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Cardiovascular Articles

  • Weekday heart attacks still getting quicker treatment at hospitals

    By Kathryn Doyle

    NEW YORK (Reuters Health) - People who arrive at the hospital with a heart attack during business hours are more likely to survive than those who show up on weeknights, weekends or holidays, according to a new study.

    Rates of death in the hospital are very low overall, at just over 4 percent, the researchers found. But some life-saving treatments can take longer to get to patients during off hours, which makes care less than optimal, they write.

    It was actually surprising how similar quality of care seemed to be for working hours and after hours in the hospital, and even for balloon angioplasty, there was only a difference of 16 minutes, said study author Dr. Jorge F. Saucedo of the NorthShore University Health System in Evanston, Illinois.

    In the most severe heart attacks, a blood vessel in the heart is completely blocked. Using a catheter to thread a balloon into the blocked artery can immediately restore blood flow.

    In the new study, which included more than 50,000 severe heart attacks between 2007 and 2010 in the U.S., patients who arrived at the hospital during work hours took an average of 56 minutes to have angioplasty, the balloon procedure. For those who arrived on nights or weekends, the average wait time was 72 minutes.

    Both times fall within the American Heart Association's recommendation of no more than 90 minutes wait for angioplasty. The time to patients getting imaging or medication was the same for both groups, according to the results in Circulation: Cardiovascular Quality and Outcomes.

    When the researchers adjusted for a variety of patient characteristics, they found those who arrived at the hospital during off hours were about 13 percent more likely to die from any cause.

    The proportion of patients who had angioplasty within the recommended 90 minutes was 89 percent during the weekdays and 79 percent during off hours.

    All in all, the numbers are better than in past studies, the authors note in their report, and in most categories there were no differences in treatment based on when patients arrived at the hospital.

    Management of these severe heart attacks seems to have improved greatly over the past several years, said Dr. Rodrigo Estévez-Loureiro of the interventional cardiology unit at Complejo Asistencial Universitario de León in Spain.

    "Differences observed in (door to balloon) times, although statistically significant, are not clinically relevant between off and on-hours," Estévez-Loureiro, who was not involved in the new study, told Reuters Health by email.

    A 16-minute delay likely will not influence overall mortality from the heart attacks he said.

    "Also surprising was the very low in- hospital mortality for both groups," Saucedo told Reuters Health.

    The hospital catheterization laboratory, where angioplasties are performed, is fully staffed during the day but most hospitals in the U.S. do not staff the lab after hours, he said. When a heart attack patient arrives on a night or weekend, staff members are paged and have to drive to the hospital from their homes.

    To make angioplasty wait times equal day and night, catheterization labs would have to be fully staffed 24-hours per day, but currently the financial and logistical costs would be too high to recommend that, Saucedo said by email.

    Patients may have waited longer to come to the hospital with heart attack symptoms in the middle of the night, which might have contributed to the increased risk of death, he noted. All things considered, the management and outcomes for people with severe heart attacks after hours was very good.

    One takeaway message for patients, he said, is to come to the hospital as soon as you have symptoms of a heart attack, including tightness of the chest, excess sweating, weakness and light-headedness.

    Estévez-Loureiro recommended calling an ambulance to get to the hospital, since medical personnel may be able to verify if you are having a heart attack on the way and start administering treatment and call the catheterization lab en route.

    SOURCE: http://bit.ly/XaY6j7 Circulation: Cardiovascular Quality and Outcomes, online July 29, 2014.

  • Short jogs linked to lower risk of death from heart disease

    By Kathryn Doyle

    NEW YORK (Reuters Health) - People who run in their spare time, even if it's not very fast or very far, tend to have a lower risk of dying from heart disease or from any cause than non-runners, according to a new study.

    The study was large but was observational, meaning the researchers asked participants about their running habits rather than randomly assigning them to running and non-running groups. So they cannot conclude that running, and not other differences between participants, was responsible for the lower risks.

    It's difficult to use more rigorous randomized controlled trials to look at outcomes like death, because that takes so long to track, said lead author Duck-chul Lee, from the College of Human Sciences at Iowa State University in Ames.

    He said the current study is the largest on this topic, but it would still be useful to conduct randomized trials to look at the effects of running on blood pressure and cholesterol, for instance.

    The researchers studied more than 55,000 generally healthy adults between ages 18 and 100. Participants answered questions about their physical activity habits over the past three months, including running speed, duration and frequency. Some were not runners at all; the rest were divided into five groups based on how much they ran each week.

    The researchers then tracked the participants using their medical records for an average of 15 years.

    About 3,400 people died during that time, including roughly 1,200 from cardiovascular causes, including heart disease and stroke.

    At the start, runners were more often male, younger and leaner. Compared to non-runners, people who ran at all were 30 percent less likely to die during the study period and 45 percent less likely to die from cardiovascular disease.

    Runners had a reduced risk of death even if they ran for less than 51 minutes or less than six miles per week, and even if they ran at a pace slower than six miles per hour, according to results published in the Journal of the American College of Cardiology.

    "I think the findings are very encouraging since the study suggests that you don't necessarily have to aim for a marathon in order to obtain the health benefits of physical activity," said Dr. Kasper Andersen of Uppsala University Hospital in Sweden.

    Andersen was not involved in the new study.

    "I guess you can interpret this as every time you go running you are putting savings in your own health bank - an investment that gives you a longer life," he told Reuters Health by email.

    Running was linked to better health regardless of sex, age, smoking status or weight, the researchers found. Runners had life expectancies three years longer than non-runners, on average.

    "The (World Health Organization) guidelines recommend at least 75 minutes per week of vigorous aerobic activity such as running," Lee told Reuters Health in an email. "However, we found mortality benefits in runners who ran even as little as 30 to 60 minutes per week."

    There haven't been as many studies on the benefits of vigorous activity as there have been for moderate activity, he said.

    "As far as recommending that people go for short jogs everyday, I do think this is something we could recommend, although with a couple caveats," said Andrea Chomistek, from the School of Public Health at Indiana University Bloomington.

    "For individuals who are currently inactive, they should probably start with walking and ease into running," she told Reuters Health in an email. "For inactive individuals who are older or have medical issues, they may want to check in with their physician before starting a running program, although walking is just fine."

    Finding a running buddy can be good motivation, Chomistek said.

    "If you know that someone is counting on you to show up, you'll be more likely to go," she said. "And longer runs are definitely more fun if you have company."

    SOURCE: http://bit.ly/1nND4lC Journal of the American College of Cardiology, online July 28, 2014.

  • Dementia patients more likely to get pacemakers: study

    By Andrew M. Seaman

    NEW YORK (Reuters Health) - People with dementia are more likely to get pacemakers than people without any cognitive impairment, according to a new study.

    The study can't explain why people with dementia are more likely to get the devices, which help control irregular heart rhythms, according to the lead author.

    "It may be completely appropriate," Nicole Fowler said. "There may be something that we haven't been able to measure that makes people with dementia need them more."

    Alternatively, she told Reuters Health that the difference could represent family members or doctors choosing more aggressive treatment for people with dementia.

    Fowler worked on the new study while at the University of Pittsburgh School of Medicine. She's now affiliated with the Indiana University Center for Aging Research in Indianapolis.

    She and her colleagues write in a research letter in JAMA Internal Medicine that people with dementia and a lesser form of thinking and memory trouble known as mild cognitive impairment can also have heart problems.

    People with dementia, their family members and their doctors should weigh the risks and benefits of using pacemakers, they add.

    For the new study, the researchers analyzed data on 16,245 people seen at 33 Alzheimer's Disease Centers from September 2005 through December 2011.

    At their first visit to the centers, about 46 percent of people had no evidence of dementia. Another 21 percent had mild cognitive impairment and 33 percent had dementia.

    Over the course of the study, four people out of every 1,000 who didn't have signs of dementia at their first visit received a pacemaker each year. The rate increased to 4.7 per 1,000 people among those with mild cognitive impairment and 6.5 per 1,000 people among those with dementia.

    The researchers found that people with dementia were 60 percent more likely to receive a pacemaker than those without dementia after taking into account their age, sex, race, location, heart health, blood pressure, stroke risk and cognitive decline during the study.

    They write that the findings are counter to expectations that people with serious and often fatal conditions might be treated less aggressively.

    Additional studies will be required to find out exactly why people with dementia are more likely to receive pacemakers, Fowler said.

    "Medical decisions for patients with dementia are really hard," she said. "We know from the data that families really struggle to make medical decisions . . . It's important to find out what are some of the things patients and families need to support their decision making."

    SOURCE: http://bit.ly/1qHE3Wz JAMA Internal Medicine, online July 28, 2014.

  • Drugs to increase "good" cholesterol may not cut deaths

    By Andrew M. Seaman

    NEW YORK (Reuters Health) - Drugs that have been investigated to increase so-called "good" cholesterol may not prevent deaths, heart attacks or strokes as many hoped, according to a new analysis.

    Due to limitations in existing studies and ongoing experiments involving these and other drugs, researchers not involved with the analysis caution that it's too early to give up on medications that increase high-density lipoprotein (HDL) cholesterol, however.

    "In the time before statins were available, there were several pieces of evidence that HDL-raising drugs reduce cardiovascular events, but since the time statins have been used there is now evidence that HDL-targeted therapies don't do anything to decrease mortality," said Dr. Darrel Francis, the study's senior author from Imperial College London.

    Unlike low-density lipoprotein (LDL), which is the so-called "bad" cholesterol that piles up in blood vessels, HDL is considered good because it's thought to chip away LDL cholesterol.

    People with low HDL levels and high LDL levels are known to be at an increased risk of death, the researchers write in the journal The BMJ.

    Drugs known as statins - such as Pfizer's Lipitor - that lower LDL have been found to be effective at reducing deaths. Attention has turned to the development of drugs that increase levels of HDL to achieve added benefits.

    Francis and his colleagues examined the results of 39 randomized controlled trials - the gold standard in medical research - that evaluated the use of three drugs known as niacin, fibrates and cholesterylester transfer protein (CETP) inhibitors.

    While the drugs differ in how they work, all three increase the amount of HDL cholesterol in the body.

    Overall, the drugs did not reduce the number of deaths from any cause or deaths from heart disease before or after statins became common.

    Before statins, fibrates reduced heart attacks and niacin reduced heart attacks and strokes. After statins, the benefit from the two HDL-increasing drugs disappeared.

    The researchers write that the simple idea that a drug that raises HDL levels should also decrease the number of heart attacks and strokes may not be correct.

    "Even if HDL is carrying cholesterol away from the coronary arteries, that doesn't mean that any therapy that raises HDL is automatically protective," Francis said. "After all, the therapy could just be blocking cholesterol traveling on HDL from exiting."

    But a closer look should be given to specific groups of patients before researchers abandon work on drugs targeting HDL cholesterol levels, cautioned Dr. Leonard Kritharides in an editorial accompanying the new study.

    Kritharides, the head of cardiology at Concord Repatriation General Hospital in Sydney, Australia, said other research has suggested there may be a benefit among people with low HDL cholesterol and high triglycerides, which is another type of fat in blood.

    "The possibility of important benefits for some patients should not be dismissed too lightly," he wrote.

    Dr. Steven Nissen, the chair of cardiovascular medicine at the Cleveland Clinic in Ohio, also said the studies included in the analysis had limitations and there are more studies on HDL-increasing drugs underway.

    "I think the science here hasn't been fully worked out and the only way to answer it is with randomized controlled trials and that's what a number of people are doing," said Nissen, who wasn't involved with the new study. He is the head of a trial for a CETP inhibitor from Eli Lilly.

    "If every study underway fails, we'll have to give up on HDL at some point," he said, adding that researchers aren't there yet.

    "What we don't need here is to prejudge ongoing research," Nissen said.

    SOURCE: http://bit.ly/1o0aGXw and http://bit.ly/1zcpif4 The BMJ, July 18, 2014.

Comprehensive Rehabilitation Articles

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Emergency News

  • U.S. advises against non-essential travel to countries hit by Ebola

    By Julie Steenhuysen

    CHICAGO (Reuters) - The U.S. Centers for Disease Control and Prevention on Thursday issued a travel advisory against non-essential travel to Guinea, Liberia and Sierra Leone to curb the spread of the Ebola outbreak in West Africa that has claimed more than 700 lives.

    CDC Director Dr. Thomas Frieden said his agency will send an additional 50 disease experts to assist with efforts to contain the highly deadly virus, in what he called "the largest, most complex outbreak that we know of in history."

    Sierra Leone has declared a state of emergency and called in troops to quarantine Ebola victims, joining neighboring Liberia in imposing controls, as the death toll from the outbreak of the virus in West Africa hit 729.

    In a conference call with reporters, Frieden said the United States is joining the World Health Organization and others in escalating efforts to fight Ebola. He estimated that it could take at least three to six months to get the outbreak under control.

    The advisory against non-essential travel to the three affected countries aims to prevent visitors from being exposed to Ebola in local health facilities should they need medical attention for other ailments, Frieden said.

    He also said airlines will continue to fly into the affected region, which will help maintain essential functions in the region.

    Earlier on Thursday, the World Health Organization said it was launching a $100 million response plan to combat Ebola in West Africa, but is not recommending travel restrictions or border closures due, saying there would be a low risk to other passengers if an infected person flew.

    CDC is also helping with screening and education efforts in West Africa to prevent sick travelers from getting on planes.

    If they do, Frieden said the agency has protocols in place to protect against further spread of disease, including notification to CDC of ill passengers on a plane before arrival, investigation of ill travelers, and, if necessary, quarantine.

    Ebola poses "little risk to the U.S. population," Frieden said on the call.

    Earlier this week, CDC issued a health alert notice, reminding U.S. healthcare workers of the importance of taking steps to prevent the spread of the virus, how to test and isolate suspected patients and how they can protect themselves from infection.

    There are no vaccines or effective treatments for Ebola, Frieden noted, adding that containing the outbreak will require the "meticulous work" of quarantining the sick and those who have been in contact with them.

  • WHO launching $100 million plan to combat Ebola

    By Reuters Staff

    GENEVA (Reuters) - The World Health Organization is launching a $100 million response plan to combat an "unprecedented" outbreak of Ebola in West Africa that has killed 729 people out of 1,323 infected since February, the U.N. agency said on Thursday.

    WHO Director-General Margaret Chan will meet in Conakry, Guinea on Friday with the presidents of affected West African nations, it said in a statement.

    "The scale of the Ebola outbreak, and the persistent threat it poses, requires WHO and Guinea, Liberia and Sierra Leone to take the response to a new level and this will require increased resources, in-country medical expertise, regional preparedness and coordination," Chan said.

    The plan identifies the need for "several hundred more personnel" to be deployed in affected countries to ease the strain on overstretched treatment facilities, the WHO said. Clinical doctors and nurses, epidemiologists and logisticians are urgently needed, it said in an appeal to donor countries.

    Sierra Leone declared a state of emergency and called in troops to quarantine Ebola victims on Thursday, joining neighboring Liberia in imposing tough controls as the death toll from the worst-ever outbreak of the virus hit 729 in West Africa.

    "The plan sets out new needs to respond to the outbreak across the countries and bring up the level of preparedness in neighboring countries," WHO spokesman Paul Garwood said. "They need better information and infection-control measures."

    The plan aims to stop transmission of the virus by strengthening disease surveillance, particularly in border areas, protecting health workers from infection and doing a better job of explaining the disease to communities.

  • Weekday heart attacks still getting quicker treatment at hospitals

    By Kathryn Doyle

    NEW YORK (Reuters Health) - People who arrive at the hospital with a heart attack during business hours are more likely to survive than those who show up on weeknights, weekends or holidays, according to a new study.

    Rates of death in the hospital are very low overall, at just over 4 percent, the researchers found. But some life-saving treatments can take longer to get to patients during off hours, which makes care less than optimal, they write.

    It was actually surprising how similar quality of care seemed to be for working hours and after hours in the hospital, and even for balloon angioplasty, there was only a difference of 16 minutes, said study author Dr. Jorge F. Saucedo of the NorthShore University Health System in Evanston, Illinois.

    In the most severe heart attacks, a blood vessel in the heart is completely blocked. Using a catheter to thread a balloon into the blocked artery can immediately restore blood flow.

    In the new study, which included more than 50,000 severe heart attacks between 2007 and 2010 in the U.S., patients who arrived at the hospital during work hours took an average of 56 minutes to have angioplasty, the balloon procedure. For those who arrived on nights or weekends, the average wait time was 72 minutes.

    Both times fall within the American Heart Association's recommendation of no more than 90 minutes wait for angioplasty. The time to patients getting imaging or medication was the same for both groups, according to the results in Circulation: Cardiovascular Quality and Outcomes.

    When the researchers adjusted for a variety of patient characteristics, they found those who arrived at the hospital during off hours were about 13 percent more likely to die from any cause.

    The proportion of patients who had angioplasty within the recommended 90 minutes was 89 percent during the weekdays and 79 percent during off hours.

    All in all, the numbers are better than in past studies, the authors note in their report, and in most categories there were no differences in treatment based on when patients arrived at the hospital.

    Management of these severe heart attacks seems to have improved greatly over the past several years, said Dr. Rodrigo Estévez-Loureiro of the interventional cardiology unit at Complejo Asistencial Universitario de León in Spain.

    "Differences observed in (door to balloon) times, although statistically significant, are not clinically relevant between off and on-hours," Estévez-Loureiro, who was not involved in the new study, told Reuters Health by email.

    A 16-minute delay likely will not influence overall mortality from the heart attacks he said.

    "Also surprising was the very low in- hospital mortality for both groups," Saucedo told Reuters Health.

    The hospital catheterization laboratory, where angioplasties are performed, is fully staffed during the day but most hospitals in the U.S. do not staff the lab after hours, he said. When a heart attack patient arrives on a night or weekend, staff members are paged and have to drive to the hospital from their homes.

    To make angioplasty wait times equal day and night, catheterization labs would have to be fully staffed 24-hours per day, but currently the financial and logistical costs would be too high to recommend that, Saucedo said by email.

    Patients may have waited longer to come to the hospital with heart attack symptoms in the middle of the night, which might have contributed to the increased risk of death, he noted. All things considered, the management and outcomes for people with severe heart attacks after hours was very good.

    One takeaway message for patients, he said, is to come to the hospital as soon as you have symptoms of a heart attack, including tightness of the chest, excess sweating, weakness and light-headedness.

    Estévez-Loureiro recommended calling an ambulance to get to the hospital, since medical personnel may be able to verify if you are having a heart attack on the way and start administering treatment and call the catheterization lab en route.

    SOURCE: http://bit.ly/XaY6j7 Circulation: Cardiovascular Quality and Outcomes, online July 29, 2014.

  • Tools for planning end of life care are varied, untested: study

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Many tools exist to help introduce people to the subject of advanced care planning, but they vary widely in what they offer and how accessible they are, according to a new research review.

    The authors found the tools that are most readily available often have not been vetted by formal studies, and the ones that have are often not accessible to the public or are specific to certain diseases.

    "Decision aids" have proliferated in many areas of medicine but have yet to really take off in the area of advanced directives, though they have a lot of potential to help doctors and patients, said Dr. Benjamin H. Levi of Penn State College of Medicine in Hershey, Pennsylvania.

    Levi was not one of the authors of the new paper in the Annals of Internal Medicine, but he did review it for the journal.

    Advance care planning helps seriously ill patients think through their treatment goals and informs care choices for the future in case they cannot express their wishes.

    Less than half of severely or terminally ill patients have an advance directive in their medical record, according to the study authors, and past research has found doctors are only correct 65 percent of the time in predicting what intensive care a patient would want.

    Some patients prioritize living longer, whereas others may not wish to be kept alive when meaningful recovery or a particular quality of life is no longer possible, write the authors, led by Mary Butler of the Minnesota Evidence-based Practice Center at the University of Minnesota School of Public Health in Minneapolis.

    One common "advanced directive" is a do not resuscitate order, but the directives can be much more nuanced than that, taking into account religion, spirituality and philosophical outlook, they note.

    It can take more than an hour to have that kind of conversation with your doctor, Levi said, time many doctors can't devote to one patient.

    "For something like advanced care planning it's way outside the experience of most people, they don't know how to word their preferences," Levi said. "The decision aid can be very useful as a stand-alone or as springboard to that conversation with your doctor."

    Decision aids, some of which actually function as legally binding final directives, should not be a substitute for talking to your doctor, though, he told Reuters Health.

    As the study notes, those aids that exist can be printed leaflets, videos or interactive sites, some of which work to introduce any person, healthy or sick, to the idea of an advance directive. Others are tailored specifically to certain long-term illnesses.

    The existing studies on these aids have not been uniform and there has not been a side-by-side comparison of the different types to see which are best, Levi said. The new research review did not attempt to do that either, rather it just accumulates the existing studies in one place, Butler and her coauthors write.

    "You can't use this article to choose one," Levi said.

    Dr. Linda L. Emanuel, director of the Buehler Center on Aging, Health & Society at Northwestern University Feinberg School of Medicine in Chicago, agreed.

    "We have no idea how to assess what's a good decision aid," Emanuel told Reuters Health by phone.

    "First of all, these decisions are assessed as good bad or indifferent in real time, and 'maybe I regret my decision but I don't know how another decision would make me feel.'"

    But there are certain criteria anyone can use to assess whether an aid might be useful, she said. It should be understandable and accessible for patients and should communicate with their healthcare teams in a useful way.

    Patients should remember that they have a federally protected right to have their preferences honored no matter how they communicate them, even verbally, she said.

    "I think there's really only one product out there that I think is good and I would recommend, it has a website that people can go to and have an interactive experience," she said, referring to PREPARE, an interactive website for families navigating medical decision making, run by the University of California.

    Emanuel also recommended The Conversation Project as "a good resource for familiarizing yourself with advanced care planning and seeing what people are talking about in the area."

    The experts agreed that advanced care planning is important and the best advice right now is to do a little exploring, try a few different decision aids and see what works for you.

    "I believe strongly that these decision tools can be helpful for folks and that they should try one or more different ones to see what works," said Dr. Michael Green of Penn State College of Medicine in Hershey. He and Levi helped develop "Making Your Wishes Known," one of the interactive web tools included in the review.

    "I think everybody should explore this, not just sick people," Green told Reuters Health. "If someone is sick and comes to the hospital, the default position is to do everything."

    "In many cases that's the right call, but in some cases it's not and what a shame and a waste and a tragedy if people undergo unnecessary unwanted treatment because there is no directive," Levi said.

    SOURCE: http://bit.ly/UzEcfY Annals of Internal Medicine, online July 29, 2014.

  • Dozens of ill Keith Urban fans treated at concert near Boston

    By Reuters Staff

    BOSTON (Reuters) - Forty-six music fans were treated for mostly alcohol-related medical problems at Australian country singer Keith Urban's concert outside Boston on Saturday night, local officials said.

    Fire and emergency medical personnel dealt with dozens of ill fans during the show at an outdoor arena in Mansfield, Massachusetts, about 25 miles south of Boston, the town's police and fire departments said in a joint statement on Sunday.

    Some 22 people were transported to area hospitals, mostly for alcohol-related illness, and more than 50 people were taken into protective custody by police, who noted that the large number of people needing treatment prompted authorities to call in ambulances from five nearby communities.

    "Last evening's Keith Urban concert was not anticipated to present with the volume of issues handled," officials said in the statement.

    The incident came a month after dozens of people were taken to hospitals for drug and alcohol-related illnesses at a house music concert at Boston's TD Garden.

    Urban, a Grammy winner who is married to Oscar-winning actress Nicole Kidman, was tapped last month to return as a judge on Fox's television singing competition "American Idol."

Surgery Articles

  • Inquiry finds "indications" of organ harvesting in Kosovo conflict

    By Julia Fioretti

    BRUSSELS (Reuters) - An EU-led inquiry found "compelling indications" that Kosovo Albanian guerrillas extracted body organs from Serb captives during the 1998-99 war and sold them, but the practice was not widespread and there was not enough evidence for a trial, the lead investigator said on Tuesday.

    After a three-year investigation, the EU-led task force said there was, however enough evidence to prosecute former leaders of the Kosovo Liberation Army (KLA) for war crimes against the ethnic Serb and Roma populations of Kosovo during the conflict.

    The investigation was prompted by a 2011 report by Council of Europe member Dick Marty that accused senior KLA commanders of involvement in the smuggling of Serb prisoners into northern Albania and the removal of their organs for sale.

    Prime Minister Hashim Thaci, himself a former KLA leader who was named in Marty's report, has dismissed the accusations as an attempt to tarnish the Kosovo Albanian fight for independence.

    U.S. prosecutor John Clint Williamson, who led the investigation, said there was no evidence of widespread organ harvesting, but that the crime had occurred a number of times.

    "There are compelling indications that this practice did occur on a very limited scale and that a small number of individuals were killed for the purpose of extracting and trafficking their organs," he told journalists.

    Other crimes perpetrated by senior KLA members, such as unlawful killings and forced disappearances, amounted to the ethnic cleansing of large portions of the Serb and Roma populations, and there was enough evidence to prosecute, Williamson said.

    DARK CLOUD

    The task force will file its indictment against former KLA leaders for war crimes once an ad hoc tribunal has been set up by the European Union and Kosovo, something Williamson said would happen next year. He did not name the people likely to be indicted.

    Prime Minister Thaci said in a statement the government would continue cooperating with the task force.

    "The government of the Republic of Kosovo appreciates the completion of the ambassador Williamson's work, which is an important step to determine potential individual responsibility and gives an end to the claims of the unfounded charges."

    Serbia's counter-insurgency campaign of 1998 and 1999 eventually drew in NATO, which bombed for 78 days to drive out Serbian forces behind the killings of Kosovo Albanian civilians. Around 10,000 Albanians and just over 2,000 Serbs are believed to have been killed during and immediately after the war.

    Kosovo declared independence in 2008 but the EU still plays a guiding role in policing and justice, particularly cases of war crimes.

    Efforts to investigate alleged war crimes committed by the guerrillas have run up against widespread intimidation in a small country where clan loyalties run deep and former KLA rebels are revered as heroes.

    Williamson condemned what he called "active efforts" to undermine the investigation.

    "As long as a few powerful people continue to thwart investigations into their own criminality, the people of Kosovo as a whole pay the price as this leaves a dark cloud over the country."

  • Inquiry finds "indications" of organ harvesting in Kosovo conflict

    By Julia Fioretti

    BRUSSELS (Reuters) - An EU-led inquiry found "compelling indications" that Kosovo Albanian guerrillas extracted body organs from Serb captives during the 1998-99 war and sold them, but the practice was not widespread and there was not enough evidence for a trial, the lead investigator said on Tuesday.

    After a three-year investigation, the EU-led task force said there was, however enough evidence to prosecute former leaders of the Kosovo Liberation Army (KLA) for war crimes against the ethnic Serb and Roma populations of Kosovo during the conflict.

    The investigation was prompted by a 2011 report by Council of Europe member Dick Marty that accused senior KLA commanders of involvement in the smuggling of Serb prisoners into northern Albania and the removal of their organs for sale.

    Prime Minister Hashim Thaci, himself a former KLA leader who was named in Marty's report, has dismissed the accusations as an attempt to tarnish the Kosovo Albanian fight for independence.

    U.S. prosecutor John Clint Williamson, who led the investigation, said there was no evidence of widespread organ harvesting, but that the crime had occurred a number of times.

    "There are compelling indications that this practice did occur on a very limited scale and that a small number of individuals were killed for the purpose of extracting and trafficking their organs," he told journalists.

    Other crimes perpetrated by senior KLA members, such as unlawful killings and forced disappearances, amounted to the ethnic cleansing of large portions of the Serb and Roma populations, and there was enough evidence to prosecute, Williamson said.

    DARK CLOUD

    The task force will file its indictment against former KLA leaders for war crimes once an ad hoc tribunal has been set up by the European Union and Kosovo, something Williamson said would happen next year. He did not name the people likely to be indicted.

    Prime Minister Thaci said in a statement the government would continue cooperating with the task force.

    "The government of the Republic of Kosovo appreciates the completion of the ambassador Williamson's work, which is an important step to determine potential individual responsibility and gives an end to the claims of the unfounded charges."

    Serbia's counter-insurgency campaign of 1998 and 1999 eventually drew in NATO, which bombed for 78 days to drive out Serbian forces behind the killings of Kosovo Albanian civilians. Around 10,000 Albanians and just over 2,000 Serbs are believed to have been killed during and immediately after the war.

    Kosovo declared independence in 2008 but the EU still plays a guiding role in policing and justice, particularly cases of war crimes.

    Efforts to investigate alleged war crimes committed by the guerrillas have run up against widespread intimidation in a small country where clan loyalties run deep and former KLA rebels are revered as heroes.

    Williamson condemned what he called "active efforts" to undermine the investigation.

    "As long as a few powerful people continue to thwart investigations into their own criminality, the people of Kosovo as a whole pay the price as this leaves a dark cloud over the country."

  • Inquiry finds "indications" of organ harvesting in Kosovo conflict

    By Julia Fioretti

    BRUSSELS (Reuters) - An EU-led inquiry found "compelling indications" that Kosovo Albanian guerrillas extracted body organs from Serb captives during the 1998-99 war and sold them, but the practice was not widespread and there was not enough evidence for a trial, the lead investigator said on Tuesday.

    After a three-year investigation, the EU-led task force said there was, however enough evidence to prosecute former leaders of the Kosovo Liberation Army (KLA) for war crimes against the ethnic Serb and Roma populations of Kosovo during the conflict.

    The investigation was prompted by a 2011 report by Council of Europe member Dick Marty that accused senior KLA commanders of involvement in the smuggling of Serb prisoners into northern Albania and the removal of their organs for sale.

    Prime Minister Hashim Thaci, himself a former KLA leader who was named in Marty's report, has dismissed the accusations as an attempt to tarnish the Kosovo Albanian fight for independence.

    U.S. prosecutor John Clint Williamson, who led the investigation, said there was no evidence of widespread organ harvesting, but that the crime had occurred a number of times.

    "There are compelling indications that this practice did occur on a very limited scale and that a small number of individuals were killed for the purpose of extracting and trafficking their organs," he told journalists.

    Other crimes perpetrated by senior KLA members, such as unlawful killings and forced disappearances, amounted to the ethnic cleansing of large portions of the Serb and Roma populations, and there was enough evidence to prosecute, Williamson said.

    DARK CLOUD

    The task force will file its indictment against former KLA leaders for war crimes once an ad hoc tribunal has been set up by the European Union and Kosovo, something Williamson said would happen next year. He did not name the people likely to be indicted.

    Prime Minister Thaci said in a statement the government would continue cooperating with the task force.

    "The government of the Republic of Kosovo appreciates the completion of the ambassador Williamson's work, which is an important step to determine potential individual responsibility and gives an end to the claims of the unfounded charges."

    Serbia's counter-insurgency campaign of 1998 and 1999 eventually drew in NATO, which bombed for 78 days to drive out Serbian forces behind the killings of Kosovo Albanian civilians. Around 10,000 Albanians and just over 2,000 Serbs are believed to have been killed during and immediately after the war.

    Kosovo declared independence in 2008 but the EU still plays a guiding role in policing and justice, particularly cases of war crimes.

    Efforts to investigate alleged war crimes committed by the guerrillas have run up against widespread intimidation in a small country where clan loyalties run deep and former KLA rebels are revered as heroes.

    Williamson condemned what he called "active efforts" to undermine the investigation.

    "As long as a few powerful people continue to thwart investigations into their own criminality, the people of Kosovo as a whole pay the price as this leaves a dark cloud over the country."

Neonatal Articles

  • Uptick seen in U.S. breast-feeding rates

    By David Beasley

    ATLANTA (Reuters) - Breast-feeding rates are rising among U.S. newborns, but most mothers still wean their babies earlier than experts recommend, federal health officials said on Thursday.

    Some 79 percent of newborns were breast-fed in 2011, up 2 percentage points from the year before, according to the U.S. Centers for Disease Control and Prevention's annual Breastfeeding Report Card.

    That number dipped to 49 percent of babies after six months and 27 percent after a year, numbers unchanged from 2010.

    The American Academy of Pediatrics recommends breast-feeding infants for at least a year and the World Health Organization recommends two years.

    Western states such as Washington, Oregon and California had the highest newborn breast-feeding rates, exceeding 90 percent.

    Some of the lowest rates, in the mid 50-percent range, were in the Deep South. In Louisiana, 56 percent of newborns were breast-fed, with 30 percent still nursing after six months.

    Help is increasingly available to mothers who want to breast-feed, the CDC report stated, with the number of health professionals specializing in lactation almost doubling between 2006 and 2013.

    Allowing babies to have "skin to skin" contact with their mothers immediately after birth and to remain in the hospital room with them encourages breast-feeding, the CDC said.

    Hospitals in the western United States allow infants to room with their mothers at twice the rate of hospitals in the Midwest and South, the CDC said.

    For the first six months of life, breast milk alone is an adequate diet for infants, according to the CDC.

    SOURCE: http://1.usa.gov/1lgO714 CDC Breastfeeding Report Card 2014, online July 31, 2014.

  • Whooping cough vaccine safe for pregnant women

    By Madeline Kennedy

    NEW YORK (Reuters Health) - Pregnant women in their third trimester can safely receive the whooping cough vaccine to prevent infections in newborns, a recent study from the UK suggests.

    Whooping cough, or pertussis, is a highly contagious disease. Its symptoms are initially mild but it can lead to serious and fatal complications, particularly for children under three months old.

    Recent increases in whooping cough infections, some resulting in deaths of newborns, prompted the UK to develop a new vaccine program in 2012. The program offered combined vaccines against diphtheria, pertussis and polio to over 700,000 women in the third trimester of pregnancy.

    "The benefit of maternal immunization is that the mother's protective antibodies are passed on to the baby before it is born, giving it the best protection it needs before they are old enough to be vaccinated themselves," Philip Bryan told Reuters Health in an email.

    He worked on the study at the Medicines and Healthcare Products Regulatory Agency (MHRA) in London.

    The U.S. Centers for Disease Control and Prevention (CDC) recommends that pregnant women are vaccinated against whooping cough, but the World Health Organization stated in a 2010 paper that there is not sufficient evidence to recommend the vaccine to pregnant women.

    The MHRA sought to add to this body of evidence and ensure the UK vaccine program was safe. Bryan said the new study "is the largest review to date of the safety of whooping cough (pertussis) vaccination in pregnancy."

    The researchers analyzed data on 20,074 pregnant women who were vaccinated against whooping cough beginning in late 2012.

    Compared to country-wide estimates, there was no increased risk of stillbirth among vaccinated women. Their pregnancies resulted in five stillbirths in the two weeks following vaccination, while the existing data would predict about seven stillbirths in the same time frame. The pattern held true later in pregnancy as well.

    Bryan and his colleagues also compared the vaccinated women to a group of similar but unvaccinated pregnant women from the previous two years.

    That analysis suggested there was no increase in other pregnancy risks after vaccination either, including death of the mother or baby, pre-eclampsia, miscarriage, C-section delivery or low birth weight. In addition, the vaccine had no effect on the length of pregnancy, according to findings published in The BMJ.

    In the U.S., the CDC recommends infants get vaccinated against pertussis initially at ages two, four and six months as part of a combined vaccine that also protects against diphtheria and tetanus called DTaP.

    There is a significant advantage to administering the pertussis vaccine to pregnant women in addition to vaccinating infants, according to Dr. Eugene Shapiro, from Yale University in New Haven, Connecticut. He wrote an editorial published with the new study.

    "With the current schedule, the three doses are not complete until six months," a time during which children are particularly vulnerable to the infection, Shapiro told Reuters Health.

    In addition, he said the maternal vaccine "protects the mother so she doesn't become ill and transmit to the infant."

    The pertussis vaccine has several known side effects, including redness and swelling at the vaccine site and fatigue and fever. But both children and adults generally tolerate it well, the researchers note.

    "Sadly, we are still seeing deaths in newborns whose mothers did not receive the vaccine for whatever reason," Bryan said. "If worries over vaccine safety is a factor in some women not having the vaccine, then the results from our large study should give that extra bit of reassurance that the vaccine is safe in pregnancy, as well as very beneficial."

    According to Bryan, the UK vaccine program has been a success. He noted that the vaccine's use has been steadily increasing in the UK and that it "has been highly effective at preventing disease and deaths in young babies."

    SOURCE: http://bit.ly/1wbJBWB and http://bit.ly/1ldYcMb The BMJ, online July 11, 2014.

  • Evidence suggests babies in womb start learning earlier than thought: study

    By Barbara Liston

    ORLANDO, Fla. (Reuters) - Babies in the womb show evidence of learning by their 34th week, three weeks earlier than previously thought, new research has found.

    "It really pushed the envelope" in terms of how early babies begin to learn, lead researcher Charlene Krueger, associate professor at the University of Florida's College of Nursing, said on Thursday.

    The study, published in the journal Infant Behavior and Development, followed 32 women from their 28th through 38th weeks of pregnancy in an investigation to pinpoint when the ability to learn emerges.

    Krueger had the women repeat three times out loud a set 15-second nursery rhyme, and do it twice a day for six weeks. The selected rhyme was previously unknown to the mothers.

    The fetuses' heart rates were monitored at 32, 33 and 34 weeks as they listened to a recording of a female stranger recite the rhyme.

    By the 34th week, Krueger said, the heart rates of the tested fetuses showed an overall slight decline while listening to the recording, compared with a control group of fetuses whose heart rates slightly accelerated while listening to a recording of a new nursery rhyme.

    Krueger said a decelerating heartbeat has long been associated with a fetus recognizing something familiar, compared with an accelerated heartbeat response to a novel sound or experience.

    "We cautiously concluded, because it was not statistically significant, that learning emerged by 34 weeks gestational age," she said.

    At that point, the mothers stopped reciting the rhyme to their babies who were tested again at 36 and 38 weeks.

    "At 38 weeks we confidently concluded the fetus could remember the rhythm of that nursery rhyme, which was four weeks after the mother stopped reciting the rhyme," Krueger said.

    "The deeper and more prolonged response (at 38 weeks), the more confident I felt that learning had gone on," she said.

    Krueger said the findings have implications for the care of pre-term babies in neonatal units. She said she next wants to experiment with placing recordings of the mothers' voices in the babies' cribs so they will benefit from positive impacts of their mothers' voices.

    "What it really shows is how sophisticated the interaction is between a mother and her infant," she said.

    SOURCE: http://bit.ly/1lEBzAl Infant Behavior and Development, May 2014.

Neuroscience Articles

  • Alzheimer's documentary 'Alive Inside' pushes for music therapy

    By Eric Kelsey

    LOS ANGELES (Reuters) - Michael Rossato-Bennett initially thought it was the worst job he had ever taken.

    The filmmaker was flabbergasted when he entered a nursing home on a commission to film a few clips for a website.

    "I walked into these hallways with hundreds of residents in wheelchairs just sitting on the side of the hallway, and I had felt like I'd entered into Dante's 'Inferno,'" he said.

    That visit, though, eventually sparked "Alive Inside," an award-winning independent documentary on musical therapy for those suffering from Alzheimer's disease and other neurological ailments.

    When Rossato-Bennett started filming three years ago he met Henry. The 94-year-old man was crumpled in his wheelchair with his head down, eyes closed and hands clasped. He had been in a nursing home for a decade and couldn't recognize his daughter.

    But when a nurse put headphones over Henry's ears and played his favorite music, he began to shuffle his feet, move his arms and sing.

    "It was like a resurrection of life in a person," Rossato-Bennett, 53, said. "Then when we took the headphones off the guy, and we started talking to him, the being revealed itself. He had this incredible voice and he spoke poetry, like greater poetry than I'm capable of."

    Henry's story, which went viral a few years ago when the video clip was released online, is a common occurrence in the film that has begun its rollout into U.S. theaters this month after winning the audience award for top U.S. documentary at the Sundance Film Festival in January.

    The documentary chronicles New York social worker Dan Cohen's effort to bring such therapy to dementia patients as a way to lessen the use of medication and combat its cost on a strained healthcare system about to absorb aging Baby Boomers.

    Cohen, the 62-year-old founder of Music & Memory, a program that seeks to make musical therapy a standard part of nursing home care, began using the treatment in 2006.

    "It was just an instant hit," Cohen said with a snap of his fingers. His program is now in more than 600 facilities worldwide.

    Music, which targets areas of the brain not affected by dementia, brings back a sense of identity to dementia patients, neurologist and author Oliver Sacks says in the film.

    "If you give somebody music for an hour, they're going to be in a better mood for the day, which is really no different if a relative visits," Cohen added.

    The film shows patients singing and dancing, seemingly re-animated while listening to music. At one point, Henry sings in the scat style of jazzman Cab Calloway, his favorite singer.

    "When people see this they get it," Cohen said.

    Many of the subjects, which also include a woman with schizophrenia and bipolar disorder, show deep emotional resonance to the music.

    "Music is a companion to our becoming," Rossato-Bennett said. "So to enter the desert of soul and bring back something that precious is a great gift."

  • U.S. Justice Department wants workers to carry heroin antidote

    By Reuters Staff

    WASHINGTON (Reuters) - U.S. law enforcement agents who deal with heroin addicts may begin carrying the drug naloxone to reverse overdoses, the Justice Department said on Thursday, responding to a surge in heroin use in the United States.

    Attorney General Eric Holder said he urged federal law enforcement agencies to identify those workers and determine whether they should be trained in how to administer the medication.

    The move will "pave the way for certain federal agents - such as emergency medical personnel - to begin carrying the potentially life-saving drug," the Justice Department said in a statement.

    Naloxone is a drug that stops opioids such as heroin from reaching receptors in the brain, which may reverse an overdose.

    Holder said in March his agency was stepping up efforts to stem sharp increases in deadly heroin overdoses, trafficking in the drug and abuse of prescription narcotics at the root of what he called an "urgent public health crisis."

    More than 16,000 people die each year from prescription opioid overdose in the United States, according to the Food and Drug Administration.

  • DNA changes linked to health effects of childhood abuse

    By Krystnell Storr

    NEW YORK (Reuters Health) - Trauma has lasting effects on mental and physical health that may stem from changes to DNA which undermine a person's ability to rebound from stress, according to new research.

    The small study of abused children adds to a growing body of evidence suggesting that experiences can alter gene activity, explaining how mental anguish can translate to lingering physical effects, and possibly opening new avenues for treatment, study authors say.

    "This could explain why children with stressful childhood experiences have a different range of problems like not doing well in school, having academic problems, or problems with judgement and decision making," said senior study author Seth Pollak, a psychologist and child development researcher at the University of Wisconsin-Madison.

    For example, one of the affected DNA sites Pollak's team focused on is involved in responding to a nerve-cell growth factor that "is what allows the brain to grow and heal during childhood and to develop," he told Reuters Health.

    The findings, Pollak said, support research showing that "genes aren't fixed and stable" as was once thought. Scientists have long known that a person's genes interact with their environment, but this kind of finding helps to illustrate how that actually works, he notes.

    The study looked at the blood cells of children who had been abused to examine changes in methylation - a chemical code along the DNA strand that helps control when genes are activated. More or less methylation can silence a gene or boost its activity.

    Past research in people and rodents has shown that traumatic experiences - including psychological stress - can alter DNA methylation, Pollak and his colleagues write in the journal Child Development.

    Research in rats, for instance, focused on a gene that makes a receptor for the stress hormone cortisol. The receptor is critical to shutting down the stress response so the body can return to normal. Without it, stress reactions affecting the brain and immune system remain in high gear, with negative consequences to health.

    Pollak and his team examined a stretch of DNA that controls the equivalent gene, known as the GR gene, in people.

    They recruited 18 children between the ages of 11 and 14 whose experience of abuse was documented by state child protective services records. They also recruited 38 children from similar neighborhoods and family backgrounds without a record of abuse to act as a comparison group.

    The researchers drew blood from each child and analyzed the methylation along a stretch of DNA that controls GR gene activity, the same stretch where changes had been seen in rats.

    After adjusting for differences associated with socioeconomic status, the researchers found that children who had been abused had extra methylation at three sites along the DNA and had less than the other kids at a fourth site. The changes suggest the GR gene might be silenced when it should normally be active and might be over-active in certain other circumstances.

    "We not only found the same effect in the children as had been found in the rodent, but we found it on the exact same part of the gene," Pollak noted.

    "If this gene isn't turned on and you are not able to actually use (cortisol), then you experience emotions like any other individual - you get upset, you get angry, you get aroused but you can't shut down," Pollak said.

    "It would lead to high levels of stress, arousal, anger, irritation but kind of an inability to regulate and come back to a calmer state," he said.

    "These are the kind of behavioral problems that have been associated with child abuse for a very long time. The whole idea that the very nature of the kind of parenting that we experience could change and turn on and off genes related to social behavior is so cool, it's a game changer," he added.

    On the other hand, Pollak pointed out, humans are not rats. Finding the same changes at the same sites in the human and rat cells strongly suggests they result from the experience of stress, the team writes in their report, and "opens a window into the molecular mechanisms linking early stress exposure to the emergence of psychopathology."

    But, the researchers caution, they did not examine whether the affected gene was more or less active in the children's bodies. The study also looked at blood cells, so they cannot be certain that the same changes are present in the kids' brain cells.

    "It's very consistent with other evidence that's coming out," said Meghan Gunnar, a professor at the University of Minnesota who was not involved in the study.

    Changes in the way genes are being regulated is certainly one very important potential mechanism that shapes how a child's body is functioning, but it's not the only way that experience can 'get under the skin' and have long term effects but it is certainly one way," said Gunnar, who leads The Early Experience, Stress Neurobiology, and Prevention Science Network.

    "Increasingly it's looking like child abuse is not just a social or welfare problem. It's now looking like a biomedical problem and we might want to view it the way we view disease," Pollak said.

    SOURCE: http://1.usa.gov/1pG0N2K Child Development, online July 24, 2014.

  • Express Scripts plans to narrow specialty drugs list further

    By Bill Berkrot

    (Reuters) - Express Scripts Holding, the largest U.S. pharmacy benefit manager, expects to exclude more expensive specialty drugs from its list of preferred medicines next year, the latest salvo in its campaign to push drugmakers to rein in prices.

    Express Scripts said it will announce its preferred drug list for 2015 in the very near future, with expensive cancer and hepatitis drugs seen as likely to come under increasing scrutiny.

    For 2014, it excluded certain specialty drugs from five therapeutic categories, including multiple sclerosis and inflammatory diseases. It has since been a vocal critic of the $84,000 cost of Sovaldi, the hepatitis C treatment introduced in December by Gilead Sciences Inc.

    "We always have to make sure that we have available for our patients the products that they need for their treatment," Express Scripts Chief Medical Officer Steve Miller said in a telephone interview. "But we have been unabashed in saying that we will move market share to the product at which we get the best clinical outcome at the best price."

    Pharmacy benefit managers, or PBMs, administer drug benefits for employers and health plans and run large mail order pharmacies.

    Express, which has nearly 25 million Americans on its National Preferred Formulary, can drive enormous revenue toward drugmakers whose products it selects. They will typically be those that offer lower prices a for similar clinical benefit and for which patients will be charged lower co-pays.

    Miller said Express Scripts impacted market share in sales of drugs for diabetes and asthma last year. It excluded GlaxoSmithKline's asthma drug Advair and Novo Nordisk's diabetes drug Victoza from the formulary, driving business toward AstraZeneca drugs, such as Symbicort and Byetta.

    Doctors prefer a wide variety of medicines at their disposal as patients can react differently to some drugs. But if a doctor wants a patient on an Express Scripts plan to use excluded rheumatoid arthritis drugs, such as Johnson & Johnson's Simponi or Pfizer Inc's Xeljanz, it must be appealed on a case-by-case basis. Express's preferred RA drugs are AbbVie's top-selling Humira and Amgen's blockbuster Enbrel.

    Miller said there are greater opportunities to narrow formularies than ever before due to far more choices within therapeutic categories.

    "We're now seeing a lot of competition across specialty drugs, even across oncology drugs. Look out for us to continue to narrow other classes," Miller said.

    However, if the potential cost savings is not significant, "no one wants to disrupt patients for pennies," he added.

    Express Scripts has Sovaldi on its formulary as it is the only available oral medicine with a cure rate above 90% and minimal side effects for the liver destroying virus. Competing hepatitis C treatments expected to hit the market in coming months are being developed by Merck & Co, AbbVie and Bristol-Meyers Squibb Co.

    Sovaldi has racked up nearly $6 billion in sales in its first two quarters on the market, shattering industry records for a new medicine.

    "We are excited for competition to get into the market place," Miller said. "The more crowded a market becomes, the more people have to consider price as a lever."

  • Depression linked to faster cognitive decline in old age

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Among older adults with dementia, those who are also depressed tend to have more rapid cognitive decline, according to a new study.

    "Many studies have found that older people with some depression are more likely to develop cognitive decline or dementia," Robert S. Wilson said.

    But there has been disagreement over whether depression actually contributes to cognitive decline or whether both are the result of other underlying problems, he told Reuters Health.

    Wilson worked on the study at the Rush Alzheimer's Disease Center in Chicago.

    He and his coauthors analyzed data on 1,700 people over age 50 who initially had no cognitive problems and were followed for an average of eight years. Each year doctors evaluated participants' depression symptoms and tested their thinking and memory skills.

    About half of the original group developed mild cognitive impairment, which often comes before dementia, and 18 percent were diagnosed with dementia.

    Participants who had more depression symptoms on their initial exams were more likely to experience cognitive decline.

    Depression symptoms were also linked to dementia and to more rapid decline after a dementia diagnosis, according to results published in Neurology.

    Almost 600 of the participants died during the study and their brains were examined postmortem.

    Among those participants, depression was still associated with faster mental decline when amyloid plaques - considered the hallmarks of Alzheimer's disease - and other neuropathological problems found on autopsy were taken into account.

    "Late life dementia is a very complex disorder and there are many factors that contribute to it, and depression is one of those factors," Wilson said.

    Depression accounted for five percent of the variability in mental decline that couldn't be attributed to other problems with the brain, he said.

    Depression symptoms did not increase once cognitive decline started, and actually decreased once dementia was diagnosed. Depression itself is an organized process of the brain, and as brain function declines it is common for people to experience periods of unhappiness but it is rare that those periods are consistent, Wilson said.

    Dr. Amos D. Korczyn, professor emeritus of neurology at Tel Aviv University in Israel, called the study an "important contribution" to scientists' understanding of how cognitive decline, depression and changes in the brain may be linked.

    "Obviously as the authors note, more work needs to be done to better understand the relationship of depression to dementia which is so important when trying to modify the disease course," he told Reuters Health in an email.

    Depression symptoms are common among people with dementia, especially early on in the disease, he said.

    It's still unclear exactly how depression might lead to cognitive decline and dementia, Wilson said.

    "Depression is probably doing something to your brain if it's affecting cognition," Wilson said. "We think in the meantime there ought to be thought given to the importance of treating depression for these people."

    Treating depression with medication or behavioral therapy might enhance mental function among people with cognitive decline or dementia, he said.

    There isn't much scientific evidence that antidepressants are effective for people with dementia but most doctors prescribe them and the impression is that they provide some relief, Korczyn said.

    "People with depression, as well as those who are demented, frequently tend to avoid exposure to others, even to friends and this may exacerbate the depression," Korczyn added. "They should be encouraged to be socially integrated."

    Caregivers often become depressed as well, and as they are usually spouses, are neither young nor necessarily healthy themselves, he noted. They should be offered help and moral support as well.

    SOURCE: http://bit.ly/NwhhyY Neurology, online July 30, 2014.

Oncology Articles

  • The Pill linked to breast cancer risk for younger women

    By Kathryn Doyle

    NEW YORK (Reuters Health) - A new statistical analysis finds that women under age 50 who were diagnosed with breast cancer were also more likely to have recently been on some versions of the Pill.

    The increased cancer risk still translates to less than a one percent chance of developing breast cancer for most younger women, researchers emphasize, so the results should not outweigh the many benefits of taking oral contraceptives.

    These results are not enough to change clinical practice or to discourage any women from taking birth control pills, said lead study author Elizabeth F. Beaber, of the Fred Hutchinson Cancer Research Center in Seattle, Washington.

    Some past research suggests that the hormones in birth control pills could "feed" hormone-sensitive tumors and thereby raise younger women's risk of a breast cancer diagnosis, or of developing more aggressive cancers (see Reuters Health article of February 26, 2013 here: http://reut.rs/1s8tM44).

    But birth control pills have evolved over the decades since their introduction and the hormone doses they contain have dropped steadily, so many studies are based on data for formulations that are no longer used, Beaber and her colleagues point out in the journal Cancer Research.

    To examine the risk in a group of women more recently on birth control pills, Beaber's team analyzed data from a large healthcare delivery system, tracking birth control pill prescriptions and breast cancer diagnoses.

    The researchers compared 1,102 women diagnosed with invasive breast cancer between 1990 and 2009 with 21,952 women without cancer who were of similar age.

    Women who had taken oral contraception during the past year, according to pharmacy records, were more likely to be in the cancer group than those who had never taken birth control pills or who had taken them more than a year prior.

    Contraceptives with higher doses of estrogen or progestin were more strongly associated with increased cancer risk.

    "Use of formulations with high dose estrogen, ethynodiol diacetate (synthetic progestin), and specific triphasic oral contraceptives in the past year was associated with an increased breast cancer risk in our study, while other formulations, including low dose estrogen oral contraceptives, did not appear to be associated with an elevated risk," Beaber told Reuters Health.

    Women who had used high-estrogen pills or those with high synthetic progestin in the past year were about 2.6 times as likely as women who had not used oral contraceptives to be diagnosed with breast cancer. Women who used norethindrone (Aygestin), a progestin-only pill, in triphasic dosing were 3.1 times more likely to have a breast cancer diagnosis.

    Overall, the risk was slightly higher for hormone-sensitive cancers than for other types of tumors, but that result was not statistically significant, meaning it could have been due to chance.

    Women in the cancer group had more family history of cancer than the comparison group, and may have differed in other ways that the authors could not account for.

    More research is required to determine why and how different birth control options might affect breast cancer risk, Beaber said.

    Nine percent of the comparison group had filled prescriptions for oral contraceptives, compared to 13 percent of women diagnosed with breast cancer, according to pharmaceutical records.

    The authors calculate that taking oral contraceptives is therefore associated with a 50 percent increase in risk of breast cancer for women like those in the study, who were between ages 20 and 49.

    Less than one percent of women will get breast cancer before age 40, according to the American Cancer Society, and even with a 50 percent relative increase that number would still be under one percent.

    For this type of study, a 50 percent increase in risk is actually quite low and can generally be dismissed as bias or random chance, Dr. David A. Grimes told Reuters Health by phone.

    Grimes is a clinical professor in the department of Obstetrics and Gynecology at UNC School of Medicine in Wilmington, North Carolina.

    "Weak associations, consistent with noise and not signal, were the overall finding," he said.

    The new results are not important for women or doctors, Grimes said. Other, better studies have found no increase in breast cancer risk with birth control, which is essential for women's health, he said.

    The new study did not include interviews with women nor did it assess whether they actually took the pills, only if they had a prescription on file at the time, he pointed out.

    The bottom line for women is that birth control pills are very safe, he said.

    Beaber and her coauthors acknowledge that their results "should be interpreted cautiously" and further studies with a larger group of women are needed to confirm the findings.

    "It is important to remember that breast cancer is rare among young women and that there are other established health benefits associated with oral contraceptive use," Beaber said.

    Oral contraception helps protects against pelvic inflammatory disease, lowers the risk of ovarian and endometrial cancers and colorectal cancers and helps maintain bone density.

    SOURCE: http://bit.ly/1oajEGg Cancer Research, online August 1, 2014.

  • Express Scripts plans to narrow specialty drugs list further

    By Bill Berkrot

    (Reuters) - Express Scripts Holding, the largest U.S. pharmacy benefit manager, expects to exclude more expensive specialty drugs from its list of preferred medicines next year, the latest salvo in its campaign to push drugmakers to rein in prices.

    Express Scripts said it will announce its preferred drug list for 2015 in the very near future, with expensive cancer and hepatitis drugs seen as likely to come under increasing scrutiny.

    For 2014, it excluded certain specialty drugs from five therapeutic categories, including multiple sclerosis and inflammatory diseases. It has since been a vocal critic of the $84,000 cost of Sovaldi, the hepatitis C treatment introduced in December by Gilead Sciences Inc.

    "We always have to make sure that we have available for our patients the products that they need for their treatment," Express Scripts Chief Medical Officer Steve Miller said in a telephone interview. "But we have been unabashed in saying that we will move market share to the product at which we get the best clinical outcome at the best price."

    Pharmacy benefit managers, or PBMs, administer drug benefits for employers and health plans and run large mail order pharmacies.

    Express, which has nearly 25 million Americans on its National Preferred Formulary, can drive enormous revenue toward drugmakers whose products it selects. They will typically be those that offer lower prices a for similar clinical benefit and for which patients will be charged lower co-pays.

    Miller said Express Scripts impacted market share in sales of drugs for diabetes and asthma last year. It excluded GlaxoSmithKline's asthma drug Advair and Novo Nordisk's diabetes drug Victoza from the formulary, driving business toward AstraZeneca drugs, such as Symbicort and Byetta.

    Doctors prefer a wide variety of medicines at their disposal as patients can react differently to some drugs. But if a doctor wants a patient on an Express Scripts plan to use excluded rheumatoid arthritis drugs, such as Johnson & Johnson's Simponi or Pfizer Inc's Xeljanz, it must be appealed on a case-by-case basis. Express's preferred RA drugs are AbbVie's top-selling Humira and Amgen's blockbuster Enbrel.

    Miller said there are greater opportunities to narrow formularies than ever before due to far more choices within therapeutic categories.

    "We're now seeing a lot of competition across specialty drugs, even across oncology drugs. Look out for us to continue to narrow other classes," Miller said.

    However, if the potential cost savings is not significant, "no one wants to disrupt patients for pennies," he added.

    Express Scripts has Sovaldi on its formulary as it is the only available oral medicine with a cure rate above 90% and minimal side effects for the liver destroying virus. Competing hepatitis C treatments expected to hit the market in coming months are being developed by Merck & Co, AbbVie and Bristol-Meyers Squibb Co.

    Sovaldi has racked up nearly $6 billion in sales in its first two quarters on the market, shattering industry records for a new medicine.

    "We are excited for competition to get into the market place," Miller said. "The more crowded a market becomes, the more people have to consider price as a lever."

  • Navigators can help guide breast cancer patients through care

    By Ronnie Cohen

    NEW YORK (Reuters Health) - Patient navigators may be able to help steer women with breast cancer through what can be a daunting treatment process, a new study suggests.

    Breast cancer kills a disproportionate share of low-income and African-American women, researchers note, and employing patient navigators is thought to be a potential way to assist underserved patients.

    "There are a lot of barriers for patients who are poor and have a low health literacy. We're really hoping that patient navigation is the solution," said Dr. Naomi Ko, who led the study at Boston University School of Medicine.

    Navigators can provide comfort, accompany patients to medical meetings, translate, map transit routes and repeat and explain complex medical recommendations.

    "We really need to figure out why it helps and where it helps. And if we can do that right, we have the potential to help a lot of needy, vulnerable, low-income minority patients get the right and timely care," Ko told Reuters Health.

    She and her team examined the records of 1,288 racially diverse women diagnosed with breast cancer at eight centers across the U.S. Roughly half of the women were assigned navigators and the rest were not.

    The researchers sought to determine whether women with navigators might be more likely to get guideline-recommended treatment. Based on women's age and the type and size of their breast tumors, that treatment included anti-estrogen therapy, radiation or chemotherapy.

    Participants eligible for anti-estrogen therapy had a 73 percent greater chance of getting that treatment when they had a navigator. That was after taking into account other potential differences between women, such as their age, ethnicity, language, insurance and treatment site.

    The finding was particularly promising because poor, minority women can have low levels of use of anti-estrogen therapy, the authors write in the Journal of Clinical Oncology. The medication treats hormone-receptor-positive breast cancer by lowering estrogen levels and blocking estrogen's ability to act on breast cancer cells.

    Navigators, however, did not seem to influence whether women received radiation after breast-conserving surgery. And at the four sites where the authors could estimate the effect of navigators on chemotherapy, patients with navigators were less likely to get recommended chemo.

    "We think patient navigation helps, but we don't know where it helps and how it helps," Ko said. "There are still a lot of questions."

    "Is (patient navigation) effective?" said biostatistician Donald Berry, from the MD Anderson Cancer Center in Houston, Texas. "If you just had to look at this study, you'd say, 'I don't know.'"

    "But it can't be bad," added Berry. He was not involved in the new research.

    Patient navigators in this study were funded by grants, Ko noted. Typically either grants or hospitals themselves cover the cost of navigators.

    Dr. Michael Alvarado told Reuters Health he sees navigators help his low-income breast cancer patients at San Francisco's county hospital.

    "The navigators we have at San Francisco General are invaluable, an amazing resource for the patients," he said. "They're an objective bystander to help give information, to relay information, to get them to their next appointment. The patients love them."

    Alvarado is a surgeon at the University of California, San Francisco Medical Center and was not involved in the current study.

    The number of options facing breast cancer patients and the amount of time and money needed to get appropriate care can be overwhelming, Alvarado said.

    "Having options is such a wonderful thing. But at the same time, patients are pulling their hair out. It's totally an information overload. They're searching for people to give them an answer, and it's complicated," he said.

    "In some of these situations, it can be daunting for patients to be in a clinic with doctors in white coats. To have a navigator as their friend, I think it gives them a lot of comfort. It makes a huge difference," Alvarado said.

    Some breast cancer treatments, such as radiation, require patients to make frequent visits to the hospital. The treatment exacts an especially heavy toll on mothers who must work to support their families, Ko said.

    "For some women, they feel very anxious about losing their job," she said. Navigators can help by informing patients about their employment rights and about disability payments, for example.

    Every day, five African-American women die of breast cancer because of a disparity in care, Ko noted.

    "With the right support and encouragement and the right team," she said, "I think we can do a lot for these patients."

    SOURCE: http://bit.ly/WN2SDs Journal of Clinical Oncology, online July 28, 2014.

  • Most kids will use shade if provided at outdoor sports camps: study

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Without any encouragement from coaches, more than two-thirds of kids at an outdoor soccer camp used nearby tents for shade during rest periods, a new study found.

    "Outdoor sports and being active are important for kids to be healthy globally, but we need to balance that with taking reasonable steps to prevent skin cancers," Dr. Ian A. Maher told Reuters Health.

    Maher worked on the pilot study at Saint Louis University in Missouri.

    Sunscreen, sun protective clothing and finding shade can all help reduce sun exposure, he said.

    "We wanted to know if we put money into these shade structures, would kids use them," Maher said.

    The researchers observed kids at a summer soccer camp in Richmond, Virginia over two weeks. Shade tents donated by Virginia Commonwealth University Medical Center and the Sun Safe Soccer program of the American Society for Dermatologic Surgery were placed within 10 yards of the field.

    Kids weren't told whether they should use the shade tents. They were given frequent five- to 10-minute rest periods during each session.

    On average, about 71 percent of kids used the shade tents during rest periods. During the first week, when the weather was sunnier, 98 percent of kids used the tents.

    Campers in their mid to late teens were less likely to use the tents than younger kids, according to findings published in JAMA Dermatology.

    "The results of this study suggest that if a culture of being 'sunsmart' is put in place that people will use it," said Dr. Robert S. Kirsner, chief of dermatology at the University of Miami Hospital in Florida. He was not part of the new study.

    The Florida Society of Dermatology and Dermatologic Surgery offers free shade structures to several schools in the state, and similar programs may be in place elsewhere, he told Reuters Health by email.

    The tents cost between $100 and $150 at sporting goods stores, Maher said. Currently, some parents provide the tents at games and there may be one or two available at a tournament.

    Ideally, he said, these tents will become a part of standard soccer team equipment, alongside balls and uniforms.

    "This is a fairly cheap, common sense step to reduce the amount of sun exposure," Maher said.

    He has had success with a program in Missouri in which local businesses pay for and sponsor the tents.

    Skin cancer is the most common type of cancer in the U.S. and the deadliest forms are caused by exposure to ultraviolet light, according to the Centers for Disease Control and Prevention.

    "You get the majority of your sun exposure before 18 years of age, when you spend a lot more time outdoors than as an adult," Maher said.

    Soccer, especially, is a very exposed sport, he said. Baseball players wear caps and have dugouts for shade breaks and football players wear helmets, which offer some sun protection.

    "Soccer teams should develop a culture of being 'sunsmart' ranging from practicing and playing at off peak sun times, if possible, wearing sun protective clothing and applying and reapplying sunscreen, and if possible using shade," Kirsner said.

    "Coaches, parents, family members and other spectators are also at risk, and thus should also take efforts to reduce excessive sun exposure," he said.

    SOURCE: http://bit.ly/1eFUc6O JAMA Dermatology, online July 30, 2014.

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Transplant Articles

  • Inquiry finds "indications" of organ harvesting in Kosovo conflict

    By Julia Fioretti

    BRUSSELS (Reuters) - An EU-led inquiry found "compelling indications" that Kosovo Albanian guerrillas extracted body organs from Serb captives during the 1998-99 war and sold them, but the practice was not widespread and there was not enough evidence for a trial, the lead investigator said on Tuesday.

    After a three-year investigation, the EU-led task force said there was, however enough evidence to prosecute former leaders of the Kosovo Liberation Army (KLA) for war crimes against the ethnic Serb and Roma populations of Kosovo during the conflict.

    The investigation was prompted by a 2011 report by Council of Europe member Dick Marty that accused senior KLA commanders of involvement in the smuggling of Serb prisoners into northern Albania and the removal of their organs for sale.

    Prime Minister Hashim Thaci, himself a former KLA leader who was named in Marty's report, has dismissed the accusations as an attempt to tarnish the Kosovo Albanian fight for independence.

    U.S. prosecutor John Clint Williamson, who led the investigation, said there was no evidence of widespread organ harvesting, but that the crime had occurred a number of times.

    "There are compelling indications that this practice did occur on a very limited scale and that a small number of individuals were killed for the purpose of extracting and trafficking their organs," he told journalists.

    Other crimes perpetrated by senior KLA members, such as unlawful killings and forced disappearances, amounted to the ethnic cleansing of large portions of the Serb and Roma populations, and there was enough evidence to prosecute, Williamson said.

    DARK CLOUD

    The task force will file its indictment against former KLA leaders for war crimes once an ad hoc tribunal has been set up by the European Union and Kosovo, something Williamson said would happen next year. He did not name the people likely to be indicted.

    Prime Minister Thaci said in a statement the government would continue cooperating with the task force.

    "The government of the Republic of Kosovo appreciates the completion of the ambassador Williamson's work, which is an important step to determine potential individual responsibility and gives an end to the claims of the unfounded charges."

    Serbia's counter-insurgency campaign of 1998 and 1999 eventually drew in NATO, which bombed for 78 days to drive out Serbian forces behind the killings of Kosovo Albanian civilians. Around 10,000 Albanians and just over 2,000 Serbs are believed to have been killed during and immediately after the war.

    Kosovo declared independence in 2008 but the EU still plays a guiding role in policing and justice, particularly cases of war crimes.

    Efforts to investigate alleged war crimes committed by the guerrillas have run up against widespread intimidation in a small country where clan loyalties run deep and former KLA rebels are revered as heroes.

    Williamson condemned what he called "active efforts" to undermine the investigation.

    "As long as a few powerful people continue to thwart investigations into their own criminality, the people of Kosovo as a whole pay the price as this leaves a dark cloud over the country."

  • Inquiry finds "indications" of organ harvesting in Kosovo conflict

    By Julia Fioretti

    BRUSSELS (Reuters) - An EU-led inquiry found "compelling indications" that Kosovo Albanian guerrillas extracted body organs from Serb captives during the 1998-99 war and sold them, but the practice was not widespread and there was not enough evidence for a trial, the lead investigator said on Tuesday.

    After a three-year investigation, the EU-led task force said there was, however enough evidence to prosecute former leaders of the Kosovo Liberation Army (KLA) for war crimes against the ethnic Serb and Roma populations of Kosovo during the conflict.

    The investigation was prompted by a 2011 report by Council of Europe member Dick Marty that accused senior KLA commanders of involvement in the smuggling of Serb prisoners into northern Albania and the removal of their organs for sale.

    Prime Minister Hashim Thaci, himself a former KLA leader who was named in Marty's report, has dismissed the accusations as an attempt to tarnish the Kosovo Albanian fight for independence.

    U.S. prosecutor John Clint Williamson, who led the investigation, said there was no evidence of widespread organ harvesting, but that the crime had occurred a number of times.

    "There are compelling indications that this practice did occur on a very limited scale and that a small number of individuals were killed for the purpose of extracting and trafficking their organs," he told journalists.

    Other crimes perpetrated by senior KLA members, such as unlawful killings and forced disappearances, amounted to the ethnic cleansing of large portions of the Serb and Roma populations, and there was enough evidence to prosecute, Williamson said.

    DARK CLOUD

    The task force will file its indictment against former KLA leaders for war crimes once an ad hoc tribunal has been set up by the European Union and Kosovo, something Williamson said would happen next year. He did not name the people likely to be indicted.

    Prime Minister Thaci said in a statement the government would continue cooperating with the task force.

    "The government of the Republic of Kosovo appreciates the completion of the ambassador Williamson's work, which is an important step to determine potential individual responsibility and gives an end to the claims of the unfounded charges."

    Serbia's counter-insurgency campaign of 1998 and 1999 eventually drew in NATO, which bombed for 78 days to drive out Serbian forces behind the killings of Kosovo Albanian civilians. Around 10,000 Albanians and just over 2,000 Serbs are believed to have been killed during and immediately after the war.

    Kosovo declared independence in 2008 but the EU still plays a guiding role in policing and justice, particularly cases of war crimes.

    Efforts to investigate alleged war crimes committed by the guerrillas have run up against widespread intimidation in a small country where clan loyalties run deep and former KLA rebels are revered as heroes.

    Williamson condemned what he called "active efforts" to undermine the investigation.

    "As long as a few powerful people continue to thwart investigations into their own criminality, the people of Kosovo as a whole pay the price as this leaves a dark cloud over the country."

  • Inquiry finds "indications" of organ harvesting in Kosovo conflict

    By Julia Fioretti

    BRUSSELS (Reuters) - An EU-led inquiry found "compelling indications" that Kosovo Albanian guerrillas extracted body organs from Serb captives during the 1998-99 war and sold them, but the practice was not widespread and there was not enough evidence for a trial, the lead investigator said on Tuesday.

    After a three-year investigation, the EU-led task force said there was, however enough evidence to prosecute former leaders of the Kosovo Liberation Army (KLA) for war crimes against the ethnic Serb and Roma populations of Kosovo during the conflict.

    The investigation was prompted by a 2011 report by Council of Europe member Dick Marty that accused senior KLA commanders of involvement in the smuggling of Serb prisoners into northern Albania and the removal of their organs for sale.

    Prime Minister Hashim Thaci, himself a former KLA leader who was named in Marty's report, has dismissed the accusations as an attempt to tarnish the Kosovo Albanian fight for independence.

    U.S. prosecutor John Clint Williamson, who led the investigation, said there was no evidence of widespread organ harvesting, but that the crime had occurred a number of times.

    "There are compelling indications that this practice did occur on a very limited scale and that a small number of individuals were killed for the purpose of extracting and trafficking their organs," he told journalists.

    Other crimes perpetrated by senior KLA members, such as unlawful killings and forced disappearances, amounted to the ethnic cleansing of large portions of the Serb and Roma populations, and there was enough evidence to prosecute, Williamson said.

    DARK CLOUD

    The task force will file its indictment against former KLA leaders for war crimes once an ad hoc tribunal has been set up by the European Union and Kosovo, something Williamson said would happen next year. He did not name the people likely to be indicted.

    Prime Minister Thaci said in a statement the government would continue cooperating with the task force.

    "The government of the Republic of Kosovo appreciates the completion of the ambassador Williamson's work, which is an important step to determine potential individual responsibility and gives an end to the claims of the unfounded charges."

    Serbia's counter-insurgency campaign of 1998 and 1999 eventually drew in NATO, which bombed for 78 days to drive out Serbian forces behind the killings of Kosovo Albanian civilians. Around 10,000 Albanians and just over 2,000 Serbs are believed to have been killed during and immediately after the war.

    Kosovo declared independence in 2008 but the EU still plays a guiding role in policing and justice, particularly cases of war crimes.

    Efforts to investigate alleged war crimes committed by the guerrillas have run up against widespread intimidation in a small country where clan loyalties run deep and former KLA rebels are revered as heroes.

    Williamson condemned what he called "active efforts" to undermine the investigation.

    "As long as a few powerful people continue to thwart investigations into their own criminality, the people of Kosovo as a whole pay the price as this leaves a dark cloud over the country."

Women’s Health Articles

  • The Pill linked to breast cancer risk for younger women

    By Kathryn Doyle

    NEW YORK (Reuters Health) - A new statistical analysis finds that women under age 50 who were diagnosed with breast cancer were also more likely to have recently been on some versions of the Pill.

    The increased cancer risk still translates to less than a one percent chance of developing breast cancer for most younger women, researchers emphasize, so the results should not outweigh the many benefits of taking oral contraceptives.

    These results are not enough to change clinical practice or to discourage any women from taking birth control pills, said lead study author Elizabeth F. Beaber, of the Fred Hutchinson Cancer Research Center in Seattle, Washington.

    Some past research suggests that the hormones in birth control pills could "feed" hormone-sensitive tumors and thereby raise younger women's risk of a breast cancer diagnosis, or of developing more aggressive cancers (see Reuters Health article of February 26, 2013 here: http://reut.rs/1s8tM44).

    But birth control pills have evolved over the decades since their introduction and the hormone doses they contain have dropped steadily, so many studies are based on data for formulations that are no longer used, Beaber and her colleagues point out in the journal Cancer Research.

    To examine the risk in a group of women more recently on birth control pills, Beaber's team analyzed data from a large healthcare delivery system, tracking birth control pill prescriptions and breast cancer diagnoses.

    The researchers compared 1,102 women diagnosed with invasive breast cancer between 1990 and 2009 with 21,952 women without cancer who were of similar age.

    Women who had taken oral contraception during the past year, according to pharmacy records, were more likely to be in the cancer group than those who had never taken birth control pills or who had taken them more than a year prior.

    Contraceptives with higher doses of estrogen or progestin were more strongly associated with increased cancer risk.

    "Use of formulations with high dose estrogen, ethynodiol diacetate (synthetic progestin), and specific triphasic oral contraceptives in the past year was associated with an increased breast cancer risk in our study, while other formulations, including low dose estrogen oral contraceptives, did not appear to be associated with an elevated risk," Beaber told Reuters Health.

    Women who had used high-estrogen pills or those with high synthetic progestin in the past year were about 2.6 times as likely as women who had not used oral contraceptives to be diagnosed with breast cancer. Women who used norethindrone (Aygestin), a progestin-only pill, in triphasic dosing were 3.1 times more likely to have a breast cancer diagnosis.

    Overall, the risk was slightly higher for hormone-sensitive cancers than for other types of tumors, but that result was not statistically significant, meaning it could have been due to chance.

    Women in the cancer group had more family history of cancer than the comparison group, and may have differed in other ways that the authors could not account for.

    More research is required to determine why and how different birth control options might affect breast cancer risk, Beaber said.

    Nine percent of the comparison group had filled prescriptions for oral contraceptives, compared to 13 percent of women diagnosed with breast cancer, according to pharmaceutical records.

    The authors calculate that taking oral contraceptives is therefore associated with a 50 percent increase in risk of breast cancer for women like those in the study, who were between ages 20 and 49.

    Less than one percent of women will get breast cancer before age 40, according to the American Cancer Society, and even with a 50 percent relative increase that number would still be under one percent.

    For this type of study, a 50 percent increase in risk is actually quite low and can generally be dismissed as bias or random chance, Dr. David A. Grimes told Reuters Health by phone.

    Grimes is a clinical professor in the department of Obstetrics and Gynecology at UNC School of Medicine in Wilmington, North Carolina.

    "Weak associations, consistent with noise and not signal, were the overall finding," he said.

    The new results are not important for women or doctors, Grimes said. Other, better studies have found no increase in breast cancer risk with birth control, which is essential for women's health, he said.

    The new study did not include interviews with women nor did it assess whether they actually took the pills, only if they had a prescription on file at the time, he pointed out.

    The bottom line for women is that birth control pills are very safe, he said.

    Beaber and her coauthors acknowledge that their results "should be interpreted cautiously" and further studies with a larger group of women are needed to confirm the findings.

    "It is important to remember that breast cancer is rare among young women and that there are other established health benefits associated with oral contraceptive use," Beaber said.

    Oral contraception helps protects against pelvic inflammatory disease, lowers the risk of ovarian and endometrial cancers and colorectal cancers and helps maintain bone density.

    SOURCE: http://bit.ly/1oajEGg Cancer Research, online August 1, 2014.

  • Uptick seen in U.S. breast-feeding rates

    By David Beasley

    ATLANTA (Reuters) - Breast-feeding rates are rising among U.S. newborns, but most mothers still wean their babies earlier than experts recommend, federal health officials said on Thursday.

    Some 79 percent of newborns were breast-fed in 2011, up 2 percentage points from the year before, according to the U.S. Centers for Disease Control and Prevention's annual Breastfeeding Report Card.

    That number dipped to 49 percent of babies after six months and 27 percent after a year, numbers unchanged from 2010.

    The American Academy of Pediatrics recommends breast-feeding infants for at least a year and the World Health Organization recommends two years.

    Western states such as Washington, Oregon and California had the highest newborn breast-feeding rates, exceeding 90 percent.

    Some of the lowest rates, in the mid 50-percent range, were in the Deep South. In Louisiana, 56 percent of newborns were breast-fed, with 30 percent still nursing after six months.

    Help is increasingly available to mothers who want to breast-feed, the CDC report stated, with the number of health professionals specializing in lactation almost doubling between 2006 and 2013.

    Allowing babies to have "skin to skin" contact with their mothers immediately after birth and to remain in the hospital room with them encourages breast-feeding, the CDC said.

    Hospitals in the western United States allow infants to room with their mothers at twice the rate of hospitals in the Midwest and South, the CDC said.

    For the first six months of life, breast milk alone is an adequate diet for infants, according to the CDC.

    SOURCE: http://1.usa.gov/1lgO714 CDC Breastfeeding Report Card 2014, online July 31, 2014.

  • On first meeting, men prefer 'nice' women: study

    By Kathryn Doyle

    NEW YORK (Reuters Health) - For heterosexual men, women who are "nice" are also "attractive," according to a new study, but the same doesn't hold true for women meeting a man for the first time.

    "Although dating patterns have changed over the years, gender-stereotypic behavior persists in the dating realm," said lead author Gurit E. Birnbaum.

    "Women are expected to be more caring and concerned about others than are men. Men, in contrast, are expected to take control of the dating environment," said Birnbaum, of the School of Psychology at the Interdisciplinary Center (IDC) in Herzliya, Israel.

    Past studies have also found that for heterosexuals, having gender-typical qualities that line up with your biological sex is generally attractive to the opposite sex, Birnbaum told Reuters Health in an email.

    To better understand why niceness in a stranger is a turn-on for men, but less of one for women, the researchers recruited around 100 heterosexual, single students from an Israeli university for each of three stages of the research.

    For the first part, students were randomly paired with another of the opposite sex in a laboratory setting. One was prompted to share a story of a recent difficulty, like failing a test, which the students then talked about for about five minutes.

    The storyteller later rated the responder's ability to understand, validate and care for them in the conversation. The storytellers also rated their partner's sexual desirability and masculinity or femininity.

    Men thought a responsive stranger was also more feminine, but women didn't equate responsiveness with masculinity, the authors report in the Personality and Social Psychology Bulletin.

    Part two involved a similar conversation between strangers in an online chat scenario, but in this case volunteers were asked to disclose a recent negative experience to an opposite-sex stranger who was actually working from a script of caring or uncaring responses.

    Again, for men but not women, a nice partner was perceived as more feminine and also more attractive.

    Part three built on part two, using the same online chat scenario but adding measures of sexual arousal and desire for a long-term relationship.

    For men, more responsive partners seemed more feminine and elicited more sexual arousal as well as greater desire for a long-term relationship.

    For heterosexual couples, a partner whose biological sex and gender markers line up - such as a woman who has feminine qualities - may be more attractive, the authors explain. Niceness lines up with our social expectations for the biological female, but not the biological male, they write.

    Men may also conflate niceness and genuine caring with sexual interest, Birnbaum noted.

    "We still do not know why women are less sexually attracted to responsive strangers; it may not necessarily have to do with 'being nice' per se," she said.

    "For example, they may perceive this person as inappropriately nice and manipulative (i.e., trying to obtain sexual favors) or as eager to please, and perhaps even as desperate, and therefore as less sexually appealing."

    Some women may like responsive men, and others may not, so the overall trend for women is not significant, she said.

    "From my perspective, these results tell us something important about the factors that guide initial attraction and how they may diverge for men and women," said Justin Lehmiller, a sex educator and researcher at Purdue University in West Lafayette, Indiana.

    A man's perceptions on meeting a nice woman seems straightforward, but a woman's perceptions appear more complicated, said Lehmiller, who was not involved in the study.

    "Women don't dislike nice men, but niceness just doesn't seem to be that important to them in a first encounter," said Eli J. Finkel of the Relationships and Motivations Lab at Northwestern University in Chicago, who also was not involved in the new research.

    "Perhaps they're focused on other variables, such as sense of humor, although we'll need to await future research to know for sure," Finkel told Reuters Health by email.

    There's no reason to think these results among 20 and 30 year olds would change for people over 40, Lehmiller said.

    "If anything, it's possible that the effects could be stronger for older men, given that older adults hold more traditional views of gender and, therefore, may be even more sensitive to gendered cues."

    But they could, and probably would, change with a different context. This study only considered initial attraction to strangers.

    In long-term relationships, kindness and honesty are among the most important traits, Lehmiller noted.

    "And while 'nice guys' may seem to come in last in this scenario, they actually finish first in the end," he said.

    SOURCE: http://bit.ly/1m18MGq The Personality and Social Psychology Bulletin, online July 25, 2014.

  • Whooping cough vaccine safe for pregnant women

    By Madeline Kennedy

    NEW YORK (Reuters Health) - Pregnant women in their third trimester can safely receive the whooping cough vaccine to prevent infections in newborns, a recent study from the UK suggests.

    Whooping cough, or pertussis, is a highly contagious disease. Its symptoms are initially mild but it can lead to serious and fatal complications, particularly for children under three months old.

    Recent increases in whooping cough infections, some resulting in deaths of newborns, prompted the UK to develop a new vaccine program in 2012. The program offered combined vaccines against diphtheria, pertussis and polio to over 700,000 women in the third trimester of pregnancy.

    "The benefit of maternal immunization is that the mother's protective antibodies are passed on to the baby before it is born, giving it the best protection it needs before they are old enough to be vaccinated themselves," Philip Bryan told Reuters Health in an email.

    He worked on the study at the Medicines and Healthcare Products Regulatory Agency (MHRA) in London.

    The U.S. Centers for Disease Control and Prevention (CDC) recommends that pregnant women are vaccinated against whooping cough, but the World Health Organization stated in a 2010 paper that there is not sufficient evidence to recommend the vaccine to pregnant women.

    The MHRA sought to add to this body of evidence and ensure the UK vaccine program was safe. Bryan said the new study "is the largest review to date of the safety of whooping cough (pertussis) vaccination in pregnancy."

    The researchers analyzed data on 20,074 pregnant women who were vaccinated against whooping cough beginning in late 2012.

    Compared to country-wide estimates, there was no increased risk of stillbirth among vaccinated women. Their pregnancies resulted in five stillbirths in the two weeks following vaccination, while the existing data would predict about seven stillbirths in the same time frame. The pattern held true later in pregnancy as well.

    Bryan and his colleagues also compared the vaccinated women to a group of similar but unvaccinated pregnant women from the previous two years.

    That analysis suggested there was no increase in other pregnancy risks after vaccination either, including death of the mother or baby, pre-eclampsia, miscarriage, C-section delivery or low birth weight. In addition, the vaccine had no effect on the length of pregnancy, according to findings published in The BMJ.

    In the U.S., the CDC recommends infants get vaccinated against pertussis initially at ages two, four and six months as part of a combined vaccine that also protects against diphtheria and tetanus called DTaP.

    There is a significant advantage to administering the pertussis vaccine to pregnant women in addition to vaccinating infants, according to Dr. Eugene Shapiro, from Yale University in New Haven, Connecticut. He wrote an editorial published with the new study.

    "With the current schedule, the three doses are not complete until six months," a time during which children are particularly vulnerable to the infection, Shapiro told Reuters Health.

    In addition, he said the maternal vaccine "protects the mother so she doesn't become ill and transmit to the infant."

    The pertussis vaccine has several known side effects, including redness and swelling at the vaccine site and fatigue and fever. But both children and adults generally tolerate it well, the researchers note.

    "Sadly, we are still seeing deaths in newborns whose mothers did not receive the vaccine for whatever reason," Bryan said. "If worries over vaccine safety is a factor in some women not having the vaccine, then the results from our large study should give that extra bit of reassurance that the vaccine is safe in pregnancy, as well as very beneficial."

    According to Bryan, the UK vaccine program has been a success. He noted that the vaccine's use has been steadily increasing in the UK and that it "has been highly effective at preventing disease and deaths in young babies."

    SOURCE: http://bit.ly/1wbJBWB and http://bit.ly/1ldYcMb The BMJ, online July 11, 2014.

  • Navigators can help guide breast cancer patients through care

    By Ronnie Cohen

    NEW YORK (Reuters Health) - Patient navigators may be able to help steer women with breast cancer through what can be a daunting treatment process, a new study suggests.

    Breast cancer kills a disproportionate share of low-income and African-American women, researchers note, and employing patient navigators is thought to be a potential way to assist underserved patients.

    "There are a lot of barriers for patients who are poor and have a low health literacy. We're really hoping that patient navigation is the solution," said Dr. Naomi Ko, who led the study at Boston University School of Medicine.

    Navigators can provide comfort, accompany patients to medical meetings, translate, map transit routes and repeat and explain complex medical recommendations.

    "We really need to figure out why it helps and where it helps. And if we can do that right, we have the potential to help a lot of needy, vulnerable, low-income minority patients get the right and timely care," Ko told Reuters Health.

    She and her team examined the records of 1,288 racially diverse women diagnosed with breast cancer at eight centers across the U.S. Roughly half of the women were assigned navigators and the rest were not.

    The researchers sought to determine whether women with navigators might be more likely to get guideline-recommended treatment. Based on women's age and the type and size of their breast tumors, that treatment included anti-estrogen therapy, radiation or chemotherapy.

    Participants eligible for anti-estrogen therapy had a 73 percent greater chance of getting that treatment when they had a navigator. That was after taking into account other potential differences between women, such as their age, ethnicity, language, insurance and treatment site.

    The finding was particularly promising because poor, minority women can have low levels of use of anti-estrogen therapy, the authors write in the Journal of Clinical Oncology. The medication treats hormone-receptor-positive breast cancer by lowering estrogen levels and blocking estrogen's ability to act on breast cancer cells.

    Navigators, however, did not seem to influence whether women received radiation after breast-conserving surgery. And at the four sites where the authors could estimate the effect of navigators on chemotherapy, patients with navigators were less likely to get recommended chemo.

    "We think patient navigation helps, but we don't know where it helps and how it helps," Ko said. "There are still a lot of questions."

    "Is (patient navigation) effective?" said biostatistician Donald Berry, from the MD Anderson Cancer Center in Houston, Texas. "If you just had to look at this study, you'd say, 'I don't know.'"

    "But it can't be bad," added Berry. He was not involved in the new research.

    Patient navigators in this study were funded by grants, Ko noted. Typically either grants or hospitals themselves cover the cost of navigators.

    Dr. Michael Alvarado told Reuters Health he sees navigators help his low-income breast cancer patients at San Francisco's county hospital.

    "The navigators we have at San Francisco General are invaluable, an amazing resource for the patients," he said. "They're an objective bystander to help give information, to relay information, to get them to their next appointment. The patients love them."

    Alvarado is a surgeon at the University of California, San Francisco Medical Center and was not involved in the current study.

    The number of options facing breast cancer patients and the amount of time and money needed to get appropriate care can be overwhelming, Alvarado said.

    "Having options is such a wonderful thing. But at the same time, patients are pulling their hair out. It's totally an information overload. They're searching for people to give them an answer, and it's complicated," he said.

    "In some of these situations, it can be daunting for patients to be in a clinic with doctors in white coats. To have a navigator as their friend, I think it gives them a lot of comfort. It makes a huge difference," Alvarado said.

    Some breast cancer treatments, such as radiation, require patients to make frequent visits to the hospital. The treatment exacts an especially heavy toll on mothers who must work to support their families, Ko said.

    "For some women, they feel very anxious about losing their job," she said. Navigators can help by informing patients about their employment rights and about disability payments, for example.

    Every day, five African-American women die of breast cancer because of a disparity in care, Ko noted.

    "With the right support and encouragement and the right team," she said, "I think we can do a lot for these patients."

    SOURCE: http://bit.ly/WN2SDs Journal of Clinical Oncology, online July 28, 2014.