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Neuroscience Articles

  • Nap time isn't one-size-fits-all

    By Lisa Rapaport

    (Reuters Health) - There's no single trick for getting toddlers and preschoolers to nap, and it's possible that some children who resist sleeping during the day are getting all the rest they need at night.

    Tackling a topic that has long baffled parents of young children, a team of Australian researchers reviewed 26 previously published studies on how naps impact sleep at night, as well as learning and behavior during the day. It may come as no surprise to parents that researchers found little consensus beyond the fact that after age two, kids who nap may not sleep as much at night.

    "The study doesn't imply you shouldn't let your kids nap," said Jodi Mindell, associate director of the sleep center at The Children's Hospital of Philadelphia. "There are only so many hours a day that you can sleep, but that doesn't mean that napping leads to poor sleep."

    By age two, many children should be sleeping during the night for about 10 to 11 hours, and getting about one to three hours during the day, said Mindell, who wasn't involved in the study.

    Children who take long naps, and still have no difficulty falling asleep at bedtime or waking up on their own in the morning, are probably getting the right amount of rest, she said.

    Several of the studies the Australian researchers reviewed focused on the relationship between naps and sleep at night. The analysis found links between naps and later bedtimes, shorter periods of sleep at night, and waking up more often during the night.

    One study of kindergarten students who had an optional nap period found that kids went to bed later after a nap than without a nap during the day.

    The relationship between napping and developmental outcomes is less clear, the study team writes in the Archives of Disease in Childhood.

    Some studies suggested that napping aided language learning, but others found the opposite.

    Anxiety and worry appeared more common in children who didn't nap, some studies found, but other research suggested a link between longer naps and children acting more withdrawn or depressed.

    None of the studies can prove cause and effect, however. Because they were "observational" in design, and didn't randomize groups of children to take or skip naps, more experiments are still needed to understand how naps impact sleep and development, the researchers note.

    A lot of the studies were also based on observation at a single point in time, said Dr. Judith Owens, director of the Center for Pediatric Sleep Disorders at Boston Children's Hospital, "so you don't know if the kids stopped napping because they're getting more sleep at night or if you had a child who was a regular napper and you suddenly took the nap away before they were ready."

    When it comes to naps, parents shouldn't focus so much on the numbers, said Owens, who wasn't involved in the new study. Instead, they should pay attention to how their child behaves.

    If for example, your child sleeps 10 hours during the week and 11 hours on the weekends, that probably means they aren't getting enough sleep, Owens said. Or, if your child often nods off in the car or while watching cartoons or movies, that's another sign they need more sleep.

    A well-rested child will wake up on their own without an alarm clock, she added.

    For toddlers or preschoolers who still need naps, they might need to nap earlier in the afternoon to avoid delaying bedtime at night so they get enough total hours of sleep in a 24-hour period, Owens said.

    "I encourage parents to know in general what the recommendations are for amounts of sleep for kids at different ages, but then really be cognizant of the other clues from each of their children that may tell them what approach is best," Owens said.

    SOURCE: http://bmj.co/1BHOmho Archives of Disease in Childhood, online February 17, 2015.

  • Spider venom may hold chemical keys to new painkillers

    By Kate Kelland

    LONDON (Reuters) - Scientists who analyzed countless chemicals in spider venom say they have identified seven compounds that block a key step in the body's ability to pass pain signals to the brain.

    In research they said could one day lead to a new class of potent painkillers, the scientists focused on 206 species of spider and searched for molecules in the venom that block nerve activity via so-called Nav1.7 channels.

    Experts estimate that as many as one in five people worldwide suffer from chronic pain and existing pain treatments often fail to give sufficient or long-term relief. Pain's economic burden is also huge, with chronic pain estimated to cost $600 billion a year in the United States alone.

    People sense pain in a part of their body when nerves from the affected area send signals to the brain through what is called the pain pathway, and it is this pathway scientists seek to disrupt when searching for potential new pain medicines.

    "A compound that blocks Nav1.7 channels is of particular interest," said Glenn King, who led the study at Australia's University of Queensland.


    He said previous research has found indifference to pain among people who lack Nav1.7 channels due to a naturally-occurring genetic mutation, so blocking these channels has the potential to turn off pain in people with normal pathways.

    Part of the search for new pain killing drugs has focused on the world's 45,000 species of spiders, many of which kill their prey with venoms that contain hundreds and even thousands of protein molecules, including some that block nerve activity.

    "A conservative estimate indicates that there are nine million spider-venom peptides, and only 0.01 percent of this vast pharmacological landscape has been explored so far," said Julie Kaae Klint, who worked with King on the study.

    The researchers, whose work was published on Thursday in the British Journal of Pharmacology, built a system that could rapidly analyze spider venom compounds. They screened venoms from 206 species and found that 40 percent contained at least one compound that blocked human Nav1.7 channels.

    Of the seven promising compounds they identified, they said one was particularly potent and also had a chemical structure that suggested it would have the kind of chemical, thermal and biological stability needed for making a drug.

    "Untapping this natural source of new medicines brings a distinct hope of accelerating the development of a new class of painkillers," said Klint.

    SOURCE: http://bit.ly/1GSal5l British Journal of Pharmacology, online March 4, 2015.

  • Doctors, patients scramble ahead of high court Obamacare decision

    By Sharon Begley

    NEW YORK (Reuters) - As the U.S. Supreme Court takes on a make-or-break Obamacare case this week, a growing number of U.S. patients and their doctors are already devising a Plan B in case they lose medical coverage.

    The Court's ruling, expected by late June, will determine whether millions of Americans will keep receiving federal subsidies to help them pay for private health insurance under President Barack Obama's healthcare law.

    The White House, which said it is confident the justices will rule in favor of the subsidies that are a key element of Obamacare, said it has no immediate fix if the decision goes the other way.

    But even physicians who think the court will uphold the subsidies are gearing up for the worst.

    Worried about newly-insured patients such as those who have just begun treatment for cancer or other serious illnesses, they are dusting off playbooks they retired when Obamacare slashed the number of uninsured people.

    Interviews with doctors reached through professional groups show that they are lining up free clinics to care for patients with chronic illnesses, asking pharmaceutical companies to provide discounted drugs, and moving up preventive-care appointments and complicated procedures.

    "We have to be able to navigate this on behalf of our patients if it comes about," said Dr. Jeff Huebner, a family physician in Madison, Wisconsin, one of the affected states.

    In King v. Burwell, the Court will decide whether the Affordable Care Act permits government subsidies for citizens of at least 34 states which use the federal HealthCare.gov marketplace to buy health insurance. It will hear oral arguments on Wednesday.

    If the justices rule that only residents of states running their own exchanges are eligible for subsidies, some 9.3 million people will have to pay their full monthly premium or lose coverage, estimates the nonpartisan Urban Institute. About 6 million are expected to be unable to afford it.

    Many providers as well as patients are unaware of the looming threat, but some physicians are already preparing for it.

    Last weekend, leaders of the National Physicians Alliance, which supports the Affordable Care Act and works to improve access to medical care, met in Washington to discuss how to work with community organizations to arrange healthcare for people who might become uninsured, said Huebner, who chairs the group's policy committee.

    "The ideas include finding organizations that make referrals to free clinics, encouraging patients to check if they qualify for Medicaid or other state programs, and if they can't get insurance then find a regular source of care that accepts payment on a sliding scale" based on ability to pay, Huebner said.

    He and other physicians are also scheduling Obamacare patients for preventive screenings, completing lab work, and writing prescription refills.

    "I would advise patients in this boat to schedule a visit with their primary care provider as soon as they can" to set up "transition plans," Huebner said.


    If the court rules against the administration, premium subsidies for people in the affected states could end immediately, though insurers would be obliged to give 90 days notice before ending coverage, according to Aetna Inc. chief executive Mark Bertolini. None of the affected states have announced contingency plans, but some are considering alternatives to help residents maintain coverage.

    In Brewton, Alabama, pediatrician Marsha Raulerson has persuaded one drug company to provide an expensive asthma medication to one of her patients if she loses her insurance.

    "But after a few months you have to re-apply" and show that the patient is still unable to afford medication, Raulerson said. "It's not an easy process, especially if you have to do it for a lot of patients." She is also stockpiling as many free samples as she can.

    Dr. Robert Wergin, a primary care physician in Milford, Nebraska, is scrambling to locate labs and imaging centers that offer the lowest prices for blood tests, X-rays and MRIs.

    "Around here, people feel responsible for their bills and I'm not sure they would come in if they lost insurance and couldn't pay," Wergin said.

    Some patients, reached through social service organizations that helped them sign up for Obamacare, are aware of the potential loss of subsidies and are trying to schedule medical procedures before the Court rules.

    Yolanda Diaz, 27, is one of them. A single mother of two, she suffers from occasional blackouts that last several minutes. She cannot afford the full premium on her wages as a pantry manager at Brevard County, Florida, community center so she pays $74.95 a month and the rest is covered by a $205 Obamacare subsidy.

    Her coverage began this month, Diaz said, and the first thing she did was make appointments for an MRI and CT scans in hopes of identifying the cause of the blackouts.

    "I would hate to have to go to the ER, but if the subsidies get taken away I don't know what I'll do," she said. U.S. law requires hospitals to treat all emergency cases regardless of ability to pay, so many uninsured patients seek care there.

    Of those expected to be priced out of insurance in case of unfavorable ruling, the Urban Institute estimated 81 percent are, like Diaz, employed full- or part-time.

    So is Theresa Cabot-Walmer. The 58-year-old Pennsylvanian pays $79 a month and receives a subsidy of about $400. On her 5-hours-a-day job as a shipping clerk she could never afford the full premium, she said.

    Her coverage has allowed her to see a physical therapist for a serious knee injury and avoid a knee-replacement surgery.

    If the Court eliminates subsidies, she plans to ask if the therapist will accept lower payments. But because that is not a sure thing, Cabot-Walmer is considering her plan B.

    "I might try to schedule knee-replacement surgery while I still have insurance."

  • Pakistan arrests parents for refusing children's polio vaccinations

    By Jibran Ahmad

    PESHAWAR, Pakistan (Reuters) - Pakistan authorities have arrested hundreds of parents who refuse to vaccinate their children against polio, officials said Tuesday, as community opposition and Taliban threats block efforts to eradicate the crippling disease in one of its last strongholds.

    Frustrated officials turned to police to deal with parents influenced by some clerics who decry government vaccination campaigns as a tool to weaken Islam, according to Pervez Kamal, director of health for Khyber-Pakhtunkhwa region in the northwest.

    "There was no other option. We have run so many awareness campaigns for the parents and general masses that there is no harm in the vaccine, but to no avail," Kamal said.

    Pakistan reported 306 polio cases last year, far and away the largest share of the 359 cases worldwide recorded by the Global Eradicate Polio Initiative.

    Kamal said on Tuesday that a list of "chronic" refusal cases has been prepared and warrants issued for more than 1,000 parents.

    "So far, we have arrested 471 parents and efforts are under way to capture others," a police officer in Peshawar said.

    Once a common childhood disease, polio - which can cause paralysis and mostly affects children under age five - has declined by 99 percent in the last 25 years with aggressive vaccination campaigns, according to the WHO.

    Polio has made a comeback in Pakistan since the Taliban, seeking to topple the state and establish strict Islamic rule, began targeting government health workers conducting vaccine campaigns.

    Sixty-four people have been killed in attacks on polio teams and their security escorts since 2012, when the Taliban banned vaccinations in areas they controlled.

    Some Pakistanis are also against vaccinations because they believe they are part of a Western plot to sterilize children.

    The image of vaccinations suffered by association after a CIA-employed Pakistani doctor used the guise of a vaccination campaign to spy on Osama bin Laden in the months up to the U.S. raid that killed the al Qaeda chief in the Pakistani city of Abbottabad in 2011.

    The government conducts a national campaign against polio every month. Data from the first campaign of the year shows that nearly 60,000 children had been missed due to parental refusals.

    A government official, Riaz Mehsud, said there had been more than 14,000 refusals alone in Peshawar.

    "We have decided to take it a challenge and make sure that every child gets vaccinated," Mehsud said.

  • Va. governor signs law allowing marijuana oil for epilepsy treatment

    By Reuters Staff

    (Reuters) - A Virginia bill that would decriminalize a liquid, non-intoxicating form or marijuana to treat severe epilepsy has been signed into law by Governor Terry McAuliffe.

    Virginia becomes the 12th state in the past year to approve use of the marijuana oil, known as cannabidiol, as a treatment for severe epilepsy, according to the Washington-based pro-marijuana group NORML.

    McAuliffe, a Democrat, signed the bill Thursday and announced the signing on his Twitter account.

    Allen St. Pierre, NORML's executive director, called the signing "farcical" since Virginia, like other states that have approved use of the oil, has no legal cultivation of marijuana and thus no way to produce it. Federal law also bars transport of the oil across state lines, he said.

Oncology Articles

  • Head of U.S. National Cancer Institute to step down

    By Reuters Staff

    NEW YORK (Reuters) - The director of the U.S. National Cancer Institute will step down later this month after nearly five years at the helm of the agency that supports basic research on cancer in academia, industry, and its own labs, the National Institutes of Health announced on Wednesday.

    Dr. Harold Varmus's resignation will be effective on March 31. Dr. Douglas Lowy, currently the deputy director, will become acting director on April 1.

    In a letter to his NCI colleagues, Varmus, who shared the 1989 Nobel Prize in Physiology or Medicine for the discovery of the cellular origin of certain cancer-causing genes, said he would establish a cancer laboratory at the Weill-Cornell Medical College in New York City and also assist the recently-founded New York Genome Center.

    During his tenure, Varmus created NCI's Center for Global Health, launched an initiative to find drugs that target a particular biochemical pathway involved in cancer, and led the cancer component of the Precision Medicine Initiative announced last month by President Barack Obama.

    From 1993 to 1999, under President Bill Clinton, Varmus served as NIH director. After leaving NIH and before returning to run NCI in 2010, he served as president of Memorial Sloan-Kettering Cancer Center in New York.

    In his letter, Varmus lamented the recent budget cutbacks NCI has suffered. Citing his previous tenure at NIH, when budgets were rising, he quoted Mae West's line, "I've been rich and I've been poor, and rich is better."

  • Healthier lungs in California kids after pollution controls

    By Gene Emery

    (Reuters Health) - Doctors have long predicted that less air pollution will produce healthier lungs. Now a first-of-its-kind study of 2,120 children in southern California has documented dramatically better lung function growth as air quality has improved.

    Over a 13-year period, the proportion of children with poor lung capacity and lung health fell by half as levels of nitrogen dioxide and particulate matter dropped. The gains were seen both in youngsters who had asthma and in those who did not.

    "It certainly supports the efforts that have been made over 40 years to improve air quality," chief author Dr. James Gauderman of the Department of Preventive Medicine at the University of Southern California in Los Angeles told Reuters Health. "We would expect improvements in other urban centers to produce similar improvements in children's health."

    The study, published in the New England Journal of Medicine, complements research showing that childhood lung function deteriorates and the risk of asthma rises as pollution levels rise.

    "This is an association study, so there's always a question of cause and effect. Maybe these people got healthier on their own, ate better diets. You can never say it's an absolute proof," said Dr. Norman H. Edelman, senior consultant for scientific affairs at the American Lung Association.

    "But it's not a standalone study. It's based on older studies that show an association between the degree of air pollution and lung function in kids. This turns around and looks at improvement," he told Reuters Health.

    Gauderman and his colleagues examined the long-term effects in children by studying three groups during three time periods between 1994 and 2011. Typically, the children entered the study around age 11 and were followed for four years, a period when the lungs are developing rapidly. All lived in the Los Angeles area, a region of the U.S. known for air pollution problems, which have been abating as a result of strict state controls.

    "We looked at the proportion of children whose lung function was below 80 percent of normal. That's a cutoff a physician will often use to flag a person for a possible issue with their lungs," Gauderman said. While 7.9 percent of children fell into that category in 1998, the proportion had dropped to 3.6 percent by 2011.

    "We certainly suspected that improving air quality would improve children's health," Gauderman said. "We were surprised by the magnitude of the effect that we've seen."

    "What's news about this is the large magnitude of the effect, from 8 percent down to 4 percent," said Edelman, who was not connected to research. "Asthma is present in 10 percent of the population and that's a major health problem. If a percentage of those kids is going to have worse asthma because the air pollution has limited their lung growth, that's a big deal."

    During the study years, the air improved "dramatically," Gauderman's team writes in their report. For example, in 1994-1997, each cubic meter of air in one of the most-polluted communities, Mira Loma, had 31.5 micrograms of small particles called PM2.5 that penetrate deep into the lungs. By 2007-2010, Mira Loma averaged 17.8 micrograms of PM2.5 per cubic meter of air, a 43 percent decline. All five study sites had significant drops in particle pollution and nitrogen dioxide, they note.

    Overall, average lung capacity increased by 91.4 milliliters for every decrease of 14.1 parts per billion in nitrogen dioxide. It rose by 65.5 ml for each decrease of 8.7 micrograms per cubic meter of particle pollution. Significant changes were not linked to ozone levels, but levels of that pollutant have not declined as dramatically over time.

    "There were significant effects on lung-function growth in both boys and girls, although the magnitude of the air-pollution effect was significantly larger in boys than in girls," the researchers conclude.

    "We found no significant association between growth in height and change in pollution during the study period, which indicates that our findings on lung-function growth are probably not the result of a secular trend in general development," they write.

    California has stricter pollution controls than the U.S. as a whole, but Edelman said even the federal clean air act has cleaned up a lot of pollution "and this study is part of that. We're making progress. There's still a long way to go. We still have much more unacceptable effects of air pollution than we should have."

    SOURCE: http://bit.ly/1GICJGO New England Journal of Medicine, online March 4, 2015.

  • Treatment for prostate cancer varies by area of U.S.

    By Kathryn Doyle

    (Reuters Health) - A new study of Medicare and private insurance claims confirms that treatment trends for localized prostate cancer differ by U.S. region, by state and even from county to county.

    Overall, though, researchers found that newer, less invasive technologies, like laparoscopic prostate removal, have supplanted older treatment methods like open surgery over time.

    "There are several treatment options for men with localized prostate cancer," said lead author Dr. K. Clinton Cary of the urology department at Indiana University School of Medicine in Indianapolis.

    "These options have grown over time to incorporate technology advances," Cary told Reuters Health by email. Nonetheless, he said, "It is interesting to see how treatment of the same condition varies depending on your geographic location."

    The researchers used data on more than 77,000 men in a Medicare database who were diagnosed with prostate cancer between 1998 and 2006 in addition to more than 63,000 in a private claims database between 2002 and 2006.

    Radical prostatectomy, surgery to remove the prostate gland and some surrounding tissue, held steady at 12 percent of patients over time in the Medicare group, but increased from 33 to 48 percent by 2006 in the privately insured group.

    This was the most common first method of treatment in the private insurance group in 2002, followed by external beam radiation therapy. In the Medicare group, radiation therapy was the most common first treatment, followed by hormone therapy.

    Nine percent of privately insured men and 14 percent of those on Medicare did not immediately receive treatment and were instead assigned "active surveillance," also known as watchful waiting, an increasingly common approach to early prostate cancers.

    Patients in the private insurer group tended to be younger than those on Medicare, and younger patients are more suited to radical prostatectomy, according to Dr. Axel Heidenreich, director of the urology clinic at University Hospital Aachen in Germany, who was not involved in the new study.

    "The significant age difference, however, raises the question if (privately insured) patients have better access to the healthcare system in terms of early detection of prostate cancer as compared to the Medicare patients," Heidenreich told Reuters Health by email.

    In 2002, only a fraction of patients in either group underwent laparoscopic-assisted prostate surgery, a robotic version of the surgery that uses smaller incisions and a thin camera to minimize the invasiveness of the procedure.

    By 2006, 41 percent of the surgeries in the private insurance group and 35 percent of the surgeries in the Medicare group were laparoscopic, according to the results published in Prostate Cancer and Prostatic Disease.

    As robot-assisted prostate surgery became more common in both groups, hormone therapy became less common over time.

    In New England, counties with more urologists per capita had lower rates of radical prostatectomy and hormone therapy, and areas with more radiation oncologists had higher rates of radiation therapy. This physician-density pattern was not seen in California or Florida, however.

    In each state, Cary noted, there was considerable variation in treatments even between counties. "These counties could be bordering one another and yet the proportion receiving radiation could be between 20 to 50 percent higher in one of the counties compared to the other," he said.

    Although insurance reimbursement was not included in the study, it may unfortunately explain some of the local and regional variation, he said. Presumably, treatments with higher reimbursements would be more common.

    "Different treatments would certainly have the possibility to yield various outcomes," Cary said, although the study did not include that information. Because they didn't have information about the men's tumor characteristics, the study team can't say whether the changes over time or by region are necessarily for the better or worse.

    "Variations do exist, but this doesn't necessarily equate to inappropriate care," he said.

    "Patients should largely rely on their treating physicians for treatment advice," Cary said. "Patients may consider seeking second opinions from high-volume centers which may include their local academic medical centers that have experience with all treatment options and can report their own tracked outcomes."

    SOURCE: http://bit.ly/1B7yTVO Prostate Cancer and Prostatic Disease, online February 10, 2015.

  • REFILE-Slash sugar intake to fight obesity, tooth decay - WHO

    (Corrects spelling of announcement in paragraph 7)

    By Reuters Staff

    GENEVA (Reuters) - Adults and children must cut the amount of sugar they consume by as much as half in North America and Western Europe and even more in other areas to lower risk of obesity and tooth decay, the World Health Organization said on Wednesday.

    New guidelines meant people should reduce the amount to less than 10 percent of their daily energy intake - or to about 50 grams or 12 teaspoons of sugar for adults, experts at the U.N. body told Reuters.

    A cut to less than 5 percent would be even better, they added.

    The WHO's recommendations to health ministries cover free sugars such as glucose and fructose, and sucrose or table sugar added to processed foods and drinks as well as sugar naturally present in honey, syrups and fruit juices.

    The current average in North and Central America was 95 grams per adult per day, in South America about 130 grams, and in Western Europe about 101 grams, said Dr. Francesco Branca, Director of WHO's Department of Nutrition for Health and Development.

    "A single can of sugar-sweetened soda contains up to 40 grams (around 10 teaspoons) of free sugar," the WHO said.

    Evidence showed adults and children who consume less sugars have lower body weight, according to the announcement.

    Current rates of sugar consumption varied widely according to age and area, it added. Intake in Europe ranged from about 7-8 percent of daily energy intake in Hungary and Norway to 16-17 percent in countries like Spain and Britain.

    Data showed rates among children in Portugal were as high as 25 percent of daily energy intake.

    "We have solid evidence that keeping intake of free sugars to less than 10 percent of total energy intake reduces the risk of overweight, obesity and tooth decay," Branca said in a statement.

  • REFILE-Slash sugar intake to fight obesity, tooth decay - WHO

    (Corrects spelling of announcement in paragraph 7)

    By Reuters Staff

    GENEVA (Reuters) - Adults and children must cut the amount of sugar they consume by as much as half in North America and Western Europe and even more in other areas to lower risk of obesity and tooth decay, the World Health Organization said on Wednesday.

    New guidelines meant people should reduce the amount to less than 10 percent of their daily energy intake - or to about 50 grams or 12 teaspoons of sugar for adults, experts at the U.N. body told Reuters.

    A cut to less than 5 percent would be even better, they added.

    The WHO's recommendations to health ministries cover free sugars such as glucose and fructose, and sucrose or table sugar added to processed foods and drinks as well as sugar naturally present in honey, syrups and fruit juices.

    The current average in North and Central America was 95 grams per adult per day, in South America about 130 grams, and in Western Europe about 101 grams, said Dr. Francesco Branca, Director of WHO's Department of Nutrition for Health and Development.

    "A single can of sugar-sweetened soda contains up to 40 grams (around 10 teaspoons) of free sugar," the WHO said.

    Evidence showed adults and children who consume less sugars have lower body weight, according to the announcement.

    Current rates of sugar consumption varied widely according to age and area, it added. Intake in Europe ranged from about 7-8 percent of daily energy intake in Hungary and Norway to 16-17 percent in countries like Spain and Britain.

    Data showed rates among children in Portugal were as high as 25 percent of daily energy intake.

    "We have solid evidence that keeping intake of free sugars to less than 10 percent of total energy intake reduces the risk of overweight, obesity and tooth decay," Branca said in a statement.

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Women’s Health Articles

  • Officials urge testing as Portland, Oregon sees rise in syphilis cases

    By Courtney Sherwood

    PORTLAND, Ore. (Reuters) - A spike in syphilis cases in Portland in the past three years has prompted concerned public health officials to urge more sexually active adults to get tested regularly for the treatable bacterial infection.

    The Portland metro area has seen about 240 new cases of the disease on average each year since 2012, many times more than the 10 to 30 cases that were detected annually before that.

    Across the country, incidences of syphilis are on the rise. The Centers for Disease Control and Prevention said last year the number of infections in the United States climbed by more than 10 percent in 2013 to 17,535 cases, compared with the previous year.

    "Nationally there's been an increase in syphilis diagnoses but our increase has exceeded the national average," Kim Toevs, a senior manager with the Multnomah County Health Department, said on Tuesday.

    Health officials in Oregon's biggest city asked the CDC for help last year, she said, and it enlisted social and behavioral scientists, as well as public health physicians, to study what caused the increase.

    Toevs said the team found that some groups of sexually active gay and bisexual men had become less vigilant about condom use as fears about HIV transmission waned, and as many people diagnosed with HIV began increasingly to receive medication that reduces the risk of transmitting that virus.

    "We've also found a link to the increase of social media applications used to meet people online, (which is) true among heterosexuals and gays both," Toevs said.

    "The more points of connection with strangers they didn't know before, the more pathways there are to spread."

    Toevs urged gay and bisexual men who have more than one partner to get tested for syphilis every three months.

    "Folks who are not at quite that risk should still test at least once a year," she said.

    Syphilis can be cured with penicillin but if left untreated can cause blindness, hearing loss, neurological damage and birth defects in children born to affected mothers.

    Half of the men with syphilis nationwide also are infected with HIV, according to the CDC.

  • CORRECTED-"Over the counter" birth control pills might save public money

    (Corrects attribution of paragraph 5.)

    By Kathryn Doyle

    (Reuters Health) - Providing no- or low-cost birth control pills over the counter may reduce costs and prevent up to a quarter of unplanned pregnancies, researchers say.

    Many women would likely start using oral contraceptives if they were available with little or no up-front cost over the counter instead of with a prescription, they suggest in the journal Contraception.

    "Making pills available without a prescription would remove the need for unnecessary, time-consuming and sometimes expensive visits to doctors' offices and clinics," wrote Diana Foster, the study's lead author from the University of California, San Francisco, in an email to Reuters Health.

    It would also allow women to avoid often monthly waits in line at the pharmacy, she said.

    The Centers for Disease Control and Prevention says about half of U.S. pregnancies are unplanned. Most occur among younger, poorer women. The primary cause is lack of access to contraception.

    The researchers used computer models to analyze several studies and databases to predict how unintended pregnancy rates might change if birth control pills were available without a prescription and with little or no cost.

    Currently, 30 percent of low-income women ages 15 to 44 years use birth control pills. Other contraception methods are less common, and 18 percent of these women use no contraception.

    Prescription birth control pills cost the public sector nearly $400 per woman each year. A pregnancy costs the public sector almost $3,000 from conception to the child's second birthday, according to a 2010 study.

    The authors of the new study project that 21 percent of low-income women at risk for unplanned pregnancies are very likely to use over-the-counter birth control pills, if available.

    "We estimate that up to a third of women using withdrawal as their main method and one in six women using no method would use pills if they were available without a prescription," Foster said.

    The ultimate number depends largely on cost, they say.

    If there is no out-of-pocket cost, the number of women taking the pill could increase by up to 21 percent and the number a less effective contraceptive method or no method at all could decrease by more than 30 percent, preventing one in four unplanned pregnancies.

    Overall, the analysis projects that making free or low-cost birth control pills available over the counter could save public insurance programs up to 10 percent and prevent up to a quarter of unplanned pregnancies.

    "The cost of pregnancy-related medical care far outweighs the cost of preventing an unintended pregnancy," Foster said.

    Under the 2010 Affordable Care Act, "most insured women do have access to at least some oral contraceptive pills with no co-pay," she said, adding that there are some exceptions.

    "The pill has been around so much longer than the other birth control methods that it would be unlikely for the other methods to go over the counter until there is some experience with OTC pills first," said senior author Dr. Daniel Grossman of Ibis Reproductive Health in Oakland, California.

    With political support building among Republicans and Democrats it may finally be the right time to actually make the Pill available over the counter, Foster said.

    SOURCE: http://bit.ly/1zV2U8D Contraception, online February 27, 2015.

  • Struggle, suffering mark lives of nearly 2 billion women -survey

    By Lisa Anderson

    NEW YORK (Thomson Reuters Foundation) - Nearly 2 billion of the world's women are struggling or suffering in their daily lives, while 620 million describe themselves as thriving, according to a Gallup poll released on Wednesday.

    Based on interviews conducted with women and men in 160 countries in 2013, the survey found that 61 percent of women globally were struggling, 26 percent thriving and 13 percent suffering - numbers that have remained virtually the same since Gallup began doing the Life Evaluation Index in 2006.

    "One of the surprising things is how much parity there is between how men and women evaluate their lives," Jon Clifton, managing director of the poll, told the Thomson Reuters Foundation.

    While men and women shared a similar perception of the overall quality of their lives, they diverged when it came to employment and safety.

    In a global workforce composed of 50 percent more men than women, men are twice as likely than women to be employed full time, according to the poll.

    "That gap is still there and it's as large as it's been for the last five years," said Julie Ray, co-author of the report.

    The perception of personal safety also differed between men and women. Asked if they felt safe walking alone at night in the city or area in which they lived, 70 percent of men said they felt safe compared with 59 percent of women, Clifton said.

    Countries where women rated their lives the worst in terms of suffering tended to be those experiencing political or economic instability, or conflict.

    Bulgaria and Afghanistan topped that list, followed by Armenia, Greece, Ukraine, Cambodia, Hungary, Turkey, Egypt and Madagascar.

    Particularly notable were Afghanistan, where no women rated their lives as positive enough to be considered thriving, and Syria, where women had the lowest positive experience score measured since Gallup began doing the poll.

    The highest percentages of women considered to be thriving were in primarily wealthy, developed countries. Iceland and Sweden led the global list, followed by Denmark, Canada, Finland, Australia, the United States, Austria, Costa Rica and New Zealand.

    Another surprising finding in the survey was that, regardless of their circumstances, most women said they experienced positive emotions on any given day, the researchers said.

    Questioned about the day before their interview, 84 percent of women globally reported that they were treated with respect; 75 percent smiled or laughed a lot; 74 percent enjoyed themselves; 70 percent were well-rested and 50 percent learned or did something interesting.

    By comparison, when asked about negative emotions on the day before their interview, only 35 percent of women worldwide reported feeling worry; 32 percent stress; 29 percent physical pain; 22 percent sadness and 20 percent anger.

    "The overall takeaway for me is that despite what women in various countries are experiencing, these data show that there is no shortage of hope," said Ray.

    The researchers questioned 125,839 adults, of whom 66,313 were women, in 136 countries and areas.

  • Large breakfast, small dinner tied to better diabetes blood sugar

    By Shereen Lehman

    (Reuters Health) - Big breakfasts and small dinners might be a healthier way to eat for people with type 2 diabetes, according to a small new study.

    Diabetics in the study who ate big breakfasts and small dinners had fewer episodes of high blood sugar than those who ate small breakfasts and large dinners, researchers found.

    Blood sugar - also known as blood glucose - is controlled by the body's internal clock, with larger blood sugar peaks after evening meals, Dr. Daniela Jakubowicz told Reuters Health in an email.

    People with type 2 diabetes often time their meals in opposition to their internal clock, said Jakubowicz, a researcher at Tel Aviv University's Wolfson Medical Center in Israel.

    "They frequently skip breakfast while eating a high-calorie dinner," she said, adding that skipping breakfast is linked to obesity and poor blood sugar control.

    The new study involved eight men and ten women with type 2 diabetes, ages 30 to 70, who were being treated with either the diabetes drug metformin and dietary advice or diet advice alone.

    Type 2 is the most common form of diabetes and is often linked to obesity. In type 2 diabetes, the body's cells are resistant to the hormone insulin, or the body doesn't make enough of it. Insulin gives blood sugar access to the body's cells to be used as fuel.

    The participants were randomly assigned to follow a meal plan that consisted of either a 700-calorie breakfast and 200-calorie dinner or a 200-calorie breakfast and a 700-calorie dinner. Both diets included a 600-calorie lunch.

    After following the assigned meal plans for six days at home, the participants spent a day at the clinic, where blood tests were taken. They repeated the experiment two weeks later with the other diet plan.

    The study team found that post-meal glucose levels were 20 percent lower, and levels of insulin were 20 percent higher, when the participants consumed the large breakfasts and small dinners, according to the results in Diabetologia.

    "Our study demonstrated that a large breakfast and reduced dinner is a beneficial alternative for the management of glucose balance during the day and should be considered as a therapeutic strategy in type 2 diabetes," Jakubowicz said.

    Jakubowicz said longer studies are needed to see if the benefits would continue over time.

    The new results support the advice to eat like a king at breakfast, a prince at lunch and a pauper at dinner, said Anna Taylor in an email to Reuters Health.

    "Select your calories with care, however; what you eat, how you eat, and when you eat all play an important role in your nutrition as well as your health," said Taylor, a registered dietitian at the Cleveland Clinic in Ohio. She wasn't involved in the study.

    She added that it's important for people to keep in mind that the study's participants took few medications and had no major complications.

    The results might therefore not apply to other groups with diabetes, Taylor said.

    She said that people with diabetes who take insulin should speak to their endocrinologists before experimenting with drastic dietary adjustments.

    SOURCE: (PDF link) http://bit.ly/1FOkBdL Diabetologia, online February 24, 2015.

  • Cancer risk above 50 percent for Brits born in 1960

    By Kathryn Doyle

    (Reuters Health) - More than half of people born after 1960 in the U.K. may be diagnosed with some form of cancer in their lifetimes, a new estimate suggests.

    While the prediction seems alarming, the researchers say the increase is partly due to people living longer overall.

    "Everyone has to die of something and the longer people live the more likely that they will have previously been treated for a serious illness," wrote Peter Sasieni, the study's senior researcher from Queen Mary University of London, in an email to Reuters Health.

    As reported in the British Journal of Cancer, he and his coauthors estimated the lifetime risk of cancer, excluding non-melanoma skin cancer, in Britain for men and women born from 1930 to 1960.

    They used data on all causes of death in the UK from 1951 through 2012 and projected causes of death from 2013 to 2060, as well as data on the number of cancer diagnoses and cancer deaths from 1971 to 2009.

    For men, lifetime cancer risk rose from about 39 percent for those born in 1930 to about 54 percent for those born in 1960. Risk increased similarly for women, from about 37 percent to about 48 percent.

    "I was surprised when I first calculated that the risk was just over 50 percent for people born in 1960," Sasieni said.

    Along with modifiable risk factors for cancer, such as obesity, he said people are more likely to develop cancer the longer they live.

    "As we become better at avoiding dying from infections, heart disease, stroke and even road accidents so we are more likely to live long enough to get cancer," Sasieni said.

    These are actually positive results, agreed Dr. Freddie Bray of the Cancer Surveillance Section at the International Agency for Research on Cancer in Lyon, France.

    "Rather little of the risk is due to an increasing cancer risk in the population," Bray, who was not involved with the new study, told Reuters Health by email.

    Also, more than half the lifetime risk for people born in 1960 comes from cancer diagnosed after age 70. In their model, almost 90 percent of men born in 1960 would be diagnosed with cancer by age 120, hypothetically, if they did not die of other causes first.

    Additionally, screening tests for breast and prostate cancer catch many more cases of the disease than would have been diagnosed previously, Sasieni said.

    He suspects the trends would be similar in North America, Western Europe and Australia.

    SOURCE: http://bit.ly/1FTgqxc British Journal of Cancer, online February 3, 2015.