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.

Neuroscience Articles

  • CORRECTED-Terminal cancer care should do more to treat depression

    ((In paragraphs 1 and 7, clarifies that the doctors surveyed for the study were in The Netherlands, not Norway).)

    By Janice Neumann

    (Reuters Health) - Depression could be clouding the last 24 hours of life for a significant number of people with advanced cancer, pointing to a need for better - and earlier - psychological help, according to a large study in The Netherlands.

    Although it's challenging to tease apart depression symptoms from the pain, fatigue and cognitive problems associated with end-stage cancer, more can be done to alleviate depression and anxiety, researchers said.

    "Health care providers may think this is a normal part of the dying process," said lead author Dr. Elene Janberidze from the European Palliative Care Research Center at the Norwegian University of Science and Technology in Trondheim.

    "However, some patients experiencing depressive symptoms and/or depression can be treated and thus both the patients and their families may have a better quality of life," Janberidze told Reuters Health in an email.

    Previous studies have estimated the rates of depression in patients with advanced cancer at anywhere from 2 percent to 56 percent, she and her colleagues write in the journal BMJ Supportive and Palliative Care.

    Janberidze said that her team chose to focus on patients in their last 24 hours of life because this group had not been well investigated.

    They used data from a 2005 nationwide Dutch survey of doctors who had signed the death certificates of patients that died within the past two months. The researchers examined data on 1,363 cancer patients during their last 24 hours of life, assessing the symptoms reported by their attending physicians and rating their level of depression.

    After accounting for symptoms of the individuals' illness, the researchers found that overall 37 percent of patients were depressed. More women than men were severely or very severely depressed, and patients aged 17 to 65 were more likely to be moderately depressed than those 80 years or older.

    Geriatricians were four times more likely than other doctors to assess their patients as seriously or severely depressed. Pain specialists, palliative care consultants, psychiatrists and psychologists were also more often tending to patients with symptoms of serious depression than to those with mild or moderate depression.

    Mild or moderately depressed patients were more likely to feel tired, anxious and confused than those without depression symptoms. Individuals who were severely or very severely depressed also tended to feel anxious.

    Holly Prigerson, who directs the Center for Research on End-of-Life Care at Cornell University, said she admired the authors for trying to gauge depression in cancer patients who were so close to death.

    "The study is novel in that it evaluates retrospectively the depressive symptom severity of patients within 24 hours of death," Prigerson said in an e-mail to Reuters Health. "I'm unaware of any other study that has attempted this."

    But Prigerson also noted some of the study's limitations, such as trying to assess patients who could be unconscious or delirious, have multiple organ failure and difficulty communicating their emotions.

    Physicians also need to distinguish physical and psychological symptoms and might not always have enough information on a patient's psychological state when they are dying or might not have enough training to diagnose their "psychological distress," she said.

    "It is also difficult to draw conclusions regarding the clinical implications of the study," Prigerson said. "Given patients are actively dying, it is doubtful that a psychosocial intervention or administration of an antidepressant will effectively improve the patients' quality of death.

    "Psychosocial interventions and care in the months and weeks leading up to the death can have a profound impact on patients' quality of life prior to death, however," Prigerson said.

    Janberidze said doctors should be checking cancer patients for physical and psychological pain and integrating palliative care with their cancer management earlier in their disease. She also said family members could help monitor the patient's pain.

    "In general it is important for family members with loved ones who have advanced stage cancer to pay attention to the signs and symptoms of depression and inform healthcare providers immediately. Doctors should investigate the patient further and recommend psychological interventions as needed," Janberidze said.

    SOURCE: http://bmj.co/1LeAEoL BMJ Supportive and Palliative Care, online February 9, 2015.

  • Younger men more bothered after prostate cancer treatment

    By Shereen Lehman

    (Reuters Health) - After treatment for localized prostate cancer, changes in quality of life will vary by age, as will men's reactions to those changes, according to a new study.

    "While older and younger men start with different baseline quality of life function, older men may be less bothered by certain declines that may affect younger patients more," Dr. Lindsay Hampson told Reuters Health in an email.

    Prostate cancer is the most common malignancy in men of all ages in the U.S. Almost 60 percent of new cases are diagnosed in men over the age of 65, and the average age is 66.

    Older men are often diagnosed with more aggressive disease and are less likely to get treatment, in part because they worry about the impact on their sexual and urinary function, Hampson and her colleagues write in European Urology.

    Determining quality of life priorities is vital to ensuring that patients make well-informed treatment decisions, said Hampson, a urologist at the University of California San Francisco.

    The researchers reviewed national data on 5,362 men diagnosed between 1999 and 2013 with aggressive prostate cancer that had not spread. The men received various treatments, including surgery, brachytherapy, external beam radiation, or androgen deprivation, or active surveillance.

    Before treatment, and again within two years later, the men filled out surveys that included quality of life questions about their urological functioning and symptoms.

    Overall, men over 70 had worse quality of life after treatment than those under 60 - except in terms of mental health - but the younger men were more bothered by quality of life declines.

    For sexual function, 40 percent of the younger men reported a decline after treatment, compared to 46 percent of the older men. But 39 percent of younger men reported worsening sexual "bother" versus just 17 percent of the older men.

    More men under 60 had declines in urinary function, with 14 percent reporting some negative change, compared to 9 percent of older men.

    It's likely that older men start out with a lower level of function, and lower expectations, and therefore are less bothered by declines, the study team writes. Or, perhaps older men have just learned to cope better with fluctuations in their functioning, they note.

    Hampson said quality of life is a very important consideration when contemplating treatment for prostate cancer, and physicians can help patients make appropriate decisions.

    "The first critical question is whether the cancer needs treatment because many prostate cancers can be safely followed with active surveillance," she said.

    "Treatment should not be deferred for older men just because of quality of life concerns, just as younger men also need to be counseled about potential changes in quality of life after treatment," Hampson said.

    Sexual and urinary problems are the most common problems after prostate cancer treatment, said Katrina Balter, a researcher at Karolinska Institute in Stockholm, Sweden, who was not involved in the study.

    "It is important to discuss potential side effects associated with different treatment options," Balter said. "If a man is sexually active, he might prioritize treatments with less risk of side effects or go for 'watchful waiting' (i.e. no treatment) whereas others may prioritize local treatment and potentially improved survival," she told Reuters Health by email.

    SOURCE: http://bit.ly/1COp3ZE European Urology, online February 2, 2015.

  • Inhaled drug may help with sociability in autism

    By Kathryn Doyle

    (Reuters Health) - In an early study, inhaling the hormone oxytocin appeared to encourage men with autism to make more eye contact.

    But this was a small experiment with several limitations and does not mean oxytocin should immediately become a therapy for autism, experts cautioned.

    Oxytocin has been touted as the "love hormone" and the "moral molecule" in the past. Naturally released during intercourse and breastfeeding, it seems to at least make people more social, if not actually more loving.

    For the new study, researchers from the Autism Research Centre at the University of Cambridge in the UK and other European institutions compared 32 men with Autism Spectrum Disorder (ASD) or Asperger Syndrome and another 34 men without those disorders but of similar age and IQ.

    Individually, the men video-chatted with a female researcher twice. Before one interview, participants inhaled oxytocin. Before the other, they inhaled a placebo spray.

    The video-chat software included eye tracking, which recorded how often the subject focused on the eyes, mouth or other face areas during the interviews.

    The female interviewer asked the men how they were doing, how the nasal spray made them feel, how they liked or didn't like being in the study and similar questions for about five minutes.

    With placebo, men with autism focused on the interviewer's eyes less often and for less time than men without autism.

    With oxytocin, the number of times men with autism looked at the interviewer's eyes rose from an average of 0.59 per second to more than 0.7 per second. For men without autism, glances at the eyes rose from 0.83 to almost 0.9 per second, the authors reported in Translational Psychiatry.

    Dr. Lawrence Scahill, director of clinical trials at the Marcus Autism Center at Emory University in Atlanta, who was not involved in the new research, told Reuters Health by email, "This is a step forward, but we should be careful not to over-interpret the results. As noted by the authors, findings with (oxytocin) in ASD have been inconsistent."

    Video interviews are not natural interaction, he noted, and the study participants with autism were "high functioning," having been medication-free for at least a year.

    The findings do add to mounting evidence that oxytocin enhances attention to the eyes, said Tobias Grossman, a developmental psychologist specializing in the brain processes underpinning social interaction at the University of Virginia in Charlottesville.

    "However, it is unclear whether increased looking to the eyes actually improves social functioning," Grossman, who was also not involved in the new study, told Reuters Health.

    Prior work with children with autism shows that oxytocin increases brain function in regions involved in social processing but doesn't affect performance of other tasks, he said.

    In other words, oxytocin may increase glances at eyes, and also brain response to eyes, but without affecting behavior when responding to eye cues, Grossman said.

    Reduced eye contact is one of the earliest warning signs in young children with autism and might be evident as soon as two to six months of age, he said. Much of what happens for these infants developmentally, and how much oxytocin may be involved, remains unknown.

    Grossman and Scahill agree that the new findings are not evidence that oxytocin should be used as a therapy for children with autism.

    SOURCE: http://bit.ly/198lLql Translational Psychiatry, online February 10, 2015.

  • Dyslexia needn't hold doctors back

    By Randi Belisomo

    (Reuters Health) - Failing kindergarten was the first of many school struggles for Blake Charlton. Diagnosed with dyslexia, he was relegated to remedial classes that he barely passed. Now, at 35, reading still poses a challenge. He's a self-described "crummy" speller who manages written communications by relying on abbreviations. People who recall his academic difficulties are often surprised at the abbreviation that now follows his name: M.D.

    "For much of high school and college, I didn't think medical school was a possibility," said Charlton, who's now a medical resident at the University of California, San Francisco and an editorial fellow for the American Medical Association journal JAMA Internal Medicine. "I spent a lifetime having to ride the short bus, identifying as someone who needs help."

    Several years after Charlton finished college, his father was diagnosed with cancer. Caring for his father, Charlton realized that his desire to become a doctor outweighed his fear of failure.

    Receiving time accommodations to take the Medical College Admission Test (MCAT), Charlton earned entry into Stanford University School of Medicine. Most classmates didn't know of his disability, and his patients don't, either.

    Charlton is a dyslexic doctor, and although studies are scant, researchers say he is one of many. Charlton knows of two others at UCSF alone.

    According to the Dyslexia Research Institute, up to 15 percent of Americans are affected by this neurological difference, resulting in language, perceptual and processing difficulties. The percentage of dyslexic doctors is difficult to measure, as many fear that disclosure could thwart professional development and compromise the trust of patients.

    For a recent paper in the Postgraduate Medical Journal, Jean Robson at Dumfries & Galloway Royal Infirmary in Dumfries, UK, and colleagues interviewed seven dyslexic first-year physicians in the Scottish National Health Service. Most said they had not disclosed their dyslexia and had experienced difficulty with communication, time-management and anxiety. (The paper is online here: http://bmj.co/1LKRIB4.)

    Commenting on those interviews, Dr. Sally Shaywitz, a physician and professor of learning development at the Yale University School of Medicine, told Reuters Health, "I think it's a really important topic but an extraordinarily small sample. One doesn't know how representative it is, because there was no control group."

    Shaywitz cites a need for more research into the experiences of dyslexic doctors, whom she says are far more numerous than most believe.

    "They worry what others will think, because there is terrible misinformation that people who are dyslexic aren't smart," Shaywitz said. "But because they have difficulties reading, they have learned to be very careful."

    Charlton said his first-hand awareness of personal deficiencies has made him a compassionate physician. He also said he re-reads everything he writes, never failing to run a spell-check. Being careful doesn't distinguish him among colleagues, however. "Doctors are very meticulous people," he said. "You wouldn't get to where we are if you were not."

    Radiologist Beryl Benacerraf is one of those meticulous dyslexic doctors. She's also a Harvard Medical School professor who was an adult before her dyslexia was diagnosed. When Benacerraf entered medical school in the mid-1970s, she says it wasn't due to academic achievement or test scores. She credits her father, immunologist Baruj Benacerraf, who later won a Nobel Prize, with pulling strings at Harvard. That help was all she needed.

    "I never was accommodated, I had to swim in the waters with everybody else," Benacerraf said. She developed "work-arounds," relying on lectures more than textbooks. She now considers her dyslexia to be a gift. Because she was naturally good at pattern recognition, radiology was a perfect fit. (She gets to look at images rather than read words.)

    "You develop the ability to be a big-picture person rather than a detail-oriented person," Benacerraf said. "Dyslexics think much faster, and it's a more creative way of thinking. I'm very proud of it."

    Charlton agrees. "A lot of us are coming to realize that there are significant downers, but there are certain things we tend to be pretty good at. There's no reason to suppose that people with this kind of brain are not good at things."

  • CORRECTED-Terminal cancer care should do more to treat depression

    ((In paragraphs 1 and 7, clarifies that the doctors surveyed for the study were in The Netherlands, not Norway).)

    By Janice Neumann

    (Reuters Health) - Depression could be clouding the last 24 hours of life for a significant number of people with advanced cancer, pointing to a need for better - and earlier - psychological help, according to a large study in The Netherlands.

    Although it's challenging to tease apart depression symptoms from the pain, fatigue and cognitive problems associated with end-stage cancer, more can be done to alleviate depression and anxiety, researchers said.

    "Health care providers may think this is a normal part of the dying process," said lead author Dr. Elene Janberidze from the European Palliative Care Research Center at the Norwegian University of Science and Technology in Trondheim.

    "However, some patients experiencing depressive symptoms and/or depression can be treated and thus both the patients and their families may have a better quality of life," Janberidze told Reuters Health in an email.

    Previous studies have estimated the rates of depression in patients with advanced cancer at anywhere from 2 percent to 56 percent, she and her colleagues write in the journal BMJ Supportive and Palliative Care.

    Janberidze said that her team chose to focus on patients in their last 24 hours of life because this group had not been well investigated.

    They used data from a 2005 nationwide Dutch survey of doctors who had signed the death certificates of patients that died within the past two months. The researchers examined data on 1,363 cancer patients during their last 24 hours of life, assessing the symptoms reported by their attending physicians and rating their level of depression.

    After accounting for symptoms of the individuals' illness, the researchers found that overall 37 percent of patients were depressed. More women than men were severely or very severely depressed, and patients aged 17 to 65 were more likely to be moderately depressed than those 80 years or older.

    Geriatricians were four times more likely than other doctors to assess their patients as seriously or severely depressed. Pain specialists, palliative care consultants, psychiatrists and psychologists were also more often tending to patients with symptoms of serious depression than to those with mild or moderate depression.

    Mild or moderately depressed patients were more likely to feel tired, anxious and confused than those without depression symptoms. Individuals who were severely or very severely depressed also tended to feel anxious.

    Holly Prigerson, who directs the Center for Research on End-of-Life Care at Cornell University, said she admired the authors for trying to gauge depression in cancer patients who were so close to death.

    "The study is novel in that it evaluates retrospectively the depressive symptom severity of patients within 24 hours of death," Prigerson said in an e-mail to Reuters Health. "I'm unaware of any other study that has attempted this."

    But Prigerson also noted some of the study's limitations, such as trying to assess patients who could be unconscious or delirious, have multiple organ failure and difficulty communicating their emotions.

    Physicians also need to distinguish physical and psychological symptoms and might not always have enough information on a patient's psychological state when they are dying or might not have enough training to diagnose their "psychological distress," she said.

    "It is also difficult to draw conclusions regarding the clinical implications of the study," Prigerson said. "Given patients are actively dying, it is doubtful that a psychosocial intervention or administration of an antidepressant will effectively improve the patients' quality of death.

    "Psychosocial interventions and care in the months and weeks leading up to the death can have a profound impact on patients' quality of life prior to death, however," Prigerson said.

    Janberidze said doctors should be checking cancer patients for physical and psychological pain and integrating palliative care with their cancer management earlier in their disease. She also said family members could help monitor the patient's pain.

    "In general it is important for family members with loved ones who have advanced stage cancer to pay attention to the signs and symptoms of depression and inform healthcare providers immediately. Doctors should investigate the patient further and recommend psychological interventions as needed," Janberidze said.

    SOURCE: http://bmj.co/1LeAEoL BMJ Supportive and Palliative Care, online February 9, 2015.

Oncology Articles

  • Parents often want changes in kids' shots schedule

    By Andrew M. Seaman

    (Reuters Health) - Many parents ask doctors to spread out toddlers' vaccines instead of following the recommended immunization schedule, according to a new study.

    Most doctors comply with the request, even though they believe the delays put the children at risk for preventable diseases and make the experience more painful, the researchers report in the journal Pediatrics.

    Only about 2 to 3 percent of parents actually refuse vaccines, said study leader Dr. Allison Kempe. But, she added, "there is an increasing number of parents asking to deviate from the schedule in other ways."

    Kempe, from the University of Colorado School of Medicine and Children's Hospital Colorado, had expected that most doctors would get such requests from parents, but not this often.

    "I was surprised by over 20 percent of doctors saying 10 percent or more of their families (had asked) to spread out vaccines," she said.

    The U.S. Centers for Disease Control and Prevention (CDC) recommends several shots during the first years of life to protect against diseases (PDF link: http://1.usa.gov/1EDPWBP). The schedule is backed by the American Academy of Family Physicians and the American Academy of Pediatrics (AAP), which publishes Pediatrics.

    The AAP says the vaccine schedule is designed to work best with children's immune systems while protecting them from diseases as soon as possible.

    The new report comes as the U.S. battles a large measles outbreak that had infected 154 people from 17 states and Washington, D.C. as of February 20, according to the CDC. The outbreak is tied to Disneyland in Anaheim, California.

    For the study, Kempe and colleagues, in collaboration with the CDC, sent surveys to 815 pediatricians and family doctors across the U.S. in 2012. They received 534 completed surveys.

    Overall, 93 percent of doctors reported at least one parental request to space out the immunizations of a child younger than two years old. And 21 percent of those doctors said at least 10 percent of families made the request.

    The doctors said parents had a variety of reasons for deviating from the recommended schedule, including concerns about complications and a belief that their children won't get a vaccine-preventable disease.

    Most doctors responding to the survey felt it's not in the child's best interest to space out vaccines, but most comply with the parents' wishes at least sometimes.

    The percentage of doctors who often or always agree to spread out vaccines more than doubled from 13 percent in a similar 2009 survey to 37 percent in the current report.

    Doctors said they tried to educate parents on the importance of following the recommended vaccine schedule, but few felt they had any effective approaches.

    "A lot of them feel what they're doing isn't making a difference," Kempe said, adding that organizations like the AAP have recommended techniques for discussing vaccines.

    "I am not convinced that we have the right methods to counter this," she said.

    She said several techniques need to be combined, including education during pregnancy, more responsible reporting by the media, limiting the use of philosophical exemptions, and better collaboration between the public and health department.

    "It can't all fall on the primary care doctors' backs," Kempe said. "It's too big and too time consuming of an issue."

    SOURCE: http://bit.ly/uFc4g2 Pediatrics, online March 2, 2015.

  • CORRECTED-Terminal cancer care should do more to treat depression

    ((In paragraphs 1 and 7, clarifies that the doctors surveyed for the study were in The Netherlands, not Norway).)

    By Janice Neumann

    (Reuters Health) - Depression could be clouding the last 24 hours of life for a significant number of people with advanced cancer, pointing to a need for better - and earlier - psychological help, according to a large study in The Netherlands.

    Although it's challenging to tease apart depression symptoms from the pain, fatigue and cognitive problems associated with end-stage cancer, more can be done to alleviate depression and anxiety, researchers said.

    "Health care providers may think this is a normal part of the dying process," said lead author Dr. Elene Janberidze from the European Palliative Care Research Center at the Norwegian University of Science and Technology in Trondheim.

    "However, some patients experiencing depressive symptoms and/or depression can be treated and thus both the patients and their families may have a better quality of life," Janberidze told Reuters Health in an email.

    Previous studies have estimated the rates of depression in patients with advanced cancer at anywhere from 2 percent to 56 percent, she and her colleagues write in the journal BMJ Supportive and Palliative Care.

    Janberidze said that her team chose to focus on patients in their last 24 hours of life because this group had not been well investigated.

    They used data from a 2005 nationwide Dutch survey of doctors who had signed the death certificates of patients that died within the past two months. The researchers examined data on 1,363 cancer patients during their last 24 hours of life, assessing the symptoms reported by their attending physicians and rating their level of depression.

    After accounting for symptoms of the individuals' illness, the researchers found that overall 37 percent of patients were depressed. More women than men were severely or very severely depressed, and patients aged 17 to 65 were more likely to be moderately depressed than those 80 years or older.

    Geriatricians were four times more likely than other doctors to assess their patients as seriously or severely depressed. Pain specialists, palliative care consultants, psychiatrists and psychologists were also more often tending to patients with symptoms of serious depression than to those with mild or moderate depression.

    Mild or moderately depressed patients were more likely to feel tired, anxious and confused than those without depression symptoms. Individuals who were severely or very severely depressed also tended to feel anxious.

    Holly Prigerson, who directs the Center for Research on End-of-Life Care at Cornell University, said she admired the authors for trying to gauge depression in cancer patients who were so close to death.

    "The study is novel in that it evaluates retrospectively the depressive symptom severity of patients within 24 hours of death," Prigerson said in an e-mail to Reuters Health. "I'm unaware of any other study that has attempted this."

    But Prigerson also noted some of the study's limitations, such as trying to assess patients who could be unconscious or delirious, have multiple organ failure and difficulty communicating their emotions.

    Physicians also need to distinguish physical and psychological symptoms and might not always have enough information on a patient's psychological state when they are dying or might not have enough training to diagnose their "psychological distress," she said.

    "It is also difficult to draw conclusions regarding the clinical implications of the study," Prigerson said. "Given patients are actively dying, it is doubtful that a psychosocial intervention or administration of an antidepressant will effectively improve the patients' quality of death.

    "Psychosocial interventions and care in the months and weeks leading up to the death can have a profound impact on patients' quality of life prior to death, however," Prigerson said.

    Janberidze said doctors should be checking cancer patients for physical and psychological pain and integrating palliative care with their cancer management earlier in their disease. She also said family members could help monitor the patient's pain.

    "In general it is important for family members with loved ones who have advanced stage cancer to pay attention to the signs and symptoms of depression and inform healthcare providers immediately. Doctors should investigate the patient further and recommend psychological interventions as needed," Janberidze said.

    SOURCE: http://bmj.co/1LeAEoL BMJ Supportive and Palliative Care, online February 9, 2015.

  • Doctors with bad news seen as less compassionate

    By Andrew M. Seaman

    (Reuters Health) - Regardless of how they frame the discussion, doctors who deliver bad news may be viewed as less compassionate by their patients, a new study suggests.

    Patients who watched videos of fictional interactions between doctors and patients felt the doctors delivering bad news were less compassionate than those giving good news, researchers found.

    Until recently, doctors and researchers believed that doctors who delivered bad news in an empathetic tone would be seen as sincere, said Dr. Eduardo Bruera, the study's lead author from the University of Texas MD Anderson Cancer Center in Houston.

    "We wanted to test if the news itself had an impact on the way the patient saw his or her doctor," Bruera said.

    The researchers showed 100 cancer patients two videos. In one, an actor playing a patient with advanced cancer was told by a doctor that there are no more treatment options. The other video showed the same scenario with a similar-looking doctor saying there may be some treatment options.

    On a scale of 0 to 50, with 50 being the least compassionate, patients gave the doctor with good news a score of 19, compared to a score of 26 for the doctor with bad news.

    What's more, 57 patients said they preferred the doctor delivering the more optimistic message, compared to 22 who preferred the doctor delivering the less optimistic news.

    "What we found out is that the patients consistently perceived the doctor who gave the more optimistic message as more compassionate," Bruera said.

    He said the findings may help explain why doctors intuitively have a difficult time delivering bad news to their patients.

    "It's unfortunate, but it's the reality of life that when the doctor needs to give the patient bad news, the perception of that patient may be that of a less compassionate doctor," Bruera said.

    There needs to be additional research into the findings, Dr. Teresa Gilewski of Memorial Sloan Kettering Cancer Center in New York City said in an editorial accompanying the new study in JAMA Oncology.

    "For example, would the patient perception be different with an in-person interaction, a longer discussion, a personal relationship with the physician, or at a different time in the patient's illness?" wrote Gilewski.

    The researchers say future research should account for the trust patients have with their doctors, too.

    Still, they also suggest researchers should craft techniques to help doctors deliver bad news without the content affecting the patients' perceptions of their compassion.

    SOURCE: http://bit.ly/1MZitVK and http://bit.ly/1MZizgi JAMA Oncology, online February 26, 2015.

  • Younger men more bothered after prostate cancer treatment

    By Shereen Lehman

    (Reuters Health) - After treatment for localized prostate cancer, changes in quality of life will vary by age, as will men's reactions to those changes, according to a new study.

    "While older and younger men start with different baseline quality of life function, older men may be less bothered by certain declines that may affect younger patients more," Dr. Lindsay Hampson told Reuters Health in an email.

    Prostate cancer is the most common malignancy in men of all ages in the U.S. Almost 60 percent of new cases are diagnosed in men over the age of 65, and the average age is 66.

    Older men are often diagnosed with more aggressive disease and are less likely to get treatment, in part because they worry about the impact on their sexual and urinary function, Hampson and her colleagues write in European Urology.

    Determining quality of life priorities is vital to ensuring that patients make well-informed treatment decisions, said Hampson, a urologist at the University of California San Francisco.

    The researchers reviewed national data on 5,362 men diagnosed between 1999 and 2013 with aggressive prostate cancer that had not spread. The men received various treatments, including surgery, brachytherapy, external beam radiation, or androgen deprivation, or active surveillance.

    Before treatment, and again within two years later, the men filled out surveys that included quality of life questions about their urological functioning and symptoms.

    Overall, men over 70 had worse quality of life after treatment than those under 60 - except in terms of mental health - but the younger men were more bothered by quality of life declines.

    For sexual function, 40 percent of the younger men reported a decline after treatment, compared to 46 percent of the older men. But 39 percent of younger men reported worsening sexual "bother" versus just 17 percent of the older men.

    More men under 60 had declines in urinary function, with 14 percent reporting some negative change, compared to 9 percent of older men.

    It's likely that older men start out with a lower level of function, and lower expectations, and therefore are less bothered by declines, the study team writes. Or, perhaps older men have just learned to cope better with fluctuations in their functioning, they note.

    Hampson said quality of life is a very important consideration when contemplating treatment for prostate cancer, and physicians can help patients make appropriate decisions.

    "The first critical question is whether the cancer needs treatment because many prostate cancers can be safely followed with active surveillance," she said.

    "Treatment should not be deferred for older men just because of quality of life concerns, just as younger men also need to be counseled about potential changes in quality of life after treatment," Hampson said.

    Sexual and urinary problems are the most common problems after prostate cancer treatment, said Katrina Balter, a researcher at Karolinska Institute in Stockholm, Sweden, who was not involved in the study.

    "It is important to discuss potential side effects associated with different treatment options," Balter said. "If a man is sexually active, he might prioritize treatments with less risk of side effects or go for 'watchful waiting' (i.e. no treatment) whereas others may prioritize local treatment and potentially improved survival," she told Reuters Health by email.

    SOURCE: http://bit.ly/1COp3ZE European Urology, online February 2, 2015.

  • Healthy diet linked to lung health

    By Roxanne Nelson

    (Reuters Health) - Among its many rewards, eating a healthy diet might help protect against the development of chronic obstructive pulmonary disease, or COPD, according to a new study.

    Based on more than 120,000 men and women followed for more than a decade, researchers calculate that those who ate a diet highest in whole grains, vegetables and nuts, and lowest in red meats and sugars were up to a third less likely to develop COPD - even if they smoked - than those who ate the worst diet.

    "I think that we need to emphasize the role of diet in respiratory diseases, which is largely unknown by the general audience," lead author Dr. Raphaëlle Varraso, from the French National Institute of Health and Medical Research in Villejuif, told Reuters Health in an email.

    "Respiratory health and lung function strongly predict general health status and all-cause mortality," she said.

    COPD is an umbrella term for a group of progressive lung diseases that block the flow of air and cause breathing problems. They include emphysema, chronic bronchitis and some types of asthma.

    According to the Centers for Disease Control and Prevention (CDC), about 15 million Americans have been diagnosed with COPD and it is the third leading cause of death in the U.S.

    "The predominant risk factor for COPD in the developed world is cigarette smoking, but up to one-third of COPD patients have never smoked, thus suggesting that other factors are involved," Varraso said.

    But relatively little attention has been paid to modifiable factors, aside from smoking, that might reduce the risk of developing COPD, including diet, she noted.

    "As the lungs exist in a high-oxygen environment, it is reasonable to hypothesize that certain exposures can increase the burden of oxidants further," she added.

    Varraso and her team used U.S. data on 73,000 women and 43,000 men who were part of long-term studies that tracked their lifestyles and medical histories between 1984 and 2000.

    The researchers rated the participants' eating habits based on the Alternate Healthy Eating Index 2010 (AHEI-2010), which is a measure of dietary quality based on current scientific evidence about the effects of nutrients on health risks. High scores on this index - developed at the Harvard School of Public Health as an alternative to the U.S. Department of Agriculture's "food pyramid" - have been shown to be associated with a lower risk of major chronic diseases.

    A better score also generally represents a diet that is high in vegetables, whole grains, polyunsaturated fats, nuts and omega-3 fatty acids, low in red and processed meats, refined grains and sugary drinks, and includes moderate alcohol consumption.

    Those with the highest AHEI-2010 scores were 33 percent less likely to develop COPD than participants with the lowest diet scores, the study team reports in the journal BMJ.

    The results held up even after the researchers accounted for other factors, such as tobacco use, exposure to second-hand smoke, weight, age and exercise habits.

    The study does not prove cause and effect, however, said Dr. Norman H. Edelman, senior consultant for scientific affairs at the American Lung Association. "It only suggests that there may be a link."

    Edelman, who was not involved in the study, added, "There has been evidence of this before, that one way to ameliorate lung disease is to eat a diet high in antioxidants. This study used a large database and suggests that diet may play a substantial role in lowering the risk."

    But the most important preventive action for lung health is still smoking cessation, Edelman emphasized. "This study doesn't change that message," he said.

    For those who would like to lower their risk of major chronic diseases, including COPD, Varraso pointed out that the AHEI guideline (http://bit.ly/RysZuA) is "quite easy" to follow.

    But for people who already have COPD, the role of diet may be different, she noted. "In our study we only investigated the role of a healthy diet on the risk of COPD."

    Varraso added that these study results should encourage clinicians to consider the potential role of the combined effect of foods in a healthy diet in promoting lung health.

    SOURCE: http://bmj.co/1Atp1In BMJ, online February 3, 2015.

Orthopedic Articles

  • NSAIDS may boost bleeding risk after heart attack

    By Kathryn Doyle

    (Reuters Health) - For people taking drugs to prevent blood clots after a heart attack, adding pain relievers like ibuprofen may lead to bleeding, stroke or another heart attack, according to a new study.

    Anyone who has had a heart attack should be prescribed both aspirin and clopidogrel, blood thinners that make platelets less sticky and reduce the risk of clots and a second heart attack, said lead author Dr. Anne-Marie Schjerning Olsen, of Copenhagen University Hospital Gentofte, Hellerup, Denmark.

    But ibuprofen and other so-called NSAIDs also thin the blood.

    NSAID (pronounced "ensaid") stands for nonsteroidal anti-inflammatory drug, and according to Olsen's results, adding an NSAID to the mix is dangerous.

    Even taking an NSAID for less than a week was associated with an increased risk of bleeding and a second heart attack, Olsen told Reuters Health by email.

    "There has been a tendency to think that short-term use of NSAIDs is safe. Our study suggests this is not the case and that even a few days of use is associated with increased risks of both bleeding and cardiac events, mainly heart attacks," she said.

    "Furthermore I was surprised that despite guidelines which discourage use of NSAIDs in patients with cardiovascular disease, one third of our population had at least one prescription for NSAIDs," she said.

    Using nationwide registries in Denmark from 2002 to 2011, the researchers examined records for more than 60,000 adults who survived at least a month after hospitalization for a heart attack. Over the course of the study, 34 percent of patients filled a prescription for an NSAID like ibuprofen or naproxen, designed to treat pain and inflammation, while they were taking anti-clotting drugs.

    Three and a half years after their heart attacks, nearly a third of the group had died. More than 5,000 heart attack survivors suffered a bleeding event in the brain, respiratory system, gastrointestinal system or any other site, and 799 died as a result.

    People who filled a prescription for an NSAID while taking other anti-clotting drugs were about twice as likely to suffer a bleeding event as those who were not taking NSAIDs, according to results in JAMA.

    Those taking NSAIDs were also more likely to suffer a stroke, second heart attack or to die of a heart event than others.

    All NSAIDs, whether prescription or over-the-counter, increase the risk of bleeding, especially gastrointestinal bleeding, Olsen said. "Some NSAIDs, for example diclofenac, are also associated with a small increase in the risk of heart attack," she said.

    Many people in this study were taking NSAIDs, so more patient and physician education is needed about the risks for people on anti-clotting medications, said Dr. Charles L. Campbell of the University of Tennessee-Chattanooga, who co-wrote an editorial on the new results.

    "Additionally, it appears some patients experienced bad outcomes following very short exposures to NSAIDS," Campbell told Reuters Health by email. "I think many of us have assumed long term exposure was worrisome but that we could 'get away' with short term use."

    Even if bleeding isn't fatal, patients will have to suspend all medications for a time, leaving them unprotected from a second heart attack, Campbell noted.

    "NSAIDs were used a lot by the patients in this study - pain is a common problem and can cause great suffering," Olsen said. "People may be happy to take these risks to have relief from pain but it is very important that they are aware of the risks and can make an informed decision about taking NSAIDs for pain relief."

    Only additional randomized trials can establish definitively that the NSAIDs caused the increased risk of bleeding and heart attack, but until then, "if NSAIDs are needed, physicians should consider the balance of risks and benefit and exercise great caution even for short-term treatment and ensure that this has been discussed with patients," Olsen said.

    SOURCE: http://bit.ly/1AoyDTw and http://bit.ly/1vtU457 JAMA, online February 24, 2015.

  • NSAIDS may boost bleeding risk after heart attack

    By Kathryn Doyle

    (Reuters Health) - For people taking drugs to prevent blood clots after a heart attack, adding pain relievers like ibuprofen may lead to bleeding, stroke or another heart attack, according to a new study.

    Anyone who has had a heart attack should be prescribed both aspirin and clopidogrel, blood thinners that make platelets less sticky and reduce the risk of clots and a second heart attack, said lead author Dr. Anne-Marie Schjerning Olsen, of Copenhagen University Hospital Gentofte, Hellerup, Denmark.

    But ibuprofen and other so-called NSAIDs also thin the blood.

    NSAID (pronounced "ensaid") stands for nonsteroidal anti-inflammatory drug, and according to Olsen's results, adding an NSAID to the mix is dangerous.

    Even taking an NSAID for less than a week was associated with an increased risk of bleeding and a second heart attack, Olsen told Reuters Health by email.

    "There has been a tendency to think that short-term use of NSAIDs is safe. Our study suggests this is not the case and that even a few days of use is associated with increased risks of both bleeding and cardiac events, mainly heart attacks," she said.

    "Furthermore I was surprised that despite guidelines which discourage use of NSAIDs in patients with cardiovascular disease, one third of our population had at least one prescription for NSAIDs," she said.

    Using nationwide registries in Denmark from 2002 to 2011, the researchers examined records for more than 60,000 adults who survived at least a month after hospitalization for a heart attack. Over the course of the study, 34 percent of patients filled a prescription for an NSAID like ibuprofen or naproxen, designed to treat pain and inflammation, while they were taking anti-clotting drugs.

    Three and a half years after their heart attacks, nearly a third of the group had died. More than 5,000 heart attack survivors suffered a bleeding event in the brain, respiratory system, gastrointestinal system or any other site, and 799 died as a result.

    People who filled a prescription for an NSAID while taking other anti-clotting drugs were about twice as likely to suffer a bleeding event as those who were not taking NSAIDs, according to results in JAMA.

    Those taking NSAIDs were also more likely to suffer a stroke, second heart attack or to die of a heart event than others.

    All NSAIDs, whether prescription or over-the-counter, increase the risk of bleeding, especially gastrointestinal bleeding, Olsen said. "Some NSAIDs, for example diclofenac, are also associated with a small increase in the risk of heart attack," she said.

    Many people in this study were taking NSAIDs, so more patient and physician education is needed about the risks for people on anti-clotting medications, said Dr. Charles L. Campbell of the University of Tennessee-Chattanooga, who co-wrote an editorial on the new results.

    "Additionally, it appears some patients experienced bad outcomes following very short exposures to NSAIDS," Campbell told Reuters Health by email. "I think many of us have assumed long term exposure was worrisome but that we could 'get away' with short term use."

    Even if bleeding isn't fatal, patients will have to suspend all medications for a time, leaving them unprotected from a second heart attack, Campbell noted.

    "NSAIDs were used a lot by the patients in this study - pain is a common problem and can cause great suffering," Olsen said. "People may be happy to take these risks to have relief from pain but it is very important that they are aware of the risks and can make an informed decision about taking NSAIDs for pain relief."

    Only additional randomized trials can establish definitively that the NSAIDs caused the increased risk of bleeding and heart attack, but until then, "if NSAIDs are needed, physicians should consider the balance of risks and benefit and exercise great caution even for short-term treatment and ensure that this has been discussed with patients," Olsen said.

    SOURCE: http://bit.ly/1AoyDTw and http://bit.ly/1vtU457 JAMA, online February 24, 2015.

  • NSAIDS may boost bleeding risk after heart attack

    By Kathryn Doyle

    (Reuters Health) - For people taking drugs to prevent blood clots after a heart attack, adding pain relievers like ibuprofen may lead to bleeding, stroke or another heart attack, according to a new study.

    Anyone who has had a heart attack should be prescribed both aspirin and clopidogrel, blood thinners that make platelets less sticky and reduce the risk of clots and a second heart attack, said lead author Dr. Anne-Marie Schjerning Olsen, of Copenhagen University Hospital Gentofte, Hellerup, Denmark.

    But ibuprofen and other so-called NSAIDs also thin the blood.

    NSAID (pronounced "ensaid") stands for nonsteroidal anti-inflammatory drug, and according to Olsen's results, adding an NSAID to the mix is dangerous.

    Even taking an NSAID for less than a week was associated with an increased risk of bleeding and a second heart attack, Olsen told Reuters Health by email.

    "There has been a tendency to think that short-term use of NSAIDs is safe. Our study suggests this is not the case and that even a few days of use is associated with increased risks of both bleeding and cardiac events, mainly heart attacks," she said.

    "Furthermore I was surprised that despite guidelines which discourage use of NSAIDs in patients with cardiovascular disease, one third of our population had at least one prescription for NSAIDs," she said.

    Using nationwide registries in Denmark from 2002 to 2011, the researchers examined records for more than 60,000 adults who survived at least a month after hospitalization for a heart attack. Over the course of the study, 34 percent of patients filled a prescription for an NSAID like ibuprofen or naproxen, designed to treat pain and inflammation, while they were taking anti-clotting drugs.

    Three and a half years after their heart attacks, nearly a third of the group had died. More than 5,000 heart attack survivors suffered a bleeding event in the brain, respiratory system, gastrointestinal system or any other site, and 799 died as a result.

    People who filled a prescription for an NSAID while taking other anti-clotting drugs were about twice as likely to suffer a bleeding event as those who were not taking NSAIDs, according to results in JAMA.

    Those taking NSAIDs were also more likely to suffer a stroke, second heart attack or to die of a heart event than others.

    All NSAIDs, whether prescription or over-the-counter, increase the risk of bleeding, especially gastrointestinal bleeding, Olsen said. "Some NSAIDs, for example diclofenac, are also associated with a small increase in the risk of heart attack," she said.

    Many people in this study were taking NSAIDs, so more patient and physician education is needed about the risks for people on anti-clotting medications, said Dr. Charles L. Campbell of the University of Tennessee-Chattanooga, who co-wrote an editorial on the new results.

    "Additionally, it appears some patients experienced bad outcomes following very short exposures to NSAIDS," Campbell told Reuters Health by email. "I think many of us have assumed long term exposure was worrisome but that we could 'get away' with short term use."

    Even if bleeding isn't fatal, patients will have to suspend all medications for a time, leaving them unprotected from a second heart attack, Campbell noted.

    "NSAIDs were used a lot by the patients in this study - pain is a common problem and can cause great suffering," Olsen said. "People may be happy to take these risks to have relief from pain but it is very important that they are aware of the risks and can make an informed decision about taking NSAIDs for pain relief."

    Only additional randomized trials can establish definitively that the NSAIDs caused the increased risk of bleeding and heart attack, but until then, "if NSAIDs are needed, physicians should consider the balance of risks and benefit and exercise great caution even for short-term treatment and ensure that this has been discussed with patients," Olsen said.

    SOURCE: http://bit.ly/1AoyDTw and http://bit.ly/1vtU457 JAMA, online February 24, 2015.

Transplant Articles

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Women’s Health Articles

  • Parents often want changes in kids' shots schedule

    By Andrew M. Seaman

    (Reuters Health) - Many parents ask doctors to spread out toddlers' vaccines instead of following the recommended immunization schedule, according to a new study.

    Most doctors comply with the request, even though they believe the delays put the children at risk for preventable diseases and make the experience more painful, the researchers report in the journal Pediatrics.

    Only about 2 to 3 percent of parents actually refuse vaccines, said study leader Dr. Allison Kempe. But, she added, "there is an increasing number of parents asking to deviate from the schedule in other ways."

    Kempe, from the University of Colorado School of Medicine and Children's Hospital Colorado, had expected that most doctors would get such requests from parents, but not this often.

    "I was surprised by over 20 percent of doctors saying 10 percent or more of their families (had asked) to spread out vaccines," she said.

    The U.S. Centers for Disease Control and Prevention (CDC) recommends several shots during the first years of life to protect against diseases (PDF link: http://1.usa.gov/1EDPWBP). The schedule is backed by the American Academy of Family Physicians and the American Academy of Pediatrics (AAP), which publishes Pediatrics.

    The AAP says the vaccine schedule is designed to work best with children's immune systems while protecting them from diseases as soon as possible.

    The new report comes as the U.S. battles a large measles outbreak that had infected 154 people from 17 states and Washington, D.C. as of February 20, according to the CDC. The outbreak is tied to Disneyland in Anaheim, California.

    For the study, Kempe and colleagues, in collaboration with the CDC, sent surveys to 815 pediatricians and family doctors across the U.S. in 2012. They received 534 completed surveys.

    Overall, 93 percent of doctors reported at least one parental request to space out the immunizations of a child younger than two years old. And 21 percent of those doctors said at least 10 percent of families made the request.

    The doctors said parents had a variety of reasons for deviating from the recommended schedule, including concerns about complications and a belief that their children won't get a vaccine-preventable disease.

    Most doctors responding to the survey felt it's not in the child's best interest to space out vaccines, but most comply with the parents' wishes at least sometimes.

    The percentage of doctors who often or always agree to spread out vaccines more than doubled from 13 percent in a similar 2009 survey to 37 percent in the current report.

    Doctors said they tried to educate parents on the importance of following the recommended vaccine schedule, but few felt they had any effective approaches.

    "A lot of them feel what they're doing isn't making a difference," Kempe said, adding that organizations like the AAP have recommended techniques for discussing vaccines.

    "I am not convinced that we have the right methods to counter this," she said.

    She said several techniques need to be combined, including education during pregnancy, more responsible reporting by the media, limiting the use of philosophical exemptions, and better collaboration between the public and health department.

    "It can't all fall on the primary care doctors' backs," Kempe said. "It's too big and too time consuming of an issue."

    SOURCE: http://bit.ly/uFc4g2 Pediatrics, online March 2, 2015.

  • Risk factors for heartburn: excess weight, smoking

    By Janice Neumann

    (Reuters Health) - Excess pounds and smoking might each raise the likelihood of frequent heartburn or gastroesophageal reflux disease (GERD), according to a large study from Norway.

    Other factors linked to higher odds of new GERD symptoms included getting older, being a woman, having less education, and even quitting smoking - if it led to weight gain.

    "Heartburn and acid regurgitation are very frequent, up to 30 percent of people in Western populations have these complaints at least weekly, so we wanted to know more about the reasons why these symptoms appear," said Dr. Eivind Ness-Jensen, the study's senior author.

    GERD is defined as having "troublesome" symptoms of acid reflux - where stomach acid flows back into the esophagus - or complications of reflux at least once a week, the study team writes in the American Journal of Gastroenterology.

    Other symptoms include hoarseness, laryngitis, dry cough and increased saliva. GERD can also eventually lead to precancerous changes in the esophagus.

    To see what characteristics predict development of GERD, the researchers analyzed data on nearly 30,000 people in Nord-Trondelag County, Norway.

    Subjects were interviewed in 1995-1997 and again in 2006-2009.

    They had no GERD symptoms in the first interview. By the second interview, 510 people had severe GERD symptoms and 14,406 still had no GERD complaints. People with very mild or less than weekly symptoms were excluded from the comparison.

    The researchers found a steady increase in GERD risk with greater excess weight, based on body mass index (BMI), a measure of weight relative to height. A BMI of less than 25 is considered normal, 26 to 29.9 is overweight or "pre-obese" and 30 or above is obese.

    In the 12-year study, the risk of developing GERD rose by 30 percent with every one-point increase in BMI, regardless of the person's starting BMI.

    People who smoked cigarettes or had smoked previously were 29 to 37 percent more likely to develop GERD than never-smokers.

    And those who stopped smoking but whose BMI rose more than 3.5 points after quitting were twice as likely to develop symptoms as people who had never smoked.

    Ness-Jensen, a public health researcher at the Norwegian University of Science and Technology in Levanger, noted in an email that one of his previous studies showed quitting smoking reduced the risk of GERD symptoms, although the current study found that weight gain could take away that protection. "So, avoid weight gain when quitting smoking," he said.

    "Obesity, especially abdominal obesity, increases the pressure on the diaphragm and the muscles separating the esophagus from the stomach, pushing acidic stomach content into the esophagus. Tobacco smoking relaxes the muscles, facilitating reflux, and reduces the production of saliva, which helps clean the esophagus," he explained.

    Men were about 20 percent less likely to have GERD symptoms than women. In addition, people with a higher education were about 30 percent less likely to develop GERD than people with less education. Simply getting older also increased the risk of symptoms by 1 percent per year.

    Dr. Ronnie Fass, chair of Gastroenterology and Hepatology at MetroHealth Medical Center in Cleveland, Ohio, said two of the study's unique findings were that men had a lower chance of getting GERD and that smoking could lead to symptoms.

    "It has been established in the literature that males and females have the same risk of having GERD . . . As a result, this is very intriguing," said Fass, who was not involved in the study.

    While past studies have linked smoking with GERD, this "is one of the first studies that in fact documented the role of smoking in causing new onset GERD-related symptoms," said Fass.

    Fass said helpful web sites for people who want more information on possible risk factors and symptoms of GERD are: http://www.gerdhelp.com/ and http://www.iffgd.org/.

    SOURCE: http://bit.ly/1AGChqJ American Journal of Gastroenterology, online February 10, 2015.

  • Ebola halts HIV progress in Sierra Leone, says U.N.

    By Misha Hussain

    DAKAR (Thomson Reuters Foundation) - The West African Ebola outbreak has halted progress in tackling HIV in Sierra Leone, shutting health clinics and scaring patients from being tested or seeking treatment, the United Nations has said.

    In an internal document seen by the Thomson Reuters Foundation, the United Nations Development Programme (UNDP) raised concerns that HIV prevalence and drug resistance in the country could increase as a result.

    The worst recorded outbreak of Ebola has killed more than 9,500 people, infected over 23,500 others and placed immense pressure on already weak health systems in hardest-hit Sierra Leone, Guinea and Liberia.

    "Hospitals have closed down because they have been overrun by Ebola patients and non-Ebola patients are too afraid to go to them for fear of catching the virus," said Hakan Bjorkman, who manages UNDP's AIDS program.

    "HIV prevention activities in schools and awareness raising for the general population has been suspended due to the restriction of movement, the closure of all education institutions and the overall ban on public gathering."

    Some 25% of patients taking antiretroviral therapy (ART) for HIV are missing clinic appointments in and around Sierra Leone's capital Freetown, where the main Ebola affected communities are, Bjorkman said.

    There has also been a decline of at least 70% in HIV testing and counseling services and logistical issues mean that essential HIV drugs are either expiring or quickly becoming out of stock, according to the UNDP document that was released internally in December.

    "If this is not dealt with quickly, we risk the virus spreading to more people, more people dying of opportunistic disease like tuberculosis and the virus building up a resistance to our drugs," Bjorkman told the Thomson Reuters Foundation by telephone from Geneva.

    Some 58,000 people are living with HIV in Sierra Leone, a country of around 6 million people. About a third of those affected need life-saving ART, however, as of June 2014, only 10,673 people were receiving ART, the report said.

    Bjorkman said the Global Fund to Fight AIDS, Tuberculosis and Malaria had provided some $55 million to deal with AIDS in Sierra Leone between 2013 and 2015, but only around $25 million had been spent to date, partly due to the Ebola response.

    "We need to kick-start counseling and testing on high risk groups, follow up on patients who have defaulted on their treatment, and restart campaigns in schools and public places now the bans have been lifted," he said.

    However, there may be one positive impact of the Ebola outbreak on HIV infection rates in West Africa.

    "People are scared of having sex in this time of Ebola, which could have an impact in reducing HIV infection too," said Bjorkman, noting that the Ebola response needs to drum home use of condoms and not just washing hands.

  • UPDATE 1-Chilean girl with cystic fibrosis tells president: Let me die

    (Adds government comments in new paragraphs 8 and 9)

    By Reuters Staff

    SANTIAGO (Reuters) - A 14-year old Chilean girl who suffers from cystic fibrosis has made an emotional plea to be allowed to die, filming herself asking President Michelle Bachelet to authorize her euthanasia.

    In a video that media said had been uploaded to her Facebook page on Sunday, Valentina Maureira said from her hospital bed: "I am asking to speak urgently to the president because I am tired of living with this sickness and she can authorize the injection to put me to sleep forever."

    Cystic fibrosis is a genetic condition that affects the lungs and other organs.

    Maureira's brother had died of the disease, her father, Freddy Maureira, told local Radio Bio Bio.

    "She has already had five operations... which have caused her a lot of suffering and pain," he said. "It was promised that things would get better, but for her it was worse."

    The video had surprised him, he added.

    A spokeswoman from the Universidad Catolica clinic in Santiago confirmed that Valentina Maureira was a patient at the hospital and said she was stable, with no immediately life-threatening conditions.

    Government spokesman Alvaro Elizalde said on Thursday that the health ministry was in contact with the family to ensure Maureira was receiving the psychological and medical treatment she needed, but ruled out euthanasia as an option.

    "We have to be completely clear, the current norm, the current law in Chile does not allow the government to agree to a request of this nature," he said.

    In Chile, as in many countries, euthanasia is against the law. The Catholic church retains a strong influence on society, and the country is one of a handful to ban abortion under any circumstances.

    Center-left Bachelet, who is a year into her second term, has introduced reforms, including a bill being debated in Congress that would relax the abortion law, that have angered conservatives.

    Bachelet's agenda has not mentioned euthanasia, though, and the government has not yet commented on the Maureira case.

  • Shares of S. Korean contraceptive makers surge after court scraps adultery ban

    By Ju-min Park

    SEOUL (Reuters) - South Korea's highest court on Thursday struck down as unconstitutional a decades-old law banning adultery, triggering a surge in shares of condom makers and morning-after pills.

    The 1953 law aimed to protect women in a male-dominated society where divorce was rare, by making marital infidelity punishable with jail.

    "The law is unconstitutional as it infringes people's right to make their own decisions on sex and secrecy and freedom of their private life, violating the principle banning excessive enforcement," said Seo Ki-seok, a Constitutional Court judge, reading an opinion on behalf of five judges.

    Seven members of the nine-judge panel deemed the law to be unconstitutional.

    After the ruling, shares in Unidus Corp, which makes latex products, including condoms, soared to the 15 percent daily limit gain.

    Hyundai Pharmaceutical Co Ltd, a maker of morning-after birth control pills and pregnancy tests, ended up 9.7 percent after the court decision, recovering earlier losses.

    Critics have said the law against adultery is outdated in a society where rapid modernizsation has often clashed with traditional values.

    In 2008, the court had upheld the law, citing South Korean society's legal perception that adultery damages social order.

    Several thousand spouses file criminal adultery complaints each year in South Korea, although jailings are rare. Prosecutors say no one was put behind bars last year, despite 892 indictments on adultery charges.