Traffic & Construction

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Traffic Updates

TRAFFIC CONGESTION AT STMC
January 5, 2015

The City will begin work on Wurzbach from Babcock Road to Fredericksburg Road to widen and enhance the sidewalks for pedestrian safety beginning the week of January 5th. The work will begin at the Babcock end of Wurzbach progressing toward Fredericksburg Road and will take approximately four months to complete. During this time, there will be lane closures and traffic congestion on Wurzbach. Please allow more time to travel through this area or take an alternate route to avoid the traffic congestion.

We wanted to make you aware of transportation and road construction project around the STMC that may result in traffic delays: Closure of Fredericksburg Road and Medical Drive Intersection Scheduled
  • The intersection of Fredericksburg Road at Medical Drive will close the night of Wednesday, November 5. Thursday morning's traffic will need to seek alternate routes. This means the new roadway surface for Fredericksburg Road - a bridge over the future through lanes of Medical Drive - will be slid into place by Saturday, November 8. Though the contractor has two full weeks (14 days) to get Fredericksburg Road reopened, TxDOT is hoping to have the work done and lanes reopened in half that time. Although this road work was delayed from its original schedule in early October, the project is back on track for implementation. Expect to see single lanes of Fredericksburg Road - and some alternating closures on Medical Drive - as crews prepare for the work on Wednesday evening. At 12:01 a.m. Thursday morning, Fredericksburg Road will close down entirely. No through traffic, and no left turns, will be permitted at this location. Traffic trying to continue on Fredericksburg Road will need to turn right onto Medical, then follow appropriate city streets to reach its destination. The official planned detour uses Wurzbach Road, the I-10 frontage roads and Callaghan Road. This info has been posted to the TxDOT blog, along with a video going through the proposed detour route. You can check out this information and video at http://txdotsanantonio.blogspot.com .

Facility Construction

UNIVERSITY HEALTH SYSTEM
Hospital Construction

This project is in progress and should be complete by the end of the fourth quarter of 2013.


STMC Quarterly Construction Project Chart

(download pdf)


STMC Construction Projects through 2013

(download pdf)


The TXDOT Fredericksburg Road & Medical Drive Project

(view link)


To submit other construction project, please email Pam Leissener

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Neuroscience Articles

  • Institutional neglect changes kids' brain structure

    By Kathryn Doyle

    (Reuters Health) - Kids who were raised in a Romanian institution for abandoned children have smaller heads, smaller brains, and different white matter structure than similar kids who were moved into high-quality foster care at an early age.

    Even those who were moved into foster care by age two have noticeably different brains from children raised in biological families.

    The findings show that the brain's wiring "is profoundly interrupted and perturbed and changed by neglect," said senior author Charles A. Nelson of Boston Children's Hospital and Harvard Medical School.

    "Some of these changes can be remediated by placement in enriched foster care," he told Reuters Health by phone.

    The Bucharest Early Intervention Project began in 2000 with 136 abandoned babies who had spent more than half of their lives in institutions, which was the standard at the time. At age two, researchers randomly selected half of the babies and arranged for them to be moved into high-quality foster homes.

    Ever since then, the researchers have been comparing the kids to similar youngsters in biological families who were never institutionalized.

    The institutions had high ratios of babies to caregivers, and children were confined to cribs, with little linguistic or sensory stimulation, to age two. Those babies grew up to have an average IQ of 70.

    "On almost every measure we see impairments," Nelson said.

    "We were first concerned that their heads weren't growing enough," he said. Then they observed reductions in brain electrical activity and in gray and white matter.

    For the current study, the researchers used data from magnetic resonance imaging of 69 of the kids' brains, taken around age eight.

    In analyzing the kids' white matter "wiring," they found significant differences in the corpus callosum and in several other areas, including the limbic circuitry and sensory processing areas, according to results in JAMA Pediatrics.

    The corpus callosum allows the two halves of the brain to communicate, which is essential for language processing. Other changes may be related to problems with attention and decision-making.

    Parents who adopt internationally from countries where this type of institutional orphanage exists may be taking on developmental issues as a result, said Jamie L. Hanson, a postdoctoral Fellow at the Carolina Consortium on Human Development at Duke University who is not part of the Romanian study.

    He worked with a population of mostly Russian adoptees now living in Wisconsin, and even after 10 years with their adoptive families, some still face these issues, he said.

    "I've heard a lot of parents struggle with the constellation of problems that their kids were going through, sometimes a mix of ADHD symptoms, social processing and interacting with peers," Hanson told Reuters Health by phone.

    Nelson said, "Brain development after birth depends on experience, especially during critical periods. If experiences don't occur during critical periods, developments don't happen."

    "The brain expects certain experiences when we come into the world, and not just changing diapers, but investing in that kid," he said.

    Most measures, but not all, were improved for kids moved to foster care early in life, he said.

    Now at the start of their 16th year of follow-up, all of the kids put in high-quality foster homes have remained there, and all but 14 who were left in the institutions have been moved out by the government, Nelson said.

    As the study progressed, Romania banned institutionalization for abandoned infants under age three. Today babies will often be reared in group homes or "social apartments" and moved into the institutions when they reach a legal age, Nelson said.

    Comparing adopted and unadopted kids in orphanages is often difficult to do - the kids who were adopted may have been better off than the others in some way. But this study sent kids to foster homes randomly, making the results much more reliable, said Michael E. Behen, a clinical psychologist/neuroscientist in the Translational Imaging Center at Children's Hospital of Michigan, who is not part of the study.

    "We do find similar things for kids who are adopted to an enriched environment in the U.S. or Canada," Behen told Reuters Health by phone. "We sort of find that over time in that adoptive environment some things seem to normalize."

    In the U.S., children are generally not raised from birth in institutions, but there are foster care situations with varying levels of neglect, and these results will be important for policy makers, Behen said.

    SOURCE: http://bit.ly/15D2g70 JAMA Pediatrics, January 26, 2015.

  • 'Autisms' a more appropriate term than 'autism,' geneticists say

    By Will Boggs MD

    (Reuters Health) - There are so many different genetic forms of autism that using the singular term, autism, is misleading, researchers say.

    "We believe a better term to use is 'the autisms,' or 'the autism spectrum disorders' (that is, plural)," Dr. Stephen W. Scherer told Reuters Health by email. "There are many different forms of autism. In other words, autism is more of a collection of different disorders that have a common clinical manifestation."

    The DNA of affected individuals varies remarkably, his team found. Two-thirds of brothers and sisters with what's still called autism spectrum disorder, or ASD, showed different genetic changes.

    Scherer, from The Hospital for Sick Children in Toronto, Ontario, Canada, is part of a team that aims to identify all the genetic changes in individuals with ASD.

    In the U.S., the Centers for Disease Control and Prevention (CDC) estimates that 1 in 68 children (1 in 42 boys and 1 in 189 girls) have an autism spectrum disorder. Recent estimates in Europe, the CDC says, are that one to two percent of children there are affected.

    When Scherer's team looked for genetic changes in the entire DNA from 85 pairs of brothers and sisters with ASD and their parents, they found an average of roughly 73 genetic changes per set of DNA -- but only 36 of the 85 families (42.4 percent) had mutations that researchers could relate to genes already linked in some way to ASD.

    And when they looked at these 36 families, only one-third of the affected brothers and sisters carried the same mutation. Siblings with different mutations showed different autism symptoms, while siblings that carried the same mutations had similar autism symptoms, the researchers reported in Nature Medicine.

    "This emphasizes that these kids have different forms of autism (each their own snowflake) and need to be treated in their own special way," Scherer said.

    "Now that we know some of the genes involved in the core features of autism, we have targets to develop new drugs and that is ongoing mainly in biotech companies and pharmaceutical companies," he said.

    In the meantime, he noted, "The best treatment for the core features in the autisms is actually intensive behavioral intervention. For this, for the best outcomes, you need to start early."

    To analyze DNA, the researchers used a technique called whole-genome sequencing. They added the results to the massive Autism Speaks-Google MSSNG database that will ultimately contain genomes of "10,000s of individuals with autism(s)," Scherer said.

    This will pave the way for better treatments, he believes. "In the future, once there is a suspected diagnosis of autism, the (child's) genome will be sequenced and doctors will compare it to the MSSNG database to find out what form of autism that child has," he said. "With this information in hand they can then better inform the family of what to do, and equally important, what not to do."

    More information about MSSNG can be found at http://www.mss.ng.

    SOURCE: http://bit.ly/1rgBrwG Nature Medicine, online January 26, 2015.

  • Deadly Japanese encephalitis surges in northeast India

    By Amarjyoti Borah

    GUWAHATI, India (Thomson Reuters Foundation) - Cases of deadly mosquito-borne Japanese encephalitis have risen nearly five-fold in five years in India's northeast Assam state as a result of warming weather and changing rainfall, health experts say.

    Between 2010 and 2014, the number of annual cases rose from 154 to 744, with deaths rising from 41 to 160, according to data from the Assam health department. The disease, which in 2009 was recorded in only half of the state's districts, now is seen in all of them.

    Doctors say climate change has played a major role in the spread of the disease, which once appear largely from May to July, but now is seen as late in the year as November, as mosquitoes survive longer in warmer conditions.

    Japanese encephalitis is characterised by inflammation of the brain and high fever.

    "Now the temperature ... which is ideal for breeding of the Culex mosquito is present almost until October or so, and as a result of this the cases of the disease are increasing," said Rabindra Nath Talukdar, a senior official of the Assam health department.

    "Initially it was only an upper Assam disease ... but now it has also been detected in lower Assam districts, and (now) cases have been reported from all the 27 districts in Assam," Talukdar said.

    MORE MOSQUITOES

    Health department officials said changes in agricultural patterns may be affecting the rise in encephalitis cases. Warmer conditions have allowed farmers to grow more crops of rice each year, which means rice paddies with standing water offer a breeding ground for mosquitoes for a larger part of each year.

    "The Culex mosquito breeds on water in the agricultural land, and now since there is water on the field for several more months than before, it gives more time and space for the mosquito to breed," Talukdar said.

    Faced with a surge in Japanese encephalitis cases, the Assam government has announced measures to tackle the problem, including more careful monitoring of cases.

    Assam Health Minister Nazrul Islam described the situation as "a huge concern".

    "I have asked the senior officials of the health department to monitor the situation carefully and to report to me on a regular basis," he said.

    GROWING OUTCRY

    Faced with a growing public outcry over the disease's rapid spread, Assam Chief Minister Tarun Gogoi has ordered officials of the Assam health department to develop a plan to control the disease.

    Plans should include "setting up of an intensive care unit in each district hospital for treatment of emergency cases, along with laboratory testing units," Gogoi said.

    As well, "I have already asked the health department to procure laboratory testing kits for quick diagnosis of the disease, adequate vaccines and medicines for the hospitals, and also to carry out intensive fogging in the affected areas," he said.

    Civil society groups and activists have however questioned why such steps were not taken earlier.

    "The data from the state health department itself shows that the disease has taken a deadly turn over the years in the state. Unfortunately the state machinery waited for the disease to go out of control, whereas it should have taken steps to control the disease much earlier," said Sankar Prasad Rai, of the All Assam Students Union (AASU).

    Several influential student groups of the state, including the All Assam Students Union and the Assam Jatiyatibadi Yuva Chatra Parishad (AJYCP), have staged protests over the government's failure to control the spread of Japanese encephalitis.

  • U.S. pediatricians reaffirm opposition to legalized pot

    By Andrew M. Seaman

    (Reuters Health) - Despite moves by some states to allow recreational and medical use of marijuana, a large group of U.S. pediatricians says in a new statement that the substance should remain - for the most part - illegal.

    In an update to its 2004 position statement on the matter, the American Academy of Pediatrics also calls for decriminalization of marijuana to lessen the lasting effects of criminal charges brought against youths - especially minorities.

    While it doesn't support legalization, the Academy says the penalties for being caught with the substance should be reduced because a criminal record can have a lasting impact on people's lives, causing them to have trouble getting jobs, housing and loans for education.

    Decriminalization of marijuana "takes this whole issue out of the criminal justice system and puts it into the health system, where it really should be," said Dr. Seth Ammerman, the statement's lead author from Stanford University in California.

    "What that would look like - we hope - (is) if you're found to be in possession of marijuana as a kid, instead of going to jail, juvenile hall or getting some sort of record, you'd be put in some sort of diversion or treatment program," Ammerman told Reuters Health.

    But while people often say marijuana is as benign as alcohol for adults, Ammerman said it's the Academy's position that the same is not true for children and adolescents.

    "It's not benign for youth," he said. "It may be benign for adults, but the Academy feels strongly that alcohol is not benign for youths either."

    The statement says the negative effects of marijuana on adolescents are well documented, including impaired short-term memory and decreased concentration and problem solving.

    Marijuana also affects motor control, which may contribute to deaths or injuries through traffic and other accidents. There are also more recent questions as to whether early use of the substance affects the brain.

    "There has been some interesting brain development research that shows the brain continues to develop into the mid-20s, and there is some research in regular to heavy users that their brain development is not normal," Ammerman said.

    While the organization is opposed to the legalization of marijuana because of the potential harm to children and adolescents, it supports studies of the effects of legalization, in states where sale and possession are allowed, in order to inform future policies and reduce use among youth.

    So far, Washington, Colorado, Oregon, Alaska and the District of Columbia allow recreational sale and/or possession of marijuana by adults. Twenty-three states and the District of Columbia allow medical use of marijuana.

    The Academy also opposes the legalization of marijuana for medical uses that haven't been evaluated through proper regulatory channels, such as the U.S. Food and Drug Administration.

    One sticking point, according to Ammerman, is that many of the ingredients in marijuana - known as cannabinoids - have not been studied.

    "There are over 200 - minimum if not more than that - and we know very little about them," he said. "These cannabinoids can have therapeutic value, but there have been no studies in children or adolescents."

    The statement does make an exception for children with a terminal illness or debilitating disease, saying marijuana should remain an option for them.

    Ammerman said the Academy also recommends that parents not use marijuana around their children.

    "They really need to be careful about their use especially around their kids and understand that kids' brains are different than adults and be good role models," he said.

    SOURCE: http://bit.ly/uFc4g2 Pediatrics, online January 26, 2015.

  • Could flu vaccination protect your sense of smell?

    By Shereen Lehman

    (Reuters Health) - In a small new study, skipping the flu vaccine was associated with a higher risk for trouble with a sense of smell or taste.

    Researchers say the results are preliminary, but since respiratory viruses are a common cause of a lost ability to smell, it's possible that the flu could be a contributing factor.

    Respiratory viruses can damage olfactory nerves directly and indirectly by causing inflammation. Sometimes the effect is temporary, but not always, Dr. Zara Patel and colleagues at the Emory University School of Medicine in Atlanta, Georgia write in JAMA Otolaryngology-Head and Neck Surgery.

    "Patients who suffer from decreased or total loss of smell, called 'hyposmia' or 'anosmia' are deeply affected by this problem," Patel told Reuters Health by email.

    "Compared to the other special senses, for example, loss of vision or hearing, the loss of smell is often thought of as relatively inconsequential, but this is far from the truth," Patel said.

    People who can't smell may lose important safety mechanisms, such as the ability to smell smoke or spoiled food, Patel said. And 80 percent of taste is linked to smell, so a total loss of smell could ruin a person's ability to enjoy food and beverages and have a negative effect on their social life.

    "This can (and often does) lead to deep depression and a drastic reduction in quality of life," Patel said, adding there is currently no established cure for the problem.

    Patel said hundreds of different respiratory viruses might have an effect like this, including some 200 viruses that cause the common cold. But the influenza virus may be preventable with vaccines.

    "I saw this as a potential opportunity to (look for) any association between rate of vaccination and rate of (olfactory) loss, and see if there's a way to eventually use this information," she said.

    Patel and colleagues identified 36 patients with olfactory problems that started after upper respiratory infections. The average duration of loss of smell was about 19 months but ranged from three to 48 months.

    They compared those patients to 38 patients of the same race, age and gender, but without olfactory problems.

    Overall, only 19 percent of the group with smell problems had been vaccinated against the flu, compared to 42 percent of the group who had no loss of smell.

    It's important to note this is a small study, and more research needs to be done, Patel cautioned.

    Now her team needs to look at this same subject with more rigorously designed studies, she said.

    Patel said viruses aren't the only cause of smell dysfunction - sinus disease, trauma and tumors are other potential causes.

    She said a few people will spontaneously recover their sense of smell after losing it, but this chance decreases as time passes from the first month after the loss.

    "If people realize they are not able to smell or taste as well as they used to, they should seek care from an otolaryngologist as soon as possible," Patel said. "Because the longer the amount of time that passes before they are able to start treatment, the less chance they have for recovery."

    SOURCE: http://bit.ly/1GwePSx JAMA Otolaryngology-Head and Neck Surgery, online January 15, 2015.

Oncology Articles

  • Novartis pharma boss expects pressure on cancer drug prices

    By Caroline Copley

    ZURICH (Reuters) - Payers are likely to put pressure on drugmakers to lower the cost of cancer medicines, particularly when alternative treatments are available, the head of Novartis' pharma division said on Tuesday.

    "I think there will be increased pressure on oncology prices," David Epstein, head of Novartis' pharmaceutical division told an analyst call after the company reported fourth-quarter results.

    The high price of new immuno-oncology drugs which are expected to be used in combination with other medicines would make it necessary to impose a limit on costs, he said.

    "I fully expect whenever a payer has good therapeutic equivalents to be able to put pressure on," he said.

    U.S. pharmacy benefit manager Express Scripts has become more aggressive in negotiating discounts on drugs for insurance plans and employers. Earlier this month it said cost savings on expensive cancer treatments could be achieved if the company were involved earlier in the decision-making process.

  • E-cigarettes would be banned in public places under California bill

    By Sharon Bernstein

    SACRAMENTO, Calif. (Reuters) - California would ban the use of electronic cigarettes in public places and ramp up enforcement against selling them to minors under a bill introduced in the legislature on Monday.

    There is growing concern about the health risks from e-cigarettes, also known as vapor cigarettes or vapes, which are not lit or smoked like their old-fashioned counterparts, but do generally release nicotine in a heated liquid.

    "Whether you get people hooked on e-cigarettes or regular cigarettes, it's nicotine addiction and it kills," Democratic state Senator Mark Leno, who introduced the bill, said in a telephone interview. "We're going to see hundreds of thousands of family members and friends die from e-cigarette use just like we did from traditional tobacco use."

    The bill would add e-cigarettes to the list of tobacco products regulated in the state, which already forbids smoking in workplaces, restaurants, bars and other places. It would also ramp up penalties for selling e-cigarettes, which come in such flavors as bubble gum and chocolate, to minors.

    California would be the fourth U.S. state to treat them like regular cigarettes, and the 23rd to regulate e-cigarettes in some way. In California, the most populous U.S. state, 122 cities and counties have banned the use of e-cigarettes in certain public places.

    Second-hand e-cigarette emissions contain cancer-causing chemicals, and could put children and others at risk if they are in proximity to users, said Kimberly Amazeen, vice president of public policy and advocacy for the American Lung Association in California.

    The bill was criticized Monday by a group calling itself the American Vaping Association, which said it would harm smokers who are trying to quit by switching to e-cigarettes, which are marketed as a safer alternative to the combustible kind because they do not flood the lungs with smoke.

    "California smokers deserve truthful information about smoke-free alternatives, not hype and conjecture designed to scare them away from attempting to quit with these innovative technology products," Gregory Conley, president of the American Vaping Association, said in a press release.

    But Leno, whose bill is backed by the American Cancer Society, the American Heart Association and the American Lung Association, said the vapor released by the e-cigarettes contains carcinogens, and the nicotine in them is addictive.

  • Safety concerns cloud early promise of powerful new cancer drugs

    By Ransdell Pierson

    NEW YORK (Reuters) - A new wave of experimental cancer drugs that directly recruit the immune system's powerful T cells are proving to be immensely effective weapons against tumors, potentially transforming the $100 billion global market for drugs that fight the disease.

    But top oncology researchers are concerned about the two emerging technologies, citing dangers seen repeatedly in clinical trials including the potentially fatal buildup of toxic debris from killed tumor cells and damage to healthy tissue. Such side effects could block regulatory approval if they aren't controlled, researchers and drug company executives said in interviews with Reuters.

    In some trials, the two new approaches, known as CAR T cells and bispecific antibodies, have eliminated all traces of blood cancers in 40 percent to 90 percent of patients who had no remaining options. The drugs could reap annual sales in the tens of billions of dollars for their manufacturers, especially if they can also eliminate solid tumors in such terminally ill patients.

    CAR T cells, or chimeric antigen receptor T cells, are T cells that have been removed from the body and attached through genetic engineering to an antibody fragment that recognizes a specific tumor protein. T cells are an especially powerful disease-fighting kind of white blood cell. The result is a drug with the killing power of a greatly enhanced T cell, combined with the tumor-spotting ability of an antibody.

    Bispecific antibodies are a twist on conventional antibodies, Y-shaped proteins whose two arms grasp for the same protein target found on cancer cells.

    With bispecifics, one arm of the antibody typically grasps a cancer cell while the other arm takes hold of T cells, bringing the mortal enemies into contact. The T cell punches holes into the adjacent tumor cell and injects deadly enzymes. Conventional antibodies, by contrast, don't directly recruit T cells.

    "Unleashing the killing power of the T cell directly on the tumor cells allows a large increase in potency of these antibodies," said Dr. David Scheinberg, chairman of molecular pharmacology at Memorial Sloan Kettering Cancer Center.

    Investor excitement over these therapies have helped boost interest from companies including Amgen Inc and Roche and have fueled a jump in share prices of smaller firms such as Kite Pharma Inc, Juno Therapeutics and Bluebird Bio.

    "We take patients that have failed every treatment, every chemo combination, that have just two to six months to live. You give them a CAR, and within 3 to 4 weeks you can see massive tumors melting away," said Arie Belldegrun, chief executive officer of Kite. The company went public in June and announced a partnership with Amgen earlier this month.

    CAR T cells could cost $300,000 to $500,000 per patient, if approved, making them among the world's most expensive drugs and testing the ability of insurers to pay for them, said Les Funtleyder of E Squared Asset Management. The hedge fund owns shares of Kite Pharma. Bispecific antibodies could command prices of $200,000 or higher, he said.

    The potency of the experimental drugs comes with some dangerous potential side effects. In the killing process, inflammatory chemicals from the medicines and the tumor cells, called cytokines, are released into the bloodstream and can cause fever, low blood pressure and rapid heartbeat that can be life-threatening.

    The drugs, because of their unique structure and how they work, make it harder to predict whether they will go astray, said Dr. Bindu George, team leader of the U.S. Food and Drug Administration's Office of Cellular, Tissue and Gene Therapies, who called CAR T drugs perhaps the most interesting new technology.

    Most CAR T cells and bispecific antibodies in development identify blood cancer cells by a specific protein, CD19, found on the surfaces of lymphomas and leukemias. Because the same protein can also be found on non-cancerous cells, the drugs can go off track and attack healthy tissues.

    "Our biggest concern would be an off-target toxicity that wasn't expected and we didn't know the cause of it," George said. In that case, "we might have to ask (the drugmaker) for additional information, how the toxicity happened, what organ it was, and literally go back to the drawing board."

    TAMING A POWERFUL DRUG

    Researchers have used anti-inflammation medications to tame some of the adverse reactions, not always successfully. A study of CAR T cell treatment sponsored by Juno for patients with aggressive non-Hodgkin's lymphoma was briefly put on hold after two people died.

    Unlike antibodies, which are excreted from the body within days or weeks, engineered CAR T cells are expected to circulate for years or even a lifetime in the bloodstream, potentially providing lasting benefits, but also risks.

    "You can start to reject normal tissues; it can kill organs or cause autoimmune disease, and you don't want that," said Zelig Eshhar, a professor emeritus of the Weizmann Institute in Israel who pioneered the CAR approach.

    To reduce that danger, researchers are attempting to build "suicide switches" into CAR T cells to turn them off after they have wiped out all signs of cancer.

    At least 30 bispecific antibodies are believed to be in development, including ones from Roche, Johnson & Johnson, AbbVie and Eli Lilly.

    A growing number of drugmakers are also racing to develop the first CAR T therapies, including Kite, Novartis, Juno, Cellectis and its partner Pfizer Inc, and Bluebird, in partnership with Celgene Corp.

    EXPENSIVE OPTION

    The FDA in December approved the first bispecific, Amgen's $178,000 Blincyto for acute lymphoblastic leukemia (ALL) that did not respond to previous treatment. The cancer, prevalent in children, is diagnosed each year in an estimated 6,020 Americans, killing about a fourth of them.

    One third of patients in the Amgen study had no detectable cancer for nearly seven months after receiving the drug through a month-long infusion.

    A main hope for Blincyto is that it will keep patients alive until they can receive stem cell transplants, their best chance of a possible cure.

    CAR technology may also come to the rescue where few options remain.

    "If doctors and specialists learn how to control this very powerful gun, CAR T cells could save hundreds of thousands of people in the United States," said Ori Hershkowitz, a Tel Aviv-based fund manager with Sphera Funds, which owns shares of Kite and rival CARs developer Novartis.

    A Novartis trial showed 27 of 30 children and adults with ALL had no signs of the disease after being treated with its CAR T drug. Some 78 percent of patients were still alive six months after treatment, while some sustained remission for up to two years.

    But everyone in the study developed cytokine release syndrome, including a severe form of it in 27 percent of patients.

    "It certainly needs to be watched and evaluated," said Usman Azam, global head of cell therapies for Novartis. He still believes the drug's benefits provide "compelling hope that you can potentially cure patients."

    Roche's Genentech unit is conducting a mid-stage trial of a bispecific antibody to treat head and neck cancer and colorectal cancer. It is studying a dozen others in preclinical trials against cancer, Alzheimer's disease and inflammatory diseases.

    Paul Carter, a Genentech executive, was cautious about the prospects.

    "It's too early to say whether this will be a home run, although there's optimism it will be at least a base hit that will help us figure out how to go further."

  • Breast cancer patients lack knowledge of their tumors

    By Andrew M. Seaman

    (Reuters Health) - Women with breast cancer often don't know what kind of tumors they have, a new study found.

    Not knowing one's tumor features isn't necessarily tied to worse outcomes, but better knowledge might help women understand treatment decisions and take medications as directed, said Dr. Rachel Freedman, the study's lead author from the Dana-Farber Cancer Institute in Boston.

    Also, she said, cancer patients who understand the basis for their treatment are generally more satisfied with that treatment.

    "Nobody to my knowledge has asked how much knowledge someone had of their own disease," she added.

    For the new study, published in the journal Cancer, Freedman and her colleagues asked 500 women from northern California about their breast cancers, which had been diagnosed between 2010 and 2011.

    Participants were asked about their tumor grade, tumor stage and whether or not their cancer feeds off the hormone estrogen or a protein called human epidermal growth factor receptor 2 (HER2).

    Fifty-five percent of women said they knew if their tumor fed off estrogen, and about a third said they knew their HER2 status. About a third said they knew their tumor's grade, which is the cancer's aggressiveness. And 82 percent of women said they knew their tumor's stage, which is how advanced the cancer is.

    Based on their medical records, only 56 percent of women reported the correct estrogen status, 58 percent reported the correct HER2 status and 57 percent reported the correct stage. Only about one in five women reported the correct grade.

    Overall, only 8 percent of women correctly answered all four questions, but the lack of knowledge was more pronounced among minority women, the researchers report.

    "Even though all these questions were low for all women, we did see difference by race and ethnicity," Freedman said.

    "What's really nice about finding something like this is that it's a modifiable problem," Freedman said. "If you can improve education and provider awareness of this, you can do something about this in the clinic."

    Dr. Michelle Shayne of the James P. Wilmot Cancer Center at the University of Rochester School of Medicine and Dentistry in Rochester, New York, who was not involved in the study, told Reuters Health, "Breast cancer patients in general are a very savvy group of individuals."

    They "tend to read a lot and bring a lot of clippings in to their oncologist and ask a lot of questions," she said, so the study findings surprised her.

    The results show that oncologists need to tailor their discussions about cancer to individual patients as much as they tailor the treatments, she said.

    Also, she said, cancer survivors should receive detailed treatment histories and information about their tumors for future medical care.

    Freedman said that in her own practice, she's been trying to explain patients' cancers in more detail, writing down the specifics and making sure they understand the information.

    "I think this raises awareness of the issue," she said. "This may be a more important issue than we previously appreciated."

    SOURCE: http://bit.ly/1gaOuII Cancer, online January 26, 2015.

  • Heeding musicians, New Orleans moves to ban smoking in bars

    By Jonathan Kaminsky

    NEW ORLEANS (Reuters) - The New Orleans City Council voted on Thursday to ban smoking in the city's bars, a move supported by several prominent local musicians who said the issue was for them a matter of workplace health.

    Most large U.S. cities already have such restrictions in place, anti-smoking advocates said, though smoking is still permitted in bars in cities including Las Vegas, Atlanta and Miami, and across much of the southeastern United States.

    The measure initially proposed in New Orleans included a ban on smoking in many outdoor areas, including parks and at city-sponsored festivals, but council members removed those restrictions before their unanimous vote to bar people from lighting up in bars and casinos.

    Smoking has been banned in Louisiana restaurants since 2007.

    The measure, which has the support of New Orleans Mayor Mitch Landrieu, is expected to take effect in April.

    "In the same way that government is responsible to make sure that there are guards on dangerous machinery, we are responsible to protect the workers in our city, including the workers in bars and casinos," said Councilwoman Susan Guidry before casting her vote.

    The ban received backing from prominent local musicians, including Kermit Ruffins, Irvin Mayfield and Deacon John Moore. Some bar owners and the casino industry opposed it, warning that it will harm business.

    The ban also covers the use of e-cigarettes, angering those who view the metal tubes that heat liquid into an inhalable vapor as less harmful than traditional cigarettes, both to their users and to those inhaling their contents secondhand.

    It exempts existing hookah bars, cigar bars, and businesses catering specifically to e-cigarettes, known as vape shops.

Orthopedic Articles

  • Portable X-ray services becoming more common

    By Daniel Gaitan

    (Reuters Health) - Portable X-ray services are becoming more popular as patients seek medical care in familiar surroundings.

    Proponents say-home X-ray services help frail patients avoid difficult and potentially hazardous trips to hospitals. Other patients seek in-home providers out of convenience, as an ankle or chest X-ray can take less than 20 minutes.

    "We go to the patient and take the X-ray, rather than having the patient go to the doctor's office," said Paul Fowler, founder of Specialty Portable X-Ray, Inc. in New York.

    "Usually, in about an hour after we take an X-ray we give these results directly to the doctor," he told Reuters Health. "With the digital X-rays, we are using probably less exposure than you would at the hospital."

    Patients must have a doctor's prescription for an x-ray, or for an ultrasound exam, which can also be done at home. Fowler's company charges about $300 for a visit for patients without health insurance, he said. Some celebrities seek his services to avoid paparazzi and unwanted attention.

    "The very wealthy who don't want to go to the emergency room, they feel like they're above that, they'll call us and say, 'I twisted my ankle, can you come over and take an X-ray of my ankle,' " he added. "I've been doing it for 35 years, it's just gotten bigger and better over the years."

    Jacob R. Wuerstle, president of Diagnostic X-ray Service, Inc. in Pennsylvania, said portable X-rays are also used in assisted living facilities and prisons.

    "We keep the patients in a setting that they're familiar with, that they're comfortable with," he told Reuters Health. The option for home X-rays is especially helpful for elderly patients in snowy parts of the country.

    His technicians scan more than 30,000 patients per year. Sessions cost about $200. "We use state-of-the-art equipment and we transmit right from the patient's bedside to the radiologist," he said.

    Wuerstle said baby boomers are the fastest growing segment of clients.

    Dr. James C. Carr, a professor of radiology at Northwestern University's Feinberg School of Medicine in Chicago, believes trained technicians using portable machines can provide quality scans for patients in rural areas or unable to move.

    "As long as the equipment is being regulated and the technologists are satisfactorily trained, concerns can be mitigated," he told Reuters Health.

    But portable X-ray machines, while convenient, may be less accurate.

    Dr. David Levin, professor and chairman emeritus of the Department of Radiology at Thomas Jefferson University Hospital in Philadelphia said he would not recommend in-home X-rays for mobile patients.

    "The quality of those images is usually not very good. If you compare the quality of those kinds of studies with the quality of a study that was performed in a hospital in a radiology department or in a private radiology office, there is going to be no comparison," he told Reuters Health. "If a portable X-ray is absolutely necessary because of the patient's clinical condition, then it's justifiable."

    As the portable X-ray market grows, state and federal regulations for radiation protection must be followed, said Dr. William Thorwarth, Jr., chief executive officer of the American College of Radiology in Virginia.

    "You want to be very certain that the technologist who's acquiring the images is appropriately trained and qualified," he told Reuters Health. "There needs to be appropriate precautions so that other people in the house are not exposed."

  • Heavy soccer playing before age 12 tied to later hip deformities

    By Kathryn Doyle

    (Reuters Heath) - In a study of Dutch professional footballers, a bone deformity at the hip was much more common among men who started playing the sport at least four times a week before age twelve.

    If the bones of the hip don't develop normally during childhood, a so-called cam deformity can occur, with extra bone growing near the ball-shaped top of the femur, potentially leading to joint damage and pain, according to the American Academy of Orthopedic Surgeons (AAOS).

    Cam deformities begin to show up on X-rays in early adolescence, and tend to be more common among males and athletes in high-impact sports, the authors of the new study note in the British Journal of Sports Medicine.

    "It is in youth, during growth, that bone activity is high and bone is very responsive to loading," said lead author Igor Tak of the Sports Rehabilitation and Manual Therapy Department at Physiotherapy Utrecht Oost in The Netherlands.

    "For girls this is between 10-14 and for boys this on the average 1.5 years later," Tak told Reuters Health by email. "This suits our findings that when the threshold of loading with a high and low frequency is set at 12 years or 13 years of age, differences are visible between hip morphology of these boys later in life when being an elite player."

    For the new study, Tak and his coauthors studied X-rays of the hips of 63 players from two Dutch football clubs. The players' average age was 23.

    The researchers also used preseason player questionnaires, which include questions about their the men's age when they started playing football and the age when they transitioned from playing three or fewer times per week to playing four or more times per week.

    On average, the players had started practicing soccer at an amateur level around age six, and entered a professional football club, which would require four or more sessions per week, between ages 12 and 13.

    The study team found that 40 of the 63 footballers had some type of cam deformity in one or both hips, while 18 had a "pathological deformity" at an angle severe enough to be associated with developing hip osteoarthritis at an older age.

    Considering the 63 players' total of 126 hips individually, 40 percent of those who had started playing in a professional club after age 12 had a cam deformity, compared to 64 percent of those who started before age 12. There was a similar difference in the number of pathological deformities.

    Cam deformities make the "ball" part of the hip's ball-and-socket less round, which can increase the risk of osteoarthritis later, Tak said. People who play ice hockey, football and basketball often have cam deformities, he said.

    Athletes may work their hip joints more and begin to experience hip pain earlier, but exercise does not cause cam deformities, according to the AAOS.

    Regular people who do not become elite athletes may experience the same thing if they play high-impact sports frequently during bone development, Tak said. Young people should moderate their high-impact sport participation around the age of the "growth spurt," and it would be helpful to more exactly define when that is, but more information is needed on this topic, he said.

    Almost a third of white males develop a cam deformity, and only a small number will develop clinical complaints of restricted range of motion or osteoarthritis pain, even at an older age, said Dr. Emmanuel Audenaert, an orthopedic surgeon at Ghent University in Belgium, who was not involved in the new study.

    For the hips, growth plates stay open until age 16 to 18, which is relatively late, Audenaert said.

    "During puberty and as a result of changing testosterone hormone balance, the growth plate weakens around the age of 12-13, making it even more sensitive to displacement or deformity," Audenaert told Reuters Health by email.

    "Severe muscular training and high loading activities should be restricted until skeletal maturity for any joint and sport," he said. "At young age sportsmen should train on endurance, and maybe most of all technique."

    The results would likely be similar for non-elite athletes, but they would not have the same close medical follow-up and their hip problems may not be detected until middle age, he said.

    The results of other investigations have been mixed and the new study only looks back at the pasts of current adult players, said Dr. Kasper Gosvig of Hvidovre Hospital in Denmark, who was not involved in the Dutch report. Another study following kids as they play sports and their cam deformities emerge is needed, he told Reuters Health by email.

    SOURCE: http://bmj.co/1KKBdHH British Journal of Sports Medicine, online January 7, 2015.

  • U.S. insurance study charts huge price gaps for hip, knee surgery

    By David Morgan

    WASHINGTON (Reuters) - Hip and knee replacements, two of the fastest-growing U.S. medical procedures, are subject to huge - and apparently random - price variations within the same geographical areas, a new insurance industry study said on Wednesday.

    The study by Blue Cross Blue Shield health insurers adds to the evidence of massive disparities between what different hospitals and medical practices charge in the world's most expensive healthcare system.

    It examined claims in 64 healthcare markets over three years and found the biggest price swings for hip surgery in Massachusetts, where the same type of care varied by more than 313 percent, from a low of $17,910 to a high of $73,987.

    The biggest gaps in total knee replacement surgery appeared in Dallas, Texas, where prices varied 267 percent from $16,772 to $61,584, according to researchers.

    Nationwide, typical knee and hip replacements cost an average of just over $30,000, the study found. Both procedures ranged as low as $11,300 in Alabama. But while the price of knee replacements soared to more than $69,000 in New York City, hip surgery climbed even further, to nearly $74,000, in Boston.

    The study, which looked at claims for more than 53,000 procedures from 2010 to 2013, underscores the inconsistencies in medical pricing at a time when employers are increasingly shifting healthcare costs to workers through high-deductible insurance plans.

    Researchers described the variations as "seemingly random" and said the data demonstrated the need for transparent pricing in medicine.

    "Extreme price variation in healthcare can have obvious financial consequences for individuals and employers," the study's authors said. "And from a macroeconomic perspective, it can have serious implications for the sustainability of (the) U.S. healthcare system."

    Researchers also noted that a lack of price variation can penalize consumers in markets where prices are consistently high, such as Fort Collins, Colorado, where knee replacements exceeded the national average by nearly $25,000 but varied locally by less than 1 percent.

    Data contained in the study reflects money that insurers and patients paid to hospitals, doctors, labs, physical therapists and others involved in procedures that are expected to increase as the U.S. population continues to age.

    The study cited independent research estimating that knee replacements tripled and hip replacements doubled between 1993 and 2009. General spending on healthcare is expected to grow 5.7 percent annually over the next decade as health coverage expands under the Affordable Care Act, according to government forecasters.

    SOURCE: http://bit.ly/1CBj3lG Blue Cross Blue Shield Association, January 21, 2015.

  • Older minds need physical and mental activity

    By Ronnie Cohen

    (Reuters Health) - Exercising the body and mind may be the best way to keep an older brain sharp, suggests a new study.

    "The best medicine is physical activity," lead researcher Ralph Martins told Reuters Health.

    "At the end of the day, the two together - physical activity and cognitive training - gave us an additional benefit," said Martins, who directs the Center of Excellence for Alzheimer's Disease Research and Care at Edith Cowan University in Perth, Australia.

    Martins and his colleagues studied 172 people from ages 60 to 85 years, assigning them randomly into four groups.

    One group walked three days a week for an hour and did 40 minutes of resistance training twice a week for 16 weeks. Another group did hour-long computer brain-training exercises five days a week, also for 16 weeks. A third group did both the physical exercise and the computer activities. A fourth group maintained their regular routines.

    The researchers write in Translational Psychiatry that only the group that engaged in both physical activity and computerized brain training showed significantly improved verbal memory, which helps people remember words and language.

    The researchers note that the study failed to show benefits for executive functions that control focus, attention to details and goal setting. They also didn't find benefits for visual memory, processing speed or attention.

    Martins said physical exercise had the most profound and constant effect.

    Dr. David Merrill also sees physical activity as the most useful aid to maintaining memory and cognitive ability as people age, but the combination of physical and mental exercise may offer "synergistic" benefits.

    "What's good for the muscular-skeletal system is good for the cardiovascular system, and it's also good for the brain," said Merrill, who is a geriatric psychiatrist at the David Geffen School of Medicine at the University of California, Los Angeles.

    "Physical exercise sets the stage for the brain to be responsive to new information," said Merrill, who was not involved with the new study. "You're all ready to build new synapses, new connections."

    Both Martins and Merrill recommend that older people exercise regularly and stay intellectually involved. Both favor real-life challenges over computerized brain exercises.

    Martins urges retirees to join service organizations, like the Rotary Club, and to dance for the physical exercise and mental acuity.

    "Full retirement doesn't make sense for graceful aging," Merrill said. "People should try to keep working not only to maintain their self-identity but to challenge their brain."

    Merrill said the new research is the most recent of a handful of studies showing that a combination of interventions can help seniors remain mentally alert.

    He advocates building up to more strenuous exercise than peple did in the study.

    "There's lots of data that shows that being physically active is good for the brain," he said. "It's almost so intuitive that it defies logic that so few people are active physically."

    The U.S. Centers for Disease Control and Prevention recommends that older adults perform moderate and vigorous aerobic and muscle-strengthening activities at least twice a week.

    SOURCE: http://bit.ly/1Kfr5Go Translational Psychiatry, online December 2, 2014.

Transplant Articles

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Women’s Health Articles

  • Breast cancer patients lack knowledge of their tumors

    By Andrew M. Seaman

    (Reuters Health) - Women with breast cancer often don't know what kind of tumors they have, a new study found.

    Not knowing one's tumor features isn't necessarily tied to worse outcomes, but better knowledge might help women understand treatment decisions and take medications as directed, said Dr. Rachel Freedman, the study's lead author from the Dana-Farber Cancer Institute in Boston.

    Also, she said, cancer patients who understand the basis for their treatment are generally more satisfied with that treatment.

    "Nobody to my knowledge has asked how much knowledge someone had of their own disease," she added.

    For the new study, published in the journal Cancer, Freedman and her colleagues asked 500 women from northern California about their breast cancers, which had been diagnosed between 2010 and 2011.

    Participants were asked about their tumor grade, tumor stage and whether or not their cancer feeds off the hormone estrogen or a protein called human epidermal growth factor receptor 2 (HER2).

    Fifty-five percent of women said they knew if their tumor fed off estrogen, and about a third said they knew their HER2 status. About a third said they knew their tumor's grade, which is the cancer's aggressiveness. And 82 percent of women said they knew their tumor's stage, which is how advanced the cancer is.

    Based on their medical records, only 56 percent of women reported the correct estrogen status, 58 percent reported the correct HER2 status and 57 percent reported the correct stage. Only about one in five women reported the correct grade.

    Overall, only 8 percent of women correctly answered all four questions, but the lack of knowledge was more pronounced among minority women, the researchers report.

    "Even though all these questions were low for all women, we did see difference by race and ethnicity," Freedman said.

    "What's really nice about finding something like this is that it's a modifiable problem," Freedman said. "If you can improve education and provider awareness of this, you can do something about this in the clinic."

    Dr. Michelle Shayne of the James P. Wilmot Cancer Center at the University of Rochester School of Medicine and Dentistry in Rochester, New York, who was not involved in the study, told Reuters Health, "Breast cancer patients in general are a very savvy group of individuals."

    They "tend to read a lot and bring a lot of clippings in to their oncologist and ask a lot of questions," she said, so the study findings surprised her.

    The results show that oncologists need to tailor their discussions about cancer to individual patients as much as they tailor the treatments, she said.

    Also, she said, cancer survivors should receive detailed treatment histories and information about their tumors for future medical care.

    Freedman said that in her own practice, she's been trying to explain patients' cancers in more detail, writing down the specifics and making sure they understand the information.

    "I think this raises awareness of the issue," she said. "This may be a more important issue than we previously appreciated."

    SOURCE: http://bit.ly/1gaOuII Cancer, online January 26, 2015.

  • Pain during sex more common after a C-section

    By Kathryn Doyle

    (Reuters Health) - A year and a half after giving birth, one in four women report pain during vaginal intercourse - and odds for the problem are higher in women who had a cesarean section, according to a new study.

    The researchers were surprised to find that almost all women experience pain the first time they have sex after childbirth, whether they resume sex in the first six weeks or wait several months, senior author Stephanie Brown told Reuters Health.

    "This is not generally known, and certainly not what most women and their partners would be told to expect," said Brown, from the Healthy Mothers Healthy Families Research Group at Murdoch Childrens Research Institute in Melbourne, Australia,

    Another surprise was that pain during intercourse was more likely after a C-section, she said.

    Brown and her coauthors studied just over 1,200 women at six maternity hospitals in Melbourne.

    Almost half had spontaneous vaginal deliveries, and most also required perineal stitches due to tearing or an episiotomy. About 11 percent gave birth vaginally with vacuum extraction or forceps, which usually caused some tearing.

    Before pregnancy, about 27 percent reported having pain during sex. By three months postpartum, when nearly 95 percent of the women had resumed vaginal intercourse, more than 44 percent were still reporting pain during sex.

    By a year and a half after childbirth almost 98 percent of women had resumed sex, and 24 percent reported pain.

    "For most women, pain gradually resolves over the course of the first year, but for about one in four women pain persists or recurs," Brown said.

    Women who delivered by emergency C-section or vacuum extraction were twice as likely to be having pain during sex at 18 months than women who had a spontaneous vaginal birth with no tearing, according to results in the British Journal of Obstetrics and Gynecology.

    The odds were also higher, but less so, for women who had planned C-sections.

    "Most people tend to assume that having a caesarean will protect the pelvic floor and therefore be associated with less problems after birth," but that doesn't appear to be the case, Brown said.

    A caesarean is a significant operation and recovery be slow, said Dr. Hannah Woolhouse, also of Murdoch Childrens Research Institute, who was not an author of the new study. "Just because a woman doesn't have a vaginal birth, doesn't mean she won't experience ongoing pelvic and abdominal pain," Woolhouse told Reuters Health by email.

    Fatigue, depression, younger age and having experienced pain with intercourse before giving birth were all associated with painful sex after childbirth, the authors found.

    Talking to a trusted, empathic health professional can be helpful for some women, Brown said.

    "When resuming a sexual relationship, taking things slowly and not feeling pressured to rush into it is important. Women taking part in our research say that knowing 'what's normal' and that what you are going through is not abnormal is also helpful," she said.

    It's important to wait until the mother is physically and emotionally ready to resume sex, said Dr. Mohammad Reza Safarinejad, a private practice urologist in Tehran, Iran, who was not involved in the study.

    "The intercourse should start with the positions she finds most comfortable," he told Reuters Health by email. "For example, side by side or spooning would be a good idea. This will put the least pressure on her abdomen, which is where the incision was done."

    Vacuum extractions and emergency C-sections are by nature unpredictable. The potential sexual consequences are unlikely to affect decision making, but for a planned cesarean with no medical cause, the mother should be informed ahead of time before she makes that choice, said Dr. Eyal Sheiner, a maternity expert at Ben-Gurion University of the Negev in Beer-Sheva, Israel, who was not part of the new study.

    The bigger issue the study raises is just how common pain during sex can be after delivery, Sheiner told Reuters Health by email.

    "Part of the reason this may be surprising is that women tend not to talk about this issue after birth," Woolhouse said. "It remains a relatively taboo topic that can be difficult to discuss with both partners and health professionals."

    SOURCE: http://bit.ly/1yNj8lV British Journal of Obstetrics and Gynecology, online January 21, 2014.

  • Complacency after a heart attack is a bad idea

    By Lisa Rapaport

    (Reuters Health) - People who seem healthy after a heart attack remain at high risk for another one, but many don't take the drugs that can improve their survival odds, researchers say.

    Swedish investigators studied heart attack patients who remained stable for the first year after leaving the hospital. One in five had another heart attack, a stroke or died from cardiovascular causes during the next three years.

    "We were surprised that the risk of future cardiovascular events in these patients was still high," said lead study author Dr. Tomas Jernberg, a cardiologist at Karolinska University Hospital in Stockholm. "We need to follow and support these patients more carefully."

    Jernberg's team analyzed outcomes for 97,254 patients who had heart attacks between 2006 and 2011 and survived for at least a week after leaving the hospital. A year later, 76,687 of those patients were considered "stable" because they hadn't had another heart attack or a stroke.

    Overall, the researchers found, the stable patients were likely to be younger, with fewer other serious health conditions, than the unstable patients. They were also slightly more likely to have had an aggressive intervention right after the first heart attack, such as angioplasty to clear a blocked artery.

    Yet in the three years following an initial stable year, 20 percent had another heart attack, stroke or other cardiovascular event. Of these, 41 percent died from a cardiovascular cause.

    The Swedish team also found that after the first year, stable patients were less likely to be on the standard medications used to manage heart patients.

    It's unclear whether doctors treating these seemingly healthier heart attack survivors were not prescribing the correct medications according to practice guidelines, or they were, and patients were not taking them.

    The research, published in the European Heart Journal, was supported by AstraZeneca PLC, which sells several medications for cardiovascular disease. Two co-authors are AstraZeneca employees.

    It's common for people to resist drugs when they don't understand the benefits, said Dr. Lisa Rosenbaum, a cardiologist at Brigham and Women's Hospital in Boston who recently published an essay in the New England Journal of Medicine about patients' feelings toward heart medications.

    "In the days immediately after a heart attack, so many people will look you right in the eye and say, 'Doctor, I'll do whatever you say and I'm going to change my life,' but the real question is what happens later," said Rosenbaum, who wasn't involved in the Swedish study.

    Some people may reject the notion of medications because if they don't take pills, they don't feel like they're sick, she said. Others may be scared of side effects. Still others may associate drugs with unhealthy lifestyle choices that contribute to heart disease and feel ashamed to take medication.

    "There isn't a silver bullet to fix this, but I think we need to focus on improving communication and removing any stigma that people may feel," Rosenbaum said. "We need to go old school and actually make time to talk to patients, which isn't something we can do in a five- or 10-minute appointment."

    Dr. Jeffrey Schussler, a cardiologist at Baylor Jack and Jane Hamilton Heart and Vascular Hospital in Dallas, agreed that most patients will stick to recommended treatment if they clearly understand the benefits.

    "In my experience, 95 percent of people are compliant, and then there will be 5 percent who smoke and drink and don't listen," said Schussler, who wasn't involved in the Swedish study.

    While medications certainly help patients remain stable after a heart attack, he said that for many, the outcome will depend on whether they continue to see a heart specialist after going home from the hospital.

    "Even if it's just once a year, you really need to see a cardiologist," Schussler said. "There can be a temptation after you're stable for a while to just see a primary care physician, but that's a mistake."

    SOURCE: http://bit.ly/1L3tl46 European Heart Journal, online January 13, 2015 and http://bit.ly/1tRJiVL, New England Journal of Medicine, January 8, 2015.

  • Laws deny leprosy sufferers right to work, travel, marry - study

    By Reuters Staff

    LONDON (Thomson Reuters Foundation) - Leprosy sufferers worldwide face discriminatory laws affecting their right to work, travel and marry, according to an advocacy group which called upon governments to follow U.N. guidelines and abolish such legislation.

    Around 20 countries, including India, Thailand and Nepal, have or continue to pass laws that discriminate against people with leprosy, the International Federation of Anti-Leprosy Associations (ILEP) said ahead of World Leprosy Day on Sunday.

    There were more than 200,000 new leprosy cases reported worldwide in 2013, yet this number has shrunk by 20 percent since 2006, according to the World Health Organization (WHO).

    The U.N adopted a resolution in 2010, urging governments to abolish all discriminatory laws against people affected by leprosy and their family, ILEP said.

    "Some countries have repealed their laws and started public education campaigns to stop stigma against men, women and children affected by leprosy... we applaud those which have taken such action," ILEP President Jan Van Berkel said in a statement.

    Millions of people and their families still suffer from the stigma associated with the disease, which is perpetuated by outdated laws and regulations, ILEP said.

    India has at least 15 laws discriminating against those with leprosy, prohibting them from standing for election or hold a driver's license, according to the anti-leprosy federation.

    People can also be forcibly removed from residential areas and segregated from society even if they have been cured.

    The study said India, home to 60 percent of the world's new leprosy cases in 2013, was reviewing its discriminatory laws.

    Thailand, Nepal and Singapore were among countries discriminating against leprosy sufferers when it came to marriage, divorce and employment, while Malaysia and South Africa have segregation and separation laws for those affected.

    The Philippines and Namibia can refuse entry visas to people with the disease, and people from Pakistan living in the Gulf states face immediate repatriation if diagnosed with leprosy.

    Dainius Pras, U.N. special rapporteur on the right to health, urged all governments to give consideration to the U.N. resolution and follow in the footsteps of Greece, China, Ethiopia, Oman, Ukraine, Estonia and Ecuador in repealing discriminatory laws, ILEP said.

    Leprosy is a chronic infectious disease causing disfiguring skin ulcers and nerve damage in the arms and legs.

    In the past leprosy, also known as Hansen's disease, was regarded as incurable, and patients often became social outcasts, but it can now be treated with antibiotics.

  • Wide use of prescription painkillers found in U.S. women of childbearing age: CDC

    By David Beasley

    ATLANTA (Reuters) - Prescription painkillers are used widely by U.S. women of childbearing age, a federal report released on Thursday found, and health officials said exposure to such drugs during pregnancy could increase the risk of birth defects.

    Of women aged 15-44, more than a third on Medicaid and a fourth on private insurance filled prescriptions for opioid pain medications each year between 2008-2012, a team from the Centers for Disease Control and Prevention said today in the Morbidity and Mortality Weekly Report.

    Opioids include medications such as hydrocodone, codeine and oxycodone that are taken to treat moderate to severe pain. The study was the first by the CDC to specifically examine their use by women of reproductive age.

    Taking the drugs during pregnancy, particularly in the early weeks, can increase the chances that babies will be born with birth defects, the CDC said.

    Given the popularity of the painkillers, a thorough health assessment of women of reproductive age is crucial before they are prescribed, officials said.

    "Many women of reproductive age are taking these medicines and may not know they are pregnant and therefore may be unknowingly exposing their unborn child," CDC Director Tom Frieden said in a statement.

    Prescription rates of opioids for reproductive-aged women were highest in the South and lowest in the Northeast, the CDC study said.

    The study did not address why more patients on Medicaid, the federal government's health insurance plan for the poor, use prescription painkillers. One reason could be that they have more health problems that require pain medication, said CDC epidemiologist Jennifer Lind, one of the study's authors.

    "There may be more women on Medicaid who are manual laborers, jobs that cause more chronic pain," Lind said in an interview.

    Half of all births in the United States are to mothers on Medicaid, according to the CDC.

    The federal health agency has launched a program called "Treating for Two" to increase awareness on the potential dangers of prescription painkillers to women of child-bearing age, Lind said.

    "What we're trying to do is expand research and also develop reliable guidance so that women and healthcare providers can have conversations and make informed decisions on what the safest options may be," she said.

    SOURCE: http://1.usa.gov/1yO8QSq MMWR, online January 22, 2015.