Research in the South Texas Medical Center



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To learn more about the studies held in the South Texas Medical Center please see the information provided by St. Luke’s Baptist, the Health Science Center, University Health System in partnership with UT Medicine here:

The South Texas Medical Center does not just treat those that are ill. The institutions located here also research and innovate treatment options. Some of the innovations used here include:

  • - Implanting the first Titanium ribs (CHRISTUS Santa Rosa)
  • - Providing the region the Gamma Knife® and Cyberknife® technologies (Methodist Hospital)
  • - Being the first to offer San Antonio the daVinci Robotic surgery (St. Luke’s Baptist Hospital)

There are over 50 centers or institutes of research in the South Texas Medical Center, many of which are affiliated with the University of Texas Health Science Center at San Antonio.

The University of Texas Health Science Center at San Antonio focuses its research on a variety of topics ranging from general medical, nursing and dental procedures to children’s cancer treatment options. Approximately 500 new studies commence each year including those in conjunction with other South Texas Medical Center Institutions.

A great example of this is the partnership between the University of Texas Health Science Center’s Department of Neurosurgery and The Brain and Stroke Network at the Baptist Health System’s St. Luke’s hospital. Their research is supported by the National Institutes of Health and investigates treatments for stroke.

The Health Science Center has achieved a number of research milestones, including the following:

  • - $228 million research portfolio
  • - $109 million in National Institute of Health funding
  • - Ranked in the top 3% of all institutions worldwide receiving federal funding
  • - Ranked #1 in Texas for funding from the National Institute on Aging
  • - $24.5 billion biomedical industry catalyst for San Antonio

The University Health System is home to the lead Level I Trauma Center for South Texas, and serves 22 South Central Texas counties. The Trauma Research Program at University Hospital focuses on identifying new and innovative ways to improve the care, management and treatment of trauma and critically ill patients. University Health System also is known as a pioneer in the field of transplants thanks to the University Transplant Center.

University Health System has achieved a number of research milestones, including the following:

  • In 1987, University Transplant Center performed the first lung transplant in North America for the treatment of emphysema.
  • In 1987, University Transplant Center performed the first heart/double lung transplant in San Antonio.
  • In 1989, University Transplant Center performed one of the first single lung transplants in the world for pulmonary hypertension.

Cardiovascular Articles

  • Checking pulse could help detect risk of a second stroke

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Stroke patients and their families can be taught to monitor the patient's pulse and detect irregular heartbeats that might lead to another stroke, according to a new study.

    Of people who have a stroke, 40 percent will suffer another one within the next 10 years, said lead author Dr. Bernd Kallmunzer of the Department of Neurology at Universitätsklinikum Erlangen in Germany.

    Taking a pulse reading can detect atrial fibrillation, a leading source of blood clots that travel to the brain and cause stroke. Detecting atrial fibrillation is important because the patient can be treated with anti-clotting medications to reduce the risk of another stroke or death, Kallmünzer told Reuters Health by email.

    Atrial fibrillation is when the two upper chambers of the heart contract very rapidly and irregularly. At first, this irregularity occurs in episodes, then the heartbeat returns to normal rhythm and may not cause any symptoms.

    There's no treatment for the fibrillation itself, but the longer a person's pulse is monitored, for example by an electronic sensor, the greater the odds of detecting fibrillation events and starting clot prevention, the authors write in the journal Neurology.

    However, not everyone has access to or can afford high-tech monitoring, so the study team tested how accurately patients and their families could detect fibrillation just by taking a pulse.

    The study included 256 patients who had suffered a first stroke and were treated at the authors' stroke unit in Germany in late 2012 or early 2013. While still hospitalized, the patients and in some cases also their relatives were taught to take pulse readings from the radial artery in the left wrist.

    The patients and families were also given printed instruction materials and a stopwatch.

    During the half-hour tutorial, patients were taught to use the stopwatch to measure pulse rate and to recognize a normal pulse sensation and an irregular sensation that may indicate atrial fibrillation.

    Atrial fibrillation feels like a 'stumbling' rhythm and may be faster than 100 beats per minute or slower than 50, Kallmünzer said. A normal heartbeat is rhythmic and regular and only changes slightly on inhale and exhale.

    The patients were then hooked up to an electrical heart monitor and the screen was covered. A healthcare professional, the patient and the patient's family all attempted to take a pulse reading.

    According to the electrical heart monitor, 172 of the patients had normal heart rhythms and 57 had atrial fibrillations - the rest had another kind of abnormal rhythm. The researchers analyzed how often wrist pulse readings achieved the same result as the electrical heart monitor.

    Almost 90 percent of the patients who were mentally able did complete a pulse reading on themselves, and correctly detected 54 percent of the atrial fibrillations. Health care providers detected 97 percent of atrial fibrillations.

    Only six patients who thought their heart rates were irregular were incorrect. A false-positive rate that low is encouraging, the authors write.

    Among patients with atrial fibrillation whose family members took the tutorial, relatives detected the irregular beats 77 percent of the time by taking the patient's pulse.

    When atrial fibrillation is detected, medication can reduce the risk of a second stroke by 60 to 70 percent in comparison to not treating patients, according to Rolf Wachter of Universitatsmedizin Gottingen in Germany.

    "This is, I would say, one of the most effective therapies in medicine," he told Reuters Health in an email.

    Wachter, who was not part of the new study, researches heart conditions like atrial fibrillation.

    "We do not specifically know whether the approach in this paper is really the best approach. Other methods, including using a machine to monitor heart rhythm, might be better at detecting fibrillations, but they haven't been compared to each other in a trial," he said.

    "In general, taking your pulse is easy, harmless and free from side effects. Therefore anyone can try to do it," Kallmünzer said. "In stroke patients with very severe disability, family members, friends or nurses can do the measurements for the patient."

    The risk of a second stroke is highest during the months after the first one, but currently researchers do not know exactly how long this kind of pulse monitoring should go on, he said.

    If you're not sure how to take your pulse or that of a family member or how often you should check, ask your doctor, he said.

    "Health care professionals, doctors and nurses have outstanding experience in this technique and will be glad to give instructions."

    SOURCE: http://bit.ly/WC2Azb Neurology, online July 23, 2014.

  • Hispanic Americans need tailored heart care: report

    By Andrew M. Seaman

    NEW YORK (Reuters Health) - Hispanic Americans make up the fastest growing minority group in the U.S. and healthcare professionals need to better understand their unique heart health risks in order to tailor their care, according to a new report from the American Heart Association.

    That's not to say the 53 million U.S. Hispanics are all the same, the authors emphasize in their review of research detailing health-related traits and trends among groups of people whose origins are in the Spanish-speaking countries of the Americas and Caribbean.

    "We hope that we can move into a new era when we can look at this population with a more nuanced perspective," said Dr. Carlos Rodriguez, the report's lead author and a cardiologist at Wake Forest Baptist Medical Center in Winston-Salem, North Carolina.

    Cardiovascular disease includes conditions that affect the heart and blood vessels, such as heart failure, strokes and high blood pressure.

    The size and growth of the U.S. Hispanic community makes the group's health vital to the nation and to reaching the American Heart Association's 2020 goals, Rodriguez and his co-authors write in the journal Circulation.

    The 2020 goals aim to improve the cardiovascular health of all Americans while reducing deaths from cardiovascular diseases by 20 percent between 2011 and 2020.

    "For us to meet those goals and for us to be a healthy population and a healthy country, all groups have to be accounted for," Rodriguez said.

    The working group that produced the new report combed through medical literature to summarize what is known about the health of Hispanic Americans, identify gaps in the research that need to be filled and come up with recommendations for healthcare providers. In total, they summarize findings from 400 studies and articles.

    Much of the information on cardiovascular disease, they found, is focused on Mexican Americans, which may give an inaccurate view of the health of other Hispanic populations, such as people from South America and Puerto Rico.

    The report notes that about a third of Mexican Americans have cardiovascular disease, which is slightly lower than non-Hispanic whites and considerably lower than non-Hispanic blacks.

    While heart disease appears to be less common overall among Hispanic Americans, the researchers found a number of specific risks that seem to afflict Hispanics more than other racial and ethnic groups.

    For example, Mexican Americans are twice as likely to have a stroke before age 60 and are more likely to be hospitalized for heart attacks than non-Hispanic Americans.

    "We found Hispanics have high rates of diabetes, high rates of high cholesterol and really very prevalent within this population is poor access to care and economic challenges that impact on healthcare," Rodriguez said.

    Hispanic American children are also more likely to be obese than non-Hispanic white children.

    And while Hispanics are less likely to smoke as a group, certain subpopulations including Mexican and Cuban men and Puerto Rican women have smoking rates much higher than the national average.

    Noting the racial diversity of certain Caribbean and Latin American countries, the researchers point out that some Hispanic Americans may also have risk factors associated with African, Asian or Amerindian roots.

    "The recognition that the Latin groups have become our largest minority group and recognizing the diversity within them and paying attention to some of the special issues that they bring is certainly a step in the right direction," Dr. Hal Strelnick said.

    Strelnick was not involved with the new report but is dean of community engagement at the Albert Einstein College of Medicine of Yeshiva University in Bronx, New York.

    "I think one could say that the study is long overdue but it's certainly welcomed," he said.

    The working group included lists of policy recommendations as well as dos and don'ts for healthcare providers in their report.

    Those recommendations include educating healthcare providers to tailor their care to language and cultural traits of Hispanic patients, better identifying subgroups by including countries of origin or descent in medical records and increasing the Hispanic healthcare workforce.

    The report authors also suggest that U.S. screenings for cardiovascular disease begin at a younger age for Hispanics, because the condition tends to start earlier in that population.

    The American Heart Association recommends that all Americans get active, control their cholesterol, eat better, manage blood pressure, lose weight, reduce blood sugar and stop smoking to improve their cardiovascular health.

    SOURCE: http://bit.ly/1sSvWGC Circulation, July 14, 2014.

  • Probiotics might help lower blood pressure

    By Krystnell Storr

    NEW YORK (Reuters Health) - Regularly consuming probiotics, or the "good" bacteria found in yogurt, milk and cheese, may help control blood pressure, according to a new review of past studies.

    Researchers found that consuming the proper amount of probiotics over at least two months appeared to modestly lower blood pressure.

    "I do not think the general public understands how probiotics might be beneficial to health at this stage," said Jing Sun, who worked on the study at the Griffith University School of Medicine and Griffith Health Institute in Queensland, Australia.

    "The challenge to us is to convince patients and clinicians to accept the product in daily life," Sun said.

    Past studies have shown probiotics can have a positive effect on blood sugar, cholesterol and certain hormones - all of which can impact blood flow, she noted.

    The new findings do not mean people should replace their blood pressure medication with probiotics and it is still unclear which strain or combination of strains might work best.

    The American Heart Association considers normal blood pressure to be a systolic reading of less than 120 millimeters of mercury (mm Hg) and a diastolic reading of less than 80 mm Hg. High blood pressure starts at 140/90 mm Hg and increases a person's risk of heart disease, stroke, kidney disorders and other health problems.

    For some people with high blood pressure the only effective treatment has been medication, but that means costs and possible side effects.

    The new review, published in the journal Hypertension, combined the results of nine studies that randomly assigned participants to take probiotics or not. Seven of the trials were double-blind, meaning neither the participants nor the experimenters knew who received probiotics and who received a probiotic-free placebo until the end of the study. The different strains of probiotics were delivered in products like yogurt and milk.

    The studies included a total of almost 550 people.

    The researchers found that on average, probiotic consumption lowered systolic blood pressure (the top number) by 3.56 mm Hg and diastolic blood pressure (the bottom number) by 2.38 mm Hg, compared to a placebo or no treatment.

    Getting at least 100 billion colony-forming units of probiotics each day, the amount in a carton of some yogurts, seemed to be necessary for significant blood pressure improvements. And no change in blood pressure was seen among participants who were given probiotics for less than eight weeks.

    The researchers noted that the effect of probiotics was strongest among people who already had elevated blood pressure.

    Lori Hoolihan, a researcher at the Dairy Council of California in Irvine who was not involved in the analysis, called probiotics a "functional food."

    She said the review is a step in the right direction.

    "Randomized clinical trials are the gold standard in research and they had a strict criteria for choosing the studies and they actually looked at human trials which are stronger than animal trials," she said.

    "They used real foods that had probiotics at realistic levels, they didn't use supplements or wacky chemical concoctions that no one has heard of. They used foods on the market so you and I could go into the market and pick (them) up," she added.

    "Americans don't like to think about bacteria so it's hard for people to embrace it but there are good and bad bacteria and there is no avoiding them. Our gut is home to many bacteria and if bumping up the amount of good bacteria can optimize health and prevent chronic diseases then that's a good thing," Hoolihan said.

    The price of probiotic supplements varies, but a 30-day supply from the drugstore may cost about $30.

    Dr. Shira Doron, who has studied probiotics at Tufts Medical Center in Boston, said that because probiotics only seemed to have an effect under certain conditions in specific groups of patients, it's hard to know how to make recommendations to patients at this time.

    What's more, she said, "The fact that each study within this meta-analysis was done using a different probiotic or combination of probiotics means that I as a physician am completely unable to say to my patient, 'Go out and buy probiotic X. It was shown to be effective in clinical trials.'"

    "We know no two probiotics act alike," Doron explained. "One simply cannot extrapolate from a study of one probiotic that another strain or even another dose or another source - dairy product, capsule, sachet, etc. - will work."

    "I don't think this is 'ready for prime time' yet, as they say. That being said, probiotics might help, and generally don't hurt, except perhaps your wallet, so if someone with high blood pressure wants to try probiotics as an adjunct to their regular blood pressure medication, I say go for it," she said.

    SOURCE: http://bit.ly/1kLRX1U Hypertension, online July 21, 2014.

  • Medication errors may be common after hospital discharge

    By Krystnell Storr

    NEW YORK (Reuters Health) - More than half of heart patients in a new U.S. study made mistakes taking their medications or misunderstood instructions given to them after being discharged from the hospital.

    Those with the lowest "health literacy" were among the most likely to make the risky errors, highlighting the importance of healthcare professionals making sure their instructions are clear and of patients being sure they understand what they need to do after they get home, the study authors say.

    "Some errors have the potential to be harmful to patients," said lead author Dr. Amanda Mixon, a hospitalist with the VA Tennessee Valley Healthcare System in Nashville.

    "Thousands of patients are discharged home with medications every day. Knowing which patients are at risk of medication errors after patients go home can help inpatient providers counsel patients about their medications before they go home," added Mixon, who is also affiliated with Vanderbilt University.

    Past research suggests that an individual's health literacy, the ability to interpret and act on health information, is a strong predictor of whether they will correctly follow instructions for their own care (see Reuters Health article of October 25, 2013, here: http://reut.rs/UdH55N).

    Overall, 20 to 30 percent of prescriptions are never filled, and 50 percent are not continued as prescribed, according to the U.S. Centers for Disease Control and Prevention.

    To assess what factors might influence whether heart patients will follow their care instructions correctly after leaving the hospital, Mixon's team recruited 471 people hospitalized for heart failure, heart attacks and related conditions, then discharged from the hospital.

    The participants' average age was 59 and just under half were women. Every participant took a seven-minute health literacy test to gauge their understanding of health information as well as a short numeracy test to measure basic math skills.

    The researchers contacted the patients by telephone two to three days after they left the hospital and compared the medications on the discharge list from their doctors to what the patients said they were taking.

    When someone said they were taking a medication not on the list, or forgot to mention one that was on the list, it was counted as an error. If a patient didn't know the purpose, dose or frequency of a medication, it was classified as a misunderstanding.

    Failure to refill a prescription, discontinuing use of a medication against a healthcare professional's orders or not being aware of a medication were also counted as errors.

    More than half - 242 of the 471 patients - had at least one discrepancy between the medications they reported taking, and the ones on their discharge list. Over a quarter left out one or more medications on their list and more than a third were taking something that wasn't on the list. And 59 percent of patients had a misunderstanding of the purpose, dose or frequency of their medications.

    Participants who scored highest on the math skills test were about 23 percent less likely than those who scored lowest to add or omit medications, the researchers report in Mayo Clinic Proceedings.

    People with the highest health literacy scores were about 16 percent less likely to make an error compared to those who scored lowest. And women were about 40 percent less likely than men to make a mistake.

    Single people were almost 70 percent more likely than people who were married to make errors. Older age and worse cognitive function also predicted higher odds of having an error.

    "It's a powerful study in that it helps to define some of the things we assume, but haven't been able to fully understand," said Dr. Benjamin Brooke, a surgeon and professor at the University of Utah School of Medicine in Salt Lake City, who was not involved in the study.

    "I think this says that we need to do a better job of understanding a patient at the time of discharge, what are their risks of having a post discharge adverse event," he told Reuters Health.

    In healthcare, "there's a lot of moving parts and it's difficult to make sure they all move in tandem," he noted. "A patient may see a doctor for 20 years and then end up seeing another one who does not know their medical history as well. But this is a global issue. There's a lot of errors that occur when we leave the hospital."

    He favors the idea of a brief health literacy test that might identify patients most likely to have trouble following treatment instructions after discharge. "Whether it's a quick streamlined tool that nurses or anyone part of the medical team can administer, it's something that might be feasible," he said.

    "The main thing is, we need to be aware of the problem and the study points out some of the things we need to focus on more closely," he said.

    Mixon said that for patients who have low health literacy or numeracy, healthcare providers need to be especially careful in counseling them about their medications at hospital discharge.

    She added that patients can also be proactive and assertive by asking a healthcare professional to carefully review the medications they are required to take at home, making sure to ask questions about previously prescribed medications and whether or not they should be continued.

    SOURCE: http://bit.ly/1jQCCm1 Mayo Clinic Proceedings, online July 03, 2014.

  • Healthy living may slow early dementia: study

    By Andrew M. Seaman

    NEW YORK (Reuters Health) - A program that emphasizes healthy eating, brain and social engagement, physical activity and heart health may slow dementia among people at risk for Alzheimer's disease, says a new preliminary report from Sweden.

    The findings can't guarantee that healthy living will prevent Alzheimer's disease but they add to growing evidence that suggests overall health is tied to dementia risk.

    "This is really hard evidence that we can do something for brain health," said Dr. Miia Kivipelto, the study's lead author, from the Karolinska Institute in Stockholm.

    The findings also show that it's not too late to help brain health since the participants were all at risk for Alzheimer's disease, Kivipelto added.

    She and her colleagues presented their findings at the Alzheimer's Association International Conference in Copenhagen, Denmark.

    An estimated 35.6 million people are living with dementia worldwide, according to the World Health Organization. Alzheimer's disease is the most common form of dementia.

    Another study presented at the same conference also suggested that controlling certain risk factors, such as high blood pressure, obesity and diabetes, may reduce the worldwide prevalence of Alzheimer's by almost a third.

    People with Alzheimer's experience memory loss, which worsens with time. The disease leads to problems with decision making and an inability to perform daily tasks. Eventually, the complications from Alzheimer's disease lead to death.

    Alzheimer's is the sixth leading cause of death in the U.S., according to the Centers for Disease Control and Prevention. About 5.3 million Americans have the disease.

    For the new study, the researchers recruited 1,260 Finnish adults between the ages of 60 and 77 years to take part in the two-year trial.

    All of the participants scored above a cutoff point on a list of lifestyle risk factors for cognitive impairment and Alzheimer's, and on a neurological test, all had cognitive performance that was average or slightly below average for their age.

    The participants were randomly assigned to a group that received basic health advice or a group that took part in a multi-component program targeting diet, exercise, heart health and brain and social engagement.

    The multi-component intervention was delivered during a series of group sessions over the course of the study.

    After two years, the researchers found the group that just got basic health advice experienced substantially more cognitive decline than the program participants.

    "We saw about a 40 percent difference between the intervention and the control groups," Kivipelto said. "It was clear the intervention group improved from baseline."

    She said the difference was robust but it's difficult to say whether the participants experienced a noticeable difference. A longer trial that's in the works will have to look at the real-world effect on people who stick with the program and whether the intervention prevents Alzheimer's.

    "I think the evidence is that this delays onset for people who don't have it," said Dr. Sam Gandy, who was not involved in the new study. "For people that do, it slows the progression. Whether it completely protects everyone, I would doubt it. Maybe there are people who have a mildly increased risk and this could prevent it."

    Gandy directs the Center for Cognitive Health at Mount Sinai Hospital in New York City.

    Kivipelto cautioned that a healthy lifestyle is no guarantee that a person won't develop Alzheimer's.

    "We know that there are people who get other diseases even if they're living in a healthy way," Kivipelto said. "We don't want to label anybody who has Alzheimer's that 'this is because of your life.'"

    Still, she said, it's not too early to recommend interventions that target diet, exercise, heart health and brain and social engagement. Many of those interventions also target other chronic health conditions.

    "It's not too early," she said. "We've already had observational studies showing the same thing."

    Gandy said he already gives his patients and their caregivers similar advice.

    "I tell them both that these are the most important things they can do to keep their brains healthy," he said.

Comprehensive Rehabilitation Articles

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Emergency News

  • Life-threatening reactions to diet drug on the rise in the UK

    By Shereen Lehman

    NEW YORK (Reuters Health) - Use of a diet drug known as DNP has been linked to five deaths in the UK since 2007, according to a new report.

    The compound, also known as 2,4-Dinitrophenol, is a synthetic chemical originally used in the manufacturing of dyes, wood preservatives, explosives and pesticides.

    DNP was developed as a weight-loss drug in the 1930s before being banned in the U.S. in 1938 after reports of severe toxic reactions, researchers note. Still, the compound remains in use, sold online in bulk powder.

    "DNP is a so called 'fat burning' product used by body builders and as a weight loss aid - it prevents energy being stored as fat, but instead this is released as heat," senior author Dr. Simon Thomas told Reuters Health in an email. "The effect is an increase in body temperature and this can damage the body's cells, e.g. in muscle, kidney and brain."

    Thomas directs the National Poisons Information Service (NPIS) in Newcastle upon Tyne, UK.

    He said DNP can cause fever, nausea or vomiting, skin discoloration or rash, breathing difficulties, abdominal pain, agitation and headache. Those could progress to confusion, seizures, kidney failure, muscle damage and bone marrow failure.

    "DNP is sold via the Internet and so we don't have good data on how many people use it," Thomas said. "Our research, however, has shown increasing numbers of people in the UK presenting with adverse clinical effects after DNP use, suggesting that increasing numbers of people have been using the chemical."

    For the new study, Thomas and his colleagues analyzed data from a phone enquiry service run by the NPIS for UK health professionals seeking information and advice about the management of people with suspected poisoning.

    Between 2007 and 2013, they found there were 39 phone calls relating to 30 different exposures to DNP involving 27 men and three women.

    Twenty-two of those exposures were reported in 2013. Only three were reported from 2007 to 2011.

    Ten of the poisoning episodes were classified as minor, 12 were moderate and five were severe. Severity information was not available for three patients.

    Five of the cases resulted in deaths - one in 2008, one in 2012 and three in 2013, according to findings published in the Emergency Medicine Journal.

    "DNP is a hazardous substance not fit for human consumption," Thomas said. "It can cause severe toxic effects that can result in death."

    The effects are also unpredictable, he added. Some people use DNP for a while without any apparent problems and then suddenly develop side effects.

    "The higher the dose used, the greater the risk of severe toxic effects, but no dose is safe," Thomas said. He and his colleagues have seen serious side effects in people using the doses recommended by websites that sell the compound.

    Dr. Edward Boyer agreed that DNP is a dangerous chemical and shouldn't be used as medication.

    Boyer is an emergency medicine physician and toxicology expert at the University of Massachusetts Medical School in Worcester. He wasn't involved in the study.

    He said the reason DNP is dangerous has to do with how the body manages energy.

    "There's a world of chemical reactions that go on inside your body and every time a chemical reaction occurs it releases heat," he told Reuters Health. "Your body takes some of that heat and normally turns it back into other chemical reactions which lead to molecules that you can use for additional energy - it's just a way of being efficient."

    Dinitrophenol breaks that cycle so instead of taking the heat that's produced from one reaction and turning it into other forms of useful energy, the body just produces more heat, Boyer said.

    Too much of that heat production, he said, and "you wind up literally baking yourself to death."

    SOURCE: http://bit.ly/1sBv0as Emergency Medicine Journal, online June 23, 2014.

  • Life-threatening reactions to diet drug on the rise in the UK

    By Shereen Lehman

    NEW YORK (Reuters Health) - Use of a diet drug known as DNP has been linked to five deaths in the UK since 2007, according to a new report.

    The compound, also known as 2,4-Dinitrophenol, is a synthetic chemical originally used in the manufacturing of dyes, wood preservatives, explosives and pesticides.

    DNP was developed as a weight-loss drug in the 1930s before being banned in the U.S. in 1938 after reports of severe toxic reactions, researchers note. Still, the compound remains in use, sold online in bulk powder.

    "DNP is a so called 'fat burning' product used by body builders and as a weight loss aid - it prevents energy being stored as fat, but instead this is released as heat," senior author Dr. Simon Thomas told Reuters Health in an email. "The effect is an increase in body temperature and this can damage the body's cells, e.g. in muscle, kidney and brain."

    Thomas directs the National Poisons Information Service (NPIS) in Newcastle upon Tyne, UK.

    He said DNP can cause fever, nausea or vomiting, skin discoloration or rash, breathing difficulties, abdominal pain, agitation and headache. Those could progress to confusion, seizures, kidney failure, muscle damage and bone marrow failure.

    "DNP is sold via the Internet and so we don't have good data on how many people use it," Thomas said. "Our research, however, has shown increasing numbers of people in the UK presenting with adverse clinical effects after DNP use, suggesting that increasing numbers of people have been using the chemical."

    For the new study, Thomas and his colleagues analyzed data from a phone enquiry service run by the NPIS for UK health professionals seeking information and advice about the management of people with suspected poisoning.

    Between 2007 and 2013, they found there were 39 phone calls relating to 30 different exposures to DNP involving 27 men and three women.

    Twenty-two of those exposures were reported in 2013. Only three were reported from 2007 to 2011.

    Ten of the poisoning episodes were classified as minor, 12 were moderate and five were severe. Severity information was not available for three patients.

    Five of the cases resulted in deaths - one in 2008, one in 2012 and three in 2013, according to findings published in the Emergency Medicine Journal.

    "DNP is a hazardous substance not fit for human consumption," Thomas said. "It can cause severe toxic effects that can result in death."

    The effects are also unpredictable, he added. Some people use DNP for a while without any apparent problems and then suddenly develop side effects.

    "The higher the dose used, the greater the risk of severe toxic effects, but no dose is safe," Thomas said. He and his colleagues have seen serious side effects in people using the doses recommended by websites that sell the compound.

    Dr. Edward Boyer agreed that DNP is a dangerous chemical and shouldn't be used as medication.

    Boyer is an emergency medicine physician and toxicology expert at the University of Massachusetts Medical School in Worcester. He wasn't involved in the study.

    He said the reason DNP is dangerous has to do with how the body manages energy.

    "There's a world of chemical reactions that go on inside your body and every time a chemical reaction occurs it releases heat," he told Reuters Health. "Your body takes some of that heat and normally turns it back into other chemical reactions which lead to molecules that you can use for additional energy - it's just a way of being efficient."

    Dinitrophenol breaks that cycle so instead of taking the heat that's produced from one reaction and turning it into other forms of useful energy, the body just produces more heat, Boyer said.

    Too much of that heat production, he said, and "you wind up literally baking yourself to death."

    SOURCE: http://bit.ly/1sBv0as Emergency Medicine Journal, online June 23, 2014.

  • Life-threatening reactions to diet drug on the rise in the UK

    By Shereen Lehman

    NEW YORK (Reuters Health) - Use of a diet drug known as DNP has been linked to five deaths in the UK since 2007, according to a new report.

    The compound, also known as 2,4-Dinitrophenol, is a synthetic chemical originally used in the manufacturing of dyes, wood preservatives, explosives and pesticides.

    DNP was developed as a weight-loss drug in the 1930s before being banned in the U.S. in 1938 after reports of severe toxic reactions, researchers note. Still, the compound remains in use, sold online in bulk powder.

    "DNP is a so called 'fat burning' product used by body builders and as a weight loss aid - it prevents energy being stored as fat, but instead this is released as heat," senior author Dr. Simon Thomas told Reuters Health in an email. "The effect is an increase in body temperature and this can damage the body's cells, e.g. in muscle, kidney and brain."

    Thomas directs the National Poisons Information Service (NPIS) in Newcastle upon Tyne, UK.

    He said DNP can cause fever, nausea or vomiting, skin discoloration or rash, breathing difficulties, abdominal pain, agitation and headache. Those could progress to confusion, seizures, kidney failure, muscle damage and bone marrow failure.

    "DNP is sold via the Internet and so we don't have good data on how many people use it," Thomas said. "Our research, however, has shown increasing numbers of people in the UK presenting with adverse clinical effects after DNP use, suggesting that increasing numbers of people have been using the chemical."

    For the new study, Thomas and his colleagues analyzed data from a phone enquiry service run by the NPIS for UK health professionals seeking information and advice about the management of people with suspected poisoning.

    Between 2007 and 2013, they found there were 39 phone calls relating to 30 different exposures to DNP involving 27 men and three women.

    Twenty-two of those exposures were reported in 2013. Only three were reported from 2007 to 2011.

    Ten of the poisoning episodes were classified as minor, 12 were moderate and five were severe. Severity information was not available for three patients.

    Five of the cases resulted in deaths - one in 2008, one in 2012 and three in 2013, according to findings published in the Emergency Medicine Journal.

    "DNP is a hazardous substance not fit for human consumption," Thomas said. "It can cause severe toxic effects that can result in death."

    The effects are also unpredictable, he added. Some people use DNP for a while without any apparent problems and then suddenly develop side effects.

    "The higher the dose used, the greater the risk of severe toxic effects, but no dose is safe," Thomas said. He and his colleagues have seen serious side effects in people using the doses recommended by websites that sell the compound.

    Dr. Edward Boyer agreed that DNP is a dangerous chemical and shouldn't be used as medication.

    Boyer is an emergency medicine physician and toxicology expert at the University of Massachusetts Medical School in Worcester. He wasn't involved in the study.

    He said the reason DNP is dangerous has to do with how the body manages energy.

    "There's a world of chemical reactions that go on inside your body and every time a chemical reaction occurs it releases heat," he told Reuters Health. "Your body takes some of that heat and normally turns it back into other chemical reactions which lead to molecules that you can use for additional energy - it's just a way of being efficient."

    Dinitrophenol breaks that cycle so instead of taking the heat that's produced from one reaction and turning it into other forms of useful energy, the body just produces more heat, Boyer said.

    Too much of that heat production, he said, and "you wind up literally baking yourself to death."

    SOURCE: http://bit.ly/1sBv0as Emergency Medicine Journal, online June 23, 2014.

Surgery Articles

  • Robot bladder surgery fails to deliver fewer complications

    By Gene Emery

    NEW YORK (Reuters Health) - Using robotic techniques to remove a cancerous bladder doesn't reduce the risk of complications compared with conventional "open" surgery, according to a new comparison of 118 patients conducted by surgeons at the Memorial Sloan Kettering Cancer Center in New York.

    The study, detailed in the New England Journal of Medicine, marks the first ongoing comparison of the risks and benefits of the two techniques. Past studies concluded that the robotic technique meant less time in the hospital and fewer complications but they were done by looking back at the records of already-treated patients.

    "There's been a lot of hype surrounding robots and it's been hard to gain perspective," said Dr. Vincent Laudone, one of the coauthors.

    Dr. Jennifer Yates, director of minimally invasive urology at the University of Massachusetts Medical School, who was not involved in the test, told Reuters Health that the findings will give surgeons pause because they're going to be surprised by the results.

    Robots have shown to be so valuable for prostate removal, many surgeons were convinced that a similar benefit would appear when they were used for bladder removal, she said. "They're going to say, 'Hey, I'm kinda surprised by this.' They're also going to be encouraged that the complication rate was comparable."

    "Bottom line: It looks like it was pretty much a wash," Laudone told Reuters Health. For patients, it means "if you're going to a surgeon who is experienced in traditional surgery and recommends traditional surgery, that's a reasonable recommendation."

    He estimated that perhaps 25 percent of bladder cancer removals, known as radical cystectomies, are currently done with robots.

    The study also found that patients who underwent conventional surgery spent about 28 percent less time in the operating room. They experienced more blood loss - about 5 ounces more - but "with that amount, we wouldn't expect to see any significant side effect," Laudone said.

    "These results highlight the need for randomized trials to inform the benefits and risks of new surgical technologies before widespread implementation," he and his colleagues concluded.

    About 67,000 bladder tumors are discovered in the U.S. each year and one quarter of them require bladder removal.

    The new study involved patients who needed both the bladder and nearby lymph nodes extracted. The men also lost their prostate and the women lost their ovaries, fallopian tubes, uterus and related organs. Even when a $2 million robot was used, conventional surgery was employed to redirect urine to the intestine.

    With robot-assisted surgery, 22 percent of the 60 patients had at least one serious complication within the first 90 days. A complication was regarded as serious if it required further surgery, intubation or major rehabilitation. The rate was essentially the same - 21 percent - with traditional surgery.

    When the researchers included lesser complications, such as those requiring intravenous medicine or blood transfusion, the risk was 62 percent with robot-assisted surgery versus 66 percent with open surgery.

    The average length of hospital stay was eight days for both groups.

    But the patients in the robot group spent two hours longer in the operating room. The average time was 5 hours 29 minutes with conventional surgery and 7 hours 36 minutes with robotic assistance.

    Both Laudone and Yates said that time difference is expected to shrink as doctors become more adept at working with robots.

    "It's an evolving technology and we're evolving in our learning to use the robot," Laudone said. "We're getting better as robotic surgeons, so operating time is diminishing. With prostate surgery, the same thing was true. Now, in some cases, doing it with the robot is faster. So the time difference is something I think will disappear with more experience."

    Yates cautioned that "this was a small study and I think it needs to be fleshed out with larger numbers. And you have to remember that Sloan Kettering is one of the more prominent high-volume institutions in the country. Whether this is generalizable to other institutions remains to be seen."

    SOURCE: http://bit.ly/1wN4FCQ New England Journal of Medicine, online July 23, 2014.

  • Fourth bacterial infection death reported at South Carolina hospital

    By Harriet McLeod

    CHARLESTON, S.C. (Reuters) - A patient who contracted a rare bacterial infection during surgery at a South Carolina hospital died last week, bringing the total deaths to four since the outbreak was first suspected in May, a hospital spokeswoman said on Tuesday.

    The four dead are among 15 patients infected by Mycobacterium abscessus during surgery at Greenville Memorial Hospital, spokeswoman Sandy Dees said.

    Hospital officials cited tap water as the likely origin of the bacteria.

    "Although we use sterile water in or near the surgical sterile field, even something as seemingly safe as pre-surgery hand washing may have contributed," said Dr. Robert Mobley Jr., the hospital's medical director of quality. "At this time, we have not been able to find any single cause or process as the trigger for the outbreak."

    Mycobacterium abscessus is commonly found in soil, water and dust, but rarely causes infection in healthy people, hospital officials said.

    Infection is usually caused by injections of contaminated substances or by invasive medical procedures using contaminated equipment or material, according to the U.S. Centers for Disease Control and Prevention.

    Mycobacterium abscessus associated with healthcare can cause infections of the skin and soft tissues under the skin or lung infections in people with chronic lung diseases, the CDC said.

    The first patient tested positive for the infection in March, and two of the infected surgical patients remained hospitalized, Dees said. All the infected patients had serious underlying medical conditions, she said.

    After an investigation assisted by the CDC and South Carolina's health agency, the hospital has started using new operating room procedures, including filtering water and flushing scrub sinks, Dees said.

  • Pregnancy doesn't drive women doctors out of surgical training

    By Ronnie Cohen

    NEW YORK (Reuters Health) - A new study disputes a common stereotype that women who become pregnant during surgical training often drop out of those training programs.

    Researchers led by Dr. Erin G. Brown of the University of California, Davis found that neither women nor men who had children born during their school's surgical residency program were more likely to quit than residents who did not have children during training.

    Brown told Reuters Health the idea for the study came to her when she was pregnant with her daughter, now one and a half years old, during her surgical residency.

    "Things are changing. It's not an overnight change. It's a slow, steady culture change away from the old boys' club mentality that women who have children during training aren't going to cut it," she said.

    "This study shows that surgical residents who have children during training are just as good," she added.

    General surgical residency programs last five years and are known for being rigorous.

    For the new study, Brown and her colleagues reviewed records on 85 residents enrolled in the University of California, Davis general surgery residency program from 1999 to 2009.

    Forty-nine of the residents were men, and the average age of all residents entering the program was almost 28 years. Overall attrition was about 19 percent, with 16 residents leaving the program.

    A similar proportion of male and female residents left the training program.

    Of the 85 residents, 25 had children born during training.

    Among female residents in particular, 25 percent had children during training and took an average maternity leave of 10 weeks. One of those women left the training program. One woman extended her residency training by two weeks, but the other women who had babies while in training completed the program on time.

    Residents with children born during the program treated a similar number of patients and were equally likely to pass their boards as those who did not have children, according to findings published in JAMA Surgery.

    In an accompanying commentary, Dr. Jeffrey Gauvin, director of the surgical training program at Santa Barbara Cottage Hospital in California, applauded the study but questioned its applicability to smaller programs like his own.

    Davis has "a deep bullpen from which a program director can call in reserves when someone is on leave," he writes. "This may be a very different scenario for small or midsized programs that have very limited - if any - reserves."

    Gauvin formerly directed the surgical residency program at the University of California, Davis.

    Brown acknowledged that smaller programs could face greater challenges in accommodating surgical residents during maternity leave. She is currently compiling data from surgical residency programs of various sizes across the nation to see if the results of the Davis study hold.

    "These are very motivated women who know what they want, and they're able to manage the stress of parenting and training and don't deviate from their career goals," Brown said.

    Women comprised just seven percent of U.S. medical school graduates in 1965, according to the Association of American Medical Colleges. Today that rate hovers near 50 percent.

    But a majority of surgical residents continue to be male, Dr. Nina Shapiro told Reuters Health.

    Shapiro, a professor of head and neck surgery at the University of California, Los Angeles, was not involved in the current study. She said she has watched life change for pregnant surgical residents since she began her training in 1991.

    "Because there's been an increase in the number of women, the climate has by default changed," she said. "There's a huge difference in 20 years."

    "The women going into surgery are very keenly watching those ahead of them. If women are showing they can have babies and be successful, I think other women are going to follow. It's really inspiring for women going into these training programs."

    Shapiro is married to another physician, and they have two young children.

    "Is it a perfect life?" she asked. "There are many days I can't see my kids. For the most part, I make it work. I never miss a school event, a big event in my kids' lives. I don't miss too many small events. I do a lot of homework. I know a lot of fifth-grade math."

    SOURCE: http://bit.ly/1n1S0L8 and http://bit.ly/1nk9sMq JAMA Surgery, online July 16, 2014.

Neonatal Articles

  • HIV-positive women in Central America pressured to sterilize

    By Katie Nguyen

    MELBOURNE (Thomson Reuters Foundation) - HIV-positive women in Central America are being pressured to undergo sterilization by prejudiced health workers and misled about the risk of the virus being transmitted to their unborn children, a study has found.

    A survey of 285 women living with HIV in El Salvador, Honduras, Mexico and Nicaragua found that 23 percent of them had faced pressure from doctors and nurses to be sterilized.

    The rate ranged from 20 percent in Nicaragua to 28 percent in Mexico, according to research by the Mesoamerican Coalition for the Reproductive Rights of Women with HIV and the Women and Health Initiative of Harvard School of Public Health.

    The consistency of the rate over a large geographical area pointed to a "systematic pattern" of pressure and coercion, said Harvard School of Public Health research fellow Tamil Kendall.

    "It's really unthinkable that women living with HIV are being pressured and forced into sterilization when treatment almost eliminates the possibility of the mother-to-child transmission... and also provides options for safer conception and pregnancy," said Kendall, who presented the research at an international conference on AIDS in Melbourne on Wednesday.

    "In this day and age there is no reason why women living with HIV can't safely exercise their reproductive rights," she told Thomson Reuters Foundation, adding that it was likely the attitude of many health workers reflected the stigma towards HIV in the societies they came from.

    UNKNOWINGLY STERILIZED

    An estimated 17.7 million women worldwide had the human immunodeficiency virus (HIV) that causes AIDS in 2012, according to the World Health Organization (WHO).

    Citing U.N. figures, Kendall said there were 59,300 women living with HIV in Mexico, El Salvador, Honduras and Nicaragua in 2012.

    The study said pregnant HIV-positive women - whose status was known to health workers - were almost eight times more likely to report an experience of pressure or coercion to sterilize than women with HIV who were not pregnant.

    In one "particularly horrific" case, Kendall said a Mexican woman was sterilized without her knowledge while under anaesthetic for a Cesarean section. When she woke up, her thumb had been dipped in ink so it could be used on a consent form.

    In another case, a young Salvadoran said nurses threatened to deny her a Cesarean unless she signed up to be sterilized.

    Health workers often fed women misinformation as a way of coercing them, said Kendall, who has carried out research on women living with HIV in Latin America for more than a decade.

    "Women are told that if they have another pregnancy that either they will die or their children will almost surely acquire HIV and die," she said.

    "Healthcare providers use these kinds of high pressure tactics to force them into sterilization, and this is simply scientifically untrue."

    Without treatment, the likelihood of a HIV-positive mother transmitting HIV to her child during pregnancy, labor, delivery or through breastfeeding ranges from 15 percent to 45 percent, WHO says. With the right antiretroviral treatment, the transmission rate can be reduced to below 5 percent.

    The women surveyed in Central America came from rich and poor, rural and urban backgrounds. Women of indigenous and African descent were also represented.

    Yet neither their ethnicity, nor economic or social status were significant in indicating whether they were likely to be pressured to sterilize, Kendall said.

    "That reinforces the idea that what is actually driving this is discrimination around HIV itself," she said.

  • Using a nicotine patch during pregnancy tied to higher ADHD risk

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Smoking during pregnancy has been linked to a higher chance of the child having attention-deficit/hyperactivity disorder (ADHD), and a new study suggests women who use nicotine replacement products may also have children with an elevated risk.

    That doesn't necessarily mean that nicotine causes ADHD, the authors note.

    For instance, it could be that women dependent on nicotine are more likely to have ADHD symptoms themselves, said senior author Dr. Carsten Obel, from Aarhus University in Denmark. The children of women who use nicotine replacement products to quit smoking may be at risk of ADHD because of genes or their family environment, he told Reuters Health by email.

    For the new study, the researchers analyzed information from Danish databases on more than 80,000 children born between 1996 and 2002.

    Mothers were interviewed while pregnant and asked if they currently smoked, used nicotine replacement products including gum, patches or sprays or had quit smoking before pregnancy without nicotine replacement. They also reported whether their husbands were current smokers.

    The researchers then followed the children through 2011 and noted hospital diagnoses of ADHD or use of medication for the disorder. Roughly two percent of children in the study were diagnosed with ADHD.

    Compared to children with nonsmoking parents, kids with two smoking parents were 83 percent more likely to develop ADHD, according to results published in Pediatrics.

    Having a mother who smoked during pregnancy seemed to be a stronger predictor of ADHD risk than having a father who smoked.

    Mothers who used nicotine replacement products had children with an increased risk of ADHD similar to the increase associated with smoking.

    At this point, it is too soon to estimate how important nicotine exposure might be for ADHD risk, Obel said.

    Mothers who had quit smoking and those who used nicotine replacement products both tended to have babies with higher, healthier birth weights than current smokers, he noted. Smoking during pregnancy is known to be associated with a lower birth weight for the baby.

    "The nicotine patch doesn't decrease birth weight, which has been used as a target measure for a long, long time," said Yoko Nomura, who studies central nervous system development at The City University of New York's Queens College.

    "We can't say the nicotine patch is useless because birth weight is so associated with many different illnesses," Nomura told Reuters Health. She was not part of the new study.

    For most people, the risk of ADHD is very small to begin with, she said.

    As of 2011, 11 percent of U.S. kids ages four to 17 had been diagnosed with ADHD, according to the Centers for Disease Control and Prevention.

    Many factors can influence the risk of ADHD, and most of the important predictors are genetic, Nomura said.

    "In order to prevent the non-genetic component of ADHD, we need to understand how smoking increases risk, and this doesn't help us learn more about that," she said.

    Parents reporting their own smoking habits may not be very reliable, given the social pressure to quit during pregnancy, she noted.

    "We have a long way to go before we can even conclude anything," Nomura said.

    "The best advice will at this point probably be to try to stop smoking without use of nicotine replacement and preferably before getting pregnant," Obel said. "If this is not possible nicotine replacement is, based on the birth weight results, preferable in comparison with continuing to smoke."

    For women who struggle to quit, even just cutting down on the number of cigarettes per day is a step in the right direction, Nomura said.

    SOURCE: http://bit.ly/1nP7FcE Pediatrics, online July 21, 2014.

  • Pregnancy doesn't drive women doctors out of surgical training

    By Ronnie Cohen

    NEW YORK (Reuters Health) - A new study disputes a common stereotype that women who become pregnant during surgical training often drop out of those training programs.

    Researchers led by Dr. Erin G. Brown of the University of California, Davis found that neither women nor men who had children born during their school's surgical residency program were more likely to quit than residents who did not have children during training.

    Brown told Reuters Health the idea for the study came to her when she was pregnant with her daughter, now one and a half years old, during her surgical residency.

    "Things are changing. It's not an overnight change. It's a slow, steady culture change away from the old boys' club mentality that women who have children during training aren't going to cut it," she said.

    "This study shows that surgical residents who have children during training are just as good," she added.

    General surgical residency programs last five years and are known for being rigorous.

    For the new study, Brown and her colleagues reviewed records on 85 residents enrolled in the University of California, Davis general surgery residency program from 1999 to 2009.

    Forty-nine of the residents were men, and the average age of all residents entering the program was almost 28 years. Overall attrition was about 19 percent, with 16 residents leaving the program.

    A similar proportion of male and female residents left the training program.

    Of the 85 residents, 25 had children born during training.

    Among female residents in particular, 25 percent had children during training and took an average maternity leave of 10 weeks. One of those women left the training program. One woman extended her residency training by two weeks, but the other women who had babies while in training completed the program on time.

    Residents with children born during the program treated a similar number of patients and were equally likely to pass their boards as those who did not have children, according to findings published in JAMA Surgery.

    In an accompanying commentary, Dr. Jeffrey Gauvin, director of the surgical training program at Santa Barbara Cottage Hospital in California, applauded the study but questioned its applicability to smaller programs like his own.

    Davis has "a deep bullpen from which a program director can call in reserves when someone is on leave," he writes. "This may be a very different scenario for small or midsized programs that have very limited - if any - reserves."

    Gauvin formerly directed the surgical residency program at the University of California, Davis.

    Brown acknowledged that smaller programs could face greater challenges in accommodating surgical residents during maternity leave. She is currently compiling data from surgical residency programs of various sizes across the nation to see if the results of the Davis study hold.

    "These are very motivated women who know what they want, and they're able to manage the stress of parenting and training and don't deviate from their career goals," Brown said.

    Women comprised just seven percent of U.S. medical school graduates in 1965, according to the Association of American Medical Colleges. Today that rate hovers near 50 percent.

    But a majority of surgical residents continue to be male, Dr. Nina Shapiro told Reuters Health.

    Shapiro, a professor of head and neck surgery at the University of California, Los Angeles, was not involved in the current study. She said she has watched life change for pregnant surgical residents since she began her training in 1991.

    "Because there's been an increase in the number of women, the climate has by default changed," she said. "There's a huge difference in 20 years."

    "The women going into surgery are very keenly watching those ahead of them. If women are showing they can have babies and be successful, I think other women are going to follow. It's really inspiring for women going into these training programs."

    Shapiro is married to another physician, and they have two young children.

    "Is it a perfect life?" she asked. "There are many days I can't see my kids. For the most part, I make it work. I never miss a school event, a big event in my kids' lives. I don't miss too many small events. I do a lot of homework. I know a lot of fifth-grade math."

    SOURCE: http://bit.ly/1n1S0L8 and http://bit.ly/1nk9sMq JAMA Surgery, online July 16, 2014.

  • India faces crisis over dwindling numbers of girls, U.N. says

    By Nita Bhalla

    NEW DELHI (Thomson Reuters Foundation) - The dwindling numbers of Indian girls, caused by the illegal abortion of millions of babies, has reached "emergency proportions", fueling an increase in crimes such as kidnapping and trafficking, the United Nations warned on Tuesday.

    Despite laws that ban expectant parents from running tests to determine the gender of unborn children, female feticide remains a common practice in parts of India, where a preference for sons runs deep.

    "It is tragically ironic that the one who creates life is herself denied the right to be born," said Lakshmi Puri, deputy executive director of U.N. Women, at the launch of a new study on sex ratios and gender-biased sex selection.

    India's traditionally male-dominated culture views sons as assets - breadwinners who will provide for the family, carry on the family name and perform the last rites for their parents, an important ritual in many faiths.

    Girls, however, are often seen as a liability, with families having to dig deep for a substantial dowry to ensure a desirable match. In a culture that views pre-marital sex as bringing shame to the girl's family, parents also worry about their safety.

    India's 2011 census showed that while the overall female-to-male ratio has improved marginally since the last census a decade ago, fewer girls were born than boys and the number of girls younger than six plummeted for the fifth straight decade.

    "The sharply declining child-sex ratio in India has reached emergency proportions and urgent action must be taken to alleviate this crisis," Puri added.

    A May 2011 study in British medical journal the Lancet found that up to 12 million Indian girls were aborted over the last three decades, resulting in a skewed child sex ratio of 918 girls to every 1,000 boys in 2011, versus 962 in 1981.

    Activists blame ultrasonography for the rise in abortions, saying the technology is used for sex determination.

    But the crime is tough to check, they add, resulting in few convictions. There were 221 cases of feticide reported in 2013, up from 210 in 2012, the National Crime Records Bureau says.

    U.N. officials said India's economic and social progress had failed in the area of sex selection, and the unbalanced sex ratio was contributing to crimes such as rape, abduction and trafficking.

    The entire social structure will have to change, with a battle waged against the root causes of a preference for sons, said Lise Grande, the U.N. resident coordinator in India.

    "This may be one of the hardest, most difficult struggles India faces, but it is arguably one of its most important," she added.

  • Babies of anxious mothers more likely to cry excessively: study

    By Shereen Lehman

    NEW YORK (Reuters Health) - Women with anxiety disorders may be more likely to have babies who cry excessively, suggests a new German study.

    Researchers already know that the children of women with anxiety disorders are more prone to develop anxiety themselves, according to Johanna Petzoldt. She led the current study at the Institute of Clinical Psychology and Psychotherapy at Dresden University of Technology.

    "We found a relationship between maternal anxiety disorders prior to, during and after pregnancy, thus, mothers with prior anxiety disorders might represent a specific risk group for having an infant that will cry excessively," Petzoldt told Reuters Health in an email.

    "Early identification and monitoring of mothers with prior anxiety disorders could be an opportunity to support mother-infant dyads at risk," she said.

    For the new study, Petzoldt and her colleagues enrolled 286 women who were early in their pregnancies.

    The women were 28 years old, on average. About 63 percent of them were unmarried and 59 percent were pregnant for the first time.

    At the beginning of the study, the researchers asked the women about any depressive or anxiety symptoms they had and when those symptoms started. Then they checked in with the women every other month until their babies were four months old and again one year later.

    In the interviews that took place after the babies were born, 29 mothers reported that their infants cried excessively. Excessive crying was defined as crying that lasts three or more hours per day, at least three days per week for a duration of three weeks or longer.

    The researchers found that women who had an anxiety disorder before becoming pregnant were more likely to have a baby that cried excessively compared with women without an anxiety disorder.

    That was also the case when including women who developed an anxiety disorder during pregnancy or after giving birth, according to results published in the Archives of Disease in Childhood.

    Unlike in previous studies, the researchers did not find a clear association between maternal depression and excessive crying among infants.

    The study doesn't prove women's anxiety caused their babies to cry more - only that there was a link between the two. And the reasons for the association still aren't clear.

    More research is needed to learn more about maternal anxiety and depression and infant crying, Petzoldt said.

    "Women can have anxiety or depression during pregnancy and it can have negative consequences for the baby," psychiatrist Dr. Ariela Frieder told Reuters Health.

    "It's very important to take an active stance to treat it. That can change the outcome and can really help the baby to do better," she said.

    Frieder, from the Department of Obstetrics and Gynecology and Women's Health at Montefiore Medical Center in New York, wasn't involved in the new study.

    She said women who are pregnant and believe they may have anxiety should tell their OB/GYN and the doctor can refer them to the appropriate mental health professionals. Talk therapy could be one option for treatment.

    In an editorial published with the study, Dr. Harriet Hiscock said there is no doubt that a mother's mood can impact her baby's behavior and vice versa.

    Hiscock, from the University of Melbourne in Australia, agreed that more research is needed to confirm the current findings.

    But in the meantime, she wrote that doctors can talk to women about anxiety and its perceived impact on their parenting style and on their infant, as long as professional support is available if needed.

    "This needs to be done sensitively as the last thing we need to do is add to a mother's 'day of worry' by blaming her for her infant's crying," Hiscock wrote.

    SOURCE: http://bit.ly/U6yS3l and http://bit.ly/1q3FnCP Archives of Disease in Childhood, online June 27, 2014.

Neuroscience Articles

  • Checking pulse could help detect risk of a second stroke

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Stroke patients and their families can be taught to monitor the patient's pulse and detect irregular heartbeats that might lead to another stroke, according to a new study.

    Of people who have a stroke, 40 percent will suffer another one within the next 10 years, said lead author Dr. Bernd Kallmunzer of the Department of Neurology at Universitätsklinikum Erlangen in Germany.

    Taking a pulse reading can detect atrial fibrillation, a leading source of blood clots that travel to the brain and cause stroke. Detecting atrial fibrillation is important because the patient can be treated with anti-clotting medications to reduce the risk of another stroke or death, Kallmünzer told Reuters Health by email.

    Atrial fibrillation is when the two upper chambers of the heart contract very rapidly and irregularly. At first, this irregularity occurs in episodes, then the heartbeat returns to normal rhythm and may not cause any symptoms.

    There's no treatment for the fibrillation itself, but the longer a person's pulse is monitored, for example by an electronic sensor, the greater the odds of detecting fibrillation events and starting clot prevention, the authors write in the journal Neurology.

    However, not everyone has access to or can afford high-tech monitoring, so the study team tested how accurately patients and their families could detect fibrillation just by taking a pulse.

    The study included 256 patients who had suffered a first stroke and were treated at the authors' stroke unit in Germany in late 2012 or early 2013. While still hospitalized, the patients and in some cases also their relatives were taught to take pulse readings from the radial artery in the left wrist.

    The patients and families were also given printed instruction materials and a stopwatch.

    During the half-hour tutorial, patients were taught to use the stopwatch to measure pulse rate and to recognize a normal pulse sensation and an irregular sensation that may indicate atrial fibrillation.

    Atrial fibrillation feels like a 'stumbling' rhythm and may be faster than 100 beats per minute or slower than 50, Kallmünzer said. A normal heartbeat is rhythmic and regular and only changes slightly on inhale and exhale.

    The patients were then hooked up to an electrical heart monitor and the screen was covered. A healthcare professional, the patient and the patient's family all attempted to take a pulse reading.

    According to the electrical heart monitor, 172 of the patients had normal heart rhythms and 57 had atrial fibrillations - the rest had another kind of abnormal rhythm. The researchers analyzed how often wrist pulse readings achieved the same result as the electrical heart monitor.

    Almost 90 percent of the patients who were mentally able did complete a pulse reading on themselves, and correctly detected 54 percent of the atrial fibrillations. Health care providers detected 97 percent of atrial fibrillations.

    Only six patients who thought their heart rates were irregular were incorrect. A false-positive rate that low is encouraging, the authors write.

    Among patients with atrial fibrillation whose family members took the tutorial, relatives detected the irregular beats 77 percent of the time by taking the patient's pulse.

    When atrial fibrillation is detected, medication can reduce the risk of a second stroke by 60 to 70 percent in comparison to not treating patients, according to Rolf Wachter of Universitatsmedizin Gottingen in Germany.

    "This is, I would say, one of the most effective therapies in medicine," he told Reuters Health in an email.

    Wachter, who was not part of the new study, researches heart conditions like atrial fibrillation.

    "We do not specifically know whether the approach in this paper is really the best approach. Other methods, including using a machine to monitor heart rhythm, might be better at detecting fibrillations, but they haven't been compared to each other in a trial," he said.

    "In general, taking your pulse is easy, harmless and free from side effects. Therefore anyone can try to do it," Kallmünzer said. "In stroke patients with very severe disability, family members, friends or nurses can do the measurements for the patient."

    The risk of a second stroke is highest during the months after the first one, but currently researchers do not know exactly how long this kind of pulse monitoring should go on, he said.

    If you're not sure how to take your pulse or that of a family member or how often you should check, ask your doctor, he said.

    "Health care professionals, doctors and nurses have outstanding experience in this technique and will be glad to give instructions."

    SOURCE: http://bit.ly/WC2Azb Neurology, online July 23, 2014.

  • Peer-led stress reduction may help mothers of kids with autism

    By Shereen Lehman

    NEW YORK (Reuters Health) - Programs teaching "mindfulness" and "positive psychology" both helped mothers of children with autism and other mental-development disabilities to reduce their stress, anxiety and depression, according to a new study.

    Most services for such families focus on the disabled child, researchers say, but improving the mental health of parents is likely to make them better caregivers and that, in turn, could improve their child's development.

    "There are literally decades of studies that have described the high levels of stress and distress, anxiety and depressive symptoms that moms and dads of children with developmental disabilities suffer, and I didn't want to describe anymore, I wanted to do something about it," said Elizabeth Dykens, who led the new study.

    "So this is really for parents - it was for their mental health and wellbeing, for their own adult development," said Dykens, an associate director of the Vanderbilt Kennedy Center for Research on Human Development in Nashville, Tennessee.

    "And I think that's what really sets it apart from the traditional interventions that are much more child oriented," she told Reuters Health.

    Past research has found that cognitive behavioral therapies, such as Mindfulness Based Stress Reduction and so-called positive psychology, are effective at reducing symptoms of stress, anxiety and even depression, Dykens and her colleagues write in the journal Pediatrics.

    Those two approaches have also been shown to lend themselves to group programs and to being delivered by non-professionals who have undergone the therapy themselves and been thoroughly trained to help peers, the authors add.

    For their study, Dykens and her colleagues enrolled 243 mothers of children with autism or other neurodevelopmental disabilities and randomly assigned them to groups that would receive either the mindfulness training or a positive psychology program called Positive Adult Development (PAD).

    "Mindfulness basically helps people focus on the present moment in a non-judgmental way, and it does that through deep belly breathing, gentle movements like yoga or qigong and meditation," Dykens said.

    She said the PAD group was more focused on thoughts, including practicing gratitude and forgiveness and defining one's own strengths.

    "Things that would counteract the anger or disappointment or feelings of guilt or sadness families often experience as they try to deal with the kids' challenging behavior and also work with the systems that are involved in providing care," she said.

    Four peer mentors, who were themselves mothers of children with developmental disabilities, had gone through the therapies and been trained to lead the groups under the supervision of a social worker.

    Both programs consisted of hour-and-a-half weekly sessions for six weeks. Psychological questionnaires were used to assess the participating mothers a total of six times before, during and up to six months after treatment.

    At the start, about 85 percent of the participating mothers had significantly elevated levels of stress, 48 percent were clinically depressed and 41 percent had anxiety disorders.

    By the end of six weeks, both groups showed significant reductions in stress, depression and anxiety levels, with sharp drops starting after just two weeks. In addition, both groups reported improved sleep and life satisfaction.

    Mothers in the mindfulness group had greater improvements in anxiety, depression, sleep and wellbeing and stronger responses in the categories of anxiety and depression, compared to the women in the positive psychology program during that time.

    The researchers speculate that may be because of the immediacy of physical relaxation promoted by the mindfulness approach. But over the longer follow-up period, mothers in the positive psychology group reported greater reductions in depression and improvements in life satisfaction compared to the mindfulness group, the researchers note.

    They acknowledge the study had some limitations because it compared two active interventions without using a comparison group that got no treatment.

    But, the study team writes, "untreated mothers of offspring with disabilities do not necessarily become less depressed over time." If anything, research shows they experience more health and mental health problems with age, the authors say.

    Dr. Eric Hollander told Reuters Health that despite its limitations, the study was large enough to show some interesting results.

    "It's pretty hard to show significant differences between active interventions but nevertheless the study did show some hints or suggestions of differences in terms of the type of interventions," he said.

    Hollander, who was not involved in the study, directs the Compulsive, Impulsive and Autism Spectrum Disorder Program at Montefiore Medical Center in New York.

    He said this is an important area for research because "families with children with autism spectrum disorder have higher caregiver burden than any other disorder."

    "I think the idea of using parents or peers to run these interventions is a good one because I think that families will identify with people who've been through the process," he said. "And it does bring down the cost."

    Dykens said that parents looking for this type of help could find books on mindfulness practice and there are some community mental health centers that offer help as well.

    Mindfulness Based Stress Reduction is a program originally developed for severely ill patients coping with pain, but is now offered more widely and parents can search online for psychotherapists, meditation centers and other health and wellness centers that may offer the course.

    Dykens added that joining parent groups and searching for local chapters of specific advocacy groups, such as the Autism Society and the National Down Syndrome Society, might also help parents.

    SOURCE: http://bit.ly/1rofAmY Pediatrics, online July 21, 2014.

  • Denver Broncos owner Pat Bowlen, battling Alzheimer's, steps down

    By Daniel Wallis

    DENVER (Reuters) - Denver Broncos owner Pat Bowlen is stepping down as he battles Alzheimer's disease, the National Football League team said on Wednesday, adding that it was saddened he could no longer take part in the club's daily operations.

    Bowlen, 70, is one of the NFL's most well-known owners and guided the Broncos to six Super Bowl appearances during his 30 years at the helm.

    "We continue to offer our full support, compassion and respect to 'Mr. B,' who has faced Alzheimer's disease with such dignity and strength," the team said in a statement.

    The team's president, Joe Ellis, will oversee day-to-day management, while a trust will handle Bowlen's ownership of the team.

    Alzheimer's is a degenerative brain disease with no known cure and is the most common cause of dementia in older people. Over time, it destroys one's memory and other cognitive abilities.

    Bowlen's long-term hope is for one of his children to run the team at the appropriate time, and his succession plan will continue to be implemented, the team said.

    With more than 300 victories, including six American Football League championships and back-to-back Super Bowls victories in 1997 and 1998, the team said Bowlen had established a "culture of winning" that is behind the Broncos' success.

    Ellis, who has worked with Bowlen for almost three decades, was also named as the Broncos' chief executive officer and adds those responsibilities to his role as team president.

    In a statement provided by the Broncos, Bowlen's wife said he had decided to keep his illness private because he believed the attention should not be on him.

    "Pat has always wanted the focus to be solely on the Denver Broncos and the great fans who have supported this team with such passion," Annabel Bowlen said.

    "Alzheimer's has taken so much from Pat, but it will never take away his love for the Denver Broncos and his sincere appreciation for the fans," she added.

  • Using a nicotine patch during pregnancy tied to higher ADHD risk

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Smoking during pregnancy has been linked to a higher chance of the child having attention-deficit/hyperactivity disorder (ADHD), and a new study suggests women who use nicotine replacement products may also have children with an elevated risk.

    That doesn't necessarily mean that nicotine causes ADHD, the authors note.

    For instance, it could be that women dependent on nicotine are more likely to have ADHD symptoms themselves, said senior author Dr. Carsten Obel, from Aarhus University in Denmark. The children of women who use nicotine replacement products to quit smoking may be at risk of ADHD because of genes or their family environment, he told Reuters Health by email.

    For the new study, the researchers analyzed information from Danish databases on more than 80,000 children born between 1996 and 2002.

    Mothers were interviewed while pregnant and asked if they currently smoked, used nicotine replacement products including gum, patches or sprays or had quit smoking before pregnancy without nicotine replacement. They also reported whether their husbands were current smokers.

    The researchers then followed the children through 2011 and noted hospital diagnoses of ADHD or use of medication for the disorder. Roughly two percent of children in the study were diagnosed with ADHD.

    Compared to children with nonsmoking parents, kids with two smoking parents were 83 percent more likely to develop ADHD, according to results published in Pediatrics.

    Having a mother who smoked during pregnancy seemed to be a stronger predictor of ADHD risk than having a father who smoked.

    Mothers who used nicotine replacement products had children with an increased risk of ADHD similar to the increase associated with smoking.

    At this point, it is too soon to estimate how important nicotine exposure might be for ADHD risk, Obel said.

    Mothers who had quit smoking and those who used nicotine replacement products both tended to have babies with higher, healthier birth weights than current smokers, he noted. Smoking during pregnancy is known to be associated with a lower birth weight for the baby.

    "The nicotine patch doesn't decrease birth weight, which has been used as a target measure for a long, long time," said Yoko Nomura, who studies central nervous system development at The City University of New York's Queens College.

    "We can't say the nicotine patch is useless because birth weight is so associated with many different illnesses," Nomura told Reuters Health. She was not part of the new study.

    For most people, the risk of ADHD is very small to begin with, she said.

    As of 2011, 11 percent of U.S. kids ages four to 17 had been diagnosed with ADHD, according to the Centers for Disease Control and Prevention.

    Many factors can influence the risk of ADHD, and most of the important predictors are genetic, Nomura said.

    "In order to prevent the non-genetic component of ADHD, we need to understand how smoking increases risk, and this doesn't help us learn more about that," she said.

    Parents reporting their own smoking habits may not be very reliable, given the social pressure to quit during pregnancy, she noted.

    "We have a long way to go before we can even conclude anything," Nomura said.

    "The best advice will at this point probably be to try to stop smoking without use of nicotine replacement and preferably before getting pregnant," Obel said. "If this is not possible nicotine replacement is, based on the birth weight results, preferable in comparison with continuing to smoke."

    For women who struggle to quit, even just cutting down on the number of cigarettes per day is a step in the right direction, Nomura said.

    SOURCE: http://bit.ly/1nP7FcE Pediatrics, online July 21, 2014.

  • Exercise may slow physical and mental decline after menopause

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Women who exercise regularly after menopause tend to maintain their physical strength and mental acuity longer than those who don't, according to a new review of past studies that found exercise that gets the heart rate up is best.

    "We found that all the studies showed that physical activity was associated with decreased rates of cognitive decline and that even becoming active in later life as opposed to a lifetime of physical activity still lowered the risk compared to those who were inactive," said Debra Anderson.

    Anderson worked on the study at the Institute of Health and Biomedical Innovation of the Queensland University of Technology in Kelvin Grove, Australia.

    She and her team reviewed 21 studies published between 2009 and 2014 assessing exercise or leisure time physical activity among women ages 65 and older. Ten were randomized controlled trials, the most rigorous kind of study, in which women were randomly assigned to different exercise programs or to no program.

    Some studies involved structured group exercise programs aimed at hitting certain heart rates and energy expenditures while others involved balance and strength training programs or yoga classes.

    Higher physical activity levels were always linked to slower physical decline and better fitness. Exercise generally seemed to preserve brain health, too, although the studies didn't agree on the strength of that association. Some concluded that a woman's brain function at age 50 largely predicted her mental faculties at ages 60 and 70, while others found that mental decline was strongly linked to being sedentary, the authors write in Maturitas.

    "We found that moderate to vigorous exercise is better than mild and gentle exercise," Anderson told Reuters Health in an email. "There was a dose response in moderate to vigorous exercise which showed more was progressively better."

    Current guidelines call for older adults to get the equivalent of 30 minutes of moderate exercise five times per week. But doctors might consider "prescribing" more intense exercise to older women, the authors suggest.

    "Based on our findings we feel this should be 30 to 45 minutes of moderate to vigorous activity at least five times per week for midlife and older women," Anderson said.

    Previously, older women have been encouraged to keep their exercise moderate, but now it seems very important that women exercise to a point where they cannot finish a sentence while exercising and breathe hard and sweat, she said.

    "I would encourage someone who has not exercised at this intensity before to see a general practitioner for a referral to an accredited exercise physiologist to talk with them on how to build up to this level," she added.

    The idea that breaking a sweat helps the brain is not new, said Selena Bartlett, a neuroscientist at Queensland University of Technology. She was not involved in the new study, but collaborates with Anderson on activity and cognition research.

    It's not clear exactly how exercise helps the brain, Bartlett told Reuters Health.

    "One thing we absolutely know is it builds muscle and strengthens the skeletal frame, and also brings oxygen and blood flow to the brain," she said.

    Keeping active helps make aging easier for everyone, not just postmenopausal women, Bartlett said, but that group might derive particular benefit. Estrogen levels decrease during menopause, and the hormone has a role in preserving brain cells and forming new memories.

    "Especially for postmenopausal women, the intensity matters for brain and body health," Bartlett said.

    SOURCE: http://bit.ly/WlzOm8 Maturitas, online June 20, 2014.

Oncology Articles

  • Robot bladder surgery fails to deliver fewer complications

    By Gene Emery

    NEW YORK (Reuters Health) - Using robotic techniques to remove a cancerous bladder doesn't reduce the risk of complications compared with conventional "open" surgery, according to a new comparison of 118 patients conducted by surgeons at the Memorial Sloan Kettering Cancer Center in New York.

    The study, detailed in the New England Journal of Medicine, marks the first ongoing comparison of the risks and benefits of the two techniques. Past studies concluded that the robotic technique meant less time in the hospital and fewer complications but they were done by looking back at the records of already-treated patients.

    "There's been a lot of hype surrounding robots and it's been hard to gain perspective," said Dr. Vincent Laudone, one of the coauthors.

    Dr. Jennifer Yates, director of minimally invasive urology at the University of Massachusetts Medical School, who was not involved in the test, told Reuters Health that the findings will give surgeons pause because they're going to be surprised by the results.

    Robots have shown to be so valuable for prostate removal, many surgeons were convinced that a similar benefit would appear when they were used for bladder removal, she said. "They're going to say, 'Hey, I'm kinda surprised by this.' They're also going to be encouraged that the complication rate was comparable."

    "Bottom line: It looks like it was pretty much a wash," Laudone told Reuters Health. For patients, it means "if you're going to a surgeon who is experienced in traditional surgery and recommends traditional surgery, that's a reasonable recommendation."

    He estimated that perhaps 25 percent of bladder cancer removals, known as radical cystectomies, are currently done with robots.

    The study also found that patients who underwent conventional surgery spent about 28 percent less time in the operating room. They experienced more blood loss - about 5 ounces more - but "with that amount, we wouldn't expect to see any significant side effect," Laudone said.

    "These results highlight the need for randomized trials to inform the benefits and risks of new surgical technologies before widespread implementation," he and his colleagues concluded.

    About 67,000 bladder tumors are discovered in the U.S. each year and one quarter of them require bladder removal.

    The new study involved patients who needed both the bladder and nearby lymph nodes extracted. The men also lost their prostate and the women lost their ovaries, fallopian tubes, uterus and related organs. Even when a $2 million robot was used, conventional surgery was employed to redirect urine to the intestine.

    With robot-assisted surgery, 22 percent of the 60 patients had at least one serious complication within the first 90 days. A complication was regarded as serious if it required further surgery, intubation or major rehabilitation. The rate was essentially the same - 21 percent - with traditional surgery.

    When the researchers included lesser complications, such as those requiring intravenous medicine or blood transfusion, the risk was 62 percent with robot-assisted surgery versus 66 percent with open surgery.

    The average length of hospital stay was eight days for both groups.

    But the patients in the robot group spent two hours longer in the operating room. The average time was 5 hours 29 minutes with conventional surgery and 7 hours 36 minutes with robotic assistance.

    Both Laudone and Yates said that time difference is expected to shrink as doctors become more adept at working with robots.

    "It's an evolving technology and we're evolving in our learning to use the robot," Laudone said. "We're getting better as robotic surgeons, so operating time is diminishing. With prostate surgery, the same thing was true. Now, in some cases, doing it with the robot is faster. So the time difference is something I think will disappear with more experience."

    Yates cautioned that "this was a small study and I think it needs to be fleshed out with larger numbers. And you have to remember that Sloan Kettering is one of the more prominent high-volume institutions in the country. Whether this is generalizable to other institutions remains to be seen."

    SOURCE: http://bit.ly/1wN4FCQ New England Journal of Medicine, online July 23, 2014.

  • Florida jury awards record $23 billion against RJ Reynolds

    By Barbara Liston

    ORLANDO, Fla. (Reuters) - A Florida jury has awarded the widow of a chain smoker who died of lung cancer 18 years ago record punitive damages of more than $23 billion in her lawsuit against the R.J. Reynolds Tobacco Company, the nation's second-biggest cigarette maker.

    The judgment, returned on Friday night, was the largest in Florida history in a wrongful death lawsuit filed by a single plaintiff, according to Ryan Julison, a spokesman for the woman's lawyer, Chris Chestnut.

    Cynthia Robinson of the Florida Panhandle city of Pensacola sued the cigarette maker in 2008 over the death of her husband, Michael Johnson, claiming the company conspired to conceal the health dangers and addictive nature of its products.

    Johnson, a hotel shuttle bus driver who died of lung cancer in 1996 at age 36, smoked one to three packs a day for more than 20 years, starting at age 13, Chestnut said.

    "He couldn't quit. He was smoking the day he died," the lawyer told Reuters on Saturday.

    After a four-week trial and 11 hours of deliberations, the jury returned a verdict granting compensatory damages of $7.3 million to the widow and the couple's child, and $9.6 million to Johnson's son from a previous relationship.

    The same jury deliberated for another seven hours before awarding Robinson the additional sum of $23.6 billion in punitive damages, according to the verdict forms.

    Lawyers for the tobacco company, a unit of Reynolds American Inc whose brands include Camel, Kool, Winston and Pall Mall cigarettes, could not immediately be reached for comment.

    But J. Jeffery Raborn, vice president and assistant general counsel for R.J. Reynolds, said in a statement quoted by the New York Times that the company planned to challenge "this runaway verdict." Such industry appeals are often successful.

    Chestnut countered, "This wasn't a runaway jury, it was a courageous one."

    He said jurors appeared to have been swayed by evidence of the company's aggressive marketing of tobacco products, particularly promotions aimed at young people, and by its claims that it was Johnson's choice to smoke.

    "They lied to Congress, they lied to the public, they lied to smokers and tried to blamed the smoker," he said.

    Robinson's lawsuit originally was part of a large class-action litigation known as the "Engle case," filed in 1994 against tobacco companies.

    A jury in that case returned a verdict in 2000 in favor of the plaintiffs awarding $145 billion in punitive damages, which at the time was the largest such judgment in U.S. history.

    That award, however, was tossed out in 2006 by the Florida Supreme Court, which decertified the class, agreeing with a lower court that the group was too disparate and that each consumer had smoked for different reasons.

    But the court said the plaintiffs could file lawsuits individually. Robinson was one of them.

    The Florida high court also let stand the jury's findings that cigarettes are defective and cause disease, and that Big Tobacco was negligent, meaning those issues did not have to be re-litigated in future lawsuits.

    The U.S. Supreme Court last month declined to hear a series of tobacco company appeals, mainly from R.J. Reynolds, seeking to overturn Florida court judgments totaling more than $70 million.

  • Musicians On Call' bring music for the soul to patients' beds

    By Daniel Gaitan

    NEW YORK (Reuters Health) - Musicians On Call, a nonprofit providing live music to the seriously ill, hopes to aggressively expand to other major cities across the U.S. next year.

    For more than a decade, volunteer artists with Musicians On Call have given bedside performances to patients undergoing treatment or unable to leave their hospital beds.

    "It's a very tangible way to give back," Pete Griffin, president of Musicians On Call, told Reuters Health. "We are not music therapy, because that is its own medical profession. What we do is bring live music, and what a lot of research shows is that that does decrease patients' stress levels and lowers blood pressure." Family members may also benefit from seeing their loved ones enjoy a "moment of normalcy."

    Since 1999, Musician On Call volunteers have performed for more than 415,000 patients in hospitals, nursing homes and hospices - but only in a handful of states.

    Griffin said the organization hopes to aggressively grow throughout 2015 and expand beyond its seven "hubs" where most Music On Call programs are located: New York, Philadelphia, Baltimore, Washington, D.C., Miami, Nashville and Los Angeles.

    For hospitals without the bedside concert program, Musicians On Call provides a collection of albums.

    "We create 'music pharmacies.' We have supporters and record labels who donate CDs, and then hospitals go on our website and request a 'music pharmacy,' a box of 200 CDs and CD players for their patients to listen to," Griffin said. Nearly 800 hospitals have requested them.

    Dr. Melinda R. Ring, an assistant professor of clinical medicine at Northwestern University's Feinberg School of Medicine in Chicago, said she believes music helps provide the seriously ill a sense of peace.

    "Music touches us. Music has the ability to transform the mood that we're in, the way we're perceiving things," Ring told Reuters Health. "For somebody who has fears about death, pain or other end-of-life issues, listening to something that can bring them joy in the hospital doesn't necessarily change the outcome of what will happen, but it changes their experience."

    Loretta Downs, past president of the Chicago End-of-Life Care Coalition and a hospice volunteer, said she would like to see more medical centers supporting Musicians On Call.

    "Music is a form of reminiscence, and if a family member or a patient can request a song that brings back positive memories, it's a great thing," Downs told Reuters Health. "We want to remember the things that made us happy."

    Downs founded Chrysalis End-of-Life Inspirations, an effort aiming to equip hospitals and nursing homes with "Chrysalis Rooms," private spaces where seriously ill patients can gather with family and friends and listen to music, among other things.

    Many artists visiting hospitals through Musicians On Call find themselves playing requests for upbeat pop songs. Currently, the most popular request from young people is "Let It Go," the Oscar-winning anthem from the animated film "Frozen."

    "When we go into the children's hospitals, a lot of them know the Disney songs," Griffin added. "With the older populations, blues and classic rock are popular. Country music is popular around Nashville, rock in the Northeast."

    Singer and songwriter Kenli Mattus was one of the first artists to work with Musicians On Call.

    "I really enjoy giving patients what I think they want. For kids, I play nursery rhyme songs or make up songs on the spot, which they really like. When I play for adults, I play Frank Sinatra, soul or gospel." Mattus told Reuters Health. "When you go room-to-room and play for a handful of people, it's an incredible personal connection. It really inspires me and makes me feel like I'm doing something good for the world."

    Other notable artists who have performed with Musicians On Call include Pharrell Williams, Kelly Clarkson and Paulina Rubio.

  • HPV test better than Pap for assessing cervical cancer risk: study

    By Andrew M. Seaman

    NEW YORK (Reuters Health) - Testing for human papillomavirus (HPV) may be the best way to know whether a woman is at risk of developing cervical cancer in the near future, according to a new study.

    Negative HPV tests provided women with more reliable assurance that they wouldn't develop cancer or other abnormal cervical changes in the next three years, compared to traditional Pap tests, researchers report.

    "Primary HPV screening might be a viable alternative to Pap screening alone," said Julia Gage, the study's lead author from the National Institutes of Health's National Cancer Institute in Bethesda, Maryland.

    About 12,000 U.S. women were diagnosed with cervical cancer in 2010 and about 4,000 died from the disease, according to the Centers for Disease Control and Prevention. Roughly 91 percent of cervical cancers are thought to be caused by HPV.

    Pap smears, which require doctors to collect cells from the cervix to look for abnormalities, have traditionally been used to determine whether a woman is at risk of developing cancer in the near future.

    In 2012, the government-backed U.S. Preventive Services Task Force recommended women between ages 21 and 65 years be screened using a Pap test every three years and said those ages 30 to 65 years could instead opt for cotesting, which is a Pap test in combination with a HPV test, every five years.

    HPV is the most common sexually transmitted infection and affects both men and women. About 79 million people have the infection but most people don't know they're infected because symptoms are uncommon.

    HPV testing also requires doctors to collect cells like they would during a Pap test but the end result is whether the woman has the virus - not abnormal cells.

    "What we wanted to see is whether primary HPV screening could be a good alternative to Pap and compare it to cotesting," Gage said.

    For the new study, the researchers used data from over one million women who were between ages 30 and 64 years and screened for cervical cancer at Kaiser Permanente Northern California since 2003.

    The researchers followed women who had a negative Pap or HPV test to see whether they developed cervical cancer during the next three years. They also looked at how many women developed cervical cancer in the five years following cotesting.

    Overall, about 20 women out of 100,000 developed cervical cancer in the three years following a negative Pap test. That compared to 11 women out of 100,000 who developed the cancer during the three years after receiving a negative HPV test.

    About 14 women out of 100,000 developed cervical cancer in the five years following negative cotests, according to results published in the Journal of the National Cancer Institute.

    Gage said the findings were not surprising, since HPV is the cause of most cervical cancers.

    She cautioned that the results do not foreshadow the death of Pap smears. The tests may still have a role in monitoring whether women with HPV, who are at an increased risk of cancer, go on to develop abnormal cervical cells.

    "We always have to reconsider how we're screening patients and focus on the best way to screen for certain cancer," said Dr. Mario Leitao Jr., a gynecological surgeon at Memorial Sloan Kettering Cancer Center in New York City.

    "I think this is very interesting because instead of doing (Pap tests) every three years you could do HPV (tests) every three years," said Leitao, who was not involved with the new study.

    He said there will be a lot of variables in deciding which test is best for women.

    "The best way to do it is still to be determined but it's important they have some form of cervical cancer screening at least every three years," Leitao said.

    He added that women also have to be their own advocates and tell their doctors that they don't need Pap tests every year.

    "It shouldn't be done more frequently than every three years," he said.

    SOURCE: http://bit.ly/UckC33 Journal of the National Cancer Institute, online July 18, 2014.

  • Depression may keep some men from fighting prostate cancer

    By Shereen Lehman

    NEW YORK (Reuters Health) - Depression may be source of disparities in the treatment men get for prostate cancer, according to a new study.

    In the analysis, older men who were depressed before they got a prostate cancer diagnosis were more likely to have aggressive cancer, less likely to undergo the recommended treatment for their stage and type of disease and more likely to die.

    "We traditionally think of disparities in healthcare by race and socioeconomic status, but our research demonstrates that mental illness can also be a significant driver of treatment choice and outcomes in terms of prostate cancer," Dr. Jim Hu told Reuters Health in an email.

    Hu is director of robotic and minimally invasive surgery at the David Geffen School of Medicine at UCLA. He led the new study that was published in Journal of Clinical Oncology.

    According to the Centers for Disease Control and Prevention, almost 200,000 men were diagnosed with prostate cancer in the U.S. in 2010, and just under 30,000 men died from the disease that year.

    Past research has linked depression to a greater likelihood of getting less-aggressive treatment and to poorer survival in other cancers, including breast and liver cancers. But little is known about how depression might affect men's diagnosis and treatment for prostate cancer, Hu and his colleagues write.

    The researchers analyzed information from a large national database of Medicare patients, focusing on more than 40,000 men diagnosed with localized prostate cancer between 2004 and 2007 and observed through 2009.

    Of those, 1,894 men were also diagnosed with depression during the two years before their cancer was detected.

    "First, we found that men with prostate cancer who were older, lower income, with more medical (conditions), white or Hispanic (versus Black and Asian), unmarried, residing in nonmetropolitan areas were more likely to be depressed," Hu said.

    "In addition, depressed men were less likely to seek out definitive therapy (surgery or radiation) in contrast to non-depressed men," he said, which goes against the current guidelines for treating intermediate- and high-risk disease.

    After adjusting for differences in the men's tumor characteristics and the treatment they chose, the researchers found that depressed men had worse overall survival compared to men who were not depressed, Hu noted.

    Hu said he was surprised by the results because depressed men were more likely to see physicians in the two years before their prostate cancer diagnosis compared to non-depressed men - an average of 43 times versus 27 times, respectively.

    The team also found that depressed men were more likely to get so-called expectant management, which includes the use of hormones to decrease the aggressiveness of prostate cancer or no treatment at all, which is called "watchful waiting" or active surveillance.

    It's possible, Hu and his colleagues write, that depression makes men less interested in screening, leading to their cancers being diagnosed at a later stage, and makes them choose less aggressive treatment. The greater number of doctor visits might be focused on mental illness, leading to less attention toward cancer screening.

    These findings cannot prove there's a cause and effect at work, the authors caution. However, they suggest that physicians should take care to ensure prostate cancer patients are getting the mental health treatment they need so depression doesn't bias a patient's treatment choices and chances for survival.

    Dr. Behfar Ehdaie, a surgeon who specializes in prostate cancer at Memorial-Sloan Kettering Cancer Center in New York, said that mental health is an important aspect of prostate cancer care.

    Given the prevalence of depression in these men, survivorship in that light has been underreported in the literature, said Ehdaie, who was not involved in the study.

    "We know that men who are diagnosed with prostate cancer have an increased risk of suicide - this was shown in a Swedish study looking at men from Sweden," he told Reuters Health.

    "This adds more data from the United States, specifically looking at men age 67 and older, that also demonstrates that mental health should be assessed and be part of our prostate cancer care," he said.

    But Ehdaie emphasized that this study does not suggest the less aggressive approach of expectant management is associated with poor outcomes, or that depression increases the risk of dying from prostate cancer.

    "The endpoint evaluated is overall survival, and we do know that from previous studies, depression is associated with cardiovascular events, for example, which are also associated with increased risk of mortality," Ehdaie said.

    That distinction between deaths from prostate cancer or progression of the disease, and overall deaths from any cause is important, he added.

    Ehdaie said that future studies are needed to determine the impact of mental health issues on treatment decision making, especially in men with intermediate- or high-risk disease who appear not to be receiving the appropriate treatment.

    "As healthcare providers, we need to be aware of the greater risk for aggressive prostate cancer in depressed men," Hu said. "Additionally, depressed men may require special attention in light of the lower initiative to follow through with physician recommendations."

    Hu added that encouraging depressed men with prostate cancer to join prostate cancer support groups may help spur them to pursue recommended treatments.

    SOURCE: http://bit.ly/UdORwx Journal of Clinical Oncology, online July 7, 2014.

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Women’s Health Articles

  • Peer-led stress reduction may help mothers of kids with autism

    By Shereen Lehman

    NEW YORK (Reuters Health) - Programs teaching "mindfulness" and "positive psychology" both helped mothers of children with autism and other mental-development disabilities to reduce their stress, anxiety and depression, according to a new study.

    Most services for such families focus on the disabled child, researchers say, but improving the mental health of parents is likely to make them better caregivers and that, in turn, could improve their child's development.

    "There are literally decades of studies that have described the high levels of stress and distress, anxiety and depressive symptoms that moms and dads of children with developmental disabilities suffer, and I didn't want to describe anymore, I wanted to do something about it," said Elizabeth Dykens, who led the new study.

    "So this is really for parents - it was for their mental health and wellbeing, for their own adult development," said Dykens, an associate director of the Vanderbilt Kennedy Center for Research on Human Development in Nashville, Tennessee.

    "And I think that's what really sets it apart from the traditional interventions that are much more child oriented," she told Reuters Health.

    Past research has found that cognitive behavioral therapies, such as Mindfulness Based Stress Reduction and so-called positive psychology, are effective at reducing symptoms of stress, anxiety and even depression, Dykens and her colleagues write in the journal Pediatrics.

    Those two approaches have also been shown to lend themselves to group programs and to being delivered by non-professionals who have undergone the therapy themselves and been thoroughly trained to help peers, the authors add.

    For their study, Dykens and her colleagues enrolled 243 mothers of children with autism or other neurodevelopmental disabilities and randomly assigned them to groups that would receive either the mindfulness training or a positive psychology program called Positive Adult Development (PAD).

    "Mindfulness basically helps people focus on the present moment in a non-judgmental way, and it does that through deep belly breathing, gentle movements like yoga or qigong and meditation," Dykens said.

    She said the PAD group was more focused on thoughts, including practicing gratitude and forgiveness and defining one's own strengths.

    "Things that would counteract the anger or disappointment or feelings of guilt or sadness families often experience as they try to deal with the kids' challenging behavior and also work with the systems that are involved in providing care," she said.

    Four peer mentors, who were themselves mothers of children with developmental disabilities, had gone through the therapies and been trained to lead the groups under the supervision of a social worker.

    Both programs consisted of hour-and-a-half weekly sessions for six weeks. Psychological questionnaires were used to assess the participating mothers a total of six times before, during and up to six months after treatment.

    At the start, about 85 percent of the participating mothers had significantly elevated levels of stress, 48 percent were clinically depressed and 41 percent had anxiety disorders.

    By the end of six weeks, both groups showed significant reductions in stress, depression and anxiety levels, with sharp drops starting after just two weeks. In addition, both groups reported improved sleep and life satisfaction.

    Mothers in the mindfulness group had greater improvements in anxiety, depression, sleep and wellbeing and stronger responses in the categories of anxiety and depression, compared to the women in the positive psychology program during that time.

    The researchers speculate that may be because of the immediacy of physical relaxation promoted by the mindfulness approach. But over the longer follow-up period, mothers in the positive psychology group reported greater reductions in depression and improvements in life satisfaction compared to the mindfulness group, the researchers note.

    They acknowledge the study had some limitations because it compared two active interventions without using a comparison group that got no treatment.

    But, the study team writes, "untreated mothers of offspring with disabilities do not necessarily become less depressed over time." If anything, research shows they experience more health and mental health problems with age, the authors say.

    Dr. Eric Hollander told Reuters Health that despite its limitations, the study was large enough to show some interesting results.

    "It's pretty hard to show significant differences between active interventions but nevertheless the study did show some hints or suggestions of differences in terms of the type of interventions," he said.

    Hollander, who was not involved in the study, directs the Compulsive, Impulsive and Autism Spectrum Disorder Program at Montefiore Medical Center in New York.

    He said this is an important area for research because "families with children with autism spectrum disorder have higher caregiver burden than any other disorder."

    "I think the idea of using parents or peers to run these interventions is a good one because I think that families will identify with people who've been through the process," he said. "And it does bring down the cost."

    Dykens said that parents looking for this type of help could find books on mindfulness practice and there are some community mental health centers that offer help as well.

    Mindfulness Based Stress Reduction is a program originally developed for severely ill patients coping with pain, but is now offered more widely and parents can search online for psychotherapists, meditation centers and other health and wellness centers that may offer the course.

    Dykens added that joining parent groups and searching for local chapters of specific advocacy groups, such as the Autism Society and the National Down Syndrome Society, might also help parents.

    SOURCE: http://bit.ly/1rofAmY Pediatrics, online July 21, 2014.

  • Bill Clinton says AIDS-free generation "within reach"

    By Katie Nguyen

    MELBOURNE (Thomson Reuters Foundation) - An AIDS-free generation is within reach if early treatment is provided to people infected with HIV and help scaled up for women and children, former U.S. president Bill Clinton said on Wednesday.

    Addressing an international conference on AIDS in the Australian city of Melbourne, Clinton said much progress has been made since the world started fighting the AIDS epidemic.

    His speech, which attracted hundreds of scientists, activists and journalists, was briefly interrupted by protesters holding placards, demanding a "Robin Hood" tax on financial transactions to fund the fight against HIV and AIDS.

    "We should no longer have any doubts, nor should anyone else, that we have the ability to see this effort through to the end," said Clinton, resuming his speech.

    "An AIDS-free generation is within our reach," he told the packed auditorium.

    Although the world had made great strides in expanding HIV treatment to millions of people, every year more than 2 million people - about four a minute - were newly infected, he said.

    The number of people dying from AIDS-related illnesses has fallen steadily in recent years. In 2013, some 1.5 million people died, compared with 2.4 million people in 2005, according to the Joint United Nations Program on HIV/AIDS (UNAIDS).

    Big challenges include finding and treating people with HIV early, and delivering care in hard-to-reach and rural places.

    He said poor countries in particular must be supported to meet specific goals over the next three to five years.

    Countries must drastically reduce the transmission of HIV through breastfeeding, ensure babies born with HIV receive immediate treatment, and identify and treat children infected with HIV in the past decade, Clinton said.

    The human immunodeficiency virus (HIV) that causes AIDS can be transmitted via blood, breast milk and by semen during sex, but can be kept in check with cocktails of drugs known as antiretroviral therapy.

    "As many as 50 percent of all new paediatric infections occur during the breastfeeding period," Clinton said.

    "So, keeping these women in care until the end of breastfeeding is perhaps the single most important thing we can do to achieve an AIDS-free generation. It's our big remaining barrier," he said.

    While the Clinton family charity, Health Access Initiative, mainly targets the poor, he acknowledged HIV was also a high-income problem. He noted too that the number of infections among younger men having sex with men is rising in the United States.

    He ended his speech, calling for a redoubling of efforts to combat stigma and prejudice which have been blamed for the high levels of HIV in the most high-risk groups: sex workers, gay men, prisoners, injecting drug users and transgender people.

  • HIV-positive women in Central America pressured to sterilize

    By Katie Nguyen

    MELBOURNE (Thomson Reuters Foundation) - HIV-positive women in Central America are being pressured to undergo sterilization by prejudiced health workers and misled about the risk of the virus being transmitted to their unborn children, a study has found.

    A survey of 285 women living with HIV in El Salvador, Honduras, Mexico and Nicaragua found that 23 percent of them had faced pressure from doctors and nurses to be sterilized.

    The rate ranged from 20 percent in Nicaragua to 28 percent in Mexico, according to research by the Mesoamerican Coalition for the Reproductive Rights of Women with HIV and the Women and Health Initiative of Harvard School of Public Health.

    The consistency of the rate over a large geographical area pointed to a "systematic pattern" of pressure and coercion, said Harvard School of Public Health research fellow Tamil Kendall.

    "It's really unthinkable that women living with HIV are being pressured and forced into sterilization when treatment almost eliminates the possibility of the mother-to-child transmission... and also provides options for safer conception and pregnancy," said Kendall, who presented the research at an international conference on AIDS in Melbourne on Wednesday.

    "In this day and age there is no reason why women living with HIV can't safely exercise their reproductive rights," she told Thomson Reuters Foundation, adding that it was likely the attitude of many health workers reflected the stigma towards HIV in the societies they came from.

    UNKNOWINGLY STERILIZED

    An estimated 17.7 million women worldwide had the human immunodeficiency virus (HIV) that causes AIDS in 2012, according to the World Health Organization (WHO).

    Citing U.N. figures, Kendall said there were 59,300 women living with HIV in Mexico, El Salvador, Honduras and Nicaragua in 2012.

    The study said pregnant HIV-positive women - whose status was known to health workers - were almost eight times more likely to report an experience of pressure or coercion to sterilize than women with HIV who were not pregnant.

    In one "particularly horrific" case, Kendall said a Mexican woman was sterilized without her knowledge while under anaesthetic for a Cesarean section. When she woke up, her thumb had been dipped in ink so it could be used on a consent form.

    In another case, a young Salvadoran said nurses threatened to deny her a Cesarean unless she signed up to be sterilized.

    Health workers often fed women misinformation as a way of coercing them, said Kendall, who has carried out research on women living with HIV in Latin America for more than a decade.

    "Women are told that if they have another pregnancy that either they will die or their children will almost surely acquire HIV and die," she said.

    "Healthcare providers use these kinds of high pressure tactics to force them into sterilization, and this is simply scientifically untrue."

    Without treatment, the likelihood of a HIV-positive mother transmitting HIV to her child during pregnancy, labor, delivery or through breastfeeding ranges from 15 percent to 45 percent, WHO says. With the right antiretroviral treatment, the transmission rate can be reduced to below 5 percent.

    The women surveyed in Central America came from rich and poor, rural and urban backgrounds. Women of indigenous and African descent were also represented.

    Yet neither their ethnicity, nor economic or social status were significant in indicating whether they were likely to be pressured to sterilize, Kendall said.

    "That reinforces the idea that what is actually driving this is discrimination around HIV itself," she said.

  • Pregnancy doesn't drive women doctors out of surgical training

    By Ronnie Cohen

    NEW YORK (Reuters Health) - A new study disputes a common stereotype that women who become pregnant during surgical training often drop out of those training programs.

    Researchers led by Dr. Erin G. Brown of the University of California, Davis found that neither women nor men who had children born during their school's surgical residency program were more likely to quit than residents who did not have children during training.

    Brown told Reuters Health the idea for the study came to her when she was pregnant with her daughter, now one and a half years old, during her surgical residency.

    "Things are changing. It's not an overnight change. It's a slow, steady culture change away from the old boys' club mentality that women who have children during training aren't going to cut it," she said.

    "This study shows that surgical residents who have children during training are just as good," she added.

    General surgical residency programs last five years and are known for being rigorous.

    For the new study, Brown and her colleagues reviewed records on 85 residents enrolled in the University of California, Davis general surgery residency program from 1999 to 2009.

    Forty-nine of the residents were men, and the average age of all residents entering the program was almost 28 years. Overall attrition was about 19 percent, with 16 residents leaving the program.

    A similar proportion of male and female residents left the training program.

    Of the 85 residents, 25 had children born during training.

    Among female residents in particular, 25 percent had children during training and took an average maternity leave of 10 weeks. One of those women left the training program. One woman extended her residency training by two weeks, but the other women who had babies while in training completed the program on time.

    Residents with children born during the program treated a similar number of patients and were equally likely to pass their boards as those who did not have children, according to findings published in JAMA Surgery.

    In an accompanying commentary, Dr. Jeffrey Gauvin, director of the surgical training program at Santa Barbara Cottage Hospital in California, applauded the study but questioned its applicability to smaller programs like his own.

    Davis has "a deep bullpen from which a program director can call in reserves when someone is on leave," he writes. "This may be a very different scenario for small or midsized programs that have very limited - if any - reserves."

    Gauvin formerly directed the surgical residency program at the University of California, Davis.

    Brown acknowledged that smaller programs could face greater challenges in accommodating surgical residents during maternity leave. She is currently compiling data from surgical residency programs of various sizes across the nation to see if the results of the Davis study hold.

    "These are very motivated women who know what they want, and they're able to manage the stress of parenting and training and don't deviate from their career goals," Brown said.

    Women comprised just seven percent of U.S. medical school graduates in 1965, according to the Association of American Medical Colleges. Today that rate hovers near 50 percent.

    But a majority of surgical residents continue to be male, Dr. Nina Shapiro told Reuters Health.

    Shapiro, a professor of head and neck surgery at the University of California, Los Angeles, was not involved in the current study. She said she has watched life change for pregnant surgical residents since she began her training in 1991.

    "Because there's been an increase in the number of women, the climate has by default changed," she said. "There's a huge difference in 20 years."

    "The women going into surgery are very keenly watching those ahead of them. If women are showing they can have babies and be successful, I think other women are going to follow. It's really inspiring for women going into these training programs."

    Shapiro is married to another physician, and they have two young children.

    "Is it a perfect life?" she asked. "There are many days I can't see my kids. For the most part, I make it work. I never miss a school event, a big event in my kids' lives. I don't miss too many small events. I do a lot of homework. I know a lot of fifth-grade math."

    SOURCE: http://bit.ly/1n1S0L8 and http://bit.ly/1nk9sMq JAMA Surgery, online July 16, 2014.

  • Exercise may slow physical and mental decline after menopause

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Women who exercise regularly after menopause tend to maintain their physical strength and mental acuity longer than those who don't, according to a new review of past studies that found exercise that gets the heart rate up is best.

    "We found that all the studies showed that physical activity was associated with decreased rates of cognitive decline and that even becoming active in later life as opposed to a lifetime of physical activity still lowered the risk compared to those who were inactive," said Debra Anderson.

    Anderson worked on the study at the Institute of Health and Biomedical Innovation of the Queensland University of Technology in Kelvin Grove, Australia.

    She and her team reviewed 21 studies published between 2009 and 2014 assessing exercise or leisure time physical activity among women ages 65 and older. Ten were randomized controlled trials, the most rigorous kind of study, in which women were randomly assigned to different exercise programs or to no program.

    Some studies involved structured group exercise programs aimed at hitting certain heart rates and energy expenditures while others involved balance and strength training programs or yoga classes.

    Higher physical activity levels were always linked to slower physical decline and better fitness. Exercise generally seemed to preserve brain health, too, although the studies didn't agree on the strength of that association. Some concluded that a woman's brain function at age 50 largely predicted her mental faculties at ages 60 and 70, while others found that mental decline was strongly linked to being sedentary, the authors write in Maturitas.

    "We found that moderate to vigorous exercise is better than mild and gentle exercise," Anderson told Reuters Health in an email. "There was a dose response in moderate to vigorous exercise which showed more was progressively better."

    Current guidelines call for older adults to get the equivalent of 30 minutes of moderate exercise five times per week. But doctors might consider "prescribing" more intense exercise to older women, the authors suggest.

    "Based on our findings we feel this should be 30 to 45 minutes of moderate to vigorous activity at least five times per week for midlife and older women," Anderson said.

    Previously, older women have been encouraged to keep their exercise moderate, but now it seems very important that women exercise to a point where they cannot finish a sentence while exercising and breathe hard and sweat, she said.

    "I would encourage someone who has not exercised at this intensity before to see a general practitioner for a referral to an accredited exercise physiologist to talk with them on how to build up to this level," she added.

    The idea that breaking a sweat helps the brain is not new, said Selena Bartlett, a neuroscientist at Queensland University of Technology. She was not involved in the new study, but collaborates with Anderson on activity and cognition research.

    It's not clear exactly how exercise helps the brain, Bartlett told Reuters Health.

    "One thing we absolutely know is it builds muscle and strengthens the skeletal frame, and also brings oxygen and blood flow to the brain," she said.

    Keeping active helps make aging easier for everyone, not just postmenopausal women, Bartlett said, but that group might derive particular benefit. Estrogen levels decrease during menopause, and the hormone has a role in preserving brain cells and forming new memories.

    "Especially for postmenopausal women, the intensity matters for brain and body health," Bartlett said.

    SOURCE: http://bit.ly/WlzOm8 Maturitas, online June 20, 2014.