Medical Institutions

Each of these major Medical Center facilities boasts its own large campus, occupies multiple buildings and employs a large portion of the more than 30,000 healthcare specialists and countless volunteers and others who work in the Medical Center each day.

We’ve come to play a vital role in the health of San Antonio and South Texas. And whatever reason brings you here, we hope we can be of help.

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Upcoming Events

  • Healthy Weight Loss / Walker Wellness

    What: Presented by Melissa Cooley, RN, BSN, CBN Bariatric Director, Metropolitan Methodist Hospital, a campus of Methodist Hospital As the holidays quickly approach, many of us are planning for family togetherness, Thanksgiving turkeys, Christmas hams and dessert, dessert, dessert! Once the holidays are behind us, though, what do we do about our new found “holiday fluff?” More importantly, what should we do about the pre-holiday pounds? Join Melissa Cooley as she discusses healthy weight loss options. She will cover techniques ranging from effective exercise techniques to surgical options. These seminars are FREE, but registration is required. Please call the Methodist Healthcare HealthLine at 210-575-0355 to RSVP. Refreshments will be provided. Attendees are encouraged, but not required to walk the mall before or after the seminar. Wonderland of the Americas encourages guests to exercise indoors in their safe, air conditioned environment.

    When: November 14, 2014 9:00 AM

  • GUSTO Push

    What: 5K, 10M and 20M open to any and all runners. Includes custom Technical Tee. Course is professionally-marked, options include Training program, InfoSessions with experts in their fields, and regular MeetUps. Runners will enjoy a great run, good food, water & electrolytes. Every race they do benefits a San Antonio area NonProfit organization. This one benefits The Children’s Bereavement Center of South Texas.

    When: November 15, 2014 8:00 AM

Neuroscience Articles

  • Showing cell phone callers the road might improve driver safety

    By Shereen Lehman

    NEW YORK (Reuters Health) - Providing a caller with views of the driver and the road ahead might reduce cell phone distraction for the driver, suggests a new study.

    Researchers used a driving simulator and video phones to examine how a driver's conversation partner - either on the phone or in the car - could affect their safety on the road.

    At any given time, about 5 percent of drivers in the U.S. are using their cell phones, but the devices are cited as a cause of distraction in 18 percent of crashes, say the authors.

    "For a number of years, we've been thinking about 'how might we make a cell phone partner - that is someone who is speaking to a driver who might be using legally a hands free cell phone . . . more like a passenger'," Arthur Kramer told Reuters Health in an email.

    Kramer, who led the study, is director of the Beckman Institute at the University of Illinois at Urbana-Champaign.

    "Because we know in the great majority of studies, the passengers, at least adult passengers who are drivers themselves, tend to be useful to drivers - it's another pair of eyes, and experienced eyes, if it's another driver," he said.

    Kramer said he and his colleagues thought it might be interesting to give the conversation partner at home or in a different location similar information to what a passenger sitting in the car would have, using a video-capable smartphone.

    "And that's what we did - we provided essentially a split screen video of the driver's face and outside the windscreen," Kramer said.

    Kramer and his team designed the study to see if the video information could make the conversation partner more like a passenger.

    They enrolled 48 college students who had two or more years of driving experience and set up four driving scenarios: the driver alone in the simulator, the driver speaking to a passenger who was also in the simulator, the driver speaking on a hands-free cell phone to someone in a different location and the driver speaking on a hands-free cell phone to someone who could see the driver and the driving scene out the front windshield with a video phone.

    Having a regular cell-phone conversation tripled the risk of collision compared to driving alone, and doubled the risk when compared with driving with a passenger or talking on the phone to a person who could see the driver and the road ahead.

    Interestingly, the study team notes in Psychological Science, drivers were least likely to remember which road signs they had seen when they drove alone as compared to having a passenger or being on either type of cell-phone call.

    The researchers also analyzed conversations between the drivers and either the passenger or the callers.

    "We found when the individuals at home or somewhere else had the split screen video they behaved, in terms of how they used language, more like the passenger," Kramer said. "That is, they were able to stop speaking when they perceived the driver was being busy."

    He added that cell phone partners with video would also reference driving events such as bicyclists or cars in close proximity, much like a passenger normally would.

    Kramer is cautiously optimistic, but still thinks talking on a cell phone while driving - even hands free - is "a stupid thing to do." He also isn't sure the video technology would be helpful for teens who might just find it more of a distraction.

    "I don't want to encourage more people to use the cell phone when they're driving but since it is indeed legal in every state in the United States, this could be one way to reduce accidents," he said.

    The study was only a simulation, so it's not clear how the technology would impact drivers in the real world.

    Arthur Goodwin, a researcher with the Highway Safety Research Center at the University of North Carolina, thinks it's an intriguing study that also provides information on how passengers might be helpful for drivers.

    Studies show that adult drivers "are less likely to be involved in a crash if they have a passenger with them, but we don't necessarily know why that's the case," Goodwin, who wasn't involved in the new study, told Reuters Health.

    "These findings suggest that passengers do pay attention to what drivers are doing and will adjust their own behavior accordingly, either by mentioning things that might be happening on the roadway or perhaps talking a little bit less than they normally would compared to somebody else who's on a cell phone," Goodwin said.

    SOURCE: http://bit.ly/1vnE95L Psychological Science, online October 8, 2104.

  • REFILE-'Exposure therapy' helps patients with prolonged grief

    (Corrects misspelling in byline, no change to article text)

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Adding one-on-one sessions focused on reliving the experience of losing a loved one to regular group therapy appears to help more patients with prolonged grief, according to a new study.

    Most people who lose a loved one feel stress, grieve and adapt over time. But seven to 10 percent of people get stuck in the grief phase and have persistent yearning for the deceased, difficulty in accepting the death, a sense of meaninglessness, bitterness about the death and difficulty in engaging in new activities, said lead author Richard A. Bryant of the School of Psychology at the University of New South Wales in Sydney, Australia.

    People with these symptoms for at least six months may be diagnosed with Prolonged Grief Disorder (PGD), although that is a relatively new diagnosis and still controversial for some psychologists, Bryant said.

    "At the moment, many doctors are probably treating them with antidepressants but we know this is quite different from depression," Bryant told Reuters Health.

    Exposure therapy, which emphasizes reliving and processing painful memories and feelings, is the "treatment of choice" for people with post traumatic stress disorder, according to Bryant (see Reuters Health story of July 17, 2013 here: http://reut.rs/1rrKXJP).

    Others have tried to adapt exposure therapy and cognitive behavioral therapy to prolonged grief, which has been successful, though having patients relive the death of a loved one is also a painful process, Bryant said.

    "What this study did is try to answer the question: do you really need to do that to treat grief?" he said.

    The study included 80 patients with PGD who all received 10 weekly two-hour group therapy sessions using cognitive behavioral therapy (CBT) techniques, like learning to manage avoidance and rumination about the death, learning distraction techniques and cultivating positive memories and new goals for the future.

    They also received four individual one-hour therapy sessions. Half of the group continued with CBT techniques, while the other half began exposure therapy focused on facing grief head-on and integrating the loss into memory.

    In exposure therapy, the patient spent 40 minutes giving a first-person, present tense account of the death of the person, including their own emotional, mental and physical experiences at the time. In addition to doing this at each of the four individual sessions, they were instructed to do the same exercise as "homework" once a week.

    Over the four sessions, therapists had the patients hone in on particularly painful aspects of the experience to be sure they were engaging fully.

    Over the course of the study, patients in the exposure group experienced greater decreases in prolonged grief symptoms, decreases in depression symptoms and increases in psychological functioning than the comparison group that got CBT alone.

    By the final therapy sessions, six people in the exposure therapy group still qualified for a PGD diagnosis, compared to 13 in the CBT-alone group.

    "Quite emphatically the findings demonstrated that patients who received (exposure therapy) did markedly better," Bryant said.

    "One of the ironies, the paradoxes about prolonged grief is that they are yearning for the deceased, but also engaged in avoidance," he said. "The loved one may have died many years earlier and they've never really gone back and felt about it. Some people may visit the gravesite every day, may set meals for the loved one every night."

    Past research suggests that some 10 percent of bereaved people experience PGD, Bryant and his colleagues write in JAMA Psychiatry. That would translate to about one million new cases each year in the United States alone.

    Since PGD is a new diagnosis, it is hard to predict who will experience grief and adapt and who will not be able to adapt, but in general those who experience prolonged grief were very emotionally dependent on the deceased, he said.

    It seems more likely to occur after certain kinds of losses, such as after a suicide or the sudden and unanticipated death of a child, said Dr. Sid Zisook of the University of California, San Diego School of Medicine.

    Zisook, who was not involved in the new study, studies treatments for "'complicated grief," another name for PGD.

    "(Complicated grief) causes great pain, interferes with ongoing life and tends to remain present for prolonged periods in the absence of treatment," Zisook told Reuters Health by email. "We recommend seeking support from family, friends and spiritual leaders (if consistent with the person's beliefs and life style) and also seeking professional help."

    In his program, patients with CG receive about 20 weeks of therapy sessions, and some start to see improvements in the first few weeks, he said.

    Many Hospices now provide bereavement care and be a valuable resource, he said.

    "If I feel that years have gone by and I still can't deal with this, I should be findings a therapist who can give me CBT," Bryant said. "People who really want to be helping people come unstuck and develop better adaptation, emotionally engaging with memories of the death, as painful as that may be, does help."

    SOURCE: http://bit.ly/1s2kpii JAMA Psychiatry, online October 22, 2014.

  • REFILE-'Exposure therapy' helps patients with prolonged grief

    (Corrects misspelling in byline, no change to article text)

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Adding one-on-one sessions focused on reliving the experience of losing a loved one to regular group therapy appears to help more patients with prolonged grief, according to a new study.

    Most people who lose a loved one feel stress, grieve and adapt over time. But seven to 10 percent of people get stuck in the grief phase and have persistent yearning for the deceased, difficulty in accepting the death, a sense of meaninglessness, bitterness about the death and difficulty in engaging in new activities, said lead author Richard A. Bryant of the School of Psychology at the University of New South Wales in Sydney, Australia.

    People with these symptoms for at least six months may be diagnosed with Prolonged Grief Disorder (PGD), although that is a relatively new diagnosis and still controversial for some psychologists, Bryant said.

    "At the moment, many doctors are probably treating them with antidepressants but we know this is quite different from depression," Bryant told Reuters Health.

    Exposure therapy, which emphasizes reliving and processing painful memories and feelings, is the "treatment of choice" for people with post traumatic stress disorder, according to Bryant (see Reuters Health story of July 17, 2013 here: http://reut.rs/1rrKXJP).

    Others have tried to adapt exposure therapy and cognitive behavioral therapy to prolonged grief, which has been successful, though having patients relive the death of a loved one is also a painful process, Bryant said.

    "What this study did is try to answer the question: do you really need to do that to treat grief?" he said.

    The study included 80 patients with PGD who all received 10 weekly two-hour group therapy sessions using cognitive behavioral therapy (CBT) techniques, like learning to manage avoidance and rumination about the death, learning distraction techniques and cultivating positive memories and new goals for the future.

    They also received four individual one-hour therapy sessions. Half of the group continued with CBT techniques, while the other half began exposure therapy focused on facing grief head-on and integrating the loss into memory.

    In exposure therapy, the patient spent 40 minutes giving a first-person, present tense account of the death of the person, including their own emotional, mental and physical experiences at the time. In addition to doing this at each of the four individual sessions, they were instructed to do the same exercise as "homework" once a week.

    Over the four sessions, therapists had the patients hone in on particularly painful aspects of the experience to be sure they were engaging fully.

    Over the course of the study, patients in the exposure group experienced greater decreases in prolonged grief symptoms, decreases in depression symptoms and increases in psychological functioning than the comparison group that got CBT alone.

    By the final therapy sessions, six people in the exposure therapy group still qualified for a PGD diagnosis, compared to 13 in the CBT-alone group.

    "Quite emphatically the findings demonstrated that patients who received (exposure therapy) did markedly better," Bryant said.

    "One of the ironies, the paradoxes about prolonged grief is that they are yearning for the deceased, but also engaged in avoidance," he said. "The loved one may have died many years earlier and they've never really gone back and felt about it. Some people may visit the gravesite every day, may set meals for the loved one every night."

    Past research suggests that some 10 percent of bereaved people experience PGD, Bryant and his colleagues write in JAMA Psychiatry. That would translate to about one million new cases each year in the United States alone.

    Since PGD is a new diagnosis, it is hard to predict who will experience grief and adapt and who will not be able to adapt, but in general those who experience prolonged grief were very emotionally dependent on the deceased, he said.

    It seems more likely to occur after certain kinds of losses, such as after a suicide or the sudden and unanticipated death of a child, said Dr. Sid Zisook of the University of California, San Diego School of Medicine.

    Zisook, who was not involved in the new study, studies treatments for "'complicated grief," another name for PGD.

    "(Complicated grief) causes great pain, interferes with ongoing life and tends to remain present for prolonged periods in the absence of treatment," Zisook told Reuters Health by email. "We recommend seeking support from family, friends and spiritual leaders (if consistent with the person's beliefs and life style) and also seeking professional help."

    In his program, patients with CG receive about 20 weeks of therapy sessions, and some start to see improvements in the first few weeks, he said.

    Many Hospices now provide bereavement care and be a valuable resource, he said.

    "If I feel that years have gone by and I still can't deal with this, I should be findings a therapist who can give me CBT," Bryant said. "People who really want to be helping people come unstuck and develop better adaptation, emotionally engaging with memories of the death, as painful as that may be, does help."

    SOURCE: http://bit.ly/1s2kpii JAMA Psychiatry, online October 22, 2014.

  • Blue-light blocking glasses may help sleep after screen time

    By Kathryn Doyle

    NEW YORK (Reuters Health) - The blue glow from televisions and other screens suppresses natural mechanisms that help us fall asleep at night, but blocking just the blue wavelength may restore normal nighttime sleepiness, according to a new study.

    Teen boys who used computers and other digital devices while wearing the glasses every evening for a week felt markedly more relaxed and sleepy at bedtime than when they just wore clear glasses, Swiss researchers found.

    "LED screens are widely-used in smart phones, tablets, computer monitors and TVs," said study coauthor Vivien Bromundt of the Centre for Chronobiology at the Psychiatric Hospital of the University of Basel.

    "The effect of screen light on the circadian physiology is particularly high in devices which are used in close distance to our eyes," Bromundt told Reuters Health by email. "Looking at these screens in the evening can keep teenagers awake since it involves light exposure, particularly in the blue-wavelength range to which the biological clock and its associated arousal promotion has its greatest sensitivity."

    Looking at computer screens in bed has been linked to insomnia and to difficulty waking up in the morning in previous studies. Light impacts circadian rhythms and sleep-wake cycles, the authors note.

    Teenagers already have a pronounced preference for staying up late, the study team writes in the Journal of Adolescent Health. But having to wake up early for school builds up a chronic sleep debt that affects teens' mood and focus.

    Light-emitting diode (LED) screens give off short-wavelength light, which has been shown to block a natural evening rise in the hormone melotonin that promotes sleepiness. Exposure to this blue light keeps the brain alert and "activated" when it should be slowing down to shift into sleep mode, the researchers say.

    For the new study, they used orange-tinted "blue-blocker" glasses that filter out short wavelengths of light in the blue portion of the visible spectrum.

    The researchers recruited 13 healthy boys between ages 15 and 17 and for one week, the teens kept to their regular sleep schedule at home but did not go out in the evenings or have caffeine drinks.

    They wore blue-blocker glasses from 6 p.m. until bed time each evening, while keeping diaries of how long they wore the glasses and how much time they spent with LED and non-LED screens as well as a sleep-wake log.

    At the end of the week, the participants spent one overnight in the laboratory, sitting for two hours in dim light, darkness for half an hour and then three hours in front of a backlit LED computer screen wearing the blue blocker glasses. They completed cognitive tests and provided saliva samples.

    Then the participants went to sleep for eight hours, and performed the same cognitive tests and saliva samples upon waking in the lab again.

    All participants went through the weeklong study protocol twice, once wearing blue-blocker glasses and once wearing clear glasses for comparison.

    The kids reported spending the same number of hours with LED screens with blue-blocker and clear glasses. They reported feeling sleepier with the blue blocker glasses, especially toward the end of the evening.

    Based on their saliva samples, kids who wore clear glasses had less melatonin, called the "darkness hormone," at bedtime. Kids who wore the blue blocker glasses had higher melatonin levels from 90 minutes to five minutes before sleep.

    The type of glasses did not seem to make a difference on the length or perceived quality of sleep itself.

    The short-wavelength photoreceptors in the eye which respond to blue light act to reset the timing of the internal clock, suppress melatonin production, improve alertness and performance, and elevate brain activation, Bromundt said.

    "Blue blockers therefore can prevent those light responses which are not helpful in the evening hours when our body and mind has to prepare for sleep," she said.

    But the blue-blocker glasses also blocked a significant amount of light generally, not just blue light, said Mary A. Carskadon, who researches associations of sleep regulatory mechanisms with sleep-wake behavior of children, adolescents and young adults at Brown University in Providence, Rhode Island.

    "Not only were they blocking blue, but they were also blocking a lot of light so it was dimmer in general," said Carskadon was not involved in the new study. "So it's hard to detect what really is inducing the effects that they see, which were not very large."

    If it is not the blue light, but the general dimness making a difference, there might be the same effect if kids just turn down the brightness on their devices, she said.

    Kids wearing clear glasses performed better on the cognitive tasks and had faster reaction times than those wearing blue blocker glasses.

    "If kids are looking at screens, playing a videogame, they are not going to want to have their performance affected," Carskadon said.

    Although they did not change sleep timing, latency or other measurable aspects of sleep quality after one week of use in this study, the blue-blocker glasses did seem to increase sleep readiness for the male teens, Bromundt said.

    The results would likely be the same for female teens as well, she said.

    "More and more suppliers of light therapy devices offer blue-blocker glasses in their range of products, because both bright light at the appropriate time of day and darkness or light-blocking devices in the evening and night are applied to consolidate our sleep-wake cycle and can therefore improve sleep and well-being," Bromundt said.

    Brown or yellow tinted glasses may reduce light transmittance also, but do not block as much light in the blue wavelength range as orange glasses, she said.

    Having and setting limits on screen time can be as difficult for adults as for kids, Carskadon told Reuters Health.

    "Many adults spend more time than is probably healthy using these devices when they could be and should be sleeping," she said. "Common sense has gone out the window a bit."

    SOURCE: http://bit.ly/1vOgtb0 Journal of Adolescent Health, online October 3, 2014.

  • Two doctor visits a year linked to better blood pressure control

    By Shereen Lehman

    NEW YORK (Reuters Health) - People who went to their doctor's office at least twice a year were more likely to keep their blood pressure under control compared to those who went once a year or not at all, says a new study.

    Having health insurance and following treatment for high cholesterol were also linked to better blood pressure control.

    "Folks that go to the doctor at least twice a year are more likely to be aware of their blood pressure, more likely to be treated, more likely to be controlled when treated and have significantly better control rates," Dr. Brent Egan, who led the study, told Reuters Health.

    "People with uncontrolled high blood pressure have a greater risk for having a stroke, having a heart attack, having heart failure and even memory loss without having a stroke," said Egan, of University of South Carolina School of Medicine in Greenville.

    He added that most people may not be aware of the fact that memory loss with aging is greater in people who have high blood pressure that's uncontrolled.

    "So there are number of reasons why it's a good thing to get the blood pressure control," said Egan, who is also medical director of the non-profit Care Coordination Institute.

    About one of every three Americans has high blood pressure, which is defined as having a reading above 140/90 mmHg. Only about half of adults with high blood pressure have it under control, the study team writes in the journal Circulation.

    A national health promotion and disease prevention initiative called Healthy Living 2020 established goals to reduce the rate of high blood pressure in the U.S. from 30 percent of all adults to 27 percent, and to increase the rate of blood pressure control to greater than 60 percent of people with high blood pressure.

    Egan and his colleagues designed the study to see how those goals are coming along. They looked at data on participants in the annual National Health and Nutrition Examination Survey who had their blood pressure checked during the period from 1999 to 2012.

    The researchers found that people who were obese, didn't have insurance and didn't see their doctors were more likely to have untreated high blood pressure.

    Egan and his team also examined what factors were associated with good blood pressure control.

    "One of the things we were looking at in this analysis was some of the modifiable variables that might, if we paid more attention to them, might help move us towards the goal," Egan said.

    The study team discovered that people who saw their doctors at least two times a year were more than three times more likely to get their blood pressure under control as those who saw a doctor less often.

    People with health insurance were about 70 percent more likely than those without it to have their blood pressure controlled.

    In addition, people who had high blood pressure and were being treated for high cholesterol were almost twice as likely to have their blood pressure under control.

    "Many people, in fact the majority of people with high blood pressure, also have a cholesterol problem," Egan said. "What our data shows is that if they're also being treated for the cholesterol they're more likely to get their blood pressure under control."

    Egan said that when doctors control both high blood pressure and cholesterol, "we reduce heart disease and stroke by about 60 percent; if we treat only one we reduce it by about 30 percent, so it's a really good idea to get both treated."

    Egan also said he thinks the Healthy Americans 2020 target of 61.2 percent, or a little over three out of every five people, with high blood pressure being controlled is an excellent goal.

    "Right now we're 10 percent below the goal and it looks like we've pretty much stabilized for the last six to seven years, and so it's clearly going to require some new efforts to get another round of progress," Egan said

    "It's sort of what we've known for years, that about a third of Americans are hypertensive and hypertension correlates with obesity," Dr. Ronald Wharton told Reuters Health.

    "Patients who tend to go to the doctor more are going to be in tune with their health and be more likely to take their health seriously," said Wharton, a cardiologist with Montefiore Medical Center in New York who wasn't involved in the study.

    Wharton said that obesity, cholesterol problems, hypertension and diabetes are not "independent parameters" - they're all interrelated.

    "When people take care of one problem, they're really taking care of multiple problems at the same time," Wharton said.

    But, "the data says we've come a long way and we've got a long way to go," Wharton added.

    "What we're facing in healthcare with obesity and hypertension, diabetes and all the ramifications is going to put an expense on the healthcare system that's going to make smoking-related illnesses look like a drop of sand on the beach," Wharton said.

    Egan said that cardiovascular disease is projected to increase healthcare costs tremendously over the next 15 years or so, roughly doubling the current cost.

    "Treating hypertension certainly is one of the ways to reduce that health burden," he said.

    SOURCE: http://bit.ly/1t48i9Y Circulation, online October 20, 2014.

Oncology Articles

  • U.S. officials considering quarantines for returning healthcare workers

    By Laila Kearney and Sebastien Malo

    NEW YORK (Reuters) - The Obama administration is considering quarantines for healthcare workers returning from Ebola-ravaged West African countries, an official said on Friday, as authorities in New York retraced the steps of a doctor with the disease.

    In Washington, President Barack Obama hugged a Dallas nurse who survived Ebola after catching it from a patient.

    Quarantining healthcare workers returning to the United States from the Ebola "hot zone" was one of a number of options being discussed by officials from across the administration, Tom Skinner, a spokesman for the Centers for Disease Control and Prevention (CDC), told Reuters.

    The CDC-led discussions began on Thursday after Dr. Craig Spencer tested positive for the disease that day after returning to New York from West Africa.

    Spencer, 33, a New Yorker who spent a month with the humanitarian group Doctors Without Borders working with Ebola patients in Guinea, was the fourth person diagnosed with the virus in the United States and the first in its largest city.

    He was awake and talking to family and friends on a cellphone and was listed in stable condition in Bellevue Hospital's isolation unit, said Dr. Mary Travis Bassett, New York's health commissioner. The CDC confirmed the diagnosis on Friday.

    Officials urged New Yorkers not to worry. Obama's embrace in the White House Oval Office with nurse Nina Pham, who was declared Ebola-free on Friday, seemed to underscore the message that the disease's threat was limited.

    Pham, one of two nurses from a Dallas hospital infected with Ebola after treating the first patient diagnosed with the disease in the United States, walked out smiling and unassisted from the Bethesda, Maryland hospital where she had been treated.

    Emory University Hospital in Atlanta and the CDC also confirmed that the other nurse, Amber Vinson, no longer had detectable levels of virus but did not set a date for her to leave that facility.

    Spencer finished his work in Guinea on Oct. 12 and arrived at John F. Kennedy International Airport in New York on Oct. 17.

    Six days later, he was quarantined at Bellevue Hospital with Ebola, unnerving financial markets amid concern the virus may spread in the city. The three previous cases diagnosed in the United States were in Dallas.

    New York City Mayor Bill de Blasio said city health department detectives were retracing all the steps taken by Spencer, but said the doctor poses no threat to others and urged New Yorkers to stick with their daily routines.

    "We are, as always, looking at each individual contact," he said.

    Health officials emphasized that the virus is not airborne but is spread through direct contact with bodily fluids from an infected person who is showing symptoms.

    Three people who had close contact with Spencer were quarantined for observation. The doctor's fiancée was among them and was isolated at the same hospital, and all three were still healthy, officials said.

    U.S. stock markets shook off Ebola fears on Friday after paring gains late on Thursday following initial reports about Spencer's case.

    The worst Ebola outbreak on record has killed at least 4,877 people and perhaps as many as 15,000, predominantly in Liberia, Sierra Leone and Guinea, according to the World Health Organization (WHO).

    Spencer's case brought to nine the total number of people treated for Ebola in U.S. hospitals since August. Just two, the nurses who treated Liberian national Thomas Eric Duncan, contracted the virus in the United States. Duncan died on Oct. 8 at Texas Health Presbyterian Hospital in Dallas, where Pham and Vinson were infected.

    Officials told New Yorkers they were safe even though Spencer had ridden subways, taken a cab and visited a bowling alley in Brooklyn between his return from Guinea and the onset of symptoms. Authorities on Friday declared the bowling alley safe.

    New York state Governor Andrew Cuomo said that unlike in Dallas, where the two hospital nurses treating Duncan contracted the disease, New York officials had time to thoroughly prepare and drill for the possibility of a case emerging in the city.

    "From a public health point of view, I feel confident that we're doing everything that we should be doing, and we have the situation under control," Cuomo said.

    LEAVING THE HOSPITAL

    Pham, who was transferred to the U.S. National Institutes of Health Clinical Center in Bethesda, Maryland, from the Dallas hospital on Oct. 16, appeared at a news briefing and thanked her doctors.

    Looking fit in a dark blazer and a turquoise blouse, Pham said that even though she no longer is infected, "I know that it may be a while before I have my strength back." She said she looked forward to seeing her family and her dog.

    White House spokesman Josh Earnest said Obama brought Pham in for a meeting to recognize her for doing her job at the Dallas hospital. Earnest said, "I think this also should be a pretty apt reminder that we do have the best medical infrastructure in the world."

    Photographs of the meeting showed Obama hugging Pham. Reporters and television cameras were not allowed in for the meeting.

    Dr. Anthony Fauci, director of the NIH's National Institute of Allergy and Infectious Diseases, said he could not pinpoint any one factor that contributed to Pham's speedy recovery. He said it could be any of a number of factors, including the fact that "she's young and very healthy" and was able to get intensive care very quickly.

    Pham received donated blood plasma from Dr. Kent Brantly, who contracted Ebola working in Liberia for a Christian relief group and survived after being treated with an experimental drug. Brantly was released from a hospital in August.

    It is believed that antibodies that fight the virus in the blood of Ebola survivors can help other patients fight it, too. Pham made a point of thanking Brantly upon her release.

    Cuomo said Spencer checked into the hospital when he realized he had a temperature of 100.3 degrees Fahrenheit, suggesting he may have caught the onset of symptoms early.

  • Two doctor visits a year linked to better blood pressure control

    By Shereen Lehman

    NEW YORK (Reuters Health) - People who went to their doctor's office at least twice a year were more likely to keep their blood pressure under control compared to those who went once a year or not at all, says a new study.

    Having health insurance and following treatment for high cholesterol were also linked to better blood pressure control.

    "Folks that go to the doctor at least twice a year are more likely to be aware of their blood pressure, more likely to be treated, more likely to be controlled when treated and have significantly better control rates," Dr. Brent Egan, who led the study, told Reuters Health.

    "People with uncontrolled high blood pressure have a greater risk for having a stroke, having a heart attack, having heart failure and even memory loss without having a stroke," said Egan, of University of South Carolina School of Medicine in Greenville.

    He added that most people may not be aware of the fact that memory loss with aging is greater in people who have high blood pressure that's uncontrolled.

    "So there are number of reasons why it's a good thing to get the blood pressure control," said Egan, who is also medical director of the non-profit Care Coordination Institute.

    About one of every three Americans has high blood pressure, which is defined as having a reading above 140/90 mmHg. Only about half of adults with high blood pressure have it under control, the study team writes in the journal Circulation.

    A national health promotion and disease prevention initiative called Healthy Living 2020 established goals to reduce the rate of high blood pressure in the U.S. from 30 percent of all adults to 27 percent, and to increase the rate of blood pressure control to greater than 60 percent of people with high blood pressure.

    Egan and his colleagues designed the study to see how those goals are coming along. They looked at data on participants in the annual National Health and Nutrition Examination Survey who had their blood pressure checked during the period from 1999 to 2012.

    The researchers found that people who were obese, didn't have insurance and didn't see their doctors were more likely to have untreated high blood pressure.

    Egan and his team also examined what factors were associated with good blood pressure control.

    "One of the things we were looking at in this analysis was some of the modifiable variables that might, if we paid more attention to them, might help move us towards the goal," Egan said.

    The study team discovered that people who saw their doctors at least two times a year were more than three times more likely to get their blood pressure under control as those who saw a doctor less often.

    People with health insurance were about 70 percent more likely than those without it to have their blood pressure controlled.

    In addition, people who had high blood pressure and were being treated for high cholesterol were almost twice as likely to have their blood pressure under control.

    "Many people, in fact the majority of people with high blood pressure, also have a cholesterol problem," Egan said. "What our data shows is that if they're also being treated for the cholesterol they're more likely to get their blood pressure under control."

    Egan said that when doctors control both high blood pressure and cholesterol, "we reduce heart disease and stroke by about 60 percent; if we treat only one we reduce it by about 30 percent, so it's a really good idea to get both treated."

    Egan also said he thinks the Healthy Americans 2020 target of 61.2 percent, or a little over three out of every five people, with high blood pressure being controlled is an excellent goal.

    "Right now we're 10 percent below the goal and it looks like we've pretty much stabilized for the last six to seven years, and so it's clearly going to require some new efforts to get another round of progress," Egan said

    "It's sort of what we've known for years, that about a third of Americans are hypertensive and hypertension correlates with obesity," Dr. Ronald Wharton told Reuters Health.

    "Patients who tend to go to the doctor more are going to be in tune with their health and be more likely to take their health seriously," said Wharton, a cardiologist with Montefiore Medical Center in New York who wasn't involved in the study.

    Wharton said that obesity, cholesterol problems, hypertension and diabetes are not "independent parameters" - they're all interrelated.

    "When people take care of one problem, they're really taking care of multiple problems at the same time," Wharton said.

    But, "the data says we've come a long way and we've got a long way to go," Wharton added.

    "What we're facing in healthcare with obesity and hypertension, diabetes and all the ramifications is going to put an expense on the healthcare system that's going to make smoking-related illnesses look like a drop of sand on the beach," Wharton said.

    Egan said that cardiovascular disease is projected to increase healthcare costs tremendously over the next 15 years or so, roughly doubling the current cost.

    "Treating hypertension certainly is one of the ways to reduce that health burden," he said.

    SOURCE: http://bit.ly/1t48i9Y Circulation, online October 20, 2014.

  • REFILE-Giving pricey hepatitis drug to prisoners may be financially wise

    (Revises para 23 to clarify quote.)

    By Andrew M. Seaman

    NEW YORK (Reuters Health) - When prisoners have hepatitis C, treating them with expensive new antiviral drugs makes fiscal sense despite the hefty pricetag, according to a new study.

    Based on computer models, new pricey drug combinations that treat hepatitis C infections were more cost-effective than older drug combinations and no treatment at all, researchers found.

    "Essentially what our model does is follow a hypothetical cohort of prisoners that looks like a prison population in the U.S.," Jeremy Goldhaber-Fiebert told Reuters Health.

    "It allows us to ask a variety of 'what-if' questions and probe how sensitive our findings are to various factors," said Goldhaber-Fiebert, the study's senior author from Stanford University in California.

    Hepatitis C is a viral infection of the liver that is typically transmitted when the blood of an infected person enters the body of a healthy person. (Most commonly, this happens when people share needles, syringes, or other equipment to inject drugs - but before 1992 hepatitis C was also transmitted by blood transfusions.)

    When people are first infected, the symptoms can include fever, nausea, stomach and joint pain, dark urine, vomiting and a yellowing of the skin and eyes.

    If left untreated, hepatitis C can slowly, over years or decades, lead to liver damage, liver failure, liver cancer, and a need for liver transplant, according to the Centers for Disease Control and Prevention (CDC). It may also lead to death.

    The CDC says about 3.2 million people in the U.S. are infected with the chronic disease. Goldhaber-Fiebert and his colleagues write in Annals of Internal Medicine that about 500,000 incarcerated people have hepatitis C.

    Until recently, the virus was treated with a combination of drugs that had to be taken for about a year and caused people to have flu-like symptoms. The treatment was only effective in a minority of patients.

    The U.S. Food and Drug Administration (FDA) approved Merck's Victrelis, which is known generically as boceprevir, in 2011 to be added to the existing combination of drugs. The new combination made the treatment more effective - and more expensive (see Reuters story of May 13, 2011 here: http://reut.rs/1yg9GGm).

    Then, the FDA approved Gilead's Sovaldi, which is known generically as sofosbuvir, in 2013. The drug is taken for 12 weeks and cures a majority of patients but comes with a price tag of $84,000 (see Reuters story of December 6, 2013 here: http://reut.rs/1ygcAuT).

    Insurers have pushed back against the price of the new medication (see Reuters story of May 20, 2014 here: http://reut.rs/1ygfGPx).

    To examine benefits and costs associated with hepatitis C treatment among the U.S. prison population, the researchers used a computer model. They compared prisoners who received 12 weeks of Sovaldi plus the original drug combination, prisoners who received 28 weeks of Victrelis plus the original drug combination and prisoners who did not receive treatment.

    They examined costs of treatment in terms of quality-adjusted life years (QALY), which is the amount of time in good health that inmates could gain from the treatment.

    Overall, they found the combination of Sovaldi and the original drugs added 2.1 QALYs at a cost of about $54,000, compared to no treatment.

    The combination including Sovaldi cost about $25,700 per QALY gained among prisoners serving short sentences and about $28,800 per QALY gained among those serving long sentences. The difference in cost can be partially attributed to various factors, including the increased risk of reinfection among people still in prison, Goldhaber-Fiebert said.

    In either case, he and his colleagues found Sovaldi combination of drugs to be less expensive per QALY than the Victrelis combination.

    However, there are other challenges when choosing a hepatitis C treatment for prisoners, the researchers write.

    For example, treating U.S. prisoners infected with hepatitis C with the Sovaldi combination may come at an upfront cost exceeding $30 billion to the prison systems. The cost benefits may not be realized until the prisoners are released on another healthcare system like Medicaid, which is government-run insurance for the poor.

    "Most people in will be out," said Dr. Anne Spaulding. "We're looking at a disease that will take 30 years to progress. A lot of hepatitis C that we're not treating in the prison will end up being very costly not just for patients who are on Medicaid, but patients who do not have Medicaid who present to emergency rooms. Someone will have to pay."

    Spaulding, who wasn't involved with the new study, is an expert on hepatitis C infections among U.S. prisoners. She's an assistant professor at Emory University's Rollins School of Public Health in Atlanta.

    The U.S. Federal Bureau of Prisons currently recommends Sovaldi for many prisoners with hepatitis C infections.

    "I think the key message would be to those who control state budgets," said Spaulding. "There are benefits to considering the health of people returning to the community. There are benefits to treating hepatitis C while they're incarcerated."

    "The group that can have the most affect on increasing the new infections of hepatitis C is actually the injection drug users," she said. "If you can get rid of the hepatitis C while they're in prison, they can't spread hepatitis C when they're in the community."

    "It's a message that needs to go to the decision makers who control the purse strings," she said, adding that this is especially true for people who control state budgets.

    Goldhaber-Fiebert said prisons and jails in the U.S. should give careful consideration to the hepatitis C treatment for the population that they provide services to.

    "High-cost treatments can also be high-value if they deliver substantial enough value," he said.

    SOURCE: http://bit.ly/1zjAkCK Annals of Internal Medicine, online October 20, 2014.

  • REFILE-Giving pricey hepatitis drug to prisoners may be financially wise

    (Revises para 23 to clarify quote.)

    By Andrew M. Seaman

    NEW YORK (Reuters Health) - When prisoners have hepatitis C, treating them with expensive new antiviral drugs makes fiscal sense despite the hefty pricetag, according to a new study.

    Based on computer models, new pricey drug combinations that treat hepatitis C infections were more cost-effective than older drug combinations and no treatment at all, researchers found.

    "Essentially what our model does is follow a hypothetical cohort of prisoners that looks like a prison population in the U.S.," Jeremy Goldhaber-Fiebert told Reuters Health.

    "It allows us to ask a variety of 'what-if' questions and probe how sensitive our findings are to various factors," said Goldhaber-Fiebert, the study's senior author from Stanford University in California.

    Hepatitis C is a viral infection of the liver that is typically transmitted when the blood of an infected person enters the body of a healthy person. (Most commonly, this happens when people share needles, syringes, or other equipment to inject drugs - but before 1992 hepatitis C was also transmitted by blood transfusions.)

    When people are first infected, the symptoms can include fever, nausea, stomach and joint pain, dark urine, vomiting and a yellowing of the skin and eyes.

    If left untreated, hepatitis C can slowly, over years or decades, lead to liver damage, liver failure, liver cancer, and a need for liver transplant, according to the Centers for Disease Control and Prevention (CDC). It may also lead to death.

    The CDC says about 3.2 million people in the U.S. are infected with the chronic disease. Goldhaber-Fiebert and his colleagues write in Annals of Internal Medicine that about 500,000 incarcerated people have hepatitis C.

    Until recently, the virus was treated with a combination of drugs that had to be taken for about a year and caused people to have flu-like symptoms. The treatment was only effective in a minority of patients.

    The U.S. Food and Drug Administration (FDA) approved Merck's Victrelis, which is known generically as boceprevir, in 2011 to be added to the existing combination of drugs. The new combination made the treatment more effective - and more expensive (see Reuters story of May 13, 2011 here: http://reut.rs/1yg9GGm).

    Then, the FDA approved Gilead's Sovaldi, which is known generically as sofosbuvir, in 2013. The drug is taken for 12 weeks and cures a majority of patients but comes with a price tag of $84,000 (see Reuters story of December 6, 2013 here: http://reut.rs/1ygcAuT).

    Insurers have pushed back against the price of the new medication (see Reuters story of May 20, 2014 here: http://reut.rs/1ygfGPx).

    To examine benefits and costs associated with hepatitis C treatment among the U.S. prison population, the researchers used a computer model. They compared prisoners who received 12 weeks of Sovaldi plus the original drug combination, prisoners who received 28 weeks of Victrelis plus the original drug combination and prisoners who did not receive treatment.

    They examined costs of treatment in terms of quality-adjusted life years (QALY), which is the amount of time in good health that inmates could gain from the treatment.

    Overall, they found the combination of Sovaldi and the original drugs added 2.1 QALYs at a cost of about $54,000, compared to no treatment.

    The combination including Sovaldi cost about $25,700 per QALY gained among prisoners serving short sentences and about $28,800 per QALY gained among those serving long sentences. The difference in cost can be partially attributed to various factors, including the increased risk of reinfection among people still in prison, Goldhaber-Fiebert said.

    In either case, he and his colleagues found Sovaldi combination of drugs to be less expensive per QALY than the Victrelis combination.

    However, there are other challenges when choosing a hepatitis C treatment for prisoners, the researchers write.

    For example, treating U.S. prisoners infected with hepatitis C with the Sovaldi combination may come at an upfront cost exceeding $30 billion to the prison systems. The cost benefits may not be realized until the prisoners are released on another healthcare system like Medicaid, which is government-run insurance for the poor.

    "Most people in will be out," said Dr. Anne Spaulding. "We're looking at a disease that will take 30 years to progress. A lot of hepatitis C that we're not treating in the prison will end up being very costly not just for patients who are on Medicaid, but patients who do not have Medicaid who present to emergency rooms. Someone will have to pay."

    Spaulding, who wasn't involved with the new study, is an expert on hepatitis C infections among U.S. prisoners. She's an assistant professor at Emory University's Rollins School of Public Health in Atlanta.

    The U.S. Federal Bureau of Prisons currently recommends Sovaldi for many prisoners with hepatitis C infections.

    "I think the key message would be to those who control state budgets," said Spaulding. "There are benefits to considering the health of people returning to the community. There are benefits to treating hepatitis C while they're incarcerated."

    "The group that can have the most affect on increasing the new infections of hepatitis C is actually the injection drug users," she said. "If you can get rid of the hepatitis C while they're in prison, they can't spread hepatitis C when they're in the community."

    "It's a message that needs to go to the decision makers who control the purse strings," she said, adding that this is especially true for people who control state budgets.

    Goldhaber-Fiebert said prisons and jails in the U.S. should give careful consideration to the hepatitis C treatment for the population that they provide services to.

    "High-cost treatments can also be high-value if they deliver substantial enough value," he said.

    SOURCE: http://bit.ly/1zjAkCK Annals of Internal Medicine, online October 20, 2014.

  • Petition calls on Roche to cut breast cancer drug price

    By Reuters Staff

    LONDON (Reuters) - A British-led petition signed by 29,000 people has demanded that Switzerland's Roche, the world's biggest maker of cancer medicines, cut the price of its expensive new breast cancer drug Kadcyla.

    The campaign shows the growing pressure on drug companies as a raft of promising new cancer treatments reach the market. U.S. insurers also say they are alarmed by a coming flood of cancer medicines with "astronomical price tags," while pricing rows have flared in France and Italy.

    Kadcyla can add about half a year to the lives of some women with inoperable breast cancer but Britain's cost watchdog NICE estimates it costs about 90,000 pounds ($145,000) per patient and is too pricey for the state-run health service.

    Roche argues the cost reflects the benefits offered by its innovative treatment. It also disputes the headline price cited by the National Institute for Health and Care Excellence (NICE).

    NICE bases its calculation on a mean treatment course of 14.5 months, whereas the median length of treatment in clinical trials -- the measure Roche believes is more relevant -- was 9.6 months, reducing the cost per patient significantly.

    The Care2 petition, calling on Roche Chief Executive Severin Schwan to reduce the price of Kadcyla to a level public health services can afford, was started by British breast cancer survivor Margaret Connolly.

    Kadcyla combines the antibody used in Roche's established Herceptin drug and a tumor-killing payload that is delivered directly into cancer cells, causing fewer chemotherapy-related side effects such as hair loss.

    It is one of a number of targeted therapies that are revolutionizing cancer care. Other promising new approaches include a range of drugs to help the immune system fight cancer, which also carry a high price.

Orthopedic Articles

  • Extra-depth shoes may help alleviate foot pain for older people

    By Kathryn Doyle

    NEW YORK (Reuters Health) - For adults over age 65 with disabling foot pain, being fitted for off-the-shelf extra-depth footwear reduced pain and improved function, according to a new study.

    This type of footwear is often marketed to people with diabetic foot ailments, for whom Medicare - the U.S. government health insurance program for people over 65 - will cover most of the cost of the shoes.

    The structure and function of the foot changes significantly with age regardless of diabetes status, said lead author Hylton B. Menz of the Lower Extremity and Gait Studies Program in the School of Allied Health at La Trobe University in Melbourne, Australia.

    "With advancing age, there is a general tendency for the foot to exhibit increased soft tissue stiffness, decreased range of motion, decreased strength, and a more pronated posture, and to function in a more pronated position with reduced range of motion and less efficient propulsion when walking," Menz told Reuters Health by email.

    A pronated foot has more weight on the inside edge of the foot, rather than evenly distributed, which can give the appearance of the ankles bending slightly toward each other.

    In addition, many older people wear ill-fitting shoes that don't accommodate the changed shape of their feet, he said.

    He and his coauthors had 120 men and women over age 65 with disabling foot pain answer a Foot Health Status Questionnaire and then divided them into two groups.

    Those in the first group were individually fitted for extra-depth shoes, while those in the second group waited until the end of the study four months later to receive their shoes. Everyone continued to receive regular podiatry care.

    Dr. Comfort, Orthofeet and Apis brand extra-depth shoes like those used in the study are available from online retailers in the U.S. for between $100 and $200 per pair.

    The extra-depth footwear group were more likely to report their foot pain had moderately or markedly improved over the four month period and developed fewer keratotic lesions, like corns or calluses, than the comparison group.

    Corns and calluses are common for older people; treating them accounts for up to 75 percent of a podiatrist's workload, Menz said.

    When the participants took the foot health questionnaire again, the special footwear group scored 11 points better for pain and 10 points better for function than the comparison group, according to the results in the Journal of Gerontology: Medical Sciences.

    Patients considered that a worthwhile improvement, Menz said. And, surprisingly, it didn't matter what the underlying cause of the foot pain was: extra-depth shoes seemed to help everyone who wore them.

    "Many older people wear ill-fitting shoes, and we know that ill-fitting shoes are associated with foot problems," he said.

    Regular footwear is generally too shallow and narrow to accommodate bunions, hammertoes and clawtoes, so the friction that develops within the shoe leads to pain and reduced function, he said.

    "Well-fitting footwear will prevent shoes pressing or rubbing against the sensitive areas of the foot including joints that have become arthritic," said Professor Wesley Vernon, head of Podiatry Services and Research Lead at Jordanthorpe Health Centre in Sheffield, UK, who was not part of the new study.

    Many patients may be reluctant to switch to "medical" footwear because of its appearance, the experts noted.

    "Some research has shown that people, particularly women, don't like the look of this extra deep and extra wide footwear and this is not age dependent," said Anita Williams, senior lecturer in the School of Health Sciences at the University of Salford in the UK.

    In her experience, many women prefer to wear pumps, she told Reuters Health by email.

    Aside from trying new shoes, maintaining a healthy body mass index may help alleviate or prevent foot pain, Menz said.

    "It is also important that older people with foot pain consult a podiatrist, particularly if they have diabetes or changing footwear does not alleviate symptoms," he said.

    SOURCE: http://bit.ly/1mUS1CV Journal of Gerontology: Medical Sciences, online September 9, 2014.

  • Extra-depth shoes may help alleviate foot pain for older people

    By Kathryn Doyle

    NEW YORK (Reuters Health) - For adults over age 65 with disabling foot pain, being fitted for off-the-shelf extra-depth footwear reduced pain and improved function, according to a new study.

    This type of footwear is often marketed to people with diabetic foot ailments, for whom Medicare - the U.S. government health insurance program for people over 65 - will cover most of the cost of the shoes.

    The structure and function of the foot changes significantly with age regardless of diabetes status, said lead author Hylton B. Menz of the Lower Extremity and Gait Studies Program in the School of Allied Health at La Trobe University in Melbourne, Australia.

    "With advancing age, there is a general tendency for the foot to exhibit increased soft tissue stiffness, decreased range of motion, decreased strength, and a more pronated posture, and to function in a more pronated position with reduced range of motion and less efficient propulsion when walking," Menz told Reuters Health by email.

    A pronated foot has more weight on the inside edge of the foot, rather than evenly distributed, which can give the appearance of the ankles bending slightly toward each other.

    In addition, many older people wear ill-fitting shoes that don't accommodate the changed shape of their feet, he said.

    He and his coauthors had 120 men and women over age 65 with disabling foot pain answer a Foot Health Status Questionnaire and then divided them into two groups.

    Those in the first group were individually fitted for extra-depth shoes, while those in the second group waited until the end of the study four months later to receive their shoes. Everyone continued to receive regular podiatry care.

    Dr. Comfort, Orthofeet and Apis brand extra-depth shoes like those used in the study are available from online retailers in the U.S. for between $100 and $200 per pair.

    The extra-depth footwear group were more likely to report their foot pain had moderately or markedly improved over the four month period and developed fewer keratotic lesions, like corns or calluses, than the comparison group.

    Corns and calluses are common for older people; treating them accounts for up to 75 percent of a podiatrist's workload, Menz said.

    When the participants took the foot health questionnaire again, the special footwear group scored 11 points better for pain and 10 points better for function than the comparison group, according to the results in the Journal of Gerontology: Medical Sciences.

    Patients considered that a worthwhile improvement, Menz said. And, surprisingly, it didn't matter what the underlying cause of the foot pain was: extra-depth shoes seemed to help everyone who wore them.

    "Many older people wear ill-fitting shoes, and we know that ill-fitting shoes are associated with foot problems," he said.

    Regular footwear is generally too shallow and narrow to accommodate bunions, hammertoes and clawtoes, so the friction that develops within the shoe leads to pain and reduced function, he said.

    "Well-fitting footwear will prevent shoes pressing or rubbing against the sensitive areas of the foot including joints that have become arthritic," said Professor Wesley Vernon, head of Podiatry Services and Research Lead at Jordanthorpe Health Centre in Sheffield, UK, who was not part of the new study.

    Many patients may be reluctant to switch to "medical" footwear because of its appearance, the experts noted.

    "Some research has shown that people, particularly women, don't like the look of this extra deep and extra wide footwear and this is not age dependent," said Anita Williams, senior lecturer in the School of Health Sciences at the University of Salford in the UK.

    In her experience, many women prefer to wear pumps, she told Reuters Health by email.

    Aside from trying new shoes, maintaining a healthy body mass index may help alleviate or prevent foot pain, Menz said.

    "It is also important that older people with foot pain consult a podiatrist, particularly if they have diabetes or changing footwear does not alleviate symptoms," he said.

    SOURCE: http://bit.ly/1mUS1CV Journal of Gerontology: Medical Sciences, online September 9, 2014.

  • Extra-depth shoes may help alleviate foot pain for older people

    By Kathryn Doyle

    NEW YORK (Reuters Health) - For adults over age 65 with disabling foot pain, being fitted for off-the-shelf extra-depth footwear reduced pain and improved function, according to a new study.

    This type of footwear is often marketed to people with diabetic foot ailments, for whom Medicare - the U.S. government health insurance program for people over 65 - will cover most of the cost of the shoes.

    The structure and function of the foot changes significantly with age regardless of diabetes status, said lead author Hylton B. Menz of the Lower Extremity and Gait Studies Program in the School of Allied Health at La Trobe University in Melbourne, Australia.

    "With advancing age, there is a general tendency for the foot to exhibit increased soft tissue stiffness, decreased range of motion, decreased strength, and a more pronated posture, and to function in a more pronated position with reduced range of motion and less efficient propulsion when walking," Menz told Reuters Health by email.

    A pronated foot has more weight on the inside edge of the foot, rather than evenly distributed, which can give the appearance of the ankles bending slightly toward each other.

    In addition, many older people wear ill-fitting shoes that don't accommodate the changed shape of their feet, he said.

    He and his coauthors had 120 men and women over age 65 with disabling foot pain answer a Foot Health Status Questionnaire and then divided them into two groups.

    Those in the first group were individually fitted for extra-depth shoes, while those in the second group waited until the end of the study four months later to receive their shoes. Everyone continued to receive regular podiatry care.

    Dr. Comfort, Orthofeet and Apis brand extra-depth shoes like those used in the study are available from online retailers in the U.S. for between $100 and $200 per pair.

    The extra-depth footwear group were more likely to report their foot pain had moderately or markedly improved over the four month period and developed fewer keratotic lesions, like corns or calluses, than the comparison group.

    Corns and calluses are common for older people; treating them accounts for up to 75 percent of a podiatrist's workload, Menz said.

    When the participants took the foot health questionnaire again, the special footwear group scored 11 points better for pain and 10 points better for function than the comparison group, according to the results in the Journal of Gerontology: Medical Sciences.

    Patients considered that a worthwhile improvement, Menz said. And, surprisingly, it didn't matter what the underlying cause of the foot pain was: extra-depth shoes seemed to help everyone who wore them.

    "Many older people wear ill-fitting shoes, and we know that ill-fitting shoes are associated with foot problems," he said.

    Regular footwear is generally too shallow and narrow to accommodate bunions, hammertoes and clawtoes, so the friction that develops within the shoe leads to pain and reduced function, he said.

    "Well-fitting footwear will prevent shoes pressing or rubbing against the sensitive areas of the foot including joints that have become arthritic," said Professor Wesley Vernon, head of Podiatry Services and Research Lead at Jordanthorpe Health Centre in Sheffield, UK, who was not part of the new study.

    Many patients may be reluctant to switch to "medical" footwear because of its appearance, the experts noted.

    "Some research has shown that people, particularly women, don't like the look of this extra deep and extra wide footwear and this is not age dependent," said Anita Williams, senior lecturer in the School of Health Sciences at the University of Salford in the UK.

    In her experience, many women prefer to wear pumps, she told Reuters Health by email.

    Aside from trying new shoes, maintaining a healthy body mass index may help alleviate or prevent foot pain, Menz said.

    "It is also important that older people with foot pain consult a podiatrist, particularly if they have diabetes or changing footwear does not alleviate symptoms," he said.

    SOURCE: http://bit.ly/1mUS1CV Journal of Gerontology: Medical Sciences, online September 9, 2014.

Transplant Articles

  • Hospital patients rarely wash their hands, may spread disease

    By Madeline Kennedy

    NEW YORK (Reuters Health) - Although healthcare workers are urged to wash their hands often and hand sanitizer dispensers are everywhere in hospitals, patients are less scrupulous and may be contributing to the spread of hospital-acquired infections, say Canadian researchers.

    After tracking hundreds of patients in a transplant ward for nearly a year, the study team found that hand washing followed less than a third of bathroom visits, and washing or hand-sanitizer use happened only rarely after patients entered or left a room.

    "We know that certain infections can be spread on people's hands, and hand washing is an important way to prevent those infections," said the study's lead author, Dr. Jocelyn Srigley, associate medical director of infection prevention and control at Hamilton Health Sciences in Hamilton, Ontario.

    One in 25 hospital patients has at least one infection contracted at the hospital at any given time, according to the U.S. Centers for Disease Control and Prevention. The CDC estimates there were 722,000 cases of hospital-acquired infection in 2011, many of them serious or even life-threatening.

    The role of healthcare workers in transferring infectious microbes from place to place and person to person in hospitals has been well-studied, and staff are trained to take measures to avoid spreading infections.

    But just two previous studies have looked at the potential for patients to spread infections in hospitals, to others and themselves, Srigley and her colleagues write in the journal Infection Control and Hospital Epidemiology.

    The Canadian study team tracked 279 adult patients in a multiorgan transplant ward using tags attached to hospital ID bracelets that sent out ultrasound signals. Wireless receivers were installed throughout the ward to pick up the signals and track each patient's location. The system also detected every time a soap or hand sanitizer dispenser was used.

    They found that patients washed their hands about 30 percent of the time during bathroom visits, 40 percent of the time during mealtimes, 3 percent of the time while using kitchens on the wards, 3 percent of the time when entering their own rooms and 7 percent when exiting their room.

    Women washed their hands more often than men, and were more likely than men to use soap when they did. All patients were more likely to wash their hands later in the day than in the morning.

    Among 1,122 visits by 97 patients to the ward's two kitchens, only 3 percent involved hand hygiene and less than one percent involved soap.

    The researchers point to a previous study that found requiring patients to disinfect their hands four times a day significantly reduced the number of respiratory and gastrointestinal disease outbreaks in a psychiatric ward.

    Srigley noted that the ultrasound observation system was not perfect and one limitation was that it, "didn't know exactly what a patient was doing in the bathroom or when they were eating, so we don't know for sure that a patient should have washed their hands at that time."

    In addition, "not all patients agreed to wear the system tags so we don't know if the ones who wore the tags are reflective of all patients," Srigley said.

    Despite these limitations, the new technology used in the study eliminated the problem of people changing their behavior when they know they're being watched, said Dr. Yuen Kwok-yung, chair of Microbiology at the University of Hong Kong.

    Kwok-yung told Reuters Health by email, "The findings will provide important data for the formulation of hand hygiene policy."

    Srigley feels that hospitals should encourage patients to wash their hands at certain times, but she is not yet sure what would be the most effective method.

    Possibilities include "putting up posters, having someone talk to patients about hand washing, providing hand sanitizer or alcohol wipes at the bedside, etc.," she said, adding that more research is necessary to determine the most effective method.

    "The key message is that hand washing is an important way for people to protect themselves and prevent infections, whether they're in the hospital, at home, at work, or anywhere else," she said. "Especially with influenza season coming up soon, hand washing can help to keep us all healthy."

    SOURCE: http://bit.ly/1CnI4zB Infection Control and Hospital Epidemiology, Online October 2, 2014.

  • Cell transplant helps paralyzed man walk with frame

    By Kate Kelland

    LONDON (Reuters) - A Polish man who was paralyzed from the chest down in a knife attack can now walk with the aid of a frame after receiving pioneering transplant treatment using cells from his nose.

    The technique, described as a breakthrough by a study in the journal Cell Transplantation, involved transplanting what are known as olfactory ensheathing cells into the patient's spinal cord and constructing a "nerve bridge" between two stumps of the damaged spinal column.

    "We believe... this procedure is the breakthrough which, as it is further developed, will result in a historic change in the currently hopeless outlook for people disabled by spinal cord injury," said Geoffrey Raisman, a professor at University College London's (UCL) institute of neurology, who led the research.

    The 38-year-old patient, Darek Fidyka, was paralyzed after suffering stab wounds to his back in 2010. Following 19 months of treatment, he has recovered some voluntary movement and some sensation in his legs, his medics said.

    The Nicholls Spinal Injury Foundation, a British-based charity which part-funded the research, said in statement that Fidyka was continuing to improve more than predicted, and was now able to drive and live more independently.

    Raisman, a UCL spinal injury specialist, worked with surgeons at Wroclaw University Hospital in Poland to remove one of Fidyka's olfactory bulbs, which give people their sense of smell, and transplant his olfactory ensheathing cells (OECs) and olfactory nerve fibroblasts (ONFs) into the damaged area.

    They used a nerve bridge constructed between the two stumps of the damage spinal column, they said in the study.

    OECs are a type of cell found in both the peripheral and central nervous system. Together with ONFs, they make bundles of nerve fiberes that run from the nasal mucosa to the olfactory bulb, where the sense of smell is located.

    When the nerve fibers that carry smell become damaged, they are replaced by new nerve fibers that re-enter the olfactory bulbs, the researchers explained in their study.

    OECs help this process by re-opening the surface of the bulbs for the new nerve fibers to enter - leading Raisman and his team to believe transplanting OECs into the damaged spinal cord could enable severed nerve fibers to re-grow.

    Raisman added that the technique of bridging the spinal cord with nerve grafts from the patient had been used in animal studies for years, but never before in combination with OECs.

    "The OECs and the ONFs appeared to work together, but the mechanism between their interaction is still unclear," he said in a statement about the work.

    Experts not directly involved in the work said its results offered some new hope, but said more work needed to be done to figure out what had led to this success, and more patients treated, before its potential could be properly assessed.

    "While this study is only in one patient, it provides hope of a possible treatment for restoration of some function in individuals with complete spinal cord injury," said John Sladek, a professor of neurology and pediatrics at the University of Colorado School of Medicine in the United States.

    Raisman and his team now plan to repeat the treatment technique in between three and five patients over the next three to five years. "This will enable a gradual optimization of the procedures," he told Reuters.

    SOURCE: http://bit.ly/ZMtGV6 Cell Transplantation, online October 21, 2014.

  • REFILE-Giving pricey hepatitis drug to prisoners may be financially wise

    (Revises para 23 to clarify quote.)

    By Andrew M. Seaman

    NEW YORK (Reuters Health) - When prisoners have hepatitis C, treating them with expensive new antiviral drugs makes fiscal sense despite the hefty pricetag, according to a new study.

    Based on computer models, new pricey drug combinations that treat hepatitis C infections were more cost-effective than older drug combinations and no treatment at all, researchers found.

    "Essentially what our model does is follow a hypothetical cohort of prisoners that looks like a prison population in the U.S.," Jeremy Goldhaber-Fiebert told Reuters Health.

    "It allows us to ask a variety of 'what-if' questions and probe how sensitive our findings are to various factors," said Goldhaber-Fiebert, the study's senior author from Stanford University in California.

    Hepatitis C is a viral infection of the liver that is typically transmitted when the blood of an infected person enters the body of a healthy person. (Most commonly, this happens when people share needles, syringes, or other equipment to inject drugs - but before 1992 hepatitis C was also transmitted by blood transfusions.)

    When people are first infected, the symptoms can include fever, nausea, stomach and joint pain, dark urine, vomiting and a yellowing of the skin and eyes.

    If left untreated, hepatitis C can slowly, over years or decades, lead to liver damage, liver failure, liver cancer, and a need for liver transplant, according to the Centers for Disease Control and Prevention (CDC). It may also lead to death.

    The CDC says about 3.2 million people in the U.S. are infected with the chronic disease. Goldhaber-Fiebert and his colleagues write in Annals of Internal Medicine that about 500,000 incarcerated people have hepatitis C.

    Until recently, the virus was treated with a combination of drugs that had to be taken for about a year and caused people to have flu-like symptoms. The treatment was only effective in a minority of patients.

    The U.S. Food and Drug Administration (FDA) approved Merck's Victrelis, which is known generically as boceprevir, in 2011 to be added to the existing combination of drugs. The new combination made the treatment more effective - and more expensive (see Reuters story of May 13, 2011 here: http://reut.rs/1yg9GGm).

    Then, the FDA approved Gilead's Sovaldi, which is known generically as sofosbuvir, in 2013. The drug is taken for 12 weeks and cures a majority of patients but comes with a price tag of $84,000 (see Reuters story of December 6, 2013 here: http://reut.rs/1ygcAuT).

    Insurers have pushed back against the price of the new medication (see Reuters story of May 20, 2014 here: http://reut.rs/1ygfGPx).

    To examine benefits and costs associated with hepatitis C treatment among the U.S. prison population, the researchers used a computer model. They compared prisoners who received 12 weeks of Sovaldi plus the original drug combination, prisoners who received 28 weeks of Victrelis plus the original drug combination and prisoners who did not receive treatment.

    They examined costs of treatment in terms of quality-adjusted life years (QALY), which is the amount of time in good health that inmates could gain from the treatment.

    Overall, they found the combination of Sovaldi and the original drugs added 2.1 QALYs at a cost of about $54,000, compared to no treatment.

    The combination including Sovaldi cost about $25,700 per QALY gained among prisoners serving short sentences and about $28,800 per QALY gained among those serving long sentences. The difference in cost can be partially attributed to various factors, including the increased risk of reinfection among people still in prison, Goldhaber-Fiebert said.

    In either case, he and his colleagues found Sovaldi combination of drugs to be less expensive per QALY than the Victrelis combination.

    However, there are other challenges when choosing a hepatitis C treatment for prisoners, the researchers write.

    For example, treating U.S. prisoners infected with hepatitis C with the Sovaldi combination may come at an upfront cost exceeding $30 billion to the prison systems. The cost benefits may not be realized until the prisoners are released on another healthcare system like Medicaid, which is government-run insurance for the poor.

    "Most people in will be out," said Dr. Anne Spaulding. "We're looking at a disease that will take 30 years to progress. A lot of hepatitis C that we're not treating in the prison will end up being very costly not just for patients who are on Medicaid, but patients who do not have Medicaid who present to emergency rooms. Someone will have to pay."

    Spaulding, who wasn't involved with the new study, is an expert on hepatitis C infections among U.S. prisoners. She's an assistant professor at Emory University's Rollins School of Public Health in Atlanta.

    The U.S. Federal Bureau of Prisons currently recommends Sovaldi for many prisoners with hepatitis C infections.

    "I think the key message would be to those who control state budgets," said Spaulding. "There are benefits to considering the health of people returning to the community. There are benefits to treating hepatitis C while they're incarcerated."

    "The group that can have the most affect on increasing the new infections of hepatitis C is actually the injection drug users," she said. "If you can get rid of the hepatitis C while they're in prison, they can't spread hepatitis C when they're in the community."

    "It's a message that needs to go to the decision makers who control the purse strings," she said, adding that this is especially true for people who control state budgets.

    Goldhaber-Fiebert said prisons and jails in the U.S. should give careful consideration to the hepatitis C treatment for the population that they provide services to.

    "High-cost treatments can also be high-value if they deliver substantial enough value," he said.

    SOURCE: http://bit.ly/1zjAkCK Annals of Internal Medicine, online October 20, 2014.

  • REFILE-Giving pricey hepatitis drug to prisoners may be financially wise

    (Revises para 23 to clarify quote.)

    By Andrew M. Seaman

    NEW YORK (Reuters Health) - When prisoners have hepatitis C, treating them with expensive new antiviral drugs makes fiscal sense despite the hefty pricetag, according to a new study.

    Based on computer models, new pricey drug combinations that treat hepatitis C infections were more cost-effective than older drug combinations and no treatment at all, researchers found.

    "Essentially what our model does is follow a hypothetical cohort of prisoners that looks like a prison population in the U.S.," Jeremy Goldhaber-Fiebert told Reuters Health.

    "It allows us to ask a variety of 'what-if' questions and probe how sensitive our findings are to various factors," said Goldhaber-Fiebert, the study's senior author from Stanford University in California.

    Hepatitis C is a viral infection of the liver that is typically transmitted when the blood of an infected person enters the body of a healthy person. (Most commonly, this happens when people share needles, syringes, or other equipment to inject drugs - but before 1992 hepatitis C was also transmitted by blood transfusions.)

    When people are first infected, the symptoms can include fever, nausea, stomach and joint pain, dark urine, vomiting and a yellowing of the skin and eyes.

    If left untreated, hepatitis C can slowly, over years or decades, lead to liver damage, liver failure, liver cancer, and a need for liver transplant, according to the Centers for Disease Control and Prevention (CDC). It may also lead to death.

    The CDC says about 3.2 million people in the U.S. are infected with the chronic disease. Goldhaber-Fiebert and his colleagues write in Annals of Internal Medicine that about 500,000 incarcerated people have hepatitis C.

    Until recently, the virus was treated with a combination of drugs that had to be taken for about a year and caused people to have flu-like symptoms. The treatment was only effective in a minority of patients.

    The U.S. Food and Drug Administration (FDA) approved Merck's Victrelis, which is known generically as boceprevir, in 2011 to be added to the existing combination of drugs. The new combination made the treatment more effective - and more expensive (see Reuters story of May 13, 2011 here: http://reut.rs/1yg9GGm).

    Then, the FDA approved Gilead's Sovaldi, which is known generically as sofosbuvir, in 2013. The drug is taken for 12 weeks and cures a majority of patients but comes with a price tag of $84,000 (see Reuters story of December 6, 2013 here: http://reut.rs/1ygcAuT).

    Insurers have pushed back against the price of the new medication (see Reuters story of May 20, 2014 here: http://reut.rs/1ygfGPx).

    To examine benefits and costs associated with hepatitis C treatment among the U.S. prison population, the researchers used a computer model. They compared prisoners who received 12 weeks of Sovaldi plus the original drug combination, prisoners who received 28 weeks of Victrelis plus the original drug combination and prisoners who did not receive treatment.

    They examined costs of treatment in terms of quality-adjusted life years (QALY), which is the amount of time in good health that inmates could gain from the treatment.

    Overall, they found the combination of Sovaldi and the original drugs added 2.1 QALYs at a cost of about $54,000, compared to no treatment.

    The combination including Sovaldi cost about $25,700 per QALY gained among prisoners serving short sentences and about $28,800 per QALY gained among those serving long sentences. The difference in cost can be partially attributed to various factors, including the increased risk of reinfection among people still in prison, Goldhaber-Fiebert said.

    In either case, he and his colleagues found Sovaldi combination of drugs to be less expensive per QALY than the Victrelis combination.

    However, there are other challenges when choosing a hepatitis C treatment for prisoners, the researchers write.

    For example, treating U.S. prisoners infected with hepatitis C with the Sovaldi combination may come at an upfront cost exceeding $30 billion to the prison systems. The cost benefits may not be realized until the prisoners are released on another healthcare system like Medicaid, which is government-run insurance for the poor.

    "Most people in will be out," said Dr. Anne Spaulding. "We're looking at a disease that will take 30 years to progress. A lot of hepatitis C that we're not treating in the prison will end up being very costly not just for patients who are on Medicaid, but patients who do not have Medicaid who present to emergency rooms. Someone will have to pay."

    Spaulding, who wasn't involved with the new study, is an expert on hepatitis C infections among U.S. prisoners. She's an assistant professor at Emory University's Rollins School of Public Health in Atlanta.

    The U.S. Federal Bureau of Prisons currently recommends Sovaldi for many prisoners with hepatitis C infections.

    "I think the key message would be to those who control state budgets," said Spaulding. "There are benefits to considering the health of people returning to the community. There are benefits to treating hepatitis C while they're incarcerated."

    "The group that can have the most affect on increasing the new infections of hepatitis C is actually the injection drug users," she said. "If you can get rid of the hepatitis C while they're in prison, they can't spread hepatitis C when they're in the community."

    "It's a message that needs to go to the decision makers who control the purse strings," she said, adding that this is especially true for people who control state budgets.

    Goldhaber-Fiebert said prisons and jails in the U.S. should give careful consideration to the hepatitis C treatment for the population that they provide services to.

    "High-cost treatments can also be high-value if they deliver substantial enough value," he said.

    SOURCE: http://bit.ly/1zjAkCK Annals of Internal Medicine, online October 20, 2014.

Women’s Health Articles

  • CORRECTED-Oklahoma judge allows law banning abortion pills to take effect

    (Corrects name of group in third paragraph to Oklahoma Coalition for Reproductive Justice, not Oklahoma Coalition for Reproductive Services)

    By Heide Brandes

    OKLAHOMA CITY (Reuters) - An Oklahoma judge said on Wednesday he will allow a law that bans abortion-inducing drugs to take effect as planned on Nov. 1, over the objections of abortion rights advocates who said the measure is poor public health policy that could put women at risk.

    Oklahoma District Court Judge Robert Stuart turned down a request by abortion rights groups to halt the measure from taking effect. Stuart also allowed a provision that would limit liability claims against physicians due to the law.

    According to the lawsuit filed on behalf of Reproductive Services in Tulsa and the Oklahoma Coalition for Reproductive Justice this month, the measure would lead to increased use of surgically induced abortions for cases where drugs can be used.

    "This law is contrary to protecting women's health and will force doctors to use an outdated and less safe medical procedure," said Autumn Katz, staff attorney for the Center for Reproductive Rights.

    The defendants said the use of the drugs could cause harm to pregnant women because they can be used for procedures not approved by the U.S. Food and Drug Administration.

    Earlier this year, lawmakers in the heavily Republican state approved new restrictions on abortion clinics they said were aimed at protecting women's health, but abortion rights advocates said were actually intended to shut clinics.

  • Hospital patients rarely wash their hands, may spread disease

    By Madeline Kennedy

    NEW YORK (Reuters Health) - Although healthcare workers are urged to wash their hands often and hand sanitizer dispensers are everywhere in hospitals, patients are less scrupulous and may be contributing to the spread of hospital-acquired infections, say Canadian researchers.

    After tracking hundreds of patients in a transplant ward for nearly a year, the study team found that hand washing followed less than a third of bathroom visits, and washing or hand-sanitizer use happened only rarely after patients entered or left a room.

    "We know that certain infections can be spread on people's hands, and hand washing is an important way to prevent those infections," said the study's lead author, Dr. Jocelyn Srigley, associate medical director of infection prevention and control at Hamilton Health Sciences in Hamilton, Ontario.

    One in 25 hospital patients has at least one infection contracted at the hospital at any given time, according to the U.S. Centers for Disease Control and Prevention. The CDC estimates there were 722,000 cases of hospital-acquired infection in 2011, many of them serious or even life-threatening.

    The role of healthcare workers in transferring infectious microbes from place to place and person to person in hospitals has been well-studied, and staff are trained to take measures to avoid spreading infections.

    But just two previous studies have looked at the potential for patients to spread infections in hospitals, to others and themselves, Srigley and her colleagues write in the journal Infection Control and Hospital Epidemiology.

    The Canadian study team tracked 279 adult patients in a multiorgan transplant ward using tags attached to hospital ID bracelets that sent out ultrasound signals. Wireless receivers were installed throughout the ward to pick up the signals and track each patient's location. The system also detected every time a soap or hand sanitizer dispenser was used.

    They found that patients washed their hands about 30 percent of the time during bathroom visits, 40 percent of the time during mealtimes, 3 percent of the time while using kitchens on the wards, 3 percent of the time when entering their own rooms and 7 percent when exiting their room.

    Women washed their hands more often than men, and were more likely than men to use soap when they did. All patients were more likely to wash their hands later in the day than in the morning.

    Among 1,122 visits by 97 patients to the ward's two kitchens, only 3 percent involved hand hygiene and less than one percent involved soap.

    The researchers point to a previous study that found requiring patients to disinfect their hands four times a day significantly reduced the number of respiratory and gastrointestinal disease outbreaks in a psychiatric ward.

    Srigley noted that the ultrasound observation system was not perfect and one limitation was that it, "didn't know exactly what a patient was doing in the bathroom or when they were eating, so we don't know for sure that a patient should have washed their hands at that time."

    In addition, "not all patients agreed to wear the system tags so we don't know if the ones who wore the tags are reflective of all patients," Srigley said.

    Despite these limitations, the new technology used in the study eliminated the problem of people changing their behavior when they know they're being watched, said Dr. Yuen Kwok-yung, chair of Microbiology at the University of Hong Kong.

    Kwok-yung told Reuters Health by email, "The findings will provide important data for the formulation of hand hygiene policy."

    Srigley feels that hospitals should encourage patients to wash their hands at certain times, but she is not yet sure what would be the most effective method.

    Possibilities include "putting up posters, having someone talk to patients about hand washing, providing hand sanitizer or alcohol wipes at the bedside, etc.," she said, adding that more research is necessary to determine the most effective method.

    "The key message is that hand washing is an important way for people to protect themselves and prevent infections, whether they're in the hospital, at home, at work, or anywhere else," she said. "Especially with influenza season coming up soon, hand washing can help to keep us all healthy."

    SOURCE: http://bit.ly/1CnI4zB Infection Control and Hospital Epidemiology, Online October 2, 2014.

  • CORRECTED-Oklahoma judge allows law banning abortion pills to take effect

    (Corrects name of group in third paragraph to Oklahoma Coalition for Reproductive Justice, not Oklahoma Coalition for Reproductive Services)

    By Heide Brandes

    OKLAHOMA CITY (Reuters) - An Oklahoma judge said on Wednesday he will allow a law that bans abortion-inducing drugs to take effect as planned on Nov. 1, over the objections of abortion rights advocates who said the measure is poor public health policy that could put women at risk.

    Oklahoma District Court Judge Robert Stuart turned down a request by abortion rights groups to halt the measure from taking effect. Stuart also allowed a provision that would limit liability claims against physicians due to the law.

    According to the lawsuit filed on behalf of Reproductive Services in Tulsa and the Oklahoma Coalition for Reproductive Justice this month, the measure would lead to increased use of surgically induced abortions for cases where drugs can be used.

    "This law is contrary to protecting women's health and will force doctors to use an outdated and less safe medical procedure," said Autumn Katz, staff attorney for the Center for Reproductive Rights.

    The defendants said the use of the drugs could cause harm to pregnant women because they can be used for procedures not approved by the U.S. Food and Drug Administration.

    Earlier this year, lawmakers in the heavily Republican state approved new restrictions on abortion clinics they said were aimed at protecting women's health, but abortion rights advocates said were actually intended to shut clinics.

  • Recalled, drug-tainted supplements still available for purchase

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Long after the Food and Drug Administration (FDA) issued recalls for dietary supplements tainted with banned drugs, more than half of the tainted supplements were still available for purchase, a new study found.

    "There's no question that these supplements that contain pharmaceuticals are not allowed to be sold, there are clear cut laws," lead author Dr. Pieter A. Cohen told Reuters Health by phone.

    The FDA does have some loose regulatory power over supplements, which are categorized like a food, Cohen said.

    If a food manufacturer's product were tainted with salmonella, the tainted food would be recalled, the factory cleaned, and then manufacturing would continue, Cohen said. In the case of supplements, the FDA issues recalls for products tainted with dangerous pharmaceuticals, but without proper enforcement the tainted products remain on the market and some companies continue to produce more, he said.

    The FDA has identified more than 400 supplement brands tainted with pharmaceuticals, and issued a recall for 70 percent of the products.

    Cohen and his coauthors studied 27 of the 274 supplements the FDA recalled between 2009 and 2012, two-thirds of which were American-made. They bought the supplements from manufacturer websites at least eight months and up to four years after their FDA recall, then tested their chemical makeup.

    The researchers found that 18 of the 27 supplements they purchased still contained a pharmaceutical adulterant, according to results in JAMA.

    The supplements were marketed for sports enhancement, weight loss and sexual enhancement, among other things.

    Among the banned substances in the products were sibutramine, a weight loss drug linked to heart attack and stroke, and phenolphthalein, a laxative being removed from many markets due to a potential link to cancer.

    "Dietary supplement manufacturers and distributors are legally responsible for marketing a safe product that is not adulterated, and that complies with FDA's good manufacturing practice regulations for dietary supplements," the FDA told Reuters Health in a statement.

    But, the FDA warned, "The supply chain for these products is extremely fragmented; one product manufactured by an unknown company overseas may be sold by dozens of different distributors in the United States. The individuals and businesses selling these products generally are difficult to locate, operate out of residential homes, and distribute via internet, small stores, and mail. Products are shipped through the international mail facilities and are often misdeclared as unrelated goods to avoid detection. Even after recall and enforcement action against one major distributor, the product may continue to be widely sold."

    Many consumers don't realize how potent these pharmaceuticals are, Cohen said.

    "Responsible manufacturers and marketers of dietary supplements applaud strong enforcement measures by FDA to address illegal products that contain undisclosed, active pharmaceutical ingredients," Steve Mister, President and CEO of the Council for Responsible Nutrition in Washington, D.C., a dietary supplement trade association, wrote in a statement. "We have zero tolerance for this problem and welcome not only recalls, but also criminal enforcement against companies that put consumers at risk."

    Although the researchers found 27 of the 274 recalled supplements still available online from manufacturers, more may be available in shops or gas stations, where an earlier study showed most people purchase supplements, said Cohen, a professor of medicine at Harvard Medical School in Boston and an internist at the Cambridge Health Alliance.

    Also, a supplement manufacturer could easily rename its recalled product and start marketing it again without reformulation, and the FDA would have to go back and test the renamed product before issuing another recall, he said.

    Although there is a framework in place to regulate supplements, enforcement is lacking, he said.

    "There's no consequences to the manufacturer, which is absurd," he said.

    Although they aimed to purchase supplements manufactured after the FDA recall, some may have been manufactured before it, the authors note.

    Some consumers may seek these products out even though they have been recalled, but many are unaware of the recall, Cohen said.

    "This is criminal activity," said Daniel Fabricant, former Director of the Division of Dietary Supplement Programs at the FDA and current CEO of the Natural Products Association, another trade association. "There needs to be some really hardcore enforcement."

    "Consumers need to understand the risks, if they can't get an erectile dysfunction drug and they go looking for a natural product tainted with pharmaceuticals," he told Reuters Health by phone.

    Some of the recalled products have labels in mixed languages, which is also against the law, Fabricant noted.

    "Right now my recommendation is for consumers to avoid muscle building supplements, weight loss and sexual enhancement supplements," which are most likely to contain dangerous drugs, Cohen said.

    These supplements either do not work or are tainted with pharmaceuticals, he said.

    Many vitamin and mineral supplements are safe, especially those sold as single ingredients, he said. Products made up of a "cocktail" of ingredients are more likely to be tainted, he said.

    SOURCE: http://bit.ly/1c9i5E4 JAMA, October 21, 2014.

  • People picking up lung meds at CVS often bought cigarettes, too: study

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Before the CVS pharmacy chain stopped selling cigarettes, some patients who were filling prescriptions for health conditions caused or worsened by smoking also bought cigarettes at the stores, according to a new study of the company's purchasing data.

    "We were interested in assessing the extent to which patients purchase cigarettes from pharmacies where they were also filling prescriptions for these drugs," said Joshua J. Gagne of Brigham and Women's Hospital and Harvard Medical School in Boston, who coauthored the new research letter.

    Executives at CVS Caremark Corp. announced in February that it would stop selling cigarettes at its 7,600 store locations by October of this year, the first U.S. drugstore chain to do so, although some cities like Boston and San Francisco already keep tobacco products out of pharmacies.

    For the new study, researchers used data on more than 360,000 Caremark pharmacy members who filled a prescription for a statin medication, used to treat high cholesterol, in 2011 or 2012.

    Of those, 38,939 were taking medication for asthma, chronic obstructive pulmonary disease (COPD), or high blood pressure or were using an oral contraceptive.

    Smoking can cause or worsen COPD, asthma and high blood pressure. It can also dramatically increase the risk of serious cardiovascular events associated with oral contraceptives, for which side effects are usually rare, Gagne said.

    Six percent of asthma or COPD medication users, 5.1 percent of blood pressure medication users and 4.8 percent of oral birth control medication users purchased cigarettes at least once with their CVS rewards card while they had those medications available to use, according to results in JAMA Internal Medicine.

    "It is discouraging to me that pharmacies sell cigarettes and other tobacco products that could worsen health and make the prescription medications that they dispense less effective or even more dangerous," Gagne told Reuters Health by email.

    The researchers did not examine how frequently cigarettes and these prescription meds were actually purchased at the same time and on the same receipt, and some of the purchases could have been made by other family members using the same CVS loyalty card, the authors note.

    "In some instances people purchased cigarettes during the same visit that they filled the prescription, but not always," Gagne said. "We did, however, assess cigarette purchases only while people had medication available by requiring either that the cigarette purchase and prescription fill occur on the same day or that the cigarette purchase happen shortly after the prescription fill while the individuals were likely using the medications."

    According to the CDC, 18 percent of adults in the U.S. are smokers. Although less than 18 percent of the patients in this data set purchased cigarettes at their CVS pharmacies, others may have been purchasing them at other locations, Gagne said.

    Smokers in focus groups in New York, California and Ohio have said they tend not to buy cigarettes at drug and grocery stores, because they are often more expensive than other retailers, said Patricia McDaniel, associate professor in sociology in the School of Nursing at the University of California, San Francisco.

    She was not involved in the new study.

    McDaniel researches stop-smoking policy. Increasing tobacco taxes, directing more money from those taxes to tobacco control programs, including money for media campaigns that denormalize smoking and the tobacco industry, reducing the retail availability of tobacco products, and passing clean indoor air laws are effective policies for smoking cessation, she told Reuters Health by email.

    "Stopping the sale of tobacco in drug stores sends a consistent health message: we sell medications to improve your health, we don't sell the single most deadly consumer product ever made," she said.

    Pharmacies should not be among the places people can purchase cigarettes, Gagne said.

    "Short of banning cigarettes completely, getting people to stop smoking is very difficult and requires a complex solution," he said. "Pharmacies should be part of the solution rather than part of the problem."

    SOURCE: http://bit.ly/1vYoKuk JAMA Internal Medicine, October 20, 2014.