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Neuroscience Articles

  • With stimulant, kids with ADHD less likely to injure themselves

    By Kathryn Doyle

    (Reuters Health) - When kids with attention-deficit hyperactivity disorder (ADHD) are taking methylphenidate, a stimulant drug, they are less likely to end up in the emergency room with a trauma injury, a new study finds.

    "Previous studies show that patients with ADHD have a higher tendency of sustaining trauma and other injuries, requiring emergency department (ED) attendance," said senior author Ian C.K. Wong of the Centre for Safe Medication Practice and Research department of pharmacology and pharmacy in Hong Kong.

    "These studies also suggest that impulsivity and poor concentration in some patients with ADHD may contribute to the high incidence of injury," Wong told Reuters Health by email.

    About five percent of U.S. children have ADHD, according to the American Psychiatric Association, although some estimates have been higher. Diagnosis rates have increased by three percent per year between 1997 and 2006, according to the Centers for Disease Control and Prevention.

    Past research has shown that kids with ADHD are more likely to end up in motor vehicle crashes or in the emergency room with injuries.

    For the new study, the researchers used data on more than 17,000 patients ages six to 19 years old who had received a methylphenidate (Ritalin) prescription between 2001 and 2013 in Hong Kong.

    They compared the number of trauma-related emergency department admissions for each child while he or she had the prescription to their number of admissions when they did not have the prescription.

    Almost 5,000 of the kids were admitted to the ED at least once over the study period. On average, they were about 9 percent less likely to visit the ED with an injury during medication periods than during times without the medication.

    The apparent effect of the medication was stronger for teens over age 16 than for younger kids, the authors write in Pediatrics.

    Since stimulant medications like methylphenidate improve concentration and reduce impulsivity, that may reduce the number of traumas in injuries for kids with ADHD, said Suzanne McCarthy, a lecturer in clinical pharmacy at University College Cork in Ireland.

    McCarthy was not involved in the new study.

    "Children and adolescents with ADHD have problems with brain functioning in the area responsible for executive functioning, meaning decision-making, judgment and the ability to inhibit impulsive actions," according to Dr. Steven P. Cuffe, professor and chair of psychiatry at the University of Florida College of Medicine in Jacksonville, who also was not part of the new study.

    "So a medication that improves this functioning could be expected to reduce impulsivity and thereby decrease trauma related ED visits," Cuffe said.

    In 2011, six percent of U.S. kids aged four to 17 were taking medication for ADHD.

    Stimulants are the drug of choice for ADHD, and methylphenidate is one of the two main treatments, the other being amphetamines (Adderall), Cuffe told Reuters Health by email.

    "One shouldn't infer that this tells you anything about potential effectiveness of other treatments for ADHD," said Dr. G. Caleb Alexander, co-director of the Center for Drug Safety and Effectiveness at Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland.

    "Stimulants are widely used and have been widely overused as well," Alexander said.

    "I don't think that this study is the final answer either," he said. "We have hierarchies of evidence for a reason."

    When enough evidence has been collected, systematic reviews help clinicians and policymakers make changes, he said. At this point, these results won't change prescribing patterns for kids with ADHD, since the primary aim of stimulants isn't to prevent broken bones, he said.

    "There are documented benefits to methylphenidate use such as improvements in the core ADHD symptoms (attention, hyperactivity, impulsivity)," McCarthy told Reuters Health by email. "There are also well documented side effects such as decreased appetite, sleep disturbances."

    Drug treatment of ADHD remains only part of a comprehensive treatment program, which incorporates psychosocial interventions as well, Wong noted.

    "Use of these medications should only be initiated after a careful evaluation, an accurate diagnosis, clear impairment in functioning due to the diagnosis, and weighing the risks and benefits," Cuffe said. "So I would focus on getting it right, not necessarily that more children and adolescents should be treated."

    SOURCE: http://bit.ly/1GM66Xj Pediatrics, online December 15, 2014.

  • Colorado awards $8 million to study medical marijuana uses

    By Keith Coffman

    DENVER (Reuters) - Colorado health officials awarded $8 million in research grants on Wednesday to study the use of medical marijuana in the treatment of symptoms associated with Parkinson's disease, childhood epilepsy and post-traumatic stress disorder.

    Colorado was one of the first two U.S. states to legalize recreational pot use, and it is among 23 states and the District of Columbia that permit use of the drug for medicinal purposes.

    But weed remains illegal under federal law for any reason, leading to a dearth of funding for medical marijuana research, and meaning results are limited and largely anecdotal.

    Awarding eight grants for landmark peer-reviewed studies into an array of maladies, the Colorado Department of Public Health and Environment said it sought to provide objective scientific research on the efficacy of medical marijuana.

    "The grant program ... should not be construed as encouraging tor sanctioning the social or recreational use of marijuana," the department said in a statement.

    Colorado lawmakers set up a Medical Marijuana Scientific Advisory Council last year and allocated $10 million to administer a program to conduct the studies. The council received some three dozen applications, from which it chose the eight approved by the department on Wednesday.

    Funding for the program is derived from taxes imposed on the state-regulated sale of medical marijuana.

    Six of the grants will go to the University of Colorado Anschutz Medical Campus, said university spokesman Mark Couch.

    Researchers there will study whether marijuana in its various forms can alleviate the tremors associated with Parkinson's and whether it can provide relief for children with brain tumors or pediatric epilepsy.

    Other projects will research using marijuana to treat irritable bowel syndrome in adolescents and young adults, and how cannabis compares with the pain medication Oxycodone.

    Teams at the University of Pennsylvania will conduct two separate studies on whether cannabis is effective in treating patients suffering from post-traumatic stress disorder, including combat veterans.

    "It's true that little research has been done due to federal restrictions. I think that will change as more states are legalizing," said Brian Smith, a spokesman for the Washington State Liquor Control Board, which oversees legalized recreational cannabis there.

    Voters in Oregon and Alaska cast ballots in November to join Colorado and Washington in legalizing recreational pot use.

  • Autism risk linked to particulate air pollution

    By Reuters Staff

    (Reuters) - Children whose mothers were exposed to high levels of fine particulate pollution in late pregnancy have up to twice the risk of developing autism as children of mothers breathing cleaner air, scientists at Harvard School of Public Health reported on Thursday.

    The greater the exposure to fine particulates emitted by fires, vehicles and industrial smokestacks, the greater the risk, according to the study published online in Environmental Health Perspectives.

    Earlier research also found an autism-pollution connection, including a 2010 study that found the risk of autism doubled if a mother, during her third trimester, lived near a freeway, a proxy for exposure to particulates. But this is the first to examine the link across the United States, and "provides additional support" to a possible link, said Heather Volk of the University of Southern California Children's Hospital, who led earlier studies.

    U.S. diagnoses of autism soared to one in 68 children in 2010 (the most recent data) from one in 150 in 2000, government scientists reported in March. Experts are divided on how much of the increase reflects greater awareness and how much truly greater incidence.

    Although the disorder has a strong genetic basis, the increasing incidence has spurred scientists to investigate environmental causes, too, since genes do not change quickly enough to explain the rise.

    The Harvard study included children of the 116,430 women in the Nurses' Health Study II, which began in 1989. The researchers collected data on where the women lived while pregnant and levels of particulate pollution. They then compared the prenatal histories of 245 children with autism spectrum disorder to 1,522 normally-developing children, all born from 1990 to 2002.

    There was no association between autism and fine particulate pollution exposure before or early in pregnancy, or after the child was born. But high levels of exposure during the third trimester doubled the risk of autism.

    Evidence that a mother-to-be's exposure to air pollution affects her child's risk of autism "is becoming quite strong," said Harvard epidemiologist Marc Weisskopf, who led the study, suggesting a way to reduce the risk.

    It is not clear how tiny particles might cause autism, but they are covered with myriad contaminants and penetrate cells, which can disrupt brain development.

    Last year the Environmental Protection Agency, citing the link to asthma, lung cancer and cardiovascular disease, tightened air quality standards for fine particulate pollution. States have until 2020 to meet the new standards.

    SOURCE: http://1.usa.gov/1w2lTep Environmental Health Perspectives, online December 18, 2014.

  • Cytisine better than nicotine replacement in helping smokers quit

    By Gene Emery

    (Reuters Health) - An inexpensive extract helps more smokers quit than nicotine patches, gum or lozenges, according to a test of 1,310 smokers in New Zealand.

    The extract is cytisine, which is found in several plant species and has been marketed over the counter for smoking cessation in some Eastern European countries such as Bulgaria for 50 years. It is not approved for use in the U.S. and other Western countries.

    "This is the first time it's been compared to a standard treatment," chief author Dr. Natalie Walker of the University of Auckland told Reuters Health by phone.

    In the test, reported in the New England Journal of Medicine, 22 percent of 655 smokers taking cytisine for one month were still off tobacco six months later, compared to 15 percent of 655 people getting nicotine replacement therapy for eight weeks.

    "When people take it, it helps mitigate some of those feelings of withdrawal, and if they do go back smoking, they don't enjoy it as much. That combination helps them quit," Walker said. All of the volunteers in the study also had telephone counseling available.

    But the risk of side effects was higher with cytosine. The biggest problems were nausea and vomiting, which was seen in 30 percent of recipients, and 28 percent reported sleep disorders, which included bad dreams. The rates of those problems among nicotine replacement recipients were just 2 percent for each.

    Nonetheless, Walker pointed out that there's a big difference in cost between the two therapies. Twenty five days of cytisine costs about $20 to $30 versus $112 to $685 for 8 to 10 weeks of nicotine replacement.

    "The majority of smokers are in lower- and middle-income countries, and they can't afford replacement therapy, so they get nothing," Walker said. "But they could have cytisine, which is so cheap for them."

    "Overall, the study shows that cytisine is at least equivalent to nicotine-replacement therapy," Dr. Nancy Rigotti of Harvard Medical School wrote in an editorial accompanying the study.

    But whether most smokers will ever get a chance to try it is unclear.

    "The good news: it's cheap. The bad news: it's cheap," said Dr. Norman Edelman, senior scientific advisor for the American Lung Association, who was not connected with the research. "You have to find someone who thinks it's worth manufacturing, going through the approval process, marketing it and making a profit."

    Walker said one of the two companies making the drug, Sopharma Ltd. of Bulgaria, has given a company called Extab Corporation the rights to market its Tabex brand of cytisine. According to the Extab website, the company is "obtaining regulatory approval for Tabex in US, EU, Japan and other major markets."

    In places where it is approved, cytisine is also sold under the brand name Desmoxan.

    Whether cytisine is better than Pfizer's smoking cessation drug varenicline, sold under the brand names Chantix or Champix, remains to be seen Edelman noted. "It seems to work pretty much the same way with the same side effects," he said.

    The dose for cytisine varied in the study, with six tablets prescribed daily for the first three days, five tablets on days 4 through 12, four tablets on days 13 to 16, three on days 17 to 20, and two on days 21 to 25.

    A significant difference in quit rates showed up during the first month; 40 percent in the cytisine group had stopped smoking versus 31 percent in the nicotine-replacement group.

    The largest effect was seen among women, whose odds of quitting were 55 percent higher with cytisine. Among men, the quit rate with cytisine was essentially the same as it was with nicotine replacement products.

    "We don't really know why this happened," Walker said in a followup email. "It's an area to explore further."

    The typical smoker relapsed after 11 days of nicotine replacement therapy and after 53 days with the drug.

    While nearly a third of the 655 cytisine recipients reported at least one side effect, 82 percent said they would recommend the drug to someone who wanted to stop smoking.

    "Only 36 (5.5 percent) people in total in the cytisine group stopped using cytisine because of an adverse event," Walker said. "The majority of side effects experienced by participants in both groups did not last long and were not serious."

    "Cytisine was not just similar to nicotine-replacement therapy but actually superior to it for continuous tobacco abstinence at 1 month," Rigotti wrote in her editorial. "(Cytisine) remained superior to nicotine-replacement therapy at a 6-month follow-up."

    But, she cautioned, "More than 20 percent of participants had used nicotine-replacement therapy in their most recent attempt to stop smoking and were already nonresponders to nicotine-replacement therapy," which might have skewed the findings.

    Walker said smokers in western countries haven't been exposed to cytisine because, until recently, much of the research on the chemical hadn't gone beyond eastern Europe (see Reuters Health article of September 28, 2011 here: http://reut.rs/1sAruIu).

    "Most of the world can't look at these papers because they can't read them and nobody translates them. And so, the information just sits there," she said.

    SOURCE: http://bit.ly/1Az0kX0 New England Journal of Medicine, online December 17, 2014.

  • UPDATE 1-Fourteen charged in deadly 2012 U.S. meningitis outbreak -prosecutors

    (New throughout, adds details from U.S. Attorney press conference)

    By Tim McLaughlin

    BOSTON (Reuters) - Two pharmacists from Massachusetts were charged with second-degree murder in connection with a deadly 2012 meningitis outbreak that killed at least 64 people and injured about 750, according to an indictment made public on Wednesday.

    The 131-count indictment accuses 14 people who either worked or acted as owners of New England Compounding Center (NECC), a specialty pharmacy that went into bankruptcy after the outbreak.

    Barry J. Cadden, 48, a pharmacist and part of NECC's ownership group, and pharmacist Glenn A. Chinn, 46, have been charged with 25 murders in seven states, according to the indictment.

    The outbreak was "an unprecedented national tragedy," Carmen Ortiz, the U.S. Attorney for the district of Massachusetts, said at a news conference. Health officials have said it was the deadliest meningitis outbreak in U.S. history.

    Prosecutors said officials at Framingham, Massachusetts-based NECC knowingly shipped contaminated steroids across the country. The drugs typically were injected in patients suffering from back pain.

    The pharmacy escaped harsh punishment from health regulators several times in the years leading up to the outbreak, according to hundreds of pages of documents obtained under a Freedom of Information Act request.

    NECC, about 20 miles west of Boston, started out as a small family business owned by members of Cadden's family, along with his brother-in-law, Gregory Conigliaro, 49, a recycling entrepreneur.

    Eventually, the operations expanded to bulk sales to hospitals and clinics in nearly 50 states, company records show. During the first 10 months of 2012, NECC generated about $32.4 million in revenue, the indictment said.

    The indictment accuses Greg Conigliaro of instructing staff to create 300 fraudulent prescriptions related to an eye anesthetic that didn't work.

    His brother, Doug Conigliaro, 53, and sister-in-law Carla Conigliaro, are accused of criminal contempt in connection with $33 million in transfers to eight different bank accounts after NECC went into bankruptcy. Carla Conigliaro, 51, was NECC's majority shareholder.

    Overall, the charges include racketeering, conspiracy, contempt and mail fraud. The 25 second-degree murder charges against Cadden and Chin fall under the Racketeer Influenced and Corrupt Organizations Act (RICO). The charges relate to patients who died in Florida, Indiana, Maryland, Michigan, North Carolina, Tennessee and Virginia.

    NECC shut down in October 2012 and filed for bankruptcy two months later under a barrage of lawsuits. This month, a trustee overseeing the bankruptcy filed a plan that would set aside at least $135 million to compensate victims and their families.

Oncology Articles

  • Global population living six years longer than in 1990 - study

    By Kate Kelland

    LONDON (Reuters) - Global life expectancy has risen by more than six years since 1990 thanks to falling death rates from cancer and heart disease in rich countries and better survival in poor countries from diarrhea, tuberculosis and malaria.

    In an analysis from the 2013 Global Burden of Disease (GBD) study, health researchers said, however, that while life expectancy is rising almost everywhere in the world, one notable exception is southern sub-Saharan Africa, where deaths from HIV/AIDS have erased some five years of life expectancy since 1990.

    "The progress we are seeing against a variety of illnesses and injuries is good - even remarkable - but we can and must do even better," said Christopher Murray, a professor of global health at the University of Washington in the United States, who led the study. It was published in The Lancet medical journal.

    Murray said a huge increase in collective action and funding given to potentially deadly infectious diseases such as diarrhea, measles, tuberculosis, HIV and malaria has had a real impact, reducing death rates and extending life expectancy.

    But he said some major chronic diseases have been neglected and are rising in importance as threats to life, particularly drug disorders, liver cirrhosis, diabetes and kidney disease.

    The GBD 2013 gives the most comprehensive and up-to-date estimates of the number of yearly deaths from 240 different causes in 188 countries over 23 years - from 1990 to 2013.

    Murray's team's latest analysis found some poorer countries have made exceptional gains in life expectancy over that time period, with people in Nepal, Rwanda, Ethiopia, Niger, Maldives, East Timor and Iran now living on average 12 years longer.

    Yet despite dramatic drops in child deaths over the last 23 years, malaria, diarrhea and respiratory infections such as pneumonia are still in the top five global causes of death in children under five, killing almost two million children between the ages of one month and 59 months every year.

    Another mixed success is that, while worldwide deaths from HIV/AIDS have fallen every year since their peak in 2005, HIV/AIDS is still the greatest cause of premature death in 20 out of 48 countries in sub-Saharan Africa.

    SOURCE: http://bit.ly/1wkC4J4 The Lancet, online December 17, 2014.

  • Colorado awards $8 million to study medical marijuana uses

    By Keith Coffman

    DENVER (Reuters) - Colorado health officials awarded $8 million in research grants on Wednesday to study the use of medical marijuana in the treatment of symptoms associated with Parkinson's disease, childhood epilepsy and post-traumatic stress disorder.

    Colorado was one of the first two U.S. states to legalize recreational pot use, and it is among 23 states and the District of Columbia that permit use of the drug for medicinal purposes.

    But weed remains illegal under federal law for any reason, leading to a dearth of funding for medical marijuana research, and meaning results are limited and largely anecdotal.

    Awarding eight grants for landmark peer-reviewed studies into an array of maladies, the Colorado Department of Public Health and Environment said it sought to provide objective scientific research on the efficacy of medical marijuana.

    "The grant program ... should not be construed as encouraging tor sanctioning the social or recreational use of marijuana," the department said in a statement.

    Colorado lawmakers set up a Medical Marijuana Scientific Advisory Council last year and allocated $10 million to administer a program to conduct the studies. The council received some three dozen applications, from which it chose the eight approved by the department on Wednesday.

    Funding for the program is derived from taxes imposed on the state-regulated sale of medical marijuana.

    Six of the grants will go to the University of Colorado Anschutz Medical Campus, said university spokesman Mark Couch.

    Researchers there will study whether marijuana in its various forms can alleviate the tremors associated with Parkinson's and whether it can provide relief for children with brain tumors or pediatric epilepsy.

    Other projects will research using marijuana to treat irritable bowel syndrome in adolescents and young adults, and how cannabis compares with the pain medication Oxycodone.

    Teams at the University of Pennsylvania will conduct two separate studies on whether cannabis is effective in treating patients suffering from post-traumatic stress disorder, including combat veterans.

    "It's true that little research has been done due to federal restrictions. I think that will change as more states are legalizing," said Brian Smith, a spokesman for the Washington State Liquor Control Board, which oversees legalized recreational cannabis there.

    Voters in Oregon and Alaska cast ballots in November to join Colorado and Washington in legalizing recreational pot use.

  • Autism risk linked to particulate air pollution

    By Reuters Staff

    (Reuters) - Children whose mothers were exposed to high levels of fine particulate pollution in late pregnancy have up to twice the risk of developing autism as children of mothers breathing cleaner air, scientists at Harvard School of Public Health reported on Thursday.

    The greater the exposure to fine particulates emitted by fires, vehicles and industrial smokestacks, the greater the risk, according to the study published online in Environmental Health Perspectives.

    Earlier research also found an autism-pollution connection, including a 2010 study that found the risk of autism doubled if a mother, during her third trimester, lived near a freeway, a proxy for exposure to particulates. But this is the first to examine the link across the United States, and "provides additional support" to a possible link, said Heather Volk of the University of Southern California Children's Hospital, who led earlier studies.

    U.S. diagnoses of autism soared to one in 68 children in 2010 (the most recent data) from one in 150 in 2000, government scientists reported in March. Experts are divided on how much of the increase reflects greater awareness and how much truly greater incidence.

    Although the disorder has a strong genetic basis, the increasing incidence has spurred scientists to investigate environmental causes, too, since genes do not change quickly enough to explain the rise.

    The Harvard study included children of the 116,430 women in the Nurses' Health Study II, which began in 1989. The researchers collected data on where the women lived while pregnant and levels of particulate pollution. They then compared the prenatal histories of 245 children with autism spectrum disorder to 1,522 normally-developing children, all born from 1990 to 2002.

    There was no association between autism and fine particulate pollution exposure before or early in pregnancy, or after the child was born. But high levels of exposure during the third trimester doubled the risk of autism.

    Evidence that a mother-to-be's exposure to air pollution affects her child's risk of autism "is becoming quite strong," said Harvard epidemiologist Marc Weisskopf, who led the study, suggesting a way to reduce the risk.

    It is not clear how tiny particles might cause autism, but they are covered with myriad contaminants and penetrate cells, which can disrupt brain development.

    Last year the Environmental Protection Agency, citing the link to asthma, lung cancer and cardiovascular disease, tightened air quality standards for fine particulate pollution. States have until 2020 to meet the new standards.

    SOURCE: http://1.usa.gov/1w2lTep Environmental Health Perspectives, online December 18, 2014.

  • Cytisine better than nicotine replacement in helping smokers quit

    By Gene Emery

    (Reuters Health) - An inexpensive extract helps more smokers quit than nicotine patches, gum or lozenges, according to a test of 1,310 smokers in New Zealand.

    The extract is cytisine, which is found in several plant species and has been marketed over the counter for smoking cessation in some Eastern European countries such as Bulgaria for 50 years. It is not approved for use in the U.S. and other Western countries.

    "This is the first time it's been compared to a standard treatment," chief author Dr. Natalie Walker of the University of Auckland told Reuters Health by phone.

    In the test, reported in the New England Journal of Medicine, 22 percent of 655 smokers taking cytisine for one month were still off tobacco six months later, compared to 15 percent of 655 people getting nicotine replacement therapy for eight weeks.

    "When people take it, it helps mitigate some of those feelings of withdrawal, and if they do go back smoking, they don't enjoy it as much. That combination helps them quit," Walker said. All of the volunteers in the study also had telephone counseling available.

    But the risk of side effects was higher with cytosine. The biggest problems were nausea and vomiting, which was seen in 30 percent of recipients, and 28 percent reported sleep disorders, which included bad dreams. The rates of those problems among nicotine replacement recipients were just 2 percent for each.

    Nonetheless, Walker pointed out that there's a big difference in cost between the two therapies. Twenty five days of cytisine costs about $20 to $30 versus $112 to $685 for 8 to 10 weeks of nicotine replacement.

    "The majority of smokers are in lower- and middle-income countries, and they can't afford replacement therapy, so they get nothing," Walker said. "But they could have cytisine, which is so cheap for them."

    "Overall, the study shows that cytisine is at least equivalent to nicotine-replacement therapy," Dr. Nancy Rigotti of Harvard Medical School wrote in an editorial accompanying the study.

    But whether most smokers will ever get a chance to try it is unclear.

    "The good news: it's cheap. The bad news: it's cheap," said Dr. Norman Edelman, senior scientific advisor for the American Lung Association, who was not connected with the research. "You have to find someone who thinks it's worth manufacturing, going through the approval process, marketing it and making a profit."

    Walker said one of the two companies making the drug, Sopharma Ltd. of Bulgaria, has given a company called Extab Corporation the rights to market its Tabex brand of cytisine. According to the Extab website, the company is "obtaining regulatory approval for Tabex in US, EU, Japan and other major markets."

    In places where it is approved, cytisine is also sold under the brand name Desmoxan.

    Whether cytisine is better than Pfizer's smoking cessation drug varenicline, sold under the brand names Chantix or Champix, remains to be seen Edelman noted. "It seems to work pretty much the same way with the same side effects," he said.

    The dose for cytisine varied in the study, with six tablets prescribed daily for the first three days, five tablets on days 4 through 12, four tablets on days 13 to 16, three on days 17 to 20, and two on days 21 to 25.

    A significant difference in quit rates showed up during the first month; 40 percent in the cytisine group had stopped smoking versus 31 percent in the nicotine-replacement group.

    The largest effect was seen among women, whose odds of quitting were 55 percent higher with cytisine. Among men, the quit rate with cytisine was essentially the same as it was with nicotine replacement products.

    "We don't really know why this happened," Walker said in a followup email. "It's an area to explore further."

    The typical smoker relapsed after 11 days of nicotine replacement therapy and after 53 days with the drug.

    While nearly a third of the 655 cytisine recipients reported at least one side effect, 82 percent said they would recommend the drug to someone who wanted to stop smoking.

    "Only 36 (5.5 percent) people in total in the cytisine group stopped using cytisine because of an adverse event," Walker said. "The majority of side effects experienced by participants in both groups did not last long and were not serious."

    "Cytisine was not just similar to nicotine-replacement therapy but actually superior to it for continuous tobacco abstinence at 1 month," Rigotti wrote in her editorial. "(Cytisine) remained superior to nicotine-replacement therapy at a 6-month follow-up."

    But, she cautioned, "More than 20 percent of participants had used nicotine-replacement therapy in their most recent attempt to stop smoking and were already nonresponders to nicotine-replacement therapy," which might have skewed the findings.

    Walker said smokers in western countries haven't been exposed to cytisine because, until recently, much of the research on the chemical hadn't gone beyond eastern Europe (see Reuters Health article of September 28, 2011 here: http://reut.rs/1sAruIu).

    "Most of the world can't look at these papers because they can't read them and nobody translates them. And so, the information just sits there," she said.

    SOURCE: http://bit.ly/1Az0kX0 New England Journal of Medicine, online December 17, 2014.

  • Docs may be too conservative about sex after heart attack

    By Andrew M. Seaman

    (Reuters Health) - Most people get no advice from their doctors about whether or when it's safe to have sex after a heart attack, according to a survey of American and Spanish patients under age 55.

    Just one in eight women and one in five men reported being counseled on sexual activity within the month following a heart attack. And those who did discuss the topic with their doctors were likely to get overly restrictive instructions, researchers found.

    "The guidelines say for an uncomplicated heart attack people should be able to resume normal sexual activity after a week," said lead author Dr. Stacy Tessler Lindau, director of the Program in Integrative Sexual Medicine at the University of Chicago Medical Center.

    Tessler Lindau added that patients often don't know if they had an uncomplicated heart attack, which is one that doesn't result in complications to other organs or body systems.

    When patients are confused, "that's when the patient and physician need to speak," she said.

    About one in five heart attacks happen in adults under age 56, the researchers note in the journal Circulation. Heart attacks can lead to reduced sexual activity because people fear sex will trigger another heart attack, they add.

    The American College of Cardiology, American Heart Association and European Society of Cardiology all support a relatively quick return to sexual activity after an uncomplicated, or "minor," heart attack.

    To see if doctors apply those guidelines in practice, the researchers surveyed 3,501 heart attack patients from 127 hospitals in Spain and the U.S. between 2008 and 2012. The average patient was 48 years old. Two thirds were women. Most participants were sexually active in the year before their heart attack.

    Most participants believed doctors should talk about sex and said they felt comfortable discussing the subject with a physician. But only 12 percent of women and 19 percent of men had such a conversation in the month after their heart attack.

    Of the minority who did discuss sex with their doctors, about a third were told they could resume sexual activity without restrictions. The others were told to limit sex, to be more passive or to keep their heart rate down.

    Spanish women were almost 40 percent more likely than Spanish men to be given restrictive advice, while U.S women were less likely than U.S. men to be told to restrict their activity. Overall, women in Spain were 36 percent more likely than U.S. women to be told to limit sexual activity.

    Further differences by country were evident. For example, most U.S. patients who talked about sex with their doctors reported that they had initiated the discussion, while most of the Spanish patients said their doctor had brought it up.

    The results might reflect an overly cautious attitude among doctors who do bring up sex, said Tessler Lindau.

    "It could be that the physicians who are motivated to raise the issue are especially cautions throughout and thinking of all potential risk to their patient after a heart attack," she said.

    Tessler Lindau said people who consider their sexual function important should ask about sex after a heart attack if their doctors don't bring it up first.

    "It's fair game," she said. "I think your physician will give you an informed response."

    Tessler Lindau said sexual function tends to be important to most people. When she's giving a presentation, she said, she often asks people to decide whether they would rather lose their dominant hand or their sexual function. They typically have to think, she said.

    "Sexual function is a basic part of human physical function," she said. "If it's not working - unlike a missing hand - the rest of the world can't see it, but it's crucial."

    SOURCE: http://bit.ly/1xrwplT Circulation, online December 15, 2014.

Orthopedic Articles

  • Review finds best exercises to prevent women's knee injury

    By Madeline Kennedy

    (Reuters Health) - Some training methods are better than others at preventing knee ligament injuries in young women, researchers advise.

    Based on 14 previous studies, the researchers say training programs that focus on strengthening the legs and hips and stabilizing the abdomen are the most effective for preventing injury to the anterior cruciate ligament (ACL), and doing more than one type of exercise is also important.

    "We know neuromuscular training can reduce ACL injury in female athletes, but we were not sure what exercises are the best to attain the maximal prophylactic effects," said Dai Sugimoto of The Micheli Center for Sports Injury Prevention and the Boston Children's Hospital Orthopaedics and Sports Medicine department, in Massachusetts.

    The ACL is the key stabilizing ligament in the knee, and is most often injured during sports that involve quick turns or pivoting movements.

    ACL injuries are very serious and can take a long time to heal, the researchers write in the British Journal of Sports Medicine. College athletes with ACL injuries lose more time on the field than athletes with ankle or traumatic head injuries, according to the researchers.

    Young women facing the greatest risk are those who play sports involving a lot of pivoting, such as soccer, basketball, lacrosse and handball, according to Sugimoto. He added that the most common age for women to be injured is around 14 to 17 years.

    Grethe Mykelburst, who outlined the risks involved with ACL injury in an email, said, "it takes you out of your sport for 6-12 months, and some don't succeed to return to their previous level." She added that the risk of getting osteoarthritis, a degenerative condition, in the knee is high after injury.

    Mykelburst, a sports physical therapist and associate professor at the Oslo Sport Trauma Research Center in Oslo, Norway, was not involved in the review.

    Sugimoto's team analyzed 14 studies of exercise intervention programs, looking specifically at four different exercise approaches including balance, jump training, abdomen stabilizing exercises and strengthening of the legs and hips.

    Training programs that aimed to build strength in the back of the legs and in the hips significantly reduced the number of ACL injuries when compared with programs that did not. That was also true of programs that focused on strengthening and developing more control of the abdomen.

    Programs that included more than one type of exercise were significantly more effective than those using only one type. "Neuromuscular training has to incorporate many exercise modes," Sugimoto told Reuters Health. "Performing only one exercise mode seems ineffective."

    The researchers note that while balance and jumping exercises were somewhat helpful in reducing injury, they were not effective unless combined with other exercises.

    The study lists a number of specific helpful exercises, including Russian hamstring curls, sit-ups, pushups and bench press. Sugimoto emphasized the hamstring curls in particular, as they work both to strengthen the legs and hips and require abdomen control.

    "With inclusion of these exercises as well as a variety of exercise modes, athletes can attain the fullest benefit from neuromuscular training and prevent ACL injury," Sugimoto said.

    Every year 350,000 people seek ACL reconstruction surgery in the United States, the authors point out.

    Sugimoto said that although surgery is the best available treatment, 24 to 30 percent of high school athletes who undergo the surgery tear their ACL again within the next several years.

    "That's why we need to prevent ACL injury in first place to avoid subsequent ACL injury and preserve a healthy knee joint," Sugimoto said.

    "The evidence is strong that neuromuscular training works," Mykelburst agreed. "As an athlete or a coach, you can't afford not using the prevention program and exercises that exist," she added.

    SOURCE: http://bmj.co/1wATVNF British Journal of Sports Medicine, online December 1, 2014.

  • Fractures are major cause of older women's hospitalizations

    By Kathryn Doyle

    (Reuters Health) - For U.S. women age 55 or older, bone fractures due to osteoporosis lead to more hospitalizations and greater healthcare costs than heart attack, stroke or breast cancer, according to a new study.

    "What we saw and what those of us in the bone heath field have known is that the burden of major osteoporotic factors is huge," said lead author Dr. Andrea Singer of MedStar Georgetown University Hospital in Washington, DC, and clinical director at the National Osteoporosis Foundation.

    More than five million people over age 50 in the U.S. have been diagnosed with the bone-weakening disease osteoporosis, including two percent of men and ten percent of women, according to the Centers for Disease Control and Prevention.

    "We really underestimate the importance of osteoporosis and fracture, and people underestimate their own risk," Singer told Reuters Health.

    She and her coauthors used inpatient data from more than 1000 hospitals nationwide.

    Between 2000 and 2011, 4.9 million women over age 55 were hospitalized for osteoporotic fracture of the hip, pelvis, arm, leg or spine, compared to 3 million for stroke, 2.9 million for heart attack and 700,000 for breast cancer.

    Osteoporotic fractures accounted for more than 40 percent of the hospitalizations, the researchers calculated, and led to an estimated hospital cost of more than $5 billion per year.

    Heart attack, stroke and breast cancer hospitalizations cost the healthcare system $4.3 billion, $3 billion and $500 million per year, respectively, according to results in Mayo Clinic Proceedings.

    Even these numbers likely underestimate the true cost of osteoporosis to the healthcare system, Singer said.

    "We've known for a long time that osteoporotic fractures are the source of a lot of expense and pain," said Dr. Ethel S. Siris, past president of the National Osteoporosis Foundation and director of the Toni Stabile Osteoporosis Center of the Columbia University Medical Center at New York-Presbyterian Hospital.

    "Since this is something that has a higher burden than other things that patients or providers worry about all the time like heart attack, stroke and breast cancer, then we ought to be doing something to ask the right questions," Singer said.

    A quarter of all people who suffer a hip fracture die within one year, which is much higher than the other diseases included in the study, she said.

    "Of the 75 percent who remain alive, many lose their independence and need assisted living," Singer said. "A lot of times people fear not necessarily dying, but being incapacitated, ending up in a nursing home. Those statistics are daunting."

    Most people who break a hip never return to their normal lives, said Siris, who was not involved in the new study.

    "Half the people who break a hip have previously broken something else, and instead of looking at that as a red flag, those people don't get evaluated, they don't get bone density tests," she told Reuters Health. "Somehow or other fractures are just not taken so seriously."

    But recognizing and treating osteoporosis after that first fracture could prevent more fractures later, Siris said.

    That can include maintaining a healthy lifestyle to prevent or slow bone loss, getting adequate calcium and vitamin D, and doing weight-bearing muscle strengthening exercise. Even people who have had a fracture already can do modified safe activities, and can take care with proper footwear, avoiding steps, and avoiding carrying heavy loads, and thereby prevent falls, Singer said.

    "In terms of building new bones and really getting to the best bone density level you can, that happens when you're young," but it's never too late to treat osteoporosis, Singer said.

    Used correctly, bisphosphonate drugs can be very effective at lowering fracture risk, Siris said.

    "There's little doubt of the benefit of treatment if you need it overwhelmingly," she said. "There are lots of good treatments."

    Older women may qualify for a bone density test, and should request one after suffering a fracture over age 50, Singer said.

    "I hope in some ways this paper serves as a call to action to providers and empowers women to think about their own bone health," she said. "If their provider isn't proactively asking, then they can ask about it."

    SOURCE: http://bit.ly/1uh2Nkb Mayo Clinic Proceedings, online December 13, 2014.

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Women’s Health Articles

  • Autism risk linked to particulate air pollution

    By Reuters Staff

    (Reuters) - Children whose mothers were exposed to high levels of fine particulate pollution in late pregnancy have up to twice the risk of developing autism as children of mothers breathing cleaner air, scientists at Harvard School of Public Health reported on Thursday.

    The greater the exposure to fine particulates emitted by fires, vehicles and industrial smokestacks, the greater the risk, according to the study published online in Environmental Health Perspectives.

    Earlier research also found an autism-pollution connection, including a 2010 study that found the risk of autism doubled if a mother, during her third trimester, lived near a freeway, a proxy for exposure to particulates. But this is the first to examine the link across the United States, and "provides additional support" to a possible link, said Heather Volk of the University of Southern California Children's Hospital, who led earlier studies.

    U.S. diagnoses of autism soared to one in 68 children in 2010 (the most recent data) from one in 150 in 2000, government scientists reported in March. Experts are divided on how much of the increase reflects greater awareness and how much truly greater incidence.

    Although the disorder has a strong genetic basis, the increasing incidence has spurred scientists to investigate environmental causes, too, since genes do not change quickly enough to explain the rise.

    The Harvard study included children of the 116,430 women in the Nurses' Health Study II, which began in 1989. The researchers collected data on where the women lived while pregnant and levels of particulate pollution. They then compared the prenatal histories of 245 children with autism spectrum disorder to 1,522 normally-developing children, all born from 1990 to 2002.

    There was no association between autism and fine particulate pollution exposure before or early in pregnancy, or after the child was born. But high levels of exposure during the third trimester doubled the risk of autism.

    Evidence that a mother-to-be's exposure to air pollution affects her child's risk of autism "is becoming quite strong," said Harvard epidemiologist Marc Weisskopf, who led the study, suggesting a way to reduce the risk.

    It is not clear how tiny particles might cause autism, but they are covered with myriad contaminants and penetrate cells, which can disrupt brain development.

    Last year the Environmental Protection Agency, citing the link to asthma, lung cancer and cardiovascular disease, tightened air quality standards for fine particulate pollution. States have until 2020 to meet the new standards.

    SOURCE: http://1.usa.gov/1w2lTep Environmental Health Perspectives, online December 18, 2014.

  • CORRECTED-Women live with incontinence, but it can be treated

    (Corrects para 9 to indicate a success rate of 34 percent in the 105 women in the intervention group who completed the study.)

    By Ronnie Cohen

    (Reuters Health) - Older women often silently suffer from treatable urinary incontinence, researchers say.

    When doctors asked about urinary incontinence and offered to treat it, women were two to three times more likely to have a reduction in symptoms than when doctors ignored the condition until patients complained, they found.

    "It's very sad because most women don't ask for help because they think there is no help for them," lead researcher Dr. Els Visser told Reuters Health.

    "What we proved with this study is that there is help for them," she said.

    A general practitioner, Visser was a doctoral student at the University of Groningen in The Netherlands when she did the research.

    Women in the study were patients in general practices in The Netherlands, at least 55 years old. Out of 2,390 women who filled out questionnaires, a third, or 744, reported involuntary urine loss at least once a month. Ultimately, 350 women with incontinence participated in the study.

    Primary care doctors in the study were randomly assigned to either raise the question of incontinence, or to provide "standard care." Doctors who asked about incontinence symptoms also ordered tests to assess the problem and then worked with urologists and physical therapists to come up with a diagnosis and a treatment plan.

    In the standard-care group, doctors waited for the patient to ask for help with her incontinence.

    A year later, 34 percent of the 105 women in the intervention group who completed the study reported that their symptoms were less severe, researchers wrote in the journal Maturitas.

    Most women had improved as a result of physical therapy and lifestyle changes, including limiting alcohol and coffee consumption, Visser said.

    The most common treatments, given to 105 women, were pelvic floor muscle training, bladder training and biofeedback from a registered pelvic physiotherapist. In addition, six women received medication, three had surgery, and 41 were referred for further diagnostic evaluations.

    Of the 184 women in the control group, only three received treatment.

    The women in the intervention group were nearly twice as likely as those in the control group to report a reduction in the severity of incontinence, the study found.

    And when the researchers looked only at women with moderate to severe incontinence (leaving out those with mild symptoms), a reduction in symptoms was nearly three times more likely for women who'd been treated, compared to those who hadn't been.

    Tatyana Shamliyan, who has done similar research, told Reuters Health the study underscores the value of having doctors ask women about urinary incontinence.

    "We have to work hard in this area because it affects the quality of life for many women," she said.

    Shamliyan, who's now a quality assurance director at Elsevier in Philadelphia, was not involved in the current study.

    "It should be a public health issue," she said. "It's not shameful. It's very common, and it's treatable. The stigma should be removed."

    Shamliyan says teenage girls should learn about the benefits of pelvic floor muscle training after childbirth in health-education classes. Urinary incontinence afflicts not only aging women but women following childbirth, she said.

    One in three women over age 55 experiences symptoms of urinary incontinence, Visser said.

    Since 2003, physiotherapists with a specialty in pelvic floor training have been working in The Netherlands, she said. But pelvic floor muscle training is not standard practice in the U.S., Shamliyan said.

    She bemoaned the fact that urinary incontinence is not part of the curriculum in U.S. nursing schools.

    "We receive invitations for mammography. It should be the same for urinary incontinence. We would ask, do you have the symptoms? If you do, contact your physician," she said.

    In The Netherlands, Visser said, doctors write prescriptions for incontinence pads. The country with 16.8 million people spent 162 million Euros on adult diapers in 2012, Visser said.

    "That's quite a lot," she said. "So it's a very expensive condition. But it's not only in the Netherlands. It's everywhere."

    Her message to patients: "Don't hesitate to ask your doctor. You can be helped."

    SOURCE: http://bit.ly/134Yvqz Maturitas, online December 1, 2014.

  • Cytisine better than nicotine replacement in helping smokers quit

    By Gene Emery

    (Reuters Health) - An inexpensive extract helps more smokers quit than nicotine patches, gum or lozenges, according to a test of 1,310 smokers in New Zealand.

    The extract is cytisine, which is found in several plant species and has been marketed over the counter for smoking cessation in some Eastern European countries such as Bulgaria for 50 years. It is not approved for use in the U.S. and other Western countries.

    "This is the first time it's been compared to a standard treatment," chief author Dr. Natalie Walker of the University of Auckland told Reuters Health by phone.

    In the test, reported in the New England Journal of Medicine, 22 percent of 655 smokers taking cytisine for one month were still off tobacco six months later, compared to 15 percent of 655 people getting nicotine replacement therapy for eight weeks.

    "When people take it, it helps mitigate some of those feelings of withdrawal, and if they do go back smoking, they don't enjoy it as much. That combination helps them quit," Walker said. All of the volunteers in the study also had telephone counseling available.

    But the risk of side effects was higher with cytosine. The biggest problems were nausea and vomiting, which was seen in 30 percent of recipients, and 28 percent reported sleep disorders, which included bad dreams. The rates of those problems among nicotine replacement recipients were just 2 percent for each.

    Nonetheless, Walker pointed out that there's a big difference in cost between the two therapies. Twenty five days of cytisine costs about $20 to $30 versus $112 to $685 for 8 to 10 weeks of nicotine replacement.

    "The majority of smokers are in lower- and middle-income countries, and they can't afford replacement therapy, so they get nothing," Walker said. "But they could have cytisine, which is so cheap for them."

    "Overall, the study shows that cytisine is at least equivalent to nicotine-replacement therapy," Dr. Nancy Rigotti of Harvard Medical School wrote in an editorial accompanying the study.

    But whether most smokers will ever get a chance to try it is unclear.

    "The good news: it's cheap. The bad news: it's cheap," said Dr. Norman Edelman, senior scientific advisor for the American Lung Association, who was not connected with the research. "You have to find someone who thinks it's worth manufacturing, going through the approval process, marketing it and making a profit."

    Walker said one of the two companies making the drug, Sopharma Ltd. of Bulgaria, has given a company called Extab Corporation the rights to market its Tabex brand of cytisine. According to the Extab website, the company is "obtaining regulatory approval for Tabex in US, EU, Japan and other major markets."

    In places where it is approved, cytisine is also sold under the brand name Desmoxan.

    Whether cytisine is better than Pfizer's smoking cessation drug varenicline, sold under the brand names Chantix or Champix, remains to be seen Edelman noted. "It seems to work pretty much the same way with the same side effects," he said.

    The dose for cytisine varied in the study, with six tablets prescribed daily for the first three days, five tablets on days 4 through 12, four tablets on days 13 to 16, three on days 17 to 20, and two on days 21 to 25.

    A significant difference in quit rates showed up during the first month; 40 percent in the cytisine group had stopped smoking versus 31 percent in the nicotine-replacement group.

    The largest effect was seen among women, whose odds of quitting were 55 percent higher with cytisine. Among men, the quit rate with cytisine was essentially the same as it was with nicotine replacement products.

    "We don't really know why this happened," Walker said in a followup email. "It's an area to explore further."

    The typical smoker relapsed after 11 days of nicotine replacement therapy and after 53 days with the drug.

    While nearly a third of the 655 cytisine recipients reported at least one side effect, 82 percent said they would recommend the drug to someone who wanted to stop smoking.

    "Only 36 (5.5 percent) people in total in the cytisine group stopped using cytisine because of an adverse event," Walker said. "The majority of side effects experienced by participants in both groups did not last long and were not serious."

    "Cytisine was not just similar to nicotine-replacement therapy but actually superior to it for continuous tobacco abstinence at 1 month," Rigotti wrote in her editorial. "(Cytisine) remained superior to nicotine-replacement therapy at a 6-month follow-up."

    But, she cautioned, "More than 20 percent of participants had used nicotine-replacement therapy in their most recent attempt to stop smoking and were already nonresponders to nicotine-replacement therapy," which might have skewed the findings.

    Walker said smokers in western countries haven't been exposed to cytisine because, until recently, much of the research on the chemical hadn't gone beyond eastern Europe (see Reuters Health article of September 28, 2011 here: http://reut.rs/1sAruIu).

    "Most of the world can't look at these papers because they can't read them and nobody translates them. And so, the information just sits there," she said.

    SOURCE: http://bit.ly/1Az0kX0 New England Journal of Medicine, online December 17, 2014.

  • Docs may be too conservative about sex after heart attack

    By Andrew M. Seaman

    (Reuters Health) - Most people get no advice from their doctors about whether or when it's safe to have sex after a heart attack, according to a survey of American and Spanish patients under age 55.

    Just one in eight women and one in five men reported being counseled on sexual activity within the month following a heart attack. And those who did discuss the topic with their doctors were likely to get overly restrictive instructions, researchers found.

    "The guidelines say for an uncomplicated heart attack people should be able to resume normal sexual activity after a week," said lead author Dr. Stacy Tessler Lindau, director of the Program in Integrative Sexual Medicine at the University of Chicago Medical Center.

    Tessler Lindau added that patients often don't know if they had an uncomplicated heart attack, which is one that doesn't result in complications to other organs or body systems.

    When patients are confused, "that's when the patient and physician need to speak," she said.

    About one in five heart attacks happen in adults under age 56, the researchers note in the journal Circulation. Heart attacks can lead to reduced sexual activity because people fear sex will trigger another heart attack, they add.

    The American College of Cardiology, American Heart Association and European Society of Cardiology all support a relatively quick return to sexual activity after an uncomplicated, or "minor," heart attack.

    To see if doctors apply those guidelines in practice, the researchers surveyed 3,501 heart attack patients from 127 hospitals in Spain and the U.S. between 2008 and 2012. The average patient was 48 years old. Two thirds were women. Most participants were sexually active in the year before their heart attack.

    Most participants believed doctors should talk about sex and said they felt comfortable discussing the subject with a physician. But only 12 percent of women and 19 percent of men had such a conversation in the month after their heart attack.

    Of the minority who did discuss sex with their doctors, about a third were told they could resume sexual activity without restrictions. The others were told to limit sex, to be more passive or to keep their heart rate down.

    Spanish women were almost 40 percent more likely than Spanish men to be given restrictive advice, while U.S women were less likely than U.S. men to be told to restrict their activity. Overall, women in Spain were 36 percent more likely than U.S. women to be told to limit sexual activity.

    Further differences by country were evident. For example, most U.S. patients who talked about sex with their doctors reported that they had initiated the discussion, while most of the Spanish patients said their doctor had brought it up.

    The results might reflect an overly cautious attitude among doctors who do bring up sex, said Tessler Lindau.

    "It could be that the physicians who are motivated to raise the issue are especially cautions throughout and thinking of all potential risk to their patient after a heart attack," she said.

    Tessler Lindau said people who consider their sexual function important should ask about sex after a heart attack if their doctors don't bring it up first.

    "It's fair game," she said. "I think your physician will give you an informed response."

    Tessler Lindau said sexual function tends to be important to most people. When she's giving a presentation, she said, she often asks people to decide whether they would rather lose their dominant hand or their sexual function. They typically have to think, she said.

    "Sexual function is a basic part of human physical function," she said. "If it's not working - unlike a missing hand - the rest of the world can't see it, but it's crucial."

    SOURCE: http://bit.ly/1xrwplT Circulation, online December 15, 2014.

  • CORRECTED-Women live with incontinence, but it can be treated

    (Corrects para 9 to indicate a success rate of 34 percent in the 105 women in the intervention group who completed the study.)

    By Ronnie Cohen

    (Reuters Health) - Older women often silently suffer from treatable urinary incontinence, researchers say.

    When doctors asked about urinary incontinence and offered to treat it, women were two to three times more likely to have a reduction in symptoms than when doctors ignored the condition until patients complained, they found.

    "It's very sad because most women don't ask for help because they think there is no help for them," lead researcher Dr. Els Visser told Reuters Health.

    "What we proved with this study is that there is help for them," she said.

    A general practitioner, Visser was a doctoral student at the University of Groningen in The Netherlands when she did the research.

    Women in the study were patients in general practices in The Netherlands, at least 55 years old. Out of 2,390 women who filled out questionnaires, a third, or 744, reported involuntary urine loss at least once a month. Ultimately, 350 women with incontinence participated in the study.

    Primary care doctors in the study were randomly assigned to either raise the question of incontinence, or to provide "standard care." Doctors who asked about incontinence symptoms also ordered tests to assess the problem and then worked with urologists and physical therapists to come up with a diagnosis and a treatment plan.

    In the standard-care group, doctors waited for the patient to ask for help with her incontinence.

    A year later, 34 percent of the 105 women in the intervention group who completed the study reported that their symptoms were less severe, researchers wrote in the journal Maturitas.

    Most women had improved as a result of physical therapy and lifestyle changes, including limiting alcohol and coffee consumption, Visser said.

    The most common treatments, given to 105 women, were pelvic floor muscle training, bladder training and biofeedback from a registered pelvic physiotherapist. In addition, six women received medication, three had surgery, and 41 were referred for further diagnostic evaluations.

    Of the 184 women in the control group, only three received treatment.

    The women in the intervention group were nearly twice as likely as those in the control group to report a reduction in the severity of incontinence, the study found.

    And when the researchers looked only at women with moderate to severe incontinence (leaving out those with mild symptoms), a reduction in symptoms was nearly three times more likely for women who'd been treated, compared to those who hadn't been.

    Tatyana Shamliyan, who has done similar research, told Reuters Health the study underscores the value of having doctors ask women about urinary incontinence.

    "We have to work hard in this area because it affects the quality of life for many women," she said.

    Shamliyan, who's now a quality assurance director at Elsevier in Philadelphia, was not involved in the current study.

    "It should be a public health issue," she said. "It's not shameful. It's very common, and it's treatable. The stigma should be removed."

    Shamliyan says teenage girls should learn about the benefits of pelvic floor muscle training after childbirth in health-education classes. Urinary incontinence afflicts not only aging women but women following childbirth, she said.

    One in three women over age 55 experiences symptoms of urinary incontinence, Visser said.

    Since 2003, physiotherapists with a specialty in pelvic floor training have been working in The Netherlands, she said. But pelvic floor muscle training is not standard practice in the U.S., Shamliyan said.

    She bemoaned the fact that urinary incontinence is not part of the curriculum in U.S. nursing schools.

    "We receive invitations for mammography. It should be the same for urinary incontinence. We would ask, do you have the symptoms? If you do, contact your physician," she said.

    In The Netherlands, Visser said, doctors write prescriptions for incontinence pads. The country with 16.8 million people spent 162 million Euros on adult diapers in 2012, Visser said.

    "That's quite a lot," she said. "So it's a very expensive condition. But it's not only in the Netherlands. It's everywhere."

    Her message to patients: "Don't hesitate to ask your doctor. You can be helped."

    SOURCE: http://bit.ly/134Yvqz Maturitas, online December 1, 2014.