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

  • Federal judge rebuffs NCAA concussion settlement

    By Reuters Staff

    (Reuters) - A federal judge on Wednesday rebuffed a $75-million NCAA settlement that aimed to end a massive class-action lawsuit over head injuries suffered by student athletes, court records show.

    U.S. District Judge John Lee wrote in a 21-page opinion that while the proposed agreement was a step in the right direction, the $70 million devoted to fund concussion testing and diagnosis for players might not cover potential costs, among other issues.

    "Although these concerns may prove surmountable, the Court cannot grant preliminary approval of the settlement as currently proposed," Lee wrote.

    There was no immediate reply to a request for comment from the National Collegiate Athletic Association (NCAA), which had previously welcomed the agreement as a way to improve sports safety.

    The lawsuit was first filed in 2011 on behalf of former Eastern Illinois football player Adrian Arrington, who said he suffered headaches and seizures as a result of five documented concussions. The proposed settlement covers other cases.

    The deal also addressed some guidelines, such as barring a student with a concussion from returning to play or practice on the same day and requiring a doctor's clearance.

    It would have also set aside $5 million for concussion research, although research done by member schools can be credited toward that amount.

    The opinion highlighted that not all plaintiffs in the case were happy with the settlement, with some taking issue over the provision barring players from bringing bodily injury claims as a class.

    The proposed NCAA settlement came a few weeks after a federal judge's preliminary approval of an open-ended settlement between the National Football League and thousands of former players in June.

    The NFL settlement money was intended to resolve all the personal injury claims for the plaintiffs' out of pocket damages.

    The danger of concussions and other head injuries has received increased attention in college and professional sports in recent years, with much of the focus on football.

    More than 450,000 NCAA student athletes compete in 23 sports. The NCAA makes revenue of about $740 million each year, court documents show.

  • Knee pain may run in the family

    By Shereen Lehman

    (Reuters Health) - People whose parents had a total knee replacement due to osteoarthritis are more than twice as likely to develop knee pain in midlife as those with no family history of knee surgery, according to a new study.

    The Australian authors say the link between parents and adult children shows that genetics may have much to do with knee problems and the pain that goes with them.

    "It was abundantly clear that genes were a strong contributor to risk of osteoarthritis but there had been limited success in finding these genes," said Dr. Graeme Jones of the University of Tasmania in Hobart, the study's senior author.

    "Thus, a better way may be to look at mechanisms by which genes lead to arthritis and the best way of doing this was to study the adult children of people who have had knee replacements for osteoarthritis," Jones told Reuters Health in an email.

    By age 45, about one-quarter to one-third of adults have had knee pain that lasted for at least one week, the study authors write in the Annals of the Rheumatic Diseases .

    The causes of knee pain aren't always clear, but previous studies have also suggested a genetic link.

    The new study is the first to examine whether people who have a family history of osteoarthritis of the knee have a greater risk of worsening knee pain, according to the authors.

    They enrolled 186 adults with at least one parent who had knee replacement surgery at one of the hospitals in Hobart, and an additional 186 adults whose parents had no history of knee arthritis or knee replacement surgery.

    At the beginning of the study, participants answered questionnaires reporting any knee pain they had experienced over the past year, and had X-rays and MRI scans of their right knees. These measures were all repeated two years later and again 10 years after the initial enrollment.

    The adults whose parents had knee replacement surgery tended to be heavier and there were more smokers compared to the control group, but there were no differences between the groups as far as visible damage to the knee joints at the beginning of the study.

    After two years both groups had about the same number of participants with knee pain - just over half. But after ten years, 74 percent of the children of parents with knee replacements had knee pain compared to 54 percent of those with no family history of knee surgery.

    Over those eight years there was also an increase in total knee pain in members of both groups, but the offspring of parents with knee surgeries tended to have a greater increase in pain.

    Even after accounting for actual structural problems in the participants' knees, the researchers found that offspring of people with knee replacement surgery were 2.2 times as likely to report that their pain had worsened compared to the controls.

    "I suppose there are many mechanisms by which genes lead to arthritis - some we can help, some we can't," Jones said. "Offspring have more pain, weigh more, are more susceptible to the effects of smoking, have weaker muscles, more splits in the cartilage and menisci and greater cartilage loss over time."

    Since differences in arthritis and other structural knee problems did not explain the differences between groups in knee pain, Jones said that genetics most likely accounted for the outcomes - for instance, a greater sensitivity to pain that might be influenced by genes.

    Still, other factors, such as aspects of the environment, that were shared by both parents and adult children could not be ruled out, he said.

    To avoid knee pain, Jones suggests that people maintain an ideal body weight, minimize their risk of knee injury, exercise more when they're younger and refrain from smoking.

    "Develop ways of decreasing pain severity, and manage stress better," he added. "Consider medications such as glucosamine if at high risk."

    SOURCE: http://bmj.co/1zCnywT Annals of the Rheumatic Diseases, online December 4, 2014.

  • REFILE-Colorado awards $8 million to study medical marijuana uses

    (Corrects paragraph 7 to clarify that funding comes from patient registration fees, not taxes on medical marijuana sales)

    By Keith Coffman

    DENVER (Reuters) - Colorado health officials awarded $8 million in research grants on Wednesday to study the use of medical marijuana in the treatment of symptoms associated with Parkinson's disease, childhood epilepsy and post-traumatic stress disorder.

    Colorado was one of the first two U.S. states to legalize recreational pot use, and it is among 23 states and the District of Columbia that permit use of the drug for medicinal purposes.

    But weed remains illegal under federal law for any reason, leading to a dearth of funding for medical marijuana research, and meaning results are limited and largely anecdotal.

    Awarding eight grants for landmark peer-reviewed studies into an array of maladies, the Colorado Department of Public Health and Environment said it sought to provide objective scientific research on the efficacy of medical marijuana.

    "The grant program ... should not be construed as encouraging tor sanctioning the social or recreational use of marijuana," the department said in a statement.

    Colorado lawmakers set up a Medical Marijuana Scientific Advisory Council last year and allocated $10 million to administer a program to conduct the studies. The council received some three dozen applications, from which it chose the eight approved by the department on Wednesday.

    Funding for the program is derived from registration fees paid by medical marijuana patients in the state.

    Six of the grants will go to the University of Colorado Anschutz Medical Campus, said university spokesman Mark Couch.

    Researchers there will study whether marijuana in its various forms can alleviate the tremors associated with Parkinson's and whether it can provide relief for children with brain tumors or pediatric epilepsy.

    Other projects will research using marijuana to treat irritable bowel syndrome in adolescents and young adults, and how cannabis compares with the pain medication Oxycodone.

    Teams at the University of Pennsylvania will conduct two separate studies on whether cannabis is effective in treating patients suffering from post-traumatic stress disorder, including combat veterans.

    "It's true that little research has been done due to federal restrictions. I think that will change as more states are legalizing," said Brian Smith, a spokesman for the Washington State Liquor Control Board, which oversees legalized recreational cannabis there.

    Voters in Oregon and Alaska cast ballots in November to join Colorado and Washington in legalizing recreational pot use.

  • Heart experts warn of air pollution dangers

    By Janice Neumann

    (Reuters Health) - Air pollution should be one of the avoidable heart risk factors - just like smoking and excess fat - that doctors warn patients to steer clear of, according to a new statement from 20 heart experts.

    Citing pollution's heavy toll on cardiovascular health, the panel urges people to take steps to protect themselves from breathing heavy traffic fumes or industrial air pollution whenever possible, and public officials to pass laws to reduce air pollution.

    "Cardiovascular disease is a huge global problem, causing immense suffering and premature death, as well as placing severe strain on national healthcare budgets and/or family finances," said Dr. Robert Storey, a professor of cardiology at the University of Sheffield in the UK and senior author of the new position paper.

    Air pollution causes more than 3 million deaths worldwide each year and causes 3.1 percent of all cases of disability, Storey and his coauthors write in the European Heart Journal.

    Air pollution is also ninth most important on a list of modifiable heart-disease risk factors - ranking above low physical activity, high-salt diet, high cholesterol and drug use, the authors point out.

    Although gaseous air pollutants can be dangerous too, Storey said, airborne particles are the biggest contributor to cardiovascular disease because they cause inflammation of the lungs and enter the circulation, inflaming blood vessels, provoking clots and causing heart rhythm disturbances.

    Particulate matter includes coarse particles from road dust, construction work and industrial emissions and fine particles from traffic, power plants and industrial and residential burning of oil, coal or wood for heating.

    The bulk of particulate air pollution is made up of these fine particles, known as PM2.5, that are less than 2.5 micrometers - about one fifth the size of visible dust.

    The World Health Organization sets the safe outdoor exposure limit for PM2.5 at an average of 25 micrograms, or 25 millionths of a gram, per cubic meter of air over a 24-hour period, or average annual levels of 10 micrograms per cubic meter. In 2013, the U.S. Environmental Protection Agency lowered the 24-hour exposure limit to an average of 12 micrograms.

    European studies have found that PM2.5 levels are often markedly higher near heavy traffic zones compared to elsewhere in the same city, and that the levels can more than double during rush hours, according to the position statement.

    Some of the authors' advice for people to protect themselves is as simple as walking, cycling and using public transportation instead of driving cars, and exercising in parks or gardens, rather than near busy roads.

    And everyone should avoid being outside when pollution is highest, though this is especially important for infants, elderly and people with heart problems, the authors say.

    People who live in heavily polluted areas should also consider ventilation systems with filtration in their homes, since a large portion of outdoor pollution can penetrate buildings.

    The use of fossil fuels for heating and energy should also be decreased, according to the statement.

    "Many countries have made good progress towards reducing risk factors such as smoking, high cholesterol and high blood pressure but much less effort has been extended on reducing exposure to air pollution," Storey said in an email to Reuters Health.

    Studies have shown even short-term exposure to high PM2.5 levels increases deaths from heart disease and respiratory disease, and that people living in places with high PM2.5 have an 11 percent greater risk of dying from heart attacks, strokes and heart failure than those who live in cleaner areas.

    Dr. Robert Brook, a cardiologist at the University of Michigan Health System and another author of the policy statement, said many people don't realize the dangerous effects of air pollution on the heart.

    "While most people can readily observe and believe that air pollution may cause lung diseases, it is in fact cardiovascular diseases that are the largest adverse health effect of fine particulate matter exposure," Brook said in an email.

    Dr. Alan Abelsohn of the Dalla Lana School of Public Health at the University of Toronto in Canada, called the statement an important reminder. Too few cardiologists and primary care doctors advise their patients of pollution's risks, he said.

    "It's a very important and neglected area of prevention," he said.

    Abelsohn, who was not involved in the position statement, noted that national-level guidelines on allowable amounts of pollution can only do so much. He said individuals should always pay attention to the local Air Quality Index, which rates the level of air pollution according to health risk, and reduce their exposure accordingly.

    Brook said that while the U.S. has made great strides reducing air pollution since the 1970s or even 2000, the efforts should continue.

    "What we should not do is lessen our regulations and pose a threat to the cardiovascular health of the nation in the name of expediency or supposed economic growth or stimulus," Brook said.

    SOURCE: http://bit.ly/1zt1Iw6 European Heart Journal, online December 9, 2014.

  • With stimulant, kids with ADHD less likely to injure themselves

    By Kathryn Doyle

    (Reuters Health) - When kids with attention-deficit hyperactivity disorder (ADHD) are taking methylphenidate, a stimulant drug, they are less likely to end up in the emergency room with a trauma injury, a new study finds.

    "Previous studies show that patients with ADHD have a higher tendency of sustaining trauma and other injuries, requiring emergency department (ED) attendance," said senior author Ian C.K. Wong of the Centre for Safe Medication Practice and Research department of pharmacology and pharmacy in Hong Kong.

    "These studies also suggest that impulsivity and poor concentration in some patients with ADHD may contribute to the high incidence of injury," Wong told Reuters Health by email.

    About five percent of U.S. children have ADHD, according to the American Psychiatric Association, although some estimates have been higher. Diagnosis rates have increased by three percent per year between 1997 and 2006, according to the Centers for Disease Control and Prevention.

    Past research has shown that kids with ADHD are more likely to end up in motor vehicle crashes or in the emergency room with injuries.

    For the new study, the researchers used data on more than 17,000 patients ages six to 19 years old who had received a methylphenidate (Ritalin) prescription between 2001 and 2013 in Hong Kong.

    They compared the number of trauma-related emergency department admissions for each child while he or she had the prescription to their number of admissions when they did not have the prescription.

    Almost 5,000 of the kids were admitted to the ED at least once over the study period. On average, they were about 9 percent less likely to visit the ED with an injury during medication periods than during times without the medication.

    The apparent effect of the medication was stronger for teens over age 16 than for younger kids, the authors write in Pediatrics.

    Since stimulant medications like methylphenidate improve concentration and reduce impulsivity, that may reduce the number of traumas in injuries for kids with ADHD, said Suzanne McCarthy, a lecturer in clinical pharmacy at University College Cork in Ireland.

    McCarthy was not involved in the new study.

    "Children and adolescents with ADHD have problems with brain functioning in the area responsible for executive functioning, meaning decision-making, judgment and the ability to inhibit impulsive actions," according to Dr. Steven P. Cuffe, professor and chair of psychiatry at the University of Florida College of Medicine in Jacksonville, who also was not part of the new study.

    "So a medication that improves this functioning could be expected to reduce impulsivity and thereby decrease trauma related ED visits," Cuffe said.

    In 2011, six percent of U.S. kids aged four to 17 were taking medication for ADHD.

    Stimulants are the drug of choice for ADHD, and methylphenidate is one of the two main treatments, the other being amphetamines (Adderall), Cuffe told Reuters Health by email.

    "One shouldn't infer that this tells you anything about potential effectiveness of other treatments for ADHD," said Dr. G. Caleb Alexander, co-director of the Center for Drug Safety and Effectiveness at Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland.

    "Stimulants are widely used and have been widely overused as well," Alexander said.

    "I don't think that this study is the final answer either," he said. "We have hierarchies of evidence for a reason."

    When enough evidence has been collected, systematic reviews help clinicians and policymakers make changes, he said. At this point, these results won't change prescribing patterns for kids with ADHD, since the primary aim of stimulants isn't to prevent broken bones, he said.

    "There are documented benefits to methylphenidate use such as improvements in the core ADHD symptoms (attention, hyperactivity, impulsivity)," McCarthy told Reuters Health by email. "There are also well documented side effects such as decreased appetite, sleep disturbances."

    Drug treatment of ADHD remains only part of a comprehensive treatment program, which incorporates psychosocial interventions as well, Wong noted.

    "Use of these medications should only be initiated after a careful evaluation, an accurate diagnosis, clear impairment in functioning due to the diagnosis, and weighing the risks and benefits," Cuffe said. "So I would focus on getting it right, not necessarily that more children and adolescents should be treated."

    SOURCE: http://bit.ly/1GM66Xj Pediatrics, online December 15, 2014.

Oncology Articles

  • Teen contraband cigarette use linked to other drugs

    By Kathryn Doyle

    (Reuters Health) - Compared to those who don't smoke illicit tobacco, kids who do are more likely to try other illegal drugs like cocaine, heroin and amphetamines, according to a recent Canadian study.

    The researchers used survey data from one point in time, so they can't say that smoking illegal cigarettes leads to drug use, only that the two often coincide and that's enough to warrant stronger tobacco control policies.

    "The concern for us is that contraband tobacco may be a gateway to other drugs, but we cannot infer causality," said coauthor Mesbah F. Sharaf of the economics department at the University of Alberta in Edmonton.

    In Canada, unmarked and untaxed contraband cigarettes are either illegally manufactured domestically or illegally imported across the U.S. border, often from Native American reservations, the authors write in The Journal of Primary Prevention.

    They cite a national survey from 2007 that found 18 percent of all cigarettes used by teens who smoked daily were contraband.

    "Here in Canada the contraband market is really substantial, almost 30 percent of tobacco sales in the whole country," Sharaf told Reuters Health.

    For the new study, he and his coauthors used data from Canada's 2010-2011 Youth Smoking Survey, a school-based survey of kids in grades six through 12.

    It included questions about smoking unbranded or Native American-brand cigarettes over the previous twelve months as well as use of amphetamines, cocaine, heroin, ecstasy and ketamine over the same period.

    Focusing on the answers from kids who smoked, the researchers found that 31 percent of them had used contraband cigarettes at least once in the previous year. And contraband cigarette smokers were more likely to report using other drugs than kids who only smoked legal cigarettes.

    Twenty percent of contraband cigarette users reported trying heroin, compared to three percent of non-contraband smokers. For hallucinogens, 46 percent of contraband smokers reported trying it, compared to 30 percent of non-contraband smokers.

    "The issue of illicit tobacco is a prominent problem worldwide," said Dr. Russ Callaghan, associate professor in the Northern Medical Program at the University of Northern British Columbia in Prince George, who was not part of the new study.

    "In general, the way it is defined is any tobacco product that doesn't have the full set of taxes or levies applied to the purchase price," Callaghan told Reuters Health.

    Illicit tobacco is less of an issue for kids in the U.S., but it is contributing to a lot of youth smoking in Canada, and the tobacco products they get largely come across the border from upstate New York, he noted.

    The new study does show an association between contraband tobacco and illegal drugs, but it cannot say anything about causation, which is important, Callaghan noted.

    Sharaf cites a Royal Canadian Mounted Police drug bust in which contraband tobacco was found with other illicit drugs as evidence that kids may be getting their illegal cigarettes and other substances from the same source.

    "So it seems that this contraband market is managed by probably organized crimes and criminal gangs that may be using contraband as an avenue to other illicit drugs," Sharaf said. "Most likely it is the same source."

    But in interviews with teen smokers in Canada, Callaghan has not found that to be the case.

    "When I've asked young people about whether their sources of illicit cigarettes and illicit drugs are the same, they say no," he said.

    Some corner stores sell the cigarettes, which could be where young people purchase them, he noted.

    Although the authors suggest the "gateway hypothesis," wherein illegal tobacco leads to the use of other illegal drugs, "I don't think they are really warranted in inferring that at all," Callaghan said.

    "I think what's probably happening here is you have young people who may be marginalized, have low academic achievement, more deviance, and they engage in both of these activities," he said.

    In the past, some have argued that marijuana is a gateway drug to more dangerous substances, and that has been mostly disproved, Callaghan said.

    "It's not that I don't think that illicit drugs are a problem, but I'd be wary of that particular line of reasoning," he said. "There's a relation, but we need to be careful. I hope it's not alarmist."

    Linking contraband tobacco to further drug use could bring more attention to the problem, but policymakers may argue to lower taxes on legitimate cigarettes to reduce the contraband market, which would in turn lead to cheaper cigarettes and more smokers, Callaghan said.

    Earlier this year, Canadian criminal codes were amended to make trade, promotion or sales of contraband a criminal offense, which is a step in the right direction, Sharaf said.

    "This needs to be supplemented with creative government measures," he said.

    SOURCE: http://bit.ly/1zu7vlf The Journal of Primary Prevention, online November 1, 2014.

  • REFILE-Colorado awards $8 million to study medical marijuana uses

    (Corrects paragraph 7 to clarify that funding comes from patient registration fees, not taxes on medical marijuana sales)

    By Keith Coffman

    DENVER (Reuters) - Colorado health officials awarded $8 million in research grants on Wednesday to study the use of medical marijuana in the treatment of symptoms associated with Parkinson's disease, childhood epilepsy and post-traumatic stress disorder.

    Colorado was one of the first two U.S. states to legalize recreational pot use, and it is among 23 states and the District of Columbia that permit use of the drug for medicinal purposes.

    But weed remains illegal under federal law for any reason, leading to a dearth of funding for medical marijuana research, and meaning results are limited and largely anecdotal.

    Awarding eight grants for landmark peer-reviewed studies into an array of maladies, the Colorado Department of Public Health and Environment said it sought to provide objective scientific research on the efficacy of medical marijuana.

    "The grant program ... should not be construed as encouraging tor sanctioning the social or recreational use of marijuana," the department said in a statement.

    Colorado lawmakers set up a Medical Marijuana Scientific Advisory Council last year and allocated $10 million to administer a program to conduct the studies. The council received some three dozen applications, from which it chose the eight approved by the department on Wednesday.

    Funding for the program is derived from registration fees paid by medical marijuana patients in the state.

    Six of the grants will go to the University of Colorado Anschutz Medical Campus, said university spokesman Mark Couch.

    Researchers there will study whether marijuana in its various forms can alleviate the tremors associated with Parkinson's and whether it can provide relief for children with brain tumors or pediatric epilepsy.

    Other projects will research using marijuana to treat irritable bowel syndrome in adolescents and young adults, and how cannabis compares with the pain medication Oxycodone.

    Teams at the University of Pennsylvania will conduct two separate studies on whether cannabis is effective in treating patients suffering from post-traumatic stress disorder, including combat veterans.

    "It's true that little research has been done due to federal restrictions. I think that will change as more states are legalizing," said Brian Smith, a spokesman for the Washington State Liquor Control Board, which oversees legalized recreational cannabis there.

    Voters in Oregon and Alaska cast ballots in November to join Colorado and Washington in legalizing recreational pot use.

  • Heart experts warn of air pollution dangers

    By Janice Neumann

    (Reuters Health) - Air pollution should be one of the avoidable heart risk factors - just like smoking and excess fat - that doctors warn patients to steer clear of, according to a new statement from 20 heart experts.

    Citing pollution's heavy toll on cardiovascular health, the panel urges people to take steps to protect themselves from breathing heavy traffic fumes or industrial air pollution whenever possible, and public officials to pass laws to reduce air pollution.

    "Cardiovascular disease is a huge global problem, causing immense suffering and premature death, as well as placing severe strain on national healthcare budgets and/or family finances," said Dr. Robert Storey, a professor of cardiology at the University of Sheffield in the UK and senior author of the new position paper.

    Air pollution causes more than 3 million deaths worldwide each year and causes 3.1 percent of all cases of disability, Storey and his coauthors write in the European Heart Journal.

    Air pollution is also ninth most important on a list of modifiable heart-disease risk factors - ranking above low physical activity, high-salt diet, high cholesterol and drug use, the authors point out.

    Although gaseous air pollutants can be dangerous too, Storey said, airborne particles are the biggest contributor to cardiovascular disease because they cause inflammation of the lungs and enter the circulation, inflaming blood vessels, provoking clots and causing heart rhythm disturbances.

    Particulate matter includes coarse particles from road dust, construction work and industrial emissions and fine particles from traffic, power plants and industrial and residential burning of oil, coal or wood for heating.

    The bulk of particulate air pollution is made up of these fine particles, known as PM2.5, that are less than 2.5 micrometers - about one fifth the size of visible dust.

    The World Health Organization sets the safe outdoor exposure limit for PM2.5 at an average of 25 micrograms, or 25 millionths of a gram, per cubic meter of air over a 24-hour period, or average annual levels of 10 micrograms per cubic meter. In 2013, the U.S. Environmental Protection Agency lowered the 24-hour exposure limit to an average of 12 micrograms.

    European studies have found that PM2.5 levels are often markedly higher near heavy traffic zones compared to elsewhere in the same city, and that the levels can more than double during rush hours, according to the position statement.

    Some of the authors' advice for people to protect themselves is as simple as walking, cycling and using public transportation instead of driving cars, and exercising in parks or gardens, rather than near busy roads.

    And everyone should avoid being outside when pollution is highest, though this is especially important for infants, elderly and people with heart problems, the authors say.

    People who live in heavily polluted areas should also consider ventilation systems with filtration in their homes, since a large portion of outdoor pollution can penetrate buildings.

    The use of fossil fuels for heating and energy should also be decreased, according to the statement.

    "Many countries have made good progress towards reducing risk factors such as smoking, high cholesterol and high blood pressure but much less effort has been extended on reducing exposure to air pollution," Storey said in an email to Reuters Health.

    Studies have shown even short-term exposure to high PM2.5 levels increases deaths from heart disease and respiratory disease, and that people living in places with high PM2.5 have an 11 percent greater risk of dying from heart attacks, strokes and heart failure than those who live in cleaner areas.

    Dr. Robert Brook, a cardiologist at the University of Michigan Health System and another author of the policy statement, said many people don't realize the dangerous effects of air pollution on the heart.

    "While most people can readily observe and believe that air pollution may cause lung diseases, it is in fact cardiovascular diseases that are the largest adverse health effect of fine particulate matter exposure," Brook said in an email.

    Dr. Alan Abelsohn of the Dalla Lana School of Public Health at the University of Toronto in Canada, called the statement an important reminder. Too few cardiologists and primary care doctors advise their patients of pollution's risks, he said.

    "It's a very important and neglected area of prevention," he said.

    Abelsohn, who was not involved in the position statement, noted that national-level guidelines on allowable amounts of pollution can only do so much. He said individuals should always pay attention to the local Air Quality Index, which rates the level of air pollution according to health risk, and reduce their exposure accordingly.

    Brook said that while the U.S. has made great strides reducing air pollution since the 1970s or even 2000, the efforts should continue.

    "What we should not do is lessen our regulations and pose a threat to the cardiovascular health of the nation in the name of expediency or supposed economic growth or stimulus," Brook said.

    SOURCE: http://bit.ly/1zt1Iw6 European Heart Journal, online December 9, 2014.

  • Global population living six years longer than in 1990 - study

    By Kate Kelland

    LONDON (Reuters) - Global life expectancy has risen by more than six years since 1990 thanks to falling death rates from cancer and heart disease in rich countries and better survival in poor countries from diarrhea, tuberculosis and malaria.

    In an analysis from the 2013 Global Burden of Disease (GBD) study, health researchers said, however, that while life expectancy is rising almost everywhere in the world, one notable exception is southern sub-Saharan Africa, where deaths from HIV/AIDS have erased some five years of life expectancy since 1990.

    "The progress we are seeing against a variety of illnesses and injuries is good - even remarkable - but we can and must do even better," said Christopher Murray, a professor of global health at the University of Washington in the United States, who led the study. It was published in The Lancet medical journal.

    Murray said a huge increase in collective action and funding given to potentially deadly infectious diseases such as diarrhea, measles, tuberculosis, HIV and malaria has had a real impact, reducing death rates and extending life expectancy.

    But he said some major chronic diseases have been neglected and are rising in importance as threats to life, particularly drug disorders, liver cirrhosis, diabetes and kidney disease.

    The GBD 2013 gives the most comprehensive and up-to-date estimates of the number of yearly deaths from 240 different causes in 188 countries over 23 years - from 1990 to 2013.

    Murray's team's latest analysis found some poorer countries have made exceptional gains in life expectancy over that time period, with people in Nepal, Rwanda, Ethiopia, Niger, Maldives, East Timor and Iran now living on average 12 years longer.

    Yet despite dramatic drops in child deaths over the last 23 years, malaria, diarrhea and respiratory infections such as pneumonia are still in the top five global causes of death in children under five, killing almost two million children between the ages of one month and 59 months every year.

    Another mixed success is that, while worldwide deaths from HIV/AIDS have fallen every year since their peak in 2005, HIV/AIDS is still the greatest cause of premature death in 20 out of 48 countries in sub-Saharan Africa.

    SOURCE: http://bit.ly/1wkC4J4 The Lancet, online December 17, 2014.

  • REFILE-Colorado awards $8 million to study medical marijuana uses

    (Corrects paragraph 7 to clarify that funding comes from patient registration fees, not taxes on medical marijuana sales)

    By Keith Coffman

    DENVER (Reuters) - Colorado health officials awarded $8 million in research grants on Wednesday to study the use of medical marijuana in the treatment of symptoms associated with Parkinson's disease, childhood epilepsy and post-traumatic stress disorder.

    Colorado was one of the first two U.S. states to legalize recreational pot use, and it is among 23 states and the District of Columbia that permit use of the drug for medicinal purposes.

    But weed remains illegal under federal law for any reason, leading to a dearth of funding for medical marijuana research, and meaning results are limited and largely anecdotal.

    Awarding eight grants for landmark peer-reviewed studies into an array of maladies, the Colorado Department of Public Health and Environment said it sought to provide objective scientific research on the efficacy of medical marijuana.

    "The grant program ... should not be construed as encouraging tor sanctioning the social or recreational use of marijuana," the department said in a statement.

    Colorado lawmakers set up a Medical Marijuana Scientific Advisory Council last year and allocated $10 million to administer a program to conduct the studies. The council received some three dozen applications, from which it chose the eight approved by the department on Wednesday.

    Funding for the program is derived from registration fees paid by medical marijuana patients in the state.

    Six of the grants will go to the University of Colorado Anschutz Medical Campus, said university spokesman Mark Couch.

    Researchers there will study whether marijuana in its various forms can alleviate the tremors associated with Parkinson's and whether it can provide relief for children with brain tumors or pediatric epilepsy.

    Other projects will research using marijuana to treat irritable bowel syndrome in adolescents and young adults, and how cannabis compares with the pain medication Oxycodone.

    Teams at the University of Pennsylvania will conduct two separate studies on whether cannabis is effective in treating patients suffering from post-traumatic stress disorder, including combat veterans.

    "It's true that little research has been done due to federal restrictions. I think that will change as more states are legalizing," said Brian Smith, a spokesman for the Washington State Liquor Control Board, which oversees legalized recreational cannabis there.

    Voters in Oregon and Alaska cast ballots in November to join Colorado and Washington in legalizing recreational pot use.

Orthopedic Articles

  • Knee pain may run in the family

    By Shereen Lehman

    (Reuters Health) - People whose parents had a total knee replacement due to osteoarthritis are more than twice as likely to develop knee pain in midlife as those with no family history of knee surgery, according to a new study.

    The Australian authors say the link between parents and adult children shows that genetics may have much to do with knee problems and the pain that goes with them.

    "It was abundantly clear that genes were a strong contributor to risk of osteoarthritis but there had been limited success in finding these genes," said Dr. Graeme Jones of the University of Tasmania in Hobart, the study's senior author.

    "Thus, a better way may be to look at mechanisms by which genes lead to arthritis and the best way of doing this was to study the adult children of people who have had knee replacements for osteoarthritis," Jones told Reuters Health in an email.

    By age 45, about one-quarter to one-third of adults have had knee pain that lasted for at least one week, the study authors write in the Annals of the Rheumatic Diseases .

    The causes of knee pain aren't always clear, but previous studies have also suggested a genetic link.

    The new study is the first to examine whether people who have a family history of osteoarthritis of the knee have a greater risk of worsening knee pain, according to the authors.

    They enrolled 186 adults with at least one parent who had knee replacement surgery at one of the hospitals in Hobart, and an additional 186 adults whose parents had no history of knee arthritis or knee replacement surgery.

    At the beginning of the study, participants answered questionnaires reporting any knee pain they had experienced over the past year, and had X-rays and MRI scans of their right knees. These measures were all repeated two years later and again 10 years after the initial enrollment.

    The adults whose parents had knee replacement surgery tended to be heavier and there were more smokers compared to the control group, but there were no differences between the groups as far as visible damage to the knee joints at the beginning of the study.

    After two years both groups had about the same number of participants with knee pain - just over half. But after ten years, 74 percent of the children of parents with knee replacements had knee pain compared to 54 percent of those with no family history of knee surgery.

    Over those eight years there was also an increase in total knee pain in members of both groups, but the offspring of parents with knee surgeries tended to have a greater increase in pain.

    Even after accounting for actual structural problems in the participants' knees, the researchers found that offspring of people with knee replacement surgery were 2.2 times as likely to report that their pain had worsened compared to the controls.

    "I suppose there are many mechanisms by which genes lead to arthritis - some we can help, some we can't," Jones said. "Offspring have more pain, weigh more, are more susceptible to the effects of smoking, have weaker muscles, more splits in the cartilage and menisci and greater cartilage loss over time."

    Since differences in arthritis and other structural knee problems did not explain the differences between groups in knee pain, Jones said that genetics most likely accounted for the outcomes - for instance, a greater sensitivity to pain that might be influenced by genes.

    Still, other factors, such as aspects of the environment, that were shared by both parents and adult children could not be ruled out, he said.

    To avoid knee pain, Jones suggests that people maintain an ideal body weight, minimize their risk of knee injury, exercise more when they're younger and refrain from smoking.

    "Develop ways of decreasing pain severity, and manage stress better," he added. "Consider medications such as glucosamine if at high risk."

    SOURCE: http://bmj.co/1zCnywT Annals of the Rheumatic Diseases, online December 4, 2014.

  • Review finds best exercises to prevent women's knee injury

    By Madeline Kennedy

    (Reuters Health) - Some training methods are better than others at preventing knee ligament injuries in young women, researchers advise.

    Based on 14 previous studies, the researchers say training programs that focus on strengthening the legs and hips and stabilizing the abdomen are the most effective for preventing injury to the anterior cruciate ligament (ACL), and doing more than one type of exercise is also important.

    "We know neuromuscular training can reduce ACL injury in female athletes, but we were not sure what exercises are the best to attain the maximal prophylactic effects," said Dai Sugimoto of The Micheli Center for Sports Injury Prevention and the Boston Children's Hospital Orthopaedics and Sports Medicine department, in Massachusetts.

    The ACL is the key stabilizing ligament in the knee, and is most often injured during sports that involve quick turns or pivoting movements.

    ACL injuries are very serious and can take a long time to heal, the researchers write in the British Journal of Sports Medicine. College athletes with ACL injuries lose more time on the field than athletes with ankle or traumatic head injuries, according to the researchers.

    Young women facing the greatest risk are those who play sports involving a lot of pivoting, such as soccer, basketball, lacrosse and handball, according to Sugimoto. He added that the most common age for women to be injured is around 14 to 17 years.

    Grethe Mykelburst, who outlined the risks involved with ACL injury in an email, said, "it takes you out of your sport for 6-12 months, and some don't succeed to return to their previous level." She added that the risk of getting osteoarthritis, a degenerative condition, in the knee is high after injury.

    Mykelburst, a sports physical therapist and associate professor at the Oslo Sport Trauma Research Center in Oslo, Norway, was not involved in the review.

    Sugimoto's team analyzed 14 studies of exercise intervention programs, looking specifically at four different exercise approaches including balance, jump training, abdomen stabilizing exercises and strengthening of the legs and hips.

    Training programs that aimed to build strength in the back of the legs and in the hips significantly reduced the number of ACL injuries when compared with programs that did not. That was also true of programs that focused on strengthening and developing more control of the abdomen.

    Programs that included more than one type of exercise were significantly more effective than those using only one type. "Neuromuscular training has to incorporate many exercise modes," Sugimoto told Reuters Health. "Performing only one exercise mode seems ineffective."

    The researchers note that while balance and jumping exercises were somewhat helpful in reducing injury, they were not effective unless combined with other exercises.

    The study lists a number of specific helpful exercises, including Russian hamstring curls, sit-ups, pushups and bench press. Sugimoto emphasized the hamstring curls in particular, as they work both to strengthen the legs and hips and require abdomen control.

    "With inclusion of these exercises as well as a variety of exercise modes, athletes can attain the fullest benefit from neuromuscular training and prevent ACL injury," Sugimoto said.

    Every year 350,000 people seek ACL reconstruction surgery in the United States, the authors point out.

    Sugimoto said that although surgery is the best available treatment, 24 to 30 percent of high school athletes who undergo the surgery tear their ACL again within the next several years.

    "That's why we need to prevent ACL injury in first place to avoid subsequent ACL injury and preserve a healthy knee joint," Sugimoto said.

    "The evidence is strong that neuromuscular training works," Mykelburst agreed. "As an athlete or a coach, you can't afford not using the prevention program and exercises that exist," she added.

    SOURCE: http://bmj.co/1wATVNF British Journal of Sports Medicine, online December 1, 2014.

  • Fractures are major cause of older women's hospitalizations

    By Kathryn Doyle

    (Reuters Health) - For U.S. women age 55 or older, bone fractures due to osteoporosis lead to more hospitalizations and greater healthcare costs than heart attack, stroke or breast cancer, according to a new study.

    "What we saw and what those of us in the bone heath field have known is that the burden of major osteoporotic factors is huge," said lead author Dr. Andrea Singer of MedStar Georgetown University Hospital in Washington, DC, and clinical director at the National Osteoporosis Foundation.

    More than five million people over age 50 in the U.S. have been diagnosed with the bone-weakening disease osteoporosis, including two percent of men and ten percent of women, according to the Centers for Disease Control and Prevention.

    "We really underestimate the importance of osteoporosis and fracture, and people underestimate their own risk," Singer told Reuters Health.

    She and her coauthors used inpatient data from more than 1000 hospitals nationwide.

    Between 2000 and 2011, 4.9 million women over age 55 were hospitalized for osteoporotic fracture of the hip, pelvis, arm, leg or spine, compared to 3 million for stroke, 2.9 million for heart attack and 700,000 for breast cancer.

    Osteoporotic fractures accounted for more than 40 percent of the hospitalizations, the researchers calculated, and led to an estimated hospital cost of more than $5 billion per year.

    Heart attack, stroke and breast cancer hospitalizations cost the healthcare system $4.3 billion, $3 billion and $500 million per year, respectively, according to results in Mayo Clinic Proceedings.

    Even these numbers likely underestimate the true cost of osteoporosis to the healthcare system, Singer said.

    "We've known for a long time that osteoporotic fractures are the source of a lot of expense and pain," said Dr. Ethel S. Siris, past president of the National Osteoporosis Foundation and director of the Toni Stabile Osteoporosis Center of the Columbia University Medical Center at New York-Presbyterian Hospital.

    "Since this is something that has a higher burden than other things that patients or providers worry about all the time like heart attack, stroke and breast cancer, then we ought to be doing something to ask the right questions," Singer said.

    A quarter of all people who suffer a hip fracture die within one year, which is much higher than the other diseases included in the study, she said.

    "Of the 75 percent who remain alive, many lose their independence and need assisted living," Singer said. "A lot of times people fear not necessarily dying, but being incapacitated, ending up in a nursing home. Those statistics are daunting."

    Most people who break a hip never return to their normal lives, said Siris, who was not involved in the new study.

    "Half the people who break a hip have previously broken something else, and instead of looking at that as a red flag, those people don't get evaluated, they don't get bone density tests," she told Reuters Health. "Somehow or other fractures are just not taken so seriously."

    But recognizing and treating osteoporosis after that first fracture could prevent more fractures later, Siris said.

    That can include maintaining a healthy lifestyle to prevent or slow bone loss, getting adequate calcium and vitamin D, and doing weight-bearing muscle strengthening exercise. Even people who have had a fracture already can do modified safe activities, and can take care with proper footwear, avoiding steps, and avoiding carrying heavy loads, and thereby prevent falls, Singer said.

    "In terms of building new bones and really getting to the best bone density level you can, that happens when you're young," but it's never too late to treat osteoporosis, Singer said.

    Used correctly, bisphosphonate drugs can be very effective at lowering fracture risk, Siris said.

    "There's little doubt of the benefit of treatment if you need it overwhelmingly," she said. "There are lots of good treatments."

    Older women may qualify for a bone density test, and should request one after suffering a fracture over age 50, Singer said.

    "I hope in some ways this paper serves as a call to action to providers and empowers women to think about their own bone health," she said. "If their provider isn't proactively asking, then they can ask about it."

    SOURCE: http://bit.ly/1uh2Nkb Mayo Clinic Proceedings, online December 13, 2014.

Transplant Articles

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Women’s Health Articles

  • Federal judge rebuffs NCAA concussion settlement

    By Reuters Staff

    (Reuters) - A federal judge on Wednesday rebuffed a $75-million NCAA settlement that aimed to end a massive class-action lawsuit over head injuries suffered by student athletes, court records show.

    U.S. District Judge John Lee wrote in a 21-page opinion that while the proposed agreement was a step in the right direction, the $70 million devoted to fund concussion testing and diagnosis for players might not cover potential costs, among other issues.

    "Although these concerns may prove surmountable, the Court cannot grant preliminary approval of the settlement as currently proposed," Lee wrote.

    There was no immediate reply to a request for comment from the National Collegiate Athletic Association (NCAA), which had previously welcomed the agreement as a way to improve sports safety.

    The lawsuit was first filed in 2011 on behalf of former Eastern Illinois football player Adrian Arrington, who said he suffered headaches and seizures as a result of five documented concussions. The proposed settlement covers other cases.

    The deal also addressed some guidelines, such as barring a student with a concussion from returning to play or practice on the same day and requiring a doctor's clearance.

    It would have also set aside $5 million for concussion research, although research done by member schools can be credited toward that amount.

    The opinion highlighted that not all plaintiffs in the case were happy with the settlement, with some taking issue over the provision barring players from bringing bodily injury claims as a class.

    The proposed NCAA settlement came a few weeks after a federal judge's preliminary approval of an open-ended settlement between the National Football League and thousands of former players in June.

    The NFL settlement money was intended to resolve all the personal injury claims for the plaintiffs' out of pocket damages.

    The danger of concussions and other head injuries has received increased attention in college and professional sports in recent years, with much of the focus on football.

    More than 450,000 NCAA student athletes compete in 23 sports. The NCAA makes revenue of about $740 million each year, court documents show.

  • Obesity can be deemed a disability at work -EU court

    By Julia Fioretti

    BRUSSELS (Reuters) - Europe's top court ruled on Thursday that obese people can be considered as disabled, but stopped short of saying that obesity was a condition that needed specific protection under European anti-discrimination laws.

    The landmark decision will be closely read by European employers and means that companies might have to provide greater support to obese staff.

    The case was instigated by a Danish court, which wanted guidance over a complaint of unfair dismissal brought by a child-minder who was sacked by a local authority.

    Karsten Kaltoft, who never weighed less than 160 kilograms (352 pounds) during his employment, argued that his obesity was one of the reasons he lost his job and that this amounted to unlawful discrimination - an allegation the council denied.

    The Court of Justice of the European Union (EJC) ruled that EU employment law did not specifically prohibit discrimination on the grounds of obesity, and said the law should not be extended to make it a protected category.

    However, the Luxembourg-based court said that if an employee's obesity hindered "full and effective participation of that person in professional life on an equal basis with other workers" then it could be considered a disability. This, in turn, is covered by anti-discrimination legislation.

    Classifying obesity as a protected characteristic - such as sex, race or age - would have required employers to take measures to ensure obese workers could perform their duties on an equal footing with others.

    "It would have opened a can of worms," said Crowley Woodford, employment partner at law firm Ashurst.

    However, Friday's nuanced ruling still leaves companies open to potential discrimination suits.

    "If you consider the obese disabled, all of a sudden it triggers certain protections for employees," said Jacob Sand, a partner at Danish law firm Gorrissen Federspiel which represented Kaltoft.

    Considering obesity a disability also reverses the burden of proof in workplace disputes over discrimination, Sand added, meaning it will be easier for employees to argue they had been discriminated against on the basis of their disability.

    "That makes it a whole lot easier for employees in that it is easier to win the case," Sand said.

    However it does not mean that employers cannot fire someone whose size means that they are unable to do their job, rather that they must consider whether any adjustments need to be made to help the employee perform their role first, said Stefan Martin, employment partner at law firm Mayer Brown.

    According to statistics from the World Health Organization (WHO), based on 2008 estimates, roughly 23 percent of European women and 20 percent of European men were obese.

    The issue of whether obesity is a disability has also been dealt with in U.S. courts, where almost one in three adults is obese, according to WHO data. Some states, such as Michigan, have enacted legislation that explicitly prohibits discrimination on the basis of a person's weight.

    The Danish court must now decide whether Kaltoft's obesity represented a disability. It is expected to reach a decision before the end of next year. Kaltoft had asked for compensation equivalent to 15 months' salary for his dismissal, Sand said.

  • Heart experts warn of air pollution dangers

    By Janice Neumann

    (Reuters Health) - Air pollution should be one of the avoidable heart risk factors - just like smoking and excess fat - that doctors warn patients to steer clear of, according to a new statement from 20 heart experts.

    Citing pollution's heavy toll on cardiovascular health, the panel urges people to take steps to protect themselves from breathing heavy traffic fumes or industrial air pollution whenever possible, and public officials to pass laws to reduce air pollution.

    "Cardiovascular disease is a huge global problem, causing immense suffering and premature death, as well as placing severe strain on national healthcare budgets and/or family finances," said Dr. Robert Storey, a professor of cardiology at the University of Sheffield in the UK and senior author of the new position paper.

    Air pollution causes more than 3 million deaths worldwide each year and causes 3.1 percent of all cases of disability, Storey and his coauthors write in the European Heart Journal.

    Air pollution is also ninth most important on a list of modifiable heart-disease risk factors - ranking above low physical activity, high-salt diet, high cholesterol and drug use, the authors point out.

    Although gaseous air pollutants can be dangerous too, Storey said, airborne particles are the biggest contributor to cardiovascular disease because they cause inflammation of the lungs and enter the circulation, inflaming blood vessels, provoking clots and causing heart rhythm disturbances.

    Particulate matter includes coarse particles from road dust, construction work and industrial emissions and fine particles from traffic, power plants and industrial and residential burning of oil, coal or wood for heating.

    The bulk of particulate air pollution is made up of these fine particles, known as PM2.5, that are less than 2.5 micrometers - about one fifth the size of visible dust.

    The World Health Organization sets the safe outdoor exposure limit for PM2.5 at an average of 25 micrograms, or 25 millionths of a gram, per cubic meter of air over a 24-hour period, or average annual levels of 10 micrograms per cubic meter. In 2013, the U.S. Environmental Protection Agency lowered the 24-hour exposure limit to an average of 12 micrograms.

    European studies have found that PM2.5 levels are often markedly higher near heavy traffic zones compared to elsewhere in the same city, and that the levels can more than double during rush hours, according to the position statement.

    Some of the authors' advice for people to protect themselves is as simple as walking, cycling and using public transportation instead of driving cars, and exercising in parks or gardens, rather than near busy roads.

    And everyone should avoid being outside when pollution is highest, though this is especially important for infants, elderly and people with heart problems, the authors say.

    People who live in heavily polluted areas should also consider ventilation systems with filtration in their homes, since a large portion of outdoor pollution can penetrate buildings.

    The use of fossil fuels for heating and energy should also be decreased, according to the statement.

    "Many countries have made good progress towards reducing risk factors such as smoking, high cholesterol and high blood pressure but much less effort has been extended on reducing exposure to air pollution," Storey said in an email to Reuters Health.

    Studies have shown even short-term exposure to high PM2.5 levels increases deaths from heart disease and respiratory disease, and that people living in places with high PM2.5 have an 11 percent greater risk of dying from heart attacks, strokes and heart failure than those who live in cleaner areas.

    Dr. Robert Brook, a cardiologist at the University of Michigan Health System and another author of the policy statement, said many people don't realize the dangerous effects of air pollution on the heart.

    "While most people can readily observe and believe that air pollution may cause lung diseases, it is in fact cardiovascular diseases that are the largest adverse health effect of fine particulate matter exposure," Brook said in an email.

    Dr. Alan Abelsohn of the Dalla Lana School of Public Health at the University of Toronto in Canada, called the statement an important reminder. Too few cardiologists and primary care doctors advise their patients of pollution's risks, he said.

    "It's a very important and neglected area of prevention," he said.

    Abelsohn, who was not involved in the position statement, noted that national-level guidelines on allowable amounts of pollution can only do so much. He said individuals should always pay attention to the local Air Quality Index, which rates the level of air pollution according to health risk, and reduce their exposure accordingly.

    Brook said that while the U.S. has made great strides reducing air pollution since the 1970s or even 2000, the efforts should continue.

    "What we should not do is lessen our regulations and pose a threat to the cardiovascular health of the nation in the name of expediency or supposed economic growth or stimulus," Brook said.

    SOURCE: http://bit.ly/1zt1Iw6 European Heart Journal, online December 9, 2014.

  • Autism risk linked to particulate air pollution

    By Reuters Staff

    (Reuters) - Children whose mothers were exposed to high levels of fine particulate pollution in late pregnancy have up to twice the risk of developing autism as children of mothers breathing cleaner air, scientists at Harvard School of Public Health reported on Thursday.

    The greater the exposure to fine particulates emitted by fires, vehicles and industrial smokestacks, the greater the risk, according to the study published online in Environmental Health Perspectives.

    Earlier research also found an autism-pollution connection, including a 2010 study that found the risk of autism doubled if a mother, during her third trimester, lived near a freeway, a proxy for exposure to particulates. But this is the first to examine the link across the United States, and "provides additional support" to a possible link, said Heather Volk of the University of Southern California Children's Hospital, who led earlier studies.

    U.S. diagnoses of autism soared to one in 68 children in 2010 (the most recent data) from one in 150 in 2000, government scientists reported in March. Experts are divided on how much of the increase reflects greater awareness and how much truly greater incidence.

    Although the disorder has a strong genetic basis, the increasing incidence has spurred scientists to investigate environmental causes, too, since genes do not change quickly enough to explain the rise.

    The Harvard study included children of the 116,430 women in the Nurses' Health Study II, which began in 1989. The researchers collected data on where the women lived while pregnant and levels of particulate pollution. They then compared the prenatal histories of 245 children with autism spectrum disorder to 1,522 normally-developing children, all born from 1990 to 2002.

    There was no association between autism and fine particulate pollution exposure before or early in pregnancy, or after the child was born. But high levels of exposure during the third trimester doubled the risk of autism.

    Evidence that a mother-to-be's exposure to air pollution affects her child's risk of autism "is becoming quite strong," said Harvard epidemiologist Marc Weisskopf, who led the study, suggesting a way to reduce the risk.

    It is not clear how tiny particles might cause autism, but they are covered with myriad contaminants and penetrate cells, which can disrupt brain development.

    Last year the Environmental Protection Agency, citing the link to asthma, lung cancer and cardiovascular disease, tightened air quality standards for fine particulate pollution. States have until 2020 to meet the new standards.

    SOURCE: http://1.usa.gov/1w2lTep Environmental Health Perspectives, online December 18, 2014.

  • CORRECTED-Women live with incontinence, but it can be treated

    (Corrects para 9 to indicate a success rate of 34 percent in the 105 women in the intervention group who completed the study.)

    By Ronnie Cohen

    (Reuters Health) - Older women often silently suffer from treatable urinary incontinence, researchers say.

    When doctors asked about urinary incontinence and offered to treat it, women were two to three times more likely to have a reduction in symptoms than when doctors ignored the condition until patients complained, they found.

    "It's very sad because most women don't ask for help because they think there is no help for them," lead researcher Dr. Els Visser told Reuters Health.

    "What we proved with this study is that there is help for them," she said.

    A general practitioner, Visser was a doctoral student at the University of Groningen in The Netherlands when she did the research.

    Women in the study were patients in general practices in The Netherlands, at least 55 years old. Out of 2,390 women who filled out questionnaires, a third, or 744, reported involuntary urine loss at least once a month. Ultimately, 350 women with incontinence participated in the study.

    Primary care doctors in the study were randomly assigned to either raise the question of incontinence, or to provide "standard care." Doctors who asked about incontinence symptoms also ordered tests to assess the problem and then worked with urologists and physical therapists to come up with a diagnosis and a treatment plan.

    In the standard-care group, doctors waited for the patient to ask for help with her incontinence.

    A year later, 34 percent of the 105 women in the intervention group who completed the study reported that their symptoms were less severe, researchers wrote in the journal Maturitas.

    Most women had improved as a result of physical therapy and lifestyle changes, including limiting alcohol and coffee consumption, Visser said.

    The most common treatments, given to 105 women, were pelvic floor muscle training, bladder training and biofeedback from a registered pelvic physiotherapist. In addition, six women received medication, three had surgery, and 41 were referred for further diagnostic evaluations.

    Of the 184 women in the control group, only three received treatment.

    The women in the intervention group were nearly twice as likely as those in the control group to report a reduction in the severity of incontinence, the study found.

    And when the researchers looked only at women with moderate to severe incontinence (leaving out those with mild symptoms), a reduction in symptoms was nearly three times more likely for women who'd been treated, compared to those who hadn't been.

    Tatyana Shamliyan, who has done similar research, told Reuters Health the study underscores the value of having doctors ask women about urinary incontinence.

    "We have to work hard in this area because it affects the quality of life for many women," she said.

    Shamliyan, who's now a quality assurance director at Elsevier in Philadelphia, was not involved in the current study.

    "It should be a public health issue," she said. "It's not shameful. It's very common, and it's treatable. The stigma should be removed."

    Shamliyan says teenage girls should learn about the benefits of pelvic floor muscle training after childbirth in health-education classes. Urinary incontinence afflicts not only aging women but women following childbirth, she said.

    One in three women over age 55 experiences symptoms of urinary incontinence, Visser said.

    Since 2003, physiotherapists with a specialty in pelvic floor training have been working in The Netherlands, she said. But pelvic floor muscle training is not standard practice in the U.S., Shamliyan said.

    She bemoaned the fact that urinary incontinence is not part of the curriculum in U.S. nursing schools.

    "We receive invitations for mammography. It should be the same for urinary incontinence. We would ask, do you have the symptoms? If you do, contact your physician," she said.

    In The Netherlands, Visser said, doctors write prescriptions for incontinence pads. The country with 16.8 million people spent 162 million Euros on adult diapers in 2012, Visser said.

    "That's quite a lot," she said. "So it's a very expensive condition. But it's not only in the Netherlands. It's everywhere."

    Her message to patients: "Don't hesitate to ask your doctor. You can be helped."

    SOURCE: http://bit.ly/134Yvqz Maturitas, online December 1, 2014.