UT Health Science Center

7703 Floyd Curl Drive
San Antonio, TX 78229
P 210.567.7000
www.uthscsa.edu

uthsca

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.

Cardiovascular Articles

  • CORRECTED-For diabetics, losing weight may delay kidney problems

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Healthy eating, staying active and losing weight are already recommended for people with type 2 diabetes, and new research suggests these steps may also delay or prevent chronic kidney disease.

    About 35 percent of U.S. adults with diabetes have some degree of kidney disease, and diabetes is the major cause of kidney failure and dialysis, according to the study's lead author Dr. William C. Knowler.

    "This result along with many others tends to reinforce the value of weight loss interventions and hopefully motivates people with diabetes to lose weight," said Knowler, who is chief of the Diabetes Epidemiology and Clinical Research Section of the National Institute of Diabetes and Digestive and Kidney Diseases in Phoenix, Arizona.

    He and his coauthors reexamined data from an existing study of lifestyle modifications for people with type 2 diabetes.

    For the original study, more than 5,000 overweight or obese Americans with type 2 diabetes ages 45 to 76 were divided into two groups. Half received diabetes support and education and the other half aimed to lose seven percent of their body weight through reduced calorie diets and increased physical activity.

    People were recruited for the study between 2001 and 2004. For the first year or so, the weight-loss group met regularly with dieticians, case managers and physical activity experts to stay on track toward their calorie, activity and weight-loss goals.

    The study continued, with encouragement to stick to diet and exercise programs, through 2012. As with many weight loss programs, the first year is the critical period for weight loss and later years are spent maintaining it, which can be difficult, Knowler said.

    At the one-year mark, the diet and exercise group had lost an average of 8.6 percent of their body weight, compared to less than one percent lost in the support-and-education group.

    Over the entire study period, people in the diet and exercise group were 31 percent less likely to develop very high risk chronic kidney disease, according to urine tests.

    The study's primary aim was to investigate the power of weight loss to reduce the risk of heart problems or stroke, and as the researchers published previously, no benefit was seen there.

    Knowler emphasized, however, that the weight loss program did improve the outlook for kidney disease and many other aspects of health, including depression, knee pain, urinary incontinence and heart rate recovery after exercise.

    Dr. Dick de Zeeuw writes in an accompanying editorial in The Lancet Diabetes and Endocrinology that he found the kidney-health benefit with no heart benefit difficult to reconcile.

    de Zeeuw, of the Department of Clinical Pharmacy and Pharmacology at the University of Groeningen in The Netherlands, also writes that using very high risk chronic kidney disease as the marker of success or failure in the study doesn't line up with what most trials like this would do if a drug were being tested instead of a lifestyle change.

    Nevertheless, these results reinforce the existing recommendation that people with type 2 diabetes should maintain a healthy weight, he told Reuters Health.

    "In one sense it doesn't add anything to existing recommendations because for overweight people, weight loss and increased activity are recommended already," Knowler said. "But we don't really put a lot of force behind that recommendation."

    For most people, telling them to lose weight and handing out some pamphlets is not enough, he said. This study indicates that an intense program of major behavioral change, including counseling, group session and mutual reinforcement can work.

    "Any approach that results in sustained weight loss should work just as well," Knowler said.

    SOURCE: http://bit.ly/1oRix03 The Lancet Diabetes and Endocrinology, online August 11, 2014.

  • For older women, working out may keep heart rates regular

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Physically active older women are less likely to suffer from atrial fibrillation, the most common form of irregular heartbeat, than less active women, according to a new U.S. study.

    Contrary to suggestions that exercise might raise the risk of abnormal heart rhythms, the analysis based on more than 80,000 postmenopausal women found the risk of atrial fibrillation was lowered by up to 44 percent with regular physical activity.

    "This is one of the reasons we ended up doing the study, we wanted to quell some of those concerns," said senior author Dr. Marco V. Perez of the Stanford Center for Inherited Cardiovascular Disease in California.

    "These are women not engaged in extreme forms of exercise, and what we found was that women who engaged in more exercise actually had a lower risk of AF," Perez told Reuters Health. "The more obese you were, the more you benefitted."

    Atrial fibrillation (AF), sometimes shortened to "AFib," affects more than 1 million U.S. women, and raises their risk of stroke and death even more than it does for men with the condition.

    Perez and his team analyzed data from the large, long-term Women's Health Initiative study. They focused on 81,317 postmenopausal women who had been followed over an average of 11 years.

    Using hospital records and Medicare claims, the researchers found that 9,792 of the women developed AF, at an average age of 63.

    Higher body mass index, a measure of weight relative to height, increased the risk for AF, as did lower levels of physical activity.

    Women who exercised an amount equivalent to five or six 30-minute walks per week or to more vigorous activity like biking twice a week, were 10 percent less likely to develop AF than sedentary women, the authors report in the Journal of the American Heart Association.

    "By the time you're 80, your risk of AFib is about 10 percent, so if you can decrease your risk by 10 percent that is significant," Perez said.

    Obese women were most likely to develop AF, but more physical activity reduced that risk. Obese, sedentary women's AF risk was 30 percent higher than that of a sedentary woman with normal BMI, and 44 percent higher than that of a normal-weight woman who exercised.

    But obese women who exercised had a 17 percent higher risk for AF than normal-weight women who exercised.

    There are other benefits as well, Perez said, since AF leads to hospitalizations and healthcare expenditures.

    Women who exercise more could also be doing other things that lower their risk of AF, but in the Women's Health Initiative data he and his team were able to account for education, income and other lifestyle factors, he said.

    "Physical activity in itself is known to help reduce cardiovascular risk factors, one of the most important of which is high blood pressure, a known mediator of risk of atrial fibrillation," said Dr. Usha B. Tedrow, director of the Clinical Cardiac Electrophysiology Program at Brigham and Women's Hospital in Boston.

    Exercise is also known to reduce inflammation, which may play a role, Tedrow told Reuters Health by email. She was not part of the new study.

    "Atrial fibrillation is a disease where many components of the condition are not under the patient's control," she said. "This study suggests one more piece of the puzzle that can allow patients slightly more control over this disease."

    Perez would recommend that postmenopausal women make time for exercise, within reason and under supervision of a doctor if starting a new and strenuous program, he said.

    High blood pressure and diabetes are also closely tied to AF, so treating those conditions is extremely important as well, he said.

    SOURCE: http://bit.ly/1nbvrQZ Journal of the American Heart Association, August 20, 2014.

  • REFILE-Travel with medications, medical devices can be daunting

    (Removes redundant attribution in 22nd paragraph)

    By Kathryn Doyle

    NEW YORK (Reuters Health) - For international travelers who need to carry medical devices and medications with them, it's not easy to find out the travel requirements at their destinations, and embassies in general aren't much help, according to a new study.

    "The problem is known to exist but has not previously been published as we have," said lead author Moses Mutie of the Faculty of Health at the University of Canberra in Bruce, Australia.

    "Most embassies focus on trade and tourism," Mutie told Reuters Health by email. "Health issues are not often a priority."

    The Australian researchers considered the situation of a traveler from their own country going to one of 25 other countries popular with Australian tourists, including destinations in Africa, the Americas, Europe, Southeast Asia and the Western Pacific.

    The researchers explored embassy and consular websites looking for the quantities and different types of medication allowed in the country for personal use, required documentation, customs information and details about travelling with medical equipment.

    They also sent a standardized email to each embassy asking those same questions.

    Two weeks later, 11 embassies had responded, two of which forwarded the questions to the Pharmacy Board of the home country but did not respond further, the authors report in Travel Medicine and Infectious Disease.

    Of the eight countries that did respond, their recommendations varied widely, and tended to be much more strict than the recommendations of the International Narcotics Control Board (INCB), an independent body implementing United Nations Drug Control Conventions.

    According to the INCB recommendations for individual travelers, you should carry a copy of the prescription, but there are no other certifications or requirements for less than 20 doses of any medication, or less than a 30-day supply of narcotics or psychotropics, such as Ambien or Haldol.

    Many embassies, however, said all drugs required special certification of ownership and personal use, beyond a valid prescription. In some countries, a visitor is required to consult a local clinician to validate ongoing need for the medication.

    Some countries warn that if authorities are in doubt, they have the right to deny entry or confiscate the medications, the authors write.

    Drugs on Schedule I of the U.S. Controlled Substances Act, including hallucinogens or stimulants with no medical use, like THC or cocaine, can never be brought across national borders.

    Neither the embassy and consular websites nor the email responses addressed medical equipment.

    Travel health and traveling with medications is a "huge mess" and "supremely unsatisfactory," said Dr. Irmgard Bauer of the Division of Tropical Health and Medicine at James Cook University in Townsville, Australia, who was not part of the study.

    Patients should turn to their treating doctor and a travel clinic, with both having the obligation to find out what is required, he told Reuters Health by email.

    "Travellers on longer trips could also be referred to a colleague in the county of destination to continue treatment and prescribe the medication," he said. "In some cases, it may mean that travel cannot happen."

    Specific outcomes for a traveler with too much medication or not enough documentation depend on the country, its law, and the person working at customs that day, Bauer said.

    "With narcotics, an arrest is not unlikely," he said. "In some countries, this will not be pleasant."

    The situation can be toughest for last minute travelers, Mutie said, but ideally there will be sufficient time to search for information ahead of time and talk to your doctor, who should be the principal source of the required information.

    Dr. Natasha Hochberg, an infectious disease physician at Boston University School of Public Health, suggested "that international travelers with chronic medical conditions seek care at least 4 to 6 weeks in advance of travel at a travel clinic to address issues related to bringing medications overseas but also to address the need for immunizations and prophylactic medication and to discuss health-promoting topics."

    Hochberg, who was not involved in the new study, added, "Travelers bringing medication overseas should bring the medication in their carry-on luggage to prevent possible loss in checked baggage, keep it in the original bottle that the medication came in, take enough to last for their trip as well as some extra in case of changes to the itinerary, and have adequate documentation including the original prescription and possibly a signed letter on travel clinic letterhead."

    For medical devices, Mutie suggests planning ahead and checking with the airline. Airlines, he notes, have published clear medical clearance guidelines in this area.

    In future, embassy websites should be designed with the user in mind, since embassies are established to provide a service, he said.

    SOURCE: http://bit.ly/1lfNmeb Travel Medicine and Infectious Disease, August 6, 2014.

  • REFILE-Travel with medications, medical devices can be daunting

    (Removes redundant attribution in 22nd paragraph)

    By Kathryn Doyle

    NEW YORK (Reuters Health) - For international travelers who need to carry medical devices and medications with them, it's not easy to find out the travel requirements at their destinations, and embassies in general aren't much help, according to a new study.

    "The problem is known to exist but has not previously been published as we have," said lead author Moses Mutie of the Faculty of Health at the University of Canberra in Bruce, Australia.

    "Most embassies focus on trade and tourism," Mutie told Reuters Health by email. "Health issues are not often a priority."

    The Australian researchers considered the situation of a traveler from their own country going to one of 25 other countries popular with Australian tourists, including destinations in Africa, the Americas, Europe, Southeast Asia and the Western Pacific.

    The researchers explored embassy and consular websites looking for the quantities and different types of medication allowed in the country for personal use, required documentation, customs information and details about travelling with medical equipment.

    They also sent a standardized email to each embassy asking those same questions.

    Two weeks later, 11 embassies had responded, two of which forwarded the questions to the Pharmacy Board of the home country but did not respond further, the authors report in Travel Medicine and Infectious Disease.

    Of the eight countries that did respond, their recommendations varied widely, and tended to be much more strict than the recommendations of the International Narcotics Control Board (INCB), an independent body implementing United Nations Drug Control Conventions.

    According to the INCB recommendations for individual travelers, you should carry a copy of the prescription, but there are no other certifications or requirements for less than 20 doses of any medication, or less than a 30-day supply of narcotics or psychotropics, such as Ambien or Haldol.

    Many embassies, however, said all drugs required special certification of ownership and personal use, beyond a valid prescription. In some countries, a visitor is required to consult a local clinician to validate ongoing need for the medication.

    Some countries warn that if authorities are in doubt, they have the right to deny entry or confiscate the medications, the authors write.

    Drugs on Schedule I of the U.S. Controlled Substances Act, including hallucinogens or stimulants with no medical use, like THC or cocaine, can never be brought across national borders.

    Neither the embassy and consular websites nor the email responses addressed medical equipment.

    Travel health and traveling with medications is a "huge mess" and "supremely unsatisfactory," said Dr. Irmgard Bauer of the Division of Tropical Health and Medicine at James Cook University in Townsville, Australia, who was not part of the study.

    Patients should turn to their treating doctor and a travel clinic, with both having the obligation to find out what is required, he told Reuters Health by email.

    "Travellers on longer trips could also be referred to a colleague in the county of destination to continue treatment and prescribe the medication," he said. "In some cases, it may mean that travel cannot happen."

    Specific outcomes for a traveler with too much medication or not enough documentation depend on the country, its law, and the person working at customs that day, Bauer said.

    "With narcotics, an arrest is not unlikely," he said. "In some countries, this will not be pleasant."

    The situation can be toughest for last minute travelers, Mutie said, but ideally there will be sufficient time to search for information ahead of time and talk to your doctor, who should be the principal source of the required information.

    Dr. Natasha Hochberg, an infectious disease physician at Boston University School of Public Health, suggested "that international travelers with chronic medical conditions seek care at least 4 to 6 weeks in advance of travel at a travel clinic to address issues related to bringing medications overseas but also to address the need for immunizations and prophylactic medication and to discuss health-promoting topics."

    Hochberg, who was not involved in the new study, added, "Travelers bringing medication overseas should bring the medication in their carry-on luggage to prevent possible loss in checked baggage, keep it in the original bottle that the medication came in, take enough to last for their trip as well as some extra in case of changes to the itinerary, and have adequate documentation including the original prescription and possibly a signed letter on travel clinic letterhead."

    For medical devices, Mutie suggests planning ahead and checking with the airline. Airlines, he notes, have published clear medical clearance guidelines in this area.

    In future, embassy websites should be designed with the user in mind, since embassies are established to provide a service, he said.

    SOURCE: http://bit.ly/1lfNmeb Travel Medicine and Infectious Disease, August 6, 2014.

  • CORRECTED-For diabetics, losing weight may delay kidney problems

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Healthy eating, staying active and losing weight are already recommended for people with type 2 diabetes, and new research suggests these steps may also delay or prevent chronic kidney disease.

    About 35 percent of U.S. adults with diabetes have some degree of kidney disease, and diabetes is the major cause of kidney failure and dialysis, according to the study's lead author Dr. William C. Knowler.

    "This result along with many others tends to reinforce the value of weight loss interventions and hopefully motivates people with diabetes to lose weight," said Knowler, who is chief of the Diabetes Epidemiology and Clinical Research Section of the National Institute of Diabetes and Digestive and Kidney Diseases in Phoenix, Arizona.

    He and his coauthors reexamined data from an existing study of lifestyle modifications for people with type 2 diabetes.

    For the original study, more than 5,000 overweight or obese Americans with type 2 diabetes ages 45 to 76 were divided into two groups. Half received diabetes support and education and the other half aimed to lose seven percent of their body weight through reduced calorie diets and increased physical activity.

    People were recruited for the study between 2001 and 2004. For the first year or so, the weight-loss group met regularly with dieticians, case managers and physical activity experts to stay on track toward their calorie, activity and weight-loss goals.

    The study continued, with encouragement to stick to diet and exercise programs, through 2012. As with many weight loss programs, the first year is the critical period for weight loss and later years are spent maintaining it, which can be difficult, Knowler said.

    At the one-year mark, the diet and exercise group had lost an average of 8.6 percent of their body weight, compared to less than one percent lost in the support-and-education group.

    Over the entire study period, people in the diet and exercise group were 31 percent less likely to develop very high risk chronic kidney disease, according to urine tests.

    The study's primary aim was to investigate the power of weight loss to reduce the risk of heart problems or stroke, and as the researchers published previously, no benefit was seen there.

    Knowler emphasized, however, that the weight loss program did improve the outlook for kidney disease and many other aspects of health, including depression, knee pain, urinary incontinence and heart rate recovery after exercise.

    Dr. Dick de Zeeuw writes in an accompanying editorial in The Lancet Diabetes and Endocrinology that he found the kidney-health benefit with no heart benefit difficult to reconcile.

    de Zeeuw, of the Department of Clinical Pharmacy and Pharmacology at the University of Groeningen in The Netherlands, also writes that using very high risk chronic kidney disease as the marker of success or failure in the study doesn't line up with what most trials like this would do if a drug were being tested instead of a lifestyle change.

    Nevertheless, these results reinforce the existing recommendation that people with type 2 diabetes should maintain a healthy weight, he told Reuters Health.

    "In one sense it doesn't add anything to existing recommendations because for overweight people, weight loss and increased activity are recommended already," Knowler said. "But we don't really put a lot of force behind that recommendation."

    For most people, telling them to lose weight and handing out some pamphlets is not enough, he said. This study indicates that an intense program of major behavioral change, including counseling, group session and mutual reinforcement can work.

    "Any approach that results in sustained weight loss should work just as well," Knowler said.

    SOURCE: http://bit.ly/1oRix03 The Lancet Diabetes and Endocrinology, online August 11, 2014.

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Surgery Articles

  • Second D.C.-area man stricken with flesh-eating bacteria -media

    By John Clarke and Ian Simpson

    Aug 22 () - (Reuters) - A flesh-eating bacterial disease has infected another Washington, D.C.-area man, local media reported on Thursday, just days after a man was released from a hospital following a near-deadly bout with the germ.

    Joe Wood of Stafford, Virginia, said he was swimming in the Potomac River near the town of Callao earlier this month when a scratch on his left leg became infected with vibrio vulnificus, an aggressive bacteria that feeds on flesh, Washington D.C.'s WTOP radio reported.

    Wood was admitted to the Mary Washington Hospital in Fredericksburg on July 5 where an infectious disease specialist performed skin graft surgery on Tuesday, the report said. Doctors told the radio station that Wood would likely survive.

    The report could not be immediately confirmed as the hospital did not return repeated calls by a Reuters reporter on Thursday.

    The news comes just days after a 66-year-old Maryland man was released from a hospital after nearly losing a leg and his life to the flesh-eating bacterial infection that he contracted in Chesapeake Bay earlier in the month.

    The bacterial strain causes severe illness characterized by fever and chills, septic shock and lesions. Symptoms include vomiting and diarrhea.

    Vibrio cases are on the rise in the region. In a 2009 study, the Chesapeake Bay Foundation found that the increase in infections was linked to pollution and unusually hot summers.

    In Maryland, the number of all vibrio cases, including the strain that afflicted the two men, reached 57 last year, a 10-year high, according to the Maryland Department of Health and Mental Hygiene.

    Virginia had eight vibrio vulnificus cases last year, according to the Virginia Department of Health. There have been 27 cases involving vibrio species overall so far this year.

    Nationwide, there are as many as 95 cases of vibrio vulnificus infections each year, 35 of which result in death, according to CDC statistics.

  • Men, substance users less likely to have weight-loss surgery

    By Ronnie Cohen

    NEW YORK (Reuters Health) - A one-size-fits-all approach to weight-loss surgery may be keeping obese men, substance users and older people out of the operating room, a new study suggests.

    The study analyzed data from a Canadian program intended to encourage obese people to undergo weight-loss surgery. More than half the patients dropped-out without having the operation, researchers found.

    Men, smokers, drinkers, drug users and people age 60 and older were the most likely to quit the program before having the operation, senior author Dr. Fayez Quereshy from the University of Toronto in Ontario told Reuters Health in a telephone interview.

    More than one-third of U.S. adults are obese and cost an estimated $147 billion a year in medical care, according to the Centers for Disease Control and Prevention.

    Weight loss operations, formally known as bariatric surgery, are known to cut obesity-related disease and healthcare costs. Prior research has shown they result in substantial weight loss and can reverse the course of some related diseases (see Reuters story of December 24, 2013 here: http://reut.rs/1BDFesE).

    In some studies, the surgery has been more effective in helping obese people shed weight than diet, exercise, therapy and drugs (see Reuters story of October 31, 2013 here: http://reut.rs/1z2YCLN).

    The operations reduce the size of the stomach so patients can eat only small amounts of food. Doctors recommend the procedures for people who are severely obese or moderately obese with serious weight-related health problems.

    But while bariatric surgery is becoming increasingly popular, the drop-out rate has also been growing, the authors write in the Journal of the American College of Surgeons.

    In the current study, they examined the records of 1,664 patients referred to the bariatric-surgery program between 2008 and 2011. Patients ranged in age from 19 to 80, with an average age of 48. They waited an average of nearly 15 months to have the surgery, the authors write.

    Body mass index (BMI), a ratio of weight to height, was higher than 40 in nearly nine of every ten people. A BMI of 40 would be roughly equivalent, for example, to a height of 5 foot 2 inches (157 cm) and a weight of 218 pounds (99 kg), or a height of 6 feet (183 cm) and a weight of 294 pounds (133 kg).

    About one in every 13 people had a BMI above 60, roughly equivalent to a height of 5 foot 2 inches and a weight of 330 pounds (150 kg),

    Most patients - 74 percent - referred to the program were women. Men were not only less likely to be referred, they were also nearly half as likely to undergo the surgery.

    Heavier patients were more likely to have the operation and older patients (i.e., those over 60) were less likely, the study found.

    Distance from home to the program appeared to have no impact on attrition.

    Smokers, drinkers and other substance users were more likely to quit before surgery. The study did not determine if they left the program on their own or were refused treatment. Substance abusers must demonstrate prolonged abstinence to be eligible for weight-loss surgery, the authors write.

    Knowing which patients are dropping out should help administrators tailor future bariatric-surgery services, Quereshy said.

    The best way to most efficiently move more patients through the system, he believes, would be to tailor the care for certain groups of people. For example, he suggested, patients with limited social networks should be connected to social workers early on.

    "In environments where resources are scarce and obesity-related complications carry a significant cost burden and patient complications, we need to think of novel ways to reduce wait times, patient dropouts and disappointments while improving satisfaction," Quereshy said.

    Bariatric surgeon Dr. Erik Dutson, from the University of California, Los Angeles, said the study's message rings just as true in America as it does in Canada. He was not involved with the current study.

    "If we are going to continue to look at bariatric surgery as the gold standard for weight loss, then we should keep our eyes open about preemptively anticipating problems with patients and make special care considerations for certain subgroups," Dutson said.

    Bariatric surgery is not risk-free. Gastric-bypass operations, for example, carry the risk of blood clots, breathing problems, heart attacks, strokes, infections and allergic reactions to anesthesia, according to the National Institutes of Health.

    Still, Dutson believes that bariatric surgery is the safest way to reduce obesity and prevent related complications, such as diabetes. He described the operation as safer than a gall bladder removal.

    "It's ironically safer to undergo an operation than to not undergo an operation," he said.

    SOURCE: http://bit.ly/1p7pDN9 Journal of the American College of Surgeons, online August 11, 2014.

  • Knee replacement may go poorly for people who think life isn't fair

    By Kathryn Doyle

    NEW YORK (Reuters Health) - People who tend to blame others for their suffering and think setbacks in their lives are irreparable tend to report more pain after knee replacement surgery, according to a new study.

    This is not the first time feelings of personal injustice have been tied to longer recovery times and increased disability after injury, the authors write.

    "Pain is a complex phenomenon that is influenced by biological, social, and psychological factors," said lead author Esther Yakobov, a doctoral student in clinical psychology at McGill University in Montreal.

    "Studies conducted with patients who suffer from chronic pain because of an injury demonstrated that individuals who judge their experience as unfair, focus on their losses, and blame others for their painful condition also tend to experience more pain and recover from their injuries slower than individuals who do not," she told Reuters Health by email.

    But those studies had been with victims of injuries, where externalizing blame is a bit easier than for degenerative conditions like osteoarthritis, she noted.

    For the new study, a group of 116 men and women with severe osteoarthritis, between ages 50 and 85 years old and scheduled for knee replacement surgery in Canada, first filled out questionnaires assessing perceived injustice, how much they think about or worry about pain and their fear of movement or re-injury.

    They rated their agreement with statements like, "It all seems so unfair" and "I am suffering because of someone else's negligence."

    With another clinical questionnaire the patients gauged their pain levels and physical functioning.

    After the knee replacement surgeries, which were all deemed successful, the patients rated their pain and function again at a one-year checkup.

    The more a patient agreed before surgery that life seems unfair and others are to blame for their problems, the more pain they reported experiencing one year after surgery. That was true even when age, sex, other health conditions and pre-surgery pain levels were accounted for, according to the results in the journal Pain.

    The more the patient thought about pain and felt helpless because of it before surgery, the more severe their disability during recovery seemed to be.

    "A decade ago, we reported that preoperative anxiety and depression influenced the outcome after surgery," said Dr. Victoria Brander, a physical medicine and rehabilitation specialist at Northwestern Orthopaedic Institute in Chicago.

    This new study adds to the effort to refine the concept, identifying specific psychological characteristics that serve as risk factors for complicated or painful recovery, Brander, who was not part of the new study, told Reuters Health by email.

    "All of these psychological factors point to the fact that patients who perceive themselves as helpless, those who are afraid, those who feel loss of control, have a more difficult time," Brander said.

    "The contrary is also true - patients who exhibit high levels of 'self-efficacy' (that is, patients who have a high degree of confidence in their own ability to achieve a goal) appear to do best after knee replacement," she said.

    Osteoarthritis, the wearing away of cartilage, joint lining, ligaments and bone in a joint, affects one third of people over age 65 in the U.S., according to the Centers for Disease Control and prevention.

    Knee replacement surgery can relieve pain and restore mobility, but about 20 percent of patients will have a problematic recovery or intense pain, based on previous research.

    How individuals perceive pain as just or unjust can vary widely between patients, and it can be influenced by many factors, so it's hard to say if having a more negative outlook is common or uncommon, Yabokov said.

    Researchers don't yet know if people with more negative outlooks only perceive their pain as worse than others or if their psychological state affects the physiology of healing and actually leads to more pain, she said.

    Nevertheless, findings like this suggest patients should be screened for their psychosocial outlook before surgery, she said.

    "This might suggest the usefulness of screening patients in terms of 'catastrophizing,' perceived injustice, fear of movement, and recovery expectancies before treatment or surgery," she said. "With this screening information, appropriate psychological intervention that targets specific risk factors of each patient can then be matched to patients' needs."

    SOURCE: http://bit.ly/1qOr9BB Pain, online July 25, 2014.

  • Hundreds rally in Ireland after rape victim says denied abortion

    By Conor Humphries

    DUBLIN (Reuters) - Hundreds of people rallied in Dublin to call for a change to Ireland's abortion laws on Wednesday after a rape victim said she was refused a termination and instead gave birth by Caesarean section.

    The young migrant's case has reignited a debate about Roman Catholic Ireland's abortion laws, among the most restrictive in Europe, that sparked large protests before parliament voted to allow limited access to abortion for the first time last year.

    "I'm here because I was horrified. This poor girl suffered because she didn't understand the convoluted, stupid system here in Ireland," said Aoife McLysaght, a 38-year old science professor, holding a sign saying 'Forced pregnancy is torture'.

    "We are trying to put pressure on the government, but it seems to be one of those things they'd prefer to ignore. I feel it's only a matter of time before this law is changed. I just want that time to be sooner so fewer people suffer."

    The young foreign national, who cannot be named for legal reasons, told the Irish Times that she became pregnant as a result of rape that took place before she arrived in Ireland.

    She sought help to end the pregnancy when she discovered she was expecting a child, but was turned down by medical authorities. While Irish women seeking abortions typically travel to Britain, which has less strict laws, the woman said she could not do this because she did not have enough money.

    Under the Protection of Life During Pregnancy bill, which was passed a year ago in the wake of the death of an Indian woman who was refused an abortion, a pregnancy can be terminated if the life of the mother is in danger, including by suicide.

    The woman said she had attempted to commit suicide, but was interrupted. But by the time she was assessed by a psychiatrist, she was told her pregnancy was too far advanced to halt it.

    Protesters gathered in central Dublin chanted 'repeal the eighth' in reference to the eighth amendment to the constitution which followed the passing of a 1983 referendum giving the unborn an equal right to life as its mother.

    A United Nations human rights committee told Ireland last month that it should revise its abortion laws to provide for additional exceptions in cases of rape, incest, serious risks to the health of the mother or fatal fetal abnormality.

    The Committee's Chairman Nigel Rodley said Irish law treated women who were raped as a "a vessel and nothing more."

    Ireland's Health Service Executive said in a statement it could not comment on the circumstances of the case until an investigation to be completed by late September.

    Prime Minister Enda Kenny's government has indicated it does not plan to address the issue before the next general election, due by early 2016. It would need to hold another referendum to further amend the law.

    The Pro Life Campaign group said in a statement that the clamor for wider access to abortion laws was obscene as a premature baby clings to life and a chilling and disturbing reminder of the inhumane reality of legalized abortion.

  • California lawmakers pass bill banning inmate sterilizations

    By Sharon Bernstein

    SACRAMENTO, Calif. (Reuters) - California lawmakers sent a bill to ban sterilization surgeries on inmates in California prisons to Governor Jerry Brown on Tuesday, after media reports and a later audit showed officials failed to follow the state's rules for obtaining consent for the procedure known as tubal ligation from incarcerated women.

    The bill prohibits sterilization in correctional facilities for birth control reasons unless a patient's life is in danger or it is medically necessary and no less drastic procedure is possible.

    "It's clear that we need to do more to make sure that forced or coerced sterilizations never again occur in our jails and prisons," said state Senator Hannah-Beth Jackson, who wrote the bill. "Pressuring a vulnerable population into making permanent reproductive choices without informed consent violates our most basic human rights."

    The measure passed the Senate floor with a unanimous vote of 33-0 and now goes to Democratic Governor Jerry Brown for his signature.

    The bill was introduced earlier this year in the wake of allegations, first raised by the non-profit Center for Investigative Reporting, that the state failed to obtain informed consent in cases of women inmates who had their fallopian tubes tied.

    An audit released in June showed that errors were made in obtaining informed consent from 39 women inmates out of 144 who had their tubes tied while incarcerated between 2005 and 2011.

    Prison rules make tubal ligation available to inmates as part of regular obstetrical care. But until the issue was brought to officials' attention in 2010 by an inmates rights group, proper authorization for the procedure was rarely obtained, the state auditor's report said.

    In 27 of those cases, a physician failed to sign the consent form as required, the audit showed. In 18 cases, there were potential violations of a mandated waiting period after women gave consent.

    The audit was the latest blow to the state's troubled prison system and came as California is struggling to meet court-ordered demands to improve medical and mental healthcare in its overcrowded prisons.

    Medical care in California's prisons has been under the supervision of a federally appointed receiver since 2006.

    The current receiver, J. Clark Kelso, was appointed in 2008, but did not learn about problems with tubal ligations until 2010, the audit said.

    Just one such procedure, deemed medically necessary, was performed after the concerns were brought to Kelso's attention, the audit said.

Neonatal Articles

  • U.S. to propose birth control exception for religious companies -source

    By Caroline Humer

    (Reuters) - The Obama administration will ensure access to birth control coverage for employees of closely-held companies that object to contraception on religious grounds, proposing a new accommodation to health benefits mandated by the Affordable Care Act, a source familiar with the plan said on Friday.

    The move follows a Supreme Court ruling in June that allowed certain for-profit companies to refuse to cover contraceptives due to the religious beliefs of their owners.

    President Barack Obama's healthcare reform law requires companies to provide free birth control coverage as a preventive service included in their health plans.

    The U.S. Department of Health and Human Services had already provided an exception to non-profit groups with religious affiliations, such as certain universities or hospitals, in 2013. The exception requires insurers to cover the cost of birth control for employees of such organizations, separate from the benefits paid for by the employers.

    On Friday, it was expected to propose an extension of that rule to closely-held companies in rules published in the Federal Register, the source said.

    The rule is in direct response to the Supreme Court ruling in favor of Hobby Lobby Stores Ltd, a family-owned chain of craft stores, and Conestoga Wood Specialties Corp of Pennsylvania. The two companies combined employ nearly 14,000 people. The accommodation is expected to impact at nearly 50 additional companies who have filed similar lawsuits.

    At the time, the justices ruled that for-profit companies can make claims under a 1993 federal law called the Religious Freedom Restoration Act that was enacted to protect religious liberty. They had suggested that the government could extend the accommodation made for non-profit groups.

    HHS also proposed on Friday an interim rule for non-profits to lay out additional ways that these companies can provide notice to the government in writing of their religious objections to providing contraception coverage.

    The interim rule for non-profits is largely in response to a Supreme Court order in July, issued days after the Hobby Lobby ruling, that gave a temporary exemption to a Christian college in Illinois. It had said that the initial process for informing insurers of their religious standing also violated their beliefs.

  • U.S. EPA makes strides in air toxics but work remains in cities -report

    By Reuters Staff

    WASHINGTON (Reuters) - The United States has made progress in reducing dangerous air pollution since 1990 but work remains to reduce risks for the country's most overburdened urban areas, the U.S. Environmental Protection Agency's top official said on Thursday.

    The EPA released to Congress its second report on integrated air toxics, citing "substantial progress" toward reducing levels of contaminants such as arsenic, mercury and lead since it launched an Integrated Urban Air Toxics Strategy in 1999.

    Air toxics, also known as toxic air pollutants or hazardous air pollutants, are pollutants that may increase the risk of cancer or other serious health effects, such as birth defects.

    EPA Administrator Gina McCarthy pointed to milestones such as a 60 percent reduction in mercury from coal-fired power plants and an 84 percent cut in lead levels in outdoor air among the agency's accomplishments.

    But she told reporters that more work needs to be done to understand air toxics better and reduce remaining risks, which are most prevalent in low-income urban areas.

    "There is more that we have to do and more that we can do," McCarthy said on a conference call.

    The report she cited highlighted six areas where the current EPA air toxics program must improve, including emissions data; ambient data in more areas covering more pollutants; better monitoring technologies; and research on health impacts of air toxics.

    McCarthy said the agency is focused on addressing environmental justice by recognizing that some of the most economically disadvantaged communities are most at risk of the negative health effects of air pollution.

    The agency will complete studies of air toxic pollution in the neighborhoods of South Philadelphia and North Birmingham, Alabama, to get better data that can help inform local decision making.

    "Environmental justice is the core of EPA's mission - striving for clean water and healthy air for every American," McCarthy said.

    For the complete 139-page EPA report, see: http://www2.epa.gov/sites/production/files/2014-08/documents/082114-urban-air-toxics-report-congress.pdf

  • California law aims to protect rights of sperm donors, surrogates

    By Sharon Bernstein

    SACRAMENTO, Calif. (Reuters) - A bill aimed at protecting the parental and adoptive rights of non-traditional families in California was sent to Governor Jerry Brown on Wednesday in an effort to close gaps in a state law that have led to at least one high-profile legal case.

    The measure by San Francisco Assemblyman Tom Ammiano, a Democrat, would require sperm donors, surrogate mothers and the people with whom they work to have a child to fill out a series of forms detailing the rights and responsibilities of each person.

    "My bill represents an opportunity to have state law keep pace with the changes in reproductive technology," Ammiano said. "With a few simple changes, we can help families thrive without needless legal battles or expensive court actions."

    Legal issues around the parental rights of sperm donors have made headlines recently over a debacle involving actor Jason Patric, who donated sperm to a now-former girlfriend and is suing for the right to be part of the child's life. Under current law, sperm donors do not typically have parental rights unless otherwise agreed by the parties involved.

    Ammiano's bill would require people who use sperm donors or surrogate mothers to fill out a series of forms outlining the parental rights and responsibilities of the donor or surrogate before conception.

    The forms required under the legislation are designed to eliminate any gray area about who has the right to visit or care for a child conceived through in vitro or other non-traditional reproductive methods.

    The bill would also create an expedited adoption process for same-sex parents. The process is meant to protect families who move from California to states where a non-biological parent is not recognized under state law unless the child has been legally adopted.

    The measure also requires couples using a surrogate to spell out how they will pay for the medical expenses of the surrogate and the care of the newborn.

  • Hundreds rally in Ireland after rape victim says denied abortion

    By Conor Humphries

    DUBLIN (Reuters) - Hundreds of people rallied in Dublin to call for a change to Ireland's abortion laws on Wednesday after a rape victim said she was refused a termination and instead gave birth by Caesarean section.

    The young migrant's case has reignited a debate about Roman Catholic Ireland's abortion laws, among the most restrictive in Europe, that sparked large protests before parliament voted to allow limited access to abortion for the first time last year.

    "I'm here because I was horrified. This poor girl suffered because she didn't understand the convoluted, stupid system here in Ireland," said Aoife McLysaght, a 38-year old science professor, holding a sign saying 'Forced pregnancy is torture'.

    "We are trying to put pressure on the government, but it seems to be one of those things they'd prefer to ignore. I feel it's only a matter of time before this law is changed. I just want that time to be sooner so fewer people suffer."

    The young foreign national, who cannot be named for legal reasons, told the Irish Times that she became pregnant as a result of rape that took place before she arrived in Ireland.

    She sought help to end the pregnancy when she discovered she was expecting a child, but was turned down by medical authorities. While Irish women seeking abortions typically travel to Britain, which has less strict laws, the woman said she could not do this because she did not have enough money.

    Under the Protection of Life During Pregnancy bill, which was passed a year ago in the wake of the death of an Indian woman who was refused an abortion, a pregnancy can be terminated if the life of the mother is in danger, including by suicide.

    The woman said she had attempted to commit suicide, but was interrupted. But by the time she was assessed by a psychiatrist, she was told her pregnancy was too far advanced to halt it.

    Protesters gathered in central Dublin chanted 'repeal the eighth' in reference to the eighth amendment to the constitution which followed the passing of a 1983 referendum giving the unborn an equal right to life as its mother.

    A United Nations human rights committee told Ireland last month that it should revise its abortion laws to provide for additional exceptions in cases of rape, incest, serious risks to the health of the mother or fatal fetal abnormality.

    The Committee's Chairman Nigel Rodley said Irish law treated women who were raped as a "a vessel and nothing more."

    Ireland's Health Service Executive said in a statement it could not comment on the circumstances of the case until an investigation to be completed by late September.

    Prime Minister Enda Kenny's government has indicated it does not plan to address the issue before the next general election, due by early 2016. It would need to hold another referendum to further amend the law.

    The Pro Life Campaign group said in a statement that the clamor for wider access to abortion laws was obscene as a premature baby clings to life and a chilling and disturbing reminder of the inhumane reality of legalized abortion.

  • Belgian infant contracts HIV via breast milk

    By Kathryn Doyle

    NEW YORK (Reuters Health) - In 2012, a one-year-old boy in Belgium acquired HIV through his mother's breast milk, a rare but not impossible form of transmission in industrialized countries, doctors say.

    "Breast milk transmission has been recognized as an efficient mode of mother to child transmission of HIV for almost 30 years," said senior author Dr. Philippe Lepage.

    This transmission is common for mothers who were already infected before giving birth in developing countries, but it's extremely rare in industrialized countries, where HIV positive women are encouraged not to breastfeed, Lepage said.

    Lepage is the head of the department of pediatrics at the Hopital Universitaire des Enfants Reine Fabiola in Brussles, Belgium.

    In this case, according to a report in the journal Pediatrics, the boy's mother was tested for HIV during pregnancy and soon after delivery. The tests were negative both times.

    His parents, both from the Democratic Republic of Congo, and three siblings were all healthy at the time of his birth.

    But at one year of age the child was hospitalized for bronchitis, where he and his mother were diagnosed with HIV.

    "If mothers become HIV infected while they're breastfeeding, their babies are at very high risk of getting the infection," said Jean Humphrey, director of the Zvitambo Institute for Maternal Child Health Research in Harare, Zimbabwe.

    She speculated that in this case, the father contracted the infection after the child was born and gave it to his wife.

    More screening wouldn't help prevent this kind of transmission, since by and large the mother will have already given the infection to her child by the time she tests positive, she said.

    "The real way to prevent this kind of infection is to make women who are breastfeeding understand that having unprotected sex while breastfeeding is putting their babies at very high risk," Humphrey said.

    In Africa, it has been suggested that all breastfeeding women use condoms during sex to drive home the message of prevention, she said.

    "Sometimes, here, men take greater notice of the fact that sleeping around puts their baby at risk compared to putting their wife at risk," she said.

    The only way to prevent this kind of transmission is strong counseling of both parents, Humphrey said.

    Lepage and his coauthors suggested the same solution in the case report.

    "These interventions should focus on parents from high-HIV frequency countries and also on health care professionals counseling pregnant women who might be unaware of the possible risk associated with breastfeeding," he told Reuters Health by email. "Counseling should address condom use and also include education on the high risk of HIV postnatal transmission after heterosexual exposure during breastfeeding."

    For a pregnant woman who knows she has HIV, whether or not she will breastfeed depends on where in the world she lives, which has been one of the most tumultuous public health policy decisions in the past 20 years, Humphrey said.

    As Lepage noted, in North America, Europe and Australia, HIV positive women do not breastfeed, since safe alternative formulas are available.

    For a time women in Africa were also encouraged to formula feed, but that policy led to a wave of diarrhea deaths, Humphrey said.

    "In developing countries, breastfeeding is so important to prevent infections," she said.

    "Now there are drug regimens in all African countries that reduce breast milk transmission rates to under 2 percent if it's done right," she said.

    With drugs that lower transmission rates, the benefits of breastfeeding now outweigh the risks in Africa, she added.

    "Still it's extremely emotive, giving different policies on breastfeeding to poor women and to wealthy women," she said.

    SOURCE: http://bit.ly/1mc1a4f Pediatrics, August 18, 2014

Neuroscience Articles

  • Former U.S. swim star Van Dyken takes first steps since paralysis

    By Susan Heavey

    WASHINGTON (Reuters) - Olympic swimming champion Amy Van Dyken took her first steps this week since being paralyzed from the waist down when she severed her spinal cord in an all-terrain vehicle crash earlier this summer.

    In videos and images she posted online, Van Dyken is seen standing and starting to walk with the help a robotic exoskeleton device aimed at supporting patients' bodies and helping them move.

    "I feel good. Woo hoo!" she said in one video, posted late Thursday.

    "Here it is... I'm WALKING!!!" she wrote in another post.

    Another photograph shows Van Dyken, who won a total of six gold medals at the 1996 and 2000 Olympics, standing alongside her husband, former Denver Broncos punter Tom Rouen.

    Van Dyken's steps come just eight days after her release from a rehabilitation center in Colorado.

    In June, Van Dyken crashed her all-terrain vehicle near her Arizona home and was left with no movement in her legs despite several surgeries. Since then, she has vowed to one day walk again and has been active on social media documenting her recovery.

    It was not immediately clear what kind of exoskeleton device Van Dyken used. An assistant in one photo appears to be wearing a shirt with the logo for Indego, a wearable, motorized device sold by Parker Hannifin Corp markets for use in medical clinics.

    ReWalk Robotics Inc, which has plans take the company public, also sells a system for both clinical and personal use. It won approval from the U.S. Food and Drug Administration earlier this year to market it as long as it continues to gather data on its use.

    Such devices also have helped other paraplegics, including a man who earlier this summer kicked the first ball of the World Cup. A British woman in 2012 used a robotic exoskeleton to complete the London Marathon, although it took her 17 days.

  • U.S. EPA makes strides in air toxics but work remains in cities -report

    By Reuters Staff

    WASHINGTON (Reuters) - The United States has made progress in reducing dangerous air pollution since 1990 but work remains to reduce risks for the country's most overburdened urban areas, the U.S. Environmental Protection Agency's top official said on Thursday.

    The EPA released to Congress its second report on integrated air toxics, citing "substantial progress" toward reducing levels of contaminants such as arsenic, mercury and lead since it launched an Integrated Urban Air Toxics Strategy in 1999.

    Air toxics, also known as toxic air pollutants or hazardous air pollutants, are pollutants that may increase the risk of cancer or other serious health effects, such as birth defects.

    EPA Administrator Gina McCarthy pointed to milestones such as a 60 percent reduction in mercury from coal-fired power plants and an 84 percent cut in lead levels in outdoor air among the agency's accomplishments.

    But she told reporters that more work needs to be done to understand air toxics better and reduce remaining risks, which are most prevalent in low-income urban areas.

    "There is more that we have to do and more that we can do," McCarthy said on a conference call.

    The report she cited highlighted six areas where the current EPA air toxics program must improve, including emissions data; ambient data in more areas covering more pollutants; better monitoring technologies; and research on health impacts of air toxics.

    McCarthy said the agency is focused on addressing environmental justice by recognizing that some of the most economically disadvantaged communities are most at risk of the negative health effects of air pollution.

    The agency will complete studies of air toxic pollution in the neighborhoods of South Philadelphia and North Birmingham, Alabama, to get better data that can help inform local decision making.

    "Environmental justice is the core of EPA's mission - striving for clean water and healthy air for every American," McCarthy said.

    For the complete 139-page EPA report, see: http://www2.epa.gov/sites/production/files/2014-08/documents/082114-urban-air-toxics-report-congress.pdf

  • Researchers reverse autism symptoms in mice by paring extra synapses

    By Sharon Begley

    NEW YORK (Reuters) - Although many things have gone wrong in the autistic brain, scientists have recently been focusing on one of the most glaring: a surplus of connections, or synapses.

    Neuroscientists reported on Thursday that, at least in lab mice, a drug that restores the healthy "synaptic pruning" that normally occurs during brain development also reverses autistic-like behaviors such as avoiding social interaction.

    "We were able to treat mice after the disease had appeared," neurobiologist David Sulzer of Columbia University Medical Center, who led the study published in the journal Neuron, said in a telephone interview. That suggests the disease could one day be treated in teenagers and adults, "though there is a lot of work to be done," he said.

    A synapse is where one neuron communicates with another, forming functional circuits. With too many synapses, a "brain region that should be talking only to a select number of other regions is receiving irrelevant information from many others," Ralph-Axel Müller of San Diego State University said by email. He has done pioneering work in overconnectivity and was not involved in the Neuron study, which he deemed "extremely exciting."

    According to the latest government estimates, one in 68 children in the United States has some form of autism.

    For the new study, Columbia's Guomei Tang painstakingly counted synapses in a key region of the cortex of 26 children with autism who had died from other causes and compared that to 22 healthy brains also donated to science.

    In the autistic brains, synaptic density was more than 50 percent higher than that in healthy brains and sometimes two-thirds greater.

    It is not clear if too many synapses are the main reason for autism, but many genes linked to autism play a role in synapse pruning. And the discovery that synapse pruning reversed autistic behavior in the lab mice suggests overconnectivity may be key.

    Sulzer's team used rapamycin, an immunosuppressant drug that prevents organ rejection and is sold by Pfizer as Rapamune. They chose rapamycin because it works by inhibiting a protein called mTOR whose overactivity, they found, inhibits synapse pruning.

    Even if the findings are confirmed - and Sulzer notes that treatments that work in lab animals often fail in people - it is unlikely that rapamycin would be used in people with autism: Its wide-scale immune-suppressing effects would likely cause serious side effects.

    "But there could be better drugs," Sulzer said, such as a molecule that dials up production of synapse-pruning proteins.

    One remaining puzzle is how the mice's brains, or the drug, know which synapses to keep and which to prune. "But the mice started behaving normally" after receiving the synapse-pruning drug, "which suggests the right ones are being pruned," Sulzer said.

    In addition to government funding, the Columbia scientists received grants from the Simons Foundation. It was established by hedge fund pioneer and Renaissance Technologies founder Jim Simons, whose daughter was diagnosed with autism.

    SOURCE: http://bit.ly/1pNZZNz Neuron, online August 21, 2014.

  • For older women, working out may keep heart rates regular

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Physically active older women are less likely to suffer from atrial fibrillation, the most common form of irregular heartbeat, than less active women, according to a new U.S. study.

    Contrary to suggestions that exercise might raise the risk of abnormal heart rhythms, the analysis based on more than 80,000 postmenopausal women found the risk of atrial fibrillation was lowered by up to 44 percent with regular physical activity.

    "This is one of the reasons we ended up doing the study, we wanted to quell some of those concerns," said senior author Dr. Marco V. Perez of the Stanford Center for Inherited Cardiovascular Disease in California.

    "These are women not engaged in extreme forms of exercise, and what we found was that women who engaged in more exercise actually had a lower risk of AF," Perez told Reuters Health. "The more obese you were, the more you benefitted."

    Atrial fibrillation (AF), sometimes shortened to "AFib," affects more than 1 million U.S. women, and raises their risk of stroke and death even more than it does for men with the condition.

    Perez and his team analyzed data from the large, long-term Women's Health Initiative study. They focused on 81,317 postmenopausal women who had been followed over an average of 11 years.

    Using hospital records and Medicare claims, the researchers found that 9,792 of the women developed AF, at an average age of 63.

    Higher body mass index, a measure of weight relative to height, increased the risk for AF, as did lower levels of physical activity.

    Women who exercised an amount equivalent to five or six 30-minute walks per week or to more vigorous activity like biking twice a week, were 10 percent less likely to develop AF than sedentary women, the authors report in the Journal of the American Heart Association.

    "By the time you're 80, your risk of AFib is about 10 percent, so if you can decrease your risk by 10 percent that is significant," Perez said.

    Obese women were most likely to develop AF, but more physical activity reduced that risk. Obese, sedentary women's AF risk was 30 percent higher than that of a sedentary woman with normal BMI, and 44 percent higher than that of a normal-weight woman who exercised.

    But obese women who exercised had a 17 percent higher risk for AF than normal-weight women who exercised.

    There are other benefits as well, Perez said, since AF leads to hospitalizations and healthcare expenditures.

    Women who exercise more could also be doing other things that lower their risk of AF, but in the Women's Health Initiative data he and his team were able to account for education, income and other lifestyle factors, he said.

    "Physical activity in itself is known to help reduce cardiovascular risk factors, one of the most important of which is high blood pressure, a known mediator of risk of atrial fibrillation," said Dr. Usha B. Tedrow, director of the Clinical Cardiac Electrophysiology Program at Brigham and Women's Hospital in Boston.

    Exercise is also known to reduce inflammation, which may play a role, Tedrow told Reuters Health by email. She was not part of the new study.

    "Atrial fibrillation is a disease where many components of the condition are not under the patient's control," she said. "This study suggests one more piece of the puzzle that can allow patients slightly more control over this disease."

    Perez would recommend that postmenopausal women make time for exercise, within reason and under supervision of a doctor if starting a new and strenuous program, he said.

    High blood pressure and diabetes are also closely tied to AF, so treating those conditions is extremely important as well, he said.

    SOURCE: http://bit.ly/1nbvrQZ Journal of the American Heart Association, August 20, 2014.

  • Former Tennessee Titans player Tim Shaw says he has ALS

    By Tim Ghianni

    NASHVILLE, Tenn. (Reuters) - Former Tennessee Titans linebacker Tim Shaw revealed he has ALS, also known as Lou Gehrig's disease, in a video that shows him dumping a bucket full of ice water over his head as part of an ALS fundraiser.

    "I'm here today to stand up and fight with all of you against this disease," he said in the video posted on Tuesday, before dousing himself as part of the "Ice Bucket Challenge" to fight ALS - amyotrophic lateral sclerosis.

    After taking the challenge, Shaw, 30, called on the Titans organization, Penn State head coach James Franklin, the school's football team and his Clarenceville, Michigan, community to do the same.

    Shaw was drafted by the Carolina Panthers from Penn State and also played for the NFL's Jacksonville Jaguars and Chicago Bears. Shaw spent three years as a Titan before leaving football in 2013.

    The challenge has become popular on social media, with celebrities such as former President George W. Bush and basketball star LeBron James posting videos online showing themselves getting doused with cold water.

    The challenge has helped raise $31.5 million for the ALS Association over the past year, more than 16 times what it raised the previous year, the organization said on Wednesday.

    More than 5,600 people are diagnosed each year with ALS, a progressive neurodegenerative disease that attacks nerve cells and pathways in the brain and spinal cord, eventually paralyzing patients, according to the organization.

    A 2012 study found that National Football League players were at greater risk than the general population of dying of neurodegenerative diseases.

Oncology Articles

  • Mammography false alarms linked with later tumor risk

    By Ronnie Cohen

    NEW YORK (Reuters Health) - Women whose screening mammograms produce false alarms have a heightened risk of being diagnosed with breast cancer years later, but the reason remains mysterious, researchers say.

    An increased risk of breast cancer among women with a "false positive" mammogram has been reported before. What's new about this study is that the authors tried to figure out how much, if any, of the extra risk is simply due to doctors missing the cancer the first time they investigated the worrisome mammogram findings.

    But mistakes from doctors missing cancers explained only a small percentage of the increased risk, according to lead author My von Euler-Chelpin, an epidemiologist from the University of Copenhagen in Denmark.

    She told Reuters Health in a telephone interview that she could not explain most of the increased risk of later breast cancer in women with false-positive mammograms. (A mammogram is considered false positive when it suggests possible breast cancer but additional screenings or a biopsy fails to find it.)

    Of more than 58,000 Danish women who had mammography between 1991 and 2005, her study identified 4,743 women with suspicious findings that were eventually declared negative.

    By 2008, 295 of those 4,743 women had been diagnosed with breast cancer, von Euler-Chelpin and colleagues reported in Cancer Epidemiology.

    Radiologists reread the original mammograms and found that doctors had actually missed the cancer in 72 of the 295 women, for a false-negative rate of 1.5 percent. Even after taking those missed cancers into account, however, the researchers found that women with false-positive mammograms were still 27 percent more likely to be diagnosed with breast cancer years later, compared to women with only negative test results.

    The risk was slightly higher in women who had surgical biopsies that turned out to be negative.

    Von Euler-Chelpin thinks a smaller percentage of American women would have an elevated risk for breast cancer after a false-positive test because the U.S. has a higher rate of false positives than Denmark. The risk of a false-positive test over 10 mammograms ranges from 58 percent to 77 percent in the U.S., while it is around 16 percent in Denmark, the study says.

    Dr. Michael Alvarado, a breast cancer surgeon from the University of California, San Francisco, agreed that the risk of being diagnosed with breast cancer after a false positive mammogram is probably lower in the U.S. than in Denmark.

    "It's hard to translate the data to the U.S. population because we have such a different screening program, we tend to biopsy everything, and we're much more aggressive," he told Reuters Health. Alvarado was not involved in the current study.

    "Is there some inherent biology of the breast that makes it suspicious and it puts you at higher risk? I don't think anyone knows what it is," he said.

    Alvarado wondered if women who get false-positive mammograms should be followed more closely by their doctors, or if false-positive patients should be screened differently.

    Von Euler-Chelpin told Reuters Health the excess rate of breast cancer among women who have had false-positive mammograms points to the need to personalize screening programs for women - and Dr. Karla Kerlikowske agreed.

    Kerlikowske, from the University of California, San Francisco, is developing a risk calculator app to guide women in deciding how often to get mammograms. The calculator considers a range of factors, including age, race, previous breast cancer, family history and breast density. Kerlikowske was not involved in the current study.

    Although having had a false-positive mammogram is associated with a woman's breast cancer risk, Kerlikowske points out that the actual risk of being diagnosed with breast cancer remains low.

    The average five-year breast cancer risk for a 50-year-old white woman with no prior family history of breast cancer is 1.25 percent, the calculator shows. It ranges from less than 1 percent, to 2.70 percent, depending upon breast density, for the same woman with a history of a prior breast biopsy, regardless of whether the biopsy was positive or negative.

    "The absolute risk is still small," Kerlikowske said. "To me, it just says, now you have this risk factor, and you have to consider it with other risk factors."

    Von Euler-Chelpin agrees.

    "This paper is one little step on the way of trying to identify high-risk groups," she said. "The goal is to find more personalized screening programs for women."

    The American Cancer Society recommends that women be screened for breast cancer every year they are in good health starting at age 40. But a growing number of researchers have questioned the benefits of annual mammograms, and since 2009 the government-backed United States Preventive Services Task Force has recommended that screening be done every two years and be generally restricted to women aged 50 to 74.

    Women in Denmark between the ages 50 to 69 are invited to have screening mammograms every other year, Von Euler-Chelpin said.

    Getting a mammogram every other year instead of annually did not increase the risk of advanced breast cancer in women ages 50 to 74, according to a study Kerlikowske published last year (see Reuters story of March 18, 2013 here: http://reut.rs/1w7CMuh).

    The recommendation to reduce the frequency and delay the start of mammography screening was based on research showing the risk of false-positive results - which needlessly expose women to the anguish of a possible breast cancer diagnosis and the ordeal of further testing - outweighed the benefits of detecting cancers earlier.

    SOURCE: http://bit.ly/1wALk81 Cancer Epidemiology, online July 14, 2014.

  • Fewer U.S. youth using sunscreen new study finds

    By David Beasley

    ATLANTA (Reuters) - Fewer U.S. teenagers are using sunscreen, even as skin cancer rates increase, a study found.

    The percentage of high school students using sunscreen dropped from 67.7% in 2001 to 56.1% in 2011, according to the study by researchers at William Paterson University in New Jersey and published August 21 in the publication Preventing Chronic Disease.

    The study analyzed survey data from high school students collected for the Centers for Disease Control and Prevention's Youth Risk Behavior Surveillance System.

    The drop in sunscreen use occurred as melanoma, the most dangerous form of skin cancer, increased 1.6% annually among men from 2001 to 2010 and 1.4% among women, the study said.

    "It's alarming," said Corey Basch, assistant professor of public heath at William Paterson and one of the study's authors. "Given that the rates of skin cancer and melanoma are going up, we would have liked to have seen sun protection measures also going up."

    The CDC recommends using sunscreen and avoiding tanning beds to avoid developing skin cancer.

    Avoiding over-exposure to the sun is particularly important during childhood and adolescence, the study said.

    The findings point to the need for a greater push to inform teenagers on the dangers of sun exposure, said Basch.

    "What we really need is to change the mindset that having this artificially tanned skin is attractive," she said.

    In Australia, a massive public information campaign called "Slip Slop Slap" included handing out free sunscreen at beaches and was effective in increasing sun protection, Basch said. Television ads showed beachgoers wearing hats and shirts.

    "Over time, it really transformed how people envisioned a beach day," Basch said. "It was no longer just frying yourself, so to speak, on a beach in a string bikini."

    While the use of sunscreen by teenagers is dropping in the United States, so is the use of indoor tanning devices, the study said.

    From 2009 to 2011, the percentage of respondents using tanning devices dropped from 15.6% to 13.3%, the study said. However, the decrease was so small that it is not considered significant, Basch said.

    SOURCE: http://1.usa.gov/1nfLiOx

    Prev Chronic Dis 2014.

  • Fewer U.S. youth using sunscreen new study finds

    By David Beasley

    ATLANTA (Reuters) - Fewer U.S. teenagers are using sunscreen, even as skin cancer rates increase, a study found.

    The percentage of high school students using sunscreen dropped from 67.7 percent in 2001 to 56.1 percent in 2011, according to the study by researchers at William Paterson University in New Jersey and published Thursday in the publication Preventing Chronic Disease.

    The study analyzed survey data from high school students collected for the Centers for Disease Control and Prevention's Youth Risk Behavior Surveillance System.

    The drop in sunscreen use occurred as melanoma, the most dangerous form of skin cancer, increased 1.6 percent annually among men from 2001 to 2010 and 1.4 percent among women, the study said.

    "It's alarming," said Corey Basch, assistant professor of public heath at William Paterson and one of the study's authors. "Given that the rates of skin cancer and melanoma are going up, we would have liked to have seen sun protection measures also going up."

    The CDC recommends using sunscreen and avoiding tanning beds to avoid developing skin cancer.

    Avoiding over-exposure to the sun is particularly important during childhood and adolescence, the study said.

    The findings point to the need for a greater push to inform teenagers on the dangers of sun exposure, said Basch.

    "What we really need is to change the mindset that having this artificially tanned skin is attractive," she said.

    In Australia, a massive public information campaign called "Slip Slop Slap" included handing out free sunscreen at beaches and was effective in increasing sun protection, Basch said. Television ads showed beachgoers wearing hats and shirts.

    "Over time, it really transformed how people envisioned a beach day," Basch said. "It was no longer just frying yourself, so to speak, on a beach in a string bikini."

    While the use of sunscreen by teenagers is dropping in the United States, so is the use of indoor tanning devices, the study said.

    From 2009 to 2011, the percentage of respondents using tanning devices dropped from 15.6 percent to 13.3 percent, the study said. However, the decrease was so small that it is not considered significant, Basch said.

    SOURCE: http://1.usa.gov/1nfLiOx Preventing Chronic Disease, online August 21, 2014.

  • U.S. EPA makes strides in air toxics but work remains in cities -report

    By Reuters Staff

    WASHINGTON (Reuters) - The United States has made progress in reducing dangerous air pollution since 1990 but work remains to reduce risks for the country's most overburdened urban areas, the U.S. Environmental Protection Agency's top official said on Thursday.

    The EPA released to Congress its second report on integrated air toxics, citing "substantial progress" toward reducing levels of contaminants such as arsenic, mercury and lead since it launched an Integrated Urban Air Toxics Strategy in 1999.

    Air toxics, also known as toxic air pollutants or hazardous air pollutants, are pollutants that may increase the risk of cancer or other serious health effects, such as birth defects.

    EPA Administrator Gina McCarthy pointed to milestones such as a 60 percent reduction in mercury from coal-fired power plants and an 84 percent cut in lead levels in outdoor air among the agency's accomplishments.

    But she told reporters that more work needs to be done to understand air toxics better and reduce remaining risks, which are most prevalent in low-income urban areas.

    "There is more that we have to do and more that we can do," McCarthy said on a conference call.

    The report she cited highlighted six areas where the current EPA air toxics program must improve, including emissions data; ambient data in more areas covering more pollutants; better monitoring technologies; and research on health impacts of air toxics.

    McCarthy said the agency is focused on addressing environmental justice by recognizing that some of the most economically disadvantaged communities are most at risk of the negative health effects of air pollution.

    The agency will complete studies of air toxic pollution in the neighborhoods of South Philadelphia and North Birmingham, Alabama, to get better data that can help inform local decision making.

    "Environmental justice is the core of EPA's mission - striving for clean water and healthy air for every American," McCarthy said.

    For the complete 139-page EPA report, see: http://www2.epa.gov/sites/production/files/2014-08/documents/082114-urban-air-toxics-report-congress.pdf

  • Cancer screenings common among older, sick Americans

    By Andrew M. Seaman

    NEW YORK (Reuters Health) - Despite potential risks and limited benefits, many Americans are still screened for cancers toward the end of their lives, according to a new study.

    Up to half of older people in the U.S. received cancer screenings even though there was a high likelihood that they would die within nine years without cancer, researchers report in JAMA Internal Medicine.

    "There is general agreement that routine cancer screening has little likelihood to result in a net benefit for individuals with limited life expectancy," write Dr. Trevor Royce and his fellow researchers from the University of North Carolina, Chapel Hill.

    Several professional societies have updated their cancer screening guidelines to suggest that people who aren't expected to live another 10 years should not be screened for certain cancers.

    For example, the American Society of Clinical Oncology, the American Cancer Society and the American Urological Association recommend stopping prostate-specific antigen (PSA) screening among men not expected to live another decade.

    PSA screening involves a blood test that looks for a protein produced by the prostate gland. High levels of the protein may suggest the presence of prostate cancer.

    "Each screening test carries different risks and benefits," said Keith Bellizzi of the University of Connecticut's Center for Public Health and Health Policy in Storrs. "Individuals should be counseled about these risks in order to make an informed decision (sometimes involving caregivers or family members)."

    Bellizzi was not involved with the new study but has done similar research (see Reuters Health story of December 12, 2011 here: http://reut.rs/1taT7L9).

    "Having said that, the challenge for clinicians is to balance the values and wishes of their patients with the available evidence regarding the benefit or lack of benefit for a specific screening test," he wrote in an email to Reuters Health.

    For the new study, the researchers analyzed data from a U.S. survey collected between 2000 and 2010 that included responses from 27,404 people 65 years old and older.

    They used the participants' responses to estimate their risk of death within the next nine years. Then, they looked to see who had recently been screened for prostate, colon, breast and cervical cancers.

    In one way or another, medical organizations support stopping screening for those four cancers among people with limited life expectancy.

    Despite those guidelines, the researchers found 55 percent of men who had a 75 percent risk of death over the next nine years had recently received a PSA screening.

    About a third of women with the same life expectancy received breast and cervical cancer screenings. Screening for cervical cancer was also common among women who had already had a hysterectomy.

    The researchers also found that 41 percent of people who were not likely to live another decade were recently screened for colon cancer.

    In an editorial accompanying the new study, Dr. Cary Gross of Yale University in New Haven, Connecticut, writes that some research found that older Americans receive colonoscopies within seven years of their previous screening. Current recommendations suggest 10 years between colonoscopies with normal results.

    Another study published in the same journal says that based on a computer model, screening older adults with colonoscopies more than once every 10 years produced small benefits.

    Researchers led by Frank van Hees of Erasmus University Medical Center in the Netherlands found that compared with screening older Americans with colonoscopies every 10 years, screening them every five years saved less than one additional life per 1,000 people.

    Screening older Americans with colonoscopies every five years also resulted in less than one quality year of life gained per 1,000 people at a cost of about $711,000.

    "This new age of skepticism is providing us with critical tools to better target screening efforts," Gross wrote. "In situations in which we are uncertain about whether benefits outweigh the risks, we need to bolster our efforts to generate evidence that can inform cancer screening decisions."

    While helpful, he added, additional research is inefficient and doctors and regulators need to take steps to address the use of cancer screenings among people with limited life expectancies.

    "These findings support other studies that suggest certain segments of the older population may be inappropriately screened for cancers," said Bellizzi. "However, the health care response should clearly not be a one size fits all solution."

    He said older adults and their health statues differ from one another.

    "Age, in and of itself, should not be a proxy for health status or be solely used as a decision tool regarding screening for a particular cancer," he added.

    SOURCE: http://bit.ly/1taSAbY, http://bit.ly/1taSAce and http://bit.ly/1taSxNy JAMA Internal Medicine, online August 18, 2014.

Orthopedic Articles

  • Knee replacement may go poorly for people who think life isn't fair

    By Kathryn Doyle

    NEW YORK (Reuters Health) - People who tend to blame others for their suffering and think setbacks in their lives are irreparable tend to report more pain after knee replacement surgery, according to a new study.

    This is not the first time feelings of personal injustice have been tied to longer recovery times and increased disability after injury, the authors write.

    "Pain is a complex phenomenon that is influenced by biological, social, and psychological factors," said lead author Esther Yakobov, a doctoral student in clinical psychology at McGill University in Montreal.

    "Studies conducted with patients who suffer from chronic pain because of an injury demonstrated that individuals who judge their experience as unfair, focus on their losses, and blame others for their painful condition also tend to experience more pain and recover from their injuries slower than individuals who do not," she told Reuters Health by email.

    But those studies had been with victims of injuries, where externalizing blame is a bit easier than for degenerative conditions like osteoarthritis, she noted.

    For the new study, a group of 116 men and women with severe osteoarthritis, between ages 50 and 85 years old and scheduled for knee replacement surgery in Canada, first filled out questionnaires assessing perceived injustice, how much they think about or worry about pain and their fear of movement or re-injury.

    They rated their agreement with statements like, "It all seems so unfair" and "I am suffering because of someone else's negligence."

    With another clinical questionnaire the patients gauged their pain levels and physical functioning.

    After the knee replacement surgeries, which were all deemed successful, the patients rated their pain and function again at a one-year checkup.

    The more a patient agreed before surgery that life seems unfair and others are to blame for their problems, the more pain they reported experiencing one year after surgery. That was true even when age, sex, other health conditions and pre-surgery pain levels were accounted for, according to the results in the journal Pain.

    The more the patient thought about pain and felt helpless because of it before surgery, the more severe their disability during recovery seemed to be.

    "A decade ago, we reported that preoperative anxiety and depression influenced the outcome after surgery," said Dr. Victoria Brander, a physical medicine and rehabilitation specialist at Northwestern Orthopaedic Institute in Chicago.

    This new study adds to the effort to refine the concept, identifying specific psychological characteristics that serve as risk factors for complicated or painful recovery, Brander, who was not part of the new study, told Reuters Health by email.

    "All of these psychological factors point to the fact that patients who perceive themselves as helpless, those who are afraid, those who feel loss of control, have a more difficult time," Brander said.

    "The contrary is also true - patients who exhibit high levels of 'self-efficacy' (that is, patients who have a high degree of confidence in their own ability to achieve a goal) appear to do best after knee replacement," she said.

    Osteoarthritis, the wearing away of cartilage, joint lining, ligaments and bone in a joint, affects one third of people over age 65 in the U.S., according to the Centers for Disease Control and prevention.

    Knee replacement surgery can relieve pain and restore mobility, but about 20 percent of patients will have a problematic recovery or intense pain, based on previous research.

    How individuals perceive pain as just or unjust can vary widely between patients, and it can be influenced by many factors, so it's hard to say if having a more negative outlook is common or uncommon, Yabokov said.

    Researchers don't yet know if people with more negative outlooks only perceive their pain as worse than others or if their psychological state affects the physiology of healing and actually leads to more pain, she said.

    Nevertheless, findings like this suggest patients should be screened for their psychosocial outlook before surgery, she said.

    "This might suggest the usefulness of screening patients in terms of 'catastrophizing,' perceived injustice, fear of movement, and recovery expectancies before treatment or surgery," she said. "With this screening information, appropriate psychological intervention that targets specific risk factors of each patient can then be matched to patients' needs."

    SOURCE: http://bit.ly/1qOr9BB Pain, online July 25, 2014.

  • Knee replacement may go poorly for people who think life isn't fair

    By Kathryn Doyle

    NEW YORK (Reuters Health) - People who tend to blame others for their suffering and think setbacks in their lives are irreparable tend to report more pain after knee replacement surgery, according to a new study.

    This is not the first time feelings of personal injustice have been tied to longer recovery times and increased disability after injury, the authors write.

    "Pain is a complex phenomenon that is influenced by biological, social, and psychological factors," said lead author Esther Yakobov, a doctoral student in clinical psychology at McGill University in Montreal.

    "Studies conducted with patients who suffer from chronic pain because of an injury demonstrated that individuals who judge their experience as unfair, focus on their losses, and blame others for their painful condition also tend to experience more pain and recover from their injuries slower than individuals who do not," she told Reuters Health by email.

    But those studies had been with victims of injuries, where externalizing blame is a bit easier than for degenerative conditions like osteoarthritis, she noted.

    For the new study, a group of 116 men and women with severe osteoarthritis, between ages 50 and 85 years old and scheduled for knee replacement surgery in Canada, first filled out questionnaires assessing perceived injustice, how much they think about or worry about pain and their fear of movement or re-injury.

    They rated their agreement with statements like, "It all seems so unfair" and "I am suffering because of someone else's negligence."

    With another clinical questionnaire the patients gauged their pain levels and physical functioning.

    After the knee replacement surgeries, which were all deemed successful, the patients rated their pain and function again at a one-year checkup.

    The more a patient agreed before surgery that life seems unfair and others are to blame for their problems, the more pain they reported experiencing one year after surgery. That was true even when age, sex, other health conditions and pre-surgery pain levels were accounted for, according to the results in the journal Pain.

    The more the patient thought about pain and felt helpless because of it before surgery, the more severe their disability during recovery seemed to be.

    "A decade ago, we reported that preoperative anxiety and depression influenced the outcome after surgery," said Dr. Victoria Brander, a physical medicine and rehabilitation specialist at Northwestern Orthopaedic Institute in Chicago.

    This new study adds to the effort to refine the concept, identifying specific psychological characteristics that serve as risk factors for complicated or painful recovery, Brander, who was not part of the new study, told Reuters Health by email.

    "All of these psychological factors point to the fact that patients who perceive themselves as helpless, those who are afraid, those who feel loss of control, have a more difficult time," Brander said.

    "The contrary is also true - patients who exhibit high levels of 'self-efficacy' (that is, patients who have a high degree of confidence in their own ability to achieve a goal) appear to do best after knee replacement," she said.

    Osteoarthritis, the wearing away of cartilage, joint lining, ligaments and bone in a joint, affects one third of people over age 65 in the U.S., according to the Centers for Disease Control and prevention.

    Knee replacement surgery can relieve pain and restore mobility, but about 20 percent of patients will have a problematic recovery or intense pain, based on previous research.

    How individuals perceive pain as just or unjust can vary widely between patients, and it can be influenced by many factors, so it's hard to say if having a more negative outlook is common or uncommon, Yabokov said.

    Researchers don't yet know if people with more negative outlooks only perceive their pain as worse than others or if their psychological state affects the physiology of healing and actually leads to more pain, she said.

    Nevertheless, findings like this suggest patients should be screened for their psychosocial outlook before surgery, she said.

    "This might suggest the usefulness of screening patients in terms of 'catastrophizing,' perceived injustice, fear of movement, and recovery expectancies before treatment or surgery," she said. "With this screening information, appropriate psychological intervention that targets specific risk factors of each patient can then be matched to patients' needs."

    SOURCE: http://bit.ly/1qOr9BB Pain, online July 25, 2014.

  • Knee replacement may go poorly for people who think life isn't fair

    By Kathryn Doyle

    NEW YORK (Reuters Health) - People who tend to blame others for their suffering and think setbacks in their lives are irreparable tend to report more pain after knee replacement surgery, according to a new study.

    This is not the first time feelings of personal injustice have been tied to longer recovery times and increased disability after injury, the authors write.

    "Pain is a complex phenomenon that is influenced by biological, social, and psychological factors," said lead author Esther Yakobov, a doctoral student in clinical psychology at McGill University in Montreal.

    "Studies conducted with patients who suffer from chronic pain because of an injury demonstrated that individuals who judge their experience as unfair, focus on their losses, and blame others for their painful condition also tend to experience more pain and recover from their injuries slower than individuals who do not," she told Reuters Health by email.

    But those studies had been with victims of injuries, where externalizing blame is a bit easier than for degenerative conditions like osteoarthritis, she noted.

    For the new study, a group of 116 men and women with severe osteoarthritis, between ages 50 and 85 years old and scheduled for knee replacement surgery in Canada, first filled out questionnaires assessing perceived injustice, how much they think about or worry about pain and their fear of movement or re-injury.

    They rated their agreement with statements like, "It all seems so unfair" and "I am suffering because of someone else's negligence."

    With another clinical questionnaire the patients gauged their pain levels and physical functioning.

    After the knee replacement surgeries, which were all deemed successful, the patients rated their pain and function again at a one-year checkup.

    The more a patient agreed before surgery that life seems unfair and others are to blame for their problems, the more pain they reported experiencing one year after surgery. That was true even when age, sex, other health conditions and pre-surgery pain levels were accounted for, according to the results in the journal Pain.

    The more the patient thought about pain and felt helpless because of it before surgery, the more severe their disability during recovery seemed to be.

    "A decade ago, we reported that preoperative anxiety and depression influenced the outcome after surgery," said Dr. Victoria Brander, a physical medicine and rehabilitation specialist at Northwestern Orthopaedic Institute in Chicago.

    This new study adds to the effort to refine the concept, identifying specific psychological characteristics that serve as risk factors for complicated or painful recovery, Brander, who was not part of the new study, told Reuters Health by email.

    "All of these psychological factors point to the fact that patients who perceive themselves as helpless, those who are afraid, those who feel loss of control, have a more difficult time," Brander said.

    "The contrary is also true - patients who exhibit high levels of 'self-efficacy' (that is, patients who have a high degree of confidence in their own ability to achieve a goal) appear to do best after knee replacement," she said.

    Osteoarthritis, the wearing away of cartilage, joint lining, ligaments and bone in a joint, affects one third of people over age 65 in the U.S., according to the Centers for Disease Control and prevention.

    Knee replacement surgery can relieve pain and restore mobility, but about 20 percent of patients will have a problematic recovery or intense pain, based on previous research.

    How individuals perceive pain as just or unjust can vary widely between patients, and it can be influenced by many factors, so it's hard to say if having a more negative outlook is common or uncommon, Yabokov said.

    Researchers don't yet know if people with more negative outlooks only perceive their pain as worse than others or if their psychological state affects the physiology of healing and actually leads to more pain, she said.

    Nevertheless, findings like this suggest patients should be screened for their psychosocial outlook before surgery, she said.

    "This might suggest the usefulness of screening patients in terms of 'catastrophizing,' perceived injustice, fear of movement, and recovery expectancies before treatment or surgery," she said. "With this screening information, appropriate psychological intervention that targets specific risk factors of each patient can then be matched to patients' needs."

    SOURCE: http://bit.ly/1qOr9BB Pain, online July 25, 2014.

Transplant Articles

  • U.S. government extends contract with Cytori for burn treatment

    By Reuters Staff

    (Reuters) - The U.S. government has extended a contract with Cytori Therapeutics to develop a cell-derived treatment for burns, the company said on Tuesday.

    The government's Biomedical Advanced Research and Development Authority (BARDA) will provide up to $20.4 million to fund early development and costs associated with a clinical trial.

    The contract is part of BARDA's national preparedness initiative to prepare in the event of mass casualties, including the involvement of burns.

    Cytori said its autologous cell therapy has the potential to improve wound healing quality and speed, and could be deployed at hospitals for potential use by non-specialist personnel.

    The funds are part of a contract won by Cytori in 2012 for work on products to treat burns and radiation. This portion of the funding takes the project into the clinical development phase.

    The clinical trial must be approved by the Food and Drug Administration. If successful it would be the first clinical trial funded by BARDA that uses an autologous (the patient's own cells) stem cell treatment, the company said.

  • U.S. government extends contract with Cytori for burn treatment

    By Reuters Staff

    (Reuters) - The U.S. government has extended a contract with Cytori Therapeutics to develop a cell-derived treatment for burns, the company said on Tuesday.

    The government's Biomedical Advanced Research and Development Authority (BARDA) will provide up to $20.4 million to fund early development and costs associated with a clinical trial.

    The contract is part of BARDA's national preparedness initiative to prepare in the event of mass casualties, including the involvement of burns.

    Cytori said its autologous cell therapy has the potential to improve wound healing quality and speed, and could be deployed at hospitals for potential use by non-specialist personnel.

    The funds are part of a contract won by Cytori in 2012 for work on products to treat burns and radiation. This portion of the funding takes the project into the clinical development phase.

    The clinical trial must be approved by the Food and Drug Administration. If successful it would be the first clinical trial funded by BARDA that uses an autologous (the patient's own cells) stem cell treatment, the company said.

  • U.S. government extends contract with Cytori for burn treatment

    By Reuters Staff

    (Reuters) - The U.S. government has extended a contract with Cytori Therapeutics to develop a cell-derived treatment for burns, the company said on Tuesday.

    The government's Biomedical Advanced Research and Development Authority (BARDA) will provide up to $20.4 million to fund early development and costs associated with a clinical trial.

    The contract is part of BARDA's national preparedness initiative to prepare in the event of mass casualties, including the involvement of burns.

    Cytori said its autologous cell therapy has the potential to improve wound healing quality and speed, and could be deployed at hospitals for potential use by non-specialist personnel.

    The funds are part of a contract won by Cytori in 2012 for work on products to treat burns and radiation. This portion of the funding takes the project into the clinical development phase.

    The clinical trial must be approved by the Food and Drug Administration. If successful it would be the first clinical trial funded by BARDA that uses an autologous (the patient's own cells) stem cell treatment, the company said.

Women’s Health Articles

  • California lawmakers pass measure requiring testing of rape kits

    By Jennifer Chaussee

    (Reuters) - Amid ongoing efforts to address a backlog of unanalyzed rape kits that go untested throughout the country, California lawmakers passed a bill on Friday requiring law enforcement to process the evidence within a certain time frame.

    The bill next goes for a procedural approval in the state Assembly next week before heading to Governor Jerry Brown's desk for his signature. Brown vetoed a pilot program in 2011 that would have required certain counties to process their backlogged rape kits.

    But the latest measure, which takes a different approach by setting up a timeline for rape kit processing, received wide bipartisan support in Sacramento after several amendments extended the amount of time law enforcement would have to process the kits.

    The bill, which passed through the state Senate unanimously, would require hospitals to submit rape kits to forensic labs within five days of collecting the DNA evidence from a sexual assault victim.

    Law enforcement would have 20 days to do so. Once a forensic lab receives a rape kit, they would have 120 days to process it.

    "Testing this evidence gets the DNA from the crime into a national database, tells rape victims we care and helps ensure that rapists are caught and convicted," said state Assembly member Nancy Skinner, who authored the bill.

    Skinner's bill comes after an audit by a district attorney and local law enforcement officials found more than 1,900 unprocessed rape kits within the Bay Area's Alameda County alone.

    Rape kits holding DNA evidence that could help catch perpetrators are often left on storage shelves in police stations and labs due to funding shortages. It can cost between $1,200 and $1,500 to test a rape kit.

    California is not the first state to address backlogged rape kits statewide. Six other states have passed legislation requiring law enforcement to inventory backlogged kits. Of those states, Texas, Illinois and Colorado also require the tests to be submitted to crime labs within a certain time frame.

    In 2003, after New York City processed 17,000 backlogged rape kits, the city's arrest rate for rape went up by 30 percentage points, from 40 percent to 70 percent.

    Currently, there are an estimated 400,000 unprocessed rape kits in the United States, according to the sexual assault advocacy group End the Backlog, which lobbies for policies to expedite rape kit processing.

  • U.S. to propose birth control exception for religious companies -source

    By Caroline Humer

    (Reuters) - The Obama administration will ensure access to birth control coverage for employees of closely-held companies that object to contraception on religious grounds, proposing a new accommodation to health benefits mandated by the Affordable Care Act, a source familiar with the plan said on Friday.

    The move follows a Supreme Court ruling in June that allowed certain for-profit companies to refuse to cover contraceptives due to the religious beliefs of their owners.

    President Barack Obama's healthcare reform law requires companies to provide free birth control coverage as a preventive service included in their health plans.

    The U.S. Department of Health and Human Services had already provided an exception to non-profit groups with religious affiliations, such as certain universities or hospitals, in 2013. The exception requires insurers to cover the cost of birth control for employees of such organizations, separate from the benefits paid for by the employers.

    On Friday, it was expected to propose an extension of that rule to closely-held companies in rules published in the Federal Register, the source said.

    The rule is in direct response to the Supreme Court ruling in favor of Hobby Lobby Stores Ltd, a family-owned chain of craft stores, and Conestoga Wood Specialties Corp of Pennsylvania. The two companies combined employ nearly 14,000 people. The accommodation is expected to impact at nearly 50 additional companies who have filed similar lawsuits.

    At the time, the justices ruled that for-profit companies can make claims under a 1993 federal law called the Religious Freedom Restoration Act that was enacted to protect religious liberty. They had suggested that the government could extend the accommodation made for non-profit groups.

    HHS also proposed on Friday an interim rule for non-profits to lay out additional ways that these companies can provide notice to the government in writing of their religious objections to providing contraception coverage.

    The interim rule for non-profits is largely in response to a Supreme Court order in July, issued days after the Hobby Lobby ruling, that gave a temporary exemption to a Christian college in Illinois. It had said that the initial process for informing insurers of their religious standing also violated their beliefs.

  • Mammography false alarms linked with later tumor risk

    By Ronnie Cohen

    NEW YORK (Reuters Health) - Women whose screening mammograms produce false alarms have a heightened risk of being diagnosed with breast cancer years later, but the reason remains mysterious, researchers say.

    An increased risk of breast cancer among women with a "false positive" mammogram has been reported before. What's new about this study is that the authors tried to figure out how much, if any, of the extra risk is simply due to doctors missing the cancer the first time they investigated the worrisome mammogram findings.

    But mistakes from doctors missing cancers explained only a small percentage of the increased risk, according to lead author My von Euler-Chelpin, an epidemiologist from the University of Copenhagen in Denmark.

    She told Reuters Health in a telephone interview that she could not explain most of the increased risk of later breast cancer in women with false-positive mammograms. (A mammogram is considered false positive when it suggests possible breast cancer but additional screenings or a biopsy fails to find it.)

    Of more than 58,000 Danish women who had mammography between 1991 and 2005, her study identified 4,743 women with suspicious findings that were eventually declared negative.

    By 2008, 295 of those 4,743 women had been diagnosed with breast cancer, von Euler-Chelpin and colleagues reported in Cancer Epidemiology.

    Radiologists reread the original mammograms and found that doctors had actually missed the cancer in 72 of the 295 women, for a false-negative rate of 1.5 percent. Even after taking those missed cancers into account, however, the researchers found that women with false-positive mammograms were still 27 percent more likely to be diagnosed with breast cancer years later, compared to women with only negative test results.

    The risk was slightly higher in women who had surgical biopsies that turned out to be negative.

    Von Euler-Chelpin thinks a smaller percentage of American women would have an elevated risk for breast cancer after a false-positive test because the U.S. has a higher rate of false positives than Denmark. The risk of a false-positive test over 10 mammograms ranges from 58 percent to 77 percent in the U.S., while it is around 16 percent in Denmark, the study says.

    Dr. Michael Alvarado, a breast cancer surgeon from the University of California, San Francisco, agreed that the risk of being diagnosed with breast cancer after a false positive mammogram is probably lower in the U.S. than in Denmark.

    "It's hard to translate the data to the U.S. population because we have such a different screening program, we tend to biopsy everything, and we're much more aggressive," he told Reuters Health. Alvarado was not involved in the current study.

    "Is there some inherent biology of the breast that makes it suspicious and it puts you at higher risk? I don't think anyone knows what it is," he said.

    Alvarado wondered if women who get false-positive mammograms should be followed more closely by their doctors, or if false-positive patients should be screened differently.

    Von Euler-Chelpin told Reuters Health the excess rate of breast cancer among women who have had false-positive mammograms points to the need to personalize screening programs for women - and Dr. Karla Kerlikowske agreed.

    Kerlikowske, from the University of California, San Francisco, is developing a risk calculator app to guide women in deciding how often to get mammograms. The calculator considers a range of factors, including age, race, previous breast cancer, family history and breast density. Kerlikowske was not involved in the current study.

    Although having had a false-positive mammogram is associated with a woman's breast cancer risk, Kerlikowske points out that the actual risk of being diagnosed with breast cancer remains low.

    The average five-year breast cancer risk for a 50-year-old white woman with no prior family history of breast cancer is 1.25 percent, the calculator shows. It ranges from less than 1 percent, to 2.70 percent, depending upon breast density, for the same woman with a history of a prior breast biopsy, regardless of whether the biopsy was positive or negative.

    "The absolute risk is still small," Kerlikowske said. "To me, it just says, now you have this risk factor, and you have to consider it with other risk factors."

    Von Euler-Chelpin agrees.

    "This paper is one little step on the way of trying to identify high-risk groups," she said. "The goal is to find more personalized screening programs for women."

    The American Cancer Society recommends that women be screened for breast cancer every year they are in good health starting at age 40. But a growing number of researchers have questioned the benefits of annual mammograms, and since 2009 the government-backed United States Preventive Services Task Force has recommended that screening be done every two years and be generally restricted to women aged 50 to 74.

    Women in Denmark between the ages 50 to 69 are invited to have screening mammograms every other year, Von Euler-Chelpin said.

    Getting a mammogram every other year instead of annually did not increase the risk of advanced breast cancer in women ages 50 to 74, according to a study Kerlikowske published last year (see Reuters story of March 18, 2013 here: http://reut.rs/1w7CMuh).

    The recommendation to reduce the frequency and delay the start of mammography screening was based on research showing the risk of false-positive results - which needlessly expose women to the anguish of a possible breast cancer diagnosis and the ordeal of further testing - outweighed the benefits of detecting cancers earlier.

    SOURCE: http://bit.ly/1wALk81 Cancer Epidemiology, online July 14, 2014.

  • Men, substance users less likely to have weight-loss surgery

    By Ronnie Cohen

    NEW YORK (Reuters Health) - A one-size-fits-all approach to weight-loss surgery may be keeping obese men, substance users and older people out of the operating room, a new study suggests.

    The study analyzed data from a Canadian program intended to encourage obese people to undergo weight-loss surgery. More than half the patients dropped-out without having the operation, researchers found.

    Men, smokers, drinkers, drug users and people age 60 and older were the most likely to quit the program before having the operation, senior author Dr. Fayez Quereshy from the University of Toronto in Ontario told Reuters Health in a telephone interview.

    More than one-third of U.S. adults are obese and cost an estimated $147 billion a year in medical care, according to the Centers for Disease Control and Prevention.

    Weight loss operations, formally known as bariatric surgery, are known to cut obesity-related disease and healthcare costs. Prior research has shown they result in substantial weight loss and can reverse the course of some related diseases (see Reuters story of December 24, 2013 here: http://reut.rs/1BDFesE).

    In some studies, the surgery has been more effective in helping obese people shed weight than diet, exercise, therapy and drugs (see Reuters story of October 31, 2013 here: http://reut.rs/1z2YCLN).

    The operations reduce the size of the stomach so patients can eat only small amounts of food. Doctors recommend the procedures for people who are severely obese or moderately obese with serious weight-related health problems.

    But while bariatric surgery is becoming increasingly popular, the drop-out rate has also been growing, the authors write in the Journal of the American College of Surgeons.

    In the current study, they examined the records of 1,664 patients referred to the bariatric-surgery program between 2008 and 2011. Patients ranged in age from 19 to 80, with an average age of 48. They waited an average of nearly 15 months to have the surgery, the authors write.

    Body mass index (BMI), a ratio of weight to height, was higher than 40 in nearly nine of every ten people. A BMI of 40 would be roughly equivalent, for example, to a height of 5 foot 2 inches (157 cm) and a weight of 218 pounds (99 kg), or a height of 6 feet (183 cm) and a weight of 294 pounds (133 kg).

    About one in every 13 people had a BMI above 60, roughly equivalent to a height of 5 foot 2 inches and a weight of 330 pounds (150 kg),

    Most patients - 74 percent - referred to the program were women. Men were not only less likely to be referred, they were also nearly half as likely to undergo the surgery.

    Heavier patients were more likely to have the operation and older patients (i.e., those over 60) were less likely, the study found.

    Distance from home to the program appeared to have no impact on attrition.

    Smokers, drinkers and other substance users were more likely to quit before surgery. The study did not determine if they left the program on their own or were refused treatment. Substance abusers must demonstrate prolonged abstinence to be eligible for weight-loss surgery, the authors write.

    Knowing which patients are dropping out should help administrators tailor future bariatric-surgery services, Quereshy said.

    The best way to most efficiently move more patients through the system, he believes, would be to tailor the care for certain groups of people. For example, he suggested, patients with limited social networks should be connected to social workers early on.

    "In environments where resources are scarce and obesity-related complications carry a significant cost burden and patient complications, we need to think of novel ways to reduce wait times, patient dropouts and disappointments while improving satisfaction," Quereshy said.

    Bariatric surgeon Dr. Erik Dutson, from the University of California, Los Angeles, said the study's message rings just as true in America as it does in Canada. He was not involved with the current study.

    "If we are going to continue to look at bariatric surgery as the gold standard for weight loss, then we should keep our eyes open about preemptively anticipating problems with patients and make special care considerations for certain subgroups," Dutson said.

    Bariatric surgery is not risk-free. Gastric-bypass operations, for example, carry the risk of blood clots, breathing problems, heart attacks, strokes, infections and allergic reactions to anesthesia, according to the National Institutes of Health.

    Still, Dutson believes that bariatric surgery is the safest way to reduce obesity and prevent related complications, such as diabetes. He described the operation as safer than a gall bladder removal.

    "It's ironically safer to undergo an operation than to not undergo an operation," he said.

    SOURCE: http://bit.ly/1p7pDN9 Journal of the American College of Surgeons, online August 11, 2014.

  • For older women, working out may keep heart rates regular

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Physically active older women are less likely to suffer from atrial fibrillation, the most common form of irregular heartbeat, than less active women, according to a new U.S. study.

    Contrary to suggestions that exercise might raise the risk of abnormal heart rhythms, the analysis based on more than 80,000 postmenopausal women found the risk of atrial fibrillation was lowered by up to 44 percent with regular physical activity.

    "This is one of the reasons we ended up doing the study, we wanted to quell some of those concerns," said senior author Dr. Marco V. Perez of the Stanford Center for Inherited Cardiovascular Disease in California.

    "These are women not engaged in extreme forms of exercise, and what we found was that women who engaged in more exercise actually had a lower risk of AF," Perez told Reuters Health. "The more obese you were, the more you benefitted."

    Atrial fibrillation (AF), sometimes shortened to "AFib," affects more than 1 million U.S. women, and raises their risk of stroke and death even more than it does for men with the condition.

    Perez and his team analyzed data from the large, long-term Women's Health Initiative study. They focused on 81,317 postmenopausal women who had been followed over an average of 11 years.

    Using hospital records and Medicare claims, the researchers found that 9,792 of the women developed AF, at an average age of 63.

    Higher body mass index, a measure of weight relative to height, increased the risk for AF, as did lower levels of physical activity.

    Women who exercised an amount equivalent to five or six 30-minute walks per week or to more vigorous activity like biking twice a week, were 10 percent less likely to develop AF than sedentary women, the authors report in the Journal of the American Heart Association.

    "By the time you're 80, your risk of AFib is about 10 percent, so if you can decrease your risk by 10 percent that is significant," Perez said.

    Obese women were most likely to develop AF, but more physical activity reduced that risk. Obese, sedentary women's AF risk was 30 percent higher than that of a sedentary woman with normal BMI, and 44 percent higher than that of a normal-weight woman who exercised.

    But obese women who exercised had a 17 percent higher risk for AF than normal-weight women who exercised.

    There are other benefits as well, Perez said, since AF leads to hospitalizations and healthcare expenditures.

    Women who exercise more could also be doing other things that lower their risk of AF, but in the Women's Health Initiative data he and his team were able to account for education, income and other lifestyle factors, he said.

    "Physical activity in itself is known to help reduce cardiovascular risk factors, one of the most important of which is high blood pressure, a known mediator of risk of atrial fibrillation," said Dr. Usha B. Tedrow, director of the Clinical Cardiac Electrophysiology Program at Brigham and Women's Hospital in Boston.

    Exercise is also known to reduce inflammation, which may play a role, Tedrow told Reuters Health by email. She was not part of the new study.

    "Atrial fibrillation is a disease where many components of the condition are not under the patient's control," she said. "This study suggests one more piece of the puzzle that can allow patients slightly more control over this disease."

    Perez would recommend that postmenopausal women make time for exercise, within reason and under supervision of a doctor if starting a new and strenuous program, he said.

    High blood pressure and diabetes are also closely tied to AF, so treating those conditions is extremely important as well, he said.

    SOURCE: http://bit.ly/1nbvrQZ Journal of the American Heart Association, August 20, 2014.