Methodist Healthcare Hospitals

Methodist Healthcare Hospitals
P 800.333.7333 (Toll Free)
www.sahealth.com

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Methodist Healthcare Hospitals Overview

As the region’s most preferred health care provider, Methodist Healthcare has a dynamic team of over 8,000 professionals and support staff devoted to fulfilling our mission of Serving Humanity to Honor God and providing exceptional and cost-effective health care accessible to all. More than 2,700 physicians in every field of specialization maintain credentials to practice at Methodist Healthcare Hospitals. In 1963, Methodist Hospital was the first hospital to open in the now world-renowned South Texas Medical Center. Methodist Hospital includes these additional campuses in the Medical Center: Methodist Heart Hospital, Methodist Children’s Hospital and Methodist Specialty and Transplant Hospital. Specialized services are provided through departments including the Texas Transplant Institute, Texas Neurosciences Institute, Gamma Knife® Center and Methodist Women’s Pavilion.

 

Chartered in 1955, Methodist Hospital became the first hospital built in the South Texas Medical Center. A group of businessmen known as the Five Oaks donated 40 acres for the development of a world-class medical hub. A groundbreaking ceremony was held in 1960 featuring a mock nuclear blast to showcase the design plans of the hospital: the world’s first nuclear-age hospital with two floors built completely underground to ensure vital services were available in the event of a nuclear attack. The hospital opened in 1963 and welcomed the first baby born in the Medical Center. Methodist Hospital now delivers more than 5,000 babies annually. In addition to its outstanding obstetrics program, Methodist Hospital is also known for its outstanding neurology and neurosurgical care as well as orthopedics, bone marrow transplants, emergency services and an oncology program which includes South Texas’ only Gamma Knife® Center. Methodist Hospital is accredited by the Joint Commission in stroke care and is one of two Texas hospitals to receive the highest quality award from the Texas medical Foundation Health Quality Institute: The Texas Medical Foundation Gold Award for Health Care Improvement.

 

As an accredited chest pain center, Methodist Heart Hospital is the area’s leader in cardiac care and recognized for an outstanding heart transplant program. Methodist Heart Hospital pioneered many firsts in cardiac care including the first balloon angioplasty, the first heart valve transplant and, the first hospital in San Antonio to offer a cardio-hospitalist program in which two cardiologists work in the hospital on rotating shifts, 24 hours a day, seven days a week, prepared to care for patients with signs and symptoms of a heart attack. Methodist Heart Hospital recently opened a Hybrid Operating Room, offering cardiology specialists and surgeons the opportunity to provide a wider range of services in a single room. Methodist Heart Hospital is the only private hospital in the area performing Transcatheter Aortic Valve Replacement, or TAVR.

 

Methodist Children’s Hospital is dedicated to providing outstanding pediatric care from children from all over Texas and beyond. Colorful images and artwork enhance every window and wall, creating a warm, welcoming environment that is focused on the health and well being of each child. Methodist Children’s Hospital has a spacious emergency department dedicated to pediatric cases with 32 individual treatment rooms, each equipped with a television and an activity center. The newborn intensive care unit is a regional center of excellence with 78 licensed beds over 19,000 square feet, caring for the most fragile premature and special needs babies. Methodist Children’s Hospital is among the nation’s largest providers of blood and marrow stem cell and cord blood transplants for children having preformed over 500 transplants since program inception.

 

 

Methodist Specialty and Transplant Hospital is a full-service facility that is widely acclaimed for its outstanding kidney, liver and pancreas transplant programs. Home to the Texas Transplant Institute, the center made medical history by performing the world’s first 16-way kidney donor exchange in three consecutive days in a single center. The kidney transplant program is the largest living donor program in the nation due to the success of its paired exchange kidney program. Other specialty areas include emergency care, psychiatry, bariatric surgery, inpatient rehabilitation and the latest treatments for cancer and incontinence. The facility houses a program with a specially trained team that works with law enforcement officers to provide forensic exams and emergency care for survivors of sexual assault.

MHS Featured Video

Neuroscience Articles

  • "Wandering eye" may raise risk of falls for older adults

    By Shereen Lehman

    (Reuters Health) - Older people with strabismus, where one eye points slightly inward or outward affecting vision, are about 27 percent more likely than people without the condition to be injured by a fall, according to a new study.

    The disorder, often called "wandering eye," becomes more common with age and can cause double vision or depth perception problems because the two eyes are not pointing in the same direction.

    Previous studies have shown that having other eye disorders like cataracts, glaucoma or age-related macular degeneration increases the risk of injuries, fractures or falls, the study team writes in JAMA Opthalmology. But this is the first to examine whether so-called binocular vision problems have the same effect.

    "Strabismus in adults is becoming more prevalent as the aging population increases and we do not know the impact of strabismus on patient quality of life and morbidity," lead author Dr. Stacy Pineles told Reuters Health in an email.

    "We hypothesized that strabismus could cause double vision or diminished depth perception, and we wanted to see whether this was associated with injuries such as falls, fractures, and musculoskeletal injuries," said Pineles, an ophthalmologist with the Jules Stein Eye Institute at the University of California, Los Angeles.

    Pineles and her colleagues looked at a random sample of Medicare claims for more than two million beneficiaries over the years 2002 to 2011.

    They found almost 100,000 diagnoses of binocular vision problems. The great majority were either strabismus or diplopia, meaning double vision, which often goes along with strabismus. On average the patients were older, white, were more often male and had other health problems like diabetes and heart disease.

    About 75 percent of those with binocular vision problems had also reported some type of musculoskeletal injury, fall or fracture during that 10-year time span, compared to about 60 percent of patients without a binocular visual disorder.

    After taking into consideration age, region and other potential contributors to falling, such as other illnesses, the researchers calculated that people with binocular vision disorders had a 27 percent higher risk of falls, fractures and injuries overall.

    For people with a specific diagnosis of diplopia, the risk was 36 percent higher.

    The study team cautions that they don't know if the injuries occurred before the vision problems were diagnosed or afterward, so they can't say for certain that the eye disorders are to blame for the falls. They also don't know which patients were being treated for their vision problems.

    Still, Pineles said that elderly patients with vision problems should be sure they optimize lighting in their homes, get help when navigating unfamiliar areas and use low-vision aids if necessary.

    Dr. Jamie Rosenberg, an ophthalmologist at Montefiore Medical Center in New York who specializes in strabismus, said that eye problems can sometimes seem less important to elderly patients compared to other illnesses they may have. But "they can affect their life in a significant way and keeping them safe from falls is a huge part of keeping older people healthy."

    Rosenberg, who wasn't involved in the new study, said there are treatment options for strabismus, such as wearing special glasses with prisms that help align the double images seen by people with diplopia.

    "Even though the eyes aren't straight the two images that are being processed by the brain will be one," she said.

    Surgery may also be an option. "A lot of people think that older people can't have strabismus surgery to straighten their eyes but that's actually not true at all," Rosenberg said.

    The new study may underestimate the magnitude of the problem, noted Priscilla Rogers, an aging and vision loss expert at the American Foundation for the Blind's Vision Aware program.

    "Only people who seek medical care from a fall would be included, so the problem is probably bigger and greater than this study suggests," she told Reuters Health in an email.

    Access to eye care may be one obstacle keeping older people from getting help for vision disorders, she noted. "Medicare does not pay for new glasses and people on a fixed income may not want to buy new glasses because they cost too much," Rogers said. "They can, after all, see - they just may not see well enough to avoid a trip or fall."

    Rogers said that fall prevention programs such as "A Matter of Balance" offered in several states (http://bit.ly/1FZWPgF ) can help reduce the risk of injuries among people with visual impairments.

    SOURCE: http://bit.ly/1wylK5I JAMA Ophthalmology, online October 23, 2014.

  • Oregon woman visits Grand Canyon ahead of planned assisted suicide

    By Reuters Staff

    (Reuters) - A 29-year-old Oregon woman with terminal brain cancer has ticked off the Grand Canyon from her bucket list and said in a video released this week that she might end her life through assisted suicide in a couple of days.

    Brittany Maynard was diagnosed in January with a glioblastoma brain tumor and has said she plans to take prescribed medication to die when her pain becomes unbearable. She has moved from her San Francisco Bay area home to Oregon, which allows assisted suicide for terminally ill patients.

    Maynard is raising funds through a group called Compassion & Choices to advocate for assisted suicide as an option for terminally ill patients. The group released her latest video on Wednesday.

    Opponents of assisted suicide say some people who are ill, especially among the elderly, might be unduly influenced by people close to them to end their lives and that other ways exist to ease the suffering of the terminally ill.

    Maynard, who has stressed that her decision to end her life is her own, had previously told People magazine, which featured her on the front page of its Oct. 27 issue, that she had picked Nov. 1, as the day she planned to die, although she also said she might change her mind.

    In her latest video, Maynard said: "So if Nov. 2 comes along and I've passed, I hope my family is still proud of me and the choices I made.

    "If Nov. 2 comes along and I'm still alive, I know that we'll still be moving forward as a family out of love for each other and that decision will come later."

    On the website of Compassion & Choices, Maynard wrote that she traveled to the Grand Canyon with her husband and her parents during the week before Oct. 24 to make her bucket list dream come true.

    Maynard suffered her worst seizure the morning after the Grand Canyon visit. Her speech was paralyzed for some time after she regained consciousness, she wrote.

    "Sadly, it is impossible to forget my cancer," she wrote.

    A representative for Compassion & Choices did not return calls.

    Since 1997, more than 750 patients in Oregon have died from ingesting medications prescribed under the state's death with dignity law, according to the Oregon Public Health Division. Four states beside Oregon allow assisted suicide.

  • Speed of weight loss may have little impact on success at keeping it off

    By Roxanne Nelson

    (Reuters Health) - In a trial of weight loss approaches, the rate at which people dropped excess pounds was not linked to their success in keeping the weight off over the next three years.

    Researchers say the small study shows that current guidelines advising slow and steady weight loss should be revised, and the focus should be instead on improving methods for helping people maintain their weight over the long term.

    The long-held belief that losing weight gradually produces better long-term outcomes seems to stem from the perception that obesity is a behavioral problem and that gradual weight loss allows more time for habits to change, the Australian study team writes in The Lancet Diabetes & Endocrinology.

    "Obesity is not just a lifestyle disease as it is commonly believed but is largely genetic," senior author Joseph Proietto, Sir Edward Dunlop Professor of Medicine at the University of Melbourne, told Reuters Health.

    Scientific evidence also does not support the superiority of a gradual approach in achieving or maintaining weight loss, he said. Regardless of how pounds are lost, many individuals have difficulty staying at their new weight and often gain it all back.

    To test whether the rate of weight loss affects whether people regain weight, Proietto and his colleagues designed a two-part trial.

    In the first part, 200 obese adults were randomly assigned to either a 12-week rapid weight loss program on a very-low-calorie liquid meal-replacement diet of 450 to 800 calories a day, or to a 36-week program of gradual weight loss. The gradual diet was based on current Australian healthy eating dietary recommendations and included one or two liquid meal replacements per day, with a goal of reducing the participants' calorie intake by 400 to 500 a day.

    In part two, people who had lost 12.5 percent or more of their body weight were able to continue into a weight maintenance program that would run for about three years. The maintenance program included an individualized eating plan and meetings with a dietician every 12 weeks.

    In the first part of the study, the researchers found, participants who lost weight faster were more likely to achieve their target weight loss. Overall, 81 percent of those in the rapid weight loss group lost 12.5 percent or more of their body weight, compared to 50 percent in gradual weight loss group.

    And in part two, the speed at which individuals had lost weight did not appear to play a role whether they regained weight or how much. Both groups gained back about 71 percent of the weight that they had initially lost.

    As observed in this study, very low calorie diets can lead to robust weight loss in a very short time, but this type of diet should only be undertaken with medical supervision, said Dr. Kishore M Gadde, from the Pennington Biomedical Research Center in Baton Rouge, Louisiana. He was not involved in the study, but wrote an accompanying editorial in the same issue of the journal.

    Keeping the weight off is all too frequently the problem, Gadde said. "Once desired weight loss is achieved, individuals need to make intensive efforts to maintain their lost weight."

    The study showed that seeing a nutrition counselor every three months is not adequate support for weight maintenance, Gadde noted.

    "Exercise can help prevent weight regain to some extent, but the intensity of exercise needed to prevent regain is difficult to incorporate into our daily lives," he told Reuters Health.

    Using diet and exercise, unfortunately only about 15 percent may be able to successfully lose weight and keep it off, he said. "Pharmacotherapy could be a consideration for those regaining weight," he said. "But, we do not have solid evidence at this time that pharmacotherapy confers long-term success."

    Proietto and his colleagues had also measured hunger-related hormones and appetite among participants in their study to see how the rate of weight loss might affect changes in feelings of hunger, both long- and short-term.

    "The rate of weight loss also did not influence the changes in hunger controlling hormones that occur with weight loss," said Proietto, who also heads the weight control clinic at Austin Health in Melbourne.

    From 2005 to 2010, Proietto chaired the Optifast Medical Advisory Committee for Nestlé Healthcare Nutrition Australia Ltd. But the company did not fund the current study.

    Proietto feels that while appetite suppression after weight loss should be considered, the problem is that there are not many effective agents and none of them have been tested for long-term safety.

    "Our study shows again that drugs are not essential for achieving weight loss but they are probably important for assisting with weight maintenance," he said.

    SOURCE: http://bit.ly/1wa7gK7 The Lancet Diabetes and Endocrinology, online October 16, 2014.

  • People with celiac disease more likely to fracture bones

    By Katryn Doyle

    (Reuters Health) - People diagnosed with celiac disease are almost twice as likely as those without it to break a bone, according to a new review of the evidence.

    More studies are needed, though, to see if people whose celiac hasn't been diagnosed yet are at similar risk, researchers say.

    About two million Americans have celiac disease - in which the immune system attacks the small intestine in response to gluten, a protein found in wheat, rye and barley - according to the National Institutes of Health.

    For the new review, researchers from the University of Tampere and Seinäjoki Central Hospital in Finland, and the University of Nottingham in the UK analyzed 16 studies that compared the incidence of bone fractures among people with and without a celiac disease diagnosis.

    In studies that looked at one point in time, people with celiac disease were almost twice as likely to have had a bone fracture in the past.

    In studies that followed people over time, those who had a diagnosis of celiac disease at the start were about 30 percent more likely to suffer a bone fracture and 69 percent more likely to have a hip fracture than others, according to the analysis published in the Journal of Clinical Endocrinology and Metabolism.

    There were only two studies of bone fractures among people with undiagnosed celiac disease - but whose blood tests showed celiac-specific antibodies - and it was not clear if there was a link to broken bones, the authors write.

    Since the disease affects nutrient absorption in the small intestine, it could lead to poor absorption of vitamin D and calcium, or chronic intestinal inflammation could interfere with bone formation, they write.

    Other possibilities to explain the connection to bone breaks include hormonal changes or a gluten-free diet, which is often low in minerals, they write.

    Other studies have found that bone density tends to go down as symptoms become worse for people with celiac disease, according to Professor Julio C. Bai at the Hospital de Gastroenterologia Dr. Carlos Bonorio Udaondo in Buenos Aires, Argentina.

    "Therefore and based on our findings, it seems reasonable to consider to evaluate bone density in those patients with symptomatic celiac disease," said Bai, who was not involved in the new study.

    Symptoms can include abdominal bloating and pain, chronic diarrhea, constipation and weight loss.

    Physical activity can help strengthen bones, he said.

    "Some areas of bone are more vulnerable to the damage induced by celiac disease," said Dr. Peter H.R. Green, an expert on celiac disease at Columbia University in New York who wasn't involved in the new review. "This relates to the type of bone and its rate of turnover."

    Everyone newly diagnosed with celiac disease is routinely given a bone density scan, as they should be, he told Reuters Health by email.

    "We have shown that a gluten free diet together with replacement of calcium and vitamin D, when necessary, results in improvement in bone density," he said.

    SOURCE: http://bit.ly/1yrO6yQ Journal of Clinical Endocrinology and Metabolism, online October 3, 2014.

  • Pfizer meningitis vaccine wins U.S. approval

    By Reuters Staff

    (Reuters) - Pfizer Inc has won U.S. approval for its Trumenba vaccine against meningitis, a potentially deadly bacterial disease that has recently caused outbreaks on college campuses, the U.S. Food and Drug Administration said on Wednesday.

    Trumenba, approved in individuals 10 to 25 years of age, has been considered one of the most important products in Pfizer's drug pipeline. It was granted accelerated approval following tests in 4,500 people in the United States, Europe and Australia.

    It is the first approved U.S. vaccine that prevents invasive disease caused by the bacterium Neisseria meningitidis B, a strain that causes disease globally in an estimated 20,000 to 80,000 people a year, and accounts for an estimated 40 percent of meningitis infections in the United States, according to Pfizer.

    Meningitis can be treated with antibiotics, but 10 to 15 percent of patients die and up to 19 percent of survivors have long term disabilities, including brain damage and limb amputations. Vaccination is deemed the best way to prevent the disease.

    Pfizer and Swiss drugmaker Novartis had both won the FDA's coveted "breakthrough therapy" designation for their rival meningitis B vaccines and were racing for the first FDA approval.

Oncology Articles

  • Oregon woman visits Grand Canyon ahead of planned assisted suicide

    By Reuters Staff

    (Reuters) - A 29-year-old Oregon woman with terminal brain cancer has ticked off the Grand Canyon from her bucket list and said in a video released this week that she might end her life through assisted suicide in a couple of days.

    Brittany Maynard was diagnosed in January with a glioblastoma brain tumor and has said she plans to take prescribed medication to die when her pain becomes unbearable. She has moved from her San Francisco Bay area home to Oregon, which allows assisted suicide for terminally ill patients.

    Maynard is raising funds through a group called Compassion & Choices to advocate for assisted suicide as an option for terminally ill patients. The group released her latest video on Wednesday.

    Opponents of assisted suicide say some people who are ill, especially among the elderly, might be unduly influenced by people close to them to end their lives and that other ways exist to ease the suffering of the terminally ill.

    Maynard, who has stressed that her decision to end her life is her own, had previously told People magazine, which featured her on the front page of its Oct. 27 issue, that she had picked Nov. 1, as the day she planned to die, although she also said she might change her mind.

    In her latest video, Maynard said: "So if Nov. 2 comes along and I've passed, I hope my family is still proud of me and the choices I made.

    "If Nov. 2 comes along and I'm still alive, I know that we'll still be moving forward as a family out of love for each other and that decision will come later."

    On the website of Compassion & Choices, Maynard wrote that she traveled to the Grand Canyon with her husband and her parents during the week before Oct. 24 to make her bucket list dream come true.

    Maynard suffered her worst seizure the morning after the Grand Canyon visit. Her speech was paralyzed for some time after she regained consciousness, she wrote.

    "Sadly, it is impossible to forget my cancer," she wrote.

    A representative for Compassion & Choices did not return calls.

    Since 1997, more than 750 patients in Oregon have died from ingesting medications prescribed under the state's death with dignity law, according to the Oregon Public Health Division. Four states beside Oregon allow assisted suicide.

  • Massachusetts town's plan to ban tobacco sales riles store owners

    By Ted Siefer

    LOWELL, Mass. (Reuters) - Store owners in a Massachusetts town proposing to bar the sale of all tobacco products objected to the proposal on Tuesday, a day after local officials announced the planned ban.

    Health officials in Westminster, about 60 miles (97 km)northwest of Boston, released a plan on Monday to bar the sale of cigarettes, chewing tobacco and cigars, as well as electronic cigarettes, citing health risks tied to the nicotine products.

    The Westminster regulation points to a ruling by the state's highest court holding that "the right to engage in business must yield to the paramount right of government to protect the public health by any rational means."

    Citing U.S. health authorities, the proposed regulation states that there is "conclusive evidence that tobacco smoking causes cancer, respiratory and cardiac diseases, (and) negative birth outcomes."

    Convenience store owners in the town of about 7,300 residents said the ban would do little to cut down on tobacco use and prompt customers to drive to the next town for the product while sharply cutting their stores' incomes.

    "It's not just the loss of tobacco sales," said Brian Vincent, the owner of Vincent's Country Store. "It's the additional impulse items smokers buy, a bottle of soda, a bag of chips for the road, scratch tickets."

    Vincent, who posted in his store a petition that had gathered 300 signatures by Tuesday morning opposing the ban, estimated that it would cost him $100,000 a year in sales.

    The New England Convenience Store Association has also taken a stand against the ban. "At the end of the day, it's businesses in the local community that will get hurt," said Stephen Ryan, the group's executive director.

    Westminster's health agent did not return requests on Tuesday for comment.

    While restrictions on smoking in specific settings have proliferated in Massachusetts and around the country, Westminster appears to be the first to consider a town-wide ban on the sale of all tobacco products.

    Historian Robert Proctor of Stanford University said he was unaware of a municipal ban on tobacco products in nearly a century.

    In Boston, a ban went into effect this year on smoking in all public parks and playgrounds.

    A three-member Westminster Board of Health will be required to vote to pass the ban.

    The board will hold a public hearing on the topic on Nov. 12.

  • Advanced ovarian cancer may someday be detected with tampons

    By Kathryn Doyle

    (Reuters Health) - In a small new study, ovarian cancer cells were detectable on the tampons of some women with advanced stage cancer.

    "This is a proof of principle study that certainly needs more work on it before we know how useful it will be," said Dr. Charles N. Landen Jr. of the University of Virginia, Department of Obstetrics and Gynecology.

    But it is helpful to know that you can pick up tumor DNA in vaginal secretions, Landen told Reuters Health by phone.

    Ovarian cancer is often diagnosed at a late stage, since there is no effective screening method for early-stage ovarian cancer. About 22,000 women are diagnosed with ovarian cancer in the U.S. each year, and almost 14,300 will die, according to the American Cancer Society.

    Landen and his coauthors studied eight women with advanced serous ovarian cancer, which is the most common form of ovarian cancer. Eight to 12 hours before surgery, they each inserted a commercially available tampon, which was removed in the operating room.

    All eight women had TP53 DNA mutations in their tumors, which is a very common mutation for this form of cancer, the authors write.

    Five of the women had intact fallopian tubes, while three had had tubal ligation surgery previously.

    Of the five women who did not have their "tubes tied," three had the exact same TP53 mutations detectable from their tampon samples, according to results published in the journal Obstetrics & Gynecology.

    Identifying three out of five, or 60 percent, of cancers is not bad, but not ideal for a disease as rare as ovarian cancer, Landen said.

    "It's not enough for us to have total confidence over its ultimate utility," he said.

    None of the women with tubal ligation had tumor mutations in their tampon samples.

    "We have no way of knowing whether or not the DNA we picked up originated in the fallopian tubes or in the abdominal cavity," but either way it does demonstrate that cancer happening elsewhere in the genital tract does affect the vaginal canal, Landen said.

    A previous study found similar tumor DNA detectable by Pap smear.

    This is not yet a breakthrough in detecting ovarian cancer, according to Paul Spellman, who researches the biology of cancer at Oregon Health & Science University in Portland, and was not involved in the study.

    "These findings are helping researchers move toward a method for screening for ovarian cancer," said Dr. Shannon N. Westin of the Department of Gynecologic Oncology and Reproductive Medicine at the University of Texas MD Anderson Cancer Center in Houston. "This has certainly been a 'holy grail' for some time."

    Westin was not involved in the new study.

    "Thus far, imaging and serum tests have not been able to reliably detect ovarian cancer at an early stage," she told Reuters Health by email. "Ovarian cancer survival is significantly improved when detected at an early stage."

    Five years after diagnosis with stage 1 ovarian cancer, approximately 90 percent of women have survived, compared to approximately 35 percent for Stage IIIc, the most commonly diagnosed stage, she said.

    It is not clear if this kind of tampon screening would identify early-stage cancers of the ovaries or fallopian tubes, Landen said.

    This pilot study did identify some advanced cancers, and may be more useful some day as targeted screening for women at high risk, like those with a family history of ovarian cancer or those with the BRCA mutations, especially younger women who still want to have children and don't want their ovaries removed unless absolutely necessary, he said.

    Though this method of detection is a long way from actually being used to screen women for early stage ovarian cancer, it does have the advantage that it's relatively easy for women to do and doesn't involve surgery, he noted.

    SOURCE: http://bit.ly/ZTNTse Obstetrics & Gynecology, November 2014.

  • Canadian guidelines recommend against prostate cancer test

    By Andrew M. Seaman

    (Reuters Health) - Men should not get a common blood test to screen for prostate cancer, according to new healthcare guidelines from Canada.

    The potential for harm after prostate-specific antigen (PSA) testing outweighs the benefit, says the Canadian Task Force on Preventive Health Care.

    "The ratio seems to be on the harm side - not the benefit side," said Dr. Neil Bell, a member of the Task Force and chair of its prostate cancer screening working group.

    The Canadian group is part of a growing list of medical organizations that either question or don't recommend the test, which looks for elevated levels of a protein produced by the prostate gland.

    The government-backed U.S. Preventive Services Task Force does not recommend PSA screening for prostate cancer. Additionally, the American College of Physicians does not recommend PSA screening among men younger than age 50 and older than age 69. Also, it says men ages 50 to 69 should be told about the "limited potential benefits and substantial harms" of screening before being offered the test.

    Prostate cancer is the most common non-skin cancer among men and the third leading cause of cancer-related death among men, but the Task Force writes in the Canadian Medical Association Journal that the lifetime risk of prostate cancer death is only about 4 percent.

    "The most typical feeling most people have is, 'If I diagnose cancer early and I treat it, I get a better outcome,'" Bell said. "For prostate cancer, that doesn't hold for a number of reasons."

    Specifically, most prostate cancers would never cause men to die or feel sick, said Bell, who is also a family physician and professor at the University of Alberta in Edmonton.

    He and his colleagues write that about 70 percent of men between ages 70 and 79 are found to have undiagnosed prostate cancer after they die.

    The new guidelines are based on a review of medical evidence related to PSA testing.

    Overall, they found strong evidence showing that men would likely experience more harm than benefit from PSA screening if they're younger than 55 or older than 70.

    The researchers say that for every 1,000 men between ages 55 and 69 screened using PSA, one will be saved from death by the test.

    Of the other 999 who get screened by PSA, 720 will test negative. Of the 280 who will test positive, 178 will get additional testing - such as invasive biopsies - that ultimately show they don't have cancer.

    Of the 102 correctly diagnosed with prostate cancer by the PSA screening, 33 will be diagnosed with cancer that would not have caused them to become ill or die and end up with complications related to their treatment. Five men will die regardless of whether they get PSA screening.

    "Available evidence does not conclusively show that PSA screening will reduce prostate cancer mortality, but it clearly shows an increased risk of harm," they write. "The task force recommends that the PSA test should not be used to screen for prostate cancer."

    In an editorial, the University of Toronto's Dr. Murray Krahn argues that doctors should not take away the choice of PSA testing from men.

    "There clearly is not enough evidence to mount an organized screening program," he writes. "However, the falling overall mortality in some countries that screen intensively, the evidence that treatment may have a very modest disease-specific mortality benefit, and the highly variable preferences for treatment outcomes suggest to me that we should not push patients out of decision-making in this area."

    The Task Force does write in its recommendations that some men may place more value on a small reduction in the risk of death and not be as concerned with the possible harm of the screening. Those men may choose to be screened, they write.

    "There are some men who may want that benefit," Bell said.

    SOURCE: http://bit.ly/ZUJW6k and http://bit.ly/ZUJQvu CMAJ, online October 27, 2014.

  • U.S. envoy in West Africa to see how world failing in Ebola fight

    By Michelle Nichols

    CONAKRY (Reuters) - Guinea plans to fight its deadly Ebola outbreak by drafting graduating medical students for national service and enlisting retired doctors and nurses, said Samantha Power, U.S. Ambassador to the United Nations, during a visit to West Africa to see how the global response is failing to stop the deadly disease.

    Power, who will also visit Sierra Leone and Liberia, said she had a "very robust" discussion with Guinea's President Alpha Conde on Sunday about the way forward and that Conde has "tremendous impatience ... wholly appropriate to the cause."

    Conde told Power of ambitious plans to increase the number of Ebola Treatment Units (ETUs) across the country.

    "But it's a real mystery as to where the healthcare workers are going to come from to staff those ETUs," Power told Reuters.

    "So he described his own recruitment drive within Guinea in order to get medical students as they come out of their training to go right into Ebola treatment as a kind of national service, also to bring all the retired doctors and nurses back and conscripting them," she said.

    The three West African countries are bearing the brunt of the worst outbreak of the hemorrhagic fever on record, which the World Health Organization (WHO) says has killed nearly 5,000 people. A small number of cases have also been reported in Mali, Nigeria, Senegal, Spain and the United States.

    "We are not on track right now to bend the curve," Power told Reuters. "I will take what I know and I learn and obviously provide it to President Obama, who's got world leaders now on speed dial on this issue."

    "Hopefully the more specific we can be in terms of what the requirements are and what other countries could usefully do, the more resources we can attract," she said.

    The United Nations said last month almost $1 billion was needed to fight Ebola for the next six months. According to the U.N. Financial Tracking Service, nearly $500 million has been committed and $280 million in non-binding pledges made.

    "As we have seen, along with Spain, it is not a virus that is going to remain contained within these three affected countries if we don't deal with it at its source," Power said.

    Aid groups on the ground said more doctors, nurses and treatment centers were needed. Ebola patients were being turned away due to a lack of beds and were usually cared for at home, where they risked infecting more people, according to aid workers.

    Power also met with aid and other groups as well as leaders of the Muslim and Catholic communities.

    BED, MEDICAL STAFF SHORTAGES

    According to the Africa Governance Initiative (AGI), even if existing international commitments are met by December, there could be a shortage of over 6,000 beds across Sierra Leone and Guinea.

    Nearly half of the beds currently planned in the three countries will lack the medical staff needed to support them, a study by AGI, former British prime minister Tony Blair's London-based development consultancy found.

    AGI based its projections on the WHO's worst-case scenario, which forecast 10,000 new cases per week in December.

    "The international community badly misjudged the impact of the Ebola epidemic in its first few months and is compounding that error by failing to act quickly enough now," AGI Chief Executive Nick Thompson said.

    He called on more countries to follow the examples of the United States, Britain and Cuba, which have deployed military and medical personnel to the region to bolster efforts to stop the epidemic at its source.

    Some Republican lawmakers have called for a travel ban on the worst-affected countries after four cases of Ebola were diagnosed in the United States. New York, New Jersey and Illinois have imposed mandatory 21-day quarantines for health care workers coming from West Africa, even if they are not sick.

    Obama has resisted such a move on advice from public health officials who say Ebola, which is spread through contact with bodily fluids of an infected person, poses no major health threat to the country.

    Power said there was a risk these new measures could deter aid workers from traveling to West Africa to help.

    "We're in very close consultations with the states, we understand the legitimate fears," Power said. "We've got to find a way to address that fear, but we can't do so in a manner that undermines our ability to deal with the problem at its source."

    "We have to find the right balance in order to continue to attract health workers at the same time we try to address the fears of the healthcare workers neighbors when they come home," she said.

    Power said the benefits of seeing the Ebola response first hand outweighed the risks of traveling to Guinea, Liberia and Sierra Leone. She added that she would take all necessary precautions during her visit and upon her return to the United States, including checking her temperature "many times a day."

    Power also plans to visit the headquarters of the United Nations Ebola response mission in Ghana, which is coordinating efforts in West Africa.

Orthopedic Articles

  • "Wandering eye" may raise risk of falls for older adults

    By Shereen Lehman

    (Reuters Health) - Older people with strabismus, where one eye points slightly inward or outward affecting vision, are about 27 percent more likely than people without the condition to be injured by a fall, according to a new study.

    The disorder, often called "wandering eye," becomes more common with age and can cause double vision or depth perception problems because the two eyes are not pointing in the same direction.

    Previous studies have shown that having other eye disorders like cataracts, glaucoma or age-related macular degeneration increases the risk of injuries, fractures or falls, the study team writes in JAMA Opthalmology. But this is the first to examine whether so-called binocular vision problems have the same effect.

    "Strabismus in adults is becoming more prevalent as the aging population increases and we do not know the impact of strabismus on patient quality of life and morbidity," lead author Dr. Stacy Pineles told Reuters Health in an email.

    "We hypothesized that strabismus could cause double vision or diminished depth perception, and we wanted to see whether this was associated with injuries such as falls, fractures, and musculoskeletal injuries," said Pineles, an ophthalmologist with the Jules Stein Eye Institute at the University of California, Los Angeles.

    Pineles and her colleagues looked at a random sample of Medicare claims for more than two million beneficiaries over the years 2002 to 2011.

    They found almost 100,000 diagnoses of binocular vision problems. The great majority were either strabismus or diplopia, meaning double vision, which often goes along with strabismus. On average the patients were older, white, were more often male and had other health problems like diabetes and heart disease.

    About 75 percent of those with binocular vision problems had also reported some type of musculoskeletal injury, fall or fracture during that 10-year time span, compared to about 60 percent of patients without a binocular visual disorder.

    After taking into consideration age, region and other potential contributors to falling, such as other illnesses, the researchers calculated that people with binocular vision disorders had a 27 percent higher risk of falls, fractures and injuries overall.

    For people with a specific diagnosis of diplopia, the risk was 36 percent higher.

    The study team cautions that they don't know if the injuries occurred before the vision problems were diagnosed or afterward, so they can't say for certain that the eye disorders are to blame for the falls. They also don't know which patients were being treated for their vision problems.

    Still, Pineles said that elderly patients with vision problems should be sure they optimize lighting in their homes, get help when navigating unfamiliar areas and use low-vision aids if necessary.

    Dr. Jamie Rosenberg, an ophthalmologist at Montefiore Medical Center in New York who specializes in strabismus, said that eye problems can sometimes seem less important to elderly patients compared to other illnesses they may have. But "they can affect their life in a significant way and keeping them safe from falls is a huge part of keeping older people healthy."

    Rosenberg, who wasn't involved in the new study, said there are treatment options for strabismus, such as wearing special glasses with prisms that help align the double images seen by people with diplopia.

    "Even though the eyes aren't straight the two images that are being processed by the brain will be one," she said.

    Surgery may also be an option. "A lot of people think that older people can't have strabismus surgery to straighten their eyes but that's actually not true at all," Rosenberg said.

    The new study may underestimate the magnitude of the problem, noted Priscilla Rogers, an aging and vision loss expert at the American Foundation for the Blind's Vision Aware program.

    "Only people who seek medical care from a fall would be included, so the problem is probably bigger and greater than this study suggests," she told Reuters Health in an email.

    Access to eye care may be one obstacle keeping older people from getting help for vision disorders, she noted. "Medicare does not pay for new glasses and people on a fixed income may not want to buy new glasses because they cost too much," Rogers said. "They can, after all, see - they just may not see well enough to avoid a trip or fall."

    Rogers said that fall prevention programs such as "A Matter of Balance" offered in several states (http://bit.ly/1FZWPgF ) can help reduce the risk of injuries among people with visual impairments.

    SOURCE: http://bit.ly/1wylK5I JAMA Ophthalmology, online October 23, 2014.

  • People with celiac disease more likely to fracture bones

    By Katryn Doyle

    (Reuters Health) - People diagnosed with celiac disease are almost twice as likely as those without it to break a bone, according to a new review of the evidence.

    More studies are needed, though, to see if people whose celiac hasn't been diagnosed yet are at similar risk, researchers say.

    About two million Americans have celiac disease - in which the immune system attacks the small intestine in response to gluten, a protein found in wheat, rye and barley - according to the National Institutes of Health.

    For the new review, researchers from the University of Tampere and Seinäjoki Central Hospital in Finland, and the University of Nottingham in the UK analyzed 16 studies that compared the incidence of bone fractures among people with and without a celiac disease diagnosis.

    In studies that looked at one point in time, people with celiac disease were almost twice as likely to have had a bone fracture in the past.

    In studies that followed people over time, those who had a diagnosis of celiac disease at the start were about 30 percent more likely to suffer a bone fracture and 69 percent more likely to have a hip fracture than others, according to the analysis published in the Journal of Clinical Endocrinology and Metabolism.

    There were only two studies of bone fractures among people with undiagnosed celiac disease - but whose blood tests showed celiac-specific antibodies - and it was not clear if there was a link to broken bones, the authors write.

    Since the disease affects nutrient absorption in the small intestine, it could lead to poor absorption of vitamin D and calcium, or chronic intestinal inflammation could interfere with bone formation, they write.

    Other possibilities to explain the connection to bone breaks include hormonal changes or a gluten-free diet, which is often low in minerals, they write.

    Other studies have found that bone density tends to go down as symptoms become worse for people with celiac disease, according to Professor Julio C. Bai at the Hospital de Gastroenterologia Dr. Carlos Bonorio Udaondo in Buenos Aires, Argentina.

    "Therefore and based on our findings, it seems reasonable to consider to evaluate bone density in those patients with symptomatic celiac disease," said Bai, who was not involved in the new study.

    Symptoms can include abdominal bloating and pain, chronic diarrhea, constipation and weight loss.

    Physical activity can help strengthen bones, he said.

    "Some areas of bone are more vulnerable to the damage induced by celiac disease," said Dr. Peter H.R. Green, an expert on celiac disease at Columbia University in New York who wasn't involved in the new review. "This relates to the type of bone and its rate of turnover."

    Everyone newly diagnosed with celiac disease is routinely given a bone density scan, as they should be, he told Reuters Health by email.

    "We have shown that a gluten free diet together with replacement of calcium and vitamin D, when necessary, results in improvement in bone density," he said.

    SOURCE: http://bit.ly/1yrO6yQ Journal of Clinical Endocrinology and Metabolism, online October 3, 2014.

  • Weak muscles can put diabetics at risk on stairs

    By Janice Neumann

    (Reuters Health) - When nerves in the legs and feet are damaged from diabetes, people often have trouble on stairs, but a new report suggests exercise might help lower their risk of falling.

    People with so-called diabetic peripheral neuropathy go up and down stairs more slowly and clumsily than healthy people because of weak muscles, sensory damage (loss of feeling) and poor coordination, say the authors of the report.

    Resistance exercises could help these individuals build up strength and avoid future falls, they wrote in the journal Diabetes Care.

    For people with diabetic peripheral neuropathy, falls "whilst walking down stairs are nearly unrecoverable," and as a result, account for a large proportion of fall-related deaths, said Joseph C. Handsaker of Manchester Metropolitan University in Manchester, UK, who led the research.

    "The aim of the study was to provide potential explanations for why patients with neuropathy are at a high risk of falling during the dangerous tasks of stair ascent and descent, in the hope that by identifying why falls occur, we can then suggest solutions for how to reduce the risk of falling," Handsaker told Reuters Health.

    An estimated 347 million people worldwide have diabetes, according to the World Health Organization. About half of patients with diabetes develop peripheral neuropathy after 10 years, Handsaker said.

    It's been known for a while that these patients have trouble on stairs, but the underlying reason hasn't been clear, Handsaker added.

    He and his colleagues compared 21 patients with diabetic neuropathy, 21 who had only diabetes, and 21 healthy individuals as they walked up and down a custom-built staircase.

    The researchers analyzed the electrical activity of participants' muscle tissue to determine when the muscles were "switched on and off" and when they reached peak activation.

    Overall, the patients with diabetic peripheral neuropathy were significantly slower at activating their knee and ankle muscles than the healthy group, and significantly slower at reaching peak knee-muscle activation.

    "The slower speed of strength generation is the key finding in this study, with alterations to muscle activation expected to contribute to the observed reductions," said Handsaker.

    For diabetics with peripheral neuropathy who'd like to strengthen their muscles and reduce their risk of falling, Handsaker suggested using isometric exercises like calf raises and knee extensions. Individuals should rapidly stretch these muscles for a second and then relax for three seconds, he said.

    His paper also advises that resistance training might be helpful, such as with weight machines, free weights or calisthenics.

    (Before starting to exercise, however, patients should get clearance from their doctors. As the American College of Sports Medicine advises, "Not all exercise programs are suitable for everyone, and some programs may result in injury.")

    Improving the strength and response of the extensor muscles will result in faster strength generation, which should improve stability during stair ascent and descent, said Handsaker.

    Dr. Michael Polydefkis, who directs the Johns Hopkins Cutaneous Nerve Laboratory and the Bayview EMG Laboratory and Diabetic Neuropathy Center, said he was glad to see a study that emphasized the effect of diabetes on people's ability to move around.

    He said people recognize the devastating effects of diseases like multiple sclerosis, Parkinson's and ALS but often don't realize how much diabetic neuropathy compromises quality of life.

    "Oftentimes peripheral neuropathy is not always given its due respect," said Polydefkis in a phone interview. "People don't really appreciate the impact this has on people's lives."

    Polydefkis, who was not involved in the study, said his patients typically complain of pain and numbness in their feet, rather than weakness. But the study showed that falls might be related to subtle muscle problems that aren't easy to detect. He often suggests balance exercises for his patients.

    Dr. Peter Dyck, who directs the Peripheral Nerve Research Laboratory at the Mayo Clinic in Rochester, Minnesota, told Reuters Health in a phone interview that the study helps confirm some of the reasons for the unsteady gait of diabetics. But Dyck, who was not involved in the study, said he wasn't convinced that exercise would help these individuals because of their sensory loss.

    "I think it's a worthwhile study, it was fun to read, but I'm not sure the take-home message is quite correct," said Dyck. "The emphasis needs to be on preventing polyneuropathy by good diabetic control."

    SOURCE: http://bit.ly/1DBSe2g Diabetes Care, online October 14, 2014.

  • Ibuprofen good as morphine, and safer, for kids with fractures

    By Kathryn Doyle

    (Reuters Health) - The narcotic drug morphine is not the best choice for pain relief in kids with broken bones, a new study suggests.

    Kids in the study took either morphine or ibuprofen by mouth. The morphine was associated with side effects like drowsiness, nausea and vomiting - but it wasn't any better than ibuprofen at relieving pain.

    "Both ibuprofen and oral morphine provided pain relief but there were no significant differences between the two agents," said lead author Dr. Naveen Poonai, a pediatric emergency physician at the London Health Sciences Centre in Ontario.

    "In our study, we found that drowsiness and nausea were the most common side effects but patients also reported dizziness and vomiting," Poonai told Reuters Health by email.

    The study involved 134 children between ages five and 17 who arrived at the emergency department with a broken bone of the arm or leg that didn't require surgery.

    Half of the kids were randomly assigned to receive oral morphine, dosed to 0.5 milligrams per kilogram of the child's weight, while the others received 10 mg/kg of ibuprofen, every six hours as needed for 24 hours after hospital discharge with a cast or sling. The medicines were not marked or labeled so the children and the parents did not know which painkiller they had received.

    Doctors told parents to use acetaminophen if needed for breakthrough pain.

    Patients received self-report pain measurement forms and were instructed to rate their pain on a scale of zero to five immediately before and 30 minutes after a painkiller dose.

    Both morphine and ibuprofen lowered pain scores by an average of 1 to 1.5 points from before administration to 30 minutes after a dose, according to results in the Canadian Medical Association Journal.

    The two groups did not differ in their overall pain reduction or in the use of acetaminophen for breakthrough pain.

    More than half of the morphine group reported a side effect of the medicine, most often drowsiness, compared to 31 percent of the ibuprofen group.

    In the morphine group, 18 patients reported nausea, compared to four in the ibuprofen group.

    Ibuprofen is a safe and effective choice for managing bone fracture pain for kids, the authors write.

    "Ibuprofen is the safer choice for the simple reason that we have a lot more experience with it in children and both health care workers and parents know what to expect when it is given," Poonai said.

    "There is very little pediatric acute pain research done in the 'at-home' setting where these analgesics are actually used," said Amy L. Drendel, an associate professor of Pediatric Emergency Medicine at the Medical College of Wisconsin in Milwaukee. "This provides real-life data about how these medications work in the outpatient setting."

    Drendel was not involved in the new study.

    "Many variables go into the decisions doctors make about pain management for children," she told Reuters Health by email. "I always recommend that parents talk with their doctor about their child's treatment to make sure their child receives the best care possible."

    Although it is understandably a big fear for doctors and parents, there is no evidence that children are at risk of opioid dependence to the same degree as adults, Poonai said.

    "Pain in the ER before a fracture is immobilized with a cast or splint is likely more severe than pain at home," he said. "But in our study we found that over 70 percent of children had pain severe enough to require pain medication after discharge."

    "This tells us that nurses and doctors should be teaching parents to recognize and manage pain at home and likely offering a dose of ibuprofen at discharge," he said.

    SOURCE: http://bit.ly/1xxCsBt Canadian Medical Association Journal, online October 27, 2014.

Transplant Articles

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Women’s Health Articles

  • REFILE-Sandwiches may be a source of too much dietary salt

    (Corrects link to Source at bottom, no change to article text)

    By Madeline Kennedy

    (Reuters Health) - Americans consume too much sodium, according to current guidelines, and much of the excess may be hidden in our sandwiches, researchers say.

    Based on national survey data depicting American eating habits over the course of a single day, the study found that half of all adults had a sandwich. And those who did took in more calories and sodium overall than those who didn't.

    The study team calculates that sandwiches, on average, contribute about a fifth of the entire day's sodium intake for people who eat them.

    "Excessive sodium intake is a health risk because of the relationship between sodium and blood pressure," said the study's lead author, Rhonda Sebastian, a nutritionist in the Food Surveys Research Group of the U.S. Department of Agriculture (USDA).

    High sodium intake has been linked to worsening high blood pressure, a condition that can, in turn, increase the risk of heart disease, congestive heart failure and kidney disease, according to the USDA's 2010 Dietary Guidelines for Americans.

    The USDA recommends that everyone, including children, should limit their sodium intake to no more than 2,300 milligrams per day, or about one teaspoon of salt.

    For "adults age 51 and older, African Americans of any age, and individuals with high blood pressure, diabetes, or chronic kidney disease," the guidelines recommend limiting sodium even further, to 1,500 mg a day.

    To see where big contributors of sodium may be lurking in the American diet, the research team used data from nearly 6,000 adults over the age of 20 who participated in the 2009-2010 What We Eat in America survey, part of the annual National Health and Nutrition Examination Survey.

    During in-person interviews, participants listed all the food and beverages they consumed during the entire previous day, including quantities.

    The results showed that in general, people consumed more sodium throughout the day than the USDA guidelines recommend: an average of 3,900 mg of sodium for sandwich eaters and 3,200 mg for those who didn't have a sandwich.

    This was true for both men and women and across all age groups, the researchers report in the Journal of the Academy of Nutrition and Dietetics.

    But the biggest spread was apparent between men who ate sandwiches, who averaged up to 4,800 mg of sodium in a day, and men who didn't eat them and averaged just under 3,900 mg.

    Men in general ate significantly more sandwiches and took in almost twice as much sodium from sandwiches as women did, Sebastian told Reuters Health in an email.

    But the explanation is not entirely that sandwich eaters consume saltier food, the study team writes in their report. The extra sodium was largely due to sandwich eaters taking in more calories overall, about 300 more than people who did not eat sandwiches.

    Patricia Guenther, a research professor in the Division of Nutrition at the University of Utah who was not involved in the study cautions, however, that it is also a matter of typical sandwich ingredients tending to be higher in sodium.

    "It's the processed meats that generally have the most sodium - cold cuts, luncheon meats, sausages, frankfurters/hot dogs," Guenther said. People do not necessarily need to avoid these foods altogether, but they should limit how much they eat, Guenther told Reuters Health in an email.

    The researchers added that cheese and yeast-based breads are also among the top contributors to the sodium content of sandwiches.

    The study did not account for additional salt sprinkled on foods or salt from non-food sources like antacids. But Sebastian said these sources make up only a small percentage of sodium intake for most people.

    Because overall calorie intake played a large role in how much sodium people took in, Sebastian said, "it's very important to pay attention to portion sizes. It's also important to select more fresh foods that are low in sodium and fewer processed foods that are high in sodium."

    Guenther advises, "pack your own lunches, make your own sandwiches, so you have control of the ingredients and the portion sizes."

    SOURCE: http://bit.ly/1rXqAp3 Journal of the Academy of Nutrition and Dietetics, Online October 5, 2014.

  • REFILE-Sandwiches may be a source of too much dietary salt

    (Corrects link to Source at bottom, no change to article text)

    By Madeline Kennedy

    (Reuters Health) - Americans consume too much sodium, according to current guidelines, and much of the excess may be hidden in our sandwiches, researchers say.

    Based on national survey data depicting American eating habits over the course of a single day, the study found that half of all adults had a sandwich. And those who did took in more calories and sodium overall than those who didn't.

    The study team calculates that sandwiches, on average, contribute about a fifth of the entire day's sodium intake for people who eat them.

    "Excessive sodium intake is a health risk because of the relationship between sodium and blood pressure," said the study's lead author, Rhonda Sebastian, a nutritionist in the Food Surveys Research Group of the U.S. Department of Agriculture (USDA).

    High sodium intake has been linked to worsening high blood pressure, a condition that can, in turn, increase the risk of heart disease, congestive heart failure and kidney disease, according to the USDA's 2010 Dietary Guidelines for Americans.

    The USDA recommends that everyone, including children, should limit their sodium intake to no more than 2,300 milligrams per day, or about one teaspoon of salt.

    For "adults age 51 and older, African Americans of any age, and individuals with high blood pressure, diabetes, or chronic kidney disease," the guidelines recommend limiting sodium even further, to 1,500 mg a day.

    To see where big contributors of sodium may be lurking in the American diet, the research team used data from nearly 6,000 adults over the age of 20 who participated in the 2009-2010 What We Eat in America survey, part of the annual National Health and Nutrition Examination Survey.

    During in-person interviews, participants listed all the food and beverages they consumed during the entire previous day, including quantities.

    The results showed that in general, people consumed more sodium throughout the day than the USDA guidelines recommend: an average of 3,900 mg of sodium for sandwich eaters and 3,200 mg for those who didn't have a sandwich.

    This was true for both men and women and across all age groups, the researchers report in the Journal of the Academy of Nutrition and Dietetics.

    But the biggest spread was apparent between men who ate sandwiches, who averaged up to 4,800 mg of sodium in a day, and men who didn't eat them and averaged just under 3,900 mg.

    Men in general ate significantly more sandwiches and took in almost twice as much sodium from sandwiches as women did, Sebastian told Reuters Health in an email.

    But the explanation is not entirely that sandwich eaters consume saltier food, the study team writes in their report. The extra sodium was largely due to sandwich eaters taking in more calories overall, about 300 more than people who did not eat sandwiches.

    Patricia Guenther, a research professor in the Division of Nutrition at the University of Utah who was not involved in the study cautions, however, that it is also a matter of typical sandwich ingredients tending to be higher in sodium.

    "It's the processed meats that generally have the most sodium - cold cuts, luncheon meats, sausages, frankfurters/hot dogs," Guenther said. People do not necessarily need to avoid these foods altogether, but they should limit how much they eat, Guenther told Reuters Health in an email.

    The researchers added that cheese and yeast-based breads are also among the top contributors to the sodium content of sandwiches.

    The study did not account for additional salt sprinkled on foods or salt from non-food sources like antacids. But Sebastian said these sources make up only a small percentage of sodium intake for most people.

    Because overall calorie intake played a large role in how much sodium people took in, Sebastian said, "it's very important to pay attention to portion sizes. It's also important to select more fresh foods that are low in sodium and fewer processed foods that are high in sodium."

    Guenther advises, "pack your own lunches, make your own sandwiches, so you have control of the ingredients and the portion sizes."

    SOURCE: http://bit.ly/1rXqAp3 Journal of the Academy of Nutrition and Dietetics, Online October 5, 2014.

  • "Wandering eye" may raise risk of falls for older adults

    By Shereen Lehman

    (Reuters Health) - Older people with strabismus, where one eye points slightly inward or outward affecting vision, are about 27 percent more likely than people without the condition to be injured by a fall, according to a new study.

    The disorder, often called "wandering eye," becomes more common with age and can cause double vision or depth perception problems because the two eyes are not pointing in the same direction.

    Previous studies have shown that having other eye disorders like cataracts, glaucoma or age-related macular degeneration increases the risk of injuries, fractures or falls, the study team writes in JAMA Opthalmology. But this is the first to examine whether so-called binocular vision problems have the same effect.

    "Strabismus in adults is becoming more prevalent as the aging population increases and we do not know the impact of strabismus on patient quality of life and morbidity," lead author Dr. Stacy Pineles told Reuters Health in an email.

    "We hypothesized that strabismus could cause double vision or diminished depth perception, and we wanted to see whether this was associated with injuries such as falls, fractures, and musculoskeletal injuries," said Pineles, an ophthalmologist with the Jules Stein Eye Institute at the University of California, Los Angeles.

    Pineles and her colleagues looked at a random sample of Medicare claims for more than two million beneficiaries over the years 2002 to 2011.

    They found almost 100,000 diagnoses of binocular vision problems. The great majority were either strabismus or diplopia, meaning double vision, which often goes along with strabismus. On average the patients were older, white, were more often male and had other health problems like diabetes and heart disease.

    About 75 percent of those with binocular vision problems had also reported some type of musculoskeletal injury, fall or fracture during that 10-year time span, compared to about 60 percent of patients without a binocular visual disorder.

    After taking into consideration age, region and other potential contributors to falling, such as other illnesses, the researchers calculated that people with binocular vision disorders had a 27 percent higher risk of falls, fractures and injuries overall.

    For people with a specific diagnosis of diplopia, the risk was 36 percent higher.

    The study team cautions that they don't know if the injuries occurred before the vision problems were diagnosed or afterward, so they can't say for certain that the eye disorders are to blame for the falls. They also don't know which patients were being treated for their vision problems.

    Still, Pineles said that elderly patients with vision problems should be sure they optimize lighting in their homes, get help when navigating unfamiliar areas and use low-vision aids if necessary.

    Dr. Jamie Rosenberg, an ophthalmologist at Montefiore Medical Center in New York who specializes in strabismus, said that eye problems can sometimes seem less important to elderly patients compared to other illnesses they may have. But "they can affect their life in a significant way and keeping them safe from falls is a huge part of keeping older people healthy."

    Rosenberg, who wasn't involved in the new study, said there are treatment options for strabismus, such as wearing special glasses with prisms that help align the double images seen by people with diplopia.

    "Even though the eyes aren't straight the two images that are being processed by the brain will be one," she said.

    Surgery may also be an option. "A lot of people think that older people can't have strabismus surgery to straighten their eyes but that's actually not true at all," Rosenberg said.

    The new study may underestimate the magnitude of the problem, noted Priscilla Rogers, an aging and vision loss expert at the American Foundation for the Blind's Vision Aware program.

    "Only people who seek medical care from a fall would be included, so the problem is probably bigger and greater than this study suggests," she told Reuters Health in an email.

    Access to eye care may be one obstacle keeping older people from getting help for vision disorders, she noted. "Medicare does not pay for new glasses and people on a fixed income may not want to buy new glasses because they cost too much," Rogers said. "They can, after all, see - they just may not see well enough to avoid a trip or fall."

    Rogers said that fall prevention programs such as "A Matter of Balance" offered in several states (http://bit.ly/1FZWPgF ) can help reduce the risk of injuries among people with visual impairments.

    SOURCE: http://bit.ly/1wylK5I JAMA Ophthalmology, online October 23, 2014.

  • Insurers have big plans for 2015 Obamacare enrollment

    By Caroline Humer

    (Reuters) - U.S. insurers planning to sell 2015 Obamacare health plans expect at least 20 percent growth in customers and in some states anticipate more than doubling sign-ups.

    In interviews with Reuters, half a dozen privately held and non-profit health insurers around the country say they are expecting this growth based on interest from potential customers they are hearing about through their call centers, sales forces and brokers.

    With the start of enrollment barely two weeks away, their assessment is dramatically different from a year ago, when it was unclear how many Americans would apply for the brand new insurance and income-based subsidies offered under President Barack Obama's healthcare law.

    Despite crippling technology issues with the HealthCare.gov website, more than 7 million people signed up for Obamacare plans in 2014.

    In Florida, Jason Alford, sales director at Health First Health Plans Inc, expects to more than double customers in Affordable Care Act compliant plans from the 4,400 it signed up this year.

    "We've just talked to so many people in the market who for one of 5 or 6 different reasons didn't enroll in 2014. We had many folks call this summer who really don't understand the open enrollment period. They are calling in August to sign up for a plan because they think it's all-year enrollment," he explained.

    When the three-month enrollment period opens on Nov. 15, it will be a critical juncture for insurers who need to build profitable businesses that can stand up as government financial supports to insurers who sell these plans decline in the next two years.

    Aimed at extending health insurance to 25 million people, the law has been controversial for its cost to taxpayers and the changes it has spurred in coverage. Millions of individual plans were canceled for 2014 and some employers stopped insuring part-time workers.

    Support for the law tends to fall along political lines and has waned overall, polls say. Public support fell to 40 percent in 2014, from 44 percent in 2012 and 42 percent in 2010, Harvard researchers said this week.

    The exchanges have become a big business for insurers like Aetna Inc and WellPoint Inc, who enrolled hundreds of thousands of new customers last year. UnitedHealth Group Inc, barely on the exchanges in 2014, will be in two dozen states. These insurers have not discussed 2015 forecasts.

    There is political importance for Obama as well. The Congressional Budget Office expects 13 million people to buy exchange plans in 2015 and 24 million in 2016. If those numbers materialize, it will make it even more difficult for Republicans and other foes to uproot the embattled law.

    Insurers would not say whether they agreed with CBO forecasts, but many interviewed by Reuters have doubled or tripled staffing to handle applicants. Some saw customer calls up 30 percent in October. Only those with qualifying events such as job loss can buy insurance outside the regular enrollment period.

    In Pennsylvania, where Medicaid is being expanded, Independence Blue Cross hopes to add about 30,000 new customers to the 165,000 it signed up for 2014 plans.

    "We're thinking pretty positive. Last week we saw our call center activity increase 31 percent from a call volume standpoint versus the previous few weeks," Brian Lobley, a senior vice president at Independence Blue Cross in Pennsylvania, said in an interview.

    Lobley is seeing growth at a slower pace than CBO suggests because some customers may qualify for benefits under Medicaid when the state makes it available for more residents.

    In Texas, one small insurer predicts growth of 15,000 to 40,000 more customers from the fewer than 500 it signed up last year.

    Non-profit insurer Community Health Choice Inc in Houston priced premium rates too high and was mostly shut out in 2014, said Daisy Morales, vice president of marketing. This year, with more competitive premiums, it expects to win new customers by gaining market share and because of forecasts for growth in the state. The insurer foresees one million new sign-ups in Texas in addition to the more than 700,000 who enrolled in 2014.

    "It's not like we're starting from scratch, like we were last year," Morales said.

  • Oregon woman visits Grand Canyon ahead of planned assisted suicide

    By Reuters Staff

    (Reuters) - A 29-year-old Oregon woman with terminal brain cancer has ticked off the Grand Canyon from her bucket list and said in a video released this week that she might end her life through assisted suicide in a couple of days.

    Brittany Maynard was diagnosed in January with a glioblastoma brain tumor and has said she plans to take prescribed medication to die when her pain becomes unbearable. She has moved from her San Francisco Bay area home to Oregon, which allows assisted suicide for terminally ill patients.

    Maynard is raising funds through a group called Compassion & Choices to advocate for assisted suicide as an option for terminally ill patients. The group released her latest video on Wednesday.

    Opponents of assisted suicide say some people who are ill, especially among the elderly, might be unduly influenced by people close to them to end their lives and that other ways exist to ease the suffering of the terminally ill.

    Maynard, who has stressed that her decision to end her life is her own, had previously told People magazine, which featured her on the front page of its Oct. 27 issue, that she had picked Nov. 1, as the day she planned to die, although she also said she might change her mind.

    In her latest video, Maynard said: "So if Nov. 2 comes along and I've passed, I hope my family is still proud of me and the choices I made.

    "If Nov. 2 comes along and I'm still alive, I know that we'll still be moving forward as a family out of love for each other and that decision will come later."

    On the website of Compassion & Choices, Maynard wrote that she traveled to the Grand Canyon with her husband and her parents during the week before Oct. 24 to make her bucket list dream come true.

    Maynard suffered her worst seizure the morning after the Grand Canyon visit. Her speech was paralyzed for some time after she regained consciousness, she wrote.

    "Sadly, it is impossible to forget my cancer," she wrote.

    A representative for Compassion & Choices did not return calls.

    Since 1997, more than 750 patients in Oregon have died from ingesting medications prescribed under the state's death with dignity law, according to the Oregon Public Health Division. Four states beside Oregon allow assisted suicide.