysiology Program at Brigham and Women's Hospital in Boston.

    Exercise is also known to reduce inflammation, which may play a role, Tedrow told Reuters Health by email. She was not part of the new study.

    "Atrial fibrillation is a disease where many components of the condition are not under the patient's control," she said. "This study suggests one more piece of the puzzle that can allow patients slightly more control over this disease."

    Perez would recommend that postmenopausal women make time for exercise, within reason and under supervision of a doctor if starting a new and strenuous program, he said.

    High blood pressure and diabetes are also closely tied to AF, so treating those conditions is extremely important as well, he said.

    SOURCE: http://bit.ly/1nbvrQZ Journal of the American Heart Association, August 20, 2014.

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

    (Removes redundant attribution in 22nd paragraph)

    By Kathryn Doyle

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

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

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

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

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

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

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

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

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

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

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

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

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

    Travel health and traveling with medications is a "huge mess" and "supremely unsatisfactory," said Dr. Irmgard Bauer of the Division of Tropical Health and Medicine at James Cook University in Townsville, Australia, who was not part of the study.

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

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

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

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

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

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

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

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

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

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

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

    (Removes redundant attribution in 22nd paragraph)

    By Kathryn Doyle

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

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

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

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

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

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

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

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

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

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

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

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

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

    Travel health and traveling with medications is a "huge mess" and "supremely unsatisfactory," said Dr. Irmgard Bauer of the Division of Tropical Health and Medicine at James Cook University in Townsville, Australia, who was not part of the study.

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

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

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

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

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

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

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

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

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

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

  • CORRECTED-For diabetics, losing weight may delay kidney problems

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Healthy eating, staying active and losing weight are already recommended for people with type 2 diabetes, and new research suggests these steps may also delay or prevent chronic kidney disease.

    About 35 percent of U.S. adults with diabetes have some degree of kidney disease, and diabetes is the major cause of kidney failure and dialysis, according to the study's lead author Dr. William C. Knowler.

    "This result along with many others tends to reinforce the value of weight loss interventions and hopefully motivates people with diabetes to lose weight," said Knowler, who is chief of the Diabetes Epidemiology and Clinical Research Section of the National Institute of Diabetes and Digestive and Kidney Diseases in Phoenix, Arizona.

    He and his coauthors reexamined data from an existing study of lifestyle modifications for people with type 2 diabetes.

    For the original study, more than 5,000 overweight or obese Americans with type 2 diabetes ages 45 to 76 were divided into two groups. Half received diabetes support and education and the other half aimed to lose seven percent of their body weight through reduced calorie diets and increased physical activity.

    People were recruited for the study between 2001 and 2004. For the first year or so, the weight-loss group met regularly with dieticians, case managers and physical activity experts to stay on track toward their calorie, activity and weight-loss goals.

    The study continued, with encouragement to stick to diet and exercise programs, through 2012. As with many weight loss programs, the first year is the critical period for weight loss and later years are spent maintaining it, which can be difficult, Knowler said.

    At the one-year mark, the diet and exercise group had lost an average of 8.6 percent of their body weight, compared to less than one percent lost in the support-and-education group.

    Over the entire study period, people in the diet and exercise group were 31 percent less likely to develop very high risk chronic kidney disease, according to urine tests.

    The study's primary aim was to investigate the power of weight loss to reduce the risk of heart problems or stroke, and as the researchers published previously, no benefit was seen there.

    Knowler emphasized, however, that the weight loss program did improve the outlook for kidney disease and many other aspects of health, including depression, knee pain, urinary incontinence and heart rate recovery after exercise.

    Dr. Dick de Zeeuw writes in an accompanying editorial in The Lancet Diabetes and Endocrinology that he found the kidney-health benefit with no heart benefit difficult to reconcile.

    de Zeeuw, of the Department of Clinical Pharmacy and Pharmacology at the University of Groeningen in The Netherlands, also writes that using very high risk chronic kidney disease as the marker of success or failure in the study doesn't line up with what most trials like this would do if a drug were being tested instead of a lifestyle change.

    Nevertheless, these results reinforce the existing recommendation that people with type 2 diabetes should maintain a healthy weight, he told Reuters Health.

    "In one sense it doesn't add anything to existing recommendations because for overweight people, weight loss and increased activity are recommended already," Knowler said. "But we don't really put a lot of force behind that recommendation."

    For most people, telling them to lose weight and handing out some pamphlets is not enough, he said. This study indicates that an intense program of major behavioral change, including counseling, group session and mutual reinforcement can work.

    "Any approach that results in sustained weight loss should work just as well," Knowler said.

    SOURCE: http://bit.ly/1oRix03 The Lancet Diabetes and Endocrinology, online August 11, 2014.

Comprehensive Rehabilitation Articles

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Emergency News

  • Drones being developed to deliver medical aid, not bombs

    By Daniel Gaitan

    NEW YORK (Reuters Health) - Unmanned aerial vehicles could one day be used to help deliver medical aid and other necessities to needy individuals in hard-to-reach areas.

    Compact aerial drones have not been widely used by American physicians and other medical providers, partly because the new technologies remain taboo and regulations have not caught up to them. But some doctors say drones could become a cost-effective way to care for patients miles away from them.

    Dr. Jeremy Tucker, an emergency physician at MedStar St. Mary's Hospital in Leonardtown, Maryland, believes drones could be safely used to deliver compact items such as vaccines, pills and even water to the seriously ill in remote areas.

    "The earliest health applications for drones will be for disaster relief," Tucker told Reuters Health. "The benefit of delivering care via drone is that you don't need a landing zone. You can deliver supplies right to the people who need them."

    Tucker, who has never piloted a drone, said using them to help fight the spread of infectious diseases could help familiarize doctors and older patients with them.

    "People are all worried about Ebola right now; you could fly in medications, supplies right to the areas needed," he added. "What I envision in the future: someone in charge of disaster relief could summon a mobile clinic, and basically with the push of a button, have mobile drones dropping off supplies, like tents and water."

    In suburban areas, Tucker said they could be used to deliver care to individuals in crowded areas, such as shopping malls or apartments.

    Palo Alto- and London-based Matternet is a start-up company working to build a drone-based delivery system for individuals in low-income countries without access to proper roads. Paola Santana, the company's chief regulatory and strategy officer, said their drones could be a cost-effective alternative to transport trucks.

    Matternet drones weigh less than 10 pounds and can carry more than half their own weight for miles.

    The name of the company - Matternet - refers to a network for transporting matter.

    "We started to think about moving stuff that was very important, that could save lives," Santana told Reuters Health. "We thought about moving very small, health-related payloads such as diagnostics, medicine and clinical supplies and creating a network with that."

    Matternet expects to launch medical drones in cooperation with nonprofit organizations in other countries as early as next year. Santana said the Federal Aviation Authority has not granted them permissions to fly their drones in U.S. airspace, causing them to experiment elsewhere.

    "We had to go to areas where the need was very high and the risk was very low," she said. "Every new technology faces this."

    Asked about privacy concerns and patient safety, Santana said Matternet has developed safeguards for their drones, including the ability to shut them down if hijacked. Their drones are designed to fly only to and from pre-programmed landing spaces.

    "We have the overview of everything that is being moved in the system, that way we can track and monitor every vehicle," she said. Most vehicles will fly at about 400 feet, or about 40 stories high.

    In 2012, Matternet carried out their first field trials throughout the Dominican Republic and Haiti. They successfully delivered small packages to a camp in Port-au-Prince that was set up after the devastating 2010 earthquake. More recently the company has tested its drones in Bhutan.

    Flying model aircrafts and drones for recreation does not usually require FAA approval, but flights for commercial operation require certified aircrafts, licensed pilots and operating approval, an FAA spokesperson told Reuters Health. Proposed rules for drones less than 55 pounds are expected to be released later this year.

  • Drones being developed to deliver medical aid, not bombs

    By Daniel Gaitan

    NEW YORK (Reuters Health) - Unmanned aerial vehicles could one day be used to help deliver medical aid and other necessities to needy individuals in hard-to-reach areas.

    Compact aerial drones have not been widely used by American physicians and other medical providers, partly because the new technologies remain taboo and regulations have not caught up to them. But some doctors say drones could become a cost-effective way to care for patients miles away from them.

    Dr. Jeremy Tucker, an emergency physician at MedStar St. Mary's Hospital in Leonardtown, Maryland, believes drones could be safely used to deliver compact items such as vaccines, pills and even water to the seriously ill in remote areas.

    "The earliest health applications for drones will be for disaster relief," Tucker told Reuters Health. "The benefit of delivering care via drone is that you don't need a landing zone. You can deliver supplies right to the people who need them."

    Tucker, who has never piloted a drone, said using them to help fight the spread of infectious diseases could help familiarize doctors and older patients with them.

    "People are all worried about Ebola right now; you could fly in medications, supplies right to the areas needed," he added. "What I envision in the future: someone in charge of disaster relief could summon a mobile clinic, and basically with the push of a button, have mobile drones dropping off supplies, like tents and water."

    In suburban areas, Tucker said they could be used to deliver care to individuals in crowded areas, such as shopping malls or apartments.

    Palo Alto- and London-based Matternet is a start-up company working to build a drone-based delivery system for individuals in low-income countries without access to proper roads. Paola Santana, the company's chief regulatory and strategy officer, said their drones could be a cost-effective alternative to transport trucks.

    Matternet drones weigh less than 10 pounds and can carry more than half their own weight for miles.

    The name of the company - Matternet - refers to a network for transporting matter.

    "We started to think about moving stuff that was very important, that could save lives," Santana told Reuters Health. "We thought about moving very small, health-related payloads such as diagnostics, medicine and clinical supplies and creating a network with that."

    Matternet expects to launch medical drones in cooperation with nonprofit organizations in other countries as early as next year. Santana said the Federal Aviation Authority has not granted them permissions to fly their drones in U.S. airspace, causing them to experiment elsewhere.

    "We had to go to areas where the need was very high and the risk was very low," she said. "Every new technology faces this."

    Asked about privacy concerns and patient safety, Santana said Matternet has developed safeguards for their drones, including the ability to shut them down if hijacked. Their drones are designed to fly only to and from pre-programmed landing spaces.

    "We have the overview of everything that is being moved in the system, that way we can track and monitor every vehicle," she said. Most vehicles will fly at about 400 feet, or about 40 stories high.

    In 2012, Matternet carried out their first field trials throughout the Dominican Republic and Haiti. They successfully delivered small packages to a camp in Port-au-Prince that was set up after the devastating 2010 earthquake. More recently the company has tested its drones in Bhutan.

    Flying model aircrafts and drones for recreation does not usually require FAA approval, but flights for commercial operation require certified aircrafts, licensed pilots and operating approval, an FAA spokesperson told Reuters Health. Proposed rules for drones less than 55 pounds are expected to be released later this year.

  • Drones being developed to deliver medical aid, not bombs

    By Daniel Gaitan

    NEW YORK (Reuters Health) - Unmanned aerial vehicles could one day be used to help deliver medical aid and other necessities to needy individuals in hard-to-reach areas.

    Compact aerial drones have not been widely used by American physicians and other medical providers, partly because the new technologies remain taboo and regulations have not caught up to them. But some doctors say drones could become a cost-effective way to care for patients miles away from them.

    Dr. Jeremy Tucker, an emergency physician at MedStar St. Mary's Hospital in Leonardtown, Maryland, believes drones could be safely used to deliver compact items such as vaccines, pills and even water to the seriously ill in remote areas.

    "The earliest health applications for drones will be for disaster relief," Tucker told Reuters Health. "The benefit of delivering care via drone is that you don't need a landing zone. You can deliver supplies right to the people who need them."

    Tucker, who has never piloted a drone, said using them to help fight the spread of infectious diseases could help familiarize doctors and older patients with them.

    "People are all worried about Ebola right now; you could fly in medications, supplies right to the areas needed," he added. "What I envision in the future: someone in charge of disaster relief could summon a mobile clinic, and basically with the push of a button, have mobile drones dropping off supplies, like tents and water."

    In suburban areas, Tucker said they could be used to deliver care to individuals in crowded areas, such as shopping malls or apartments.

    Palo Alto- and London-based Matternet is a start-up company working to build a drone-based delivery system for individuals in low-income countries without access to proper roads. Paola Santana, the company's chief regulatory and strategy officer, said their drones could be a cost-effective alternative to transport trucks.

    Matternet drones weigh less than 10 pounds and can carry more than half their own weight for miles.

    The name of the company - Matternet - refers to a network for transporting matter.

    "We started to think about moving stuff that was very important, that could save lives," Santana told Reuters Health. "We thought about moving very small, health-related payloads such as diagnostics, medicine and clinical supplies and creating a network with that."

    Matternet expects to launch medical drones in cooperation with nonprofit organizations in other countries as early as next year. Santana said the Federal Aviation Authority has not granted them permissions to fly their drones in U.S. airspace, causing them to experiment elsewhere.

    "We had to go to areas where the need was very high and the risk was very low," she said. "Every new technology faces this."

    Asked about privacy concerns and patient safety, Santana said Matternet has developed safeguards for their drones, including the ability to shut them down if hijacked. Their drones are designed to fly only to and from pre-programmed landing spaces.

    "We have the overview of everything that is being moved in the system, that way we can track and monitor every vehicle," she said. Most vehicles will fly at about 400 feet, or about 40 stories high.

    In 2012, Matternet carried out their first field trials throughout the Dominican Republic and Haiti. They successfully delivered small packages to a camp in Port-au-Prince that was set up after the devastating 2010 earthquake. More recently the company has tested its drones in Bhutan.

    Flying model aircrafts and drones for recreation does not usually require FAA approval, but flights for commercial operation require certified aircrafts, licensed pilots and operating approval, an FAA spokesperson told Reuters Health. Proposed rules for drones less than 55 pounds are expected to be released later this year.

Surgery Articles

  • Knee replacement may go poorly for people who think life isn't fair

    By Kathryn Doyle

    NEW YORK (Reuters Health) - People who tend to blame others for their suffering and think setbacks in their lives are irreparable tend to report more pain after knee replacement surgery, according to a new study.

    This is not the first time feelings of personal injustice have been tied to longer recovery times and increased disability after injury, the authors write.

    "Pain is a complex phenomenon that is influenced by biological, social, and psychological factors," said lead author Esther Yakobov, a doctoral student in clinical psychology at McGill University in Montreal.

    "Studies conducted with patients who suffer from chronic pain because of an injury demonstrated that individuals who judge their experience as unfair, focus on their losses, and blame others for their painful condition also tend to experience more pain and recover from their injuries slower than individuals who do not," she told Reuters Health by email.

    But those studies had been with victims of injuries, where externalizing blame is a bit easier than for degenerative conditions like osteoarthritis, she noted.

    For the new study, a group of 116 men and women with severe osteoarthritis, between ages 50 and 85 years old and scheduled for knee replacement surgery in Canada, first filled out questionnaires assessing perceived injustice, how much they think about or worry about pain and their fear of movement or re-injury.

    They rated their agreement with statements like, "It all seems so unfair" and "I am suffering because of someone else's negligence."

    With another clinical questionnaire the patients gauged their pain levels and physical functioning.

    After the knee replacement surgeries, which were all deemed successful, the patients rated their pain and function again at a one-year checkup.

    The more a patient agreed before surgery that life seems unfair and others are to blame for their problems, the more pain they reported experiencing one year after surgery. That was true even when age, sex, other health conditions and pre-surgery pain levels were accounted for, according to the results in the journal Pain.

    The more the patient thought about pain and felt helpless because of it before surgery, the more severe their disability during recovery seemed to be.

    "A decade ago, we reported that preoperative anxiety and depression influenced the outcome after surgery," said Dr. Victoria Brander, a physical medicine and rehabilitation specialist at Northwestern Orthopaedic Institute in Chicago.

    This new study adds to the effort to refine the concept, identifying specific psychological characteristics that serve as risk factors for complicated or painful recovery, Brander, who was not part of the new study, told Reuters Health by email.

    "All of these psychological factors point to the fact that patients who perceive themselves as helpless, those who are afraid, those who feel loss of control, have a more difficult time," Brander said.

    "The contrary is also true - patients who exhibit high levels of 'self-efficacy' (that is, patients who have a high degree of confidence in their own ability to achieve a goal) appear to do best after knee replacement," she said.

    Osteoarthritis, the wearing away of cartilage, joint lining, ligaments and bone in a joint, affects one third of people over age 65 in the U.S., according to the Centers for Disease Control and prevention.

    Knee replacement surgery can relieve pain and restore mobility, but about 20 percent of patients will have a problematic recovery or intense pain, based on previous research.

    How individuals perceive pain as just or unjust can vary widely between patients, and it can be influenced by many factors, so it's hard to say if having a more negative outlook is common or uncommon, Yabokov said.

    Researchers don't yet know if people with more negative outlooks only perceive their pain as worse than others or if their psychological state affects the physiology of healing and actually leads to more pain, she said.

    Nevertheless, findings like this suggest patients should be screened for their psychosocial outlook before surgery, she said.

    "This might suggest the usefulness of screening patients in terms of 'catastrophizing,' perceived injustice, fear of movement, and recovery expectancies before treatment or surgery," she said. "With this screening information, appropriate psychological intervention that targets specific risk factors of each patient can then be matched to patients' needs."

    SOURCE: http://bit.ly/1qOr9BB Pain, online July 25, 2014.

  • Hundreds rally in Ireland after rape victim says denied abortion

    By Conor Humphries

    DUBLIN (Reuters) - Hundreds of people rallied in Dublin to call for a change to Ireland's abortion laws on Wednesday after a rape victim said she was refused a termination and instead gave birth by Caesarean section.

    The young migrant's case has reignited a debate about Roman Catholic Ireland's abortion laws, among the most restrictive in Europe, that sparked large protests before parliament voted to allow limited access to abortion for the first time last year.

    "I'm here because I was horrified. This poor girl suffered because she didn't understand the convoluted, stupid system here in Ireland," said Aoife McLysaght, a 38-year old science professor, holding a sign saying 'Forced pregnancy is torture'.

    "We are trying to put pressure on the government, but it seems to be one of those things they'd prefer to ignore. I feel it's only a matter of time before this law is changed. I just want that time to be sooner so fewer people suffer."

    The young foreign national, who cannot be named for legal reasons, told the Irish Times that she became pregnant as a result of rape that took place before she arrived in Ireland.

    She sought help to end the pregnancy when she discovered she was expecting a child, but was turned down by medical authorities. While Irish women seeking abortions typically travel to Britain, which has less strict laws, the woman said she could not do this because she did not have enough money.

    Under the Protection of Life During Pregnancy bill, which was passed a year ago in the wake of the death of an Indian woman who was refused an abortion, a pregnancy can be terminated if the life of the mother is in danger, including by suicide.

    The woman said she had attempted to commit suicide, but was interrupted. But by the time she was assessed by a psychiatrist, she was told her pregnancy was too far advanced to halt it.

    Protesters gathered in central Dublin chanted 'repeal the eighth' in reference to the eighth amendment to the constitution which followed the passing of a 1983 referendum giving the unborn an equal right to life as its mother.

    A United Nations human rights committee told Ireland last month that it should revise its abortion laws to provide for additional exceptions in cases of rape, incest, serious risks to the health of the mother or fatal fetal abnormality.

    The Committee's Chairman Nigel Rodley said Irish law treated women who were raped as a "a vessel and nothing more."

    Ireland's Health Service Executive said in a statement it could not comment on the circumstances of the case until an investigation to be completed by late September.

    Prime Minister Enda Kenny's government has indicated it does not plan to address the issue before the next general election, due by early 2016. It would need to hold another referendum to further amend the law.

    The Pro Life Campaign group said in a statement that the clamor for wider access to abortion laws was obscene as a premature baby clings to life and a chilling and disturbing reminder of the inhumane reality of legalized abortion.

  • California lawmakers pass bill banning inmate sterilizations

    By Sharon Bernstein

    SACRAMENTO, Calif. (Reuters) - California lawmakers sent a bill to ban sterilization surgeries on inmates in California prisons to Governor Jerry Brown on Tuesday, after media reports and a later audit showed officials failed to follow the state's rules for obtaining consent for the procedure known as tubal ligation from incarcerated women.

    The bill prohibits sterilization in correctional facilities for birth control reasons unless a patient's life is in danger or it is medically necessary and no less drastic procedure is possible.

    "It's clear that we need to do more to make sure that forced or coerced sterilizations never again occur in our jails and prisons," said state Senator Hannah-Beth Jackson, who wrote the bill. "Pressuring a vulnerable population into making permanent reproductive choices without informed consent violates our most basic human rights."

    The measure passed the Senate floor with a unanimous vote of 33-0 and now goes to Democratic Governor Jerry Brown for his signature.

    The bill was introduced earlier this year in the wake of allegations, first raised by the non-profit Center for Investigative Reporting, that the state failed to obtain informed consent in cases of women inmates who had their fallopian tubes tied.

    An audit released in June showed that errors were made in obtaining informed consent from 39 women inmates out of 144 who had their tubes tied while incarcerated between 2005 and 2011.

    Prison rules make tubal ligation available to inmates as part of regular obstetrical care. But until the issue was brought to officials' attention in 2010 by an inmates rights group, proper authorization for the procedure was rarely obtained, the state auditor's report said.

    In 27 of those cases, a physician failed to sign the consent form as required, the audit showed. In 18 cases, there were potential violations of a mandated waiting period after women gave consent.

    The audit was the latest blow to the state's troubled prison system and came as California is struggling to meet court-ordered demands to improve medical and mental healthcare in its overcrowded prisons.

    Medical care in California's prisons has been under the supervision of a federally appointed receiver since 2006.

    The current receiver, J. Clark Kelso, was appointed in 2008, but did not learn about problems with tubal ligations until 2010, the audit said.

    Just one such procedure, deemed medically necessary, was performed after the concerns were brought to Kelso's attention, the audit said.

  • Preventable hospital deaths after urological surgery rising: study

    By Kathryn Doyle

    NEW YORK (Reuters Health) - As more urological surgeries are performed outside hospitals, deaths from preventable complications among men and women getting inpatient surgery have risen, according to a new study.

    It's likely that older, sicker and poorer people make up more of the population having inpatient surgery, not that the surgeries are getting more dangerous, researchers say.

    "Our present findings provide evidence of a major shift in the type of patients being admitted for urological surgery," lead author Dr. Jesse Sammon told Reuters Health. "Historically, a much larger proportion of relatively healthy urology patients were admitted for low-risk procedures."

    Sammon, a urologist at the VUI Center for Outcomes Research, Analytics and Evaluation at Henry Ford Health System in Detroit, and his coauthors used data on all hospital discharges of patients undergoing low-risk surgeries like transurethral resection of the prostate and bladder biopsy, which included almost eight million surgeries between 1998 and 2010. About two-thirds of the patients were men.

    Hospital admissions decreased annually, and overall the risk of dying in the hospital was less than one percent.

    In-hospital deaths following urologic surgery stayed stable over the study period but deaths attributable to "failure to rescue" following recognizable or preventable complications, increased 1.5 percent per year on average, Sammon said.

    Recognizable or preventable complications included sepsis, pneumonia, blood clots, shock or cardiac arrest. Upper gastrointestinal bleeding during admission for surgery was also included.

    Older, sicker and minority patients or those with public insurance were more likely to die as a result of a potentially preventable cause, according to the results published in BJU International.

    "There's a pretty wide variety of types of procedures here, but they tilt toward men because they include prostate procedures," said Dr. Hung-Jui Tan, a urology fellow at UCLA who was not involved in the new study.

    Overall the mortality rates were quite low, even lower than some other studies have found, he told Reuters Health.

    Healthier patients being treated without being inpatients could be one explanation for the rise in inpatient deaths from complications, but it could also have to do with a increasing emphasis on coding and accounting for complications that could lead to mortality over the period of the study, he said.

    "Making surgery safer down the road will really involve being aware of complications that have the highest risk of downstream issues, morbidity and death," Tan said.

    Patients should not be concerned that their outpatient procedures may be unsafe, he said.

    "For urology patients the rate of both in-hospital mortality and (failure to rescue) are lower than for the overall surgical population," Sammon said. "That said, while improvements in mortality and (failure to rescue) mortality are being made in the overall surgical population that is not the case for urology patients."

    Patients should be encouraged to seek care at institutions that perform a large number of whatever procedure they require, which may require more travel, he noted.

    SOURCE: http://bit.ly/VCWOfJ BJUI, online August 19, 2014.

  • Extra mastectomy may not extend life for some breast cancer patients

    By Kathryn Doyle

    NEW YORK (Reuters Health) - For some women with early stage breast cancer, removing the healthy breast likely doesn't afford much of a survival benefit, according to a new study.

    "A lot of women with cancer in one breast decide to have both breasts removed to try to improve their survival or life expectancy," said senior author Dr. Todd M. Tuttle, a surgeon at the University of Minnesota in Minneapolis.

    For some women - such as those at high genetic risk for breast cancer - removing a still-healthy breast may very well help in the long run, Tuttle said. But the women in the current study did not have the BRCA gene mutations that would have greatly increased their risk of cancer in both breasts.

    Tuttle and his coauthors used published data to develop a model for predicting survival rates over 20 years for women diagnosed with stage I or II cancer at age 40, 50 or 60.

    According to the existing data, more than 98 percent of women diagnosed with stage I breast cancer will survive at least 10 years, and 90 percent will survive for 20 years. For stage II breast cancer, 77 percent survive for at least 10 years and 58 percent survive at least 20 years.

    For all age groups and tumor types in the study, the risk of developing cancer in the opposite breast after diagnosis was less than one percent each year, the authors wrote in the Journal of the National Cancer Institute.

    Given how rare breast cancer in the opposite breast is for this group of women, having both breasts removed at once only increased life expectancy by at most seven months for women diagnosed with stage I cancer and less than four months for women with stage II cancer. Estimates were even lower for older women and women with estrogen-receptor positive cancers.

    "We chose the best group that we could possibly find - women less than 40, women with estrogen-receptor negative breast cancer, women with stage I," Tuttle told Reuters Health by phone. "Even in that group there was not a meaningful survival benefit."

    Prophylactic mastectomy of the healthy breast has become much more common in recent years, in part because doctors suggest it and in part because women believe it will help them in the long run, Tuttle said.

    Given that a double mastectomy essentially doubles the invasiveness and surgical risk of a one-sided mastectomy, complication rates from the surgery double as well, he said. The new model did not account for other factors including surgical complications, cost or quality of life.

    In an editorial published with the study, Dr. Stephen G. Pauker and Dr. Mohamed Alseiari write, "Although the survival benefit from (removing the other breast) is small as demonstrated in this model, it is greater than zero, which suggests that for some patients even that small gain may be enough to make (the surgery) a not unreasonable choice."

    Pauker and Alseiari study clinical decision-making at Tufts Medical Center in Boston.

    For those women very troubled by the 0.7 percent chance of developing cancer in the second breast, the additional surgery may be worthwhile.

    But from a societal perspective, the cost of the procedure, its complications, reconstruction and resulting negative effects on body image may outweigh the modest benefit of the extra surgery, they write.

    Adding quality of life to the model would likely diminish the benefit further and turn it into a net harm, they write. Ultimately, the choice should depend on the patient's unique values and expectations.

    Tuttle reiterated that his hypothetical survival model only applies to women without the BRCA mutation.

    "The group that benefits primarily from contralateral mastectomy is the ones with hereditary breast cancer," he said. "I always recommend that women see a genetic counselor and get the genetic testing."

    He added, "If you have the mutation, it's a very reasonable option to consider."

    SOURCE: http://bit.ly/1l7FxaA, http://bit.ly/1oNicpj Journal of the National Cancer Institute, August 8, 2014.

Neonatal Articles

  • U.S. EPA makes strides in air toxics but work remains in cities -report

    By Reuters Staff

    WASHINGTON (Reuters) - The United States has made progress in reducing dangerous air pollution since 1990 but work remains to reduce risks for the country's most overburdened urban areas, the U.S. Environmental Protection Agency's top official said on Thursday.

    The EPA released to Congress its second report on integrated air toxics, citing "substantial progress" toward reducing levels of contaminants such as arsenic, mercury and lead since it launched an Integrated Urban Air Toxics Strategy in 1999.

    Air toxics, also known as toxic air pollutants or hazardous air pollutants, are pollutants that may increase the risk of cancer or other serious health effects, such as birth defects.

    EPA Administrator Gina McCarthy pointed to milestones such as a 60 percent reduction in mercury from coal-fired power plants and an 84 percent cut in lead levels in outdoor air among the agency's accomplishments.

    But she told reporters that more work needs to be done to understand air toxics better and reduce remaining risks, which are most prevalent in low-income urban areas.

    "There is more that we have to do and more that we can do," McCarthy said on a conference call.

    The report she cited highlighted six areas where the current EPA air toxics program must improve, including emissions data; ambient data in more areas covering more pollutants; better monitoring technologies; and research on health impacts of air toxics.

    McCarthy said the agency is focused on addressing environmental justice by recognizing that some of the most economically disadvantaged communities are most at risk of the negative health effects of air pollution.

    The agency will complete studies of air toxic pollution in the neighborhoods of South Philadelphia and North Birmingham, Alabama, to get better data that can help inform local decision making.

    "Environmental justice is the core of EPA's mission - striving for clean water and healthy air for every American," McCarthy said.

    For the complete 139-page EPA report, see: http://www2.epa.gov/sites/production/files/2014-08/documents/082114-urban-air-toxics-report-congress.pdf

  • California law aims to protect rights of sperm donors, surrogates

    By Sharon Bernstein

    SACRAMENTO, Calif. (Reuters) - A bill aimed at protecting the parental and adoptive rights of non-traditional families in California was sent to Governor Jerry Brown on Wednesday in an effort to close gaps in a state law that have led to at least one high-profile legal case.

    The measure by San Francisco Assemblyman Tom Ammiano, a Democrat, would require sperm donors, surrogate mothers and the people with whom they work to have a child to fill out a series of forms detailing the rights and responsibilities of each person.

    "My bill represents an opportunity to have state law keep pace with the changes in reproductive technology," Ammiano said. "With a few simple changes, we can help families thrive without needless legal battles or expensive court actions."

    Legal issues around the parental rights of sperm donors have made headlines recently over a debacle involving actor Jason Patric, who donated sperm to a now-former girlfriend and is suing for the right to be part of the child's life. Under current law, sperm donors do not typically have parental rights unless otherwise agreed by the parties involved.

    Ammiano's bill would require people who use sperm donors or surrogate mothers to fill out a series of forms outlining the parental rights and responsibilities of the donor or surrogate before conception.

    The forms required under the legislation are designed to eliminate any gray area about who has the right to visit or care for a child conceived through in vitro or other non-traditional reproductive methods.

    The bill would also create an expedited adoption process for same-sex parents. The process is meant to protect families who move from California to states where a non-biological parent is not recognized under state law unless the child has been legally adopted.

    The measure also requires couples using a surrogate to spell out how they will pay for the medical expenses of the surrogate and the care of the newborn.

  • Hundreds rally in Ireland after rape victim says denied abortion

    By Conor Humphries

    DUBLIN (Reuters) - Hundreds of people rallied in Dublin to call for a change to Ireland's abortion laws on Wednesday after a rape victim said she was refused a termination and instead gave birth by Caesarean section.

    The young migrant's case has reignited a debate about Roman Catholic Ireland's abortion laws, among the most restrictive in Europe, that sparked large protests before parliament voted to allow limited access to abortion for the first time last year.

    "I'm here because I was horrified. This poor girl suffered because she didn't understand the convoluted, stupid system here in Ireland," said Aoife McLysaght, a 38-year old science professor, holding a sign saying 'Forced pregnancy is torture'.

    "We are trying to put pressure on the government, but it seems to be one of those things they'd prefer to ignore. I feel it's only a matter of time before this law is changed. I just want that time to be sooner so fewer people suffer."

    The young foreign national, who cannot be named for legal reasons, told the Irish Times that she became pregnant as a result of rape that took place before she arrived in Ireland.

    She sought help to end the pregnancy when she discovered she was expecting a child, but was turned down by medical authorities. While Irish women seeking abortions typically travel to Britain, which has less strict laws, the woman said she could not do this because she did not have enough money.

    Under the Protection of Life During Pregnancy bill, which was passed a year ago in the wake of the death of an Indian woman who was refused an abortion, a pregnancy can be terminated if the life of the mother is in danger, including by suicide.

    The woman said she had attempted to commit suicide, but was interrupted. But by the time she was assessed by a psychiatrist, she was told her pregnancy was too far advanced to halt it.

    Protesters gathered in central Dublin chanted 'repeal the eighth' in reference to the eighth amendment to the constitution which followed the passing of a 1983 referendum giving the unborn an equal right to life as its mother.

    A United Nations human rights committee told Ireland last month that it should revise its abortion laws to provide for additional exceptions in cases of rape, incest, serious risks to the health of the mother or fatal fetal abnormality.

    The Committee's Chairman Nigel Rodley said Irish law treated women who were raped as a "a vessel and nothing more."

    Ireland's Health Service Executive said in a statement it could not comment on the circumstances of the case until an investigation to be completed by late September.

    Prime Minister Enda Kenny's government has indicated it does not plan to address the issue before the next general election, due by early 2016. It would need to hold another referendum to further amend the law.

    The Pro Life Campaign group said in a statement that the clamor for wider access to abortion laws was obscene as a premature baby clings to life and a chilling and disturbing reminder of the inhumane reality of legalized abortion.

  • Belgian infant contracts HIV via breast milk

    By Kathryn Doyle

    NEW YORK (Reuters Health) - In 2012, a one-year-old boy in Belgium acquired HIV through his mother's breast milk, a rare but not impossible form of transmission in industrialized countries, doctors say.

    "Breast milk transmission has been recognized as an efficient mode of mother to child transmission of HIV for almost 30 years," said senior author Dr. Philippe Lepage.

    This transmission is common for mothers who were already infected before giving birth in developing countries, but it's extremely rare in industrialized countries, where HIV positive women are encouraged not to breastfeed, Lepage said.

    Lepage is the head of the department of pediatrics at the Hopital Universitaire des Enfants Reine Fabiola in Brussles, Belgium.

    In this case, according to a report in the journal Pediatrics, the boy's mother was tested for HIV during pregnancy and soon after delivery. The tests were negative both times.

    His parents, both from the Democratic Republic of Congo, and three siblings were all healthy at the time of his birth.

    But at one year of age the child was hospitalized for bronchitis, where he and his mother were diagnosed with HIV.

    "If mothers become HIV infected while they're breastfeeding, their babies are at very high risk of getting the infection," said Jean Humphrey, director of the Zvitambo Institute for Maternal Child Health Research in Harare, Zimbabwe.

    She speculated that in this case, the father contracted the infection after the child was born and gave it to his wife.

    More screening wouldn't help prevent this kind of transmission, since by and large the mother will have already given the infection to her child by the time she tests positive, she said.

    "The real way to prevent this kind of infection is to make women who are breastfeeding understand that having unprotected sex while breastfeeding is putting their babies at very high risk," Humphrey said.

    In Africa, it has been suggested that all breastfeeding women use condoms during sex to drive home the message of prevention, she said.

    "Sometimes, here, men take greater notice of the fact that sleeping around puts their baby at risk compared to putting their wife at risk," she said.

    The only way to prevent this kind of transmission is strong counseling of both parents, Humphrey said.

    Lepage and his coauthors suggested the same solution in the case report.

    "These interventions should focus on parents from high-HIV frequency countries and also on health care professionals counseling pregnant women who might be unaware of the possible risk associated with breastfeeding," he told Reuters Health by email. "Counseling should address condom use and also include education on the high risk of HIV postnatal transmission after heterosexual exposure during breastfeeding."

    For a pregnant woman who knows she has HIV, whether or not she will breastfeed depends on where in the world she lives, which has been one of the most tumultuous public health policy decisions in the past 20 years, Humphrey said.

    As Lepage noted, in North America, Europe and Australia, HIV positive women do not breastfeed, since safe alternative formulas are available.

    For a time women in Africa were also encouraged to formula feed, but that policy led to a wave of diarrhea deaths, Humphrey said.

    "In developing countries, breastfeeding is so important to prevent infections," she said.

    "Now there are drug regimens in all African countries that reduce breast milk transmission rates to under 2 percent if it's done right," she said.

    With drugs that lower transmission rates, the benefits of breastfeeding now outweigh the risks in Africa, she added.

    "Still it's extremely emotive, giving different policies on breastfeeding to poor women and to wealthy women," she said.

    SOURCE: http://bit.ly/1mc1a4f Pediatrics, August 18, 2014

  • U.S. court revives challenge to New York City circumcision law

    By Jonathan Stempel

    NEW YORK (Reuters) - A federal appeals court on Friday revived an effort to block a New York City regulation that requires people who perform a Jewish circumcision ritual on infants that involves oral suction to first obtain parental consent.

    A unanimous panel of the 2nd U.S. Circuit Court of Appeals said a trial judge had been too deferential to the city, which had linked the ritual to a deadly form of herpes, in rejecting a request by rabbinical groups for a preliminary injunction.

    The three-judge panel directed U.S. District Judge Naomi Reice Buchwald in Manhattan to instead use "strict scrutiny" to see if the regulation infringed the plaintiffs' free exercise of religion, violating the First Amendment.

    At issue was the ritual metzitzah b'peh (MBP), in which a mohel who performs a circumcision uses oral suction to draw blood away from a wound on an infant's penis. The procedure is sometimes performed in ultra-Orthodox communities.

    In September 2012, the New York City Board of Health voted to require mohels to obtain advance consent in which parents acknowledged the risk of herpes infection linked to the ritual.

    This came after city health officials identified 11 cases since 2000 in which infant boys contracted herpes simplex virus (HSV) following circumcisions believed to involve oral suction. Two of the boys died.

    The Central Rabbinical Congress of the United States and Canada, the International Bris Association and some rabbis sought to halt enforcement, but Buchwald denied the request, saying the regulation addressed "legitimate societal concerns."

    Circuit Judge Debra Ann Livingston, however, wrote for the 2nd Circuit that the regulation was not neutral toward religion because it "purposefully singles out religious conduct performed by a subset of Orthodox Jews," and applies exclusively to them.

    As a result she said Buchwald should have not reviewed simply whether there was a rational basis for the regulation.

    "The Department (of Health) may have legitimate reasons for addressing HSV infection risk among infants primarily, if not exclusively, by regulating MBP," Livingston wrote. "On the present record, however, the plaintiffs have made a sufficient case for strict scrutiny by establishing that the risk of transmission by reason of metzitzah b'peh has been singled out."

    The 2nd Circuit did not rule on the regulation's constitutionality.

    The city's law department had no comment on the decision.

    In a joint statement, the plaintiffs called the decision a "great victory," and said they remain ready to work with city officials "to protect our children's health while fully respecting and accommodating our religious practice."

    The case is Central Rabbinical Congress of the United States and Canada et al v. New York City Department of Health & Mental Hygiene et al, 2nd U.S. Circuit Court of Appeals, No. 13-107.

Neuroscience Articles

  • U.S. EPA makes strides in air toxics but work remains in cities -report

    By Reuters Staff

    WASHINGTON (Reuters) - The United States has made progress in reducing dangerous air pollution since 1990 but work remains to reduce risks for the country's most overburdened urban areas, the U.S. Environmental Protection Agency's top official said on Thursday.

    The EPA released to Congress its second report on integrated air toxics, citing "substantial progress" toward reducing levels of contaminants such as arsenic, mercury and lead since it launched an Integrated Urban Air Toxics Strategy in 1999.

    Air toxics, also known as toxic air pollutants or hazardous air pollutants, are pollutants that may increase the risk of cancer or other serious health effects, such as birth defects.

    EPA Administrator Gina McCarthy pointed to milestones such as a 60 percent reduction in mercury from coal-fired power plants and an 84 percent cut in lead levels in outdoor air among the agency's accomplishments.

    But she told reporters that more work needs to be done to understand air toxics better and reduce remaining risks, which are most prevalent in low-income urban areas.

    "There is more that we have to do and more that we can do," McCarthy said on a conference call.

    The report she cited highlighted six areas where the current EPA air toxics program must improve, including emissions data; ambient data in more areas covering more pollutants; better monitoring technologies; and research on health impacts of air toxics.

    McCarthy said the agency is focused on addressing environmental justice by recognizing that some of the most economically disadvantaged communities are most at risk of the negative health effects of air pollution.

    The agency will complete studies of air toxic pollution in the neighborhoods of South Philadelphia and North Birmingham, Alabama, to get better data that can help inform local decision making.

    "Environmental justice is the core of EPA's mission - striving for clean water and healthy air for every American," McCarthy said.

    For the complete 139-page EPA report, see: http://www2.epa.gov/sites/production/files/2014-08/documents/082114-urban-air-toxics-report-congress.pdf

  • Researchers reverse autism symptoms in mice by paring extra synapses

    By Sharon Begley

    NEW YORK (Reuters) - Although many things have gone wrong in the autistic brain, scientists have recently been focusing on one of the most glaring: a surplus of connections, or synapses.

    Neuroscientists reported on Thursday that, at least in lab mice, a drug that restores the healthy "synaptic pruning" that normally occurs during brain development also reverses autistic-like behaviors such as avoiding social interaction.

    "We were able to treat mice after the disease had appeared," neurobiologist David Sulzer of Columbia University Medical Center, who led the study published in the journal Neuron, said in a telephone interview. That suggests the disease could one day be treated in teenagers and adults, "though there is a lot of work to be done," he said.

    A synapse is where one neuron communicates with another, forming functional circuits. With too many synapses, a "brain region that should be talking only to a select number of other regions is receiving irrelevant information from many others," Ralph-Axel Müller of San Diego State University said by email. He has done pioneering work in overconnectivity and was not involved in the Neuron study, which he deemed "extremely exciting."

    According to the latest government estimates, one in 68 children in the United States has some form of autism.

    For the new study, Columbia's Guomei Tang painstakingly counted synapses in a key region of the cortex of 26 children with autism who had died from other causes and compared that to 22 healthy brains also donated to science.

    In the autistic brains, synaptic density was more than 50 percent higher than that in healthy brains and sometimes two-thirds greater.

    It is not clear if too many synapses are the main reason for autism, but many genes linked to autism play a role in synapse pruning. And the discovery that synapse pruning reversed autistic behavior in the lab mice suggests overconnectivity may be key.

    Sulzer's team used rapamycin, an immunosuppressant drug that prevents organ rejection and is sold by Pfizer as Rapamune. They chose rapamycin because it works by inhibiting a protein called mTOR whose overactivity, they found, inhibits synapse pruning.

    Even if the findings are confirmed - and Sulzer notes that treatments that work in lab animals often fail in people - it is unlikely that rapamycin would be used in people with autism: Its wide-scale immune-suppressing effects would likely cause serious side effects.

    "But there could be better drugs," Sulzer said, such as a molecule that dials up production of synapse-pruning proteins.

    One remaining puzzle is how the mice's brains, or the drug, know which synapses to keep and which to prune. "But the mice started behaving normally" after receiving the synapse-pruning drug, "which suggests the right ones are being pruned," Sulzer said.

    In addition to government funding, the Columbia scientists received grants from the Simons Foundation. It was established by hedge fund pioneer and Renaissance Technologies founder Jim Simons, whose daughter was diagnosed with autism.

    SOURCE: http://bit.ly/1pNZZNz Neuron, online August 21, 2014.

  • For older women, working out may keep heart rates regular

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Physically active older women are less likely to suffer from atrial fibrillation, the most common form of irregular heartbeat, than less active women, according to a new U.S. study.

    Contrary to suggestions that exercise might raise the risk of abnormal heart rhythms, the analysis based on more than 80,000 postmenopausal women found the risk of atrial fibrillation was lowered by up to 44 percent with regular physical activity.

    "This is one of the reasons we ended up doing the study, we wanted to quell some of those concerns," said senior author Dr. Marco V. Perez of the Stanford Center for Inherited Cardiovascular Disease in California.

    "These are women not engaged in extreme forms of exercise, and what we found was that women who engaged in more exercise actually had a lower risk of AF," Perez told Reuters Health. "The more obese you were, the more you benefitted."

    Atrial fibrillation (AF), sometimes shortened to "AFib," affects more than 1 million U.S. women, and raises their risk of stroke and death even more than it does for men with the condition.

    Perez and his team analyzed data from the large, long-term Women's Health Initiative study. They focused on 81,317 postmenopausal women who had been followed over an average of 11 years.

    Using hospital records and Medicare claims, the researchers found that 9,792 of the women developed AF, at an average age of 63.

    Higher body mass index, a measure of weight relative to height, increased the risk for AF, as did lower levels of physical activity.

    Women who exercised an amount equivalent to five or six 30-minute walks per week or to more vigorous activity like biking twice a week, were 10 percent less likely to develop AF than sedentary women, the authors report in the Journal of the American Heart Association.

    "By the time you're 80, your risk of AFib is about 10 percent, so if you can decrease your risk by 10 percent that is significant," Perez said.

    Obese women were most likely to develop AF, but more physical activity reduced that risk. Obese, sedentary women's AF risk was 30 percent higher than that of a sedentary woman with normal BMI, and 44 percent higher than that of a normal-weight woman who exercised.

    But obese women who exercised had a 17 percent higher risk for AF than normal-weight women who exercised.

    There are other benefits as well, Perez said, since AF leads to hospitalizations and healthcare expenditures.

    Women who exercise more could also be doing other things that lower their risk of AF, but in the Women's Health Initiative data he and his team were able to account for education, income and other lifestyle factors, he said.

    "Physical activity in itself is known to help reduce cardiovascular risk factors, one of the most important of which is high blood pressure, a known mediator of risk of atrial fibrillation," said Dr. Usha B. Tedrow, director of the Clinical Cardiac Electrophysiology Program at Brigham and Women's Hospital in Boston.

    Exercise is also known to reduce inflammation, which may play a role, Tedrow told Reuters Health by email. She was not part of the new study.

    "Atrial fibrillation is a disease where many components of the condition are not under the patient's control," she said. "This study suggests one more piece of the puzzle that can allow patients slightly more control over this disease."

    Perez would recommend that postmenopausal women make time for exercise, within reason and under supervision of a doctor if starting a new and strenuous program, he said.

    High blood pressure and diabetes are also closely tied to AF, so treating those conditions is extremely important as well, he said.

    SOURCE: http://bit.ly/1nbvrQZ Journal of the American Heart Association, August 20, 2014.

  • Former Tennessee Titans player Tim Shaw says he has ALS

    By Tim Ghianni

    NASHVILLE, Tenn. (Reuters) - Former Tennessee Titans linebacker Tim Shaw revealed he has ALS, also known as Lou Gehrig's disease, in a video that shows him dumping a bucket full of ice water over his head as part of an ALS fundraiser.

    "I'm here today to stand up and fight with all of you against this disease," he said in the video posted on Tuesday, before dousing himself as part of the "Ice Bucket Challenge" to fight ALS - amyotrophic lateral sclerosis.

    After taking the challenge, Shaw, 30, called on the Titans organization, Penn State head coach James Franklin, the school's football team and his Clarenceville, Michigan, community to do the same.

    Shaw was drafted by the Carolina Panthers from Penn State and also played for the NFL's Jacksonville Jaguars and Chicago Bears. Shaw spent three years as a Titan before leaving football in 2013.

    The challenge has become popular on social media, with celebrities such as former President George W. Bush and basketball star LeBron James posting videos online showing themselves getting doused with cold water.

    The challenge has helped raise $31.5 million for the ALS Association over the past year, more than 16 times what it raised the previous year, the organization said on Wednesday.

    More than 5,600 people are diagnosed each year with ALS, a progressive neurodegenerative disease that attacks nerve cells and pathways in the brain and spinal cord, eventually paralyzing patients, according to the organization.

    A 2012 study found that National Football League players were at greater risk than the general population of dying of neurodegenerative diseases.

  • Foreign assisted suicide cases in Switzerland double in 4 years

    By Reuters Staff

    ZURICH (Reuters) - The number of foreigners traveling to Switzerland to commit assisted suicide doubled over a four-year period, a study published in the Journal of Medical Ethics said on Thursday.

    In 2012, 172 foreigners took their lives in Switzerland, which has liberal euthanasia rules, up from 86 in 2009, with citizens from Germany and Britain making up almost two-thirds of the total, the study found.

    Assisted suicide has been legal in Switzerland since the 1940s, if performed by someone with no direct interest in the death.

    "Mercy killing" is also legal in the Netherlands, Luxembourg, Belgium, and some U.S. states but remains illegal in many countries, pushing some terminally ill people in those coutries to travel abroad where they can be helped to die without fear of their loved ones, or doctors, being prosecuted.

    Courts in Britain, France and the European Court of Human Rights have been struggling with the delicate issue in recent months.

    Neurological conditions, such as paralysis, ALS, Parkinson's and multiple sclerosis were the decisive factor in almost half of the cases examined in the study.

    A rise in the number of foreign assisted suicides has provoked heated debate in Switzerland. In 2011, voters in the canton of Zurich rejected proposed bans on assisted suicide and "suicide tourism." A year later, the national parliament voted against tightening controls on the practice.

    An analysis of the 611 cases between 2008 and 2012 found people from 31 countries were helped to die in Switzerland during the period. The median age was 69.

    Nearly half came from Germany, while 20 percent were British. Other countries in the top 10 included France and Italy, which both saw particularly steep rises.

    SOURCE: http://bit.ly/1toHhwc Journal of Medical Ethics, online August 20, 2014.

    (Reporting by Caroline Copley; Editing by Robin Pomeroy)

Oncology Articles

  • Fewer U.S. youth using sunscreen new study finds

    By David Beasley

    ATLANTA (Reuters) - Fewer U.S. teenagers are using sunscreen, even as skin cancer rates increase, a study found.

    The percentage of high school students using sunscreen dropped from 67.7 percent in 2001 to 56.1 percent in 2011, according to the study by researchers at William Paterson University in New Jersey and published Thursday in the publication Preventing Chronic Disease.

    The study analyzed survey data from high school students collected for the Centers for Disease Control and Prevention's Youth Risk Behavior Surveillance System.

    The drop in sunscreen use occurred as melanoma, the most dangerous form of skin cancer, increased 1.6 percent annually among men from 2001 to 2010 and 1.4 percent among women, the study said.

    "It's alarming," said Corey Basch, assistant professor of public heath at William Paterson and one of the study's authors. "Given that the rates of skin cancer and melanoma are going up, we would have liked to have seen sun protection measures also going up."

    The CDC recommends using sunscreen and avoiding tanning beds to avoid developing skin cancer.

    Avoiding over-exposure to the sun is particularly important during childhood and adolescence, the study said.

    The findings point to the need for a greater push to inform teenagers on the dangers of sun exposure, said Basch.

    "What we really need is to change the mindset that having this artificially tanned skin is attractive," she said.

    In Australia, a massive public information campaign called "Slip Slop Slap" included handing out free sunscreen at beaches and was effective in increasing sun protection, Basch said. Television ads showed beachgoers wearing hats and shirts.

    "Over time, it really transformed how people envisioned a beach day," Basch said. "It was no longer just frying yourself, so to speak, on a beach in a string bikini."

    While the use of sunscreen by teenagers is dropping in the United States, so is the use of indoor tanning devices, the study said.

    From 2009 to 2011, the percentage of respondents using tanning devices dropped from 15.6 percent to 13.3 percent, the study said. However, the decrease was so small that it is not considered significant, Basch said.

    SOURCE: http://1.usa.gov/1nfLiOx Preventing Chronic Disease, online August 21, 2014.

  • U.S. EPA makes strides in air toxics but work remains in cities -report

    By Reuters Staff

    WASHINGTON (Reuters) - The United States has made progress in reducing dangerous air pollution since 1990 but work remains to reduce risks for the country's most overburdened urban areas, the U.S. Environmental Protection Agency's top official said on Thursday.

    The EPA released to Congress its second report on integrated air toxics, citing "substantial progress" toward reducing levels of contaminants such as arsenic, mercury and lead since it launched an Integrated Urban Air Toxics Strategy in 1999.

    Air toxics, also known as toxic air pollutants or hazardous air pollutants, are pollutants that may increase the risk of cancer or other serious health effects, such as birth defects.

    EPA Administrator Gina McCarthy pointed to milestones such as a 60 percent reduction in mercury from coal-fired power plants and an 84 percent cut in lead levels in outdoor air among the agency's accomplishments.

    But she told reporters that more work needs to be done to understand air toxics better and reduce remaining risks, which are most prevalent in low-income urban areas.

    "There is more that we have to do and more that we can do," McCarthy said on a conference call.

    The report she cited highlighted six areas where the current EPA air toxics program must improve, including emissions data; ambient data in more areas covering more pollutants; better monitoring technologies; and research on health impacts of air toxics.

    McCarthy said the agency is focused on addressing environmental justice by recognizing that some of the most economically disadvantaged communities are most at risk of the negative health effects of air pollution.

    The agency will complete studies of air toxic pollution in the neighborhoods of South Philadelphia and North Birmingham, Alabama, to get better data that can help inform local decision making.

    "Environmental justice is the core of EPA's mission - striving for clean water and healthy air for every American," McCarthy said.

    For the complete 139-page EPA report, see: http://www2.epa.gov/sites/production/files/2014-08/documents/082114-urban-air-toxics-report-congress.pdf

  • Cancer screenings common among older, sick Americans

    By Andrew M. Seaman

    NEW YORK (Reuters Health) - Despite potential risks and limited benefits, many Americans are still screened for cancers toward the end of their lives, according to a new study.

    Up to half of older people in the U.S. received cancer screenings even though there was a high likelihood that they would die within nine years without cancer, researchers report in JAMA Internal Medicine.

    "There is general agreement that routine cancer screening has little likelihood to result in a net benefit for individuals with limited life expectancy," write Dr. Trevor Royce and his fellow researchers from the University of North Carolina, Chapel Hill.

    Several professional societies have updated their cancer screening guidelines to suggest that people who aren't expected to live another 10 years should not be screened for certain cancers.

    For example, the American Society of Clinical Oncology, the American Cancer Society and the American Urological Association recommend stopping prostate-specific antigen (PSA) screening among men not expected to live another decade.

    PSA screening involves a blood test that looks for a protein produced by the prostate gland. High levels of the protein may suggest the presence of prostate cancer.

    "Each screening test carries different risks and benefits," said Keith Bellizzi of the University of Connecticut's Center for Public Health and Health Policy in Storrs. "Individuals should be counseled about these risks in order to make an informed decision (sometimes involving caregivers or family members)."

    Bellizzi was not involved with the new study but has done similar research (see Reuters Health story of December 12, 2011 here: http://reut.rs/1taT7L9).

    "Having said that, the challenge for clinicians is to balance the values and wishes of their patients with the available evidence regarding the benefit or lack of benefit for a specific screening test," he wrote in an email to Reuters Health.

    For the new study, the researchers analyzed data from a U.S. survey collected between 2000 and 2010 that included responses from 27,404 people 65 years old and older.

    They used the participants' responses to estimate their risk of death within the next nine years. Then, they looked to see who had recently been screened for prostate, colon, breast and cervical cancers.

    In one way or another, medical organizations support stopping screening for those four cancers among people with limited life expectancy.

    Despite those guidelines, the researchers found 55 percent of men who had a 75 percent risk of death over the next nine years had recently received a PSA screening.

    About a third of women with the same life expectancy received breast and cervical cancer screenings. Screening for cervical cancer was also common among women who had already had a hysterectomy.

    The researchers also found that 41 percent of people who were not likely to live another decade were recently screened for colon cancer.

    In an editorial accompanying the new study, Dr. Cary Gross of Yale University in New Haven, Connecticut, writes that some research found that older Americans receive colonoscopies within seven years of their previous screening. Current recommendations suggest 10 years between colonoscopies with normal results.

    Another study published in the same journal says that based on a computer model, screening older adults with colonoscopies more than once every 10 years produced small benefits.

    Researchers led by Frank van Hees of Erasmus University Medical Center in the Netherlands found that compared with screening older Americans with colonoscopies every 10 years, screening them every five years saved less than one additional life per 1,000 people.

    Screening older Americans with colonoscopies every five years also resulted in less than one quality year of life gained per 1,000 people at a cost of about $711,000.

    "This new age of skepticism is providing us with critical tools to better target screening efforts," Gross wrote. "In situations in which we are uncertain about whether benefits outweigh the risks, we need to bolster our efforts to generate evidence that can inform cancer screening decisions."

    While helpful, he added, additional research is inefficient and doctors and regulators need to take steps to address the use of cancer screenings among people with limited life expectancies.

    "These findings support other studies that suggest certain segments of the older population may be inappropriately screened for cancers," said Bellizzi. "However, the health care response should clearly not be a one size fits all solution."

    He said older adults and their health statues differ from one another.

    "Age, in and of itself, should not be a proxy for health status or be solely used as a decision tool regarding screening for a particular cancer," he added.

    SOURCE: http://bit.ly/1taSAbY, http://bit.ly/1taSAce and http://bit.ly/1taSxNy JAMA Internal Medicine, online August 18, 2014.

  • NSAIDs tied to reduced breast cancer recurrence among obese

    By Andrew M. Seaman

    NEW YORK (Reuters Health) - In overweight women, aspirin or other drugs that reduce inflammation might make certain breast cancers more treatable, researchers suggest.

    Hormone-driven breast cancer was less likely to return in overweight women who regularly used anti-inflammatory medicines, they found.

    But their findings don't prove the drugs prevent cancer and it's too soon to tell women to start taking them to protect against cancer recurrence, the researchers warn.

    Still, senior researcher Linda deGraffenried of The University of Texas in Austin told Reuters Health said, "I was probably as surprised as anyone that we found such a dramatic effect that we did."

    She and her colleagues write in the journal Cancer Research that in past studies, breast cancer outcomes tended to be worse in obese women than in thinner women.

    That's thought to be particularly true for postmenopausal women with a type of breast cancer that is fueled by the hormone estrogen.

    Women produce significantly less estrogen after menopause, but an enzyme in fat still makes estrogen from other compounds. Postmenopausal women with estrogen-driven breast cancer can take medicine to stop that process, but those drugs are less effective among the obese.

    To see if there was a link between use of so-called non-steroidal anti-inflammatory drugs, or NSAIDs, and the risk of breast cancer returning, the researchers looked at data from 440 women treated in Texas for estrogen-driven breast cancer between 1987 and 2011. Most of the women were overweight or obese and had gone through menopause.

    NSAIDs - including aspirin, ibuprofen and naproxen - reduce inflammation throughout the body.

    About 6 percent of women who reported regular NSAID use had their cancers return, compared to about 12 percent of those who didn't report regular NSAID use.

    The cancers that did return among those who used NSAIDs also tended to reappear later than the cancers of those who didn't take NSAIDs, the researchers found.

    Using lab experiments and blood samples, the researchers then sought to find an explanation for the link between regular NSAID use and the risk of returning breast cancer among overweight women.

    Compared to normal weight women, deGraffenried said the lab results suggest that the bodies of overweight women are more hospitable environments to estrogen-driven breast cancers and make it more difficult for treatments to work.

    By reducing inflammation through the use of NSAIDs, the environment within the bodies of obese women in which the cancer lives becomes more like the environment of normal weight women.

    "We are really truly starting to appreciate that it takes a village to support a cancer growth," deGraffenried said.

    It's too soon to tell obese women to start taking aspirin or other NSAIDs to reduce the risk of their breast cancer from coming back, she and another researcher said.

    "What this study does is provide more evidence for the plausibility of this," Dr. Clifford Hudis, who was not involved with the new study, told Reuters Health.

    Hudis, chief of the Breast Cancer Medicine Service at Memorial Sloan Kettering Cancer Center in New York City, said the new study had some limitations.

    "The women in this study were not randomly assigned to take or not take the drug in question," he said. "The doctor recommended it to them or they chose to take it for some other reason. It wasn't assigned to them. It does not show and it's far short of showing causation."

    More reliable studies are being planned, deGraffenried said.

    "These studies give promise but they're still preliminary," she said.

    SOURCE: http://bit.ly/1BjUomK Cancer Research, online August 14, 2014.

  • Extra mastectomy may not extend life for some breast cancer patients

    By Kathryn Doyle

    NEW YORK (Reuters Health) - For some women with early stage breast cancer, removing the healthy breast likely doesn't afford much of a survival benefit, according to a new study.

    "A lot of women with cancer in one breast decide to have both breasts removed to try to improve their survival or life expectancy," said senior author Dr. Todd M. Tuttle, a surgeon at the University of Minnesota in Minneapolis.

    For some women - such as those at high genetic risk for breast cancer - removing a still-healthy breast may very well help in the long run, Tuttle said. But the women in the current study did not have the BRCA gene mutations that would have greatly increased their risk of cancer in both breasts.

    Tuttle and his coauthors used published data to develop a model for predicting survival rates over 20 years for women diagnosed with stage I or II cancer at age 40, 50 or 60.

    According to the existing data, more than 98 percent of women diagnosed with stage I breast cancer will survive at least 10 years, and 90 percent will survive for 20 years. For stage II breast cancer, 77 percent survive for at least 10 years and 58 percent survive at least 20 years.

    For all age groups and tumor types in the study, the risk of developing cancer in the opposite breast after diagnosis was less than one percent each year, the authors wrote in the Journal of the National Cancer Institute.

    Given how rare breast cancer in the opposite breast is for this group of women, having both breasts removed at once only increased life expectancy by at most seven months for women diagnosed with stage I cancer and less than four months for women with stage II cancer. Estimates were even lower for older women and women with estrogen-receptor positive cancers.

    "We chose the best group that we could possibly find - women less than 40, women with estrogen-receptor negative breast cancer, women with stage I," Tuttle told Reuters Health by phone. "Even in that group there was not a meaningful survival benefit."

    Prophylactic mastectomy of the healthy breast has become much more common in recent years, in part because doctors suggest it and in part because women believe it will help them in the long run, Tuttle said.

    Given that a double mastectomy essentially doubles the invasiveness and surgical risk of a one-sided mastectomy, complication rates from the surgery double as well, he said. The new model did not account for other factors including surgical complications, cost or quality of life.

    In an editorial published with the study, Dr. Stephen G. Pauker and Dr. Mohamed Alseiari write, "Although the survival benefit from (removing the other breast) is small as demonstrated in this model, it is greater than zero, which suggests that for some patients even that small gain may be enough to make (the surgery) a not unreasonable choice."

    Pauker and Alseiari study clinical decision-making at Tufts Medical Center in Boston.

    For those women very troubled by the 0.7 percent chance of developing cancer in the second breast, the additional surgery may be worthwhile.

    But from a societal perspective, the cost of the procedure, its complications, reconstruction and resulting negative effects on body image may outweigh the modest benefit of the extra surgery, they write.

    Adding quality of life to the model would likely diminish the benefit further and turn it into a net harm, they write. Ultimately, the choice should depend on the patient's unique values and expectations.

    Tuttle reiterated that his hypothetical survival model only applies to women without the BRCA mutation.

    "The group that benefits primarily from contralateral mastectomy is the ones with hereditary breast cancer," he said. "I always recommend that women see a genetic counselor and get the genetic testing."

    He added, "If you have the mutation, it's a very reasonable option to consider."

    SOURCE: http://bit.ly/1l7FxaA, http://bit.ly/1oNicpj Journal of the National Cancer Institute, August 8, 2014.

Orthopedic Articles

  • Knee replacement may go poorly for people who think life isn't fair

    By Kathryn Doyle

    NEW YORK (Reuters Health) - People who tend to blame others for their suffering and think setbacks in their lives are irreparable tend to report more pain after knee replacement surgery, according to a new study.

    This is not the first time feelings of personal injustice have been tied to longer recovery times and increased disability after injury, the authors write.

    "Pain is a complex phenomenon that is influenced by biological, social, and psychological factors," said lead author Esther Yakobov, a doctoral student in clinical psychology at McGill University in Montreal.

    "Studies conducted with patients who suffer from chronic pain because of an injury demonstrated that individuals who judge their experience as unfair, focus on their losses, and blame others for their painful condition also tend to experience more pain and recover from their injuries slower than individuals who do not," she told Reuters Health by email.

    But those studies had been with victims of injuries, where externalizing blame is a bit easier than for degenerative conditions like osteoarthritis, she noted.

    For the new study, a group of 116 men and women with severe osteoarthritis, between ages 50 and 85 years old and scheduled for knee replacement surgery in Canada, first filled out questionnaires assessing perceived injustice, how much they think about or worry about pain and their fear of movement or re-injury.

    They rated their agreement with statements like, "It all seems so unfair" and "I am suffering because of someone else's negligence."

    With another clinical questionnaire the patients gauged their pain levels and physical functioning.

    After the knee replacement surgeries, which were all deemed successful, the patients rated their pain and function again at a one-year checkup.

    The more a patient agreed before surgery that life seems unfair and others are to blame for their problems, the more pain they reported experiencing one year after surgery. That was true even when age, sex, other health conditions and pre-surgery pain levels were accounted for, according to the results in the journal Pain.

    The more the patient thought about pain and felt helpless because of it before surgery, the more severe their disability during recovery seemed to be.

    "A decade ago, we reported that preoperative anxiety and depression influenced the outcome after surgery," said Dr. Victoria Brander, a physical medicine and rehabilitation specialist at Northwestern Orthopaedic Institute in Chicago.

    This new study adds to the effort to refine the concept, identifying specific psychological characteristics that serve as risk factors for complicated or painful recovery, Brander, who was not part of the new study, told Reuters Health by email.

    "All of these psychological factors point to the fact that patients who perceive themselves as helpless, those who are afraid, those who feel loss of control, have a more difficult time," Brander said.

    "The contrary is also true - patients who exhibit high levels of 'self-efficacy' (that is, patients who have a high degree of confidence in their own ability to achieve a goal) appear to do best after knee replacement," she said.

    Osteoarthritis, the wearing away of cartilage, joint lining, ligaments and bone in a joint, affects one third of people over age 65 in the U.S., according to the Centers for Disease Control and prevention.

    Knee replacement surgery can relieve pain and restore mobility, but about 20 percent of patients will have a problematic recovery or intense pain, based on previous research.

    How individuals perceive pain as just or unjust can vary widely between patients, and it can be influenced by many factors, so it's hard to say if having a more negative outlook is common or uncommon, Yabokov said.

    Researchers don't yet know if people with more negative outlooks only perceive their pain as worse than others or if their psychological state affects the physiology of healing and actually leads to more pain, she said.

    Nevertheless, findings like this suggest patients should be screened for their psychosocial outlook before surgery, she said.

    "This might suggest the usefulness of screening patients in terms of 'catastrophizing,' perceived injustice, fear of movement, and recovery expectancies before treatment or surgery," she said. "With this screening information, appropriate psychological intervention that targets specific risk factors of each patient can then be matched to patients' needs."

    SOURCE: http://bit.ly/1qOr9BB Pain, online July 25, 2014.

  • Knee replacement may go poorly for people who think life isn't fair

    By Kathryn Doyle

    NEW YORK (Reuters Health) - People who tend to blame others for their suffering and think setbacks in their lives are irreparable tend to report more pain after knee replacement surgery, according to a new study.

    This is not the first time feelings of personal injustice have been tied to longer recovery times and increased disability after injury, the authors write.

    "Pain is a complex phenomenon that is influenced by biological, social, and psychological factors," said lead author Esther Yakobov, a doctoral student in clinical psychology at McGill University in Montreal.

    "Studies conducted with patients who suffer from chronic pain because of an injury demonstrated that individuals who judge their experience as unfair, focus on their losses, and blame others for their painful condition also tend to experience more pain and recover from their injuries slower than individuals who do not," she told Reuters Health by email.

    But those studies had been with victims of injuries, where externalizing blame is a bit easier than for degenerative conditions like osteoarthritis, she noted.

    For the new study, a group of 116 men and women with severe osteoarthritis, between ages 50 and 85 years old and scheduled for knee replacement surgery in Canada, first filled out questionnaires assessing perceived injustice, how much they think about or worry about pain and their fear of movement or re-injury.

    They rated their agreement with statements like, "It all seems so unfair" and "I am suffering because of someone else's negligence."

    With another clinical questionnaire the patients gauged their pain levels and physical functioning.

    After the knee replacement surgeries, which were all deemed successful, the patients rated their pain and function again at a one-year checkup.

    The more a patient agreed before surgery that life seems unfair and others are to blame for their problems, the more pain they reported experiencing one year after surgery. That was true even when age, sex, other health conditions and pre-surgery pain levels were accounted for, according to the results in the journal Pain.

    The more the patient thought about pain and felt helpless because of it before surgery, the more severe their disability during recovery seemed to be.

    "A decade ago, we reported that preoperative anxiety and depression influenced the outcome after surgery," said Dr. Victoria Brander, a physical medicine and rehabilitation specialist at Northwestern Orthopaedic Institute in Chicago.

    This new study adds to the effort to refine the concept, identifying specific psychological characteristics that serve as risk factors for complicated or painful recovery, Brander, who was not part of the new study, told Reuters Health by email.

    "All of these psychological factors point to the fact that patients who perceive themselves as helpless, those who are afraid, those who feel loss of control, have a more difficult time," Brander said.

    "The contrary is also true - patients who exhibit high levels of 'self-efficacy' (that is, patients who have a high degree of confidence in their own ability to achieve a goal) appear to do best after knee replacement," she said.

    Osteoarthritis, the wearing away of cartilage, joint lining, ligaments and bone in a joint, affects one third of people over age 65 in the U.S., according to the Centers for Disease Control and prevention.

    Knee replacement surgery can relieve pain and restore mobility, but about 20 percent of patients will have a problematic recovery or intense pain, based on previous research.

    How individuals perceive pain as just or unjust can vary widely between patients, and it can be influenced by many factors, so it's hard to say if having a more negative outlook is common or uncommon, Yabokov said.

    Researchers don't yet know if people with more negative outlooks only perceive their pain as worse than others or if their psychological state affects the physiology of healing and actually leads to more pain, she said.

    Nevertheless, findings like this suggest patients should be screened for their psychosocial outlook before surgery, she said.

    "This might suggest the usefulness of screening patients in terms of 'catastrophizing,' perceived injustice, fear of movement, and recovery expectancies before treatment or surgery," she said. "With this screening information, appropriate psychological intervention that targets specific risk factors of each patient can then be matched to patients' needs."

    SOURCE: http://bit.ly/1qOr9BB Pain, online July 25, 2014.

  • Knee replacement may go poorly for people who think life isn't fair

    By Kathryn Doyle

    NEW YORK (Reuters Health) - People who tend to blame others for their suffering and think setbacks in their lives are irreparable tend to report more pain after knee replacement surgery, according to a new study.

    This is not the first time feelings of personal injustice have been tied to longer recovery times and increased disability after injury, the authors write.

    "Pain is a complex phenomenon that is influenced by biological, social, and psychological factors," said lead author Esther Yakobov, a doctoral student in clinical psychology at McGill University in Montreal.

    "Studies conducted with patients who suffer from chronic pain because of an injury demonstrated that individuals who judge their experience as unfair, focus on their losses, and blame others for their painful condition also tend to experience more pain and recover from their injuries slower than individuals who do not," she told Reuters Health by email.

    But those studies had been with victims of injuries, where externalizing blame is a bit easier than for degenerative conditions like osteoarthritis, she noted.

    For the new study, a group of 116 men and women with severe osteoarthritis, between ages 50 and 85 years old and scheduled for knee replacement surgery in Canada, first filled out questionnaires assessing perceived injustice, how much they think about or worry about pain and their fear of movement or re-injury.

    They rated their agreement with statements like, "It all seems so unfair" and "I am suffering because of someone else's negligence."

    With another clinical questionnaire the patients gauged their pain levels and physical functioning.

    After the knee replacement surgeries, which were all deemed successful, the patients rated their pain and function again at a one-year checkup.

    The more a patient agreed before surgery that life seems unfair and others are to blame for their problems, the more pain they reported experiencing one year after surgery. That was true even when age, sex, other health conditions and pre-surgery pain levels were accounted for, according to the results in the journal Pain.

    The more the patient thought about pain and felt helpless because of it before surgery, the more severe their disability during recovery seemed to be.

    "A decade ago, we reported that preoperative anxiety and depression influenced the outcome after surgery," said Dr. Victoria Brander, a physical medicine and rehabilitation specialist at Northwestern Orthopaedic Institute in Chicago.

    This new study adds to the effort to refine the concept, identifying specific psychological characteristics that serve as risk factors for complicated or painful recovery, Brander, who was not part of the new study, told Reuters Health by email.

    "All of these psychological factors point to the fact that patients who perceive themselves as helpless, those who are afraid, those who feel loss of control, have a more difficult time," Brander said.

    "The contrary is also true - patients who exhibit high levels of 'self-efficacy' (that is, patients who have a high degree of confidence in their own ability to achieve a goal) appear to do best after knee replacement," she said.

    Osteoarthritis, the wearing away of cartilage, joint lining, ligaments and bone in a joint, affects one third of people over age 65 in the U.S., according to the Centers for Disease Control and prevention.

    Knee replacement surgery can relieve pain and restore mobility, but about 20 percent of patients will have a problematic recovery or intense pain, based on previous research.

    How individuals perceive pain as just or unjust can vary widely between patients, and it can be influenced by many factors, so it's hard to say if having a more negative outlook is common or uncommon, Yabokov said.

    Researchers don't yet know if people with more negative outlooks only perceive their pain as worse than others or if their psychological state affects the physiology of healing and actually leads to more pain, she said.

    Nevertheless, findings like this suggest patients should be screened for their psychosocial outlook before surgery, she said.

    "This might suggest the usefulness of screening patients in terms of 'catastrophizing,' perceived injustice, fear of movement, and recovery expectancies before treatment or surgery," she said. "With this screening information, appropriate psychological intervention that targets specific risk factors of each patient can then be matched to patients' needs."

    SOURCE: http://bit.ly/1qOr9BB Pain, online July 25, 2014.

Transplant Articles

  • U.S. government extends contract with Cytori for burn treatment

    By Reuters Staff

    (Reuters) - The U.S. government has extended a contract with Cytori Therapeutics to develop a cell-derived treatment for burns, the company said on Tuesday.

    The government's Biomedical Advanced Research and Development Authority (BARDA) will provide up to $20.4 million to fund early development and costs associated with a clinical trial.

    The contract is part of BARDA's national preparedness initiative to prepare in the event of mass casualties, including the involvement of burns.

    Cytori said its autologous cell therapy has the potential to improve wound healing quality and speed, and could be deployed at hospitals for potential use by non-specialist personnel.

    The funds are part of a contract won by Cytori in 2012 for work on products to treat burns and radiation. This portion of the funding takes the project into the clinical development phase.

    The clinical trial must be approved by the Food and Drug Administration. If successful it would be the first clinical trial funded by BARDA that uses an autologous (the patient's own cells) stem cell treatment, the company said.

  • U.S. government extends contract with Cytori for burn treatment

    By Reuters Staff

    (Reuters) - The U.S. government has extended a contract with Cytori Therapeutics to develop a cell-derived treatment for burns, the company said on Tuesday.

    The government's Biomedical Advanced Research and Development Authority (BARDA) will provide up to $20.4 million to fund early development and costs associated with a clinical trial.

    The contract is part of BARDA's national preparedness initiative to prepare in the event of mass casualties, including the involvement of burns.

    Cytori said its autologous cell therapy has the potential to improve wound healing quality and speed, and could be deployed at hospitals for potential use by non-specialist personnel.

    The funds are part of a contract won by Cytori in 2012 for work on products to treat burns and radiation. This portion of the funding takes the project into the clinical development phase.

    The clinical trial must be approved by the Food and Drug Administration. If successful it would be the first clinical trial funded by BARDA that uses an autologous (the patient's own cells) stem cell treatment, the company said.

  • U.S. government extends contract with Cytori for burn treatment

    By Reuters Staff

    (Reuters) - The U.S. government has extended a contract with Cytori Therapeutics to develop a cell-derived treatment for burns, the company said on Tuesday.

    The government's Biomedical Advanced Research and Development Authority (BARDA) will provide up to $20.4 million to fund early development and costs associated with a clinical trial.

    The contract is part of BARDA's national preparedness initiative to prepare in the event of mass casualties, including the involvement of burns.

    Cytori said its autologous cell therapy has the potential to improve wound healing quality and speed, and could be deployed at hospitals for potential use by non-specialist personnel.

    The funds are part of a contract won by Cytori in 2012 for work on products to treat burns and radiation. This portion of the funding takes the project into the clinical development phase.

    The clinical trial must be approved by the Food and Drug Administration. If successful it would be the first clinical trial funded by BARDA that uses an autologous (the patient's own cells) stem cell treatment, the company said.

Women’s Health Articles

  • For older women, working out may keep heart rates regular

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Physically active older women are less likely to suffer from atrial fibrillation, the most common form of irregular heartbeat, than less active women, according to a new U.S. study.

    Contrary to suggestions that exercise might raise the risk of abnormal heart rhythms, the analysis based on more than 80,000 postmenopausal women found the risk of atrial fibrillation was lowered by up to 44 percent with regular physical activity.

    "This is one of the reasons we ended up doing the study, we wanted to quell some of those concerns," said senior author Dr. Marco V. Perez of the Stanford Center for Inherited Cardiovascular Disease in California.

    "These are women not engaged in extreme forms of exercise, and what we found was that women who engaged in more exercise actually had a lower risk of AF," Perez told Reuters Health. "The more obese you were, the more you benefitted."

    Atrial fibrillation (AF), sometimes shortened to "AFib," affects more than 1 million U.S. women, and raises their risk of stroke and death even more than it does for men with the condition.

    Perez and his team analyzed data from the large, long-term Women's Health Initiative study. They focused on 81,317 postmenopausal women who had been followed over an average of 11 years.

    Using hospital records and Medicare claims, the researchers found that 9,792 of the women developed AF, at an average age of 63.

    Higher body mass index, a measure of weight relative to height, increased the risk for AF, as did lower levels of physical activity.

    Women who exercised an amount equivalent to five or six 30-minute walks per week or to more vigorous activity like biking twice a week, were 10 percent less likely to develop AF than sedentary women, the authors report in the Journal of the American Heart Association.

    "By the time you're 80, your risk of AFib is about 10 percent, so if you can decrease your risk by 10 percent that is significant," Perez said.

    Obese women were most likely to develop AF, but more physical activity reduced that risk. Obese, sedentary women's AF risk was 30 percent higher than that of a sedentary woman with normal BMI, and 44 percent higher than that of a normal-weight woman who exercised.

    But obese women who exercised had a 17 percent higher risk for AF than normal-weight women who exercised.

    There are other benefits as well, Perez said, since AF leads to hospitalizations and healthcare expenditures.

    Women who exercise more could also be doing other things that lower their risk of AF, but in the Women's Health Initiative data he and his team were able to account for education, income and other lifestyle factors, he said.

    "Physical activity in itself is known to help reduce cardiovascular risk factors, one of the most important of which is high blood pressure, a known mediator of risk of atrial fibrillation," said Dr. Usha B. Tedrow, director of the Clinical Cardiac Electrophysiology Program at Brigham and Women's Hospital in Boston.

    Exercise is also known to reduce inflammation, which may play a role, Tedrow told Reuters Health by email. She was not part of the new study.

    "Atrial fibrillation is a disease where many components of the condition are not under the patient's control," she said. "This study suggests one more piece of the puzzle that can allow patients slightly more control over this disease."

    Perez would recommend that postmenopausal women make time for exercise, within reason and under supervision of a doctor if starting a new and strenuous program, he said.

    High blood pressure and diabetes are also closely tied to AF, so treating those conditions is extremely important as well, he said.

    SOURCE: http://bit.ly/1nbvrQZ Journal of the American Heart Association, August 20, 2014.

  • California law aims to protect rights of sperm donors, surrogates

    By Sharon Bernstein

    SACRAMENTO, Calif. (Reuters) - A bill aimed at protecting the parental and adoptive rights of non-traditional families in California was sent to Governor Jerry Brown on Wednesday in an effort to close gaps in a state law that have led to at least one high-profile legal case.

    The measure by San Francisco Assemblyman Tom Ammiano, a Democrat, would require sperm donors, surrogate mothers and the people with whom they work to have a child to fill out a series of forms detailing the rights and responsibilities of each person.

    "My bill represents an opportunity to have state law keep pace with the changes in reproductive technology," Ammiano said. "With a few simple changes, we can help families thrive without needless legal battles or expensive court actions."

    Legal issues around the parental rights of sperm donors have made headlines recently over a debacle involving actor Jason Patric, who donated sperm to a now-former girlfriend and is suing for the right to be part of the child's life. Under current law, sperm donors do not typically have parental rights unless otherwise agreed by the parties involved.

    Ammiano's bill would require people who use sperm donors or surrogate mothers to fill out a series of forms outlining the parental rights and responsibilities of the donor or surrogate before conception.

    The forms required under the legislation are designed to eliminate any gray area about who has the right to visit or care for a child conceived through in vitro or other non-traditional reproductive methods.

    The bill would also create an expedited adoption process for same-sex parents. The process is meant to protect families who move from California to states where a non-biological parent is not recognized under state law unless the child has been legally adopted.

    The measure also requires couples using a surrogate to spell out how they will pay for the medical expenses of the surrogate and the care of the newborn.

  • Hundreds rally in Ireland after rape victim says denied abortion

    By Conor Humphries

    DUBLIN (Reuters) - Hundreds of people rallied in Dublin to call for a change to Ireland's abortion laws on Wednesday after a rape victim said she was refused a termination and instead gave birth by Caesarean section.

    The young migrant's case has reignited a debate about Roman Catholic Ireland's abortion laws, among the most restrictive in Europe, that sparked large protests before parliament voted to allow limited access to abortion for the first time last year.

    "I'm here because I was horrified. This poor girl suffered because she didn't understand the convoluted, stupid system here in Ireland," said Aoife McLysaght, a 38-year old science professor, holding a sign saying 'Forced pregnancy is torture'.

    "We are trying to put pressure on the government, but it seems to be one of those things they'd prefer to ignore. I feel it's only a matter of time before this law is changed. I just want that time to be sooner so fewer people suffer."

    The young foreign national, who cannot be named for legal reasons, told the Irish Times that she became pregnant as a result of rape that took place before she arrived in Ireland.

    She sought help to end the pregnancy when she discovered she was expecting a child, but was turned down by medical authorities. While Irish women seeking abortions typically travel to Britain, which has less strict laws, the woman said she could not do this because she did not have enough money.

    Under the Protection of Life During Pregnancy bill, which was passed a year ago in the wake of the death of an Indian woman who was refused an abortion, a pregnancy can be terminated if the life of the mother is in danger, including by suicide.

    The woman said she had attempted to commit suicide, but was interrupted. But by the time she was assessed by a psychiatrist, she was told her pregnancy was too far advanced to halt it.

    Protesters gathered in central Dublin chanted 'repeal the eighth' in reference to the eighth amendment to the constitution which followed the passing of a 1983 referendum giving the unborn an equal right to life as its mother.

    A United Nations human rights committee told Ireland last month that it should revise its abortion laws to provide for additional exceptions in cases of rape, incest, serious risks to the health of the mother or fatal fetal abnormality.

    The Committee's Chairman Nigel Rodley said Irish law treated women who were raped as a "a vessel and nothing more."

    Ireland's Health Service Executive said in a statement it could not comment on the circumstances of the case until an investigation to be completed by late September.

    Prime Minister Enda Kenny's government has indicated it does not plan to address the issue before the next general election, due by early 2016. It would need to hold another referendum to further amend the law.

    The Pro Life Campaign group said in a statement that the clamor for wider access to abortion laws was obscene as a premature baby clings to life and a chilling and disturbing reminder of the inhumane reality of legalized abortion.

  • California lawmakers pass bill banning inmate sterilizations

    By Sharon Bernstein

    SACRAMENTO, Calif. (Reuters) - California lawmakers sent a bill to ban sterilization surgeries on inmates in California prisons to Governor Jerry Brown on Tuesday, after media reports and a later audit showed officials failed to follow the state's rules for obtaining consent for the procedure known as tubal ligation from incarcerated women.

    The bill prohibits sterilization in correctional facilities for birth control reasons unless a patient's life is in danger or it is medically necessary and no less drastic procedure is possible.

    "It's clear that we need to do more to make sure that forced or coerced sterilizations never again occur in our jails and prisons," said state Senator Hannah-Beth Jackson, who wrote the bill. "Pressuring a vulnerable population into making permanent reproductive choices without informed consent violates our most basic human rights."

    The measure passed the Senate floor with a unanimous vote of 33-0 and now goes to Democratic Governor Jerry Brown for his signature.

    The bill was introduced earlier this year in the wake of allegations, first raised by the non-profit Center for Investigative Reporting, that the state failed to obtain informed consent in cases of women inmates who had their fallopian tubes tied.

    An audit released in June showed that errors were made in obtaining informed consent from 39 women inmates out of 144 who had their tubes tied while incarcerated between 2005 and 2011.

    Prison rules make tubal ligation available to inmates as part of regular obstetrical care. But until the issue was brought to officials' attention in 2010 by an inmates rights group, proper authorization for the procedure was rarely obtained, the state auditor's report said.

    In 27 of those cases, a physician failed to sign the consent form as required, the audit showed. In 18 cases, there were potential violations of a mandated waiting period after women gave consent.

    The audit was the latest blow to the state's troubled prison system and came as California is struggling to meet court-ordered demands to improve medical and mental healthcare in its overcrowded prisons.

    Medical care in California's prisons has been under the supervision of a federally appointed receiver since 2006.

    The current receiver, J. Clark Kelso, was appointed in 2008, but did not learn about problems with tubal ligations until 2010, the audit said.

    Just one such procedure, deemed medically necessary, was performed after the concerns were brought to Kelso's attention, the audit said.

  • Walking, biking and taking public transit tied to lower weight

    By Andrew M. Seaman

    NEW YORK (Reuters Health) - People who walk, bike or take public transportation to work tend to be thinner than those who ride in their own cars, according to a new study from the UK.

    The new findings - including that taking public transportation was just as beneficial as the other "active commuting" modes - point to significant health benefits across society if more people left their cars at home, researchers say.

    "It seems to suggest switching your commute mode - where you can build in just a bit of incidental physical activity - you may be able to cut down on your chance of being overweight and achieve a healthier body composition as well," said Ellen Flint, who led the study.

    Flint and her colleagues from London School of Hygiene and Tropical Medicine and University College London write at TheBMJ.com that physical activity has decreased along with the proportion of people taking active modes of transportation to work.

    There is also evidence to suggest greater increases in obesity rates in areas with larger declines in active travel, they add.

    Active travel or commuting typically refers to walking or biking to work, but Flint and her colleagues suggest the term should be expanded to include taking public transportation, such as buses and trains.

    In their study, Flint said, they found people who reported walking to work weren't walking far - about a mile or less.

    "The walking that goes into commuting to public transport is a similar amount," she told Reuters Health.

    While there is evidence to support a link between walking and biking to work and reduced weight, there is little research that also looks at people who take public transportation.

    For the new study, Flint and her colleagues used data collected from a national sample of people living in the UK who answered survey questions and were visited by a nurse. The researchers had data from 7,424 people on how much body fat they had and from 7,534 on their body mass index (BMI), a measure of weight relative to height.

    In the survey, 76 percent of men and 72 percent of women reported taking a private mode of transportation - usually a car - to work. Ten percent of men and 11 percent of women reported using mostly public transportation and 14 percent of men and 17 percent of women walked or biked to work.

    After adjusting for traits or behaviors that may influence weight or body fat, such as socioeconomic status and other exercise, the researchers found that people who walked, biked or took public transportation to work had lower average BMIs and body fat percentages than people who used private transportation.

    "When you compare public transport to private transport the results are pretty similar to when you compare active transport to private transport," Flint said.

    She and her colleagues write that the differences in body mass and fat would be noticeable. For example, men who actively commuted to work or took public transportation had a BMI score between 0.9 and 1.1 points lower than the men who drove themselves. That can be the equivalent of weighing about seven pounds less for a middle aged man of average height.

    The men's body fat was also between 1.4 and 1.5 percentage points lower among active and public transport commuters, compared to men who drove.

    Similar results were seen for women, whose BMI scores were between 0.7 and 0.9 points lower among active and public commuters compared to women who drove. For a 5-foot 4-inch woman the difference would translate to about 6 lbs.

    Amy Auchincloss of Drexel University in Philadelphia said the study's results are strong because its data are from people living in many different areas, although the findings can't prove that walking, biking or taking public transportation causes people to lose weight.

    "But at minimum it appears from these preliminary data that not driving/not using automobiles will at least aide populations in healthier weight maintenance - if not directly lead to healthier weight," Auchincloss, who was not involved with the new study, said in an email.

    Other studies have also suggested that a more active commute to work has a variety of benefits, according to Anthony Laverty, who co-wrote an editorial accompanying the new study.

    "This study focuses on weight," he said. "There are other studies that show people who don't drive to work are less likely to have high blood pressure and diabetes."

    "If we had this big shift of people taking public transport, walking or cycling you would have these benefits add up," said Laverty, of Imperial College London.

    With obesity prevention already a focus of policymakers, Flint said working on getting more people to walk, bike or take public transportation may be worthwhile.

    "In Britain - in common with a lot of industrial nations - the vast majority of commuters use cars. Therefore there is a huge potential for an intervention of access to public transportation for health benefit," she said.

    SOURCE: http://bit.ly/YuljgS TheBMJ, online August 19, 2014.