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Neuroscience Articles

  • Dyslexia needn't hold doctors back

    By Randi Belisomo

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  • Terminal cancer care should do more to treat depression

    By Janice Neumann

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  • UPDATE 1-Daily tasks predict hospitalization, death for heart failure patients

    (Updates Source link at bottom, no change to article text)

    By Kathryn Doyle

    (Reuters Health) - Heart failure patients who struggle with daily tasks like bathing or dressing are more likely to be hospitalized and tend to die sooner than those who are more independent, according to a new study.

    More than five million people in the U.S. have heart failure, meaning their hearts cannot supply enough blood and oxygen to other organs, and about half die within five years of diagnosis, according to the Centers for Disease Control and Prevention. Treatments include medications, a low-salt diet and daily physical activity.

    "I certainly suspected that patients who had increasing difficulty with daily living would be at increased risk for death," but just how accurately a brief questionnaire could predict hospitalization and death was surprising, said Dr. Shannon Dunlay, lead author of the study and an advanced heart failure cardiologist at the Mayo Clinic in Rochester, Minnesota.

    For the study, more than 1,000 people with heart failure, and an average age of 75, filled out questionnaires assessing their ability to perform nine activities of daily living, including feeding themselves, dressing, using the toilet, housekeeping, climbing stairs, walking and bathing.

    Many of the participants had other health problems like high blood pressure, diabetes or past strokes.

    Those who had difficulty with things like bathing or housekeeping were classified as having "moderate difficulty" and those who struggled to feed themselves, use the toilet or dress themselves were classified as having "severe difficulty."

    Almost 60 percent of people reported difficulty with at least one of the nine activities. Around one quarter had moderate difficulty and 13 percent had severe difficulty.

    After about three years, more than half of the patients had died and more than 900 had been hospitalized at least once.

    The study team adjusted for other illnesses, and found that compared to people with no difficulty with daily activities, those with moderate difficulty were 50 percent more likely to die, and those with severe difficulty were more than twice as likely to die during the study.

    Those with moderate or severe difficulty were also more likely to be hospitalized for heart problems or for any reason than those with no difficulty, according to the results published in Circulation: Heart Failure.

    People with heart failure tend to be elderly and to have other chronic health conditions, so it can be difficult to separate out what is actually causing the decline in function, Dunlay told Reuters Health.

    Doctors do ask their patients about their ability to get around the house and complete daily tasks, but sometimes it can be hard to fit this conversation in with a regular clinic visit, Dunlay said.

    Adding a quick questionnaire to the appointment could be a good tool for doctors to assess their patients' risk of death and hospitalization, which can vary widely for people with heart failure, she said. Some patients do maintain most functional ability, while others will have severe disability.

    Many patients become asymptomatic with therapy, according to Dr. Eldrin F. Lewis of the cardiovascular division at Brigham and Women's Hospital in Boston, who wrote an editorial accompanying the new research. "Providers should always aim to get patients to the point where they can do all of the things that they enjoy," he told Reuters Health by email.

    "When I first meet a patient, I often ask them about their hobbies so that I can be realistic with them regarding their ability to eventually do those activities," he said.

    People who were older, female, unmarried and had other health conditions like diabetes, dementia or morbid obesity tended to have more difficulty with daily activities and were therefore at higher risk of hospitalization and death, the authors note.

    People who are married have a partner to help with daily tasks and may not notice their functional decline as much as those who are widowed, Dunlay said. Women may have worse outcomes because they tend to be slightly older than men when they develop heart failure.

    "Certainly the next step is to better understand whether there are interventions we can do to improve or halt the progression of decline," both to extend life expectancy and to improve quality of life immediately, Dunlay said.

    "Is there an optimal time to catch patients, and intervene with physical therapy?" she said. "For some patients quality of life is as, or more, important than living longer."

    Even before a doctor asks, family are probably already aware that a person with heart failure is having trouble with daily activities, and shouldn't hesitate to bring it up in the doctor's office, she said.

    SOURCE: http://bit.ly/1weXaVR Circulation: Heart Failure, online February 25, 2015.

  • Daily tasks predict hospitalization, death for heart failure patients

    By Kathryn Doyle

    (Reuters Health) - Heart failure patients who struggle with daily tasks like bathing or dressing are more likely to be hospitalized and tend to die sooner than those who are more independent, according to a new study.

    More than five million people in the U.S. have heart failure, meaning their hearts cannot supply enough blood and oxygen to other organs, and about half die within five years of diagnosis, according to the Centers for Disease Control and Prevention. Treatments include medications, a low-salt diet and daily physical activity.

    "I certainly suspected that patients who had increasing difficulty with daily living would be at increased risk for death," but just how accurately a brief questionnaire could predict hospitalization and death was surprising, said Dr. Shannon Dunlay, lead author of the study and an advanced heart failure cardiologist at the Mayo Clinic in Rochester, Minnesota.

    For the study, more than 1,000 people with heart failure, and an average age of 75, filled out questionnaires assessing their ability to perform nine activities of daily living, including feeding themselves, dressing, using the toilet, housekeeping, climbing stairs, walking and bathing.

    Many of the participants had other health problems like high blood pressure, diabetes or past strokes.

    Those who had difficulty with things like bathing or housekeeping were classified as having "moderate difficulty" and those who struggled to feed themselves, use the toilet or dress themselves were classified as having "severe difficulty."

    Almost 60 percent of people reported difficulty with at least one of the nine activities. Around one quarter had moderate difficulty and 13 percent had severe difficulty.

    After about three years, more than half of the patients had died and more than 900 had been hospitalized at least once.

    The study team adjusted for other illnesses, and found that compared to people with no difficulty with daily activities, those with moderate difficulty were 50 percent more likely to die, and those with severe difficulty were more than twice as likely to die during the study.

    Those with moderate or severe difficulty were also more likely to be hospitalized for heart problems or for any reason than those with no difficulty, according to the results published in Circulation: Heart Failure.

    People with heart failure tend to be elderly and to have other chronic health conditions, so it can be difficult to separate out what is actually causing the decline in function, Dunlay told Reuters Health.

    Doctors do ask their patients about their ability to get around the house and complete daily tasks, but sometimes it can be hard to fit this conversation in with a regular clinic visit, Dunlay said.

    Adding a quick questionnaire to the appointment could be a good tool for doctors to assess their patients' risk of death and hospitalization, which can vary widely for people with heart failure, she said. Some patients do maintain most functional ability, while others will have severe disability.

    Many patients become asymptomatic with therapy, according to Dr. Eldrin F. Lewis of the cardiovascular division at Brigham and Women's Hospital in Boston, who wrote an editorial accompanying the new research. "Providers should always aim to get patients to the point where they can do all of the things that they enjoy," he told Reuters Health by email.

    "When I first meet a patient, I often ask them about their hobbies so that I can be realistic with them regarding their ability to eventually do those activities," he said.

    People who were older, female, unmarried and had other health conditions like diabetes, dementia or morbid obesity tended to have more difficulty with daily activities and were therefore at higher risk of hospitalization and death, the authors note.

    People who are married have a partner to help with daily tasks and may not notice their functional decline as much as those who are widowed, Dunlay said. Women may have worse outcomes because they tend to be slightly older than men when they develop heart failure.

    "Certainly the next step is to better understand whether there are interventions we can do to improve or halt the progression of decline," both to extend life expectancy and to improve quality of life immediately, Dunlay said.

    "Is there an optimal time to catch patients, and intervene with physical therapy?" she said. "For some patients quality of life is as, or more, important than living longer."

    Even before a doctor asks, family are probably already aware that a person with heart failure is having trouble with daily activities, and shouldn't hesitate to bring it up in the doctor's office, she said.

    SOURCE: http://bit.ly/1DVp0OE Circulation: Heart Failure, online February 25, 2015.

  • Study links common food additives to Crohn's disease, colitis

    By Will Dunham

    WASHINGTON (Reuters) - Common additives in ice cream, margarine, packaged bread and many processed foods may promote the inflammatory bowel diseases ulcerative colitis and Crohn's disease as well as a group of obesity-related conditions, scientists said on Wednesday.

    The researchers focused on emulsifiers, chemicals added to many food products to improve texture and extend shelf life. In mouse experiments, they found emulsifiers can change the species composition of gut bacteria and induce intestinal inflammation.

    Such inflammation is associated with the frequently debilitating Crohn's disease and ulcerative colitis as well as metabolic syndrome, a group of conditions that increase risk for type-2 diabetes, heart disease and stroke.

    Mice were fed emulsifiers diluted in drinking water or added into food, which were found to trigger low-grade intestinal inflammation and features of metabolic syndrome such as blood glucose level abnormalities, increased body weight and abdominal fat.

    Consuming emulsifiers increased the risk of colitis, mimicking human inflammatory bowel disease, in mice genetically susceptible to the condition, the study found.

    Georgia State University microbiologist Benoit Chassaing, whose study appears in the journal Nature, said the effects seen in mice "may be observed in humans as well."

    The study involved two widely used emulsifiers, polysorbate 80 and carboxymethylcellulose. The researchers are planning human studies and are already studying other emulsifiers.

    Emulsifiers are used in margarine, mayonnaise, creamy sauces, candy, ice cream, packaged processed foods and baked goods. They can make products like mayonnaise smooth and creamy instead of an unappetizing amalgam of water and oily globules.

    A key feature of inflammatory bowel diseases and metabolic syndrome is a change in the gut microbiota - the roughly 100 trillion bacteria that inhabit the intestinal tract - in ways that promote inflammation. In mice given emulsifiers, the bacteria were more apt to digest and infiltrate the dense mucus layer that lines and protects the intestines.

    Incidence of inflammatory bowel disease and metabolic syndrome started rising in the mid-20th century at roughly the same time that food manufacturers began widespread emulsifier use, the researchers said.

    "We were thinking there was some non-genetic factor out there, some environmental factor, that would be explaining the increase in these chronic inflammatory diseases," Georgia State immunologist Andrew Gewirtz said.

    "And we thought that emulsifiers were a good candidate because they are so ubiquitous and their use has roughly paralleled the increase in these diseases. But I guess we were surprised at how strong the effects were."

    SOURCE: http://bit.ly/1zf7JbH Nature, online February 25, 2015.

Oncology Articles

  • Healthy diet linked to lung health

    By Roxanne Nelson

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  • Terminal cancer care should do more to treat depression

    By Janice Neumann

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  • In landmark FDA tobacco study, e-cig questions likely to linger

    By Toni Clarke

    (Reuters) - The U.S. Food and Drug Administration is poised to release initial data from a landmark study into how Americans use tobacco products, but researchers expect many key questions about e-cigarettes to remain unanswered.

    The five-year Population Assessment of Tobacco and Health (PATH) Study of about 46,000 people, begun in 2011, is expected to provide a wealth of data about smoking behavior that could shape regulations ranging from warning labels and advertising restrictions to new product approvals.

    "It is going to provide the most fine-grain, comprehensive, highest quality data on tobacco use that has ever been collected in the United States," said Stanton Glantz, a tobacco control expert at the University of California, San Francisco.

    The FDA gained authority under a 2009 law to regulate cigarettes, smokeless tobacco and roll-your-own tobacco. It must issue new rules before it has authority to regulate e-cigarettes, cigars, hookahs and water pipes, among others. It has issued a draft proposal and is currently reviewing public comment before releasing final rules.

    Some experts say the PATH study may not be able to capture crucial details about the use of electronic cigarettes, vapor tanks and other devices as tastes and technology are evolving so rapidly.

    "While all this data that is being accumulated through the PATH study is great, it is unclear to me how much is going to be useful for setting the policy and regulations of the future." said Scott Ballin, a health policy consultant based in Washington, D.C.

    The study is being funded by the FDA and administered by the National Institutes of Health. Responses from about 20,000 participants will be released on Thursday at the annual meeting of the Society for Research on Nicotine and Tobacco in Philadelphia.

    Each participant is being followed over time, allowing researchers to assess trends, such as which products are gaining in popularity and which are fading. Researchers are also collecting biological samples that will allow scientists to compare subjective responses about, for example, nicotine exposure, with physical data.

    Kurt Ribisl, a professor at the University of North Carolina Gillings School of Global Public Health, said the size of the study means researchers will gain unprecedented detail about specific groups of people.

    Such detail could prove valuable to the agency as it weighs whether or not to ban menthol cigarettes, which are particularly popular in African American communities.

    It is unclear whether the study will provide enough detail about e-cigarette use to answer public health questions about whether flavors in e-cigarettes attract youngsters to the products. Neither is there likely to be much data about average doses of nicotine consumed, since many vaping devices can be customized to release different levels of nicotine.

    "When you get to e-cigarettes it's really complicated," Ribisl, who also sits on the FDA's tobacco products scientific advisory committee. "It's a vexing and complex issue."

  • UPDATE 1-Daily tasks predict hospitalization, death for heart failure patients

    (Updates Source link at bottom, no change to article text)

    By Kathryn Doyle

    (Reuters Health) - Heart failure patients who struggle with daily tasks like bathing or dressing are more likely to be hospitalized and tend to die sooner than those who are more independent, according to a new study.

    More than five million people in the U.S. have heart failure, meaning their hearts cannot supply enough blood and oxygen to other organs, and about half die within five years of diagnosis, according to the Centers for Disease Control and Prevention. Treatments include medications, a low-salt diet and daily physical activity.

    "I certainly suspected that patients who had increasing difficulty with daily living would be at increased risk for death," but just how accurately a brief questionnaire could predict hospitalization and death was surprising, said Dr. Shannon Dunlay, lead author of the study and an advanced heart failure cardiologist at the Mayo Clinic in Rochester, Minnesota.

    For the study, more than 1,000 people with heart failure, and an average age of 75, filled out questionnaires assessing their ability to perform nine activities of daily living, including feeding themselves, dressing, using the toilet, housekeeping, climbing stairs, walking and bathing.

    Many of the participants had other health problems like high blood pressure, diabetes or past strokes.

    Those who had difficulty with things like bathing or housekeeping were classified as having "moderate difficulty" and those who struggled to feed themselves, use the toilet or dress themselves were classified as having "severe difficulty."

    Almost 60 percent of people reported difficulty with at least one of the nine activities. Around one quarter had moderate difficulty and 13 percent had severe difficulty.

    After about three years, more than half of the patients had died and more than 900 had been hospitalized at least once.

    The study team adjusted for other illnesses, and found that compared to people with no difficulty with daily activities, those with moderate difficulty were 50 percent more likely to die, and those with severe difficulty were more than twice as likely to die during the study.

    Those with moderate or severe difficulty were also more likely to be hospitalized for heart problems or for any reason than those with no difficulty, according to the results published in Circulation: Heart Failure.

    People with heart failure tend to be elderly and to have other chronic health conditions, so it can be difficult to separate out what is actually causing the decline in function, Dunlay told Reuters Health.

    Doctors do ask their patients about their ability to get around the house and complete daily tasks, but sometimes it can be hard to fit this conversation in with a regular clinic visit, Dunlay said.

    Adding a quick questionnaire to the appointment could be a good tool for doctors to assess their patients' risk of death and hospitalization, which can vary widely for people with heart failure, she said. Some patients do maintain most functional ability, while others will have severe disability.

    Many patients become asymptomatic with therapy, according to Dr. Eldrin F. Lewis of the cardiovascular division at Brigham and Women's Hospital in Boston, who wrote an editorial accompanying the new research. "Providers should always aim to get patients to the point where they can do all of the things that they enjoy," he told Reuters Health by email.

    "When I first meet a patient, I often ask them about their hobbies so that I can be realistic with them regarding their ability to eventually do those activities," he said.

    People who were older, female, unmarried and had other health conditions like diabetes, dementia or morbid obesity tended to have more difficulty with daily activities and were therefore at higher risk of hospitalization and death, the authors note.

    People who are married have a partner to help with daily tasks and may not notice their functional decline as much as those who are widowed, Dunlay said. Women may have worse outcomes because they tend to be slightly older than men when they develop heart failure.

    "Certainly the next step is to better understand whether there are interventions we can do to improve or halt the progression of decline," both to extend life expectancy and to improve quality of life immediately, Dunlay said.

    "Is there an optimal time to catch patients, and intervene with physical therapy?" she said. "For some patients quality of life is as, or more, important than living longer."

    Even before a doctor asks, family are probably already aware that a person with heart failure is having trouble with daily activities, and shouldn't hesitate to bring it up in the doctor's office, she said.

    SOURCE: http://bit.ly/1weXaVR Circulation: Heart Failure, online February 25, 2015.

  • Daily tasks predict hospitalization, death for heart failure patients

    By Kathryn Doyle

    (Reuters Health) - Heart failure patients who struggle with daily tasks like bathing or dressing are more likely to be hospitalized and tend to die sooner than those who are more independent, according to a new study.

    More than five million people in the U.S. have heart failure, meaning their hearts cannot supply enough blood and oxygen to other organs, and about half die within five years of diagnosis, according to the Centers for Disease Control and Prevention. Treatments include medications, a low-salt diet and daily physical activity.

    "I certainly suspected that patients who had increasing difficulty with daily living would be at increased risk for death," but just how accurately a brief questionnaire could predict hospitalization and death was surprising, said Dr. Shannon Dunlay, lead author of the study and an advanced heart failure cardiologist at the Mayo Clinic in Rochester, Minnesota.

    For the study, more than 1,000 people with heart failure, and an average age of 75, filled out questionnaires assessing their ability to perform nine activities of daily living, including feeding themselves, dressing, using the toilet, housekeeping, climbing stairs, walking and bathing.

    Many of the participants had other health problems like high blood pressure, diabetes or past strokes.

    Those who had difficulty with things like bathing or housekeeping were classified as having "moderate difficulty" and those who struggled to feed themselves, use the toilet or dress themselves were classified as having "severe difficulty."

    Almost 60 percent of people reported difficulty with at least one of the nine activities. Around one quarter had moderate difficulty and 13 percent had severe difficulty.

    After about three years, more than half of the patients had died and more than 900 had been hospitalized at least once.

    The study team adjusted for other illnesses, and found that compared to people with no difficulty with daily activities, those with moderate difficulty were 50 percent more likely to die, and those with severe difficulty were more than twice as likely to die during the study.

    Those with moderate or severe difficulty were also more likely to be hospitalized for heart problems or for any reason than those with no difficulty, according to the results published in Circulation: Heart Failure.

    People with heart failure tend to be elderly and to have other chronic health conditions, so it can be difficult to separate out what is actually causing the decline in function, Dunlay told Reuters Health.

    Doctors do ask their patients about their ability to get around the house and complete daily tasks, but sometimes it can be hard to fit this conversation in with a regular clinic visit, Dunlay said.

    Adding a quick questionnaire to the appointment could be a good tool for doctors to assess their patients' risk of death and hospitalization, which can vary widely for people with heart failure, she said. Some patients do maintain most functional ability, while others will have severe disability.

    Many patients become asymptomatic with therapy, according to Dr. Eldrin F. Lewis of the cardiovascular division at Brigham and Women's Hospital in Boston, who wrote an editorial accompanying the new research. "Providers should always aim to get patients to the point where they can do all of the things that they enjoy," he told Reuters Health by email.

    "When I first meet a patient, I often ask them about their hobbies so that I can be realistic with them regarding their ability to eventually do those activities," he said.

    People who were older, female, unmarried and had other health conditions like diabetes, dementia or morbid obesity tended to have more difficulty with daily activities and were therefore at higher risk of hospitalization and death, the authors note.

    People who are married have a partner to help with daily tasks and may not notice their functional decline as much as those who are widowed, Dunlay said. Women may have worse outcomes because they tend to be slightly older than men when they develop heart failure.

    "Certainly the next step is to better understand whether there are interventions we can do to improve or halt the progression of decline," both to extend life expectancy and to improve quality of life immediately, Dunlay said.

    "Is there an optimal time to catch patients, and intervene with physical therapy?" she said. "For some patients quality of life is as, or more, important than living longer."

    Even before a doctor asks, family are probably already aware that a person with heart failure is having trouble with daily activities, and shouldn't hesitate to bring it up in the doctor's office, she said.

    SOURCE: http://bit.ly/1DVp0OE Circulation: Heart Failure, online February 25, 2015.

Orthopedic Articles

  • NSAIDS may boost bleeding risk after heart attack

    By Kathryn Doyle

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  • NSAIDS may boost bleeding risk after heart attack

    By Kathryn Doyle

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  • NSAIDS may boost bleeding risk after heart attack

    By Kathryn Doyle

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Transplant Articles

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Women’s Health Articles

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

    (Adds government comments in new paragraphs 8 and 9)

    By Reuters Staff

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

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

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

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

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

    The video had surprised him, he added.

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

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

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

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

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

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

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

    By Ju-min Park

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

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

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

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

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

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

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

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

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

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

    By Reuters Staff

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

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

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

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

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

    The video had surprised him, he added.

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

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

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

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

  • Women's rights activist urges female anatomy lesson for Idaho lawmaker

    By Laura Zuckerman

    SALMON, Idaho (Reuters) - A National Organization for Women executive urged an Idaho state lawmaker on Wednesday to consult with his female relatives about anatomy after he appeared to suggest during a legislative hearing that pills swallowed by women traveled to the uterus.

    The question of where pills may go after being ingested arose during testimony before a state House committee whose Republican majority voted to approve a bill that would ban doctors from using video teleconferencing to prescribe so-called abortion pills.

    Republican state Representative Vito Barbieri asked a Boise-area physician who testified in opposition to the bill on Monday how colonoscopies were conducted by doctors from remote locations.

    Dr. Julie Madsen said patients swallowed camera-equipped pills that captured images as they traveled through the intestines and the pictures were uploaded by doctors sitting at computer screens that could be hundreds of miles away.

    Barbieri asked if camera-equipped pills could likewise be used to produce images of women's wombs.

    "Can this same procedure then be done in a pregnancy? Swallowing a camera and helping the doctor determine what the situation is?" Barbieri asked.

    Madsen replied: "It cannot be done in pregnancy simply because when you swallow a pill, it would not end up in the vagina."

    Barbieri then responded: "Fascinating. That certainly makes sense, doctor."

    The exchange did not make sense to National Organization for Women regional director Marian Bradley, who represents the women's rights group in states including Idaho and Montana.

    On Wednesday, Bradley called on Barbieri and any other Republicans pushing abortion restrictions to confer with female relatives to clear up any confusion about women's bodies.

    "Maybe they want to talk to their wives or daughters and learn basic anatomy," she told Reuters.

    Bradley said Barbieri appeared to lack knowledge required to make sound judgments about medical procedures for women.

    "I think his remarks mean he doesn't know enough to be responsible for women's healthcare decisions," she said.

    Barbieri did not respond immediately to a request for comment late Wednesday.

  • Weight-loss surgery tied to pregnancy benefits, risks

    By Andrew M. Seaman

    (Reuters Health) - Weight loss surgery may reduce some of the pregnancy risks associated with obesity, but it could also put women and their infants at greater risk for other problems, according to a new study in Sweden.

    Compared to obese women who didn't have so-called bariatric surgery, women who did were less likely to develop diabetes during pregnancy and less likely to deliver overly large babies, researchers report in The New England Journal of Medicine.

    However, the women who had surgery were more likely to have shorter pregnancies and to deliver smaller-than-normal babies. There was also a possible link to increased risk of stillbirth and neonatal death among the babies of women who had the surgery.

    Bariatric surgery "has both positive and negative influences on the risk of complications during a subsequent pregnancy," said Kari Johansson, the study's lead author from the Karolinska Institute in Stockholm.

    Johansson cautioned in her email to Reuters Health that the study shows ties between weight-loss surgery and pregnancy outcomes, but doesn't prove cause and effect.

    Weight-loss surgery reduces the size of the stomach, and in some cases bypasses part of the digestive tract.

    While it's known that women who are overweight or obese have more pregnancy complications, the researchers say there is little information about pregnancy after weight-loss surgery.

    Their new study involved nearly 3,000 Swedish pregnancies between 2006 and 2011 - including 596 in women who had weight-loss surgery within the previous five years, and another 2356 in women whose pre-pregnancy weight was similar to what the weight-loss surgery patients had weighed before their surgery.

    Overall, there was no difference between the two groups in the risk of going into labor early. Also, there was no difference in the risk for birth defects.

    Only about 2 percent of women in the surgery group developed diabetes during pregnancy, compared to about 7 percent in the non-surgery group. Also, about 9 percent of women in the surgery group delivered overly large babies, compared to about 22 percent of the non-surgery group.

    But about 16 percent of women in the surgery group gave birth to smaller-than-normal babies, compared to about 8 percent of women in the non-surgery group. Also, the women who had surgery had pregnancies lasting 273 days, compared to about 278 days among the women who didn't have surgery. Both of those durations are within the normal range, however.

    The researchers also found that about 2 percent of pregnancies after weight-loss surgery ended in stillbirths or the death of infants within the first month of life, compared to about 1 percent of pregnancies in women who didn't have surgery.

    The researchers can't say whether the increased risk of stillbirth or infant death was simply by chance, however.

    "We therefore do not have a large enough sample to give any clear answer about this," Johansson said. "This outcome needs to be studied further in even larger samples of patients."

    In an editorial, Dr. Aaron Caughey of Oregon Health and Science University in Portland wrote that other factors could influence complication rates, include complications during previous pregnancies.

    Dr. Loralei Thornburg, who wasn't involved in the new study, also pointed out that 98 percent of the women who had weight-loss surgery had the procedure that bypasses part of the small intestine.

    "I think we have to interpret the findings with caution for different types of surgeries," said Thornburg, who is a high-risk pregnancy expert at the University of Rochester Medical Center in New York.

    She also said the study did not focus on many outcomes that may be better for mothers after weight-loss surgery, including their risk of death.

    Thornburg, who said her center sees many women after weight-loss surgery, said women should always have discussions with their doctors before becoming pregnant - procedure or not.

    She said women who had the surgery may need additional counseling about nutrition, care around remaining excess weight and possibly more monitoring. Additionally, they should talk about fertility before their surgery, she said.

    "You should absolutely talk to your doctor," Thornburg said. "Everyone should strive to be at a healthy weight and in a healthy lifestyle before they enter pregnancy."

    SOURCE: http://bit.ly/1zffE8V The New England Journal of Medicine, online February 25, 2015.