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

  • Pakistan arrests parents for refusing children's polio vaccinations

    By Jibran Ahmad

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    By Reuters Staff

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

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

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

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

  • Low blood pressure with medicine tied to faster mental decline

    By Kathryn Doyle

    (Reuters Health) - For older people with mild cognitive impairment or dementia, low blood pressure might be linked to faster mental decline, according to a new study.

    There is not much data on blood pressure in people with cognitive impairment, lead author Dr. Enrico Mossello of the University of Florence in Italy told Reuters Health by email.

    This new study, he added, is the first to suggest that cognitive declines might happen faster in older people on blood pressure medicine whose systolic pressure - the top number - is low.

    Between 2009 and 2012, Mossello and his coauthors analyzed 172 older people. Most had dementia; about a third had only mild cognitive impairment. Almost 70 percent were taking medication for high blood pressure.

    The researchers recorded participants' blood pressure and their performance on a mental test. They repeated all the measurements six to 18 months later - by which time mental function had declined for the whole group, on average, and disability had increased.

    The researchers divided participants into three groups based on daytime readings of systolic blood pressure, which is the "120" of a healthy "120 over 80 millimeters of Mercury" blood pressure reading.

    People in the lowest third of systolic blood pressure scores (below 128 mm Hg) had bigger decreases on their mental performance tests than those in the middle and high blood pressure groups, according to results in JAMA Internal Medicine.

    When the researchers took blood pressure medications into account, only those on the medications who also had lower blood pressure experienced more cognitive decline.

    Naturally low blood pressure may not be harmful, but these results suggest that excessive lowering of blood pressure with antihypertensive drugs seems to affect cognition negatively, Mossello said.

    "The idea has crystallized that all high blood pressure is bad," said Dr. Rudolf Westendorp of the faculty of health and medical sciences at the University of Copenhagen in Denmark.

    "The dogma is that blood pressure should always be below 140/85, but that is simply not true," Westendorp, who coauthored an editorial accompanying the new research, told Reuters Health by email.

    Frail older people experience more dizziness on standing because blood pressure drops below a minimum that keeps the brain oxygenated, he said.

    "Many have tripped or collapsed with often fatal consequences," he said. "That's why doctors should taper blood pressure lowering medication when older patients develop this type of symptoms and prevent these unwanted side effects."

    This does not mean that high blood pressure is better, Mossello stressed. He said patients should never stop their blood pressure medication until a doctor orders it.

    "There are many dementia patients with high blood pressure, hopefully treated, who will experience blood pressure decrease in the course of the disease and need attention to have their therapy adjusted and avoid overtreatment," Mossello said.

    He emphasized that daytime blood pressure readings were more predictive than office readings. People may get nervous at doctors' offices, which falsely increases their blood pressure readings.

    "Probably systolic blood pressure values between 130 and 145 are fine for most older patients with dementia," he added.

    SOURCE: http://bit.ly/1NaiPch and http://bit.ly/1F5nNBz JAMA Internal Medicine, online March 2, 2015.

  • Harvard prevention trial studies tau, Alzheimer's other protein

    By Julie Steenhuysen

    CHICAGO (Reuters) - Alzheimer's researchers at Harvard for the first time are scanning the brains of healthy patients for the presence of a hallmark protein called tau, which forms toxic tangles of nerve fibers associated with the fatal disease.

    The new scans are part of a large clinical trial called Anti-Amyloid Treatment in Asymptomatic Alzheimer's or A4, the first designed to identify and treat patients in the earliest stages of Alzheimer's, before memory loss begins.

    Patients accepted into the A4 trial already have deposits of beta amyloid, the other protein associated with Alzheimer's. The addition of the tau scan will allow scientists to get a much clearer picture of the events that lead to Alzheimer's. The disease affects 5 million Americans, and 16 million are projected to be afflicted by 2050.

    Dr. Reisa Sperling of Massachusetts General Hospital in Boston, who is leading the 1,000-patient trial, said tau is commonly found in small amounts in healthy people over age 70, but it is generally confined to an area of the brain called the medial temporal lobe.

    When amyloid is present, it somehow opens the door for tau to spread to other parts of the brain, causing widespread cell death and cognitive decline.

    "Tau is the actual bad actor on the front line that tears up the brain. Being able to see it in living humans is a breakthrough," said Dr. Keith Johnson, director of molecular neuroimaging at Massachusetts General, who is leading the imaging portion of the A4 trial.

    In the study, patients will be offered treatments to remove amyloid from the brain in the hopes of keeping tau in check.

    Several companies have developed drugs aiming to remove amyloid and alter the course of Alzheimer's, but all failed to show a significant benefit. Sperling and other researchers believe that's because the drugs were introduced too late after the onset of disease.

    In 2012, Eli Lilly's solanezumab failed to slow the disease in patients with two trials of patients with mild to moderate symptoms. But combined results showed the drug appeared to slow cognitive decline by 34 percent among patients who started with only mild symptoms.

    Patients in the A4 trial will be randomized to receive Lilly's anti-amyloid drug or a placebo for about three years. Lilly is funding the trial, along with the National Institutes of Health and several philanthropic organizations.

    Researchers plan to do tau imaging on up to 500 patients in the A4 trial. The tau imaging will be paid for by the Accelerating Medicines Partnership, which is sponsored by the National Institutes of Health and the Alzheimer's Association.

    Arthur Canter, 67, a retired executive from Boston, will be the first A4 patient to be scanned for tau. Canter, who has a sharp memory and quick wit, already has amyloid building up in his brain.

    Canter gets his scan on Tuesday and fully expects it will show deposits of tau forming as well. His mother, 91, has Alzheimer's, and his father showed signs of dementia when he died in his 70s from an unrelated condition.

    "My assumption, predicated on my own genetics, is that I am likely to be get Alzheimer's. In this regard, I'd rather hit it head on," he said.

  • High school athletes need more help with mental health issues

    By Lisa Rapaport

    (Reuters Health) - While concussions and physical injuries in high school sports are commanding more attention, young athletes still aren't getting enough help with mental health issues such as depression, bullying, substance abuse, and eating disorders, experts say.

    New guidelines released this morning at the sixth Youth Sports Safety Summit in Dallas, hosted by the National Athletic Trainers' Association and the Youth Sports Safety Alliance, urge coaches and parents to be more vigilant in watching for signs of mental distress.

    "Concussions are a big issue and deserve to be taken seriously, but in my 35 years practicing as an athletic trainer you had four to five times more athletes requiring mental health care than trying to recover from concussions," said Timothy Neal, chair of the task force that wrote the recommendations for handling psychological problems among high school athletes.

    A challenge with detecting and treating mental health issues in high school athletes is broaching concerns without making young people feel stigmatized, said Neal, former head athletic trainer at Syracuse University.

    "There is no substitute for just getting to know the players, and paying attention when you see their behavior change so that you can just casually ask them how things are going and keep a dialogue going that makes them feel safe talking about whatever might be going on," Neal told Reuters Health in a phone interview.

    The recommendations are intended to make sure coaches, teachers, athletic trainers, school nurses, and parents all know the warning signs for psychological problems and have plans in place for referring students to mental health professionals when necessary.

    Along with ordinary pressures of high school, athletes face many situations that can contribute to mental health problems, such as being cut from a team, getting injured, making mistakes on the field, receiving media attention, and competing for athletic scholarships.

    Often, physical injuries spur psychological ones, said Dr. Margot Putukian, a co-author of the recommendations and director of athletic medicine at Princeton University.

    Especially if the injury requires surgery and weeks or months on the sidelines, "the injury itself can be a trigger that unmasks underlying psychological issues," Putukian said in a phone interview.

    For teens who may be prone to periods of moodiness, parents and coaches should intervene if the behavior changes continue over time, she said.

    "If someone is withdrawn or isolating or not spending time with their friends and having difficulty sleeping and it persists, then you have to be concerned," Putukian said.

    The recommendations, published in the Journal of Athletic Training, detail common symptoms of mental health problems in athletes.

    For example, athletes with eating disorders might exercise compulsively, suffer from extreme dehydration, or have gastrointestinal problems.

    Athletes being bullied might have unexplained injuries, lost personal items, or complain of frequent headaches or stomach pain. Those doing the bullying might become increasingly aggressive, have unexplained money or belongings, or get in frequent verbal or physical fights.

    Students who are depressed might lack energy or lose interest in sports, or have a change in appetite that leads them to gain or lose a visible amount of weight. Often, students who abuse drugs and alcohol also have an underlying mental health issue such as depression.

    Parents and coaches must collaborate on mental health issues as they would for physical injuries, said Dr. Victor Schwartz, medical director of the Jed Foundation, which focuses on athletes and mental health, and clinical associate professor of psychiatry at NYU Langone Medical Center.

    "Parents and coaches and every other adult in the school athletic community needs to take on responsibility not just to make sure that kids' knees are healthy but also that their minds are healthy too," Schwartz, who wasn't involved in the guidelines, said in a phone interview. "The guidelines are putting mental health front and center and providing some tools for recognizing issues and getting kids help."

    SOURCE: http://bit.ly/1AQ2eFD Journal of Athletic Training, March 2015.

Oncology Articles

  • Cancer risk above 50 percent for Brits born in 1960

    By Kathryn Doyle

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  • Hunger and frustration grow at Ebola ground zero in Guinea

    By Misha Hussain

    MELIANDOU, Guinea (Thomson Reuters Foundation) - A charred kapok tree and around a dozen graves scattered amongst the mud brick houses of Meliandou are painful reminders of the toll Ebola has taken on this village in southeast Guinea.

    Scientists traced the source of the worst-ever outbreak of Ebola to two-year-old Emile Ouamouno, who they believe contracted the disease while playing near the tree, home to hundreds of bats that may have been hosting the deadly virus.

    The boy's father, Etienne Ouamouno, said Emile fell ill in December 2013, and infected his sister and mother who was eight months pregnant at the time. Over a year later, having lost all his immediate family, Etienne Ouamouno has difficulty in finding words to describe his grief.

    For now, his body language does the talking.

    Sitting at the foot of the kapok tree, which has since been set alight by the villagers to smoke out all the bats, Ouamouno nervously lights up a cigarette and takes a number of short drags in quick succession before flicking off the ash.

    There is a long, uncomfortable silence as he contemplates the significance of this spot. Almost 24,000 people mainly in hardest-hit Guinea, Sierra Leone and Liberia, have been infected and some 9,700 have died from Ebola as a result of the chain of transmission that started here.

    "It wasn't Emile that started it," Ouamouno finally says in Kissi, the local language. "Emile was too young to eat bats, and he was too small to be playing in the bush all on his own. He was always with his mother."

    NO INCOME

    For Ouamouno and thousands of others in the forest region of southeastern Guinea, once the breadbasket of the West African nation, the suffering has only deepened. Ebola has left them scared, frustrated and jobless.

    "There's food on the market, but not enough money to buy it. Around 100,000 people are out of work since the mining companies closed due to Ebola," said Jean-Luc Siblot, emergency coordinator for the World Food Programme (WFP) in Guinea.

    "Closures of borders with Ivory Coast, Liberia and Mali and the lack of willingness for food transporters to come into the region meant agricultural collectives were stuck with their products," Siblot told the Thomson Reuters Foundation.

    Jobs have dried up in 91 percent of the communities surveyed by WFP in the forest region. Farmers in other parts of the country say up to 50 percent of their crop has spoiled because they could not be sold across borders.

    WFP estimates that up to 1 million people do not get three meals a day and many have to sell their assets to buy food. Ebola has made this worse.

    Since September, WFP has distributed over 15,000 tonnes of food aid to around 550,000 people in the forest region, including the prefectures of Macenta, Gueckedou and Kissidougou, where the outbreak was the most ferocious.

    MARSHALL PLAN

    In the dense undergrowth around Meliandou, children pick mushrooms for dinner while their mothers make palm oil in the village courtyard. But palm oil alone will not feed the family, nor will it sell for enough to put food on the table.

    "What we need right now is agricultural support. We need more classrooms, a church, and health posts staffed with doctors and equipped with medicine," said Ouamouno, who started to open up with the encouragement of the village chief.

    In January, global aid agency Oxfam called for a multi-million dollar post-Ebola "Marshall Plan" to help Guinea, Sierra Leone and Liberia -- similar to a U.S. aid programme to help rebuild shattered European economies after World War Two.

    The idea was revived on Tuesday as the leaders of the countries met international donors in Brussels to discuss their response to Ebola.

    Back in Meliandou, villagers were sceptical of the government's intentions ahead of presidential elections due later this year.

    "The government has never done anything for us in the past, so why would they change now," said Ouamouno, reflecting the view of many in this largely anti-government region of the country.

  • Harvard prevention trial studies tau, Alzheimer's other protein

    By Julie Steenhuysen

    CHICAGO (Reuters) - Alzheimer's researchers at Harvard for the first time are scanning the brains of healthy patients for the presence of a hallmark protein called tau, which forms toxic tangles of nerve fibers associated with the fatal disease.

    The new scans are part of a large clinical trial called Anti-Amyloid Treatment in Asymptomatic Alzheimer's or A4, the first designed to identify and treat patients in the earliest stages of Alzheimer's, before memory loss begins.

    Patients accepted into the A4 trial already have deposits of beta amyloid, the other protein associated with Alzheimer's. The addition of the tau scan will allow scientists to get a much clearer picture of the events that lead to Alzheimer's. The disease affects 5 million Americans, and 16 million are projected to be afflicted by 2050.

    Dr. Reisa Sperling of Massachusetts General Hospital in Boston, who is leading the 1,000-patient trial, said tau is commonly found in small amounts in healthy people over age 70, but it is generally confined to an area of the brain called the medial temporal lobe.

    When amyloid is present, it somehow opens the door for tau to spread to other parts of the brain, causing widespread cell death and cognitive decline.

    "Tau is the actual bad actor on the front line that tears up the brain. Being able to see it in living humans is a breakthrough," said Dr. Keith Johnson, director of molecular neuroimaging at Massachusetts General, who is leading the imaging portion of the A4 trial.

    In the study, patients will be offered treatments to remove amyloid from the brain in the hopes of keeping tau in check.

    Several companies have developed drugs aiming to remove amyloid and alter the course of Alzheimer's, but all failed to show a significant benefit. Sperling and other researchers believe that's because the drugs were introduced too late after the onset of disease.

    In 2012, Eli Lilly's solanezumab failed to slow the disease in patients with two trials of patients with mild to moderate symptoms. But combined results showed the drug appeared to slow cognitive decline by 34 percent among patients who started with only mild symptoms.

    Patients in the A4 trial will be randomized to receive Lilly's anti-amyloid drug or a placebo for about three years. Lilly is funding the trial, along with the National Institutes of Health and several philanthropic organizations.

    Researchers plan to do tau imaging on up to 500 patients in the A4 trial. The tau imaging will be paid for by the Accelerating Medicines Partnership, which is sponsored by the National Institutes of Health and the Alzheimer's Association.

    Arthur Canter, 67, a retired executive from Boston, will be the first A4 patient to be scanned for tau. Canter, who has a sharp memory and quick wit, already has amyloid building up in his brain.

    Canter gets his scan on Tuesday and fully expects it will show deposits of tau forming as well. His mother, 91, has Alzheimer's, and his father showed signs of dementia when he died in his 70s from an unrelated condition.

    "My assumption, predicated on my own genetics, is that I am likely to be get Alzheimer's. In this regard, I'd rather hit it head on," he said.

  • Parents often want changes in kids' shots schedule

    By Andrew M. Seaman

    (Reuters Health) - Many parents ask doctors to spread out toddlers' vaccines instead of following the recommended immunization schedule, according to a new study.

    Most doctors comply with the request, even though they believe the delays put the children at risk for preventable diseases and make the experience more painful, the researchers report in the journal Pediatrics.

    Only about 2 to 3 percent of parents actually refuse vaccines, said study leader Dr. Allison Kempe. But, she added, "there is an increasing number of parents asking to deviate from the schedule in other ways."

    Kempe, from the University of Colorado School of Medicine and Children's Hospital Colorado, had expected that most doctors would get such requests from parents, but not this often.

    "I was surprised by over 20 percent of doctors saying 10 percent or more of their families (had asked) to spread out vaccines," she said.

    The U.S. Centers for Disease Control and Prevention (CDC) recommends several shots during the first years of life to protect against diseases (PDF link: http://1.usa.gov/1EDPWBP). The schedule is backed by the American Academy of Family Physicians and the American Academy of Pediatrics (AAP), which publishes Pediatrics.

    The AAP says the vaccine schedule is designed to work best with children's immune systems while protecting them from diseases as soon as possible.

    The new report comes as the U.S. battles a large measles outbreak that had infected 154 people from 17 states and Washington, D.C. as of February 20, according to the CDC. The outbreak is tied to Disneyland in Anaheim, California.

    For the study, Kempe and colleagues, in collaboration with the CDC, sent surveys to 815 pediatricians and family doctors across the U.S. in 2012. They received 534 completed surveys.

    Overall, 93 percent of doctors reported at least one parental request to space out the immunizations of a child younger than two years old. And 21 percent of those doctors said at least 10 percent of families made the request.

    The doctors said parents had a variety of reasons for deviating from the recommended schedule, including concerns about complications and a belief that their children won't get a vaccine-preventable disease.

    Most doctors responding to the survey felt it's not in the child's best interest to space out vaccines, but most comply with the parents' wishes at least sometimes.

    The percentage of doctors who often or always agree to spread out vaccines more than doubled from 13 percent in a similar 2009 survey to 37 percent in the current report.

    Doctors said they tried to educate parents on the importance of following the recommended vaccine schedule, but few felt they had any effective approaches.

    "A lot of them feel what they're doing isn't making a difference," Kempe said, adding that organizations like the AAP have recommended techniques for discussing vaccines.

    "I am not convinced that we have the right methods to counter this," she said.

    She said several techniques need to be combined, including education during pregnancy, more responsible reporting by the media, limiting the use of philosophical exemptions, and better collaboration between the public and health department.

    "It can't all fall on the primary care doctors' backs," Kempe said. "It's too big and too time consuming of an issue."

    SOURCE: http://bit.ly/uFc4g2 Pediatrics, online March 2, 2015.

  • CORRECTED-Terminal cancer care should do more to treat depression

    ((In paragraphs 1 and 7, clarifies that the doctors surveyed for the study were in The Netherlands, not Norway).)

    By Janice Neumann

    (Reuters Health) - Depression could be clouding the last 24 hours of life for a significant number of people with advanced cancer, pointing to a need for better - and earlier - psychological help, according to a large study in The Netherlands.

    Although it's challenging to tease apart depression symptoms from the pain, fatigue and cognitive problems associated with end-stage cancer, more can be done to alleviate depression and anxiety, researchers said.

    "Health care providers may think this is a normal part of the dying process," said lead author Dr. Elene Janberidze from the European Palliative Care Research Center at the Norwegian University of Science and Technology in Trondheim.

    "However, some patients experiencing depressive symptoms and/or depression can be treated and thus both the patients and their families may have a better quality of life," Janberidze told Reuters Health in an email.

    Previous studies have estimated the rates of depression in patients with advanced cancer at anywhere from 2 percent to 56 percent, she and her colleagues write in the journal BMJ Supportive and Palliative Care.

    Janberidze said that her team chose to focus on patients in their last 24 hours of life because this group had not been well investigated.

    They used data from a 2005 nationwide Dutch survey of doctors who had signed the death certificates of patients that died within the past two months. The researchers examined data on 1,363 cancer patients during their last 24 hours of life, assessing the symptoms reported by their attending physicians and rating their level of depression.

    After accounting for symptoms of the individuals' illness, the researchers found that overall 37 percent of patients were depressed. More women than men were severely or very severely depressed, and patients aged 17 to 65 were more likely to be moderately depressed than those 80 years or older.

    Geriatricians were four times more likely than other doctors to assess their patients as seriously or severely depressed. Pain specialists, palliative care consultants, psychiatrists and psychologists were also more often tending to patients with symptoms of serious depression than to those with mild or moderate depression.

    Mild or moderately depressed patients were more likely to feel tired, anxious and confused than those without depression symptoms. Individuals who were severely or very severely depressed also tended to feel anxious.

    Holly Prigerson, who directs the Center for Research on End-of-Life Care at Cornell University, said she admired the authors for trying to gauge depression in cancer patients who were so close to death.

    "The study is novel in that it evaluates retrospectively the depressive symptom severity of patients within 24 hours of death," Prigerson said in an e-mail to Reuters Health. "I'm unaware of any other study that has attempted this."

    But Prigerson also noted some of the study's limitations, such as trying to assess patients who could be unconscious or delirious, have multiple organ failure and difficulty communicating their emotions.

    Physicians also need to distinguish physical and psychological symptoms and might not always have enough information on a patient's psychological state when they are dying or might not have enough training to diagnose their "psychological distress," she said.

    "It is also difficult to draw conclusions regarding the clinical implications of the study," Prigerson said. "Given patients are actively dying, it is doubtful that a psychosocial intervention or administration of an antidepressant will effectively improve the patients' quality of death.

    "Psychosocial interventions and care in the months and weeks leading up to the death can have a profound impact on patients' quality of life prior to death, however," Prigerson said.

    Janberidze said doctors should be checking cancer patients for physical and psychological pain and integrating palliative care with their cancer management earlier in their disease. She also said family members could help monitor the patient's pain.

    "In general it is important for family members with loved ones who have advanced stage cancer to pay attention to the signs and symptoms of depression and inform healthcare providers immediately. Doctors should investigate the patient further and recommend psychological interventions as needed," Janberidze said.

    SOURCE: http://bmj.co/1LeAEoL BMJ Supportive and Palliative Care, online February 9, 2015.

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Women’s Health Articles

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

    By Shereen Lehman

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  • Cancer risk above 50 percent for Brits born in 1960

    By Kathryn Doyle

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    By Kathryn Doyle

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

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

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

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

    Foster and her colleagues say about half of U.S. pregnancies are unplanned. Most occur among younger, poorer women. The primary cause is lack of access to contraception.

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

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

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

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

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

    The ultimate number depends largely on cost, they say.

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

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

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

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

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

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

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

  • In Gaza, demand grows for a plastic surgeon's services

    By Nidal al-Mughrabi

    GAZA (Reuters) - In a smart building in an upscale neighborhood of Gaza City, Salah El-Zanin is seeing a growing number of clients. Trained in Greece, he is the only plastic surgeon in Gaza with European qualifications, and his business is booming.

    Some of his patients want to repair scars left by bombs and bullets; others are young men and women seeking everything from nose jobs to breast enlargements.

    "Women are all the same everywhere," said Zanin, who has been practicing for 30 years and whose three-room clinic is bedecked with certificates announcing his qualifications. "They may speak different languages, but they all have the same desires and needs about beauty and life."

    In a conservative society such as Gaza, where the Islamist group Hamas has held sway since 2007, it is hard to pin down how widespread plastic surgery is becoming. But Zanin says three years ago he might have seen a couple of patients a day, and now he sees up to 15.

    In his reception hall one recent morning, eight men and women were waiting for their appointments. Some have suffered disfiguring injuries from the wars Israel and Hamas have fought in Gaza since 2008. Others might want anything from botox injections to liposuction to nose and breast operations.

    "When a man or a woman has a big nose, that is ugly," he said. "When we do it for them, they will look better and handsome and as a result they will feel better."

    Gaza, home to 1.8 million people, has an unemployment rate of 45 percent and a per capita income of just $950 a year. It is a wonder residents can afford to spend what little they have on cosmetic operations.

    But Zanin said the desire for a better appearance was universal, even if Gazans were initially reluctant. He declined to say how much his treatments cost, but said they were less expensive than anywhere else in the world.

    "The beginning was difficult, the issue of trust, people's fears towards cosmetic surgery and the fact that they did not know me," he said. Now, his popularity means he is regularly importing new equipment from Europe to keep up with demand.

    Zanin says he doesn't carry out operations that contravene religious practices and makes sure that husbands are aware and involved when it comes to their wives' treatments.

    Mohammed, who was wounded in last year's war between Hamas and Israel, has received treatment for painful nerve damage in his legs after losing a large amount of flesh. Two months on, he says the legs look better and the pain has gone.

    Those waiting to see Zanin this week did not want to speak about their cosmetic surgery plans, but one woman who recently underwent a breast enlargement at his clinic pronounced herself very pleased with the results.

    "I feel more confident in myself now," she said. "I smile when I look at myself in the mirror."

  • Hunger and frustration grow at Ebola ground zero in Guinea

    By Misha Hussain

    MELIANDOU, Guinea (Thomson Reuters Foundation) - A charred kapok tree and around a dozen graves scattered amongst the mud brick houses of Meliandou are painful reminders of the toll Ebola has taken on this village in southeast Guinea.

    Scientists traced the source of the worst-ever outbreak of Ebola to two-year-old Emile Ouamouno, who they believe contracted the disease while playing near the tree, home to hundreds of bats that may have been hosting the deadly virus.

    The boy's father, Etienne Ouamouno, said Emile fell ill in December 2013, and infected his sister and mother who was eight months pregnant at the time. Over a year later, having lost all his immediate family, Etienne Ouamouno has difficulty in finding words to describe his grief.

    For now, his body language does the talking.

    Sitting at the foot of the kapok tree, which has since been set alight by the villagers to smoke out all the bats, Ouamouno nervously lights up a cigarette and takes a number of short drags in quick succession before flicking off the ash.

    There is a long, uncomfortable silence as he contemplates the significance of this spot. Almost 24,000 people mainly in hardest-hit Guinea, Sierra Leone and Liberia, have been infected and some 9,700 have died from Ebola as a result of the chain of transmission that started here.

    "It wasn't Emile that started it," Ouamouno finally says in Kissi, the local language. "Emile was too young to eat bats, and he was too small to be playing in the bush all on his own. He was always with his mother."

    NO INCOME

    For Ouamouno and thousands of others in the forest region of southeastern Guinea, once the breadbasket of the West African nation, the suffering has only deepened. Ebola has left them scared, frustrated and jobless.

    "There's food on the market, but not enough money to buy it. Around 100,000 people are out of work since the mining companies closed due to Ebola," said Jean-Luc Siblot, emergency coordinator for the World Food Programme (WFP) in Guinea.

    "Closures of borders with Ivory Coast, Liberia and Mali and the lack of willingness for food transporters to come into the region meant agricultural collectives were stuck with their products," Siblot told the Thomson Reuters Foundation.

    Jobs have dried up in 91 percent of the communities surveyed by WFP in the forest region. Farmers in other parts of the country say up to 50 percent of their crop has spoiled because they could not be sold across borders.

    WFP estimates that up to 1 million people do not get three meals a day and many have to sell their assets to buy food. Ebola has made this worse.

    Since September, WFP has distributed over 15,000 tonnes of food aid to around 550,000 people in the forest region, including the prefectures of Macenta, Gueckedou and Kissidougou, where the outbreak was the most ferocious.

    MARSHALL PLAN

    In the dense undergrowth around Meliandou, children pick mushrooms for dinner while their mothers make palm oil in the village courtyard. But palm oil alone will not feed the family, nor will it sell for enough to put food on the table.

    "What we need right now is agricultural support. We need more classrooms, a church, and health posts staffed with doctors and equipped with medicine," said Ouamouno, who started to open up with the encouragement of the village chief.

    In January, global aid agency Oxfam called for a multi-million dollar post-Ebola "Marshall Plan" to help Guinea, Sierra Leone and Liberia -- similar to a U.S. aid programme to help rebuild shattered European economies after World War Two.

    The idea was revived on Tuesday as the leaders of the countries met international donors in Brussels to discuss their response to Ebola.

    Back in Meliandou, villagers were sceptical of the government's intentions ahead of presidential elections due later this year.

    "The government has never done anything for us in the past, so why would they change now," said Ouamouno, reflecting the view of many in this largely anti-government region of the country.