University Health System

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San Antonio, TX 78229
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University Health System Overview

University Health System is a nationally recognized academic medical center. Thanks to its partnership with UT Medicine San Antonio, it has positioned itself as a leader in advanced treatment options, new technologies and clinical research.

For 2012-2013, U.S. News & World Report ranked University Hospital as the best regional hospital in the San Antonio metro area. In addition, University Health System is the first health organization in Bexar County and South Texas to earn Magnet® status – a recognition from the American Nurses Credentialing Center (ANCC) granted to only about six percent of U.S. hospitals.

University Hospital currently operates 496 beds, and is the lead Level I trauma center for all of South Texas. It is also the only pediatric trauma center recognized by the American College of Surgeons, able to provide expert trauma care for critically injured and burned children. Centers of excellence include Organ Transplantation, Cardiovascular Disease and Neurosciences.

University Health System is expanding to meet the needs of San Antonio and South Texas’ growing community through its Capital Improvement Program (CIP). The expansion project includes a new, ten-story, one million-square-foot tower at University Hospital that will open in early 2014. A new 269,000-square-foot Clinical Pavilion on the Robert B. Green Campus downtown opened in January 2013, offering patients expanded primary and urgent care services to include a new PediExpress. The Clinical Pavilion is home to over 100 specialists and state-of-the-art technology including enhanced imaging and an outpatient surgery center opening in May, 2013.

University Featured Video

Neuroscience Articles

  • Bhopal's toxic legacy lives on, 30 years after industrial disaster

    By Danish Siddiqui and Nita Bhalla

    BHOPAL/NEW DELHI (Thomson Reuters Foundation) - Beyond the iron gates of the derelict pesticide plant where one of the world's worst industrial disasters occurred, administrative buildings lie in ruins, vegetation overgrown and warehouses bolted.

    Massive vessels, interconnected by a multitude of corroded pipes that once carried chemical slurries, have rusted beyond repair. In the dusty control room, a soiled sticker on a wall panel reads "Safety is everyone's business".

    On the night of Dec. 2, 1984, the factory owned by the U.S. multinational Union Carbide Corp accidentally leaked cyanide gas into the air, killing thousands of largely poor Indians in the central city of Bhopal.

    Thirty years later, the toxic legacy of this factory lives on, say human rights groups, as thousands of tonnes of hazardous waste remains buried underground, slowly poisoning the drinking water of more than 50,000 people and affecting their health.

    Activists want this waste removed and disposed of away from the area, and feel Indian authorities, who now own the site, have fumbled on taking action - either by clearing up the waste itself or in pursuing Union Carbide to take responsibility.

    "There is a very high prevalence of anemia, delayed menarches in girls and painful skin conditions. But what is most pronounced is the number of children with birth defects," said activist Satinath Sarangi from the Bhopal Medical Appeal which runs a clinic for gas victims.

    "Children are born with conditions such as twisted limbs, brain damage, musculoskeletal disorders ... this is what we see in every fourth or fifth household in these communities."

    Sarangi admits there has been no long-term epidemiological research which conclusively proves that birth defects are directly related to the drinking of the contaminated water.

    TOXIC WATER

    Built in 1969, the Union Carbide plant in Madhya Pradesh state was seen as a symbol of a new industrialized India, generating thousands of jobs for the poor and, at the same time, manufacturing cheap pesticides for millions of farmers.

    Fifteen years later, 40 tonnes of Methyl Isocyanate gas was released and carried by the wind to the surrounding densely populated disaster remains unclear and under debate.

    The government recorded 5,295 deaths, but activists claim 25,000 people died in the aftermath and following years.

    Another 100,000 people who were exposed to the gas continue to suffer today with sicknesses such as cancer, blindness, respiratory problems, immune and neurological disorders. Some children born to survivors have mental or physical disabilities.

    While those directly affected receive free medical health care, activists say authorities have failed to support those sick from drinking the contaminated water and a second generation of children born with birth defects.

    In a rehabilitation center run by the charity Chingari Trust, located 500 meters from the factory site, disabled children aged between 6 months and 12 years gather for treatment which ranges from speech and hearing issues to physiotherapy.

    "Our life changed emotionally and physically since we got to know about his medical problem when was just 4 months old," said 26-year-old Sufia, sitting on a mat on the floor, cradling her two-year-old son Mustafa who has cerebral palsy.

    "We had to stop the therapy when he was 8-months-old as it was very expensive. My husband is an electrician and doesn't earn much. With the center it is good as it's free. It's also good to meet other mothers with their children and realize that I am not alone."

    CALL FOR CLEAN-UP

    The government was forced to recognize the water was contaminated in 2012 when the Supreme Court ordered that clean drinking water be supplied to some 22 communities living around the factory site.

    "I don't think there is any doubt now that the waste dumped by Union Carbide is a serious problem and that it needs to be dealt with urgently," said Sunita Narain, director of the Delhi-based think-tank Center for Science and Environment.

    Studies by Narain's organization in 2009 found samples taken from around the factory site contained chlorinated benzene compounds and organochlorine pesticides 561 times the national standard.

    The profile of the chemicals found in samples from within the site matched the chemicals in drinking water in the outside colonies, said the report, leaving no doubt that there could be no other source of these toxins than Union Carbide.

    Studies since have confirmed water pollution, but the hazardous waste remains in pits in some 21 locations within the 68-acre site and buried in a wasteland outside, largely due to wrangles between authorities and activists on its disposal.

    The United Nations this week welcomed a government decision to reconsider the official figure of people affected by the gas leak, and look into additional compensation, but pressed authorities to get rid of the toxic waste.

    "New victims of the Bhopal disaster are born every day, and suffer life-long from adverse health impacts," said Baskut Tuncak, U.N. Special Rapporteur on human rights and toxic waste.

    "Without cleaning the contamination, the number of victims of the toxic legacy left by Union Carbide will continue to grow, and, together, India's financial liability to a rising number of victims," he added in a statement.

    Activists want Union Carbide, which was taken over by Dow Chemical Company in 2001, to take the waste out of the country, saying there are no adequate facilities in India to deal with it. They have also criticized state authorities for not pursuing the corporation for the clean-up. State government officials were not immediately available for comment.

    Seventeen people living around the plant have filed a petition in the U.S. courts to get the multinational to bear the cost of the clean-up.

    Dow Chemical Co. has long denied responsibility, saying Union Carbide spent $2 million on remediating the site, adding that Indian authorities at the time approved, monitored and directed every step of the clean-up work.

    Union Carbide was sued by the Indian government after the disaster and agreed to pay an out-of-court settlement of $470 million in damages in 1989. The company says the Indian government then took control of the site in 1998, assuming all accountability, including clean-up activities.

    "While Union Carbide continues to have the utmost respect and sympathy for the victims, we find that many of the issues being discussed today have already been resolved and responsibilities assigned for those that remain," Tomm F. Sprick, Director of Union Carbide Information Center, told the Thomson Reuters Foundation in an email.

  • REFILE-Mindfulness program may improve some rheumatoid arthritis symptoms

    (Corrects spelling of Dr. Kreitzer's name in paragraphs 20 and 21)

    By Shereen Lehman

    (Reuters Health) - A two-month program combining gentle yoga with meditation techniques, known as Mindfulness Based Stress Reduction, seemed to ease tenderness, pain and stiffness among patients with rheumatoid arthritis in a new study.

    "I think these findings are pretty consistent with other studies of mindfulness and chronic conditions," said Mary Jo Kreitzer, who was not involved in the research.

    Although it was small, and relatively brief, the study's findings were impressive, said Kreitzer, the founder and director of the University of Minnesota Center for Spirituality and Healing.

    "I would say more research is needed to really understand how the mechanisms work," Kreitzer told Reuters Health, "so this trial is incredibly encouraging, but it's not definitive."

    Mindfulness Based Stress Reduction (MBSR) is a program developed decades ago at the University of Massachusetts to help seriously ill patients cope with pain, such as from advanced cancer or AIDS. But in recent years that program has been adapted and offered more widely to people seeking relief from pain and stress of many kinds.

    "Mindfulness training involves the cultivation of nonjudgemental attention to unwanted thoughts, feelings and bodily experiences via meditation and may help ameliorate both psychological and physical symptoms of chronic disease," write the study authors in Annals of the Rheumatic Diseases.

    Previous research has found mixed success when MBSR is used by sufferers of various conditions. For instance, in one trial among patients with fibromyalgia - a widespread pain syndrome of unknown cause - MBSR had little effect (see Reuters Health story of December 28, 2010 here: http://reut.rs/1HG0Sja).

    But Francesca Fogarty at the University of Auckland in New Zealand, who led the new study, and her coauthors note that past research has found MBSR improves the psychological wellbeing of rheumatoid arthritis patients.

    They wanted to see if mindfulness techniques had any impact on the disease process itself.

    Rheumatoid arthritis is a chronic disease caused by the immune system attacking tissue in the joints, especially in the hands and feet, and sometimes causes problems in other parts of the body, such as the eyes, skin, lungs and blood vessels.

    For their study, Fogarty's team enrolled 42 patients with rheumatoid arthritis who had no previous experience with meditation. Twenty one participants were put into a treatment group, and the other 21 served as a comparison group who were told they could go through the MBSR program after the study.

    The treatment group participated in an eight-week program of meditation, gentle stretching and light yoga. Right after the program ended, and again at two, four and six months later, the study team assessed participants' disease symptoms.

    These included the number of tender and swollen joints, levels of C-reactive protein (a marker of inflammation) and the patients' own assessments of their stiffness and pain based on a scale of 1 to 100.

    On average, and throughout the follow-up period, morning stiffness, tenderness and pain scores were lowered among those who had gone through MBSR, but not in the comparison group.

    There were no differences, however, in objective measures of disease activity like C-reactive protein levels and number of swollen joints between the MBSR and comparison groups.

    The authors conclude that MBSR likely helped participants by changing their "experience" of the disease.

    "This pattern of effects is also consistent with evidence linking mindfulness training to improved pain regulation and well-established links between reduced pain and greater wellbeing among people with rheumatoid arthritis," the authors write.

    "I think it follows the line of so many studies that have been coming out about mindfulness-based stress reduction over the last 15 years. Literally hundreds of studies have come out," Kreitzer said.

    "Mindfulness is a way to slow down and be in the present moment and that's what mindfulness training is, so in a mindfulness class people focus on breathing and relaxation and that's sort of how they ease into a practice of meditation," she said.

    Kreitzer said she thinks the study also demonstrates how important self-care and self-management approaches are. There's so much that people can do on their own," she said, adding that for many a sense of empowerment comes from being able to do something about their symptoms.

    MBSR classes are widely available at hospitals and privately, as well as through online programs (http://bit.ly/1vjU4kG), Kreitzer said.

    "People can just check with local healthcare facilities or even use Google to see if there are any mindfulness programs in their communities," she said.

    SOURCE: http://bmj.co/1HEG0J5 Annals of the Rheumatic Diseases, online November 18, 2104.

  • Celiac disease showing up in many forms and at all ages

    By Janice Neumann

    (Reuters Health) - A classical set of celiac disease symptoms no longer reflects the profile of most newly-diagnosed patients, according to a new study from Italy.

    Instead, doctors need to take other symptoms into account and consider the possibility of celiac disease, even when patients don't fit the old image of the condition, researchers say.

    "It's been a gradual phenomenon since the 1970s that fewer people are presenting with the classical diarrhea and more with non-classical or silent presentation, both in adults and children," said Dr. Peter Green, who wasn't involved in the study.

    "We don't actually know why one person has diarrhea and another presents with abdominal pain or osteoporosis," said Green, director of the Celiac Disease Center at Columbia University in New York.

    Dr. Umberto Volta and his coauthors write in the journal BMC Gastroenterology that just 15 years ago, celiac disease was still thought of mainly as a rare pediatric food intolerance, whose most common signs were diarrhea and intestinal damage that was diagnosed through a biopsy.

    The disease is now known to be an autoimmune disorder, caused by an inability to tolerate the gluten protein in wheat, barley and rye.

    Eating gluten typically causes inflammation of the intestinal lining in people with celiac disease and makes it hard to absorb nutrients.

    Research shows that more than 1 percent of people worldwide have the disease, but most may not know it, the authors of the study note. The diagnosis is based on a blood test for signs of the abnormal immune response, such as antibodies, as well as biopsy in some cases.

    With his colleagues, Volta, a professor of medicine at the University of Bologna in Italy and vice president of the Ethical Committee at St. Orsola-Malpighi University Hospital, looked at the celiac patients diagnosed over the course of 15 years at that hospital.

    The study involved 770 patients, 599 of them female, diagnosed between 1998 and 2007. Nearly half were diagnosed during the first 10 years of the study period and the rest in the last five years, indicating a steep rise in rates of diagnosis.

    Among all the patients, 610 people, or 79 percent, had symptoms when they were diagnosed. But most of their problems were not the typical diarrhea and weight loss, but rather "non-classical" issues like bloating, osteoporosis and anemia. Diarrhea was a symptom in just 27 percent of patients.

    Indeed, classical symptoms became less common over the years, decreasing from 47 percent of patients during the first 10 years to 13 percent in the last five. Meanwhile, other problems, as well as a lack of any significant related illness, increased by more than 86 percent.

    "The most striking change in clinical presentation of celiac disease over time has been the decrease of diarrhea as the leading symptom and the progressive increase of other non-classical gastrointestinal symptoms (such as constipation, bloating and alternate bowel habits as well as gastro-esophageal reflux, nausea, vomiting and dyspepsia)," Volta said in an e-mail to Reuters Health.

    "A high proportion of celiac disease patients did not show any gastrointestinal symptom, but they displayed extra-intestinal manifestations such as iron-deficiency anemia, unexplained osteoporosis, abnormalities of liver-function tests and recurrent miscarriages," he said.

    The most common illness associated with celiac was thyroid disease. Only half the patients had severe intestinal damage, and 25 percent had partial damage.

    In later years, more patients were diagnosed through blood tests. That may be one factor accounting for the changing pattern of typical symptoms, Volta said, because the patients were diagnosed earlier, before gluten had done its damage.

    "The effects of gluten weren't as severe yet," Volta said. "The story of celiac disease has been radically changed by the discovery celiac disease-related antibodies, which identify plenty of unsuspected cases."

    Green agreed that testing has vastly improved diagnosis of the disease. He said that in the United Kingdom, anyone with iron deficiency or migraine is tested for celiac disease.

    While most celiac specialists understand the varied symptoms, other physicians might not, he said. Green pointed out that in the United States, only 17 percent of people with the disease are actually diagnosed.

    "Anyone can have celiac disease, it's common and underdiagnosed," said Green. "The message we want to get out is if you think you've got celiac disease, don't just go on a gluten-free diet, test for it."

    Volta said he hoped the study reminded doctors about the many problems that can signal celiac disease.

    "I hope doctors keep in mind that celiac disease is a very frequent food intolerance, which should be investigated not only in patients with diarrhea and overt malabsorption, but also in people (with other symptoms)," Volta said.

    "The treatment by gluten-free diet improves the quality of life in symptomatic patients and prevents complications in all celiac disease patients including those without symptoms," he said.

    SOURCE: http://bit.ly/1ATNpT3 BMC Gastroenterology, Nov. 18, 2014.

  • Hormones only one factor in sexual function during menopause

    By Kathryn Doyle

    (Reuters Health) - Testosterone and other reproductive hormones do play a role - but probably a small one - in women's feelings of sexual desire during menopause, according to a new study.

    Factors like emotional wellbeing and quality of the intimate relationship may be more important, says lead author Dr. John F. Randolph, Jr., of the University of Michigan Health System in Ann Arbor.

    "The big thing that came out of this is it has long been assumed or theorized that hormones played a big role, but it's been hard to prove," Randolph told Reuters Health. "Hormones definitely do play a role but it's not a big one."

    For the new study, researchers studied data from more than 3,000 middle-aged women participating for at least 10 years in an ongoing study that included annual questionnaires about sexuality and blood tests to measure hormone levels.

    The women were between 42 and 52 years old at the beginning of the study. By the 10th year, 77 percent were post-menopausal and 7 percent were using hormone replacement therapy.

    Yearly questionnaires addressed how often the women felt desire in the past six months to engage in any form of sexual activity either alone or with a partner, and how frequently they had done so. Those who reported having sexual activities with a partner were asked about their levels of arousal, ability to climax, frequency of vaginal or pelvic pain during intercourse and lubricant use.

    Women with higher levels of testosterone tended to report more frequent masturbation, more sexual desire and arousal than those with lower levels, according to the results published in the Journal of Clinical Endocrinology and Metabolism.

    Women who had higher levels of follicle stimulating hormone, which rises during menopause, tended to report masturbating, feeling arousal and experiencing orgasm less often than others.

    Hormones did not appear to be linked to pain with intercourse. Even for the other measures of sexual function, hormones only accounted for part of the picture, Randolph said.

    Those who said they had fewer sad moods and higher levels of satisfaction in their relationships also reported better sexual function.

    "Women's sexual function is pretty complicated and it would be naïve to assume only one factor is important," Randolph said.

    Men have 10 times as much testosterone as women, so it's harder to measure the influence of the hormone for females, he said. And it's new to consider a metric like masturbation frequency, which hasn't been studied much for this age group of women but is an important indicator of sexual function, he said.

    "Our work shows that there are a lot of other things that are equally or more likely to be important, the big ones are partner relationship and mood," Randolph said.

    "This is an article confirming the potential role of testosterone in women's sexuality independently from a partner and it adds a piece to the story that sexual function is driven by androgen but sexual behavior is related to the context, especially the partner," said Dr. Rossella Nappi of the Research Center for Reproductive Medicine and Unit of Gynecological Endocrinology and Menopause at the University of Pavia in Italy.

    Nappi was not involved in the new research.

    "Some women retain the ability to masturbate and climax across menopause because of higher androgen levels but maybe their sexual function with a partner is impaired due to many other reasons," she told Reuters Health by email.

    Testosterone seems to have a modest effect on sexual health for menopausal women, but it remains to be seen how it affects women at older ages, and whether or not testosterone therapy will at some point be a viable therapy, Randolph said.

    "It's a really hot topic with men right now because more people are asking for it and doctors are prescribing it," he said. "From a treatment perspective, we really don't know what the long term effects of giving testosterone are, and we need more information."

    The Endocrine Society has recommended against testosterone therapy for women based on the evidence at this point.

    "There are other things that probably have a bigger bearing on what's going on," Randolph said. "We should look at the whole picture rather than focusing on one single thing, and probably that means that testosterone as a treatment is not going to be something the vast majority of women will need."

    SOURCE: http://bit.ly/1pmxpEU Journal of Clinical Endocrinology and Metabolism, online November 20, 2014.

  • REFILE-Mindfulness program may improve some rheumatoid arthritis symptoms

    (Corrects spelling of Dr. Kreitzer's name in paragraphs 20 and 21)

    By Shereen Lehman

    (Reuters Health) - A two-month program combining gentle yoga with meditation techniques, known as Mindfulness Based Stress Reduction, seemed to ease tenderness, pain and stiffness among patients with rheumatoid arthritis in a new study.

    "I think these findings are pretty consistent with other studies of mindfulness and chronic conditions," said Mary Jo Kreitzer, who was not involved in the research.

    Although it was small, and relatively brief, the study's findings were impressive, said Kreitzer, the founder and director of the University of Minnesota Center for Spirituality and Healing.

    "I would say more research is needed to really understand how the mechanisms work," Kreitzer told Reuters Health, "so this trial is incredibly encouraging, but it's not definitive."

    Mindfulness Based Stress Reduction (MBSR) is a program developed decades ago at the University of Massachusetts to help seriously ill patients cope with pain, such as from advanced cancer or AIDS. But in recent years that program has been adapted and offered more widely to people seeking relief from pain and stress of many kinds.

    "Mindfulness training involves the cultivation of nonjudgemental attention to unwanted thoughts, feelings and bodily experiences via meditation and may help ameliorate both psychological and physical symptoms of chronic disease," write the study authors in Annals of the Rheumatic Diseases.

    Previous research has found mixed success when MBSR is used by sufferers of various conditions. For instance, in one trial among patients with fibromyalgia - a widespread pain syndrome of unknown cause - MBSR had little effect (see Reuters Health story of December 28, 2010 here: http://reut.rs/1HG0Sja).

    But Francesca Fogarty at the University of Auckland in New Zealand, who led the new study, and her coauthors note that past research has found MBSR improves the psychological wellbeing of rheumatoid arthritis patients.

    They wanted to see if mindfulness techniques had any impact on the disease process itself.

    Rheumatoid arthritis is a chronic disease caused by the immune system attacking tissue in the joints, especially in the hands and feet, and sometimes causes problems in other parts of the body, such as the eyes, skin, lungs and blood vessels.

    For their study, Fogarty's team enrolled 42 patients with rheumatoid arthritis who had no previous experience with meditation. Twenty one participants were put into a treatment group, and the other 21 served as a comparison group who were told they could go through the MBSR program after the study.

    The treatment group participated in an eight-week program of meditation, gentle stretching and light yoga. Right after the program ended, and again at two, four and six months later, the study team assessed participants' disease symptoms.

    These included the number of tender and swollen joints, levels of C-reactive protein (a marker of inflammation) and the patients' own assessments of their stiffness and pain based on a scale of 1 to 100.

    On average, and throughout the follow-up period, morning stiffness, tenderness and pain scores were lowered among those who had gone through MBSR, but not in the comparison group.

    There were no differences, however, in objective measures of disease activity like C-reactive protein levels and number of swollen joints between the MBSR and comparison groups.

    The authors conclude that MBSR likely helped participants by changing their "experience" of the disease.

    "This pattern of effects is also consistent with evidence linking mindfulness training to improved pain regulation and well-established links between reduced pain and greater wellbeing among people with rheumatoid arthritis," the authors write.

    "I think it follows the line of so many studies that have been coming out about mindfulness-based stress reduction over the last 15 years. Literally hundreds of studies have come out," Kreitzer said.

    "Mindfulness is a way to slow down and be in the present moment and that's what mindfulness training is, so in a mindfulness class people focus on breathing and relaxation and that's sort of how they ease into a practice of meditation," she said.

    Kreitzer said she thinks the study also demonstrates how important self-care and self-management approaches are. There's so much that people can do on their own," she said, adding that for many a sense of empowerment comes from being able to do something about their symptoms.

    MBSR classes are widely available at hospitals and privately, as well as through online programs (http://bit.ly/1vjU4kG), Kreitzer said.

    "People can just check with local healthcare facilities or even use Google to see if there are any mindfulness programs in their communities," she said.

    SOURCE: http://bmj.co/1HEG0J5 Annals of the Rheumatic Diseases, online November 18, 2104.

Oncology Articles

  • U.S. Supreme Court Justice Ginsburg released from hospital

    By Reuters Staff

    WASHINGTON (Reuters) - U.S. Supreme Court Justice Ruth Bader Ginsburg, the oldest member of the nine-justice court, was released from a Washington hospital on Thursday after undergoing a heart procedure, a court statement said.

    Ginsburg, 81, had a stent placed in her right coronary artery at MedStar Washington Hospital Center on Wednesday to improve blood flow after she reported discomfort following routine exercise.

    "Justice Ginsburg was released from the hospital this morning," court spokeswoman Kathleen Arberg said in a statement.

    Ginsburg, appointed by President Bill Clinton in 1993, is the most senior liberal justice on the conservative-leaning court. As such, she is often the lead dissenting voice when the court is split 5-4.

    She has survived serious bouts with cancer in 1999 and 2009.

    In a July interview with Reuters, Ginsburg said she did not intend to leave the bench in the near future unless her health changed. She said she underwent regular medical check-ups for cancer and worked out twice a week with a personal trainer.

    "Thank goodness I haven't slowed down," Ginsburg said at the time.

  • FDA regs highlight harms of indoor tanning

    By Roxanne Nelson

    (Reuters Health) - Early in 2014, the United States Food and Drug Administration moved tanning lamps into a new category of "moderately harmful" medical devices, and with good reason, researchers say.

    In a review of the evidence that indoor tanning does damage, and has no health benefits, the study authors point out that the new rules will force device manufacturers and salons to do more to protect users.

    "We feel that this is a very positive move by the FDA," said Dr. Henry Lim, chairman of dermatology at Henry Ford Medical Center in Detroit, Michigan, and senior author of the review. "There is a lot of evidence that early and frequent use of tanning beds increases the risk of skin cancer."

    Among the new requirements is that all sunlamps have a "black box warning label" that says they shouldn't be used by people under age 18, Lim's team writes.

    This is the strictest warning that the FDA puts on products, and it is used when there is reasonable evidence of a serious hazard, Kim and his coauthors point out in the Journal of the American Academy of Dermatology.

    "The new regulations don't ban the use of tanning beds for children and teens," Lim cautioned. "That will be up to the discretion of the salons."

    However, the FDA guidelines will probably prompt more states to enact legislation, Lim told Reuters Health. Currently, 41 states including the District of Columbia have some type of regulation in place, such as requiring parental consent.

    Several states have completely banned indoor tanning for minors, as has Brazil. In July, Hawaii became the 10th state to do so, joining Vermont, California, Illinois, Louisiana, Minnesota, Oregon, Nevada, Texas and Washington.

    "Earlier exposure to indoor tanning is associated with a greater risk for developing basal cell carcinoma at a young age," said Margaret Karagas, director of the Children's Environmental Health and Disease Prevention Research Center at Dartmouth University in Hanover, New Hampshire.

    "The new FDA regulations reinforce the science that teens and young adults may be especially vulnerable to developing skin cancer if they use tanning beds," said Karagas. She was not involved in the review but recently published a study showing that a high proportion of patients with early-onset basal cell carcinoma had used indoor tanning.

    Basal cell carcinoma is the most common type of skin cancer. While it is not as dangerous as other types, it can be very destructive and disfiguring.

    However, Lim's team also points to studies that found people who were exposed to tanning beds before the age of 35 years had a significantly higher risk of developing melanoma, the deadliest type of skin cancer.

    In their report, the researchers review the science of how skin's exposure to ultraviolet light from tanning beds, or the sun, causes the DNA damage that can lead to cancer. "Tanning is a clinical manifestation of cellular stress," they emphasize.

    "Moreover, the common misconception that tanned skin offers protection from future UV radiation is proved false as there is no biochemical mechanism restricting further mutagenesis upon subsequent exposure," they write.

    The study team covers evidence that use of tanning beds can be addictive in the same way as a drug. And they point out that the devices primarily emit UV-A light, which is less effective at inducing skin to make vitamin D than UV-B, so there's no argument for a health benefit there.

    It's uncertain how much of an effect these new regulations will have on tanning bed users, Lim's team says.

    Nearly 30 million Americans use tanning beds each year, and more than 2 million of them are teenagers, according to the American Academy of Dermatology.

    Regular and heavy users are at the greatest risk, the authors note. More than 1 million people are estimated to use tanning salons each day in the U.S., indicating many repeat users. And about 70 percent of users are girls and young women between the ages of 16 and 29 years old.

    These data are the most troubling, they write, since young women are known to be the most at-risk population for developing melanoma associated with the use of tanning beds.

    "Pediatricians should counsel parents and patients about the risks of using tanning beds," Karagas said.

    Lim's team hopes their review will be used by doctors as a resource for doing just that.

    SOURCE: http://bit.ly/1prBRCr Journal of the American Academy of Dermatology, online November 11, 2014.

  • REFILE-Mindfulness program may improve some rheumatoid arthritis symptoms

    (Corrects spelling of Dr. Kreitzer's name in paragraphs 20 and 21)

    By Shereen Lehman

    (Reuters Health) - A two-month program combining gentle yoga with meditation techniques, known as Mindfulness Based Stress Reduction, seemed to ease tenderness, pain and stiffness among patients with rheumatoid arthritis in a new study.

    "I think these findings are pretty consistent with other studies of mindfulness and chronic conditions," said Mary Jo Kreitzer, who was not involved in the research.

    Although it was small, and relatively brief, the study's findings were impressive, said Kreitzer, the founder and director of the University of Minnesota Center for Spirituality and Healing.

    "I would say more research is needed to really understand how the mechanisms work," Kreitzer told Reuters Health, "so this trial is incredibly encouraging, but it's not definitive."

    Mindfulness Based Stress Reduction (MBSR) is a program developed decades ago at the University of Massachusetts to help seriously ill patients cope with pain, such as from advanced cancer or AIDS. But in recent years that program has been adapted and offered more widely to people seeking relief from pain and stress of many kinds.

    "Mindfulness training involves the cultivation of nonjudgemental attention to unwanted thoughts, feelings and bodily experiences via meditation and may help ameliorate both psychological and physical symptoms of chronic disease," write the study authors in Annals of the Rheumatic Diseases.

    Previous research has found mixed success when MBSR is used by sufferers of various conditions. For instance, in one trial among patients with fibromyalgia - a widespread pain syndrome of unknown cause - MBSR had little effect (see Reuters Health story of December 28, 2010 here: http://reut.rs/1HG0Sja).

    But Francesca Fogarty at the University of Auckland in New Zealand, who led the new study, and her coauthors note that past research has found MBSR improves the psychological wellbeing of rheumatoid arthritis patients.

    They wanted to see if mindfulness techniques had any impact on the disease process itself.

    Rheumatoid arthritis is a chronic disease caused by the immune system attacking tissue in the joints, especially in the hands and feet, and sometimes causes problems in other parts of the body, such as the eyes, skin, lungs and blood vessels.

    For their study, Fogarty's team enrolled 42 patients with rheumatoid arthritis who had no previous experience with meditation. Twenty one participants were put into a treatment group, and the other 21 served as a comparison group who were told they could go through the MBSR program after the study.

    The treatment group participated in an eight-week program of meditation, gentle stretching and light yoga. Right after the program ended, and again at two, four and six months later, the study team assessed participants' disease symptoms.

    These included the number of tender and swollen joints, levels of C-reactive protein (a marker of inflammation) and the patients' own assessments of their stiffness and pain based on a scale of 1 to 100.

    On average, and throughout the follow-up period, morning stiffness, tenderness and pain scores were lowered among those who had gone through MBSR, but not in the comparison group.

    There were no differences, however, in objective measures of disease activity like C-reactive protein levels and number of swollen joints between the MBSR and comparison groups.

    The authors conclude that MBSR likely helped participants by changing their "experience" of the disease.

    "This pattern of effects is also consistent with evidence linking mindfulness training to improved pain regulation and well-established links between reduced pain and greater wellbeing among people with rheumatoid arthritis," the authors write.

    "I think it follows the line of so many studies that have been coming out about mindfulness-based stress reduction over the last 15 years. Literally hundreds of studies have come out," Kreitzer said.

    "Mindfulness is a way to slow down and be in the present moment and that's what mindfulness training is, so in a mindfulness class people focus on breathing and relaxation and that's sort of how they ease into a practice of meditation," she said.

    Kreitzer said she thinks the study also demonstrates how important self-care and self-management approaches are. There's so much that people can do on their own," she said, adding that for many a sense of empowerment comes from being able to do something about their symptoms.

    MBSR classes are widely available at hospitals and privately, as well as through online programs (http://bit.ly/1vjU4kG), Kreitzer said.

    "People can just check with local healthcare facilities or even use Google to see if there are any mindfulness programs in their communities," she said.

    SOURCE: http://bmj.co/1HEG0J5 Annals of the Rheumatic Diseases, online November 18, 2104.

  • Celiac disease showing up in many forms and at all ages

    By Janice Neumann

    (Reuters Health) - A classical set of celiac disease symptoms no longer reflects the profile of most newly-diagnosed patients, according to a new study from Italy.

    Instead, doctors need to take other symptoms into account and consider the possibility of celiac disease, even when patients don't fit the old image of the condition, researchers say.

    "It's been a gradual phenomenon since the 1970s that fewer people are presenting with the classical diarrhea and more with non-classical or silent presentation, both in adults and children," said Dr. Peter Green, who wasn't involved in the study.

    "We don't actually know why one person has diarrhea and another presents with abdominal pain or osteoporosis," said Green, director of the Celiac Disease Center at Columbia University in New York.

    Dr. Umberto Volta and his coauthors write in the journal BMC Gastroenterology that just 15 years ago, celiac disease was still thought of mainly as a rare pediatric food intolerance, whose most common signs were diarrhea and intestinal damage that was diagnosed through a biopsy.

    The disease is now known to be an autoimmune disorder, caused by an inability to tolerate the gluten protein in wheat, barley and rye.

    Eating gluten typically causes inflammation of the intestinal lining in people with celiac disease and makes it hard to absorb nutrients.

    Research shows that more than 1 percent of people worldwide have the disease, but most may not know it, the authors of the study note. The diagnosis is based on a blood test for signs of the abnormal immune response, such as antibodies, as well as biopsy in some cases.

    With his colleagues, Volta, a professor of medicine at the University of Bologna in Italy and vice president of the Ethical Committee at St. Orsola-Malpighi University Hospital, looked at the celiac patients diagnosed over the course of 15 years at that hospital.

    The study involved 770 patients, 599 of them female, diagnosed between 1998 and 2007. Nearly half were diagnosed during the first 10 years of the study period and the rest in the last five years, indicating a steep rise in rates of diagnosis.

    Among all the patients, 610 people, or 79 percent, had symptoms when they were diagnosed. But most of their problems were not the typical diarrhea and weight loss, but rather "non-classical" issues like bloating, osteoporosis and anemia. Diarrhea was a symptom in just 27 percent of patients.

    Indeed, classical symptoms became less common over the years, decreasing from 47 percent of patients during the first 10 years to 13 percent in the last five. Meanwhile, other problems, as well as a lack of any significant related illness, increased by more than 86 percent.

    "The most striking change in clinical presentation of celiac disease over time has been the decrease of diarrhea as the leading symptom and the progressive increase of other non-classical gastrointestinal symptoms (such as constipation, bloating and alternate bowel habits as well as gastro-esophageal reflux, nausea, vomiting and dyspepsia)," Volta said in an e-mail to Reuters Health.

    "A high proportion of celiac disease patients did not show any gastrointestinal symptom, but they displayed extra-intestinal manifestations such as iron-deficiency anemia, unexplained osteoporosis, abnormalities of liver-function tests and recurrent miscarriages," he said.

    The most common illness associated with celiac was thyroid disease. Only half the patients had severe intestinal damage, and 25 percent had partial damage.

    In later years, more patients were diagnosed through blood tests. That may be one factor accounting for the changing pattern of typical symptoms, Volta said, because the patients were diagnosed earlier, before gluten had done its damage.

    "The effects of gluten weren't as severe yet," Volta said. "The story of celiac disease has been radically changed by the discovery celiac disease-related antibodies, which identify plenty of unsuspected cases."

    Green agreed that testing has vastly improved diagnosis of the disease. He said that in the United Kingdom, anyone with iron deficiency or migraine is tested for celiac disease.

    While most celiac specialists understand the varied symptoms, other physicians might not, he said. Green pointed out that in the United States, only 17 percent of people with the disease are actually diagnosed.

    "Anyone can have celiac disease, it's common and underdiagnosed," said Green. "The message we want to get out is if you think you've got celiac disease, don't just go on a gluten-free diet, test for it."

    Volta said he hoped the study reminded doctors about the many problems that can signal celiac disease.

    "I hope doctors keep in mind that celiac disease is a very frequent food intolerance, which should be investigated not only in patients with diarrhea and overt malabsorption, but also in people (with other symptoms)," Volta said.

    "The treatment by gluten-free diet improves the quality of life in symptomatic patients and prevents complications in all celiac disease patients including those without symptoms," he said.

    SOURCE: http://bit.ly/1ATNpT3 BMC Gastroenterology, Nov. 18, 2014.

  • Breast cancer recurrence risk down since 1980s

    By Andrew M. Seaman

    (Reuters Health) - Rates of breast cancer recurrence fell by half or more between the 1980s and the early 2000s - likely due to improved treatments and increased screenings, according to a new study from Canada.

    The analysis of data on Canadian breast cancer patients offers reassurance that breast cancer survival is improving and also provides updated data to researchers, said the study's lead author, Dr. Karen Gelmon from the BC Cancer Agency in Vancouver, British Columbia.

    "It gives some contemporary numbers to people designing trials testing adjuvant treatments," she said.

    An earlier study, published in the 1990s and based on data from 1978 to 1988, found that women whose breast cancers fed off the hormone estrogen (so-called estrogen-receptor positive breast cancers) had a consistent risk of the cancer recurring over time. For breast cancers not driven by estrogen, recurrence risk was high for five years after successful treatment, but then dropped below the risk of those with estrogen-receptor (ER)-positive cancers.

    In the new study, published in the Journal of Clinical Oncology, Gelmon's team compared data on 7,178 women treated for early to moderately-advanced breast cancer during two different periods: 1986 to 1992, and 2004 to 2008.

    The researchers matched the cancer characteristics of each patient from the first period to a patient from the second period, including estrogen-receptor status as well as the presence of another protein on cancer cells, HER2.

    The HER2 molecule helps drive cancer-cell growth. Tumors with HER2 tend to be more aggressive than HER2-negative ones, the researchers note.

    Starting in the 1990s, drugs targeting molecules on cancer cells like HER2 became available. Together with improved early detection of less-advanced cancers, which gives such drugs a better chance of working, the targeted therapies have been credited with improving overall cancer survival

    In the new study, the overall risk of breast cancer recurrence for women in the later group was about 50 percent lower than for women in the earlier group, for each year after being cancer-free.

    Like the 1990s study, the new analysis found a high risk of recurrence within the first five years among women with cancers that were not driven by estrogen. Among women treated in the 2000s, that early increased risk was less dramatic, however.

    Specifically, the risk of recurrence after one year was about 11 percent among women from the earlier period with cancers not driven by estrogen, compared to about a 6 percent risk among women with the same type of cancer in the later period.

    "It showed we were doing better, but the peaks are still there," Gelmon said.

    The researchers also found that HER2-positive cancers saw some of the greatest reductions in recurrence risk.

    For example, the risk of recurrence in the second year of being cancer-free among women whose tumors were HER2-positive and ER-negative fell from about 23 percent in the earlier period to about 9 percent in the most recent period.

    The new study can't show why recurrence rates improved, but the researchers say it's most likely a result of screening leading to early detection and more "comprehensive and appropriate" treatments targeting specific cancer types.

    For example, they also saw large increases in the use of chemotherapy, and of drugs targeting estrogen-driven cancers, among the most recent patients.

    Drugs targeting HER2-positive cancers were not available in the earlier time period.

    "I think the most important thing is (the study) validates all these things we've been doing all these years," said Dr. Marleen Meyers, an oncologist and breast cancer expert at the NYU Langone Medical Center's Perlmutter Cancer Center in New York City.

    Meyers, who wasn't involved in the new study, also called the findings reassuring.

    "I think we continue to learn," she said. "I think this is very good, very positive information for women."

    SOURCE: http://bit.ly/1vOlzpm Journal of Clinical Oncology, online November 24, 2014.

Orthopedic Articles

  • REFILE-Needy patients to get new hips or knees for free next week

    (In first sentence, changes "two years" to "three years")

    By Randi Belisomo

    (Reuters Health) - Excruciating hip pain forced 50-year-old Army veteran David Chalker to leave his machinist job three years ago, a decision that led to mounting debt, inability to afford health insurance and even a move into his in-laws' home with his wife and three daughters. But his family is counting on one operation next week - entirely free of charge - to change the course of both his health and finances.

    The Long Island, New York resident is one of 120 patients scheduled for hip or knee replacement during the first week of December, provided by Operation Walk USA. The nonprofit organization is a coalition of 85 orthopedic surgeons in 23 states volunteering to operate on patients who do not qualify for government assistance but cannot afford surgery on their own.

    "I would have been in miserable pain for the next who knows how many years until I got enough money to get insurance," said Chalker, who gave up his family's health coverage last year when his rate spiked to more than $1800 monthly.

    Chalker's wife, Lisa, said she felt like she won the lottery when they learned he met requirements for surgery. "We have a chance at a new start, he has a chance to be pain-free, and we can get back on our feet," she said.

    Orthopedic surgeon Matthew Hepinstall will implant Chalker's two new hips next Friday at Franklin Hospital in Valley Stream, New York. On Wednesday, Hepinstall will provide two other free surgeries at Manhattan's Lenox Hill Hospital.

    "The patients involved have severe difficulty walking, severe difficulty with daily activities and severe daily pain," Hepinstall said. "The operation will improve their ability to walk and ability to work and provide for their family."

    Since 2010, Operation Walk USA has provided more than $13 million in services for nearly 500 patients. To qualify, patients must be U.S. citizens or permanent residents, fall within 100 to 200 percent of federal poverty guidelines and have no access to Medicaid, the government program that helps with medical costs for some people with limited income.

    Pre- and post-operation services, like physical therapy, are free of charge. Implants are donated by device manufacturers, and doctors, nurses and technicians volunteer their time and skill.

    The biggest barrier to growth of the program, according to founder Dr. Adolph Lombardi, is finding hospitals willing to donate space. This year, 36 hospitals are participating.

    "Many think doctors are financially incentivized, but at the heart of it, we really want to help people," said Lombardi, an orthopedic surgeon in New Albany, Ohio. "When you work every day and work very hard, there's something about the person that comes up and gives you a big smile and says 'you changed my life.' There's not a dollar bill that can buy that."

    Janet Sitzmann has difficulty measuring the impact of a double knee replacement from Operation Walk USA in 2012. The now 57-year-old Kansas City, Missouri resident said her life before surgery was "pretty small," defined by trips to work, the grocery store and her laundry duties at home.

    The massage therapist was eventually laid off, as her rheumatoid arthritis made it hard to perform her duties. Sitzmann could not imagine her future, as it was difficult enough to envision her day. "I had a limited number of steps I could take in one day, and I really guarded them," she said.

    After the operation, she returned to work and to volunteering. She joined a choir and lost 35 pounds as a result of her increased activity. Sitzmann traveled to Europe for the birth of a grandchild three months after surgery, a trip she said would have been impossible without new knees.

    "Whatever I want to do now, I go do it."

    More information about Operation Walk USA is at opwalkusa.com. A separate organization, called simply Operation Walk (operationwalk.org/), provides similar free surgeries in developing countries.

  • REFILE-Needy patients to get new hips or knees for free next week

    (In first sentence, changes "two years" to "three years")

    By Randi Belisomo

    (Reuters Health) - Excruciating hip pain forced 50-year-old Army veteran David Chalker to leave his machinist job three years ago, a decision that led to mounting debt, inability to afford health insurance and even a move into his in-laws' home with his wife and three daughters. But his family is counting on one operation next week - entirely free of charge - to change the course of both his health and finances.

    The Long Island, New York resident is one of 120 patients scheduled for hip or knee replacement during the first week of December, provided by Operation Walk USA. The nonprofit organization is a coalition of 85 orthopedic surgeons in 23 states volunteering to operate on patients who do not qualify for government assistance but cannot afford surgery on their own.

    "I would have been in miserable pain for the next who knows how many years until I got enough money to get insurance," said Chalker, who gave up his family's health coverage last year when his rate spiked to more than $1800 monthly.

    Chalker's wife, Lisa, said she felt like she won the lottery when they learned he met requirements for surgery. "We have a chance at a new start, he has a chance to be pain-free, and we can get back on our feet," she said.

    Orthopedic surgeon Matthew Hepinstall will implant Chalker's two new hips next Friday at Franklin Hospital in Valley Stream, New York. On Wednesday, Hepinstall will provide two other free surgeries at Manhattan's Lenox Hill Hospital.

    "The patients involved have severe difficulty walking, severe difficulty with daily activities and severe daily pain," Hepinstall said. "The operation will improve their ability to walk and ability to work and provide for their family."

    Since 2010, Operation Walk USA has provided more than $13 million in services for nearly 500 patients. To qualify, patients must be U.S. citizens or permanent residents, fall within 100 to 200 percent of federal poverty guidelines and have no access to Medicaid, the government program that helps with medical costs for some people with limited income.

    Pre- and post-operation services, like physical therapy, are free of charge. Implants are donated by device manufacturers, and doctors, nurses and technicians volunteer their time and skill.

    The biggest barrier to growth of the program, according to founder Dr. Adolph Lombardi, is finding hospitals willing to donate space. This year, 36 hospitals are participating.

    "Many think doctors are financially incentivized, but at the heart of it, we really want to help people," said Lombardi, an orthopedic surgeon in New Albany, Ohio. "When you work every day and work very hard, there's something about the person that comes up and gives you a big smile and says 'you changed my life.' There's not a dollar bill that can buy that."

    Janet Sitzmann has difficulty measuring the impact of a double knee replacement from Operation Walk USA in 2012. The now 57-year-old Kansas City, Missouri resident said her life before surgery was "pretty small," defined by trips to work, the grocery store and her laundry duties at home.

    The massage therapist was eventually laid off, as her rheumatoid arthritis made it hard to perform her duties. Sitzmann could not imagine her future, as it was difficult enough to envision her day. "I had a limited number of steps I could take in one day, and I really guarded them," she said.

    After the operation, she returned to work and to volunteering. She joined a choir and lost 35 pounds as a result of her increased activity. Sitzmann traveled to Europe for the birth of a grandchild three months after surgery, a trip she said would have been impossible without new knees.

    "Whatever I want to do now, I go do it."

    More information about Operation Walk USA is at opwalkusa.com. A separate organization, called simply Operation Walk (operationwalk.org/), provides similar free surgeries in developing countries.

  • REFILE-Mindfulness program may improve some rheumatoid arthritis symptoms

    (Corrects spelling of Dr. Kreitzer's name in paragraphs 20 and 21)

    By Shereen Lehman

    (Reuters Health) - A two-month program combining gentle yoga with meditation techniques, known as Mindfulness Based Stress Reduction, seemed to ease tenderness, pain and stiffness among patients with rheumatoid arthritis in a new study.

    "I think these findings are pretty consistent with other studies of mindfulness and chronic conditions," said Mary Jo Kreitzer, who was not involved in the research.

    Although it was small, and relatively brief, the study's findings were impressive, said Kreitzer, the founder and director of the University of Minnesota Center for Spirituality and Healing.

    "I would say more research is needed to really understand how the mechanisms work," Kreitzer told Reuters Health, "so this trial is incredibly encouraging, but it's not definitive."

    Mindfulness Based Stress Reduction (MBSR) is a program developed decades ago at the University of Massachusetts to help seriously ill patients cope with pain, such as from advanced cancer or AIDS. But in recent years that program has been adapted and offered more widely to people seeking relief from pain and stress of many kinds.

    "Mindfulness training involves the cultivation of nonjudgemental attention to unwanted thoughts, feelings and bodily experiences via meditation and may help ameliorate both psychological and physical symptoms of chronic disease," write the study authors in Annals of the Rheumatic Diseases.

    Previous research has found mixed success when MBSR is used by sufferers of various conditions. For instance, in one trial among patients with fibromyalgia - a widespread pain syndrome of unknown cause - MBSR had little effect (see Reuters Health story of December 28, 2010 here: http://reut.rs/1HG0Sja).

    But Francesca Fogarty at the University of Auckland in New Zealand, who led the new study, and her coauthors note that past research has found MBSR improves the psychological wellbeing of rheumatoid arthritis patients.

    They wanted to see if mindfulness techniques had any impact on the disease process itself.

    Rheumatoid arthritis is a chronic disease caused by the immune system attacking tissue in the joints, especially in the hands and feet, and sometimes causes problems in other parts of the body, such as the eyes, skin, lungs and blood vessels.

    For their study, Fogarty's team enrolled 42 patients with rheumatoid arthritis who had no previous experience with meditation. Twenty one participants were put into a treatment group, and the other 21 served as a comparison group who were told they could go through the MBSR program after the study.

    The treatment group participated in an eight-week program of meditation, gentle stretching and light yoga. Right after the program ended, and again at two, four and six months later, the study team assessed participants' disease symptoms.

    These included the number of tender and swollen joints, levels of C-reactive protein (a marker of inflammation) and the patients' own assessments of their stiffness and pain based on a scale of 1 to 100.

    On average, and throughout the follow-up period, morning stiffness, tenderness and pain scores were lowered among those who had gone through MBSR, but not in the comparison group.

    There were no differences, however, in objective measures of disease activity like C-reactive protein levels and number of swollen joints between the MBSR and comparison groups.

    The authors conclude that MBSR likely helped participants by changing their "experience" of the disease.

    "This pattern of effects is also consistent with evidence linking mindfulness training to improved pain regulation and well-established links between reduced pain and greater wellbeing among people with rheumatoid arthritis," the authors write.

    "I think it follows the line of so many studies that have been coming out about mindfulness-based stress reduction over the last 15 years. Literally hundreds of studies have come out," Kreitzer said.

    "Mindfulness is a way to slow down and be in the present moment and that's what mindfulness training is, so in a mindfulness class people focus on breathing and relaxation and that's sort of how they ease into a practice of meditation," she said.

    Kreitzer said she thinks the study also demonstrates how important self-care and self-management approaches are. There's so much that people can do on their own," she said, adding that for many a sense of empowerment comes from being able to do something about their symptoms.

    MBSR classes are widely available at hospitals and privately, as well as through online programs (http://bit.ly/1vjU4kG), Kreitzer said.

    "People can just check with local healthcare facilities or even use Google to see if there are any mindfulness programs in their communities," she said.

    SOURCE: http://bmj.co/1HEG0J5 Annals of the Rheumatic Diseases, online November 18, 2104.

  • Celiac disease showing up in many forms and at all ages

    By Janice Neumann

    (Reuters Health) - A classical set of celiac disease symptoms no longer reflects the profile of most newly-diagnosed patients, according to a new study from Italy.

    Instead, doctors need to take other symptoms into account and consider the possibility of celiac disease, even when patients don't fit the old image of the condition, researchers say.

    "It's been a gradual phenomenon since the 1970s that fewer people are presenting with the classical diarrhea and more with non-classical or silent presentation, both in adults and children," said Dr. Peter Green, who wasn't involved in the study.

    "We don't actually know why one person has diarrhea and another presents with abdominal pain or osteoporosis," said Green, director of the Celiac Disease Center at Columbia University in New York.

    Dr. Umberto Volta and his coauthors write in the journal BMC Gastroenterology that just 15 years ago, celiac disease was still thought of mainly as a rare pediatric food intolerance, whose most common signs were diarrhea and intestinal damage that was diagnosed through a biopsy.

    The disease is now known to be an autoimmune disorder, caused by an inability to tolerate the gluten protein in wheat, barley and rye.

    Eating gluten typically causes inflammation of the intestinal lining in people with celiac disease and makes it hard to absorb nutrients.

    Research shows that more than 1 percent of people worldwide have the disease, but most may not know it, the authors of the study note. The diagnosis is based on a blood test for signs of the abnormal immune response, such as antibodies, as well as biopsy in some cases.

    With his colleagues, Volta, a professor of medicine at the University of Bologna in Italy and vice president of the Ethical Committee at St. Orsola-Malpighi University Hospital, looked at the celiac patients diagnosed over the course of 15 years at that hospital.

    The study involved 770 patients, 599 of them female, diagnosed between 1998 and 2007. Nearly half were diagnosed during the first 10 years of the study period and the rest in the last five years, indicating a steep rise in rates of diagnosis.

    Among all the patients, 610 people, or 79 percent, had symptoms when they were diagnosed. But most of their problems were not the typical diarrhea and weight loss, but rather "non-classical" issues like bloating, osteoporosis and anemia. Diarrhea was a symptom in just 27 percent of patients.

    Indeed, classical symptoms became less common over the years, decreasing from 47 percent of patients during the first 10 years to 13 percent in the last five. Meanwhile, other problems, as well as a lack of any significant related illness, increased by more than 86 percent.

    "The most striking change in clinical presentation of celiac disease over time has been the decrease of diarrhea as the leading symptom and the progressive increase of other non-classical gastrointestinal symptoms (such as constipation, bloating and alternate bowel habits as well as gastro-esophageal reflux, nausea, vomiting and dyspepsia)," Volta said in an e-mail to Reuters Health.

    "A high proportion of celiac disease patients did not show any gastrointestinal symptom, but they displayed extra-intestinal manifestations such as iron-deficiency anemia, unexplained osteoporosis, abnormalities of liver-function tests and recurrent miscarriages," he said.

    The most common illness associated with celiac was thyroid disease. Only half the patients had severe intestinal damage, and 25 percent had partial damage.

    In later years, more patients were diagnosed through blood tests. That may be one factor accounting for the changing pattern of typical symptoms, Volta said, because the patients were diagnosed earlier, before gluten had done its damage.

    "The effects of gluten weren't as severe yet," Volta said. "The story of celiac disease has been radically changed by the discovery celiac disease-related antibodies, which identify plenty of unsuspected cases."

    Green agreed that testing has vastly improved diagnosis of the disease. He said that in the United Kingdom, anyone with iron deficiency or migraine is tested for celiac disease.

    While most celiac specialists understand the varied symptoms, other physicians might not, he said. Green pointed out that in the United States, only 17 percent of people with the disease are actually diagnosed.

    "Anyone can have celiac disease, it's common and underdiagnosed," said Green. "The message we want to get out is if you think you've got celiac disease, don't just go on a gluten-free diet, test for it."

    Volta said he hoped the study reminded doctors about the many problems that can signal celiac disease.

    "I hope doctors keep in mind that celiac disease is a very frequent food intolerance, which should be investigated not only in patients with diarrhea and overt malabsorption, but also in people (with other symptoms)," Volta said.

    "The treatment by gluten-free diet improves the quality of life in symptomatic patients and prevents complications in all celiac disease patients including those without symptoms," he said.

    SOURCE: http://bit.ly/1ATNpT3 BMC Gastroenterology, Nov. 18, 2014.

  • REFILE-Mindfulness program may improve some rheumatoid arthritis symptoms

    (Corrects spelling of Dr. Kreitzer's name in paragraphs 20 and 21)

    By Shereen Lehman

    (Reuters Health) - A two-month program combining gentle yoga with meditation techniques, known as Mindfulness Based Stress Reduction, seemed to ease tenderness, pain and stiffness among patients with rheumatoid arthritis in a new study.

    "I think these findings are pretty consistent with other studies of mindfulness and chronic conditions," said Mary Jo Kreitzer, who was not involved in the research.

    Although it was small, and relatively brief, the study's findings were impressive, said Kreitzer, the founder and director of the University of Minnesota Center for Spirituality and Healing.

    "I would say more research is needed to really understand how the mechanisms work," Kreitzer told Reuters Health, "so this trial is incredibly encouraging, but it's not definitive."

    Mindfulness Based Stress Reduction (MBSR) is a program developed decades ago at the University of Massachusetts to help seriously ill patients cope with pain, such as from advanced cancer or AIDS. But in recent years that program has been adapted and offered more widely to people seeking relief from pain and stress of many kinds.

    "Mindfulness training involves the cultivation of nonjudgemental attention to unwanted thoughts, feelings and bodily experiences via meditation and may help ameliorate both psychological and physical symptoms of chronic disease," write the study authors in Annals of the Rheumatic Diseases.

    Previous research has found mixed success when MBSR is used by sufferers of various conditions. For instance, in one trial among patients with fibromyalgia - a widespread pain syndrome of unknown cause - MBSR had little effect (see Reuters Health story of December 28, 2010 here: http://reut.rs/1HG0Sja).

    But Francesca Fogarty at the University of Auckland in New Zealand, who led the new study, and her coauthors note that past research has found MBSR improves the psychological wellbeing of rheumatoid arthritis patients.

    They wanted to see if mindfulness techniques had any impact on the disease process itself.

    Rheumatoid arthritis is a chronic disease caused by the immune system attacking tissue in the joints, especially in the hands and feet, and sometimes causes problems in other parts of the body, such as the eyes, skin, lungs and blood vessels.

    For their study, Fogarty's team enrolled 42 patients with rheumatoid arthritis who had no previous experience with meditation. Twenty one participants were put into a treatment group, and the other 21 served as a comparison group who were told they could go through the MBSR program after the study.

    The treatment group participated in an eight-week program of meditation, gentle stretching and light yoga. Right after the program ended, and again at two, four and six months later, the study team assessed participants' disease symptoms.

    These included the number of tender and swollen joints, levels of C-reactive protein (a marker of inflammation) and the patients' own assessments of their stiffness and pain based on a scale of 1 to 100.

    On average, and throughout the follow-up period, morning stiffness, tenderness and pain scores were lowered among those who had gone through MBSR, but not in the comparison group.

    There were no differences, however, in objective measures of disease activity like C-reactive protein levels and number of swollen joints between the MBSR and comparison groups.

    The authors conclude that MBSR likely helped participants by changing their "experience" of the disease.

    "This pattern of effects is also consistent with evidence linking mindfulness training to improved pain regulation and well-established links between reduced pain and greater wellbeing among people with rheumatoid arthritis," the authors write.

    "I think it follows the line of so many studies that have been coming out about mindfulness-based stress reduction over the last 15 years. Literally hundreds of studies have come out," Kreitzer said.

    "Mindfulness is a way to slow down and be in the present moment and that's what mindfulness training is, so in a mindfulness class people focus on breathing and relaxation and that's sort of how they ease into a practice of meditation," she said.

    Kreitzer said she thinks the study also demonstrates how important self-care and self-management approaches are. There's so much that people can do on their own," she said, adding that for many a sense of empowerment comes from being able to do something about their symptoms.

    MBSR classes are widely available at hospitals and privately, as well as through online programs (http://bit.ly/1vjU4kG), Kreitzer said.

    "People can just check with local healthcare facilities or even use Google to see if there are any mindfulness programs in their communities," she said.

    SOURCE: http://bmj.co/1HEG0J5 Annals of the Rheumatic Diseases, online November 18, 2104.

Transplant Articles

  • Organ donors who need kidneys jump to front of transplant line

    By Ronnie Cohen

    NEW YORK (Reuters Health) - Organ donors who later need a kidney go to the top of the transplant waiting list and get higher quality kidneys than their counterparts who were not donors, a new study found.

    The finding shows that a U.S. policy prioritizing previous organ donors on the transplant waiting list is working, the study's lead author, Dr. Peter Reese, told Reuters Health.

    "A lot of donors I meet want reassurance that if they do reach end-stage renal disease they'll receive priority on the transplant list," he said. "I think this study provides an important piece of reassurance."

    Reese, from the University of Pennsylvania's Perelman School of Medicine in Philadelphia, and colleagues compared 239 prior organ donors to similar non-donors who were wait-listed for transplants from 1996 until 2010.

    The median wait for a new kidney was 145 days for the donors, compared to 1,607 days for patients who were similar to them but hadn't ever donated an organ, the study found.

    It also found that 5 percent of prior organ donors died before receiving a transplant, compared to 13 percent of the matched candidates.

    "It's an important validation that the system works," Dr. Dorry Segev told Reuters Health. Segev is an epidemiologist and transplant surgeon at Johns Hopkins School of Medicine in Baltimore, Maryland and was not involved with the current study.

    "We in transplantation have put in a rescue system for the rare kidney donor who happens to develop kidney failure . . . and this is evidence that this system is working well," he said.

    Since 1996 in the U.S., living organ donors have been granted priority for kidneys procured from deceased donors, the authors write in the Journal of the American Society of Nephrology.

    The selection criteria for living donors are designed to identify individuals who are at low risk for ultimately needing kidney transplants themselves. Transplant teams carefully screen donor applicants and impress upon them the importance of maintaining healthy lifestyles and getting checkups, Reese and Segev said.

    Recent research has found, however, that although the risk of a donor later needing a new kidney remains low, it is eight times higher than the risk for the average healthy person, the new study says.

    But, Reese said, it's still a very rare event.

    Over the years of the study, there were more than 84,000 living kidney donors in the U.S. alone, according to data from the Organ Procurement and Transplantation Network.

    Segev said his research shows that the absolute risk of kidney failure for prior donors is 31 out of 10,000, compared to 27 out of 10,000 for non-donors.

    He was not surprised to see that the system of prioritizing donors is working. But he said the question that continues to concern him is whether prior donors who develop kidney failure are being sent to transplant centers for evaluation.

    Segev is studying that question.

    Another previous study of his found that the vast majority of kidney failure patients saw no need for a kidney transplant because they felt they were doing fine on dialysis (see Reuters Health story of September 19, 2014 here: http://reut.rs/1yeXQ0V). But Segev believes transplants are always superior to dialysis.

    Kidney transplants double a recipient's life expectancy, he said.

    Since the 1990s, advances in immune-suppression have made it safer to receive organs from unrelated donors. Less invasive surgical techniques also make it easier to donate.

    "We have to really impress on donors that if they donate they're committing to a healthy lifestyle," Reese said.

    "There is definitely risk," he said. "But I think my job is to choose people whose risk is low, reasonable and who are not ambivalent."

    SOURCE: http://bit.ly/1F9WswL Journal of the American Society of Nephrology, online November 20, 2014.

  • Double arm transplant recipient thanks doctors in Boston

    By Richard Valdmanis

    BOSTON (Reuters) - A 40-year-old quadruple amputee on Tuesday thanked the Boston surgeons who performed a rare dual arm transplant on him last month and described the experience of getting the new limbs as surreal.

    Will Lautzenheiser, who lost his arms and legs to a streptococcal infection in 2011, said he has limited function in the new arms, which are encumbered by wrappings to help with healing.

    The arms were attached from an anonymous donor in a nine-hour operation at Brigham & Women's Hospital.

    "I want to thank the doctors for their great service," an emotional Lautzenheiser said at a news conference at the hospital. "I want to thank everyone."

    He said having the new limbs was "incredible" and "surreal."

    Lautzenheiser, a former professor of film production and screenwriting at Boston University and Montana State University, has a long stretch of therapy ahead but hopes to return to his career.

    The family of the anonymous donor told Lautzenheiser in a statement issued Tuesday that it hoped he would make a "wonderful recovery, and that your loved ones will be able to enjoy your warm embrace."

    The surgery involved 35 medical staff, including 13 surgeons, according to Brigham & Women's Hospital.

    While rare, there have been other double-arm transplants in the United States recent years. In 2012, a U.S. soldier who lost all four limbs in a roadside explosion in Iraq had double-arm transplant surgery at Johns Hopkins in Baltimore.

Women’s Health Articles

  • Heavy drinking raises women's injury risk more than men's

    By Janice Neumann

    (Reuters Health) - Heavy drinking increases the risk of being injured, and far more so for women than men, researchers say.

    In a review of emergency department admissions in 18 countries, they also found that violence was involved in twice as many drinking-related injuries as were traffic collisions, falls or other causes.

    "Even small amounts of drinking put one at risk for injury," said lead researcher Cheryl Cherpitel of the Alcohol Research Group in Emeryville, California.

    After three standard drinks, both men and women were about 4.5 times more likely to be injured than when they were not drinking, the authors report in the journal Addiction.

    But after that point, women's risk started rising faster until it was double, then triple that of men. Compared to when they were not drinking, after 15 drinks men were 12 times more likely to be injured but women were 22 times more likely to be injured. The odds of injury peaked for both sexes at about 30 drinks.

    A standard "drink" is typically any amount that contains 14 grams of pure alcohol. That would translate to 12 ounces of beer containing 5 percent alcohol, five ounces of wine with 12 percent alcohol or 1.5 ounces of hard liquor containing 40 percent alcohol.

    The study looked at data on 13,119 injured men and women ages 18 and older who were admitted to 37 emergency departments after having up to 30 drinks in the previous six hours.

    Those data included information from eight countries (Argentina, Belarus, Brazil, the Czech Republic, India, Mexico, New Zealand and Sweden) from a 2001-2002 World Health Organization study. The authors also added 2006-2009 data from 10 countries (Switzerland, Ireland, China and Korea, Dominican Republic, Guatemala, Guyana, Nicaragua, Panama and Canada) to get a better sense of the risks by gender, age, cause of injury and country-level drinking pattern.

    Cherpitel, who also directs the WHO Collaborating Center on Alcohol Epidemiology and Injury, and her colleagues found that drinking-related injuries were more common in some countries, including Guatemala, Mexico and Nicaragua.

    The researchers say injuries are a bigger problem in countries where regular moderate drinking, such as with meals, is less of a norm, so more drinking episodes are likely to be binge-drinking.

    "People in the different countries can actually consume the same amount of alcohol but the pattern of drinking really makes a big difference," said Cherpitel, noting that people in Mediterranean countries may drink a lot but spread it over a longer period of time.

    They did not find any significant differences in drinking-related injuries by age group.

    The differences between the sexes in injury risk may be due in part to men's greater tolerance for alcohol, Cherpitel said.

    Women were probably more likely to have violence-related injuries than men, judging from the study results, she noted. The study didn't compare men and women's risk of violence, but injuries involving altercations were twice as likely as traffic accidents and nearly twice as likely as falls.

    "Certainly there are probably a lot of women who have not been drinking who are the victim of a violent episode because of who they were with," Cherpitel said.

    Dr. Maria Raven, an assistant professor of Emergency Medicine at the University of California, San Francisco, said that she and her colleagues routinely look for injuries whenever an intoxicated person comes to the emergency department.

    "Maintaining that high index of suspicion is the safest way we have to assure we're not missing significant injuries in people who are intoxicated," Raven told Reuters Health. "All of us have found severe injury when we didn't suspect we would."

    SOURCE: http://bit.ly/11jRuRd Addiction, online November 13, 2014.

  • South African mother turns tragedy into fight against HIV

    By Katie Nguyen

    LONDON (Thomson Reuters Foundation) - Johanna Satekge was pregnant with her first-born when she tested positive for HIV in South Africa's Limpopo province in 2000.

    When her son was born, he weighed 3.6 kgs. When he died seven months later, he had wasted away to 2 kgs. After three years, Satekge got pregnant again, this time giving birth to a daughter she named Blessing.

    "She was healthy, I breastfed her. Then she got ill and died after seven months," said the 39-year-old, taking out her wallet to show Blessing's photo.

    "You can see how painful it was. Losing those children was not easy for me. Seeing those tiny babies die before me, was really unbearable," she told the Thomson Reuters Foundation in an interview in London ahead of World AIDS Day.

    Satekge does not know for sure how she contracted HIV but believes it may have been the result of being raped in her 20s.

    She was woken up one night by noises in the tin shack she shared with her family.

    "I realised there was someone in the house and when I started to scream, he took out a gun," she said. "He was not alone, there were three. I was raped and they ran away."

    After reporting the attack to the police, Satekge was tested for HIV. Her result was negative, but no one urged her to get tested again and she was not given post-exposure prophylaxis (PEP), a course of anti-HIV medication, which, if administered early enough, can prevent infection.

    COURAGE

    A decade on, Satekge is a mother again, to a son whose name, Lefa, means "Wealth" and a daughter, Tiisetso, meaning "Courage". Both were born without HIV.

    After losing Blessing, Satekge started taking antiretroviral drugs which help prevent HIV being passed on to others. When her viral load - the presence of HIV in the blood - was so low as to be undetectable, her doctor encouraged her to start a family.

    Now Satekge advises other HIV-positive women on how to prevent the transmission of the virus that causes AIDS to their children.

    Women account for 58 percent of those with HIV in sub-Saharan Africa, which is also home to 85 percent of pregnant women with HIV, according to UNAIDS.

    Coverage of services to prevent mother-to-child transmission of HIV in sub-Saharan Africa has reached 68 percent from 56 percent in 2011, UNAIDS said this week. It also noted that the number of children newly infected with HIV in the region fell by 43 percent to 210,000 in 2013 from 370,000 in 2009.

    Despite this progress, up to 600 babies are infected with HIV in sub-Saharan Africa every day, most of them acquiring it from their mothers during pregnancy, childbirth and breastfeeding, according to charity mothers2mothers (m2m).

    Without treatment, about half of these children will die before the age of two, it says.

    For the past five years, Satekge has worked alongside doctors and nurses as an m2m "mother mentor", offering support and health education to HIV-positive mothers and other women in a bid to reverse the trend. Similar m2m programmes have been rolled out in Kenya, Lesotho, Malawi, Swaziland and Uganda.

    'HIV IS NOT INHERITED'

    Satekge says there have been big advances in the almost 15 years since her status was revealed.

    "It was hard to be diagnosed at that time. You used to see just images of skeletal people," Satekge said. "My niece, who I was raising, would sometimes come home from primary school, crying: 'How is mama HIV positive? Is she going to die?'"

    Even going to church back then offered little comfort.

    "I used to go to church but I stopped after the pastor said HIV is a punishment from God," Satekge recalled.

    Now she receives calls from clergymen requesting that she speak to their congregations about HIV. "The stigma has reduced," she said.

    Mothers whose daughters are pregnant seek out Satekge at the clinic where her team sees more than 300 women a month, asking her to advise them to test for HIV.

    But many hurdles remain.

    Less than half of all adults living with HIV in sub-Saharan Africa know their HIV status. Almost 60 percent of people in South Africa do not have access to antiretroviral therapy, according to UNAIDS.

    Young women and girls are disproportionately affected by HIV. HIV infection rates are on average five times higher among girls than boys and sexual violence is a persistent threat.

    Success in the fight against the epidemic depends on people like Satekge, who are seen as role models to many.

    "I've got meaning," Satekge said. "Every day I say I'm going to work and save somebody's life. My slogan is 'HIV is not inherited.'"

  • Pursuit and restraint raise police officers' risk of sudden death

    By Kathryn Doyle

    (Reuters Health) - Police officers are at increased risk for sudden cardiac death when performing stressful duties like chasing, restraining or fighting with suspects, researchers say.

    Sudden cardiac death is up to 70 times more likely during those kinds of stressful activities, compared to when police officers perform routine duties, according a new study of U.S. law enforcement deaths.

    The results aren't surprising, said senior author Dr. Stefanos N. Kales of Harvard School of Public Health in Boston.

    "In the general population those really stressful things like anger or physical stress, like a lot of snow shoveling for a person who is usually sedentary, can serve as triggers for cardiovascular events," Kales told Reuters Health.

    "We thought the same thing could happen with law enforcement officers but we were struck by the magnitude of the risks," Kales said.

    He and his coauthors studied 441 cases of law enforcement officers' sudden cardiac death on the job between 1984 and 2010.

    Sudden cardiac death occurs when the heart stops beating abruptly because of abnormal rhythms. It can strike young athletes with undiagnosed heart problems. But most often, cardiac arrest happens when people with cardiovascular disease are under severe physical or psychological stress.

    Kales' team reported in the journal BMJ that while routine duties take up about 75 percent of an officer's time, 77 percent of cardiac deaths occurred during more stressful activities. For example, 25 percent occurred during a restraint or physical altercation, 20 percent during physical training, 12 percent during pursuits, and 8% during rescue operations. The remaining deaths did not fit into any of the pre-determined duty categories.

    The researchers calculated that police officers spend 1 to 2 percent of their work time using restraints or engaged in altercations, but because those activities accounted for 25 percent of deaths, they raise the risk by 30-fold to 70-fold compared to when an officer is performing routine duties.

    Similarly, pursuits made up less than 2 percent of officers' on-duty time, but raised the risk of cardiac death 30- to 50-fold.

    Overall, however, sudden cardiac deaths accounted for just 10 percent of all on-duty deaths for police officers. The majority involved traumas like gunshot wounds or car accidents.

    "The absolute risk for most individuals and all police is quite low and primarily limited to people who have underlying disease, who may not know that they have underlying disease," Kales said.

    The authors recommend that physical fitness be a job requirement for police officers, and should be maintained after graduation from the academy.

    Police departments should also ban smoking, since it is so harmful to heart health, Kales said. "Given that we compensate police or firefighters for retirement and disability, it really is incumbent on the jurisdiction to ban smoking," Kales added.

    Denise L. Smith, director of the First Responder Health and Safety Lab at Skidmore College in Saratoga Springs, New York, told Reuters Health, "In the general population there is no public safety risk, only risk to the individual, for sudden cardiac death. But here public safety may be put at risk."

    "First responders come from the general population so they're just like the rest of us as far as lack of fitness, obesity, blood glucose, cholesterol," added Smith, who was not involved in the study. "They need to be fitter and healthier than the rest of us."

    Dr. Franklin H. Zimmerman, Senior Attending Cardiologist and Director of Critical Care at Phelps Memorial Hospital in Sleepy Hollow, New York, who also was not affiliated with the study, pointed out that police officers often develop bad habits after graduating from the academy and don't maintain their fitness.

    "Law enforcement is basically a sedentary activity, and you need to go zero to 90 within a few seconds," Zimmerman said. "Even professional athletes, you would never ask them to start sprinting out of a chair."

    The experts agreed that officers should have annual or near-annual physical examinations to monitor their weight and other risk factors, and that stress testing may be useful for certain officers with more cardiovascular risk to identify those who might be at higher risk for sudden cardiac death.

    SOURCE: http://bit.ly/1vm3WvC BMJ, online November 18, 2014.

  • WHO advises male Ebola survivors to abstain from sex

    By Reuters Staff

    LONDON (Reuters) - Men who recover from Ebola should abstain from sex for three months to minimise the risk of passing the virus on in their semen, the World Health Organisation (WHO) said on Friday.

    Ebola, a disease that has infected and killing thousands in a vast epidemic in West Africa, normally spreads via bodily fluids such as blood, saliva and faeces. Although sexual transmission of Ebola virus disease has never been documented, the virus has been detected in the survivors' semen.

    "Men who have recovered from Ebola virus disease should be aware that seminal fluid may be infectious for as long as three months after onset of symptoms," the WHO said in a statement.

    "Because of the potential to transmit the virus sexually during this time, they should maintain good personal hygiene after masturbation, and either abstain from sex (including oral sex) for three months after onset of symptoms, or use condoms if abstinence is not possible."

    Almost 16,000 people are known to have been infected with Ebola in the current outbreak and 5,689 of them have died. The virus causes haemorrhagic fever, and there is as yet no cure or vaccine.

    Almost all the cases and all but 15 deaths have been in Guinea, Sierra Leone and Liberia - the three hardest-hit countries, which reported 600 new cases in the past week, the WHO said in its latest update.

  • Exercise may prevent excess weight gain during pregnancy

    By Shereen Lehman

    (Reuters Health) - Moderate exercise is encouraged during pregnancy for plenty of reasons, but it may also help women avoid gaining too much weight, say UK researchers.

    They reviewed studies since the 1990s looking at whether exercise alone helps prevent excess weight gain during pregnancy, and found that it does, or helps with weight loss after delivery, and found that it doesn't.

    They also found a total of only five solid studies on those questions.

    "There isn't enough research being conducted regarding the effects of exercise on gestational weight gain or postpartum weight loss," said Dr. Kirsty Elliot-Sale of the Sport, Health and Performance Enhancement Research Group at Nottingham Trent University, who led the review.

    "Of those few good - as defined by appropriate research design - studies, exercise seems to be an effective tool during pregnancy to limit excessive gestational weight gain but so far exercise (walking) has not been shown to be effective for postpartum weight loss," Elliot-Sale told Reuters Health by email.

    The U.S. Institute of Medicine advises women who are normal weight before they get pregnant to gain 25 to 35 pounds during their pregnancy. Women who are overweight should gain from 15 to 25 pounds, and obese women should gain from 11 to 20 pounds, according to IOM guidelines.

    Elliot-Sale said that weight gain exceeding the appropriate amount has implications for both mothers and infants. It also contributes to postpartum weight retention and ultimately, if unchecked, a higher risk of obesity.

    Elliot-Sale added that it's an area of research that urgently needs to be discussed and addressed.

    "Women should be supported and guided during this potentially overwhelming time and losing pregnancy-related weight should be made easier and not overtake this special time," she said.

    Elliot-Sale and colleagues reviewed the results of three research studies that compared exercise programs to regular care, or to other types of interventions during pregnancy, and two studies done during the year following pregnancy.

    The researchers found that, on average, women who exercised during their pregnancies gained about five pounds less than their counterparts who didn't exercise.

    There were no differences in weight loss after pregnancy between women who exercised and those who didn't, according to the results in the British Journal of Sports Medicine.

    Elliot-Sale said she still believes that exercise is the answer, which is why she's now conducting studies on weight loss after pregnancy.

    "Obviously, physical activity should be paired with good nutritional practices; however women should be cautioned not to overly restrict dietary energy intake whilst breastfeeding," Elliot-Sale said.

    "I love it and my niche happens to be women and heart disease and trying to get the OB/GYNs to take more of an active role in managing women's comprehensive health," said Dr. Mary Rosser.

    "I think the more we see in the literature studies like this, the more awareness it raises, not only on the patients' part, but I'm talking about the providers' part as well," said Rosser, an obstetrician/gynecologist at Montefiore Medical Center in New York.

    Rosser, who was not involved in the review, said the fact that only five studies were available highlights the need for more research.

    "I think that that's just more evidence that we need more randomized control trials to look at this issue, and it just increases our awareness," she said.

    Rosser said that excessive weight gain during pregnancy and weight retention between pregnancies is becoming more common. She added that doctors are seeing more women who are overweight before ever getting pregnant.

    Excessive weight gain could increase the risk of more complicated pregnancies, preeclampsia and gestational diabetes, she noted.

    "We also have now seen in the literature that women who have these problems during pregnancy are at up to five times greater risk of having cardiovascular disease in their lifetime," Rosser said.

    Rosser said that women who exercise before pregnancy are more likely to work out during pregnancy, but it's not too late to start an exercise program during pregnancy.

    "We have to educate women that it's okay to exercise during pregnancy," she said.

    Rosser advises women to talk to their obstetricians and ask about what kinds of activities are safe.

    "I am a fan of brisk walking, and if you have no other complications I think that's very helpful," she said. "And also psychologically it helps everyone to exercise."

    SOURCE: http://bmj.co/1yXEL1I British Journal of Sports Medicine, online November 18, 2014.