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

Neuroscience Articles

  • Don't worry: Neuroticism linked to Alzheimer's risk in women

    By Andrew M. Seaman

    NEW YORK (Reuters Health) - Anxious, jealous, moody, distressed women are more likely to develop Alzheimer's disease later in life than their calmer and less stressed-out counterparts, suggests a new study.

    Women who scored highest on a test for neuroticism in mid-life were twice as likely to go on to develop Alzheimer's disease, compared to women with the lowest neuroticism scores, researchers found.

    "All common disorders like Alzheimer's disease or cardiovascular disease are multi-factorial and this is one of the factors," said Dr. Ingmar Skoog, the study's senior author from the University of Gothenburg in Sweden.

    The findings may suggest that people with certain negative personality traits could use behavioral therapies to tackle those and thereby also reduce their risk of developing Alzheimer's disease later in life, researchers said.

    "I think for the average person, it's not that 'I have neuroticism and I'm going to get Alzheimer's disease,'" said Dr. James Galvin. "It's, 'I have these traits and doing something about these traits can do something about my risk.'"

    Galvin, who was not involved in the new study, is a professor of neurology, psychiatry, and population health at NYU Langone Medical Center in New York City.

    About 5 million Americans are living Alzheimer's disease, according to the U.S. Centers for Disease Control and Prevention. It is the most common form of dementia.

    While the exact cause of Alzheimer's disease is unknown, researchers have identified a variety of risk factors for developing the condition, including high blood pressure and high cholesterol.

    Skoog and his colleagues write in the journal Neurology that personality may also influence Alzheimer's risk through its effects on behavior and lifestyle. Neuroticism, specifically, has already been linked to dementia and Alzheimer's disease, they add.

    For the new study, the researchers tracked 800 middle-aged women for 38 years starting in 1968 when they were between 38 and 54 years old.

    About 19 percent - or 153 - of the women ended up with dementia by the end of the study. Of those, 104 were diagnosed with Alzheimer's disease.

    Women who scored the highest on a test for neuroticism at the start of the study were twice as likely to be diagnosed with Alzheimer's disease, compared to those who scored lowest on that test.

    After accounting for stresses the women experienced throughout their lives, the connection between neuroticism and dementia weakened. The researchers have previously reported that stress during middle-age may increase the risk of dementia, including Alzheimer's disease.

    In addition to neuroticism, the researchers also looked at how extroverted the women were and found that being extroverted was tied to less stress. Women who were the most neurotic and least extroverted were most likely to develop Alzheimer's disease.

    While the study only included women, Skoog and Galvin both said they don't think the results would be different among men.

    The results do not prove that being neurotic causes Alzheimer's disease. There can be a few explanations, including, for example, that neuroticism may promote unhealthy lifestyles or behaviors that increase other risk factors for Alzheimer's disease.

    Still, Skoog said, addressing neuroticism with treatments like cognitive behavioral therapy may lower stress throughout a person's life and ultimately reduce the risk of Alzheimer's disease.

    "If we can identify things that are addressable in midlife, then we may be able to subsequently reduce the risk of bad outcomes in later life," Galvin said.

    Healthy diet and exercise in midlife have also been thought to reduce the likelihood of developing Alzheimer's disease later on, Skoog said.

    "Now you have this thing, if you have a high neuroticism scores, you can try to do something about it," he said. "I think that's the take home message for this."

    SOURCE: http://bit.ly/1xCRlWx Neurology, online October 1, 2014.

  • YOUR MONEY-How to choose the best rehab facility

    By Beth Pinsker

    NEW YORK (Reuters) - This summer, I had the arduous and rushed task of picking a rehabilitation center for my dad, as post-operative complications left him too ill to return home at the time, yet the hospital was keen to discharge him.

    This is an endeavor few people think about. Recent market research by Genesis HealthCare shows that 96 percent of people between 60 and 75 don't expect surgery or an injury over the next year. Some 83 percent could not name a single rehabilitation center.

    "There's no brand loyalty, no preferences - and that leaves the consumer out there with an A-Z list and not knowing what to do," says Carol Rohrbaugh, a vice president of business development for Genesis, which has more than 400 care facilities across 28 states.

    After my father's first surgery in late July, my family - pushed for time - selected a place from a list of rehab centers provided by the hospital based on location.

    This would seem a logical factor to have based the decision on. However, medication didn't arrive on time, nurses were harried and the ward overcrowded with dementia patients, who were monitored in the hallways.

    In fact, there are remarkable differences among rehab facilities, which I learned after my dad required a second surgery and further rehab. Some are the dingy warehouses of everyone's nightmares while others resemble vacation spas.

    Here's what the experts say on how you can pick the best rehab facility:

    PLAN AHEAD

    Just as you might know what hospital you'd wish to be admitted to in an emergency, consider what you'd do if you're released from hospital but aren't well enough to return home, advises Dr. Rebecca Boxer, a associate professor of medicine at the University of Colorado School of Medicine in Aurora.

    "When people don't know what they don't know, it can be a disaster," she says.

    Research can be as simple as word-of-mouth recommendations. Get past a certain age and you're bound to know somebody who stayed at a rehab center after a hip replacement, (or whose mother did). Find out about response time to the call button, medication management and food quality.

    RESEARCH

    After my dad's second hospital stay, we did more intensive research, branching out beyond the hospital's provided list to stand-alone rehab centers and regional specialty centers.

    We checked the Medicare ratings (http://www.medicare.gov/nursinghomecompare/) and any reviews that were available on web sites (like http://caring.com), but the information online was limited.

    Medicare ratings can be misleading, too, says Boxer, because they measure limited criteria, like rate of flu vaccination, which has little bearing on helping my dad walk again.

    JUDGING BY LOOKS (OR SMELL)

    Judging a place by looks can be deceiving, as fancy décor doesn't mean there is good nursing care, says Bunni Dybnis, a certified geriatric care manager in the Los Angeles area (http://livhome.com).

    "Sometimes, good to your eyes may not be good at all," she says.

    Dybnis suggests concentrating most on what the staff is doing. Are they waiting for the bell to go off or are they checking on patients constantly? What is happening at night?

    There is a lot to be said for the "smell" test. The newer facilities that have spiffed up features - bistro-style dining, lounge areas with big TVs, ornate lobbies - definitely appealed to my family emotionally.

    DURATION OF STAY

    More telling are the hallways. Some traditional nursing homes I toured had rehab patients intermixed with long-term residents with serious disabilities, including dementia. That's frightening for morale if you're there with a broken hip.

    A few had separate wings for short-term patients, with their own rehabilitation services and amenities. One was a hospital-level setting with specialty care for my dad's condition, and one was only for rehab patients.

    "Those that earmark a certain section for skilled rehab, that's preferable than having it all mixed up with long-term care," advises Boxer.

    Two of the biggest nursing care systems, Genesis Health Systems and HCR ManorCare, are attempting to upgrade services for short-term rehab patients as they jockey for market share. Other systems are also adding new facilities.

    Genesis has a growing chain of 10 Power Back centers that are for rehab only. All rooms are private, a chef prepares food in an open lobby kitchen and the TVs have 400 channels for a fee of $3 per day. (Disclosure: My dad ended up in one of these centers).

    HCR ManorCare has MedBridge, short-term rehabs units among its 300 facilities in 32 states. While they've had these going on 10 years, they just started to conceptualize them as a product, with some in stand-alone buildings.

    EVALUATE EXTRAS

    Care for the patient is all-inclusive on most plans, but that doesn't mean there won't be costs. Medicare covers 20 days at 100 percent after a qualifying hospital stay, and then charges a co-pay of $152 per day for the next 80 days.

    Private insurance varies greatly, with some charging a daily co-pay of $25 to $50 and some having limits on the number of days covered.

    If you're paying out of pocket, costs run about $12,000 a month at HCR ManorCare facilities, says Julie DiCicco, manager of market development at HCR ManorCare. At-home care costs $20 per hour or more.

    Incidentals can include phone and TV access, salon services, personal laundry and transport to medical appointments outside the facility.

    Some experimental or "extra" therapies are not covered or only partially covered - such as Power Back's rehab program to help people drive again, which can cost $300 to $600 out of pocket.

    Family extras can add up quickly, especially if members need travel and lodging, not to mention the cost of lost time at work.

    For those who can't handle the list, there are geriatric care managers like Dybnis who work for hourly rates ranging from $80 to $135 an hour.

    "A care manager in THE area where your parent is can have a lot of insight," says Boxer, especially if you're trying to triage care from far away. "They can be a lifesaver."

  • For most Americans, spanking is OK, implements are not, poll shows

    By David Bailey

    (Reuters) - Nearly seven in 10 Americans believe spanking a child is acceptable at home and a majority say corporal punishment is tolerable provided it does not involve implements such as the one a National Football League star used on his son, a Reuters/Ipsos poll found.

    The findings help explain where Americans stand on corporal punishment after the indictment on child abuse charges of Adrian Peterson, a top NFL running back, in a case that sparked a contentious public debate over what is acceptable.

    The 29-year-old Minnesota Viking allegedly left bruises and wounds on his 4-year-old son while disciplining him with the whippy end of a tree branch, called a switch, an act that Peterson has publicly admitted to.

    The online survey of 3,637 adults found that about 68 percent approved of spanking at home, and that figure varied little between race and income groups.

    But there were regional differences. About eight in 10 respondents from the Southwest, which included Peterson's home state of Texas, said corporal punishment should be allowed at home, while just over half of New England respondents held that view.

    A majority of respondents, about 60 percent, said corporal punishment was acceptable if it doesn't leave a physical mark, about the same number who said it should be allowed if it doesn't involve an implement such as a belt, cane or paddle.

    "I don't care what age the child is or what they did, you don't use anything but your hand. I'm sorry, but that just goes above and beyond as far as I am concerned," said respondent Esther Negrin, 78, of Las Vegas, Nevada.

    Negrin said a "swat on the behind" was a very rare occurrence while she was raising her three children.

    MAJORITY PUNISHED AS CHILDREN

    The survey supports the belief that corporal punishment is employed less these days in the United States than decades ago.

    Three in four respondents said they had received corporal punishment as a child, more whites than minorities, and whites with children at home were slightly more likely to say they had carried out corporal punishment than were minorities.

    More older respondents reported receiving corporal punishment than did younger adults.

    After his Sept. 12 indictment, Peterson, a 2012 NFL most valuable player, said he disciplined his son the way he was as a child and caused an injury he never intended or thought would happen.

    Poll respondent Joyce Ray, 72, said she used the technique of "time out" a lot while raising 10 children.

    "I don't believe in people beating on their children or starving them or things like that as punishment," said Ray, a retired seamstress from Junction City, Oregon.

    "But I do believe that a swat across the fanny is not going to hurt them any and maybe will teach them a lesson," she added.

    The Peterson case is one of five recent domestic violence incidents involving NFL players that have raised questions about the league's handling of disciplinary cases. It is the only one involving a child.

    About 12 percent of respondents strongly disagreed with corporal punishment being allowed at home.

    Poll respondent Donald Barton, like the American Academy of Pediatrics, said he strongly opposes corporal punishment including spanking for children in part because it sends the message that physical force is acceptable.

    "Timeouts are good because they make the kids concentrate on what they did, rather than pain," said Barton, 61, who lives in Detroit, Michigan.

    The pediatrics academy has said physical discipline of children has been linked to a range of mental health problems and can make children more aggressive.

    The poll was conducted from Sept. 19 through Sept. 30 as the NFL struggled with questions over initial light punishment for Peterson and former Baltimore Ravens running back Ray Rice.

    Peterson was reactivated to play after he sat out one game following the indictment, but on Sept. 17 the Vikings reversed course and suspended him indefinitely as criticism mounted from fans and sponsors. He is scheduled to appear in court on Oct. 8.

    The precision of the Reuters/Ipsos online polls is measured using a credibility interval. In this survey, the credibility interval was 1.8 percentage points for the 3,637 adults surveyed online on whether corporal punishment is OK if it is spanking only.

  • Loss of smell may be predictor of death in older adults -study

    By Bill Berkrot

    (Reuters) - Being unable to smell bacon frying may be far more dire than simply missing out on one of life's pleasures. In older adults, it could be a predictor of increased risk of death within five years.

    In a study of more than 3,000 people aged 57 to 85, 39 percent of subjects who failed a simple smelling test died within five years, according to results published on Wednesday in the science journal PLOS ONE.

    That compared with a 19 percent death rate within five years for those with moderate smell loss and 10 percent for those deemed to have a healthy sense of smell.

    "Compared to a person with a normal sense of smell, a person with an absent sense of smell has three times greater risk of dying within a five-year span," Dr. Jayant Pinto, the study's lead author, said in a telephone interview.

    "What this tells us is your sense of smell is a great indicator of your overall health," said Pinto, an associate professor at the University of Chicago who specializes in genetics and treatment of olfactory and sinus disease.

    He likened the loss of smell to a canary in a coal mine. "It doesn't cause death, but it's an early warning that something has gone badly wrong."

    The smell test was conducted in 2005 using "Sniffin' Sticks," which resemble felt-tip pens, that were loaded with five different odors subjects were asked to identify: peppermint, fish, orange, rose or leather.

    Nearly 78 percent of those tested were able to identify at least four of the five scents and so classified as having normal sense of smell. Almost 20 percent got two or three of the scents right, while the remaining 3.5 percent could correctly identify one or none of the five, researchers said.

    In 2010 and 2011, the survey team confirmed which participants were still alive. During the five years, 430 of the 3,005 subjects, or 12.5 percent, had died.

    Researchers conducted interviews to adjust for variables and risk factors, such as age, smoking, alcohol use, overall health and socioeconomic status. In the end, those with greater smell loss when first tested were substantially more likely to have died five years later.

    "It predicted it quite strongly," Pinto said.

    Researchers noted that a healthy olfactory system has stem cells that self-regenerate. They speculated that a loss of smell could signal a decrease in the body's ability to rebuild key components and may be a harbinger of more serious health problems.

    "If one's sense of smell is in decline, it's a warning sign for doctors taking care of such patients," Pinto said.

    SOURCE: http://bit.ly/1vy3iup PLOS ONE, online October 1, 2014.

  • Study finds weak evidence for garlic in high blood pressure

    By Shereen Lehman

    NEW YORK (Reuters Health) - A new analysis of past clinical trials using garlic supplements against high blood pressure finds a modest benefit, but researchers urge longer, more rigorous studies to assess the popular alternative "treatment."

    "Many individuals with high blood pressure oppose conventional antihypertensive drugs and are more open to 'natural' treatment," said the study's senior author Dr. Alain Nordmann, of the Basel Institute for Clinical Epidemiology and Biostatics at the University of Basel in Switzerland.

    "There is some evidence that garlic may lower blood pressure in individuals with hypertension in the short-term, but the quality of the studies are not that great and long-term data is missing," Nordmann told Reuters Health in an email.

    Nearly one of every three adults in the United States has high blood pressure, which increases their risk of heart attacks, strokes, heart failure and kidney disease.

    Worldwide, high blood pressure, or hypertension, contributes to about half of deaths due to stroke or heart disease, Nordmann and his colleagues write in the American Journal of Hypertension.

    A significant portion of people with high blood pressure don't have it under control, they add, and one reason is that patients often fail to take their medications.

    Seeking alternatives to current blood pressure medicines, many people have turned to garlic - usually in the form of dried-garlic capsules - for its supposed blood pressure lowering properties. But only a handful of trials have shown evidence that garlic helps people with hypertension.

    Nordmann and colleagues collected data from nine previously published studies that included 482 people with blood pressure readings of at least 140/90 mm Hg, the cutoff for diagnosis of high blood pressure.

    All the studies compared garlic with either a placebo or regular care and lasted at least four weeks.

    When Nordmann's team combined the data, they found statistically significant reductions in systolic blood pressure (the top number) by about 9 mm Hg and diastolic blood pressure by about 4 mm Hg when garlic preparations were used.

    The authors say the effect was comparable to blood pressure-lowering medications, at least in the short term.

    But, they note, most of the studies were small, and their methods were not ideal. In addition, most of the studies used garlic powder, but the dosages ranged from 600 to 2,400 milligrams per day. And some of the studies used fresh garlic instead.

    When the review team re-analyzed the results using only the highest quality studies, the effectiveness of garlic was not as strong.

    "More than 25 years after the first garlic trial it is about time to conduct 'the' definite trial," Nordmann said. "I assume funding is the problem since no drug company has an interest in a natural product lowering blood pressure."

    Nordmann said that people who are thinking about using garlic should wait until larger, high quality long-term trials are completed before taking garlic.

    "If they refuse to take conventional antihypertensive drugs, garlic is an option, but blood pressure must be carefully monitored," he said.

    "I think that they did a very good faith effort to thoroughly evaluate the literature about the potential impact of garlic on blood pressure," said Dr. Robert Ostfeld, a cardiologist and director of the Cardiac Wellness Program at Montefiore Medical Center in New York.

    "And there are some interesting reasons to think that garlic might be helpful for blood pressure in that there are other studies that suggest garlic may improve blood vessel function, and it has antioxidant and anti-inflammatory properties," said Ostfeld, who was not involved in the new study.

    He noted that there are "plusses and minuses" when doing this type of analysis of previous research, including biases in the individual studies, and the authors acknowledge that.

    Osfeld agrees with the conclusion that there's insufficient evidence to have confidence that garlic is an effective therapy for high blood pressure.

    "I think honestly the jury is still out," he said. There's a physiological rationale to think it might work, but we lack conclusive evidence, he said.

    Ostfeld said that for the most part, eating garlic is safe, except for some people who may be taking multiple blood thinners, such as Coumadin. He added that patients on these medications should talk to their doctor before taking garlic.

    It's very important for people to know they should not replace proven therapies for high blood pressure with garlic based on this study, Ostfeld said.

    He added that it's common for people to look for a magic bullet to fix a problem such as high blood pressure.

    "I think a magic bullet already exists and that would be a healthier lifestyle - a whole-food, plant-based diet, which garlic can be a delicious addition to, and regular exercise as your medical condition permits," he said.

    "I think the combination of those two things will go a very long way to helping to improve oneself and garlic is a piece of that very, very important puzzle," Ostfeld said.

    SOURCE: http://bit.ly/1sLlxOb American Journal of Hypertension, online September 18, 2104.

Oncology Articles

  • CORRECTED-Discuss risks of radiation imaging: cardiologists

    (Corrects name of academic journal in paragraph 5 to Circulation.)

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Cardiologists should discuss with patients the risks and benefits of chest imaging using ionizing radiation before the procedure, according to a new statement endorsed by several medical organizations.

    Ionizing radiation, which can come from cardiac stress tests, CT scans and certain heart procedures, is tied to increased cancer risk.

    "There is continuing concern on the part of patients in the area of ionizing radiation," said Dr. Andrew J. Einstein, an associate professor of medicine in radiology at Columbia University in New York.

    In general, the risks of the radiation are small and the benefits of clinically appropriate imaging outweigh the risks, but many patients still have unanswered questions, said Einstein, a member of the writing committee for the new statement.

    The statement, published in the journal Circulation, is endorsed by the American Heart Association, the American College of Cardiology and several other medical organizations.

    "The purpose of this document is to address physicians in particular and provide recommendations in terms of methods that can enhance safety and methods that can enhance patient understanding," he told Reuters Health by phone.

    He and his coauthors recommend that providers explain to patients why radiation imaging is being used, the risks it involves and the benefits it offers.

    The decision to go ahead with ionizing radiation imaging should be shared between the doctor and the patient, they write.

    "Patient centered imaging is really tailored to the needs of the patient and their preferences," Einstein said. "The education responsibility falls squarely on the doctors."

    "As doctors, it is our obligation to make sure that we, our colleagues and our patients understand the potential benefits of a medical imaging study as well as potential risks," he said. "Patients shouldn't be scared off by a one in X chance of developing cancer, they should be reassured by the benefits of the imaging."

    For example, concerned patients should be reassured during certain heart procedures that the benefits are greater than the small risk posed by the radiation, Einstein said.

    Radiation imaging helps obtain useful, in many cases crucial information for decisions regarding the treatment, which often is life-saving, said Yehoshua Socol, a physicist and executive analyst at Falcon Analytics in Karnei Shomron, Israel.

    Socol was not involved in writing the new statement.

    Cancer risk only elevates slightly after multiple exposures to the radiation, he told Reuters Health by email.

    Past studies have found, however, that the small amount of radiation absorbed through medical tests may increase the risk of cancer over a lifetime (see Reuters Health stories of June 6, 2012 here: http://reut.rs/Ms8cWl and of July 13, 2009 here: http://reut.rs/1yylxne).

    For heart patients, there is no federal regulation of radiation dose for medical tests, leaving the appropriate use in the hands of doctors.

    "When it comes to ionizing radiation doses there is tremendous variability between facilities for the same tests," Einstein said.

    Some of that is because doses are tailored to the individual patient, but some is unnecessary, he said.

    The statement includes recommendations for making sure the right test is being done at the right time and that the lowest possible dose of radiation is used.

    "You should use enough radiation to answer the question but not more so than you need," he said.

    Doctors ordering imaging tests should understand when each type of test is appropriate, the typical average radiation dose, diagnostic accuracy, potential risks, availability, cost, and convenience, according to the statement.

    SOURCE: http://bit.ly/1orlP5v Circulation, online September 29, 2014

  • CORRECTED-Discuss risks of radiation imaging: cardiologists

    (Corrects name of academic journal in paragraph 5 to Circulation.)

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Cardiologists should discuss with patients the risks and benefits of chest imaging using ionizing radiation before the procedure, according to a new statement endorsed by several medical organizations.

    Ionizing radiation, which can come from cardiac stress tests, CT scans and certain heart procedures, is tied to increased cancer risk.

    "There is continuing concern on the part of patients in the area of ionizing radiation," said Dr. Andrew J. Einstein, an associate professor of medicine in radiology at Columbia University in New York.

    In general, the risks of the radiation are small and the benefits of clinically appropriate imaging outweigh the risks, but many patients still have unanswered questions, said Einstein, a member of the writing committee for the new statement.

    The statement, published in the journal Circulation, is endorsed by the American Heart Association, the American College of Cardiology and several other medical organizations.

    "The purpose of this document is to address physicians in particular and provide recommendations in terms of methods that can enhance safety and methods that can enhance patient understanding," he told Reuters Health by phone.

    He and his coauthors recommend that providers explain to patients why radiation imaging is being used, the risks it involves and the benefits it offers.

    The decision to go ahead with ionizing radiation imaging should be shared between the doctor and the patient, they write.

    "Patient centered imaging is really tailored to the needs of the patient and their preferences," Einstein said. "The education responsibility falls squarely on the doctors."

    "As doctors, it is our obligation to make sure that we, our colleagues and our patients understand the potential benefits of a medical imaging study as well as potential risks," he said. "Patients shouldn't be scared off by a one in X chance of developing cancer, they should be reassured by the benefits of the imaging."

    For example, concerned patients should be reassured during certain heart procedures that the benefits are greater than the small risk posed by the radiation, Einstein said.

    Radiation imaging helps obtain useful, in many cases crucial information for decisions regarding the treatment, which often is life-saving, said Yehoshua Socol, a physicist and executive analyst at Falcon Analytics in Karnei Shomron, Israel.

    Socol was not involved in writing the new statement.

    Cancer risk only elevates slightly after multiple exposures to the radiation, he told Reuters Health by email.

    Past studies have found, however, that the small amount of radiation absorbed through medical tests may increase the risk of cancer over a lifetime (see Reuters Health stories of June 6, 2012 here: http://reut.rs/Ms8cWl and of July 13, 2009 here: http://reut.rs/1yylxne).

    For heart patients, there is no federal regulation of radiation dose for medical tests, leaving the appropriate use in the hands of doctors.

    "When it comes to ionizing radiation doses there is tremendous variability between facilities for the same tests," Einstein said.

    Some of that is because doses are tailored to the individual patient, but some is unnecessary, he said.

    The statement includes recommendations for making sure the right test is being done at the right time and that the lowest possible dose of radiation is used.

    "You should use enough radiation to answer the question but not more so than you need," he said.

    Doctors ordering imaging tests should understand when each type of test is appropriate, the typical average radiation dose, diagnostic accuracy, potential risks, availability, cost, and convenience, according to the statement.

    SOURCE: http://bit.ly/1orlP5v Circulation, online September 29, 2014

  • French pharmacies shuttered in protest against reform plans

    By Reuters Staff

    PARIS (Reuters) - All but a handful of France's pharmacies were closed on Tuesday to protest the Socialist government's plans to introduce more competition into the sector.

    Pharmacists were the latest profession to challenge President Francois Hollande's plans to deregulate their activities following a first-ever street protest earlier this month by notaries.

    Economy Minister Emmanuel Macron hopes to give the euro zone's second-biggest economy a boost by shaking up regulations that currently give 37 professions, ranging from court clerks to taxi drivers, a monopoly-like grip on their industry.

    Pharmacists are worried that the reform will allow supermarkets to sell over-the-counter drugs and pave the way to big outside investors buying up owner-run pharmacies.

    About 97 percent of the pharmacies not ordered by law to remain open remained shuttered on Tuesday, according to the national order of pharmacists.

    Big retailers like supermarket chain E.Leclerc are lobbying hard to win the right to sell non-prescription drugs, including by airing prime-time television spots.

    Macron, a 36-year-old former investment banker who was also previously Hollande's top economic adviser, said there were many false ideas circulating about the deregulation bill, which he aims to present at the end of the year.

    "The bill aims to modernise the country in order to create activity wherever it's possible and to lower prices for households and companies," Macron said in an interview with regional newspaper Paris-Normandie.

  • Roche breast cancer drug "unprecedented" in extending lives

    By Ben Hirschler

    MADRID (Reuters) - A new breast cancer drug from Roche has shown "unprecedented" benefits in extending lives in a clinical trial and experts urged its widespread use for women with an aggressive form of the disease.

    Patients with a type of breast cancer known as HER2 positive, which makes up about a quarter of all breast cancers, who were given Perjeta on top of older medicine Herceptin and chemotherapy lived 15.7 months longer than those on Herceptin and chemotherapy alone.

    That is the longest extension to survival ever seen for a drug studied in metastatic breast cancer and also an unusually good result for any type of metastatic cancer, where disease has spread to other parts of the body.

    The result is a vindication of combining medicines that fight tumour cells in a variety of ways.

    Both Herceptin and Perjeta are antibodies designed to block the function of HER2, a protein produced by a cancer-linked gene. Perjeta, also known as pertuzumab, binds to a different part of the same protein, which makes combining the two drugs extra effective.

    "The results, I think, are phenomenal," lead researcher Sandra Swain from the Washington Hospital Center told the European Society for Medical Oncology (ESMO) annual congress in Madrid on Sunday.

    "The survival improvement of nearly 16 months ... is unprecedented among studies of metastatic breast cancer."

    Perjeta, which was approved by regulators two years ago, was tested in the Roche-backed study involving more than 800 women.

    Researchers had previously reported the Perjeta drug regimen significantly extended progression-free survival, or the period of time patients live without their disease worsening, but the final overall survival data has taken longer to collect.

    The median overall survival time was 56.5 months for those given Perjeta against the already impressive 40.8 months for patients taking only the older drugs.

    Looking at the study results a different way, the risk of dying was reduced by 32 percent for women who received the Perjeta regimen compared to those who got Herceptin and chemotherapy.

    While both Perjeta and Herceptin have side effects, including rash, diarrhea and a potentially adverse impact on heart function, using the two drugs together did not make these issues any worse.

    "I think these data are really compelling," said Eric Van Cutsem of the University of Leuven, who was not involved in the research. "When you see in breast cancer such a big change in survival with not a lot of cardio-toxicities then that is really practice-changing."

    REMARKABLE RESULTS

    Swain and Javier Cortes, another researcher on the study from the Vall D'Hebron Institute of Oncology in Barcelona, said the results suggested using Perjeta should now be the standard of care for HER2 positive breast cancer patients.

    A favorable reaction from oncologists will underpin expectations of strong sales for Perjeta, which analysts currently expect to sell $3.1 billion a year by 2018, according to consensus forecasts compiled by Thomson Reuters Cortellis.

    But it poses a challenge for healthcare providers, since Perjeta and Herceptin are costly injectable drugs and the multiple-drug regimen promises to strain budgets.

    In the United States, the monthly price of Perjeta is approximately $5,900, while Herceptin costs around $5,300, a Roche spokeswoman said. Prices in Europe are lower.

    For Roche, Perjeta is an important new product that should help defend its position in breast cancer, following the success of Herceptin, which was first approved in 1998.

    The company said the latest data would be submitted to regulatory authorities around the world for inclusion in the prescribing information for Perjeta.

    The Swiss drugmaker also has another related drug called Kadcyla, which is also being tested in combination with Perjeta. Some analysts believe Kadcyla's prospects could be curbed if results from that combination are not better than the impressive findings reported this weekend.

  • Florida marijuana campaign heats up, could raise Nov. turnout

    By Bill Cotterell

    TALLAHASSEE (Reuters) - Opponents of a proposal to let doctors in Florida prescribe marijuana are poised to launch a $1.6 million advertising campaign on Monday, with potential side effects for the state's heated race for governor in November.

    Political consultants say a public battle over the proposed constitutional amendment to allow medical marijuana, included on this year's midterm election ballot, could boost turnout among young voters for Democrat Charlie Crist, who supports the measure. The extra support may be enough to help him defeat incumbent Republican Governor Rick Scott, who opposes it.

    But opponents of Amendment 2 got a major boost when Sheldon Adelson, Las Vegas casino magnate and a major Republican fundraiser, put up $2.5 million of the $3.2 million raised by Drug Free Florida.

    The ads will attack "loopholes," which law enforcement authorities say could lead to recreational use of the drug, said Sarah Bascom, whose Tallahassee consulting firm is handling the Drug Free Florida campaign.

    "Our message is, this is not about sick people," she said. Even if more young voters turn out for the marijuana referendum, Bascom said "a vote down-ticket doesn't mean they're going to vote up-ticket" in the governor's race.

    Some 23 U.S. states and the District of Columbia already have passed laws allowing medical marijuana in some form, beginning with California in 1996.

    The public petition campaign that put the amendment on the Florida ballot promised relief for suffers of diseases like cancer, AIDS and ALS, also known as Lou Gehrig's disease. But the measure would also allow doctors to prescribe marijuana whenever they determine benefits outweigh potential risks.

    The no campaign is being supported by wide-ranging "Don't Let Florida Go To Pot" coalition of medical and law-enforcement organizations arguing that the amendment does not provide any minimum age or residency requirements for obtaining marijuana.

    Orlando trial lawyer John Morgan, a Crist backer who figures on spending $6 million of his own money on the medical-marijuana initiative, believes the referendum will draw up to 4 percent more voters to the polls Nov. 4, including college students who believe marijuana is no big deal, elderly voters who have friends who covertly puff some pot to relieve nausea from chemotherapy and libertarians who believe it is none of the government's business.

    Morgan, who has been touring the state in a motorcoach, said the amendment might help Crist in what is expected to be a close race, but denied sponsoring the drive for that reason.

    "We're registering people who never registered before, so I think turnout is going to be 2, 3, maybe even 4 points higher than we might have seen, but for this," he said during a visit to the University of Florida last week.

    While supporting the amendment, Crist has distanced himself a little from the medical marijuana campaign.

    "It might get more younger voters to turn out," Crist, a former Republican who was governor 2007-11, said in an interview. "I really don't know is the honest answer," he added. "It may well increase turnout because if you're educating people about this being on the ballot, who otherwise might not have known it, then you're ginning it up."

    Supporters of the amendment say polling shows nearly 70 percent of likely voters back the measure with only 28 percent opposed.

    But a recent Public Policy Polling survey showed just 61 percent support and a poll by the Tampa Bay Times/Bay News 9 and the Bob Graham Center at the University of Florida showed only 57 percent backing. Florida constitutional amendments require 60 percent support to pass.

    Steve Schale, a member of the Crist campaign and a senior aide in President Barack Obama's two Florida campaigns, said amendment supporters might favor Crist more than Scott, but jobs, education and many other issues will be more decisive.

    David Johnson of Strategic Vision in Atlanta, a Republican campaign planner, said it was hard to see young voters turning out in large numbers over one issue.

    However, he cautioned, "Remember, even an uptick of 1 or 2 percent in a close race could make the difference."

Orthopedic Articles

  • YOUR MONEY-How to choose the best rehab facility

    By Beth Pinsker

    NEW YORK (Reuters) - This summer, I had the arduous and rushed task of picking a rehabilitation center for my dad, as post-operative complications left him too ill to return home at the time, yet the hospital was keen to discharge him.

    This is an endeavor few people think about. Recent market research by Genesis HealthCare shows that 96 percent of people between 60 and 75 don't expect surgery or an injury over the next year. Some 83 percent could not name a single rehabilitation center.

    "There's no brand loyalty, no preferences - and that leaves the consumer out there with an A-Z list and not knowing what to do," says Carol Rohrbaugh, a vice president of business development for Genesis, which has more than 400 care facilities across 28 states.

    After my father's first surgery in late July, my family - pushed for time - selected a place from a list of rehab centers provided by the hospital based on location.

    This would seem a logical factor to have based the decision on. However, medication didn't arrive on time, nurses were harried and the ward overcrowded with dementia patients, who were monitored in the hallways.

    In fact, there are remarkable differences among rehab facilities, which I learned after my dad required a second surgery and further rehab. Some are the dingy warehouses of everyone's nightmares while others resemble vacation spas.

    Here's what the experts say on how you can pick the best rehab facility:

    PLAN AHEAD

    Just as you might know what hospital you'd wish to be admitted to in an emergency, consider what you'd do if you're released from hospital but aren't well enough to return home, advises Dr. Rebecca Boxer, a associate professor of medicine at the University of Colorado School of Medicine in Aurora.

    "When people don't know what they don't know, it can be a disaster," she says.

    Research can be as simple as word-of-mouth recommendations. Get past a certain age and you're bound to know somebody who stayed at a rehab center after a hip replacement, (or whose mother did). Find out about response time to the call button, medication management and food quality.

    RESEARCH

    After my dad's second hospital stay, we did more intensive research, branching out beyond the hospital's provided list to stand-alone rehab centers and regional specialty centers.

    We checked the Medicare ratings (http://www.medicare.gov/nursinghomecompare/) and any reviews that were available on web sites (like http://caring.com), but the information online was limited.

    Medicare ratings can be misleading, too, says Boxer, because they measure limited criteria, like rate of flu vaccination, which has little bearing on helping my dad walk again.

    JUDGING BY LOOKS (OR SMELL)

    Judging a place by looks can be deceiving, as fancy décor doesn't mean there is good nursing care, says Bunni Dybnis, a certified geriatric care manager in the Los Angeles area (http://livhome.com).

    "Sometimes, good to your eyes may not be good at all," she says.

    Dybnis suggests concentrating most on what the staff is doing. Are they waiting for the bell to go off or are they checking on patients constantly? What is happening at night?

    There is a lot to be said for the "smell" test. The newer facilities that have spiffed up features - bistro-style dining, lounge areas with big TVs, ornate lobbies - definitely appealed to my family emotionally.

    DURATION OF STAY

    More telling are the hallways. Some traditional nursing homes I toured had rehab patients intermixed with long-term residents with serious disabilities, including dementia. That's frightening for morale if you're there with a broken hip.

    A few had separate wings for short-term patients, with their own rehabilitation services and amenities. One was a hospital-level setting with specialty care for my dad's condition, and one was only for rehab patients.

    "Those that earmark a certain section for skilled rehab, that's preferable than having it all mixed up with long-term care," advises Boxer.

    Two of the biggest nursing care systems, Genesis Health Systems and HCR ManorCare, are attempting to upgrade services for short-term rehab patients as they jockey for market share. Other systems are also adding new facilities.

    Genesis has a growing chain of 10 Power Back centers that are for rehab only. All rooms are private, a chef prepares food in an open lobby kitchen and the TVs have 400 channels for a fee of $3 per day. (Disclosure: My dad ended up in one of these centers).

    HCR ManorCare has MedBridge, short-term rehabs units among its 300 facilities in 32 states. While they've had these going on 10 years, they just started to conceptualize them as a product, with some in stand-alone buildings.

    EVALUATE EXTRAS

    Care for the patient is all-inclusive on most plans, but that doesn't mean there won't be costs. Medicare covers 20 days at 100 percent after a qualifying hospital stay, and then charges a co-pay of $152 per day for the next 80 days.

    Private insurance varies greatly, with some charging a daily co-pay of $25 to $50 and some having limits on the number of days covered.

    If you're paying out of pocket, costs run about $12,000 a month at HCR ManorCare facilities, says Julie DiCicco, manager of market development at HCR ManorCare. At-home care costs $20 per hour or more.

    Incidentals can include phone and TV access, salon services, personal laundry and transport to medical appointments outside the facility.

    Some experimental or "extra" therapies are not covered or only partially covered - such as Power Back's rehab program to help people drive again, which can cost $300 to $600 out of pocket.

    Family extras can add up quickly, especially if members need travel and lodging, not to mention the cost of lost time at work.

    For those who can't handle the list, there are geriatric care managers like Dybnis who work for hourly rates ranging from $80 to $135 an hour.

    "A care manager in THE area where your parent is can have a lot of insight," says Boxer, especially if you're trying to triage care from far away. "They can be a lifesaver."

  • Acupuncture may not be effective for knee pain: study

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Acupuncture won't improve chronic knee pain in middle-aged people, researchers say.

    In their study, real acupuncture using needles and lasers was no more helpful than sham acupuncture for chronic knee pain among people 50 years old and older.

    "It is surprising that our study showed acupuncture was not effective compared to sham acupuncture, because many people with chronic knee pain report that treatment with acupuncture is beneficial for their symptoms," said Rana S. Hinman, the study's lead author from the University of Melbourne, Australia.

    Previous research showed acupuncture to be effective, although the benefits compared to mock acupuncture have been generally small and of questionable benefit, she told Reuters Health by email.

    The researchers write in JAMA - the Journal of the American Medical Association - that many people over age 50 are plagued with chronic knee pain. Many of them turn to alternative treatments, such as acupuncture.

    Acupuncturists may use a combination of traditional Chinese and Western techniques with needles or low-intensity lasers. However, the effectiveness of laser acupuncture had been uncertain, the researchers write.

    To test whether needle or laser acupuncture is superior to no acupuncture or sham acupuncture, the researchers divided 282 patients over age 50 with chronic knee pain and morning stiffness into four groups.

    The type of knee pain in the study is common with osteoarthritis, which is the result of normal joint wear and tear over the years.

    One group didn't receive acupuncture. Another group received needle acupuncture, another laser acupuncture and the last group received sham laser acupuncture. All of the treatments were delivered by family physicians who were trained in acupuncture.

    Patients received eight to 12 treatments over three months. Each treatment session lasted about 20 minutes.

    The laser and sham laser treatments looked the same to both patients and acupuncturists, but the laser was not turned on for the sham group.

    The patients rated their average knee pain and physical function on questionnaires at the beginning of the study, after three months of treatment and again at one year.

    There were "modest improvements" in pain at three months in the needle and laser acupuncture groups compared to the no-treatment group, but not compared to the sham group.

    And there were no differences between any of the groups on measures of knee pain and function after one year.

    This suggests that there were no "real" or "direct" effects of needle or laser acupuncture, Hinman said. The improvements patients felt were likely due to the placebo effect.

    "Acupuncture tends to be more effective for people who believe in the benefits of acupuncture," she said. "In our study, people did not know that were signing up for an acupuncture study, so our participants were less likely to be 'believers' in acupuncture, which probably explains why acupuncture was ineffective in our study."

    The new results are very similar to those of a review of individual patient data in 2012, said Andrew Vickers.

    Vickers, who led the previous review, is an attending research methodologist at Memorial Sloan Kettering Cancer Center in New York City and was not involved in the new study.

    The new review may have found a benefit from real acupuncture compared to sham acupuncture if the study included more people, he told Reuters Health by email.

    "About three million Americans try acupuncture per year, and chronic pain is the most common indication," he said.

    People with chronic pain should see a pain specialist, as there are many options for treatment, including acupuncture, he said.

    "As the authors suggest, the findings of this study are applicable to patients with moderate to severe persistent knee pain, and acupuncture may be effective in some people with neuropathic (nerve related) pain," said Dr. A. Abhishek, an arthritis researcher and associate professor at the University of Nottingham in the UK.

    The UK's National Institute for Clinical Excellence and Health does not recommend acupuncture for treating knee osteoarthritis, but does recommend it for persistent low back pain as it can be effective in that scenario, Abhishek, who was not part of the new study, told Reuters Health by email.

    As alternatives to acupuncture, Hinman said physical therapy, knee braces and exercise can all help alleviate chronic knee pain.

    SOURCE: http://bit.ly/WddS8K JAMA, online September 30, 2014.

  • Studies criticize U.S. medical device approval process

    By Andrew M. Seaman

    NEW YORK (Reuters Health) - Information on the safety and effectiveness of medical devices before and after they are cleared by U.S. health regulators can be improved, according to two new studies.

    One study found many U.S. Food and Drug Administration (FDA)-cleared medical devices meant to be implanted in the body were not backed by publicly available evidence that they are similar to a device already on the market.

    "Let the buyer beware before getting an implant in their body, because there may be no evidence the implant is going to benefit them and no study done in case it might harm them," said Diana Zuckerman, the study's lead author and president of the National Center for Health Research in Washington, D.C.

    The new report is not the first time researchers have criticized the process the FDA uses to evaluate many medical devices.

    In 2011, the Institute of Medicine issued a report that the medical device evaluation process known as 510(k) is fatally flawed and should be replaced. The FDA, which requested the report, disagreed. (See Reuters story of July 29, 2011 here: http://reut.rs/qAKdUv.)

    The 510(k) process allows medical devices to get to market faster if they are "substantially equivalent" to devices already being sold. Certain information that's submitted to the FDA about the devices must be made publicly available as a summary, Zuckerman and her colleagues write in JAMA Internal Medicine.

    For the new study, the researchers evaluated the publicly available information for implantable devices cleared by the FDA through the 510(k) process between 2008 and 2012. Because those devices are supposed to be similar to another device already on the market, the researchers also looked at the available information for those original devices.

    Overall, they were looking for information on 50 devices cleared between 2008 and 2012 and 1,105 previously cleared devices.

    They found enough evidence to support the claim that eight (or 16 percent) of the 50 new devices were substantially equivalent to previously cleared devices. Of those previously cleared devices, only 31 (or about 3 percent) were supported by publicly available evidence.

    "The study relied on publicly available information, and as noted by the authors, this information is generally limited because manufacturers are only required by law to provide either a safety summary or a safety statement for the public," the FDA said in a statement to Reuters Health.

    "However, the FDA reviews a significant amount of data - far more than what is publicly available - to determine whether or not to clear an implantable device under a 510(k). This approach has served the American public well by balancing the need for robust evidence to assure safety while expeditiously bringing new technologies to the patients who need them," the statement continued.

    Zuckerman said the companies are not providing sufficient summaries of its evidence, which are required by law.

    "I think this is a report card going forward," she said. "Clearly the FDA and companies are failing to provide information to doctors and patients so they can make reasonable judgments to affect their lives."

    In another study in the same journal, researchers led by Ian Reynolds at The Pew Charitable Trusts in Washington, D.C. found that barriers may decrease the usefulness of studies completed after medical devices are approved by the FDA.

    The researchers found the FDA ordered more than 223 studies for 158 medical devices between the start of 2005 and the end of 2011. Only one of the studies led to an action by the FDA other than a change of the devices label.

    "We encourage the agency to work together with all stakeholders to evaluate how these studies can more effectively be used to improve the public health," they write.

    In a commentary accompanying the new study, Elisabeth Dietrich from the University of California, San Francisco and Maryland's Secretary of Health and Mental Hygiene Dr. Joshua M. Sharfstein write that the FDA has already taken steps to address many of the issues pointed out in the new studies.

    "It is important to recognize and support this progress, even as the FDA's performance continues to be monitored through research and oversight," they write.

    SOURCES: http://bit.ly/1xusqo1, http://bit.ly/1u6xFYp, http://bit.ly/1wRBQqJ and http://bit.ly/Zl8KFp JAMA Internal Medicine, online September 29, 2014.

  • Too little research supports newer joint implants: study

    By Kathryn Doyle

    NEW YORK (Reuters Health) - There is not much hard evidence that new artificial joint devices, including ceramic-on-ceramic bearings for hip replacement and high flexion knee replacement, are better than older options - and in some cases they may be worse - according to a new review.

    Senior author Dr. Art Sedrakyan and his team reviewed clinical trials, comparative studies and registries for evidence that five new implantable device innovations were effective and safe.

    Similar research published in 2011 led to manufacturers withdrawing some metal-on-metal hip replacement options, which turned out to have higher failure rates than others because the metal parts rubbing together created debris that could lead to inflammation and tissue damage.

    "Back in 2011 when we published the first paper on metal-on-metal hips, hundreds of people contacted me and asked if they should be worried about hip replacement in general," said Sedrakyan, of the Patient Centered Comparative Effectiveness Program and U.S. Food and Drug Administration Medical Device Epidemiology Science and Infrastructure Center at Weill Cornell Medical College in New York.

    "The answer is 'no' because the procedure is generally very safe and outcomes are generally good," he told Reuters Health.

    However, new product designs tend to be based on engineering data more than on clinical data, he said. It seems, logically, like a new design may have an advantage over the old, but that often isn't supported by evidence with real patients, he said.

    Sedrakyan and his team looked for evidence supporting five recently introduced and well-known hip and knee devices, including ceramic-on-ceramic bearings, modular femoral necks and uncemented monoblock cups for total hip replacement, as well as high-flexion knee replacement and gender-specific knee replacement.

    All these technologies are already "implemented" in patients, the authors write in the journal BMJ.

    The 118 studies comparing outcomes with these devices versus older options were of varying quality and few were high-quality randomized trials, the study team found.

    None of the five devices appeared to improve functioning or survival more than the older versions. And some of them had up to twice the rate of needing replacement in a subsequent "revision" surgery compared to existing options.

    Registries showed modular femoral necks were revised 1.9 times as often as predecessor technologies, and ceramic-on-ceramic hip bearings and high-flexion knee bearings were also replaced more often, according to the results.

    None of the newer devices appeared to have poor enough outcomes that their use should necessarily be discontinued, Sedrakyan said, but there was generally a lack of evidence in their favor.

    "The technologies that are supposed to be better are not proving to be better and some which are widely used happen to be worse," Sedrakyan said.

    The data show that not all new orthopedic devices are being studied carefully, and when they are being studied, the studies themselves may be limited in quality, said Dr. Aaron S. Kesselheim of Brigham and Women's Hospital in Boston who co-authored an editorial on the topic in BMJ.

    Older implants may not always be safer, but since they have been around longer and used in more patients it's easier for safety issues to come to light, he said.

    "Of course, that issue would only emerge if someone's looking for it, and unfortunately, safety data on implants are not systematically collected all the time," Kesselheim told Reuters Health by email.

    Hospital administrators usually choose and purchase the devices that end up inside patients, he said. But patients can have a voice, and should ask their surgeons if the device slated for their surgery has been proven effective and safe, not just that it is widely used or popular with some patients, Sedrakyan said.

    Many patients do not know to ask this question, and the implant itself may be decided on at the time of surgery, Kesselheim said.

    "Stakeholders like surgeons, regulators and patients need to work together to demand a different and improved system of surveillance of these new products," Sedrakyan said.

    SOURCE: http://bit.ly/1xHna1p and http://bit.ly/1Dl6VY4 BMJ, online September 9, 2014.

Transplant Articles

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Women’s Health Articles

  • Don't worry: Neuroticism linked to Alzheimer's risk in women

    By Andrew M. Seaman

    NEW YORK (Reuters Health) - Anxious, jealous, moody, distressed women are more likely to develop Alzheimer's disease later in life than their calmer and less stressed-out counterparts, suggests a new study.

    Women who scored highest on a test for neuroticism in mid-life were twice as likely to go on to develop Alzheimer's disease, compared to women with the lowest neuroticism scores, researchers found.

    "All common disorders like Alzheimer's disease or cardiovascular disease are multi-factorial and this is one of the factors," said Dr. Ingmar Skoog, the study's senior author from the University of Gothenburg in Sweden.

    The findings may suggest that people with certain negative personality traits could use behavioral therapies to tackle those and thereby also reduce their risk of developing Alzheimer's disease later in life, researchers said.

    "I think for the average person, it's not that 'I have neuroticism and I'm going to get Alzheimer's disease,'" said Dr. James Galvin. "It's, 'I have these traits and doing something about these traits can do something about my risk.'"

    Galvin, who was not involved in the new study, is a professor of neurology, psychiatry, and population health at NYU Langone Medical Center in New York City.

    About 5 million Americans are living Alzheimer's disease, according to the U.S. Centers for Disease Control and Prevention. It is the most common form of dementia.

    While the exact cause of Alzheimer's disease is unknown, researchers have identified a variety of risk factors for developing the condition, including high blood pressure and high cholesterol.

    Skoog and his colleagues write in the journal Neurology that personality may also influence Alzheimer's risk through its effects on behavior and lifestyle. Neuroticism, specifically, has already been linked to dementia and Alzheimer's disease, they add.

    For the new study, the researchers tracked 800 middle-aged women for 38 years starting in 1968 when they were between 38 and 54 years old.

    About 19 percent - or 153 - of the women ended up with dementia by the end of the study. Of those, 104 were diagnosed with Alzheimer's disease.

    Women who scored the highest on a test for neuroticism at the start of the study were twice as likely to be diagnosed with Alzheimer's disease, compared to those who scored lowest on that test.

    After accounting for stresses the women experienced throughout their lives, the connection between neuroticism and dementia weakened. The researchers have previously reported that stress during middle-age may increase the risk of dementia, including Alzheimer's disease.

    In addition to neuroticism, the researchers also looked at how extroverted the women were and found that being extroverted was tied to less stress. Women who were the most neurotic and least extroverted were most likely to develop Alzheimer's disease.

    While the study only included women, Skoog and Galvin both said they don't think the results would be different among men.

    The results do not prove that being neurotic causes Alzheimer's disease. There can be a few explanations, including, for example, that neuroticism may promote unhealthy lifestyles or behaviors that increase other risk factors for Alzheimer's disease.

    Still, Skoog said, addressing neuroticism with treatments like cognitive behavioral therapy may lower stress throughout a person's life and ultimately reduce the risk of Alzheimer's disease.

    "If we can identify things that are addressable in midlife, then we may be able to subsequently reduce the risk of bad outcomes in later life," Galvin said.

    Healthy diet and exercise in midlife have also been thought to reduce the likelihood of developing Alzheimer's disease later on, Skoog said.

    "Now you have this thing, if you have a high neuroticism scores, you can try to do something about it," he said. "I think that's the take home message for this."

    SOURCE: http://bit.ly/1xCRlWx Neurology, online October 1, 2014.

  • No-cost, long-acting contraception cuts teen pregnancy by 79 percent

    By Gene Emery

    NEW YORK (Reuters Health) - A program that offered long-acting no-cost contraception to U.S. girls and women age 15 to 19 reduced the teenage pregnancy rate by 79 percent over five years and cut the abortion rate by 77 percent, according to the results of a new study.

    "This has really important public health implications in the United States, where we have had persistent challenges in trying to decrease unintended pregnancy," said Cynthia Harper, a professor of obstetrics, gynecology and reproductive services at the University of California, San Francisco. She was not involved in the research.

    "The findings were surprising because they had such a large impact," she told Reuters Health.

    The report in the October 2 New England Journal of Medicine comes at a time when more than 600,000 U.S. teens become pregnant each year.

    By age 20, about 20 percent of white teens and 40 percent of Hispanic and black teens will have been pregnant, according to The National Campaign to Prevent Teen and Unplanned Pregnancy.

    The new study comes from the Contraceptive CHOICE Project conducted in the St. Louis area. It was designed to see if teen pregnancy rates could be brought down by aggressively providing information on contraceptives and offering contraception for free.

    "For many years, parents, practitioners and policy makers thought, 'Those (long-acting contraception) methods aren't for teens; they're not going to want those methods.' We were able to demonstrate that if they are properly counseled and if they have a choice, they will pick those methods, actually use them, and have really great outcomes as a result," said chief author Gina Secura of the Washington University School of Medicine in St. Louis.

    The teens, all of whom had sought contraceptive services through a clinic, were told about various types of birth control, including the long-term injectable and implantable contraceptives such as IUDs that have been used around the world for years and whose effects are reversible. Generally, fewer than 5 percent of U.S. teens use such methods.

    Ultimately, 72 percent of the 1,404 teenage girls and women enrolled in the study went with an intrauterine device (IUD) or an implant. Only 12.5 percent opted for an oral contraceptive pill. The volunteers were followed for as long as three years during the study period, which lasted from 2008 to 2013.

    The annual rate of pregnancy was 3.40 percent compared to 15.85 percent in a survey of sexually experienced U.S. teens and women in the same age group. The likelihood of giving birth each year was 1.94 percent among the St. Louis teens versus 9.40 percent nationally.

    The abortion rate was 0.97 percent when the long-acting contraception was free, compared to 4.15 percent in the rest of the U.S.

    "These methods are not known by teens and providers are not used to providing them," Harper said.

    She said young women seeking contraception should initially ask their doctor which method is the most effective because - unlike doctor-patient discussions about other medical treatments - when it comes to contraception, "effectiveness is not always one of the things that is discussed."

    "What we saw was that among the teens who started with the shorter-acting methods like the pill or the patch, after a while they started to see they were forgetting to use them. And they then transitioned to a long-acting method," Secura told Reuters Health.

    The girls and women in the study were not new to sex. Nearly half had already had an unintended pregnancy, 18 percent reported having had at least one abortion and nearly three quarters reported having sexual intercourse during the 30 days before they enrolled in the study. Only 3 percent were sexually inexperienced.

    When the researchers compared the young women in the study to all U.S. women - both sexually experienced and inexperienced - ages 15 to 19, they found that the program reduced the pregnancy rate by 41 percent, the birth rate by 44 percent and the abortion rate by 34 percent.

    Secura said more teens and young adults are not using the longer-acting methods because, "Historically, it's been easier for practitioners to write a prescription for pills and have a teen go on her way."

    In addition, inserting long-acting contraception devices "take more training than some family physicians are used to," Harper said.

    The other problem: the longer-acting methods are far more expensive, at first.

    "The up-front costs are anywhere from $500 to $1,000, depending on the device and the cost of the insertion," said Secura.

    "You reach cost neutrality within two years with the long-acting methods. But these methods last three, four, five, or six years. So not only are they more effective, they start to regain the financial investment while they're still in use," she said.

    "Hopefully, data like this can show people why it's so important to cover contraceptives for women's health," said Harper.

    SOURCE: http://bit.ly/1DO0r4l The New England Journal of Medicine, online October 1, 2014.

  • University of California to create gender-neutral restrooms

    By Alex Dobuzinskis

    LOS ANGELES (Reuters) - The University of California will designate gender-neutral restrooms at its 10 campuses to accommodate transgender students, in a move that may be the first of its kind for a system of colleges in the United States.

    University of California President Janet Napolitano's office said in a statement on Monday that the action stems from an effort to make the system more welcoming to lesbian, gay, bisexual and transgender students.

    Under the plan, all single-stall restrooms at University of California campuses will be converted to gender-neutral facilities, officials said, and newly built and renovated campuses will also have such accommodations that can be used by everyone.

    University of California officials do not have details on how many single-stall restrooms exist at the system's 10 campuses, which in total serve about 238,000 students, nor how much it will cost to convert them, said Brooke Converse, a spokeswoman for the system.

    A slightly different policy already exists for students in the state's kindergarten through grade 12 system after California last year approved the first state law in the United States requiring public schools to allow transgender students to choose which restrooms they want to use.

    University of California appears to be the first university system to move to designate bathrooms as gender neutral at all its campuses, Genny Beemyn, coordinator of the trans policy clearinghouse for the LGBT group Campus Pride, said in an email.

    The recommendation was made by an LGBT advisory panel that Napolitano established in June.

    In another change Napolitano has pledged to implement, students who have not legally changed their name will be allowed to use a different one on certain campus records, officials said in a statement. The step is expected to help transgender students with a male or female given name who want to use a different name.

  • Global spa, wellness industry estimated at $3.4 trillion -report

    By Patricia Reaney

    NEW YORK (Reuters) - A growing middle class and consumers' evolving attitudes toward health and travel have fueled a global spa and wellness industry worth an estimated $3.4 trillion in 2013, according to a report released on Tuesday.

    Nutrition and weight loss, preventive and personalized health, complementary and alternative medicine, and beauty and anti-aging treatments were the biggest growing sectors, the report compiled by the non-profit research center SRI International showed.

    "All across the world we have seen, from Asia to Europe to Africa to North America, more and more people are consciously thinking about healthy food, exercising, looking to nature, getting massages and doing yoga," said Ophelia Yeung, a senior consultant for SRI International who led the study.

    Spa treatments and products, alternative and complementary treatments and weight-loss programs once considered beyond the means of many people, she added, are becoming more mainstream with a growing middle class.

    While medical care treats illness and disease, wellness is focused on prevention through a variety of healthy habits, nutritional eating, exercise and treatments.

    To compile the report, researchers looked at wellness sectors ranging from mind and body fitness to beauty and anti-aging, spas and workplace wellness.

    The global spa industry generated $94 billion last year, according to the Global Spa and Wellness Economy Monitor report, up from $60 billion in 2007.

    With more than 32,000 spas, Europe had the highest revenue of $29.8 billion, followed by the Asia-Pacific region with $18.8 billion and North America with $18.3 billion.

    Emerging markets in the Middle East and Africa have been growing the fastest in terms of adding spas. In Asia, China and India are leading growth, while in Europe it is Eastern Europe, Russia and the Baltic states.

    Thermal/mineral springs generated $50 billion worldwide but the biggest industry sector was wellness tourism, or travel associated with maintaining or enhancing one's personal wellbeing and health, which accounted for $494 billion.

    "Wellness travel is a very fast growing segment within travel. That's because as people become more conscious about a healthy lifestyle they naturally want to extend that when they travel," Yeung said.

    The report showed that the number of people taking international and domestic wellness tourism trips grew by 12 percent from 2012 to 2013. That was 36 percent faster than overall tourism trip growth, which is estimated at 9 percent.

    The SRI report was commissioned by the annual Global Spa & Wellness Summit. More than 400 wellness industry leaders from 45 countries attended the 2014 summit in Morocco earlier this month.

  • Endo reaches deal to end remaining U.S. lawsuits over mesh

    By Jessica Dye

    NEW YORK (Reuters) - Endo International Plc said on Tuesday it had reached agreements to settle up to 20,000 legal claims from women who said they were harmed by transvaginal mesh devices, ending nearly all of the U.S. cases against it and its American Medical Systems unit.

    Endo, which did not admit liability, said it would increase the amount of money it had set aside to cover vaginal mesh claims from $1.2 billion to approximately $1.6 billion in connection with the latest agreements, according to a regulatory filing from the company.

    Previously, in April, Endo announced it reached agreements to settle up to approximately 21,700 additional mesh claims with separate plaintiffs' law firms. Last year, it settled an undisclosed number of cases for $54.5 million.

    Endo President and Chief Executive Officer Rajiv De Silva said in a statement that he was "pleased to resolve substantially all of the remaining U.S. vaginal mesh litigation claims facing our AMS business."

    Endo and its Minnesota-based AMS subsidiary are among several major medical-device manufacturers who have faced a wave of litigation in the last few years over the devices, which are used to treat stress urinary incontinence and pelvic organ prolapse. The women suing the companies have accused the companies of selling subpar devices that caused injuries such as chronic pain, incontinence, bleeding and infection.

    Endo was the first major mesh defendant to reach a resolution largely ending the litigation against it. C.R. Bard Inc and Johnson & Johnson's Ethicon Inc unit are facing tens of thousands of lawsuits over similar products, with several trials scheduled for the fall.

    Many of those cases have been consolidated before U.S. District Judge Joseph Goodwin in the Southern District of West Virginia, who is overseeing more than 60,000 mesh cases against seven manufacturers.

    In 2008, the U.S. Food and Drug Administration notified transvaginal mesh manufacturers about reports of potential complications stemming from the devices. In 2012, the agency ordered AMS and other manufacturers to conduct post-market safety studies and monitor the rate at which adverse events were reported.

    The FDA announced earlier this year it is considering a proposal to tighten safety standards for mesh used to treat pelvic organ prolapse.