UT Health Science Center

7703 Floyd Curl Drive
San Antonio, TX 78229
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the UT Health Science Center Overview

The University of Texas Health Science Center at San Antonio serves San Antonio and the 50,000 square-mile area of South Texas. It trains more than 3,000 students every year in affiliated hospitals, clinics and healthcare facilities around the area. The center is accredited by the Commission on Colleges of the Southern Association of Colleges and Schools to award certificates, baccalaureate, master’s, doctoral and professional degrees.

Educational programs available at the Health Science Center range from medicine, dentistry and nursing to graduate  biomedical sciences and health professions such as clinical laboratory sciences, physical therapy and occupational therapy. The center’s School of Medicine is fully accredited by the Liaison Committee on Medical Education and is recognized as one of the best in the state and nation.

The Health Science Center is a respected and internationally recognized biomedical research university promoting the discovery, development and dissemination of biomedical solutions. Research conducted at the Health Science Center ranges from cancer therapy, longevity and aging studies, and pregnancy and newborn conditions to community-based health promotion in women and children, integration of medicine and science, and psychiatric genetic research.

The School of Medicine’s faculty practice is UT Medicine San Antonio which includes the Cancer Therapy & Research Center (CTRC), one of the elite cancer centers in the country to be designated as a National Cancer Institute Cancer Center.

Neuroscience Articles

  • Punishment can worsen bedwetting

    By Shereen Lehman

    (Reuters Health) - Punishing children for bedwetting won't solve the problem and may make it worse, researchers say.

    In a new study, children who were punished for wetting the bed at night were more likely to be depressed and had worse overall quality of life overall compared to bed-wetters who were not punished.

    Nighttime bedwetting, or "nocturnal enuresis," affects about 15 percent of young children and is three times more common in boys than girls, according to the authors. Up to a third of parents punish their kids for bedwetting, they add.

    While parents might think punishment will make bedwetting stop, they should know that punishment can actually make the problem worse, leading to more frequent bedwetting, more depression and a poorer quality of life for the child, the researchers wrote in the journal Child Abuse and Neglect.

    Dr. Faten Nabeel Al-Zaben of the Faculty of Medicine at King Abdulaziz University in Jeddah, Saudi Arabia, and a colleague studied 65 children ages seven to 13 years old who wet their beds, and 40 healthy children without a bedwetting problem as a comparison group.

    Next, the researchers divided the children with bedwetting problems into two groups, those who were punished for bedwetting and those who weren't.

    On average, children who were punished for bedwetting at night wet their beds more often than the children who weren't punished.

    The punished kids also showed symptoms of depression that were more severe than the other two groups of kids.

    The effect was worst when parents physically punished their kids, and the more often they punished their children, the more likely the children were to be depressed and have reduced quality of life scores.

    "Urinary incontinence affects both the child and the family on several levels. It is often a source of shame and embarrassment for the affected child, and children who have experienced treatment failure have a lower self-esteem," the authors write.

    Dr. Max Maizels, a pediatric urologist at the Ann and Robert H. Lurie Children's Hospital of Chicago who was not involved in the study, said that most healthcare workers would agree that punishment causes problems for kids.

    "Most instances of bedwetting, whether they run in the family or not, have to do with heavy sleep and a sluggish coordination between bladder signals that say 'take me to the bathroom' and a deep level of sleep that prevents the signals from reaching awareness," Maizels told Reuters Health in an email.

    He said that if that coordination is sluggish then the bladder empties without the child's permission, so anything that can be done to accentuate the child's awareness will help reduce bedwetting.

    "One common thing that can be done is called positive practice, where children lay in bed before they go to sleep and practice getting up and going to the bathroom," Maizels said.

    He added that reading children's books about bedwetting before bed also helps raise awareness.

    A change of scenery or temperature may help too.

    Maizels said that when families go on a vacation or to Grandma's house, they're startled when the bedwetting that happens with some regularity at home is reduced while they're away.

    "Cold seems to set up bedwetting. Some families have a child's bed adjacent to an exposed wall and by moving the bed away from the cold wall it seems to reduce wetting," Maizels said.

    Maizels also said that some dietary changes may help.

    "Keep things that may irritate the bladder away from the diet while the bedwetting is resolving like carbonated beverages, citrus, melons, caffeinated foods," he said.

    Maizels also explained that constipation can be a big factor in bedwetting when the over-full bowel puts pressure on the bladder.

    "Try laxatives, milk of magnesia or any of the common laxatives, prune juice, or apple juice works to help with evacuating," Maizels said.

    SOURCE: http://bit.ly/1w2kaFR Child Abuse and Neglect, online November 27, 2014.

  • Complex jobs might help maintain brain fitness in aging

    By Janice Neumann

    (Reuters Health) - Regardless of IQ, people who work at complex jobs have a slightly higher chance of being better thinkers as they age, a recent study suggests.

    "When we look at the association between complexity of work with people or data, we see that those in more complex jobs generally do better on a range of cognitive ability measures," said Alan Gow, one of the study authors.

    "That's not necessarily surprising . . . but we were able to add an interesting twist," said Gow, an assistant professor of psychology at the School of Life Sciences at Heriot-Watt University in Edinburgh, Scotland.

    The researchers knew from earlier work that complex jobs might help protect cognitive ability later in life. So they added the childhood IQs of 1,066 people in Scotland from a 1936 study to their analysis.

    They also grouped the people from that study according to profession - for example, architect, engineer and lawyer (higher thinking jobs) or typist and salesperson (requiring less complicated thinking).

    The study participants, all age 70 during the new analysis, took cognitive tests that determined general thinking ability, speed and memory. Their educational and criminal backgrounds and access to services were also factored in.

    By including data on IQ from the participants when they were 11 years old, "the association between more complex jobs and better cognitive outcomes is reduced, but there remains a small additional benefit for our cognitive abilities from being in more complex jobs," Gow told Reuters Health in an email.

    Childhood IQ explained about half of the difference in later thinking ability in the participants. And complex jobs were responsible for about 1 to 2 percent of the cognitive differences betweeen people later in life, according to the results in the journal Neurology.

    The researchers said the cognitive benefit of a complex job was similar to the benefits of not smoking on later cognition.

    "It's been proposed, for example, that more complex work with people and data might require the deployment of various cognitive abilities; this may develop these skills, or at least protect them from decline, and people are exploring what those suggested mechanisms might actually look like in terms of changes in the brain," Gow said.

    He's been looking at a variety of lifestyle factors that might predict cognitive ability in older people, including leisure and physical activity and social networks and support.

    "The reason I focus on factors like these is that many, though not all, of course, are amenable to change. If we can identify the things that protect or harm our cognitive abilities, we will be able to provide clear information or design better interventions," Gow said.

    "I think the opportunity to use our thinking and reasoning skills and continually use them throughout our lives likely contributes to our ability to stay sharp," said Sian Beilock, a psychology professor at the University of Chicago.

    "So being able to do complex thinking and reasoning in our profession is one way to continually flex our cognitive horsepower or brain power," said Beilock, who was not involved in the study.

    Other ways to ward off cognitive decline include exercise, and remembering our strengths, rather than dwelling on what we're forgetting, he said.

    "Doing things to get rid of those worries, whether reminding yourself you have lots of experience or jotting down things (like worries) in notes . . . can help ensure you can use all the brain power at your disposal," Beilock said.

    SOURCE: http://bit.ly/1GpNbBn Neurology, online December 9, 2014.

  • Animal research at NIH lab challenged by members of Congress

    By Bridgett Novak

    (Reuters Health) - Animal research practices at a National Institutes of Health (NIH) facility in Poolesville, Maryland are being challenged by four members of Congress, who have asked the NIH director to commission a bioethical review of experiments being conducted on monkeys at the lab.

    For the past 30 years, the Laboratory of Comparative Ethology, which is run by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), has conducted maternal deprivation experiments on hundreds of infant macaques that are bred to carry different versions of genes known to be risk factors for mental illnesses in humans.

    Starting soon after birth, the baby monkeys are reportedly subjected to fear, stress, and pain-inducing tests; half are separated from their mothers to assess the effects of maternal deprivation.

    In a December 22 letter to NIH Director Francis Collins, the representatives - Lucille Roybal-Allard (D-CA), Dina Titus (D-NV), Sam Farr (D-CA) and Eliot Engel (D-NY) - point out that "prominent experts . . . have raised questions about the scientific and ethical justification of these particular experiments."

    "To date," they write, "NIH's various responses to members of the public and Members of Congress about this subject have not adequately addressed these concerns. In view of this, we are requesting that your office commission a Bioethics Consultation of these experiments . . . and provide us with a Consultation Report by February 27, 2015."

    According to the letter from the Congressional representatives, the maternal deprivation research at the Poolesville facility has "been going on since 1983, receives millions of taxpayer dollars each year and is currently approved to continue through 2017."

    A spokesperson for Rep. Farr told Reuters Health by email that reports in the news about painful experiments on the baby monkeys "are troubling" and Rep. Farr and the other representatives "are asking for the report so they have a full understanding of exactly what experiments are being performed."

    An NIH spokesperson confirmed that the agency had received the letter and was preparing a response.

    A spokesperson for Dr. Stephen Suomi, Chief of the Laboratory of Comparative Ethology, wrote in an email to Reuters Health, "The NIH is preparing a response and Dr. Suomi has been in touch with Dr. Collins' office. Dr. Suomi hopes you will understand, however, that it would not be appropriate for him to comment outside of NIH's response to the original Congressional inquiry."

    Dr. Alka Chandna, senior laboratory oversight specialist for People for the Ethical Treatment of Animals (PETA), told Reuters Health there have been no publicly-documented developments in the treatment of human mental illness resulting from these NIH studies.

    Meanwhile, he added, "sophisticated human-based methodologies, such as functional magnetic resonance imaging (fMRI), have yielded important insights into human mental illness and are paving the path forward."

    "Given the harm caused to animals, the experiments' limited relevance to humans, the substantial financial cost, and the existence of superior non-animal research methods, the continued use of animals in this work is scientifically and ethically unjustifiable," Chandna told Reuters in an email.

    PETA is calling on the NIH to end these specific experiments immediately.

    "In light of the tremendous physical and psychological harm done to primates used in these NIH experiments and the absence of any gains made as a result, it would seem to be amply clear that these experiments simply cannot be justified," Chandna said.

    NIH is currently supporting a phase-out of research using great apes, such as chimpanzees, following a 2011 report from the Institute of Medicine (IOM) that called most biomedical research on chimps unnecessary. The IOM recommended that chimps only be used for research in cases when there are no other alternatives, it would be unethical to conduct the study using humans, public health is at stake and the animals are kept in physical and social environments similar to their natural habitats.

    The congressional letter comes on the heels of a December 11 report by the U.S. Department of Agriculture on animal research nationwide (available online here: http://1.usa.gov/1zirOhJ).

    While the data show a 10 percent decline in the overall number of USDA-regulated animals confined to and experimented on in labs between 2008 and 2013 (from 1.15 to 1.03 million), the number of animals used in painful experiments without any analgesia over the same time period rose by 12 percent (from 76,400 to 85,300).

    The USDA's data tracks just the legally-protected animals - i.e., monkeys, hamsters, sheep, ferrets, cats and dogs - and not the mice, rats, and cold-blooded animals that constitute the majority of the animals used in laboratories.

    The Animal Welfare Act, which is administered by the USDA, stops short of requiring analgesia for pain in laboratory animals. It advises experimenters to minimize the pain and distress experienced by animals by means of appropriate use of sedatives, analgesics or anesthetics - but it also gives researchers leeway to withhold such agents when "scientifically justified."

  • Argentine prosthetic arm 1st in region to read muscle impulses

    By Reuters Staff

    SANTA FE, Argentina (Reuters) - A laboratory in the Argentine farm province of Santa Fe has developed what it calls the first prosthetic arm in Latin America to use sensors to respond to nerve impulses at a price that could radically expand the use of such devices.

    The bionic skeleton of the prosthetic has a flexible claw-like hand consisting of a thumb, index and middle finger. It is covered with a lifelike glove that can sport rings, bracelets, nail polish, anything to lend a normal look while allowing wearers to perform such tasks as writing and washing dishes.

    "It detects electrical signals that are generated by the muscles at the point of contact between the arm and the prosthetic," said engineer Sebastian Vicario, who is working on the project for Bioparx Health Technology, based in provincial capital Santa Fe.

    "The impulse is sent to a micro-controller that relays the signal to a motor that moves the hand," Vicario added.

    He said the price of the prosthetic, scheduled to hit the market next year, will be about $22,000, versus the average $47,000 fetched by similar devices already on the market. Bioparx hopes the relatively low cost will induce insurance companies to include the device in their coverage plans.

    After years using a clunky mechanical prosthetic that allowed little dexterity, 53-year-old Stella Azambullo, who lost her right arm in an industrial accident, has been testing the device over the last two years.

    "It's nice to be able to do things that I have not been able to, mainly stuff around the house," she told Reuters. "I can finally move freely. Not 100 percent, but mostly."

  • L.A. judge orders halt to smartphone app for medical pot delivery

    By Alex Dobuzinskis

    LOS ANGELES (Reuters) - A judge in Los Angeles ordered a smartphone application company on Tuesday to stop arranging the delivery of medical marijuana to customers in the city in violation of a ban on such businesses, prosecutors said.

    Los Angeles City Attorney Mike Feuer's office filed a lawsuit on December 2 seeking a preliminary injunction against the Nestdrop app in the latest salvo in an ongoing tug-of-war over medical cannabis in America's second-largest city.

    About 130 medical marijuana shops have been granted immunity under a ballot measure approved by voters in 2013 that meanwhile outlawed the operation of hundreds of other similar businesses.

    The lawsuit filed in Los Angeles Superior Court marked the first time that local authorities have targeted a medical marijuana delivery app, a service that prosecutors argue is prohibited under the 2013 measure.

    On Tuesday, Los Angeles Superior Court Judge Robert O'Brien granted the city's request for a preliminary injunction blocking the use of Nestdrop to arrange for medical marijuana deliveries in Los Angeles, and ordered it to remove any reference to such deliveries from the app, Feuer's office said in a statement.

    Feuer's office estimates that since the prosecutor took office last year he has closed more than 400 medical marijuana dispensaries, which represents half the number of such businesses officials believe to be operating in Los Angles.

    He also forced the closure of a popular farmers' market for medical marijuana.

    Nestdrop co-founder Michael Pycher in a statement criticized the move to stop medical marijuana from being brought to the Los Angeles homes of the app's users, deliveries that he said are handled by "qualified partners" and not the company itself.

    "Patients use Nestdrop in order to have their medicine delivered, often because they are either too sick from their symptoms or unwilling to inconvenience a friend or loved one that would need to go to the collective (marijuana dispensary) on their behalf," he said.

    Pycher said his firm will continue to serve areas outside Los Angeles city limits.

    A map of its coverage area on its website shows Nestdrop serves Los Angeles and surrounding communities, but the company did not appear to serve areas outside Southern California.

    Feuer's office is seeking civil penalties against the company for what prosecutors say are violations of the voter-approved measure restricting medical marijuana in the city, and for unfair businesses practices.

Oncology Articles

  • Self-exam and doctor's-exam find similar breast tumors

    By Kathryn Doyle

    (Reuters Health) - Women's self-exams and physical exams by a doctor both detect breast cancer tumors at about the same size, but older women are more likely to have a tumor discovered via doctor's examination, according to a new Swiss study.

    The authors, led by Fabienne Dominique Schwab of University Hospital Basel, conclude that breast exams by doctors should be an integral part of general medical care for older women.

    "What they essentially said was there wasn't a whole lot of difference in these two modes of detection except that older women were more likely to have their cancers detected by clinical exam," said Dr. Robert Smith, an epidemiologist at the American Cancer Society in Atlanta, Georgia who was not involved in the new study.

    The authors considered tumor size, location and detection method for 948 women treated in Switzerland between 1990 and 2009.

    In 236 women, doctors found the tumors during an exam, while 712 women had discovered their own tumors.

    Women who found their own tumors had an average age of 60, compared to an average age of nearly 66 for women whose tumors were found through clinical breast exam. Both methods found the same number of tumors in the same locations and of similar size, averaging 22 millimeters (about 9/10ths of an inch), the authors write.

    Tumors in the central region of the breast tended to be larger - an average of 25 mm versus about 19-21 mm for those at the periphery - the authors reported in the journal The Breast.

    Doctors and women who perform regular self-examinations should pay particular attention to the central region, the authors advise.

    Older women may be more likely to overlook or neglect breast lumps, and less likely to go for mammograms, so doctors tend to discover more tumors of their tumors, the study team writes.

    The American Cancer Society (ACS) recommends a clinical breast examination, which includes palpation by a health professional, about once every three years between ages 20 and 40, and yearly for older women.

    Some women do self-exams once a month, but choosing not to do them regularly or at all is okay, according to the ACS.

    "It is encouraging and perhaps to be celebrated that women are detecting similar rates of cancers and this should arm women with confidence that they are performing this task well," said Victoria Harmer, Team Leader and Clinical Nurse Specialist in the breast care unit at Imperial College Healthcare NHS Trust in London.

    "The risk of breast cancer increases with a woman's age, so it is vital older women continue to be breast aware," said Harmer, who was not involved in the new study.

    Anthony B. Miller of the Dalla Lana School of Public Health at the University of Toronto has studied breast cancer detection in a large group of women in an ongoing study begun in 1980.

    "Although in the (Canadian National Breast Screening Study) we learnt that women who practice (self-exam) well had a reduced rate of death from breast cancer, what we tend to promote now is what people call breast self-awareness," Miller told Reuters Health by email. "By this we mean that women should be aware of the structure of their own breasts and should be alert to any change, which if it occurs, should lead them to seek professional advice."

    Especially for young women, self-exam tends to create many false alarms, he said.

    Some some women can have "lumpy" breasts, Miller said, adding that "very few lumps turn out to be breast cancer."

    The ACS recommends annual mammograms starting at age 40. But the U.S. Preventive Services Task Force, a government-backed panel that weighs current medical evidence, recommends mammograms every two years starting at age 50 for women without special risk factors (see Reuters Health article of April 1, 2014 here: http://reut.rs/1CxdWUf).

    It is questionable whether clinical breast exams add anything on top of the mammograms, Smith said.

    Clinical breast exam quality in the U.S. is low, he noted. "In the U.S. it is quite cursory, it doesn't take very long," Smith said. "The physician usually has not had much training in clinical breast examination."

    In the big picture, mammograms are going to account for more breast cancer discoveries than clinical exam, and the new results do not change existing ACS recommendations, he said.

    SOURCE: http://bit.ly/1sstTVB The Breast, online December 5, 2014.

  • Online mammography information may be too technical

    By Roxanne Nelson

    (Reuters) - The Web is a popular source of health information, but online educational material about mammograms may be too complicated for many Americans, according to a new study.

    Researchers looked at dozens of websites about the breast x-rays and found the patient-education articles and background information on all of them were written well above the average reading level.

    "Unfortunately, the average American adult reads only at a seventh-eighth grade level," write the authors, led by Dr. Rend Al-Khalili of the radiology department at the University of Medicine and Dentistry of New Jersey.

    Many women are already confused by recent changes in guidelines for how often they should get mammograms, especially women in their 40s, Al-Khalili and her colleagues point out in the journal Academic Radiology.

    That confusion is likely to lead women to look online for information, so healthcare professionals should make sure the materials they post are clear and easy to understand, the authors say.

    The U.S. Department of Health and Human Services recommends that websites for patients be written below the sixth-grade reading level to target the average American adult.

    The new study is not the first, however, to find problems with medical information online. Similar results were found in recent studies of information about self-injury, giving birth after cesarean section and colon cancer screening (see Reuters Health article of March 27, 2014 here: http://reut.rs/1tdgk2y).

    In that research, the problems ranged from scarcity of information on a particular topic, to inaccuracy and text written at a reading level that was too high.

    Dr. Al-Khalili and her colleagues reviewed a total of 42 mammography-related websites using several standard reading-level measurement tools.

    They divided the sites into four categories based on their sources: 17 sites were from U.S. hospitals and universities, nine from professional medical societies, five from doctors' practices and 11 from miscellaneous healthcare-associated websites related to mammography for breast cancer screening.

    The material from all four website categories was written at more than a ninth-grade reading level, with about 80 percent of them written at the 10th-grade level or higher.

    By a "readability" measure the U.S. government uses, most of the materials would be "very difficult" for most 10th graders, and the rest would be of "average" difficulty, but still above 6th grade level.

    The study authors urge doctors to help patients understand the material they read online.

    They also point out that patients may have difficulty understanding information during discussions with their doctor as well. So it's important, they write, for doctors to avoid medical jargon when speaking to patients.

    "It's often assumed that only limited segments of the public have challenges with literacy and with understanding health information," said Felicia Hill-Briggs, senior director of Population Health Research and Development at Johns Hopkins HealthCare in Baltimore, Maryland.

    "Developers of internet-based patient education may think that internet users are not part of that segment of the population," said Hill-Briggs, who was not involved in the new study.

    The vast majority of adults in the U.S. have some trouble understanding or using health information, she noted. "For that reason, no matter who the target audience is for health information, it is important to present that information using plain, easy to understand, language."

    Hill-Briggs added, "Many people in healthcare and in public health are unaware of the current recommendations for readability of patient education materials."

    It's difficult for most people, including people working in medicine and health care professions, to take complex information or terminology, and find ways to describe them in clear, simple terms, she said.

    "It's very important for developers of patient education to utilize proven techniques and resources to do this work," she said. "Ultimately, the public cannot benefit from the education they cannot understand, process or easily put to use."

    SOURCE: http://bit.ly/1B6bOl2 Academic Radiology, online December 5, 2014.

  • Putin orders vodka price cap as Russia's economic crisis escalates

    By Reuters Staff

    MOSCOW (Reuters) - Russian President Vladimir Putin ordered his government on Wednesday to rein in rising vodka prices, as he battles to preserve his popularity amid an aggravating economic crisis.

    Putin told a meeting with government officials and regional governors that expensive vodka prices encourage the production of bootleg spirits, which carry greater risks to people's health than legally produced alcohol.

    Russia is facing its worst economic crisis since 1998, when the country devalued the ruble and defaulted on its debt. Putin's popularity is partly based on his reputation for providing prosperity and stability.

    "The overshoot of vodka prices leads only to increasing consumption of bootleg (spirits)," said Putin, who is known for promoting a healthy lifestyle. "I think the relevant structures (government bodies) should think of that," he added.

    According to a study by leading international universities last year, a quarter of all Russian men die before they reach their mid-fifties, and their love of alcohol - particularly vodka - is partly to blame.

    The government-regulated minimum retail price of half a liter of vodka has been increased by around 30 percent since last year to 220 rubles ($4).

    Russia has been tightening regulations for producers of vodka and beer, such as Russia's Synergy, Poland's CEDC and Danish brewer Carlsberg.

    Russia's economy is expected to slide into recession in 2015 due to falling oil prices and Western sanction over the Ukraine crisis. Annual inflation, meanwhile, is expected to exceed 10 percent this year.

  • L.A. judge orders halt to smartphone app for medical pot delivery

    By Alex Dobuzinskis

    LOS ANGELES (Reuters) - A judge in Los Angeles ordered a smartphone application company on Tuesday to stop arranging the delivery of medical marijuana to customers in the city in violation of a ban on such businesses, prosecutors said.

    Los Angeles City Attorney Mike Feuer's office filed a lawsuit on December 2 seeking a preliminary injunction against the Nestdrop app in the latest salvo in an ongoing tug-of-war over medical cannabis in America's second-largest city.

    About 130 medical marijuana shops have been granted immunity under a ballot measure approved by voters in 2013 that meanwhile outlawed the operation of hundreds of other similar businesses.

    The lawsuit filed in Los Angeles Superior Court marked the first time that local authorities have targeted a medical marijuana delivery app, a service that prosecutors argue is prohibited under the 2013 measure.

    On Tuesday, Los Angeles Superior Court Judge Robert O'Brien granted the city's request for a preliminary injunction blocking the use of Nestdrop to arrange for medical marijuana deliveries in Los Angeles, and ordered it to remove any reference to such deliveries from the app, Feuer's office said in a statement.

    Feuer's office estimates that since the prosecutor took office last year he has closed more than 400 medical marijuana dispensaries, which represents half the number of such businesses officials believe to be operating in Los Angles.

    He also forced the closure of a popular farmers' market for medical marijuana.

    Nestdrop co-founder Michael Pycher in a statement criticized the move to stop medical marijuana from being brought to the Los Angeles homes of the app's users, deliveries that he said are handled by "qualified partners" and not the company itself.

    "Patients use Nestdrop in order to have their medicine delivered, often because they are either too sick from their symptoms or unwilling to inconvenience a friend or loved one that would need to go to the collective (marijuana dispensary) on their behalf," he said.

    Pycher said his firm will continue to serve areas outside Los Angeles city limits.

    A map of its coverage area on its website shows Nestdrop serves Los Angeles and surrounding communities, but the company did not appear to serve areas outside Southern California.

    Feuer's office is seeking civil penalties against the company for what prosecutors say are violations of the voter-approved measure restricting medical marijuana in the city, and for unfair businesses practices.

  • Hepatitis patients often 'fall off' the treatment path

    By Andrew M. Seaman

    (Reuters Health) - Many people with hepatitis C end up not receiving adequate treatment, because they lose their way through the medical system during the early stages of their care, researchers say.

    In Philadelphia, only about 2 percent of patients thought to be infected with the hepatitis C virus end up receiving treatment, health department officials there estimated.

    "It's a serious problem," said the study's lead author Kendra Viner. "There are actions that need to be taken at every level to move people through the continuum."

    Viner is the coordinator for the Hepatitis C Surveillance Program at the Philadelphia Department of Public Health.

    At least one percent of Americans are chronically infected with the hepatitis C virus, according to the Centers for Disease Control and Prevention (CDC) (see Reuters Health story of March 7, 2014 here: http://reut.rs/1wi7pao.)

    Hepatitis C infects the liver and is typically transmitted by exposure to infected blood. If left untreated, it can lead to liver damage, liver failure and cancer, according to the CDC. Hepatitis C is one of the major reasons why people get liver transplants.

    By pairing data from Philadelphia's comprehensive hepatitis C monitoring program with national data, the researchers estimated that roughly 47,000 individuals - or about 3 percent of Philadelphia's 1.6 million residents - are infected with hepatitis C.

    While the city - like most - requires that hepatitis C cases be reported to the health department, it only received positive test results from 13,596. Of those, only about half went on to have their infection confirmed with another test.

    Of those who received the confirmation test, less than a third were in care, but only about 15 percent - less than 1,000 people - were receiving treatment.

    "It just gets more and more sparse," Viner said.

    Her team's results, first released online in the journal Hepatology in late October, will be published in an upcoming print issue of the journal.

    Viner said there are ways to increase the number of people receiving care, including doctors testing the right people for the virus.

    The government-backed U.S. Preventive Services Task Force recommends that adults at increased risk for infection, such as injection drug users, should be tested. Also, adults born between 1945 and 1965 should be tested once.

    Also, Viner said, doctors should order a specific test that only requires one blood sample to do both the initial and confirmation testing.

    "Then it's also improving surveillance across the board of this disease," she said.

    New drugs, which are much more effective at knocking out the virus without severe side effects, may also help in the long run, Viner said.

    "I think the treatments are fantastic," she said. "As long as we get people to that stage in the cascade, the outlook is very good."

    Past research suggests that advances in treatment and increased screening may reduce the burden of hepatitis C from about one in 100 Americans to about one in 1,500 by 2036 (see Reuters Health story of August 4, 2014 here: http://reut.rs/1widwv6.)

    Viner said Philadelphia is currently using this data to look at the burden of the virus in specific area within the city.

    "We can use that to work with our prevention team here to coordinate education efforts and additional screening campaigns," she said.

    SOURCE: http://bit.ly/1sV2M5L Hepatology, online October 28, 2014.

Orthopedic Articles

  • In overweight kids, some exercises can strain feet

    By Roxanne Nelson

    (Reuters Health) - In overweight children, exercise can put pressure on their developing feet, say Australian researchers.

    They point out that overweight children are at risk for foot pain and discomfort because they tend to have fatter and flatter feet, which can lead to increased pressure on the arched portion of the sole.

    That, in turn, could stop kids from participating in physical activity, they warn in a recent paper.

    "Physical activity is certainly crucial to health and well-being, and halting weight gain is important," said Diane L Riddiford-Harland of the University of Wollongong, who led a study of the effect of exercise on overweight kids' feet.

    Since these children might be uncomfortable while exercising, alternate forms of activity are probably necessary, she explained.

    "Non-weight bearing physical activity such as swimming or cycling may be a good option," Riddiford-Harland told Reuters Health in an email. "There are all types of aquatic movement activities and cycling-type activities children can participate in, but going to the pool/beach or on a bike ride with an adult can be enjoyable and are usually quite affordable."

    She and her coauthors had found in a previous study that overweight kids had higher "plantar pressures" on the middle and fore-foot areas of the sole while walking than normal-weight kids.

    They also linked the higher pressures and a flattening of the arches to a likelihood the kids would be less physically active.

    In the new study, they divided a group of children who were already participating in a obesity treatment trial into three groups. One group focused on getting the children to be more physically active. A second group emphasized activity plus a parent-centered diet-modification program. The third group did not involve physical activity, only the dietary modification.

    Thirty-four kids participated. They were five to nine years old and generally healthy, except for being their obesity.

    After six months, all the children had grown in height and lost some weight.

    All the children's feet also grew in length and arch height, representing normal growth, but none of the other proportions of their feet had changed.

    The lack of structural differences between the kids who exercised and those who didn't was surprising to the researchers. But, they say, the measurement at six months may have taken place too long after the 10-week weight-loss trial ended to detect changes caused by exercise.

    "As the musculoskeletal system is still developing in young children, carrying excessive body mass will likely lead to long term health complications as they continue to age," Riddiford-Harland said.

    "We still need to systematically determine just what causes the pain or discomfort that has been reported by these children, how prevalent it is, what makes it worse and does anything make it better, because being physically active and remaining physically active throughout life is imperative for good health," she added.

    Podiatrist Alan MacGill, a fellow of the American College of Foot and Ankle Surgeons who wasn't involved in the study, pointed out that supportive shoes and orthotics would help children with flat feet.

    "The devices can help control excessive motion in the foot," he said. "The shoe should be the correct size for the child and not too flimsy from toe to heel."

    SOURCE: http://bit.ly/1x35nSc Journal of Science and Medicine in Sport, online November 13, 2014.

  • In overweight kids, some exercises can strain feet

    By Roxanne Nelson

    (Reuters Health) - In overweight children, exercise can put pressure on their developing feet, say Australian researchers.

    They point out that overweight children are at risk for foot pain and discomfort because they tend to have fatter and flatter feet, which can lead to increased pressure on the arched portion of the sole.

    That, in turn, could stop kids from participating in physical activity, they warn in a recent paper.

    "Physical activity is certainly crucial to health and well-being, and halting weight gain is important," said Diane L Riddiford-Harland of the University of Wollongong, who led a study of the effect of exercise on overweight kids' feet.

    Since these children might be uncomfortable while exercising, alternate forms of activity are probably necessary, she explained.

    "Non-weight bearing physical activity such as swimming or cycling may be a good option," Riddiford-Harland told Reuters Health in an email. "There are all types of aquatic movement activities and cycling-type activities children can participate in, but going to the pool/beach or on a bike ride with an adult can be enjoyable and are usually quite affordable."

    She and her coauthors had found in a previous study that overweight kids had higher "plantar pressures" on the middle and fore-foot areas of the sole while walking than normal-weight kids.

    They also linked the higher pressures and a flattening of the arches to a likelihood the kids would be less physically active.

    In the new study, they divided a group of children who were already participating in a obesity treatment trial into three groups. One group focused on getting the children to be more physically active. A second group emphasized activity plus a parent-centered diet-modification program. The third group did not involve physical activity, only the dietary modification.

    Thirty-four kids participated. They were five to nine years old and generally healthy, except for being their obesity.

    After six months, all the children had grown in height and lost some weight.

    All the children's feet also grew in length and arch height, representing normal growth, but none of the other proportions of their feet had changed.

    The lack of structural differences between the kids who exercised and those who didn't was surprising to the researchers. But, they say, the measurement at six months may have taken place too long after the 10-week weight-loss trial ended to detect changes caused by exercise.

    "As the musculoskeletal system is still developing in young children, carrying excessive body mass will likely lead to long term health complications as they continue to age," Riddiford-Harland said.

    "We still need to systematically determine just what causes the pain or discomfort that has been reported by these children, how prevalent it is, what makes it worse and does anything make it better, because being physically active and remaining physically active throughout life is imperative for good health," she added.

    Podiatrist Alan MacGill, a fellow of the American College of Foot and Ankle Surgeons who wasn't involved in the study, pointed out that supportive shoes and orthotics would help children with flat feet.

    "The devices can help control excessive motion in the foot," he said. "The shoe should be the correct size for the child and not too flimsy from toe to heel."

    SOURCE: http://bit.ly/1x35nSc Journal of Science and Medicine in Sport, online November 13, 2014.

  • In overweight kids, some exercises can strain feet

    By Roxanne Nelson

    (Reuters Health) - In overweight children, exercise can put pressure on their developing feet, say Australian researchers.

    They point out that overweight children are at risk for foot pain and discomfort because they tend to have fatter and flatter feet, which can lead to increased pressure on the arched portion of the sole.

    That, in turn, could stop kids from participating in physical activity, they warn in a recent paper.

    "Physical activity is certainly crucial to health and well-being, and halting weight gain is important," said Diane L Riddiford-Harland of the University of Wollongong, who led a study of the effect of exercise on overweight kids' feet.

    Since these children might be uncomfortable while exercising, alternate forms of activity are probably necessary, she explained.

    "Non-weight bearing physical activity such as swimming or cycling may be a good option," Riddiford-Harland told Reuters Health in an email. "There are all types of aquatic movement activities and cycling-type activities children can participate in, but going to the pool/beach or on a bike ride with an adult can be enjoyable and are usually quite affordable."

    She and her coauthors had found in a previous study that overweight kids had higher "plantar pressures" on the middle and fore-foot areas of the sole while walking than normal-weight kids.

    They also linked the higher pressures and a flattening of the arches to a likelihood the kids would be less physically active.

    In the new study, they divided a group of children who were already participating in a obesity treatment trial into three groups. One group focused on getting the children to be more physically active. A second group emphasized activity plus a parent-centered diet-modification program. The third group did not involve physical activity, only the dietary modification.

    Thirty-four kids participated. They were five to nine years old and generally healthy, except for being their obesity.

    After six months, all the children had grown in height and lost some weight.

    All the children's feet also grew in length and arch height, representing normal growth, but none of the other proportions of their feet had changed.

    The lack of structural differences between the kids who exercised and those who didn't was surprising to the researchers. But, they say, the measurement at six months may have taken place too long after the 10-week weight-loss trial ended to detect changes caused by exercise.

    "As the musculoskeletal system is still developing in young children, carrying excessive body mass will likely lead to long term health complications as they continue to age," Riddiford-Harland said.

    "We still need to systematically determine just what causes the pain or discomfort that has been reported by these children, how prevalent it is, what makes it worse and does anything make it better, because being physically active and remaining physically active throughout life is imperative for good health," she added.

    Podiatrist Alan MacGill, a fellow of the American College of Foot and Ankle Surgeons who wasn't involved in the study, pointed out that supportive shoes and orthotics would help children with flat feet.

    "The devices can help control excessive motion in the foot," he said. "The shoe should be the correct size for the child and not too flimsy from toe to heel."

    SOURCE: http://bit.ly/1x35nSc Journal of Science and Medicine in Sport, online November 13, 2014.

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Women’s Health Articles

  • Self-exam and doctor's-exam find similar breast tumors

    By Kathryn Doyle

    (Reuters Health) - Women's self-exams and physical exams by a doctor both detect breast cancer tumors at about the same size, but older women are more likely to have a tumor discovered via doctor's examination, according to a new Swiss study.

    The authors, led by Fabienne Dominique Schwab of University Hospital Basel, conclude that breast exams by doctors should be an integral part of general medical care for older women.

    "What they essentially said was there wasn't a whole lot of difference in these two modes of detection except that older women were more likely to have their cancers detected by clinical exam," said Dr. Robert Smith, an epidemiologist at the American Cancer Society in Atlanta, Georgia who was not involved in the new study.

    The authors considered tumor size, location and detection method for 948 women treated in Switzerland between 1990 and 2009.

    In 236 women, doctors found the tumors during an exam, while 712 women had discovered their own tumors.

    Women who found their own tumors had an average age of 60, compared to an average age of nearly 66 for women whose tumors were found through clinical breast exam. Both methods found the same number of tumors in the same locations and of similar size, averaging 22 millimeters (about 9/10ths of an inch), the authors write.

    Tumors in the central region of the breast tended to be larger - an average of 25 mm versus about 19-21 mm for those at the periphery - the authors reported in the journal The Breast.

    Doctors and women who perform regular self-examinations should pay particular attention to the central region, the authors advise.

    Older women may be more likely to overlook or neglect breast lumps, and less likely to go for mammograms, so doctors tend to discover more tumors of their tumors, the study team writes.

    The American Cancer Society (ACS) recommends a clinical breast examination, which includes palpation by a health professional, about once every three years between ages 20 and 40, and yearly for older women.

    Some women do self-exams once a month, but choosing not to do them regularly or at all is okay, according to the ACS.

    "It is encouraging and perhaps to be celebrated that women are detecting similar rates of cancers and this should arm women with confidence that they are performing this task well," said Victoria Harmer, Team Leader and Clinical Nurse Specialist in the breast care unit at Imperial College Healthcare NHS Trust in London.

    "The risk of breast cancer increases with a woman's age, so it is vital older women continue to be breast aware," said Harmer, who was not involved in the new study.

    Anthony B. Miller of the Dalla Lana School of Public Health at the University of Toronto has studied breast cancer detection in a large group of women in an ongoing study begun in 1980.

    "Although in the (Canadian National Breast Screening Study) we learnt that women who practice (self-exam) well had a reduced rate of death from breast cancer, what we tend to promote now is what people call breast self-awareness," Miller told Reuters Health by email. "By this we mean that women should be aware of the structure of their own breasts and should be alert to any change, which if it occurs, should lead them to seek professional advice."

    Especially for young women, self-exam tends to create many false alarms, he said.

    Some some women can have "lumpy" breasts, Miller said, adding that "very few lumps turn out to be breast cancer."

    The ACS recommends annual mammograms starting at age 40. But the U.S. Preventive Services Task Force, a government-backed panel that weighs current medical evidence, recommends mammograms every two years starting at age 50 for women without special risk factors (see Reuters Health article of April 1, 2014 here: http://reut.rs/1CxdWUf).

    It is questionable whether clinical breast exams add anything on top of the mammograms, Smith said.

    Clinical breast exam quality in the U.S. is low, he noted. "In the U.S. it is quite cursory, it doesn't take very long," Smith said. "The physician usually has not had much training in clinical breast examination."

    In the big picture, mammograms are going to account for more breast cancer discoveries than clinical exam, and the new results do not change existing ACS recommendations, he said.

    SOURCE: http://bit.ly/1sstTVB The Breast, online December 5, 2014.

  • Online mammography information may be too technical

    By Roxanne Nelson

    (Reuters) - The Web is a popular source of health information, but online educational material about mammograms may be too complicated for many Americans, according to a new study.

    Researchers looked at dozens of websites about the breast x-rays and found the patient-education articles and background information on all of them were written well above the average reading level.

    "Unfortunately, the average American adult reads only at a seventh-eighth grade level," write the authors, led by Dr. Rend Al-Khalili of the radiology department at the University of Medicine and Dentistry of New Jersey.

    Many women are already confused by recent changes in guidelines for how often they should get mammograms, especially women in their 40s, Al-Khalili and her colleagues point out in the journal Academic Radiology.

    That confusion is likely to lead women to look online for information, so healthcare professionals should make sure the materials they post are clear and easy to understand, the authors say.

    The U.S. Department of Health and Human Services recommends that websites for patients be written below the sixth-grade reading level to target the average American adult.

    The new study is not the first, however, to find problems with medical information online. Similar results were found in recent studies of information about self-injury, giving birth after cesarean section and colon cancer screening (see Reuters Health article of March 27, 2014 here: http://reut.rs/1tdgk2y).

    In that research, the problems ranged from scarcity of information on a particular topic, to inaccuracy and text written at a reading level that was too high.

    Dr. Al-Khalili and her colleagues reviewed a total of 42 mammography-related websites using several standard reading-level measurement tools.

    They divided the sites into four categories based on their sources: 17 sites were from U.S. hospitals and universities, nine from professional medical societies, five from doctors' practices and 11 from miscellaneous healthcare-associated websites related to mammography for breast cancer screening.

    The material from all four website categories was written at more than a ninth-grade reading level, with about 80 percent of them written at the 10th-grade level or higher.

    By a "readability" measure the U.S. government uses, most of the materials would be "very difficult" for most 10th graders, and the rest would be of "average" difficulty, but still above 6th grade level.

    The study authors urge doctors to help patients understand the material they read online.

    They also point out that patients may have difficulty understanding information during discussions with their doctor as well. So it's important, they write, for doctors to avoid medical jargon when speaking to patients.

    "It's often assumed that only limited segments of the public have challenges with literacy and with understanding health information," said Felicia Hill-Briggs, senior director of Population Health Research and Development at Johns Hopkins HealthCare in Baltimore, Maryland.

    "Developers of internet-based patient education may think that internet users are not part of that segment of the population," said Hill-Briggs, who was not involved in the new study.

    The vast majority of adults in the U.S. have some trouble understanding or using health information, she noted. "For that reason, no matter who the target audience is for health information, it is important to present that information using plain, easy to understand, language."

    Hill-Briggs added, "Many people in healthcare and in public health are unaware of the current recommendations for readability of patient education materials."

    It's difficult for most people, including people working in medicine and health care professions, to take complex information or terminology, and find ways to describe them in clear, simple terms, she said.

    "It's very important for developers of patient education to utilize proven techniques and resources to do this work," she said. "Ultimately, the public cannot benefit from the education they cannot understand, process or easily put to use."

    SOURCE: http://bit.ly/1B6bOl2 Academic Radiology, online December 5, 2014.

  • Mother's depression when kids are young linked to risky teen behaviors

    By Shereen Lehman

    (Reuters Health) - Having a depressed mother during elementary or middle school raises the likelihood a child will engage in risky behaviors like drinking and smoking during the teen years, according to a new Canadian study.

    Based on nearly 3,000 children followed since they were toddlers, the researchers also found that kids with depressed mothers in "middle childhood" were likely to start risky health behaviors earlier in their adolescence than other kids.

    "Although there is a fairly good body of evidence suggesting that maternal depression is associated with depression in the child, there is a lot less about how maternal depression might influence adolescent behavior," Ian Colman, the study's senior author, told Reuters Health in an email.

    "Given how prevalent maternal depression is, and that risky adolescent behaviors are associated with poor long-term outcomes in adulthood, we thought better evidence in this area could be really useful" said Colman, a researcher at the University of Ottowa in Ontario.

    Previous studies have suggested a link between a mother's depression during pregnancy or right after a baby is born to the teenager's mental health (see Reuters Health article of October 10, 2013 here: http://reut.rs/1zWKAiz).

    But not much is known about maternal depression and later adolescent behaviors, Colman's team writes in the journal Pediatrics.

    The study team analyzed data from the National Longitudinal Survey of Children and Youth, a large Canadian population study that began when the kids were ages two to five in 1994 and ended in 2009 when they were teenagers.

    .

    Every two years, the participating mothers answered questions about their own physical and mental health, and about the health of their kids and spouses or partners, their available social support and family functioning.

    Once the children reached the age of 10 or 11, they filled out their own questionnaires.

    When they reached adolescence, the young participants were asked about their engagement in risky behaviors such as drug and alcohol use, carrying a weapon or running away from home. A total of 2,910 teens completed the study,

    The researchers found that teens who had been exposed to maternal depressive symptoms during middle childhood were more likely to use alcohol, cigarettes or marijuana, and to engage in violent and nonviolent delinquent behavior.

    In addition, they were more likely to engage in these behaviors earlier than teens whose mothers had low or no symptoms of depression.

    The study team also found that teens exposed to recurrent maternal depression throughout their childhood engaged in more nonviolent risky behaviors compared to those whose mothers had low or no depression.

    In contrast, kids whose mothers' depression symptoms started when the child was already in the early teens did not engage in more risky behaviors than kids without any maternal depression exposure.

    The results don't prove that the mothers' symptoms when their children were young caused the children's behavior in adolescence.

    But, the authors write, middle childhood is a period of increasing cognitive, social and emotional development. Kids in this age group begin school, refine their language skills and increasingly engage in social peer relationships. Being exposed to a mother's depressive symptoms and negative parenting behaviors may harm the child's own development during this sensitive time and lead to "lasting deficits," they speculate.

    Colman said that asking for help can be hard, but even just talking about how she is feeling can sometimes be a really helpful start on the road to recovery for a mother experiencing depression.

    Colman thinks it's great that there seems to be a growing focus on maternal health, but added, "let's not forget that what is good for mothers is often good for their kids as well."

    SOURCE: http://bit.ly/1rd5zfb Pediatrics, online December 22, 2014.

  • Turkey's Erdogan says birth control 'treason' against Turkish lineage

    By Reuters Staff

    ISTANBUL (Reuters) - Turkish President Tayyip Erdogan has described birth control as a form of "treason," saying it threatened the country's bloodline.

    Erdogan urged a newly married couple at their wedding late on Sunday to have at least three children to help boost Turkish population figures, a common refrain from the president, who worries a declining birth rate may undermine economic growth.

    "For years they committed a treason of birth control in this country, seeking to dry up our bloodline. Lineage is very important both economically and spiritually," he told the couple after serving as their witness at the wedding. A video of the speech was posted on the mainstream Radikal news website.

    Last month, Erdogan, a devout Muslim, said it was unnatural to consider women and men equal and said feminists did not understand the importance of motherhood. In 2012, he sought to effectively outlaw abortion, but later dropped the plan amid a public outcry.

    Erdogan regularly faces criticism for an authoritarian style of rule after 11 years in power.

    Turkey's population growth has been slowing in recent years and the live-birth rate hovered at 2.07 percent last year, according to official statistics.

  • U.S. court strikes down North Carolina ultrasound abortion law

    By Colleen Jenkins

    WINSTON-SALEM, N.C. (Reuters) - A North Carolina law requiring doctors to perform an ultrasound and describe the displayed images to women seeking abortions constitutes compelled speech that violates the patients' free speech rights, a U.S. appeals court ruled on Monday.

    The 4th Circuit Court of Appeals upheld a district judge's decision that struck down the 2011 provision, agreeing that doctors could not be forced to disseminate the state's message discouraging abortion.

    "This compelled speech, even though it is a regulation of the medical profession, is ideological in intent and in kind," Judge J. Harvie Wilkinson III wrote in a unanimous ruling by a three-judge panel.

    "While the state itself may promote through various means childbirth over abortion, it may not coerce doctors into voicing that message on behalf of the state in the particular manner and setting attempted here," the ruling said.

    North Carolina's Republican-led legislature passed the abortion measure over a veto by then-Governor Beverly Perdue, a Democrat.

    Several groups, including the American Civil Liberties Union, the Center for Reproductive Rights and Planned Parenthood Federation of America, challenged the law on constitutional grounds. They said requiring abortion providers to explain the images in an ultrasound to patients before performing the procedure infringed upon their right to free speech.

    "We're thrilled that the appellate court rejected this unconscionable attempt to intrude on the doctor-patient relationship," said Nancy Northup, president and CEO of the Center for Reproductive Rights.

    The U.S. Supreme Court legalized abortion nationwide in 1973 but lawmakers in more conservative states have enacted laws that seek to place restrictions on the procedure.

    Republican lawmakers in North Carolina have defended the ultrasound requirement as providing crucial information for women making an irrevocable decision. Under the law, women could avert their eyes and not listen to the explanation of the fetus images.