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

  • Sleep apnea tied to memory problems

    By Andrew M. Seaman

    (Reuters Health) - The ability to remember locations and directions may suffer when deep sleep is disrupted by breathing difficulties, a new study suggests.

    People with sleep apnea tended to score worse on spatial memory tests after sleeping without their breathing aid, compared to mornings after they'd used their breathing aids at night, researchers found.

    "There had been some evidence in animal models that REM sleep or dreaming sleep is important for spatial memory, but no one had shown or proven that in people," said Dr. Andrew Varga, the study's lead author from NYU Langone Medical Center in New York City.

    "Spatial memory" helps people remember how to get to their children's schools, or where they left their keys, for example.

    It's thought that people may have difficulty forming new spatial memories if their deep sleep and shallow sleep are interrupted, according to Varga.

    People with sleep apnea - some 18 million Americans, according to the National Sleep Foundation - experience numerous pauses in breathing that can last from seconds to minutes. As a result, people with sleep apnea are often tired when they wake.

    To see whether individuals with sleep apnea tended to have more difficulty forming new spatial memories, the researchers recruited 18 such people to spend two nights in their sleep center, about two weeks apart.

    The volunteers had always slept with a so-called CPAP machine to eliminate sleep apnea. During one night in the sleep lab, they slept with CPAP. The other night, their CPAP was reduced or turned off during deep sleep to induce apnea.

    On each of the two nights, before they went to bed, participants were asked to complete a video game maze. The next morning, they completed the maze again.

    After a night of sleep with their CPAP machine, the time it took the volunteers to complete the maze improved by about 30 percent. They also traveled farther in the maze and spent less time backtracking.

    But after a night with sleep apnea, the volunteers were about 4 percent slower at completing the maze, compared to the night before.

    "People had no improvement and actually on average they got a bit worse," Varga said. "We interpret that to mean their consolidation in spatial memory wasn't as good when REM (deep) sleep was disrupted."

    The researchers can't say whether the worse performance is directly from the disruptions in sleep caused by the apnea, or whether it's the lack of oxygen the condition causes.

    Varga said they are testing the apnea or oxygen question now. They are also looking at whether apnea during shallow sleep affects spatial memory.

    "The thought is that you need both (deep and shallow sleep)," he said. "If you don't have one or the other, you don't' have the ability to consolidate the information."

    Varga said he hopes the results of the study, published in The Journal of Neuroscience, will encourage more doctors to treat sleep apnea early - instead of waiting until the condition worsens.

    "Apnea is very common and has a variety of deleterious effects that have to do not only with cardiovascular health, but also there is an emerging dataset - of which this paper is only one piece - to suggest there are really cognitive effects also," he said.

    SOURCE: http://bit.ly/1rG9B9I The Journal of Neuroscience, online October 29, 2014.

  • "Wandering eye" may raise risk of falls for older adults

    By Shereen Lehman

    (Reuters Health) - Older people with strabismus, where one eye points slightly inward or outward affecting vision, are about 27 percent more likely than people without the condition to be injured by a fall, according to a new study.

    The disorder, often called "wandering eye," becomes more common with age and can cause double vision or depth perception problems because the two eyes are not pointing in the same direction.

    Previous studies have shown that having other eye disorders like cataracts, glaucoma or age-related macular degeneration increases the risk of injuries, fractures or falls, the study team writes in JAMA Opthalmology. But this is the first to examine whether so-called binocular vision problems have the same effect.

    "Strabismus in adults is becoming more prevalent as the aging population increases and we do not know the impact of strabismus on patient quality of life and morbidity," lead author Dr. Stacy Pineles told Reuters Health in an email.

    "We hypothesized that strabismus could cause double vision or diminished depth perception, and we wanted to see whether this was associated with injuries such as falls, fractures, and musculoskeletal injuries," said Pineles, an ophthalmologist with the Jules Stein Eye Institute at the University of California, Los Angeles.

    Pineles and her colleagues looked at a random sample of Medicare claims for more than two million beneficiaries over the years 2002 to 2011.

    They found almost 100,000 diagnoses of binocular vision problems. The great majority were either strabismus or diplopia, meaning double vision, which often goes along with strabismus. On average the patients were older, white, were more often male and had other health problems like diabetes and heart disease.

    About 75 percent of those with binocular vision problems had also reported some type of musculoskeletal injury, fall or fracture during that 10-year time span, compared to about 60 percent of patients without a binocular visual disorder.

    After taking into consideration age, region and other potential contributors to falling, such as other illnesses, the researchers calculated that people with binocular vision disorders had a 27 percent higher risk of falls, fractures and injuries overall.

    For people with a specific diagnosis of diplopia, the risk was 36 percent higher.

    The study team cautions that they don't know if the injuries occurred before the vision problems were diagnosed or afterward, so they can't say for certain that the eye disorders are to blame for the falls. They also don't know which patients were being treated for their vision problems.

    Still, Pineles said that elderly patients with vision problems should be sure they optimize lighting in their homes, get help when navigating unfamiliar areas and use low-vision aids if necessary.

    Dr. Jamie Rosenberg, an ophthalmologist at Montefiore Medical Center in New York who specializes in strabismus, said that eye problems can sometimes seem less important to elderly patients compared to other illnesses they may have. But "they can affect their life in a significant way and keeping them safe from falls is a huge part of keeping older people healthy."

    Rosenberg, who wasn't involved in the new study, said there are treatment options for strabismus, such as wearing special glasses with prisms that help align the double images seen by people with diplopia.

    "Even though the eyes aren't straight the two images that are being processed by the brain will be one," she said.

    Surgery may also be an option. "A lot of people think that older people can't have strabismus surgery to straighten their eyes but that's actually not true at all," Rosenberg said.

    The new study may underestimate the magnitude of the problem, noted Priscilla Rogers, an aging and vision loss expert at the American Foundation for the Blind's Vision Aware program.

    "Only people who seek medical care from a fall would be included, so the problem is probably bigger and greater than this study suggests," she told Reuters Health in an email.

    Access to eye care may be one obstacle keeping older people from getting help for vision disorders, she noted. "Medicare does not pay for new glasses and people on a fixed income may not want to buy new glasses because they cost too much," Rogers said. "They can, after all, see - they just may not see well enough to avoid a trip or fall."

    Rogers said that fall prevention programs such as "A Matter of Balance" offered in several states (http://bit.ly/1FZWPgF ) can help reduce the risk of injuries among people with visual impairments.

    SOURCE: http://bit.ly/1wylK5I JAMA Ophthalmology, online October 23, 2014.

  • Oregon woman visits Grand Canyon ahead of planned assisted suicide

    By Reuters Staff

    (Reuters) - A 29-year-old Oregon woman with terminal brain cancer has ticked off the Grand Canyon from her bucket list and said in a video released this week that she might end her life through assisted suicide in a couple of days.

    Brittany Maynard was diagnosed in January with a glioblastoma brain tumor and has said she plans to take prescribed medication to die when her pain becomes unbearable. She has moved from her San Francisco Bay area home to Oregon, which allows assisted suicide for terminally ill patients.

    Maynard is raising funds through a group called Compassion & Choices to advocate for assisted suicide as an option for terminally ill patients. The group released her latest video on Wednesday.

    Opponents of assisted suicide say some people who are ill, especially among the elderly, might be unduly influenced by people close to them to end their lives and that other ways exist to ease the suffering of the terminally ill.

    Maynard, who has stressed that her decision to end her life is her own, had previously told People magazine, which featured her on the front page of its Oct. 27 issue, that she had picked Nov. 1, as the day she planned to die, although she also said she might change her mind.

    In her latest video, Maynard said: "So if Nov. 2 comes along and I've passed, I hope my family is still proud of me and the choices I made.

    "If Nov. 2 comes along and I'm still alive, I know that we'll still be moving forward as a family out of love for each other and that decision will come later."

    On the website of Compassion & Choices, Maynard wrote that she traveled to the Grand Canyon with her husband and her parents during the week before Oct. 24 to make her bucket list dream come true.

    Maynard suffered her worst seizure the morning after the Grand Canyon visit. Her speech was paralyzed for some time after she regained consciousness, she wrote.

    "Sadly, it is impossible to forget my cancer," she wrote.

    A representative for Compassion & Choices did not return calls.

    Since 1997, more than 750 patients in Oregon have died from ingesting medications prescribed under the state's death with dignity law, according to the Oregon Public Health Division. Four states beside Oregon allow assisted suicide.

  • Speed of weight loss may have little impact on success at keeping it off

    By Roxanne Nelson

    (Reuters Health) - In a trial of weight loss approaches, the rate at which people dropped excess pounds was not linked to their success in keeping the weight off over the next three years.

    Researchers say the small study shows that current guidelines advising slow and steady weight loss should be revised, and the focus should be instead on improving methods for helping people maintain their weight over the long term.

    The long-held belief that losing weight gradually produces better long-term outcomes seems to stem from the perception that obesity is a behavioral problem and that gradual weight loss allows more time for habits to change, the Australian study team writes in The Lancet Diabetes & Endocrinology.

    "Obesity is not just a lifestyle disease as it is commonly believed but is largely genetic," senior author Joseph Proietto, Sir Edward Dunlop Professor of Medicine at the University of Melbourne, told Reuters Health.

    Scientific evidence also does not support the superiority of a gradual approach in achieving or maintaining weight loss, he said. Regardless of how pounds are lost, many individuals have difficulty staying at their new weight and often gain it all back.

    To test whether the rate of weight loss affects whether people regain weight, Proietto and his colleagues designed a two-part trial.

    In the first part, 200 obese adults were randomly assigned to either a 12-week rapid weight loss program on a very-low-calorie liquid meal-replacement diet of 450 to 800 calories a day, or to a 36-week program of gradual weight loss. The gradual diet was based on current Australian healthy eating dietary recommendations and included one or two liquid meal replacements per day, with a goal of reducing the participants' calorie intake by 400 to 500 a day.

    In part two, people who had lost 12.5 percent or more of their body weight were able to continue into a weight maintenance program that would run for about three years. The maintenance program included an individualized eating plan and meetings with a dietician every 12 weeks.

    In the first part of the study, the researchers found, participants who lost weight faster were more likely to achieve their target weight loss. Overall, 81 percent of those in the rapid weight loss group lost 12.5 percent or more of their body weight, compared to 50 percent in gradual weight loss group.

    And in part two, the speed at which individuals had lost weight did not appear to play a role whether they regained weight or how much. Both groups gained back about 71 percent of the weight that they had initially lost.

    As observed in this study, very low calorie diets can lead to robust weight loss in a very short time, but this type of diet should only be undertaken with medical supervision, said Dr. Kishore M Gadde, from the Pennington Biomedical Research Center in Baton Rouge, Louisiana. He was not involved in the study, but wrote an accompanying editorial in the same issue of the journal.

    Keeping the weight off is all too frequently the problem, Gadde said. "Once desired weight loss is achieved, individuals need to make intensive efforts to maintain their lost weight."

    The study showed that seeing a nutrition counselor every three months is not adequate support for weight maintenance, Gadde noted.

    "Exercise can help prevent weight regain to some extent, but the intensity of exercise needed to prevent regain is difficult to incorporate into our daily lives," he told Reuters Health.

    Using diet and exercise, unfortunately only about 15 percent may be able to successfully lose weight and keep it off, he said. "Pharmacotherapy could be a consideration for those regaining weight," he said. "But, we do not have solid evidence at this time that pharmacotherapy confers long-term success."

    Proietto and his colleagues had also measured hunger-related hormones and appetite among participants in their study to see how the rate of weight loss might affect changes in feelings of hunger, both long- and short-term.

    "The rate of weight loss also did not influence the changes in hunger controlling hormones that occur with weight loss," said Proietto, who also heads the weight control clinic at Austin Health in Melbourne.

    From 2005 to 2010, Proietto chaired the Optifast Medical Advisory Committee for Nestlé Healthcare Nutrition Australia Ltd. But the company did not fund the current study.

    Proietto feels that while appetite suppression after weight loss should be considered, the problem is that there are not many effective agents and none of them have been tested for long-term safety.

    "Our study shows again that drugs are not essential for achieving weight loss but they are probably important for assisting with weight maintenance," he said.

    SOURCE: http://bit.ly/1wa7gK7 The Lancet Diabetes and Endocrinology, online October 16, 2014.

  • People with celiac disease more likely to fracture bones

    By Katryn Doyle

    (Reuters Health) - People diagnosed with celiac disease are almost twice as likely as those without it to break a bone, according to a new review of the evidence.

    More studies are needed, though, to see if people whose celiac hasn't been diagnosed yet are at similar risk, researchers say.

    About two million Americans have celiac disease - in which the immune system attacks the small intestine in response to gluten, a protein found in wheat, rye and barley - according to the National Institutes of Health.

    For the new review, researchers from the University of Tampere and Seinäjoki Central Hospital in Finland, and the University of Nottingham in the UK analyzed 16 studies that compared the incidence of bone fractures among people with and without a celiac disease diagnosis.

    In studies that looked at one point in time, people with celiac disease were almost twice as likely to have had a bone fracture in the past.

    In studies that followed people over time, those who had a diagnosis of celiac disease at the start were about 30 percent more likely to suffer a bone fracture and 69 percent more likely to have a hip fracture than others, according to the analysis published in the Journal of Clinical Endocrinology and Metabolism.

    There were only two studies of bone fractures among people with undiagnosed celiac disease - but whose blood tests showed celiac-specific antibodies - and it was not clear if there was a link to broken bones, the authors write.

    Since the disease affects nutrient absorption in the small intestine, it could lead to poor absorption of vitamin D and calcium, or chronic intestinal inflammation could interfere with bone formation, they write.

    Other possibilities to explain the connection to bone breaks include hormonal changes or a gluten-free diet, which is often low in minerals, they write.

    Other studies have found that bone density tends to go down as symptoms become worse for people with celiac disease, according to Professor Julio C. Bai at the Hospital de Gastroenterologia Dr. Carlos Bonorio Udaondo in Buenos Aires, Argentina.

    "Therefore and based on our findings, it seems reasonable to consider to evaluate bone density in those patients with symptomatic celiac disease," said Bai, who was not involved in the new study.

    Symptoms can include abdominal bloating and pain, chronic diarrhea, constipation and weight loss.

    Physical activity can help strengthen bones, he said.

    "Some areas of bone are more vulnerable to the damage induced by celiac disease," said Dr. Peter H.R. Green, an expert on celiac disease at Columbia University in New York who wasn't involved in the new review. "This relates to the type of bone and its rate of turnover."

    Everyone newly diagnosed with celiac disease is routinely given a bone density scan, as they should be, he told Reuters Health by email.

    "We have shown that a gluten free diet together with replacement of calcium and vitamin D, when necessary, results in improvement in bone density," he said.

    SOURCE: http://bit.ly/1yrO6yQ Journal of Clinical Endocrinology and Metabolism, online October 3, 2014.

Oncology Articles

  • High triglycerides linked with prostate cancer recurrence

    By Ronnie Cohen

    NEW YORK (Reuters Health) - A new study has linked high triglyceride levels in the blood with recurrence of prostate cancer.

    Among men who had surgery for prostate cancer, those with elevated triglyceride levels before surgery were 35 percent more likely to show signs of a cancer recurrence than men with normal preoperative levels.

    Eating more calories than you can burn can hike levels of triglycerides, which are a type of fat in the blood.

    The study reinforces the benefits of maintaining a healthy lifestyle, epidemiologist Elizabeth Platz told Reuters Health.

    "We do know how to lower risk of disease, including prostate cancer, with lifestyle changes," she said. "The triglycerides are increased in part due to poor diet."

    Platz, who studies cancer prevention at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, was not involved with the current study.

    "We all need to think about modifying behaviors that promote well being in general - not smoking, reducing obesity, increasing physical activity while decreasing sedentary time," she said.

    Investigators studied the records of men who were not taking cholesterol-lowering statin pills before their prostates were removed at six Veterans Affairs hospitals in California, Georgia and North Carolina.

    After prostate cancer treatment, 293 of the 843 men in the study had a so-called biochemical recurrence, defined as a rising level of PSA, or prostate-specific antigen, in their blood.

    The researchers expected to find more prostate cancer recurrences in men with high pre-surgical cholesterol levels. But they did not.

    Instead, they found that for the overall group, only high triglycerides raised recurrence risk, according to the study published in Cancer, Epidemiology, Biomarkers & Prevention.

    When the researchers looked only at the 325 men with abnormally high preoperative cholesterol levels, however, they found the risk of recurrence increased 9 percent for each 10 milligrams per deciliter in total cholesterol above the abnormal cutoff of 200 mg/dL.

    More striking, though, was their finding that among men with abnormally low levels of "good" HDL cholesterol (that is, below the desired level of 40 mg/dL), every extra 10 mg/dL of HDL brought the risk of recurrence down by 39 percent.

    "Our findings suggest that controlling lipid levels is not only important for cardiovascular disease but also may have a role in prostate cancer," lead author Emma Allott from Duke University Medical School in Durham, North Carolina told Reuters Health.

    The study can't prove that cholesterol and triglycerides caused the recurrence of prostate cancer.

    Still, Allott said, "Controlling your lipid levels is well known to reduce your risk of cardiovascular disease. Here we're showing that there may be a role for prostate cancer."

    Aside from non-melanoma skin cancer, prostate cancer is the most commonly diagnosed cancer in American men, according to the federal Centers for Disease Control and Prevention. In 2011, nearly 210,000 men were diagnosed with prostate cancer and 27,970 died from it.

    The researchers call for additional studies of the role of cholesterol in prostate cancer growth. They also note that other studies have linked cholesterol-lowering statins with a reduced risk of prostate cancer recurrence.

    But both Platz and Allott say the study should not be interpreted as a call for taking cholesterol-lowering drugs.

    "We would not ever say that men should take a statin drug to prevent prostate cancer," Platz said. "Statin drugs do have widely known adverse health effects."

    "Improving your diet and taking more exercise," Allott said, "there's no potential harm with that bit of advice."

    SOURCE: http://bit.ly/1ngr3Wt Cancer Epidemiology, Biomarkers & Prevention, online October 10, 2014.

  • Former Adobe exec's start-up seeks to improve the mammogram experience

    By Reuters Staff

    SAN FRANCISCO (Reuters) - Former Adobe Chief Medical Officer Melissa Dyrdahl hopes to bring a spa-like feel to the experience of breast cancer screenings.

    Her start-up, Ella Health, has opened seven mammogram centers across the United States, in places ranging from Toms River, New Jersey to San Francisco. Ella's pitch: to improve the often nerve-wracking process so women will not skip their annual mammogram.

    "We want women to feel like they're in a spa, not a cold and clinical hospital," Dyrdahl, who is chief executive of the company, said in an interview. For instance, Ella reminds its technicians to be "warm and caring" and gives patients a private dressing room and heated cloth robe.

    In recent years, the company has secured capital to purchase 3D mammography units and offer a test that takes X-rays at different angles of the breast. At some $450,000, the equipment is far more expensive than standard mammography units.

    Dyrdahl, also a former marketing director at Apple Inc, said she joined the company after years of "terrible" mammogram experiences. Dyrdahl is herself a breast cancer survivor.

    The American Cancer Society recommends that women over 40 get annual mammograms, but researchers have found that 50 percent of women with insurance opt out, even though most women in that age range are not responsible for additional out-of-pocket costs.

    Ella Health is marketing its service to smaller, independent obstetricians and gynecologists, as well as directly to female patients.

    It is branching out into other areas of women's health. It recently launched a physical therapy service linked to major life events, such as pregnancy and menopause. Dyrdahl said she is also exploring mental and sexual health.

    Ella Health has raised funding from Polaris Venture Partners in Boston, CHL Medical Partners and private investors. The company is planning to raise additional funding in the coming year to fuel expansion across the United States.

  • Oregon woman visits Grand Canyon ahead of planned assisted suicide

    By Reuters Staff

    (Reuters) - A 29-year-old Oregon woman with terminal brain cancer has ticked off the Grand Canyon from her bucket list and said in a video released this week that she might end her life through assisted suicide in a couple of days.

    Brittany Maynard was diagnosed in January with a glioblastoma brain tumor and has said she plans to take prescribed medication to die when her pain becomes unbearable. She has moved from her San Francisco Bay area home to Oregon, which allows assisted suicide for terminally ill patients.

    Maynard is raising funds through a group called Compassion & Choices to advocate for assisted suicide as an option for terminally ill patients. The group released her latest video on Wednesday.

    Opponents of assisted suicide say some people who are ill, especially among the elderly, might be unduly influenced by people close to them to end their lives and that other ways exist to ease the suffering of the terminally ill.

    Maynard, who has stressed that her decision to end her life is her own, had previously told People magazine, which featured her on the front page of its Oct. 27 issue, that she had picked Nov. 1, as the day she planned to die, although she also said she might change her mind.

    In her latest video, Maynard said: "So if Nov. 2 comes along and I've passed, I hope my family is still proud of me and the choices I made.

    "If Nov. 2 comes along and I'm still alive, I know that we'll still be moving forward as a family out of love for each other and that decision will come later."

    On the website of Compassion & Choices, Maynard wrote that she traveled to the Grand Canyon with her husband and her parents during the week before Oct. 24 to make her bucket list dream come true.

    Maynard suffered her worst seizure the morning after the Grand Canyon visit. Her speech was paralyzed for some time after she regained consciousness, she wrote.

    "Sadly, it is impossible to forget my cancer," she wrote.

    A representative for Compassion & Choices did not return calls.

    Since 1997, more than 750 patients in Oregon have died from ingesting medications prescribed under the state's death with dignity law, according to the Oregon Public Health Division. Four states beside Oregon allow assisted suicide.

  • Massachusetts town's plan to ban tobacco sales riles store owners

    By Ted Siefer

    LOWELL, Mass. (Reuters) - Store owners in a Massachusetts town proposing to bar the sale of all tobacco products objected to the proposal on Tuesday, a day after local officials announced the planned ban.

    Health officials in Westminster, about 60 miles (97 km)northwest of Boston, released a plan on Monday to bar the sale of cigarettes, chewing tobacco and cigars, as well as electronic cigarettes, citing health risks tied to the nicotine products.

    The Westminster regulation points to a ruling by the state's highest court holding that "the right to engage in business must yield to the paramount right of government to protect the public health by any rational means."

    Citing U.S. health authorities, the proposed regulation states that there is "conclusive evidence that tobacco smoking causes cancer, respiratory and cardiac diseases, (and) negative birth outcomes."

    Convenience store owners in the town of about 7,300 residents said the ban would do little to cut down on tobacco use and prompt customers to drive to the next town for the product while sharply cutting their stores' incomes.

    "It's not just the loss of tobacco sales," said Brian Vincent, the owner of Vincent's Country Store. "It's the additional impulse items smokers buy, a bottle of soda, a bag of chips for the road, scratch tickets."

    Vincent, who posted in his store a petition that had gathered 300 signatures by Tuesday morning opposing the ban, estimated that it would cost him $100,000 a year in sales.

    The New England Convenience Store Association has also taken a stand against the ban. "At the end of the day, it's businesses in the local community that will get hurt," said Stephen Ryan, the group's executive director.

    Westminster's health agent did not return requests on Tuesday for comment.

    While restrictions on smoking in specific settings have proliferated in Massachusetts and around the country, Westminster appears to be the first to consider a town-wide ban on the sale of all tobacco products.

    Historian Robert Proctor of Stanford University said he was unaware of a municipal ban on tobacco products in nearly a century.

    In Boston, a ban went into effect this year on smoking in all public parks and playgrounds.

    A three-member Westminster Board of Health will be required to vote to pass the ban.

    The board will hold a public hearing on the topic on Nov. 12.

  • Advanced ovarian cancer may someday be detected with tampons

    By Kathryn Doyle

    (Reuters Health) - In a small new study, ovarian cancer cells were detectable on the tampons of some women with advanced stage cancer.

    "This is a proof of principle study that certainly needs more work on it before we know how useful it will be," said Dr. Charles N. Landen Jr. of the University of Virginia, Department of Obstetrics and Gynecology.

    But it is helpful to know that you can pick up tumor DNA in vaginal secretions, Landen told Reuters Health by phone.

    Ovarian cancer is often diagnosed at a late stage, since there is no effective screening method for early-stage ovarian cancer. About 22,000 women are diagnosed with ovarian cancer in the U.S. each year, and almost 14,300 will die, according to the American Cancer Society.

    Landen and his coauthors studied eight women with advanced serous ovarian cancer, which is the most common form of ovarian cancer. Eight to 12 hours before surgery, they each inserted a commercially available tampon, which was removed in the operating room.

    All eight women had TP53 DNA mutations in their tumors, which is a very common mutation for this form of cancer, the authors write.

    Five of the women had intact fallopian tubes, while three had had tubal ligation surgery previously.

    Of the five women who did not have their "tubes tied," three had the exact same TP53 mutations detectable from their tampon samples, according to results published in the journal Obstetrics & Gynecology.

    Identifying three out of five, or 60 percent, of cancers is not bad, but not ideal for a disease as rare as ovarian cancer, Landen said.

    "It's not enough for us to have total confidence over its ultimate utility," he said.

    None of the women with tubal ligation had tumor mutations in their tampon samples.

    "We have no way of knowing whether or not the DNA we picked up originated in the fallopian tubes or in the abdominal cavity," but either way it does demonstrate that cancer happening elsewhere in the genital tract does affect the vaginal canal, Landen said.

    A previous study found similar tumor DNA detectable by Pap smear.

    This is not yet a breakthrough in detecting ovarian cancer, according to Paul Spellman, who researches the biology of cancer at Oregon Health & Science University in Portland, and was not involved in the study.

    "These findings are helping researchers move toward a method for screening for ovarian cancer," said Dr. Shannon N. Westin of the Department of Gynecologic Oncology and Reproductive Medicine at the University of Texas MD Anderson Cancer Center in Houston. "This has certainly been a 'holy grail' for some time."

    Westin was not involved in the new study.

    "Thus far, imaging and serum tests have not been able to reliably detect ovarian cancer at an early stage," she told Reuters Health by email. "Ovarian cancer survival is significantly improved when detected at an early stage."

    Five years after diagnosis with stage 1 ovarian cancer, approximately 90 percent of women have survived, compared to approximately 35 percent for Stage IIIc, the most commonly diagnosed stage, she said.

    It is not clear if this kind of tampon screening would identify early-stage cancers of the ovaries or fallopian tubes, Landen said.

    This pilot study did identify some advanced cancers, and may be more useful some day as targeted screening for women at high risk, like those with a family history of ovarian cancer or those with the BRCA mutations, especially younger women who still want to have children and don't want their ovaries removed unless absolutely necessary, he said.

    Though this method of detection is a long way from actually being used to screen women for early stage ovarian cancer, it does have the advantage that it's relatively easy for women to do and doesn't involve surgery, he noted.

    SOURCE: http://bit.ly/ZTNTse Obstetrics & Gynecology, November 2014.

Orthopedic Articles

  • Could breathing differently change how people climb mountains?

    By Kathryn Doyle

    NEW YORK (Reuters Health) - A brief new report claims that using a breathing technique based on Tibetan Buddhist tradition, 26 inexperienced mountain climbers made it up Mt. Kilimanjaro in Africa in 48 hours while avoiding acute mountain sickness.

    They were trained to take quick deep breaths constantly while climbing, said coauthor Dr. Geert A. Buijze of the Department of Orthopedic Surgery at the Academic Medical Center Amsterdam in The Netherlands.

    "Compare it to the deep breathing when performing strenuous exercises," Buijze told Reuters Health by email.

    Acute mountain sickness (AMS) can affect anyone who ascends above 8,000 feet too rapidly. Symptoms are usually mild, but severe cases can result in blue skin, chest tightness, confusion, coughing up blood and inability to walk.

    For the new experiment, which was reported in a letter to the editor in Wilderness & Environmental Medicine, the climbers received special training in advance, including mindset coaching, cold exposure, and breathing technique practice.

    They were trained to intentionally hyperventilate while climbing, including regular 30-minute breathing sessions, using the "Wim Hof" method, inspired by Tummo meditation.

    "During the exercises, periods of strong hyperventilation were alternated with short periods of breath retention," Buijze said.

    The method of hyperventilation can improve endurance and enhance perceived energy levels as well as generate more body heat during cold exposure, the authors write.

    The Kilimanjaro ascent usually takes four to seven days even for experienced climbers, they say, and 24 of their group of 26 nonathletes - some of whom also had diagnoses like multiple sclerosis, rheumatoid arthritis or cancer - reached the summit (at 5,895 meters, or 19,341 feet, above sea level) in 48 hours.

    Unlike most other high peaks, climbing to the top of Mount Kilimanjaro doesn't require special equipment. "Most climbers reach the crater rim with little more than a walking stick, proper clothing and determination," according to the official website of Tanzania National Parks.

    "The greatest challenge of summiting Mount Kilimanjaro in 48 hours is not so much the distance or ascent but the high altitude with inherent risk of AMS," Buijze said. "The climbers rested and slept several hours each night, similar to other climbers. The differences are the longer distances of ascent each day and no resting days required for acclimatization."

    Two trekkers had to stop 200 meters short of the summit with symptoms of physical or respiratory exhaustion. None of the climbers experienced severe AMS, while six had moderate AMS and 22 had mild symptoms.

    The exact mechanism of AMS is still unclear, and why this breath training would have prevented or treated it is also unclear, the authors write, but the fact that the climbers were extensively trained in the technique was probably important.

    The safety of the technique will need to be studied more before any recommendations can be made, Buijze said.

    AMS tends to be especially common on Kilimanjaro, said Andrew Luks, a pulmonary and critical care specialist at Harborview Medical Center in Seattle.

    Even with the fastest path, the Marangu Route, experienced climbers take four to five days to make the ascent, Luks said. He was not involved in the new study.

    "In general, the faster you go, the greater the likelihood you will have severe AMS," he said. "It is without further information hard to believe that 92 percent of these people could summit by that route in only two days time."

    Some studies have suggested that ventilating more may be protective, he said.

    "The gist of it is it's an intriguing idea but it is nowhere near ready for prime time and should not change anyone's practice now," he said.

    "The major weakness of this study is the lack of an appropriate control group and the lack of blinding the subjects and investigators towards the intervention," said Dr. Peter Bartsch, Chair in Sports Medicine at the University of Heidelberg in Germany, who was also not involved in the study.

    Bartsch has studied similar ascents in the Swiss-Italian Alps, and moderate AMS affected about half of the climbers, while severe AMS was rare, he said.

    The only difference in the new results is that moderate AMS affected fewer climbers, he said.

    "This may, to a large extent, be attributed to a placebo effect which is considerable with reporting symptoms of AMS as we had shown in a study," Bartsch said. "In summary, we cannot draw any generalizable conclusions from this preliminary report."

    Luks agreed.

    "We can't look at their results and say, oh this works," Luks said. "You can only say, hmm, it's possible."

    SOURCE: http://bit.ly/105xelL Wilderness & Environmental Medicine, October 13, 2014

  • "Wandering eye" may raise risk of falls for older adults

    By Shereen Lehman

    (Reuters Health) - Older people with strabismus, where one eye points slightly inward or outward affecting vision, are about 27 percent more likely than people without the condition to be injured by a fall, according to a new study.

    The disorder, often called "wandering eye," becomes more common with age and can cause double vision or depth perception problems because the two eyes are not pointing in the same direction.

    Previous studies have shown that having other eye disorders like cataracts, glaucoma or age-related macular degeneration increases the risk of injuries, fractures or falls, the study team writes in JAMA Opthalmology. But this is the first to examine whether so-called binocular vision problems have the same effect.

    "Strabismus in adults is becoming more prevalent as the aging population increases and we do not know the impact of strabismus on patient quality of life and morbidity," lead author Dr. Stacy Pineles told Reuters Health in an email.

    "We hypothesized that strabismus could cause double vision or diminished depth perception, and we wanted to see whether this was associated with injuries such as falls, fractures, and musculoskeletal injuries," said Pineles, an ophthalmologist with the Jules Stein Eye Institute at the University of California, Los Angeles.

    Pineles and her colleagues looked at a random sample of Medicare claims for more than two million beneficiaries over the years 2002 to 2011.

    They found almost 100,000 diagnoses of binocular vision problems. The great majority were either strabismus or diplopia, meaning double vision, which often goes along with strabismus. On average the patients were older, white, were more often male and had other health problems like diabetes and heart disease.

    About 75 percent of those with binocular vision problems had also reported some type of musculoskeletal injury, fall or fracture during that 10-year time span, compared to about 60 percent of patients without a binocular visual disorder.

    After taking into consideration age, region and other potential contributors to falling, such as other illnesses, the researchers calculated that people with binocular vision disorders had a 27 percent higher risk of falls, fractures and injuries overall.

    For people with a specific diagnosis of diplopia, the risk was 36 percent higher.

    The study team cautions that they don't know if the injuries occurred before the vision problems were diagnosed or afterward, so they can't say for certain that the eye disorders are to blame for the falls. They also don't know which patients were being treated for their vision problems.

    Still, Pineles said that elderly patients with vision problems should be sure they optimize lighting in their homes, get help when navigating unfamiliar areas and use low-vision aids if necessary.

    Dr. Jamie Rosenberg, an ophthalmologist at Montefiore Medical Center in New York who specializes in strabismus, said that eye problems can sometimes seem less important to elderly patients compared to other illnesses they may have. But "they can affect their life in a significant way and keeping them safe from falls is a huge part of keeping older people healthy."

    Rosenberg, who wasn't involved in the new study, said there are treatment options for strabismus, such as wearing special glasses with prisms that help align the double images seen by people with diplopia.

    "Even though the eyes aren't straight the two images that are being processed by the brain will be one," she said.

    Surgery may also be an option. "A lot of people think that older people can't have strabismus surgery to straighten their eyes but that's actually not true at all," Rosenberg said.

    The new study may underestimate the magnitude of the problem, noted Priscilla Rogers, an aging and vision loss expert at the American Foundation for the Blind's Vision Aware program.

    "Only people who seek medical care from a fall would be included, so the problem is probably bigger and greater than this study suggests," she told Reuters Health in an email.

    Access to eye care may be one obstacle keeping older people from getting help for vision disorders, she noted. "Medicare does not pay for new glasses and people on a fixed income may not want to buy new glasses because they cost too much," Rogers said. "They can, after all, see - they just may not see well enough to avoid a trip or fall."

    Rogers said that fall prevention programs such as "A Matter of Balance" offered in several states (http://bit.ly/1FZWPgF ) can help reduce the risk of injuries among people with visual impairments.

    SOURCE: http://bit.ly/1wylK5I JAMA Ophthalmology, online October 23, 2014.

  • People with celiac disease more likely to fracture bones

    By Katryn Doyle

    (Reuters Health) - People diagnosed with celiac disease are almost twice as likely as those without it to break a bone, according to a new review of the evidence.

    More studies are needed, though, to see if people whose celiac hasn't been diagnosed yet are at similar risk, researchers say.

    About two million Americans have celiac disease - in which the immune system attacks the small intestine in response to gluten, a protein found in wheat, rye and barley - according to the National Institutes of Health.

    For the new review, researchers from the University of Tampere and Seinäjoki Central Hospital in Finland, and the University of Nottingham in the UK analyzed 16 studies that compared the incidence of bone fractures among people with and without a celiac disease diagnosis.

    In studies that looked at one point in time, people with celiac disease were almost twice as likely to have had a bone fracture in the past.

    In studies that followed people over time, those who had a diagnosis of celiac disease at the start were about 30 percent more likely to suffer a bone fracture and 69 percent more likely to have a hip fracture than others, according to the analysis published in the Journal of Clinical Endocrinology and Metabolism.

    There were only two studies of bone fractures among people with undiagnosed celiac disease - but whose blood tests showed celiac-specific antibodies - and it was not clear if there was a link to broken bones, the authors write.

    Since the disease affects nutrient absorption in the small intestine, it could lead to poor absorption of vitamin D and calcium, or chronic intestinal inflammation could interfere with bone formation, they write.

    Other possibilities to explain the connection to bone breaks include hormonal changes or a gluten-free diet, which is often low in minerals, they write.

    Other studies have found that bone density tends to go down as symptoms become worse for people with celiac disease, according to Professor Julio C. Bai at the Hospital de Gastroenterologia Dr. Carlos Bonorio Udaondo in Buenos Aires, Argentina.

    "Therefore and based on our findings, it seems reasonable to consider to evaluate bone density in those patients with symptomatic celiac disease," said Bai, who was not involved in the new study.

    Symptoms can include abdominal bloating and pain, chronic diarrhea, constipation and weight loss.

    Physical activity can help strengthen bones, he said.

    "Some areas of bone are more vulnerable to the damage induced by celiac disease," said Dr. Peter H.R. Green, an expert on celiac disease at Columbia University in New York who wasn't involved in the new review. "This relates to the type of bone and its rate of turnover."

    Everyone newly diagnosed with celiac disease is routinely given a bone density scan, as they should be, he told Reuters Health by email.

    "We have shown that a gluten free diet together with replacement of calcium and vitamin D, when necessary, results in improvement in bone density," he said.

    SOURCE: http://bit.ly/1yrO6yQ Journal of Clinical Endocrinology and Metabolism, online October 3, 2014.

  • Weak muscles can put diabetics at risk on stairs

    By Janice Neumann

    (Reuters Health) - When nerves in the legs and feet are damaged from diabetes, people often have trouble on stairs, but a new report suggests exercise might help lower their risk of falling.

    People with so-called diabetic peripheral neuropathy go up and down stairs more slowly and clumsily than healthy people because of weak muscles, sensory damage (loss of feeling) and poor coordination, say the authors of the report.

    Resistance exercises could help these individuals build up strength and avoid future falls, they wrote in the journal Diabetes Care.

    For people with diabetic peripheral neuropathy, falls "whilst walking down stairs are nearly unrecoverable," and as a result, account for a large proportion of fall-related deaths, said Joseph C. Handsaker of Manchester Metropolitan University in Manchester, UK, who led the research.

    "The aim of the study was to provide potential explanations for why patients with neuropathy are at a high risk of falling during the dangerous tasks of stair ascent and descent, in the hope that by identifying why falls occur, we can then suggest solutions for how to reduce the risk of falling," Handsaker told Reuters Health.

    An estimated 347 million people worldwide have diabetes, according to the World Health Organization. About half of patients with diabetes develop peripheral neuropathy after 10 years, Handsaker said.

    It's been known for a while that these patients have trouble on stairs, but the underlying reason hasn't been clear, Handsaker added.

    He and his colleagues compared 21 patients with diabetic neuropathy, 21 who had only diabetes, and 21 healthy individuals as they walked up and down a custom-built staircase.

    The researchers analyzed the electrical activity of participants' muscle tissue to determine when the muscles were "switched on and off" and when they reached peak activation.

    Overall, the patients with diabetic peripheral neuropathy were significantly slower at activating their knee and ankle muscles than the healthy group, and significantly slower at reaching peak knee-muscle activation.

    "The slower speed of strength generation is the key finding in this study, with alterations to muscle activation expected to contribute to the observed reductions," said Handsaker.

    For diabetics with peripheral neuropathy who'd like to strengthen their muscles and reduce their risk of falling, Handsaker suggested using isometric exercises like calf raises and knee extensions. Individuals should rapidly stretch these muscles for a second and then relax for three seconds, he said.

    His paper also advises that resistance training might be helpful, such as with weight machines, free weights or calisthenics.

    (Before starting to exercise, however, patients should get clearance from their doctors. As the American College of Sports Medicine advises, "Not all exercise programs are suitable for everyone, and some programs may result in injury.")

    Improving the strength and response of the extensor muscles will result in faster strength generation, which should improve stability during stair ascent and descent, said Handsaker.

    Dr. Michael Polydefkis, who directs the Johns Hopkins Cutaneous Nerve Laboratory and the Bayview EMG Laboratory and Diabetic Neuropathy Center, said he was glad to see a study that emphasized the effect of diabetes on people's ability to move around.

    He said people recognize the devastating effects of diseases like multiple sclerosis, Parkinson's and ALS but often don't realize how much diabetic neuropathy compromises quality of life.

    "Oftentimes peripheral neuropathy is not always given its due respect," said Polydefkis in a phone interview. "People don't really appreciate the impact this has on people's lives."

    Polydefkis, who was not involved in the study, said his patients typically complain of pain and numbness in their feet, rather than weakness. But the study showed that falls might be related to subtle muscle problems that aren't easy to detect. He often suggests balance exercises for his patients.

    Dr. Peter Dyck, who directs the Peripheral Nerve Research Laboratory at the Mayo Clinic in Rochester, Minnesota, told Reuters Health in a phone interview that the study helps confirm some of the reasons for the unsteady gait of diabetics. But Dyck, who was not involved in the study, said he wasn't convinced that exercise would help these individuals because of their sensory loss.

    "I think it's a worthwhile study, it was fun to read, but I'm not sure the take-home message is quite correct," said Dyck. "The emphasis needs to be on preventing polyneuropathy by good diabetic control."

    SOURCE: http://bit.ly/1DBSe2g Diabetes Care, online October 14, 2014.

  • Ibuprofen good as morphine, and safer, for kids with fractures

    By Kathryn Doyle

    (Reuters Health) - The narcotic drug morphine is not the best choice for pain relief in kids with broken bones, a new study suggests.

    Kids in the study took either morphine or ibuprofen by mouth. The morphine was associated with side effects like drowsiness, nausea and vomiting - but it wasn't any better than ibuprofen at relieving pain.

    "Both ibuprofen and oral morphine provided pain relief but there were no significant differences between the two agents," said lead author Dr. Naveen Poonai, a pediatric emergency physician at the London Health Sciences Centre in Ontario.

    "In our study, we found that drowsiness and nausea were the most common side effects but patients also reported dizziness and vomiting," Poonai told Reuters Health by email.

    The study involved 134 children between ages five and 17 who arrived at the emergency department with a broken bone of the arm or leg that didn't require surgery.

    Half of the kids were randomly assigned to receive oral morphine, dosed to 0.5 milligrams per kilogram of the child's weight, while the others received 10 mg/kg of ibuprofen, every six hours as needed for 24 hours after hospital discharge with a cast or sling. The medicines were not marked or labeled so the children and the parents did not know which painkiller they had received.

    Doctors told parents to use acetaminophen if needed for breakthrough pain.

    Patients received self-report pain measurement forms and were instructed to rate their pain on a scale of zero to five immediately before and 30 minutes after a painkiller dose.

    Both morphine and ibuprofen lowered pain scores by an average of 1 to 1.5 points from before administration to 30 minutes after a dose, according to results in the Canadian Medical Association Journal.

    The two groups did not differ in their overall pain reduction or in the use of acetaminophen for breakthrough pain.

    More than half of the morphine group reported a side effect of the medicine, most often drowsiness, compared to 31 percent of the ibuprofen group.

    In the morphine group, 18 patients reported nausea, compared to four in the ibuprofen group.

    Ibuprofen is a safe and effective choice for managing bone fracture pain for kids, the authors write.

    "Ibuprofen is the safer choice for the simple reason that we have a lot more experience with it in children and both health care workers and parents know what to expect when it is given," Poonai said.

    "There is very little pediatric acute pain research done in the 'at-home' setting where these analgesics are actually used," said Amy L. Drendel, an associate professor of Pediatric Emergency Medicine at the Medical College of Wisconsin in Milwaukee. "This provides real-life data about how these medications work in the outpatient setting."

    Drendel was not involved in the new study.

    "Many variables go into the decisions doctors make about pain management for children," she told Reuters Health by email. "I always recommend that parents talk with their doctor about their child's treatment to make sure their child receives the best care possible."

    Although it is understandably a big fear for doctors and parents, there is no evidence that children are at risk of opioid dependence to the same degree as adults, Poonai said.

    "Pain in the ER before a fracture is immobilized with a cast or splint is likely more severe than pain at home," he said. "But in our study we found that over 70 percent of children had pain severe enough to require pain medication after discharge."

    "This tells us that nurses and doctors should be teaching parents to recognize and manage pain at home and likely offering a dose of ibuprofen at discharge," he said.

    SOURCE: http://bit.ly/1xxCsBt Canadian Medical Association Journal, online October 27, 2014.

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Women’s Health Articles

  • Former Adobe exec's start-up seeks to improve the mammogram experience

    By Reuters Staff

    SAN FRANCISCO (Reuters) - Former Adobe Chief Medical Officer Melissa Dyrdahl hopes to bring a spa-like feel to the experience of breast cancer screenings.

    Her start-up, Ella Health, has opened seven mammogram centers across the United States, in places ranging from Toms River, New Jersey to San Francisco. Ella's pitch: to improve the often nerve-wracking process so women will not skip their annual mammogram.

    "We want women to feel like they're in a spa, not a cold and clinical hospital," Dyrdahl, who is chief executive of the company, said in an interview. For instance, Ella reminds its technicians to be "warm and caring" and gives patients a private dressing room and heated cloth robe.

    In recent years, the company has secured capital to purchase 3D mammography units and offer a test that takes X-rays at different angles of the breast. At some $450,000, the equipment is far more expensive than standard mammography units.

    Dyrdahl, also a former marketing director at Apple Inc, said she joined the company after years of "terrible" mammogram experiences. Dyrdahl is herself a breast cancer survivor.

    The American Cancer Society recommends that women over 40 get annual mammograms, but researchers have found that 50 percent of women with insurance opt out, even though most women in that age range are not responsible for additional out-of-pocket costs.

    Ella Health is marketing its service to smaller, independent obstetricians and gynecologists, as well as directly to female patients.

    It is branching out into other areas of women's health. It recently launched a physical therapy service linked to major life events, such as pregnancy and menopause. Dyrdahl said she is also exploring mental and sexual health.

    Ella Health has raised funding from Polaris Venture Partners in Boston, CHL Medical Partners and private investors. The company is planning to raise additional funding in the coming year to fuel expansion across the United States.

  • Police harass Kenyan patients and clinics as abortion battle heats up

    By Katy Migiro

    NAIROBI (Thomson Reuters Foundation) - Police threats against patients and medics they accuse of giving "illegal abortions", coupled with reversals in Kenyan policies, are stirring fears likely to reduce access to safe abortions, campaigners said.

    Doctors and nurses say police intimidation has increased since last month's sentencing to death of a nurse, Jackson Tali, for murder after a woman died in his car.

    "The police have taken advantage of the ruling to harass healthcare providers in the country," said a statement from the Reproductive Health and Rights Alliance, a coalition including the Kenya Medical Association and National Nurses Association of Kenya.

    Tali, has appealed the ruling, arguing that he tried to save the woman's life in 2009 when she came to his clinic in Gachie, 15km west of Nairobi, bleeding heavily.

    The fear provoked by the Tali ruling will make it harder for women to receive safe abortions or post-abortion care, campaigners said.

    "If I come in bleeding, the healthcare provider would feel: 'No, no, no, if I touch her and then something happens, I could be charged with murder'," said Judith Okal, a Nairobi-based lawyer with the Center for Reproductive Rights advocacy group told the Thomson Reuters Foundation.

    Police walked into one health clinic and threatened to arrest women they claimed were seeking abortions, Okal said.

    In another case, she said a nurse paid a bribe after police told him: "You have heard of that nurse who was charged and sentenced for procuring an abortion. We can charge you with that."

    "The police are visiting clinics on Fridays to extort money from the health providers claiming that we should be jailed," gynaecologist John Nyamu said in the statement.

    Nyamu spent a year in jail awaiting trial for murder after his clinic was raided in 2004. He was later acquitted.

    Police in Kenya could not immediately be reached for comment.

    ONE-THIRD OF MATERNAL DEATHS

    Abortion is a hotly contested issue in Kenya and across Africa, where conservative religious beliefs hold sway.

    Unsafe abortions, often caused by inserting knitting needles into the cervix or drinking bleach, account for 35 percent of maternal deaths in Kenya, versus the global average of 13 percent.

    At least 2,600 Kenyan women die in public hospitals each year after having botched backstreet abortions. Many more die at home without seeking medical care.

    "How to perform an abortion" was the most popular Google search topic in Kenya in 2012.

    Prior to 2010, three doctors had to given written consent for the procedure to be performed.

    In its 2010 constitution, Kenya allowed the procedure if a health professional deems it necessary for emergency treatment or "the life or health of the mother is in danger".

    However, enforcement of the law is ambiguous.

    Rich women easily access safe abortions in private facilities, but the poor and uneducated risk their lives trying to expel the foetus themselves or with backstreet quacks, believing that they cannot legally get an abortion.

    The government is fighting to undo the increased access promised by the constitution, campaigners said.

    In 2012, the government published for the first time safe abortion guidelines for medics, but the health ministry's Director of Medical Services (DMS) rescinded them in December 2013.

    In February, the DMS forbid government healthcare providers from attending trainings on safe abortion.

    "It's like the ministry is on a path to make sure that women and girls in Kenya are not going to get access to safe abortion services," Okal said.

    A 2013 government report estimated that 464,000 abortions are performed in Kenya each year.

  • REFILE-Sandwiches may be a source of too much dietary salt

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

    By Madeline Kennedy

    (Reuters Health) - Americans consume too much sodium, according to current guidelines, and much of the excess may be hidden in our sandwiches, researchers say.

    Based on national survey data depicting American eating habits over the course of a single day, the study found that half of all adults had a sandwich. And those who did took in more calories and sodium overall than those who didn't.

    The study team calculates that sandwiches, on average, contribute about a fifth of the entire day's sodium intake for people who eat them.

    "Excessive sodium intake is a health risk because of the relationship between sodium and blood pressure," said the study's lead author, Rhonda Sebastian, a nutritionist in the Food Surveys Research Group of the U.S. Department of Agriculture (USDA).

    High sodium intake has been linked to worsening high blood pressure, a condition that can, in turn, increase the risk of heart disease, congestive heart failure and kidney disease, according to the USDA's 2010 Dietary Guidelines for Americans.

    The USDA recommends that everyone, including children, should limit their sodium intake to no more than 2,300 milligrams per day, or about one teaspoon of salt.

    For "adults age 51 and older, African Americans of any age, and individuals with high blood pressure, diabetes, or chronic kidney disease," the guidelines recommend limiting sodium even further, to 1,500 mg a day.

    To see where big contributors of sodium may be lurking in the American diet, the research team used data from nearly 6,000 adults over the age of 20 who participated in the 2009-2010 What We Eat in America survey, part of the annual National Health and Nutrition Examination Survey.

    During in-person interviews, participants listed all the food and beverages they consumed during the entire previous day, including quantities.

    The results showed that in general, people consumed more sodium throughout the day than the USDA guidelines recommend: an average of 3,900 mg of sodium for sandwich eaters and 3,200 mg for those who didn't have a sandwich.

    This was true for both men and women and across all age groups, the researchers report in the Journal of the Academy of Nutrition and Dietetics.

    But the biggest spread was apparent between men who ate sandwiches, who averaged up to 4,800 mg of sodium in a day, and men who didn't eat them and averaged just under 3,900 mg.

    Men in general ate significantly more sandwiches and took in almost twice as much sodium from sandwiches as women did, Sebastian told Reuters Health in an email.

    But the explanation is not entirely that sandwich eaters consume saltier food, the study team writes in their report. The extra sodium was largely due to sandwich eaters taking in more calories overall, about 300 more than people who did not eat sandwiches.

    Patricia Guenther, a research professor in the Division of Nutrition at the University of Utah who was not involved in the study cautions, however, that it is also a matter of typical sandwich ingredients tending to be higher in sodium.

    "It's the processed meats that generally have the most sodium - cold cuts, luncheon meats, sausages, frankfurters/hot dogs," Guenther said. People do not necessarily need to avoid these foods altogether, but they should limit how much they eat, Guenther told Reuters Health in an email.

    The researchers added that cheese and yeast-based breads are also among the top contributors to the sodium content of sandwiches.

    The study did not account for additional salt sprinkled on foods or salt from non-food sources like antacids. But Sebastian said these sources make up only a small percentage of sodium intake for most people.

    Because overall calorie intake played a large role in how much sodium people took in, Sebastian said, "it's very important to pay attention to portion sizes. It's also important to select more fresh foods that are low in sodium and fewer processed foods that are high in sodium."

    Guenther advises, "pack your own lunches, make your own sandwiches, so you have control of the ingredients and the portion sizes."

    SOURCE: http://bit.ly/1rXqAp3 Journal of the Academy of Nutrition and Dietetics, Online October 5, 2014.

  • REFILE-Sandwiches may be a source of too much dietary salt

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

    By Madeline Kennedy

    (Reuters Health) - Americans consume too much sodium, according to current guidelines, and much of the excess may be hidden in our sandwiches, researchers say.

    Based on national survey data depicting American eating habits over the course of a single day, the study found that half of all adults had a sandwich. And those who did took in more calories and sodium overall than those who didn't.

    The study team calculates that sandwiches, on average, contribute about a fifth of the entire day's sodium intake for people who eat them.

    "Excessive sodium intake is a health risk because of the relationship between sodium and blood pressure," said the study's lead author, Rhonda Sebastian, a nutritionist in the Food Surveys Research Group of the U.S. Department of Agriculture (USDA).

    High sodium intake has been linked to worsening high blood pressure, a condition that can, in turn, increase the risk of heart disease, congestive heart failure and kidney disease, according to the USDA's 2010 Dietary Guidelines for Americans.

    The USDA recommends that everyone, including children, should limit their sodium intake to no more than 2,300 milligrams per day, or about one teaspoon of salt.

    For "adults age 51 and older, African Americans of any age, and individuals with high blood pressure, diabetes, or chronic kidney disease," the guidelines recommend limiting sodium even further, to 1,500 mg a day.

    To see where big contributors of sodium may be lurking in the American diet, the research team used data from nearly 6,000 adults over the age of 20 who participated in the 2009-2010 What We Eat in America survey, part of the annual National Health and Nutrition Examination Survey.

    During in-person interviews, participants listed all the food and beverages they consumed during the entire previous day, including quantities.

    The results showed that in general, people consumed more sodium throughout the day than the USDA guidelines recommend: an average of 3,900 mg of sodium for sandwich eaters and 3,200 mg for those who didn't have a sandwich.

    This was true for both men and women and across all age groups, the researchers report in the Journal of the Academy of Nutrition and Dietetics.

    But the biggest spread was apparent between men who ate sandwiches, who averaged up to 4,800 mg of sodium in a day, and men who didn't eat them and averaged just under 3,900 mg.

    Men in general ate significantly more sandwiches and took in almost twice as much sodium from sandwiches as women did, Sebastian told Reuters Health in an email.

    But the explanation is not entirely that sandwich eaters consume saltier food, the study team writes in their report. The extra sodium was largely due to sandwich eaters taking in more calories overall, about 300 more than people who did not eat sandwiches.

    Patricia Guenther, a research professor in the Division of Nutrition at the University of Utah who was not involved in the study cautions, however, that it is also a matter of typical sandwich ingredients tending to be higher in sodium.

    "It's the processed meats that generally have the most sodium - cold cuts, luncheon meats, sausages, frankfurters/hot dogs," Guenther said. People do not necessarily need to avoid these foods altogether, but they should limit how much they eat, Guenther told Reuters Health in an email.

    The researchers added that cheese and yeast-based breads are also among the top contributors to the sodium content of sandwiches.

    The study did not account for additional salt sprinkled on foods or salt from non-food sources like antacids. But Sebastian said these sources make up only a small percentage of sodium intake for most people.

    Because overall calorie intake played a large role in how much sodium people took in, Sebastian said, "it's very important to pay attention to portion sizes. It's also important to select more fresh foods that are low in sodium and fewer processed foods that are high in sodium."

    Guenther advises, "pack your own lunches, make your own sandwiches, so you have control of the ingredients and the portion sizes."

    SOURCE: http://bit.ly/1rXqAp3 Journal of the Academy of Nutrition and Dietetics, Online October 5, 2014.

  • "Wandering eye" may raise risk of falls for older adults

    By Shereen Lehman

    (Reuters Health) - Older people with strabismus, where one eye points slightly inward or outward affecting vision, are about 27 percent more likely than people without the condition to be injured by a fall, according to a new study.

    The disorder, often called "wandering eye," becomes more common with age and can cause double vision or depth perception problems because the two eyes are not pointing in the same direction.

    Previous studies have shown that having other eye disorders like cataracts, glaucoma or age-related macular degeneration increases the risk of injuries, fractures or falls, the study team writes in JAMA Opthalmology. But this is the first to examine whether so-called binocular vision problems have the same effect.

    "Strabismus in adults is becoming more prevalent as the aging population increases and we do not know the impact of strabismus on patient quality of life and morbidity," lead author Dr. Stacy Pineles told Reuters Health in an email.

    "We hypothesized that strabismus could cause double vision or diminished depth perception, and we wanted to see whether this was associated with injuries such as falls, fractures, and musculoskeletal injuries," said Pineles, an ophthalmologist with the Jules Stein Eye Institute at the University of California, Los Angeles.

    Pineles and her colleagues looked at a random sample of Medicare claims for more than two million beneficiaries over the years 2002 to 2011.

    They found almost 100,000 diagnoses of binocular vision problems. The great majority were either strabismus or diplopia, meaning double vision, which often goes along with strabismus. On average the patients were older, white, were more often male and had other health problems like diabetes and heart disease.

    About 75 percent of those with binocular vision problems had also reported some type of musculoskeletal injury, fall or fracture during that 10-year time span, compared to about 60 percent of patients without a binocular visual disorder.

    After taking into consideration age, region and other potential contributors to falling, such as other illnesses, the researchers calculated that people with binocular vision disorders had a 27 percent higher risk of falls, fractures and injuries overall.

    For people with a specific diagnosis of diplopia, the risk was 36 percent higher.

    The study team cautions that they don't know if the injuries occurred before the vision problems were diagnosed or afterward, so they can't say for certain that the eye disorders are to blame for the falls. They also don't know which patients were being treated for their vision problems.

    Still, Pineles said that elderly patients with vision problems should be sure they optimize lighting in their homes, get help when navigating unfamiliar areas and use low-vision aids if necessary.

    Dr. Jamie Rosenberg, an ophthalmologist at Montefiore Medical Center in New York who specializes in strabismus, said that eye problems can sometimes seem less important to elderly patients compared to other illnesses they may have. But "they can affect their life in a significant way and keeping them safe from falls is a huge part of keeping older people healthy."

    Rosenberg, who wasn't involved in the new study, said there are treatment options for strabismus, such as wearing special glasses with prisms that help align the double images seen by people with diplopia.

    "Even though the eyes aren't straight the two images that are being processed by the brain will be one," she said.

    Surgery may also be an option. "A lot of people think that older people can't have strabismus surgery to straighten their eyes but that's actually not true at all," Rosenberg said.

    The new study may underestimate the magnitude of the problem, noted Priscilla Rogers, an aging and vision loss expert at the American Foundation for the Blind's Vision Aware program.

    "Only people who seek medical care from a fall would be included, so the problem is probably bigger and greater than this study suggests," she told Reuters Health in an email.

    Access to eye care may be one obstacle keeping older people from getting help for vision disorders, she noted. "Medicare does not pay for new glasses and people on a fixed income may not want to buy new glasses because they cost too much," Rogers said. "They can, after all, see - they just may not see well enough to avoid a trip or fall."

    Rogers said that fall prevention programs such as "A Matter of Balance" offered in several states (http://bit.ly/1FZWPgF ) can help reduce the risk of injuries among people with visual impairments.

    SOURCE: http://bit.ly/1wylK5I JAMA Ophthalmology, online October 23, 2014.