Traffic & Construction

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Traffic Updates

TRAFFIC CONGESTION AT STMC
We wanted to make you aware of a large transportation project around the STMC that will result in severe traffic problems:
  • The grade separation at Fred & Med will be a huge project lasting nearly two years. Please check the TxDot website for updates. Traffic will be impacted on both Medical and Fredericksburg roads.

For this reason, we are suggesting that you consider alternative routes through the STMC. We suggest you do this sooner rather than later.

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

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STMC Construction Projects through 2013

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The TXDOT Fredericksburg Road & Medical Drive Project

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To submit other construction project, please email Pam Leissener

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Neuroscience Articles

  • Post-immunization epilepsy likely not related to vaccine: study

    By Anne Harding

    NEW YORK (Reuters Health) - Children who start having seizures soon after a vaccination and go on to develop epilepsy usually turn out to have an underlying cause of the seizure disorder, according to a new study published in Pediatrics.

    "It's reassuring to hear that with follow-up testing, the vast majority of these cases can be identified as coming from a different cause," Dr. Shannon MacDonald told Reuters Health.

    "These types of studies are important because parents have a right to expect that we take vaccine safety seriously and that we investigate any potential adverse events following immunization," added MacDonald, who studies vaccine safety and parents' decision-making about vaccines at the University of Calgary but wasn't involved in the new research.

    Some babies and young children are prone to have convulsions, or seizures, when they develop a high fever. One in 25 children will have at least one of these events, known as febrile seizures, according to the US National Institute of Neurological Disorders and Stroke (NINDS).

    While febrile seizures can be frightening to parents, they usually are brief and cause no harm.

    In the days after receiving a vaccine, compared to other times, children are two to five times more likely to have a febrile seizure, according to the authors of the new study.

    "When a child has its first seizure shortly after a vaccination, and continues to have seizures thereafter, parents may think the vaccination has caused the epilepsy. However, in our study the majority of children who developed epilepsy after a vaccination, had a genetic or structural cause of the epilepsy," Dr. Nienke Verbeek, a clinical geneticist at University Medical Centre Utrecht in The Netherlands, told Reuters Health.

    "In these children, the vaccination should only be considered a trigger for the first seizure that thereby unmasks the child's underlying susceptibility for epilepsy," Verbeek added.

    Roughly one in every 100 healthy, normally developing children will develop epilepsy after a febrile seizure, according to NINDS, but children with certain conditions, including cerebral palsy and developmental delay, are at greater risk.

    To better understand the relationship between febrile seizures and epilepsy, the researchers looked at nearly a thousand children who had a first seizure within several days of being vaccinated. Twenty-six of the children were later diagnosed with epilepsy, and the researchers were able to follow up with 23 of them.

    Eight of the children had Dravet syndrome, a rare genetic condition in which seizures may be brought on by fever, infectious disease, or vaccination. Three of the children had developmental delays and structural brain defects that could cause epilepsy. Four other children had gene mutations that could cause epilepsy, brain malformations, or a family history of the disease.

    "Although no underlying cause was detected in one-third of children with epilepsy with vaccination-related onset, a genetic basis of epilepsy in these children is still possible: genetic analyses were incomplete, some children had positive family histories for seizures, and molecular defects underlying many genetically determined epilepsies have yet to be discovered," Verbeek and her colleagues write.

    "For parents it is important to understand that a genetic cause (a so called DNA-mutation) for epilepsy cannot be induced by vaccinations," Verbeek told Reuters Health. " These mutations are already present in the child before it is born. They may have been transmitted by one of the parents, but more commonly have occurred spontaneously around the time of conception."

    The findings "provide a pretty strong case that this was not caused by the vaccination," Dr. Jorn Olsen told Reuters Health in a telephone interview.

    Olsen, a professor at Aarhus University in Denmark and at UCLA who has studied febrile seizures and epilepsy, added, "They probably would have gotten epilepsy in every case so that the disease was present at least for some of these already at the time when they had the vaccination."

    SOURCE: http://bit.ly/1tZc99l Pediatrics, online September 15, 2014.

  • Mice given human brain gene learned tasks faster -study

    By Sharon Begley

    NEW YORK (Reuters) - Although it's far from the sort of brain transplant beloved by science fiction enthusiasts, scientists have taken one step in that direction: they have spliced a key human brain gene into mice.

    In the first study designed to assess how partially 'humanizing' brains of a different species affects key cognitive functions, scientists reported on Monday that mice carrying a human gene associated with language learned new ways to find food in mazes faster than normal mice.

    By isolating the effects of one gene, the work sheds light on its function and hints at the evolutionary changes that led to the unique capabilities of the human brain.

    For the study, scientists used hundreds of mice genetically engineered to carry the human version of Foxp2, a gene linked to speech and language. In a 2009 study, mice carrying human Foxp2 developed more-complex neurons and more-efficient brain circuits.

    Building on that, neuroscientists led by Christiane Schreiweis and Ann Graybiel of the Massachusetts Institute of Technology trained mice to find chocolate in a maze. The animals had two options: use landmarks like lab equipment and furniture visible from the maze ("at the T-intersection, turn toward the chair") or by the feel of the floor ("smooth, turn right;" "nubby, turn left").

    Mice with the human gene learned the route as well by seven days as regular mice did by 11, scientists reported in Proceedings of the National Academy of Sciences.

    Surprisingly, however, when the scientists removed all the landmarks in the room, so mice could only learn by the feel-of-the-floor rule, the regular rodents did as well as the humanized ones. They also did just as well when the landmarks were present but the floor textiles were removed.

    It was only when mice could use both learning techniques that those with the human brain gene excelled.

    That suggested, Graybiel said, that what the human gene does is increase cognitive flexibility: it lets the brain segue from remembering consciously in what's called declarative learning ("turn left at the gas station") to remembering unconsciously (take a right once the floor turns from tile to carpet).

    Unconscious, or procedural, learning is the kind the feel-of-the-floor cue produced: the mice didn't have to consciously think about the meaning of rough or smooth. They felt, they turned - much as people stop consciously thinking about directions on a regular route and navigate automatically.

    "No one knows how the brain makes transitions from thinking about something consciously to doing it unconsciously," Graybiel said. "But mice with the human form of Foxp2 did much better."

    If Foxp2 produces the cognitive flexibility to switch between forms of learning, that may help explain its role in speech and language.

    When children learn to speak, they transition from consciously mimicking words they hear to speaking automatically. That suggests that switching from declarative to procedural memory, as the humanized mice did so well thanks to Foxp2, "is a crucial part of the process," Graybiel said.

    SOURCE: http://bit.ly/1qXpcUQ Proceedings of the National Academy of Sciences, September 15, 2014.

  • Chiropractic care may ease back-related leg pain

    By Shereen Lehman

    NEW YORK (Reuters Health) - People with leg pain related to back problems had more short-term relief if they received chiropractic care along with exercise and advice, rather than exercise and advice alone, a new study has found.

    Patients with back-related leg pain, such as sciatica, are usually treated with prescription medications, injections and surgery.

    Increasingly, spinal manipulative therapy by chiropractors, exercise and self-management are being recommended as low-risk strategies for back-related leg pain, but good research studies have been lacking, experts say.

    "Spinal manipulation combined with home exercise may be worth trying for those with back-related leg pain that has lasted more than four weeks," Gert Bronfort told Reuters Health in an email.

    Bronfort, who led the study, is a researcher with the Integrative Health and Wellbeing Research Program at the University of Minnesota in Minneapolis.

    "This combination resulted in advantages in pain reduction, disability, global improvement, satisfaction, medication use and general physical health status after 12 weeks," he said.

    Nine months after the treatment ended, patients who received chiropractic therapy were still doing better than the other group in terms of global improvement, medication use and satisfaction, he added.

    Bronfort said that about four out of five people will develop low back pain during their lifetime, and up to 40 percent of them will develop back-related leg pain.

    As reported in Annals of Internal Medicine, Bronfort and colleagues enrolled 192 adults with back pain that had been radiating into the leg for at least four weeks. Patients were recruited through newspaper advertisements, direct mail, and community posters.

    Half the patients received instructions for specific exercises to do at home plus simple pain management techniques. In addition, during the first 12 weeks, they visited a chiropractor up to 20 times for 10 to 20 minutes of spinal manipulation at each visit.

    Patients in the other group also received the instructions for exercises and pain management techniques. They too met with a chiropractor, exercise therapist, or personal trainer during the first 12 weeks, but for four one-hour sessions without spinal manipulation.

    The patients were asked to rate their pain at the beginning of the study, after the 12 weeks of treatments and again at the end of the year.

    At 12 weeks, 37 percent of the spinal manipulation group felt their pain was reduced by at least three-quarters, compared to 19 percent of those who received exercise and advice only.

    In addition, the patients who had spinal manipulation had higher scores for overall improvement and satisfaction.

    By the one-year follow-up, the no-manipulation group had caught up, and there was no longer a significant difference in pain relief. But the scores for overall improvement and satisfaction remained higher for the patients who received spinal manipulative therapy.

    "We actually find the outcomes of the home exercise alone group to be very interesting," Bronfort said.

    Almost half of these patients experienced a 50 percent reduction in leg pain symptoms in both the short (at 12 weeks) and long term (at 52 weeks), Bronfort said.

    "That's an important improvement and warrants future research," he said, "We look forward to investigating how home exercise alone may compare to usual medical treatment and/or no treatment at all."

    "This is a well-conducted study by a group of well-respected chiropractic researchers," Sidney Rubinstein told Reuters Health in an email.

    Rubinstein is a researcher with the Department of Health Sciences at the University of Amsterdam in The Netherlands. He wasn't involved in the study, but has recently published a paper analyzing previous studies on spinal manipulative therapy.

    "It is perhaps the only study of good methodological quality using a robust sample of patients which examines the additional benefit of spinal manipulative therapy in those with sub-acute or chronic back-related leg pain," Rubinstein said.

    Rubinstein said it would be necessary to conduct an economic evaluation to determine if the use of spinal manipulative therapy in addition to home exercises is worth the cost.

    "This of course, must be considered in light of alternatives for this condition, such as epidural steroid injections or surgery, which are not only much more costly but also associated with important (and serious) adverse events," he said.

    Bronfort said his team feels that as long as there are no serious medical complications, patients can focus on self-management strategies.

    "Try and keep moving . . . simple activities like taking short walks and changing positions frequently (both advised in the home exercise program) may be helpful," he said.

    But, he added, for people who have pain that is too severe for to deal with on their own, seeing a chiropractor, physical therapist, or osteopath who can use spinal manipulation might help relieve their pain - possibly without the use of medications.

    SOURCE: http://bit.ly/1s3PM2z Annals of Internal Medicine, online September 15, 2014.

  • Community music lessons helpful for at-risk kids

    By Shereen Lehman

    NEW YORK (Reuters Health) - Community-based music lessons for disadvantaged youth can have positive biological effects on their brains, a new study found.

    "Music training directs children's attention to sounds, and teaches them to make sound-meaning connections, eventually leading to heightened biological processing of sound that is associated with superior academic performance," study leader Nina Kraus told Reuters Health in an email.

    "Learning to make music appears to remodel children's brains in ways that facilitate and improve their ability to learn academic content," said Kraus, who directs Northwestern University's Auditory Neuroscience Laboratory in Evanston, Illinois.

    The children were actively playing instruments themselves rather than passively listening to others' music, Kraus pointed out.

    The study team collaborated with Harmony Project, a community music program that has provided free music instruments and instruction to more than 1,000 children in the Los Angeles area in low-income neighborhoods, Kraus said.

    "Studies of music training's benefits have generally focused on private instruction, which tends to be expensive and is usually an option only for privileged children," Kraus said.

    "The breakthrough with this study is the discovery of positive biological changes following participation in a free community music education program offered in low-income neighborhoods," she added.

    As reported in the Journal of Neuroscience, 44 children between the ages of six and nine participated in the study. They all went to public schools and lived in gang-reduction zones of Los Angeles.

    The children were split into two groups. One group started lessons right away. For two hours per week, they received training in music fundamentals and learning to play the recorder. Most kids progressed to group instruction with instruments after about six months.

    The second group waited a year before starting lessons.

    Each year the research team evaluated the children's ability to process speech.

    Children who took lessons for two years showed improvements in their ability to distinguish similar sounds. These changes were not apparent after only one year, however.

    "We're not claiming music is a quick fix and we're not saying music is the single, perfect way to improve academic performance, but music-making does provide a host of ingredients for brain stimulation," Kraus said.

    Aniruddh Patel, a psychology researcher from Tufts University in Boston, told Reuters Health by phone, "I think it's an important study -- we need a lot more of this kind of work where neuroscientists actually go into the schools and look at the effect of real world musical training programs on children."

    Studies should focus particularly on "children who stand to gain a lot from these things - low socio-economic status children that may not be receiving a lot of other enrichment at home or in other activities," said Patel. He has done research on how musical training produces benefits but wasn't involved in this new study.

    Patel would like to see more studies that build on this one. For example, he would like to see music training compared to other types of training, or studies of both neural and behavioral measures of language processing.

    "So there are clearly ways in which the study could be expanded, and future work could ask more and deeper questions, but in terms of getting a foot in the door with this type of research, I think it's a landmark study," he said.

    Patel said more work like this is needed, particularly as communities think about reshaping school curricula and setting priorities.

    "It always seems like music is the first to go when budgets get tight - never based on any evidence but just on the intuition that it's kind of a frill," he said. But, he added, we know that music deeply engages the emotional system of the brain and children learn best when they're excited about things.

    More information about Harmony Project is available at http://www.harmony-project.org/.

    SOURCE: http://bit.ly/1w919qx Journal of Neuroscience, online September 3, 2014.

  • Scientists "reset" stem cells to study start of human development

    By Kate Kelland

    LONDON (Reuters) - British and Japanese scientists have managed to "reset" human stem cells to their earliest state, opening up a new realm of research into the start of human development and potentially life-saving regenerative medicines.

    In work described by one independent expert as "a major step forward," the scientists said they had successfully rebooted pluripotent stem cells so they were equivalent to those of a 7 to 10-day old embryo, before it implants in the womb.

    By studying the reset cells, they said they hoped they would now be able to learn more about embryo development, and how it can go wrong and cause miscarriage and developmental disorders.

    "These cells may represent the real starting point for formation of tissues in the human embryo," said Austin Smith, director of the Britain's Cambridge Stem Cell Institute, who co-led the research published in the journal Cell on Thursday.

    "We hope that in time they will allow us to unlock the fundamental biology of early development, which is impossible to study directly in people," he added.

    Human pluripotent stem cells, which have the potential to become any of the cells and tissues in the body, can already be made in a lab either from cells extracted from early-stage embryos or from adult cells that have been induced, or reprogrammed, into an earlier state.

    But, the researchers said in a statement, until now it has proved difficult to generate human pluripotent stem cells that are at an early enough, pristine stage, before they have started changing.

    Instead, scientists have only derived cells that are slightly further down the developmental pathway, not a totally "blank slate," Smith said.

    Experts say that by helping to regenerate tissue, stem cell science could offer new ways of treating conditions for which there are currently no cures - including heart and eye diseases, Parkinson's and stroke.

    "GOOD NEWS FOR PATIENTS"

    The process of generating stem cells in the lab is much easier to control in mouse cells, which can be frozen in a state of very early pluripotency using a protein called LIF. Human cells are not as responsive to LIF, so they must be controlled in a different way that involves switching key genes on and off.

    Smith said this was the main reason why scientists have been unable to generate human pluripotent cells that are as primitive and pristine as their mouse equivalents.

    To avoid this problem, the scientists introduced two genes - NANOG and KLF2 - which caused a network of genes controlling the cell to reboot and induce the early pluripotent state.

    Yasuhiro Takashima of the Japan Science and Technology Agency, who worked with Smith, said the reset cells opened the door to a new phase of research.

    "We now need to carry out further studies to establish how our cells compare with others," he said. "We don't yet know whether these will be a better starting point than existing stem cells for therapies, but being able to start entirely from scratch could prove beneficial."

    Chris Mason, a stem cell expert and professor of regenerative medicine at University College London who was not involved in this work, praised its results and implications.

    "Having a source of pristine stem cells which can be precisely changed into clinical-relevant cell types is a major step forward," he said in an emailed comment.

    "The benefits could be safer and more clinically effective cell therapies produced at lower cost - good news for patients and healthcare providers."

    SOURCE: http://bit.ly/1pTjRdv Cell, online September 11, 2014.

Oncology Articles

  • Costly eye drug and far cheaper alternative have similar side effects -study

    By Ben Hirschler

    LONDON (Reuters) - Injecting Roche's cancer drug Avastin as a cheap eye treatment does not appear to increase deaths or serious side effects, according to an independent study that is likely to fuel a row over the medicine's unapproved use.

    An analysis of nine clinical trials - including three unpublished ones - concluded that health policies favoring the much more expensive eye drug Lucentis over Avastin were not supported by current evidence.

    The study was published on Monday in The Cochrane Library journal, which is produced by the Cochrane Collaboration, a non-profit group that reviews trial data to assess the value of drugs.

    There has been a fierce debate for many years over whether Avastin should be used as a cut-price alternative in patients with wet age-related macular degeneration (wAMD), a leading cause of blindness in the elderly.

    Avastin is not licensed for wAMD but it works in a similar way to authorized treatments for the condition - Lucentis, which is marketed by Novartis and Roche, and Eylea, from Bayer and Regeneron Pharmaceuticals.

    A number of doctors in the United States and Europe already use Avastin in wAMD on an unapproved basis and some pharmacies provide a service of splitting the cancer medicine into smaller doses for eye injections.

    The issue is particularly hot in Europe after French lawmakers voted in July to allow Avastin's use, while Roche and Novartis have faced recent regulatory scrutiny in France and Italy on suspicion of anti-competitive practices. The companies have denied any wrongdoing.

    COST DIFFERENCE

    In France, Avastin costs about 30 euros ($38.84) per dose, against the 900 euros charged for an injection of Lucentis.

    Novartis and Roche have always discouraged the substitution of Avastin for Lucentis, saying that the two drugs were developed for different therapeutic purposes.

    A closely watched U.S. government-sponsored study in 2011 concluded that Avastin worked as well as Lucentis in treating vision loss from wAMD but had more adverse side effects.

    However, the Cochrane paper found that the safety of Avastin when used in wAMD appeared to be comparable with that of Lucentis, except for a higher rate of gastrointestinal disorders.

    David Tovey, editor in chief of the Cochrane Library, said the review addressed a question of "immense importance to health systems in many countries".

    The Cochrane researchers noted, however, that their findings were not definitive and that they now plan to conduct a larger review to assess additional sources of evidence.

    Novartis said in a statement that Lucentis had a well-known safety profile with more than 2.8 million patient-treatment years of use globally. Avastin's use in the eye, by contrast, has not been systematically reviewed by health authorities.

    Roche said it believed that Lucentis is the most appropriate medicine for wAMD, adding that the Cochrane review appears to be based on studies that were not designed to detect differences related to safety aspects.

    Lucentis is marketed by Novartis outside the United States and is the company's third-biggest seller, with $2.4 billion in sales last year. Sales of Lucentis for Roche, which markets the treatment in the United States, were $1.9 billion.

  • Toronto Mayor Rob Ford has tumor, election campaign up in air

    By Andrea Hopkins

    TORONTO (Reuters) - Speculation swept Canada's biggest city on Thursday after Toronto Mayor Rob Ford, who made global headlines last year for admitting he had smoked crack cocaine, was hospitalized with an abdominal tumor just six weeks before the mayoral election.

    With biopsy results expected by the end of the week, Ford's illness raised the possibility that he might have to pull out of the Oct. 27 election after having clung to power through a string of scandals, including his appearance in expletive-ridden videos and accusations that he ordered a jailhouse beating.

    Ford's brother and campaign manager, Doug Ford, was expected to update the city on the mayor's health and political future on Thursday, but pundits were already mulling the mayor's options in a close-run election race in which Ford is one of three frontrunners.

    "To some extent or another, the future of the city rests in the status of a tumor in the mayor's belly," columnist Edward Keenan wrote in the Toronto Star, the city's biggest daily newspaper and the one most critical of Ford.

    "Whether he can carry on and fight, and what that will mean for his support, whether he needs to withdraw and turn a campaign that has been largely about his governance on its head, whether his brother might run in his place. The decisions need to be made soon," Keenan wrote.

    Friday is the deadline for candidates to remove their names to the ballot and for new ones to be added. Rob Ford's brother Doug is also a city councillor.

    News of the tumor broke in the early evening on Wednesday after the mayor went to hospital complaining of unbearable abdominal pains. "It's not a small tumor," the hospital's president said, noting that Ford had been suffering from pain for more than three months.

    Rob Ford's father, Doug Ford Sr., a politician and businessman, died of colon cancer less than three months after being diagnosed in 2006.

    In 2009, doctors removed a tumor from Rob Ford's appendix but the then-city councillor returned to work in good health.

    The mayor spent two months in rehab for drug and alcohol abuse in May and June, emerging noticeably thinner though still obese. He said he regretted not getting treatment "years ago" to treat his alcohol addiction.

    Ford, who came to power in 2010 pledging to cut waste at city hall and keep a lid on taxes, has a core base of suburban support, but he has come under fire for use of crack cocaine and for several videos showing him drunk, spewing racial slurs, and threatening violence.

    His two main opponents in election wished the mayor well as they went ahead with a two-hour breakfast debate on Thursday that Ford had been scheduled to attend.

    A poll released on Wednesday showed Ford running in second place with 28 percent of the vote, behind conservative frontrunner John Tory, who had 40 percent of voter support. Left-leaning candidate Olivia Chow was in third place with 21 percent of the vote.

  • REFILE-Cancer-zapping proton therapy only suitable for rare patients

    (Corrects byline, no change to article text)

    By Kate Kelland

    LONDON (Reuters) - A new cancer-zapping therapy for which a British couple took their child to the Czech Republic amid an international police hunt and media storm can be highly effective, experts say, but is only suitable for rare tumors.

    The parents of British five-year-old Ashya King, who has a brain tumor, ignored medical advice, removed him from hospital and left the country at the end of August, saying they wanted to take him to a private clinic in Prague for proton beam therapy - a type of radiotherapy not currently available in Britain.

    The couple were detained in Spain after an international manhunt that drew condemnation in British media, separated from their sick son and then released days later by a Spanish judge.

    They arrived with Ashya in Prague on Monday and visited the clinic to begin discussing a treatment plan.

    Experts caution, however, that the treatment - a more targeted way of destroying cancerous cells than conventional radiation using photon beams - only offers extra benefits in a small minority of cancer cases.

    They declined to comment directly on Ashya King's case but said the type of brain cancer he has - medulloblastoma - is not usually suited to proton beam treatment.

    "Dose for dose, proton beam therapy is actually no more effective on the cancer cells than conventional radiotherapy - so it isn't a magic bullet in that sense," said Adrian Crellin, a consultant clinical oncologist and the government's national clinical lead in proton beam therapy.

    "What it does do, however, is allow us to take advantage of a different set of properties of the proton, and that - particularly for something like some children's cancers - gives the opportunity to reduce some of the later side effects."

    The treatment uses beams of protons rather than X-rays or photons and targets them at the cancerous cells to kill them.

    The protons are directed at a tumor more precisely than X-rays and unlike in conventional radiotherapy, the proton beams stop once they hit the target rather than continuing through the body - making them less likely to harm healthy tissue.

    Simon Jolly, a lecturer in accelerator physics at University College London (UCL), said these key features of the proton beam make it highly suited to some hard-to-reach tumors, or tumors growing very close to other key organs that could be badly affected by radiation, such as the brain stem or spinal cord.

    "What you're trying to do is deliver dose to the cells that you want to kill... and do it in a targeted way," Jolly told reporters at a briefing for reporters given by experts on proton therapy.

    "The key advantage with the proton is that it goes in and then stops. And it dumps must of its energy, doing most of its damage, at the end of its path. So not only are you doing less damage on the way in, but it also means that if there are sensitive areas on the far side of the tumor, you will not damage them."

    But proton beam therapy is not recommended for medulloblastoma because the treatment should not be targeted to the tumor only.

    "There are some tumors that require radiotherapy to the whole brain and whole spinal cord," said Yen-Ching Chang, a specialist in pediatric radiotherapy at UCL.

    In cases of medulloblastoma, she added, "we're unable to spare any part of the brain (from radiation)...so the reduction of long-term side-effects is less."

    The government's department of health says that from April 2018, proton beam therapy will be offered to up to 1,500 cancer patients at two major hospitals - UCL in London and the Christie cancer hospital in the northern hub city of Manchester.

    Until then, British cancer patients who doctors believe would benefit from the specialist treatment will continue to be sent overseas - either to the United States or Switzerland - for treatment paid for by the taxpayer-funded National Health Service (NHS), the experts said.

    Crellin said that in 2013, almost 100 children and 24 adults in Britain were approved for NHS funding to have proton beam treatment abroad.

  • REFILE-What cancer patients want and what Medicare covers may differ

    (Adds new paragraph 19 to clarify that Medicare has a limited pilot program offering some services not usually covered for cancer patients)

    By Kathryn Doyle

    NEW YORK (Reuters Health) - When asked what Medicare should cover for cancer patients in their last months of life, many patients and their caregivers choose benefits the federal insurance does not offer, like home-based long term care and concurrent palliative care, according to a new study based on interviews.

    Given an array of options, a limited budget and a chance to discuss the choices, patients and caregivers were not very likely to devote all coverage to curative cancer treatment, said lead author Donald H. Taylor Jr, of the Sanford School of Public Policy at Duke University in Durham, North Carolina.

    "It is important to not over-interpret our results, because they were obtained in a hypothetical context, meaning the choices stated did not impact the actual care they received," Taylor told Reuters Health by email.

    Medicare covers what it defines as "reasonable and necessary care" and its standards have come to guide what private insurers are willing to pay for as well, Taylor and his colleagues write in the Journal of Clinical Oncology. As Medicare spending is targeted by federal cost cutting, the risk that patient choices will be narrowed increases, they write.

    To gauge what cancer patients most want from Medicare coverage, the researchers gathered more than 400 participants who were either Medicare beneficiaries over age 65 undergoing treatment for cancer, had recently been treated for cancer or were helping to care for a cancer patient on Medicare.

    Of the 194 caregivers, most were spouses of cancer patients. Half of the patients reported spending more than $2,000 out of pocket on medical care over the previous year.

    The participants met in small groups for a 2.5 hour session that included going over educational materials about Medicare benefit categories, individually choosing benefit categories and discussing as a group what benefits should be covered.

    Each person was given a circular game board and 50 stickers to allocate between 15 benefit categories, some of which are not covered by Medicare. The number of stickers given to each benefit category indicated the level of care the patient or caregiver wanted for that benefit.

    Some of the covered benefit categories were cancer therapy and primary care, while cash payments, home-based long term care and "concurrent" palliative care that's integrated into cancer treatment were options that are not covered by Medicare.

    The researchers estimated that Medicare pays out about $35,000 for a cancer patient over the last six months of life. Divided into 50 units, that meant that one sticker on the board represented $700 of coverage.

    Almost everyone allocated coverage to cancer care itself, usually an intermediate or high level of care, and most also chose primary care and prescription drug coverage, which are covered by Medicare.

    More than 80 percent of participants also chose palliative care, home care and nursing home care. Only 12 percent chose the maximum amount of cancer care.

    Around half of the group also chose some level of unrestricted cash, home-based long term care services or concurrent palliative care, which is beyond the current hospice benefits covered by Medicare. People who chose these categories allocated up to 30 percent of their hypothetical budget to them, the researchers note.

    "We placed participants under a serious resource constraint," Taylor said. "So, when around half of participants choose some level of unrestricted cash, they are not simply saying 'I would like some money.' Instead, they are saying 'I will take less health care in order to get unrestricted cash."

    Currently, Medicare covers curative cancer treatment and hospice care, but not at the same time. Many participants in this study would choose concurrent palliative care which may indicate that system should change, he said.

    "The existing bright line 'curative v. hospice' choice that currently exists in Medicare I think does need to be changed toward a concurrent palliative care model," he said.

    Other options, like cash benefits, were more outlandish and speculative, Taylor said.

    "Unrestricted cash seems very unlikely, while concurrent palliative care seems quite likely to be covered within the next few years," he said.

    Indeed, Taylor said, Duke's hospice is among several centers that will be participating in a three-year Medicare Care Choices pilot program offering concurrent palliative care and other services to patients still receiving cancer treatment. (See Reuters article of May 14, 2014, here: http://bit.ly/1lEogpl).

    It makes sense that people would want palliative and long term care, said Peter Neumann, professor of medicine at the Sackler School of Graduate Biomedical Sciences at Tufts University in Boston. Neumann was not part of the new study.

    "It's a very interesting exercise to ask people the kinds of benefits they want and compare it to what exists," Neumann told Reuters Health.

    "Medicare can't cover everything," he said. "To change the law to cover more long term care, for example, would be a big change."

    Traditionally, Medicare has covered non-experimental medical care, but custodial services and long-term care have not been covered because they are not "medical care," Taylor said.

    "If we moved toward focusing on quality of life improvements, then long term care would likely rise as well, certainly as compared to many health care options for which the evidence of benefit is quite low, while the cost is quite high," Taylor said.

    SOURCE: http://bit.ly/1uiW2lw Journal of Clinical Oncology, online August 25, 2014.

  • REFILE-Cancer-zapping proton therapy only suitable for rare patients

    (Corrects byline, no change to article text)

    By Kate Kelland

    LONDON (Reuters) - A new cancer-zapping therapy for which a British couple took their child to the Czech Republic amid an international police hunt and media storm can be highly effective, experts say, but is only suitable for rare tumors.

    The parents of British five-year-old Ashya King, who has a brain tumor, ignored medical advice, removed him from hospital and left the country at the end of August, saying they wanted to take him to a private clinic in Prague for proton beam therapy - a type of radiotherapy not currently available in Britain.

    The couple were detained in Spain after an international manhunt that drew condemnation in British media, separated from their sick son and then released days later by a Spanish judge.

    They arrived with Ashya in Prague on Monday and visited the clinic to begin discussing a treatment plan.

    Experts caution, however, that the treatment - a more targeted way of destroying cancerous cells than conventional radiation using photon beams - only offers extra benefits in a small minority of cancer cases.

    They declined to comment directly on Ashya King's case but said the type of brain cancer he has - medulloblastoma - is not usually suited to proton beam treatment.

    "Dose for dose, proton beam therapy is actually no more effective on the cancer cells than conventional radiotherapy - so it isn't a magic bullet in that sense," said Adrian Crellin, a consultant clinical oncologist and the government's national clinical lead in proton beam therapy.

    "What it does do, however, is allow us to take advantage of a different set of properties of the proton, and that - particularly for something like some children's cancers - gives the opportunity to reduce some of the later side effects."

    The treatment uses beams of protons rather than X-rays or photons and targets them at the cancerous cells to kill them.

    The protons are directed at a tumor more precisely than X-rays and unlike in conventional radiotherapy, the proton beams stop once they hit the target rather than continuing through the body - making them less likely to harm healthy tissue.

    Simon Jolly, a lecturer in accelerator physics at University College London (UCL), said these key features of the proton beam make it highly suited to some hard-to-reach tumors, or tumors growing very close to other key organs that could be badly affected by radiation, such as the brain stem or spinal cord.

    "What you're trying to do is deliver dose to the cells that you want to kill... and do it in a targeted way," Jolly told reporters at a briefing for reporters given by experts on proton therapy.

    "The key advantage with the proton is that it goes in and then stops. And it dumps must of its energy, doing most of its damage, at the end of its path. So not only are you doing less damage on the way in, but it also means that if there are sensitive areas on the far side of the tumor, you will not damage them."

    But proton beam therapy is not recommended for medulloblastoma because the treatment should not be targeted to the tumor only.

    "There are some tumors that require radiotherapy to the whole brain and whole spinal cord," said Yen-Ching Chang, a specialist in pediatric radiotherapy at UCL.

    In cases of medulloblastoma, she added, "we're unable to spare any part of the brain (from radiation)...so the reduction of long-term side-effects is less."

    The government's department of health says that from April 2018, proton beam therapy will be offered to up to 1,500 cancer patients at two major hospitals - UCL in London and the Christie cancer hospital in the northern hub city of Manchester.

    Until then, British cancer patients who doctors believe would benefit from the specialist treatment will continue to be sent overseas - either to the United States or Switzerland - for treatment paid for by the taxpayer-funded National Health Service (NHS), the experts said.

    Crellin said that in 2013, almost 100 children and 24 adults in Britain were approved for NHS funding to have proton beam treatment abroad.

Orthopedic Articles

  • Chiropractic care may ease back-related leg pain

    By Shereen Lehman

    NEW YORK (Reuters Health) - People with leg pain related to back problems had more short-term relief if they received chiropractic care along with exercise and advice, rather than exercise and advice alone, a new study has found.

    Patients with back-related leg pain, such as sciatica, are usually treated with prescription medications, injections and surgery.

    Increasingly, spinal manipulative therapy by chiropractors, exercise and self-management are being recommended as low-risk strategies for back-related leg pain, but good research studies have been lacking, experts say.

    "Spinal manipulation combined with home exercise may be worth trying for those with back-related leg pain that has lasted more than four weeks," Gert Bronfort told Reuters Health in an email.

    Bronfort, who led the study, is a researcher with the Integrative Health and Wellbeing Research Program at the University of Minnesota in Minneapolis.

    "This combination resulted in advantages in pain reduction, disability, global improvement, satisfaction, medication use and general physical health status after 12 weeks," he said.

    Nine months after the treatment ended, patients who received chiropractic therapy were still doing better than the other group in terms of global improvement, medication use and satisfaction, he added.

    Bronfort said that about four out of five people will develop low back pain during their lifetime, and up to 40 percent of them will develop back-related leg pain.

    As reported in Annals of Internal Medicine, Bronfort and colleagues enrolled 192 adults with back pain that had been radiating into the leg for at least four weeks. Patients were recruited through newspaper advertisements, direct mail, and community posters.

    Half the patients received instructions for specific exercises to do at home plus simple pain management techniques. In addition, during the first 12 weeks, they visited a chiropractor up to 20 times for 10 to 20 minutes of spinal manipulation at each visit.

    Patients in the other group also received the instructions for exercises and pain management techniques. They too met with a chiropractor, exercise therapist, or personal trainer during the first 12 weeks, but for four one-hour sessions without spinal manipulation.

    The patients were asked to rate their pain at the beginning of the study, after the 12 weeks of treatments and again at the end of the year.

    At 12 weeks, 37 percent of the spinal manipulation group felt their pain was reduced by at least three-quarters, compared to 19 percent of those who received exercise and advice only.

    In addition, the patients who had spinal manipulation had higher scores for overall improvement and satisfaction.

    By the one-year follow-up, the no-manipulation group had caught up, and there was no longer a significant difference in pain relief. But the scores for overall improvement and satisfaction remained higher for the patients who received spinal manipulative therapy.

    "We actually find the outcomes of the home exercise alone group to be very interesting," Bronfort said.

    Almost half of these patients experienced a 50 percent reduction in leg pain symptoms in both the short (at 12 weeks) and long term (at 52 weeks), Bronfort said.

    "That's an important improvement and warrants future research," he said, "We look forward to investigating how home exercise alone may compare to usual medical treatment and/or no treatment at all."

    "This is a well-conducted study by a group of well-respected chiropractic researchers," Sidney Rubinstein told Reuters Health in an email.

    Rubinstein is a researcher with the Department of Health Sciences at the University of Amsterdam in The Netherlands. He wasn't involved in the study, but has recently published a paper analyzing previous studies on spinal manipulative therapy.

    "It is perhaps the only study of good methodological quality using a robust sample of patients which examines the additional benefit of spinal manipulative therapy in those with sub-acute or chronic back-related leg pain," Rubinstein said.

    Rubinstein said it would be necessary to conduct an economic evaluation to determine if the use of spinal manipulative therapy in addition to home exercises is worth the cost.

    "This of course, must be considered in light of alternatives for this condition, such as epidural steroid injections or surgery, which are not only much more costly but also associated with important (and serious) adverse events," he said.

    Bronfort said his team feels that as long as there are no serious medical complications, patients can focus on self-management strategies.

    "Try and keep moving . . . simple activities like taking short walks and changing positions frequently (both advised in the home exercise program) may be helpful," he said.

    But, he added, for people who have pain that is too severe for to deal with on their own, seeing a chiropractor, physical therapist, or osteopath who can use spinal manipulation might help relieve their pain - possibly without the use of medications.

    SOURCE: http://bit.ly/1s3PM2z Annals of Internal Medicine, online September 15, 2014.

  • About half of ACL surgeries end with a return to competitive play

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Most athletes who undergo ACL reconstruction surgery do return to some form of sport, but only 55 percent will return to competitive level sports, an updated review suggests.

    About 200,000 anterior cruciate ligament (ACL) knee injuries happen each year in the United States, and half of those injuries are surgically repaired, according to the American Academy of Orthopaedic Surgeons. Surgeons usually replace the torn ligament with a grafted replacement.

    The authors reviewed the topic in 2010 and found that less than half of patients returned to competitive level sport, but since then, reporting on whether or not athletes return to play after surgery has increased, they write in the British Journal of Sports Medicine.

    "I think we used to presume that everyone returned to their sport after surgery, especially since one of the main reasons why people have surgery is because they want to return to sport," said lead author Clare L. Ardern. "But clearly these results show that this is not the case."

    "I think this is lower than what we previously assumed was the case, but having said that, this doesn't mean that people stopped playing sport altogether," said Ardern, of the School of Allied Health in the Faculty of Health Sciences at La Trobe University in Bundoora, Australia.

    "Some people may have changed the sport they played, but we were not able to measure this in our study," she told Reuters Health by email.

    Ardern and her team reviewed 69 new articles on ACL surgery and return to play published between April 2010 and November 2013.

    Of the 7,556 patients in total, 81 percent returned to some level of sport after surgery, while 65 percent returned to pre-injury level and 55 percent returned to competitive level sports.

    This is an area where sports medicine specialists strive to improve," said Gregory D. Myer, director of the Human Performance Laboratory at Cincinnati Children's Hospital Medical Center in Ohio.

    "Our mission in sports medicine is to get everyone back to their pre-injury activity levels regardless of the injury," said Myer, who was not involved in the review. "A 55 percent success rate is certainly below the standards we aim to achieve."

    Younger players and men were more likely to return to sport than older players or women, the researchers found.

    Elite athletes were about six times more likely to return to competitive sport than non-elite athletes.

    Not surprisingly, better physical function after surgery increased the chances of returning to sports. Patients who were able to hop the same distance on each leg after surgery were more likely to play competitively again.

    "These results are only generalizable if you were an athlete prior to sustaining the injury," Myer said.

    Psychological function seemed to make a difference too.

    Patients who had more fear of injuring themselves again and less psychological readiness to play were less likely to return to pre-injury level sport.

    Psychological factors may be modifiable, unlike gender or age, which makes mental readiness to play an important factor for doctors to consider, the authors write.

    "More and more we are recognizing that physical and mental recovery is important to maximize the chances of returning to sport after surgery," Ardern said. "This means that patients and their physical therapists need to make sure they also address both aspects."

    Patients should make sure they really understand what surgery and rehabilitation involves, and work with their physical therapist to set realistic goals, she said.

    "Sometimes it can be useful to talk to teammates or friends who have had an ACL injury and made a successful return to sport about what it took and what to expect," Ardern said. "In a team environment, if there are teammates with ACL injuries, it can be helpful for them to be paired together for rehabilitation to motivate each other."

    SOURCE: http://bit.ly/1BpJV8s British Journal of Sports Medicine, online August 25, 2014.

  • Avoiding 'not tonight honey, I have a backache': study

    By Andrew M. Seaman

    NEW YORK (Reuters Health) - For men who find it painful to put their backs into it during sex, a new Canadian study suggests that some positions are better than others.

    Researchers identified certain sex positions as less likely to trigger lower-back pain, but said that choosing the best ones depends on the type of pain the men experience.

    "The patient with their physical therapist or whoever their primary care provider is will work out which category of back pain they fall into," said the study's senior author Stuart McGill, who directs the Spine Biomechanics Laboratory at the University of Waterloo in Ontario.

    He and his colleague write in the journal Spine that past research has tied the frequency of sexual activity to quality of life and used it as a marker of health and disability. Other studies have also found that up to 84 percent of people with lower-back pain report having sex less frequently.

    About one in five men with lower-back pain report discomfort during sex - specifically with pelvic movements and finding comfortable positions, they point out.

    Despite the evidence that pain during sex may lead to decreased sexual activity among people with lower-back pain, McGill and his colleague say there had never been a scientific analysis of movements and posture during sex.

    "For the first time, we can give guidance to the clinicians when patients come in with all kinds of pain triggers, to give them some evidence-based ranking of different positions," he told Reuters Health.

    If people can find positions that don't affect their back-pain triggers, McGill said, they may have a more active sex life.

    Doctors typically recommend spooning - where the partners lie on their sides with the man behind the woman - to reduce pain, but McGill said that recommendation and others were mostly based on opinion.

    For the new study, the researchers recruited 10 healthy male-female couples in their mid-20s and mid-30s to be analyzed by a computer while they attempted five different sex positions provided by the researchers.

    The researchers were then able to compare the men's spine movement during sex to movements known to trigger lower-back pain. Based on those comparisons, they found some positions that may be less likely to cause pain.

    For example, while spooning has been recommended, it is actually one of the worst positions for men who get pain when they lean forward.

    Instead, a position where the woman gets on all fours and the man kneels behind her was suggested as least taxing on the back. Some people refer to the position as "doggy-style," said McGill. Additionally, the man lying on top of the woman with his arms outstretched and supporting his body was thought to be less likely to cause pain.

    McGill cautioned that the position really needs to be tailored to the person and their specific sensitivities, however.

    "Even within a category, we would perform slight modifications with each of these styles with the patient," he said. "You've got to tune the technique for the individual and sometimes that tuning is quite subtle."

    More studies are planned for women with lower-back pain and people who had hip surgery, McGill added.

    SOURCE: http://bit.ly/1rWQj6j Spine, online September 10, 2014.

Transplant Articles

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Women’s Health Articles

  • American waistlines still expanding, study says

    By Andrew M. Seaman

    NEW YORK (Reuters Health) - The average waistline of Americans increased by more than an inch over the past decade, according to a study from U.S. health researchers.

    Along with the increase in waist circumference measurements, the number of Americans with abdominal obesity increased by about eight percentage points between 1999-2000 and 2011-2012, researchers from the Centers of Disease Control and Prevention (CDC) found.

    "We've been doing these studies for a number of years now," said Dr. Earl Ford, the study's lead author. "We've had three previous publications. Our last one looked through 2008 so we wanted to see what was happening in recent years."

    Many studies on obesity use a measurement known as body mass index (BMI), which is a measurement of weight in relation to height.

    BMI may not be an accurate measure of abdominal obesity, because it gives a measurement of overall body mass. BMI can't measure how the weight is distributed.

    "There are some researchers that feel waist circumference is a better measure of abdominal obesity," Ford said.

    Abdominal obesity tends to be associated with worse health outcomes. Sometimes the fat tends to collect around the body's internal organs, but it's still unclear why it worsens outcomes.

    Abdominal obesity is defined as a waist circumference of about 40 inches for men and about 35 inches for women, the researchers write in JAMA, the journal of the American Medical Association.

    For the new study, they used data from a national study conducted every two years. Overall, they had data on 32,816 men and nonpregnant women 20 years old and older.

    The average waist circumference increased from 37.6 inches in 1999-2000 to 38.8 inches in 2011-2012.

    Overall, men had the smallest average increase in waist circumference of 0.8 inches. The average waist circumference of women increased by about 1.5 inches.

    The prevalence of abdominal obesity increased from 46.4 percent in 1999-2000 to 54.2 percent in 2011-2012. Again, women had the greatest increase in rates of abdominal obesity.

    African and Mexican Americans also had larger increases in waist circumference and abdominal obesity, compared to white Americans, researchers found.

    In contrast to the increases in waist circumference and abdominal obesity, Ford and his colleagues write that past studies have found no change in BMI between 2003-2004 and 2011-2012.

    They say the difference between stagnate BMI scores and increasing waist circumference may be attributable to worse sleep, disruption to hormones and certain medications. Those are just speculations, however.

    "We're still at a high level of obesity regardless of how you want to measure it," Ford said.

    "People still have to watch their diets and physical activity levels," he said.

    SOURCE: http://bit.ly/1siMIty JAMA, online September 16, 2014.

  • Parents' whooping cough vaccines may protect babies

    By Andrew M. Seaman

    NEW YORK (Reuters Health) - When babies are too young to get the whooping cough vaccine, vaccinating their parents might protect them from the dangerous infection, a new study suggests.

    Young children were 51 percent less likely to be diagnosed with pertussis - also known as whooping cough - when their parents had been immunized against the infection at least four weeks earlier, compared to children in homes where parents weren't immunized, researchers found.

    The main message for parents is to get the diphtheria-tetanus-acellular pertussis (Tdap) vaccine, wrote Helen Quinn, the study's lead author, in an email to Reuters Health.

    "They should make sure they are aware of current recommendations regarding Tdap vaccination in their country and follow this advice and also be aware if there is a pertussis epidemic in their local area, particularly at the time of the birth of a new baby," wrote Quinn, from Australia's National Center for Immunization Research and Surveillance of Vaccine Preventable Diseases in Westmead.

    Whooping cough typically isn't dangerous in adults, but it can make babies very sick. In some cases, symptoms may overwhelm the respiratory system and lead to death.

    Infants receive their first dose of the whooping cough vaccine at two months of age, according to the U.S. Centers for Disease Control and Prevention (CDC) vaccination schedule. They don't complete the full course of three doses until they're six months old, however.

    As a way to protect infants younger than six months old, some researchers and public health officials have called for so-called cocooning, which is the vaccination of people who often come in contact with the child.

    The vaccine offered to adults as a booster shot is known as Tdap. Children receive a shot known as DTaP.

    Quinn and her colleagues write in Pediatrics that there has been limited evidence on whether the cocooning method works.

    For the new study, they analyzed data collected between April 2009 and April 2011 on Australian infants younger than four months, including 217 who were diagnosed with whooping cough and 585 who remained healthy.

    In homes where the babies stayed healthy, 32 percent of mothers had received a Tdap vaccine at least four weeks before the data were collected. Among the babies with whooping cough, however, only 22 percent of mothers had received a Tdap vaccine. Similar results were seen among fathers.

    After the researchers accounted for traits that may affect an infant's risk of catching whooping cough, including the number of brothers and sisters, they found that vaccinating both parents is tied to a 51 percent reduced risk of whooping cough in a child under four months old.

    Vaccinating the mother appeared to be especially important, reducing the risk of whooping cough by 42 percent alone. Vaccinating the fathers increased that protection to a 51 percent reduced risk.

    Quinn said more research is needed to know when is the best time for parents to get the Tdap vaccine.

    "In the United States, where vaccination during pregnancy is recommended, this is still the best recommendation," she said.

    The CDC says pregnant women should receive the Tdap vaccine between the 27th and 36th week. The recommendation is supported by the American College of Obstetricians and Gynecologists and the American College of Nurse-Midwives.

    Quinn also said other family members and close contacts share the responsibility of keeping infants healthy.

    "It is very important that other household members, such as siblings, are up to date with vaccinations, as they can also be a source of infection for very young babies," she said.

    SOURCE: http://bit.ly/1uP0sig Pediatrics, online September 15, 2014.

  • About half of ACL surgeries end with a return to competitive play

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Most athletes who undergo ACL reconstruction surgery do return to some form of sport, but only 55 percent will return to competitive level sports, an updated review suggests.

    About 200,000 anterior cruciate ligament (ACL) knee injuries happen each year in the United States, and half of those injuries are surgically repaired, according to the American Academy of Orthopaedic Surgeons. Surgeons usually replace the torn ligament with a grafted replacement.

    The authors reviewed the topic in 2010 and found that less than half of patients returned to competitive level sport, but since then, reporting on whether or not athletes return to play after surgery has increased, they write in the British Journal of Sports Medicine.

    "I think we used to presume that everyone returned to their sport after surgery, especially since one of the main reasons why people have surgery is because they want to return to sport," said lead author Clare L. Ardern. "But clearly these results show that this is not the case."

    "I think this is lower than what we previously assumed was the case, but having said that, this doesn't mean that people stopped playing sport altogether," said Ardern, of the School of Allied Health in the Faculty of Health Sciences at La Trobe University in Bundoora, Australia.

    "Some people may have changed the sport they played, but we were not able to measure this in our study," she told Reuters Health by email.

    Ardern and her team reviewed 69 new articles on ACL surgery and return to play published between April 2010 and November 2013.

    Of the 7,556 patients in total, 81 percent returned to some level of sport after surgery, while 65 percent returned to pre-injury level and 55 percent returned to competitive level sports.

    This is an area where sports medicine specialists strive to improve," said Gregory D. Myer, director of the Human Performance Laboratory at Cincinnati Children's Hospital Medical Center in Ohio.

    "Our mission in sports medicine is to get everyone back to their pre-injury activity levels regardless of the injury," said Myer, who was not involved in the review. "A 55 percent success rate is certainly below the standards we aim to achieve."

    Younger players and men were more likely to return to sport than older players or women, the researchers found.

    Elite athletes were about six times more likely to return to competitive sport than non-elite athletes.

    Not surprisingly, better physical function after surgery increased the chances of returning to sports. Patients who were able to hop the same distance on each leg after surgery were more likely to play competitively again.

    "These results are only generalizable if you were an athlete prior to sustaining the injury," Myer said.

    Psychological function seemed to make a difference too.

    Patients who had more fear of injuring themselves again and less psychological readiness to play were less likely to return to pre-injury level sport.

    Psychological factors may be modifiable, unlike gender or age, which makes mental readiness to play an important factor for doctors to consider, the authors write.

    "More and more we are recognizing that physical and mental recovery is important to maximize the chances of returning to sport after surgery," Ardern said. "This means that patients and their physical therapists need to make sure they also address both aspects."

    Patients should make sure they really understand what surgery and rehabilitation involves, and work with their physical therapist to set realistic goals, she said.

    "Sometimes it can be useful to talk to teammates or friends who have had an ACL injury and made a successful return to sport about what it took and what to expect," Ardern said. "In a team environment, if there are teammates with ACL injuries, it can be helpful for them to be paired together for rehabilitation to motivate each other."

    SOURCE: http://bit.ly/1BpJV8s British Journal of Sports Medicine, online August 25, 2014.

  • Seattle court orders HIV-positive man to stop spreading the virus

    By Reuters Staff

    SEATTLE (Reuters) - An HIV-positive man in Seattle could face jail time if he fails to comply with a court order seeking to prevent him from spreading the disease to his sexual partners, King County officials said Thursday.

    Public health officials took the rare step of seeking a cease-and-desist order against the man, identified only as "AO," who became aware of his HIV-positive status in 2008 but has since infected at least eight people, court documents said.

    Health officials in Seattle said the move was not criminalizing sexual behavior or infringing on personal liberty, but was instead aimed at protecting public health.

    "All of our work related to the case in question has been designed to ensure that an HIV infected person receives needed medical care and adopts behaviors that protect both him and his sex partners," King County Health spokeswoman Hilary Karasz said in a statement.

    The agency said it has only sought a cease-and-desist order against an HIV-positive individual once before, in 1993.

    In this case, the man must show up for counseling sessions and adopt behaviors that will protect future sexual partners, according to the court order.

    If he does not comply, he could face jail time for contempt of court, officials said.

  • Sleeping 7 to 8 hours a night linked to taking fewer sick days

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Adults who say they sleep between seven and eight hours per night miss fewer work days due to sickness than others, according to a Finnish study.

    The researchers calculate that if insomnia, apnea and other kinds of sleep disturbances were eliminated, the total cost of worker sick days could be cut by 28 percent.

    "Previous studies have already shown associations between insomnia and sickness absence and there is some evidence regarding the association between sleep duration and sickness absence," said lead author Tea Lallukka, a special researcher at the Finnish Institute of Occupational Health in Helsinki.

    But the new study looks at a nationally representative sample of people, which also covers many different types of employment, Lallukka told Reuters Health by email.

    She and her coauthors used data from a national survey of Finnish workers over age 30 in 2000, including 1,875 women and 1,885 men.

    The participants answered questions about their sleep disturbances, insomnia symptoms, daytime sleepiness and the average hours of sleep they got per 24 hours and had medical exams to detect mental or physical illnesses.

    The researchers also looked up their work absences from 2000 through 2008 in the Social Insurance Institution of Finland database, which registers sickness absences.

    Taking age into account, men who reported frequent insomnia symptoms had more than 10 sick days per year, compared to five absences for men who never or rarely had symptoms.

    Results were similar for women and for most types of sleep disturbance.

    Sleeping between seven and eight hours per night, which included most of the adults in the study, was associated with the fewest sick days per year. Ten percent of women and 13 percent of men reported sleeping an average of six hours per night, and less than three percent reported five hours or fewer.

    "It is well know that chronic sleep deficiency causes several daytime impairments," said Borge Sivertsen, a researcher at the Norwegian Institute of Public Health, headquartered in Oslo, Norway.

    "Our ability to sustain attention and maintain peak cognitive performance is significantly reduced if we are sleep deprived over longer periods," Sivertsen told Reuters Health by email. He was not involved in the new study.

    For the Finnish men, optimal sleep duration was 7 hours 46 minutes per day, with women peaking at 7 hours 38 minutes per day, according to the results published in the journal Sleep.

    "Those sleeping 5 hours or less or 10 hours or more were absent from work 5 to 9 days more each year, as compared to those with optimal sleep," Lallukka said.

    The relationship held even when age, education level, various physical and psychosocial working conditions, health behaviors and clinically assessed physical and mental health conditions were accounted for, she said.

    People who sleep the optimal amount may do other things to reduce their risk of sickness absences too, said Paula Salo of the University of Turku in Finland and the Research Team for Psychosocial Factors at the Finnish Institute of Occupational Health.

    "People who get the sleep they need may in general take better care of their own health and wellbeing, which obviously maintains work ability, too," Salo told Reuters Health by email.

    "Perhaps they, for example, maintain more regular schedules for sleeping, eating, exercising, etc., that support wellbeing. They may also have, for example, more efficient strategies for coping with stress, which very easily disrupts sleep, enabling them to sleep well and preventing them from falling ill," said Salo, who was not part of the new study.

    Sleep disturbances can result in huge costs due to sickness absence, decline in cognitive functioning and productivity, accidents at work while commuting, Lallukka said

    "The results of this new study are broadly consistent with those of comparable studies in the U.S. in showing that disturbed sleep is a very common and much more serious problem in the general population than is generally appreciated," said Ronald C. Kessler of Harvard Medical School in Boston, who wasn't involved in the study.

    Lallukka noted that individual sleep needs may vary, and one person should not necessarily apply the results of the population-level observational study to their day-to-day routine.

    "If you feel you do not perform optimally, or don't feel rested when you awake, this might be an indication that you do not get enough sleep," Sivertsen said.

    There are many good treatment options, including cognitive behavioral therapy, which does not involve drugs, he added.

    "If one is not tired, and is functioning fine, and finds the sleep sufficient and refreshing, there is no need to worry," Lallukka said.

    SOURCE: http://bit.ly/1rWGlBK Sleep, September 2014.