Research in the South Texas Medical Center



Want to Volunteer for a Study or Participate in a Clinical Trial?

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

  • Self management may reduce blood pressure: study

    By Andrew M. Seaman

    NEW YORK (Reuters Health) - Even people at significant risk for heart attacks and strokes can take an active role in reducing their own high blood pressure, by measuring it themselves and adjusting their medications, according to a new study from the UK.

    Researchers found that patients who closely monitored their own blood pressure and medications, using detailed instructions from their doctors, lowered their readings more than patients who relied on their healthcare providers to take periodic readings and make medication changes.

    "We've previously done a study with a group of people with uncomplicated hypertension (or high blood pressure)," said Dr. Richard McManus, the report's lead author. "We wanted to see if that intervention would also work with people with greater coronary heart disease and in the elderly."

    The intervention consisted of patients creating a detailed plan with their doctor, measuring their own blood pressure daily and adjusting their medications according to their blood pressure readings and instructions in the plan.

    This new approach resulted in better management and lower blood pressure after a year, in part because doctors tend to be reluctant to change medications based on blood pressure readings recorded at a single healthcare visit, the researchers suggest.

    Healthcare providers don't always act on readings that are above target, McManus said.

    He and his colleague write in JAMA that other studies have found self monitoring of blood pressure may result in lower readings and many people in the UK already monitor their own blood pressure.

    For the new study, the researchers enrolled 552 patients with high blood pressure and a history of other significant health problems, such as strokes, heart attacks, diabetes and kidney disease. The patients were recruited from 59 doctors' offices in the UK and participated in the trial between 2011 and 2013.

    Normal blood pressure is considered to be a systolic (the top number) reading of 120 millimeters of mercury (mmHg) or less and a diastolic (the bottom number) of 80 mmHg or less, according to the U.S. National Institutes of Health.

    High blood pressure is usually defined as a systolic reading above 140 mmHg and a diastolic reading of 90m mmHg or more. Any reading between the normal and high categories is considered to be "prehypertension."

    Half of the patients were assigned to take part in the intervention and the other half were assigned to receive usual care, which consisted of periodic visits to their doctors for blood pressure readings and medication adjustment.

    At the beginning of the study, the participants in each group had an average blood pressure reading of about 144 mmHg over about 80 mmHg.

    Among patients in the self-management group, the number and types of medications taken tended to increase, so that after 12 months, they were taking, on average, 3.3 doses of medication a day compared to 2.6 in the usual care group.

    After 12 months, the systolic reading fell in both groups, but significantly more among those who took their own readings and managed their own medications.

    People in the usual care group saw their average systolic reading fall to about 138 mmHg after one year, compared to 128 mmHg among those in the intervention group.

    "These differences in blood pressure that were observed in this study were quite substantial," said Dr. Steven Nissen, chairman of the Robert and Suzanne Tomsich Department of Cardiovascular Medicine located on the main campus of Cleveland Clinic in Ohio.

    Any reduction in blood pressure of more than 2 or 3 mmHg is a noticeable difference, said Nissen, who wasn't involved in the new study but coauthored a commentary on it in the journal.

    While the results can't prove whether those in the intervention group went on to have fewer strokes and heart attacks, Nissen said lower blood pressure is tied to better long-term outcomes.

    He cautioned that not every person with blood pressure problems will be able to handle their own readings or medication management.

    "It just means you can't go into every community and expect every patient to have the sophistication and means to follow this type of algorithm," Nissen said.

    He added that people have difficulty controlling their blood pressure for a variety of reasons - not just that doctors won't adjust medication during office visits.

    For example, Nissen said, people in the U.S. may also have trouble accessing healthcare and affording prescriptions. He said self treatment is a potential option, however.

    "There are a lot of people out there with high blood pressure - a significant number of them (are) still above targeted readings despite treatment," McManus said. "This is an intervention that could be used in those people."

    He cautioned, however, that people need to talk with their doctors about this type of blood pressure management and should not attempt it on their own.

    SOURCE: http://bit.ly/1lwkHSh and http://bit.ly/1opxQqO JAMA, online August 26, 2014.

  • CORRECTED-Travel with medications, medical devices can be daunting

    (In paragraph 14, clarifies Dr. Bauer's comment)

    By Kathryn Doyle

    NEW YORK (Reuters Health) - For international travelers who need to carry medical devices and medications with them, it's not easy to find out the travel requirements at their destinations, and embassies in general aren't much help, according to a new study.

    "The problem is known to exist but has not previously been published as we have," said lead author Moses Mutie of the Faculty of Health at the University of Canberra in Bruce, Australia.

    "Most embassies focus on trade and tourism," Mutie told Reuters Health by email. "Health issues are not often a priority."

    The Australian researchers considered the situation of a traveler from their own country going to one of 25 other countries popular with Australian tourists, including destinations in Africa, the Americas, Europe, Southeast Asia and the Western Pacific.

    The researchers explored embassy and consular websites looking for the quantities and different types of medication allowed in the country for personal use, required documentation, customs information and details about travelling with medical equipment.

    They also sent a standardized email to each embassy asking those same questions.

    Two weeks later, 11 embassies had responded, two of which forwarded the questions to the Pharmacy Board of the home country but did not respond further, the authors report in Travel Medicine and Infectious Disease.

    Of the eight countries that did respond, their recommendations varied widely, and tended to be much more strict than the recommendations of the International Narcotics Control Board (INCB), an independent body implementing United Nations Drug Control Conventions.

    According to the INCB recommendations for individual travelers, you should carry a copy of the prescription, but there are no other certifications or requirements for less than 20 doses of any medication, or less than a 30-day supply of narcotics or psychotropics, such as Ambien or Haldol.

    Many embassies, however, said all drugs required special certification of ownership and personal use, beyond a valid prescription. In some countries, a visitor is required to consult a local clinician to validate ongoing need for the medication.

    Some countries warn that if authorities are in doubt, they have the right to deny entry or confiscate the medications, the authors write.

    Drugs on Schedule I of the U.S. Controlled Substances Act, including hallucinogens or stimulants with no medical use, like THC or cocaine, can never be brought across national borders.

    Neither the embassy and consular websites nor the email responses addressed medical equipment.

    The lack of information for travelers offered by local embassies may sometimes indicate a lack of suitable regulations in destination countries, or that no one knows where to find them, said Dr. Irmgard Bauer of the Division of Tropical Health and Medicine at James Cook University in Townsville, Australia, who was not part of the study. She called the situation a "huge mess."

    Patients should turn to their treating doctor and a travel clinic, with both having the obligation to find out what is required, she told Reuters Health by email.

    "Travellers on longer trips could also be referred to a colleague in the country of destination to continue treatment and prescribe the medication," she said. "In some cases, it may mean that travel cannot happen."

    Specific outcomes for a traveler with too much medication or not enough documentation depend on the country, its law, and the person working at customs that day, Bauer said.

    "With narcotics, an arrest is not unlikely," she said. "In some countries, this will not be pleasant."

    The situation can be toughest for last minute travelers, Mutie said, but ideally there will be sufficient time to search for information ahead of time and talk to your doctor, who should be the principal source of the required information.

    Dr. Natasha Hochberg, an infectious disease physician at Boston University School of Public Health, suggested "that international travelers with chronic medical conditions seek care at least 4 to 6 weeks in advance of travel at a travel clinic to address issues related to bringing medications overseas but also to address the need for immunizations and prophylactic medication and to discuss health-promoting topics."

    Hochberg, who was not involved in the new study, added, "Travelers bringing medication overseas should bring the medication in their carry-on luggage to prevent possible loss in checked baggage, keep it in the original bottle that the medication came in, take enough to last for their trip as well as some extra in case of changes to the itinerary, and have adequate documentation including the original prescription and possibly a signed letter on travel clinic letterhead."

    For medical devices, Mutie suggests planning ahead and checking with the airline. Airlines, he notes, have published clear medical clearance guidelines in this area.

    In future, embassy websites should be designed with the user in mind, since embassies are established to provide a service, he said.

    SOURCE: http://bit.ly/1lfNmeb Travel Medicine and Infectious Disease, August 6, 2014.

  • CORRECTED-Travel with medications, medical devices can be daunting

    (In paragraph 14, clarifies Dr. Bauer's comment)

    By Kathryn Doyle

    NEW YORK (Reuters Health) - For international travelers who need to carry medical devices and medications with them, it's not easy to find out the travel requirements at their destinations, and embassies in general aren't much help, according to a new study.

    "The problem is known to exist but has not previously been published as we have," said lead author Moses Mutie of the Faculty of Health at the University of Canberra in Bruce, Australia.

    "Most embassies focus on trade and tourism," Mutie told Reuters Health by email. "Health issues are not often a priority."

    The Australian researchers considered the situation of a traveler from their own country going to one of 25 other countries popular with Australian tourists, including destinations in Africa, the Americas, Europe, Southeast Asia and the Western Pacific.

    The researchers explored embassy and consular websites looking for the quantities and different types of medication allowed in the country for personal use, required documentation, customs information and details about travelling with medical equipment.

    They also sent a standardized email to each embassy asking those same questions.

    Two weeks later, 11 embassies had responded, two of which forwarded the questions to the Pharmacy Board of the home country but did not respond further, the authors report in Travel Medicine and Infectious Disease.

    Of the eight countries that did respond, their recommendations varied widely, and tended to be much more strict than the recommendations of the International Narcotics Control Board (INCB), an independent body implementing United Nations Drug Control Conventions.

    According to the INCB recommendations for individual travelers, you should carry a copy of the prescription, but there are no other certifications or requirements for less than 20 doses of any medication, or less than a 30-day supply of narcotics or psychotropics, such as Ambien or Haldol.

    Many embassies, however, said all drugs required special certification of ownership and personal use, beyond a valid prescription. In some countries, a visitor is required to consult a local clinician to validate ongoing need for the medication.

    Some countries warn that if authorities are in doubt, they have the right to deny entry or confiscate the medications, the authors write.

    Drugs on Schedule I of the U.S. Controlled Substances Act, including hallucinogens or stimulants with no medical use, like THC or cocaine, can never be brought across national borders.

    Neither the embassy and consular websites nor the email responses addressed medical equipment.

    The lack of information for travelers offered by local embassies may sometimes indicate a lack of suitable regulations in destination countries, or that no one knows where to find them, said Dr. Irmgard Bauer of the Division of Tropical Health and Medicine at James Cook University in Townsville, Australia, who was not part of the study. She called the situation a "huge mess."

    Patients should turn to their treating doctor and a travel clinic, with both having the obligation to find out what is required, she told Reuters Health by email.

    "Travellers on longer trips could also be referred to a colleague in the country of destination to continue treatment and prescribe the medication," she said. "In some cases, it may mean that travel cannot happen."

    Specific outcomes for a traveler with too much medication or not enough documentation depend on the country, its law, and the person working at customs that day, Bauer said.

    "With narcotics, an arrest is not unlikely," she said. "In some countries, this will not be pleasant."

    The situation can be toughest for last minute travelers, Mutie said, but ideally there will be sufficient time to search for information ahead of time and talk to your doctor, who should be the principal source of the required information.

    Dr. Natasha Hochberg, an infectious disease physician at Boston University School of Public Health, suggested "that international travelers with chronic medical conditions seek care at least 4 to 6 weeks in advance of travel at a travel clinic to address issues related to bringing medications overseas but also to address the need for immunizations and prophylactic medication and to discuss health-promoting topics."

    Hochberg, who was not involved in the new study, added, "Travelers bringing medication overseas should bring the medication in their carry-on luggage to prevent possible loss in checked baggage, keep it in the original bottle that the medication came in, take enough to last for their trip as well as some extra in case of changes to the itinerary, and have adequate documentation including the original prescription and possibly a signed letter on travel clinic letterhead."

    For medical devices, Mutie suggests planning ahead and checking with the airline. Airlines, he notes, have published clear medical clearance guidelines in this area.

    In future, embassy websites should be designed with the user in mind, since embassies are established to provide a service, he said.

    SOURCE: http://bit.ly/1lfNmeb Travel Medicine and Infectious Disease, August 6, 2014.

  • New recommendations for overweight people with heart risks

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Overweight patients with risk factors for heart disease should be sent by their doctors for "intensive behavioral counseling" about diet or exercise, according to new recommendations from the United States Preventive Services Task Force (USPSTF).

    That includes overweight people with high blood pressure, high cholesterol, 'metabolic syndrome' or blood sugar levels higher then normal and on the cusp of type 2 diabetes.

    A literature review commissioned for the government-backed USPSTF, published in the Annals of Internal Medicine, found that intensive behavioral counseling can help lower these patients' risk for heart problems.

    "My message for patients would be that we have the ability by changing our behavior to modify our risk for heart disease and stroke and your doctors can help you do that," Dr. Michael L. LeFevre, the chair of the Task Force, told Reuters Health by phone.

    LeFevre is also vice chair in the Department of Family and Community Medicine at the University of Missouri School of Medicine in Columbia.

    The recommendations are targeted to health care providers more than to patients, LeFevre said.

    To patients, he says, "The most important thing that we can do right now is have you lose some weight, be more active but just offering that advice and giving you a pamphlet, we don't really find any evidence that that's helpful."

    Instead, the Task Force review found, intensive behavioral counseling - involving multiple sessions with experts in nutrition and exercise over an extended period, for several months to a year - can help people lose weight and bring down their blood pressure and cholesterol.

    The researchers reviewed 74 studies of various lifestyle interventions and found that with intensive counseling, many health markers were improved one and two years later, and the risk of diabetes decreased.

    "This crystalizes 25 years of research and a huge number of studies but I don't think this is new or earth shattering information," said Dr. Jennifer S. Lin of the Kaiser Permanente Center for Health Research in Portland Oregon.

    Lin was the lead author of the literature review.

    There is a great deal of data on people with heart attack and stroke risk factors and most of those studies focused on a combination of diet and exercise counseling, so those kinds of programs have the most evidence behind them at this point, she said.

    "On average we're talking about a few milligrams of cholesterol per deciliter of blood or a couple of millimeters of Mercury decrease in blood pressure," Lin told Reuters Health by phone.

    "We're calling that a modest benefit applied to a population but even these modest benefits translate into health outcomes that patients can actually feel," she said.

    Patients can't necessarily feel when their blood pressure goes down, but they can feel if they do or do not have a heart attack, she said.

    The best counseling interventions are not only frequent but conducted by trained dietitians, nutritionists, health educators and physiologists, she said.

    "They're more than just didactic, more than classroom based interventions, they're individualized," she said.

    One-on-one counseling gives experts time to assess the barriers to healthy diet and exercise for each person and help them overcome them, LeFevre said.

    "We need to see people repeatedly, to work with them and reinforce what's going on," LeFevre said.

    The USPSTF issued the same recommendation for the first time in 2012, but only for obese patients without heart disease risk factors.

    While family physicians could provide these counseling services themselves, most of the programs studied involved referrals to experts in the same office or elsewhere in the community, he said.

    "To be perfectly honest, a rate limiting step for implementation of this guideline is that there are a lot of doctors out there but (they) don't really have the time or skills to do this themselves, or the resources," LeFevre said.

    Even sending patients to other experts means finding those people and coordinating care with nutrition and exercise programs and checking in periodically to see how things are going, he said.

    Right now, larger health organizations like Kaiser Permanente in California or Group Health in Washington are most likely to be able to do this, he said. For doctors outside large health systems, it is much easier to order a blood test or write a prescription than coordinate long-term behavioral counseling, he said.

    "It's problematic that this kind of care is generally not paid for by the U.S health system," Lin said. "Those resources should be made more available."

    There are commercial diet and exercise programs which are legitimate and good at what they do but the patient needs to pay out of pocket, she said.

    "Many primary care physicians and many patients would not have access to these types of interventions," she said.

    SOURCE: http://bit.ly/1i46lF7 Annals of Internal Medicine, August 25, 2014.

  • Heart doctors overstate benefits of procedures for stable chest pain

    By Will Boggs MD

    NEW YORK (Reuters Health) - Cardiologists sometimes overstate the benefits of an invasive procedure for chronic angina and patients make decisions based on what cardiologists tell them.

    Symptoms of angina, such as chest pain, arise from clogged arteries in the heart and may improve faster with so-called percutaneous coronary interventions (PCI) than with medication. Evidence suggests, however, that when angina is stable - that is, when it occurs predictably, like after a certain amount of exercise - then PCI does not reduce the risk of death or heart attack.

    But patients with stable angina often think PCI does lower those risks. Three new reports in JAMA Internal Medicine explore why and how this might be happening.

    In the first study, a team led by Dr. Sarah L. Goff from Tufts University School of Medicine in Springfield, Massachusetts analyzed conversations about PCI between 20 cardiologists and 40 patients with stable coronary artery disease.

    In a PCI procedure, doctors inject a dye into the blood vessels of the heart, and if X-ray imaging (angiography) shows an artery is clogged, it's reopened using tools inserted into the heart through an artery in the arm or groin. Usually, a small metal device called a stent is inserted, to keep the artery open.

    In only two encounters did cardiologists tell patients that PCI could improve their angina symptoms but would not reduce their risk of MI or death.

    In five encounters, the benefits of PCI were explicitly overstated, and in a number of encounters the cardiologists implicitly overstated the benefits of angiography and PCI.

    Cardiologists discussed the risks of the procedure in only a limited way, and no cardiologist mentioned the possibility of kidney failure as a risk.

    In 30 encounters, cardiologists took the lead in the decision-making process in ways that could discourage patients from participating.

    "When patients with chronic stable angina are advised to undergo (angiography) and possible stent placement, they should ask what factors specific to their health history the cardiologist considered before recommending the procedure, what the risks of the procedure are, what the benefit is likely to be, what research the risks and benefits presented were derived from, what medications they will need to take after a stent is placed, what the alternative options are for them," Goff told Reuters Health by email.

    She added, "If they do not understand what the cardiologist says at any point in the decision process, they should feel comfortable asking for clarification."

    "I think it is very important to know that this study is not intended to be critical of cardiologists," Goff cautioned. "We could not, with this study design, assess patient understanding and it is quite possible in the few transcripts we analyzed where the cardiologists made the benefits quite clear that the patients still believed having a stent placed would prevent an MI and/or death."

    Dr. Clara Carpeggiani from CNR Institute of Clinical Physiology, Pisa, Italy told Reuters Health by email that patients should be explicit when asking their cardiologists about their options. She said they should ask:

    - What coronary angioplasty or PCI?

    - What is the purpose of the procedure?

    - What are the benefits?

    - What are the risks?

    - Are there alternative therapies? What are their risks and benefits?

    The Society for Cardiovascular Angiography and Interventions offers another resource: five things physicians and patients should question, available here: http://bit.ly/1nuFIYz.

    In another study, Dr. Michael B. Rothberg from the Cleveland Clinic in Ohio and his colleagues had volunteers read one of three descriptions of the risks and benefits of PCI for stable angina. One description had no information about the effects of PCI on heart attack risk; one description said PCI will not reduce the risk for heart attack; and one explained why PCI does not reduce the risk for heart attack.

    Compared with the other two groups, those who received no information about the relationship between PCI and heart attack risk were most likely to believe that PCI prevents heart attack, were most likely to choose PCI, and were least likely to agree to medical therapy.

    "We were not surprised to find that in the absence of information, most people assumed that PCI would prevent a heart attack," Rothberg told Reuters Health. "We were surprised that even after they were told that PCI would not prevent a heart attack, more than 30 (percent) continued to believe it would. We were even more surprised to find that many people falsely remembered the physician saying that PCI would prevent a heart attack, even though he never said that, and in some cases said the opposite."

    "We were also surprised to find that when patients were told that PCI does not prevent a heart attack, they were more likely to agree to take medications-something they should all do regardless of whether they decide to have PCI," Rothberg said.

    Finally, in a third study, Dr. Steven M. Bradley from the Veterans Affairs Eastern Colorado HealthCare System in Denver and colleagues used records from the National Cardiovascular Data Registry to show that when angiography was performed in patients without angina symptoms, there was a higher risk that PCI would be done inappropriately.

    "Future studies need to define the aspects of care delivery that lead to optimal patient selection for coronary angiography and PCI," Bradley told Reuters Health. "This may include greater patient involvement in the decision process and application of the Appropriate Use Criteria in measurement, reporting, and clinical decision support of high-quality patient selection for coronary angiography and PCI."

    SOURCE: http://bit.ly/IZGqPC JAMA Internal Medicine, August 25, 2014.

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Surgery Articles

  • Robotic prostate removal tied to surgical changes, costs

    By Andrew M. Seaman

    NEW YORK (Reuters Health) - The introduction of robotic surgery for prostate cancer may have led to changes in the number of surgeons performing prostate removals and in the overall cost, according to a new study.

    With the technology being used more widely, fewer doctors are performing the procedure and the overall cost of prostate removal has gone up, researchers found.

    While studies examining the benefits and potential harms of robotic surgery have produced mixed results, the researchers write in BJU International that there is little information on how the innovation influenced prostate removal in the U.S.

    "We knew by anecdotal reports as well as the scientific literature that it had become relatively widespread but we didn't know how that had been done," said Dr. Steven Chang, the study's lead author from Harvard Medical School, Brigham and Women's Hospital and the Dana-Farber Cancer Institute in Boston.

    Robotic-assisted radical prostatectomy, which is the removal of the prostate with the help of a robot, began after U.S. regulators approved Intuitive Surgical, Inc.'s da Vinci Surgical System in 2000.

    Before that, surgeons would remove the prostate through a relatively large incision in so-called open surgery - or through a small incision with the help of a camera, in laparoscopic surgery.

    For the new study, the researchers used data on nearly 490,000 men who had their prostates removed between 2003 and 2010. Of those, 338,448 had open or laparoscopic surgery and 150,921 had robotic-assisted surgery.

    Overall, there was a dramatic increase in the number of prostate removals with the new technology. The proportion of surgeons doing at least half of their prostate removals with the robot increased from 0.7 percent in 2003 to about 42 percent by 2010.

    Surgeons who had been doing more than 24 prostate removals each year were the most likely to start using the new technology.

    The researchers also found that the number of surgeons performing prostate removals decreased during the study period from about 10,000 to 8,200.

    Chang said the finding that fewer surgeons are performing the procedure is likely because the ones who were only doing a few every year decided to stop altogether.

    "It was fairly obvious that the people who adopted this technology had a higher volume per year than people who did not adopt this technology," he said.

    "We have seen a concentration of da Vinci use among high volume surgeons, which we think is a positive for the healthcare system," said Dave Rosa, the executive vice president and chief scientific officer of Intuitive Surgical, Inc., in a statement emailed to Reuters Health.

    "Da Vinci use for radical prostatectomy has been shown to have clinical advantages over open prostatectomy in most of the dozens of comparative clinical studies published," Rosa added.

    The current study was not designed to analyze which type of surgery is safer or leads to fewer complications, Chang said.

    "I don't think anyone really knows that answer and I don't know if that study will ever be done," Dr. Jeff Karnes, who was not involved with the new study, told Reuters Health.

    When it comes to prostate removal, the surgeon's experience is likely more important than whether it's done with or without a robot, said Karnes, an urologist from the Mayo Clinic in Rochester, Minnesota.

    Chang and his colleagues also found that the introduction of the new technology was tied to an increase in overall U.S. spending on prostate removals.

    They write that the increase in cost is likely related to an increased number of prostate removals and increased cost for each procedure.

    Robotic-assisted prostate removals cost more than open surgeries throughout the study but the researchers found that the cost of the older surgical methods also increased toward the end of the study.

    They can't say, based on their data, why the cost of open or laparoscopic surgeries began to increase, but they suggest it may be due to slower surgeons continuing to use open surgeon or innovations in open surgery that drove the price up.

    Alternatively, Karnes said it could also be a result of riskier prostate removals, which take more time, needing open surgery.

    Intuitive Surgical, Inc.'s Rosa said a thorough study would take into account overall societal costs in an economic analysis. Those costs include how the patients faired after the procedure.

    "Costs can be calculated very differently in economic studies depending on the methodology used," he said.

    Chang said a goal in the future would be to do a more thorough cost analysis that includes more indirect costs.

    Overall, Karnes said he is not surprised by the results of the study.

    "We know that when a hospital acquires the technology the number of robot procedures go up in that hospital," he said.

    For patients faced with prostate removal, he said it's likely best to make a decision on open or robotic-assisted surgery based on the surgeon's experience and performance.

    SOURCE: http://bit.ly/1luyDMz BJU International, online August 26, 2014.

  • Second D.C.-area man stricken with flesh-eating bacteria -media

    By John Clarke and Ian Simpson

    Aug 22 () - (Reuters) - A flesh-eating bacterial disease has infected another Washington, D.C.-area man, local media reported on Thursday, just days after a man was released from a hospital following a near-deadly bout with the germ.

    Joe Wood of Stafford, Virginia, said he was swimming in the Potomac River near the town of Callao earlier this month when a scratch on his left leg became infected with vibrio vulnificus, an aggressive bacteria that feeds on flesh, Washington D.C.'s WTOP radio reported.

    Wood was admitted to the Mary Washington Hospital in Fredericksburg on July 5 where an infectious disease specialist performed skin graft surgery on Tuesday, the report said. Doctors told the radio station that Wood would likely survive.

    The report could not be immediately confirmed as the hospital did not return repeated calls by a Reuters reporter on Thursday.

    The news comes just days after a 66-year-old Maryland man was released from a hospital after nearly losing a leg and his life to the flesh-eating bacterial infection that he contracted in Chesapeake Bay earlier in the month.

    The bacterial strain causes severe illness characterized by fever and chills, septic shock and lesions. Symptoms include vomiting and diarrhea.

    Vibrio cases are on the rise in the region. In a 2009 study, the Chesapeake Bay Foundation found that the increase in infections was linked to pollution and unusually hot summers.

    In Maryland, the number of all vibrio cases, including the strain that afflicted the two men, reached 57 last year, a 10-year high, according to the Maryland Department of Health and Mental Hygiene.

    Virginia had eight vibrio vulnificus cases last year, according to the Virginia Department of Health. There have been 27 cases involving vibrio species overall so far this year.

    Nationwide, there are as many as 95 cases of vibrio vulnificus infections each year, 35 of which result in death, according to CDC statistics.

  • Men, substance users less likely to have weight-loss surgery

    By Ronnie Cohen

    NEW YORK (Reuters Health) - A one-size-fits-all approach to weight-loss surgery may be keeping obese men, substance users and older people out of the operating room, a new study suggests.

    The study analyzed data from a Canadian program intended to encourage obese people to undergo weight-loss surgery. More than half the patients dropped-out without having the operation, researchers found.

    Men, smokers, drinkers, drug users and people age 60 and older were the most likely to quit the program before having the operation, senior author Dr. Fayez Quereshy from the University of Toronto in Ontario told Reuters Health in a telephone interview.

    More than one-third of U.S. adults are obese and cost an estimated $147 billion a year in medical care, according to the Centers for Disease Control and Prevention.

    Weight loss operations, formally known as bariatric surgery, are known to cut obesity-related disease and healthcare costs. Prior research has shown they result in substantial weight loss and can reverse the course of some related diseases (see Reuters story of December 24, 2013 here: http://reut.rs/1BDFesE).

    In some studies, the surgery has been more effective in helping obese people shed weight than diet, exercise, therapy and drugs (see Reuters story of October 31, 2013 here: http://reut.rs/1z2YCLN).

    The operations reduce the size of the stomach so patients can eat only small amounts of food. Doctors recommend the procedures for people who are severely obese or moderately obese with serious weight-related health problems.

    But while bariatric surgery is becoming increasingly popular, the drop-out rate has also been growing, the authors write in the Journal of the American College of Surgeons.

    In the current study, they examined the records of 1,664 patients referred to the bariatric-surgery program between 2008 and 2011. Patients ranged in age from 19 to 80, with an average age of 48. They waited an average of nearly 15 months to have the surgery, the authors write.

    Body mass index (BMI), a ratio of weight to height, was higher than 40 in nearly nine of every ten people. A BMI of 40 would be roughly equivalent, for example, to a height of 5 foot 2 inches (157 cm) and a weight of 218 pounds (99 kg), or a height of 6 feet (183 cm) and a weight of 294 pounds (133 kg).

    About one in every 13 people had a BMI above 60, roughly equivalent to a height of 5 foot 2 inches and a weight of 330 pounds (150 kg),

    Most patients - 74 percent - referred to the program were women. Men were not only less likely to be referred, they were also nearly half as likely to undergo the surgery.

    Heavier patients were more likely to have the operation and older patients (i.e., those over 60) were less likely, the study found.

    Distance from home to the program appeared to have no impact on attrition.

    Smokers, drinkers and other substance users were more likely to quit before surgery. The study did not determine if they left the program on their own or were refused treatment. Substance abusers must demonstrate prolonged abstinence to be eligible for weight-loss surgery, the authors write.

    Knowing which patients are dropping out should help administrators tailor future bariatric-surgery services, Quereshy said.

    The best way to most efficiently move more patients through the system, he believes, would be to tailor the care for certain groups of people. For example, he suggested, patients with limited social networks should be connected to social workers early on.

    "In environments where resources are scarce and obesity-related complications carry a significant cost burden and patient complications, we need to think of novel ways to reduce wait times, patient dropouts and disappointments while improving satisfaction," Quereshy said.

    Bariatric surgeon Dr. Erik Dutson, from the University of California, Los Angeles, said the study's message rings just as true in America as it does in Canada. He was not involved with the current study.

    "If we are going to continue to look at bariatric surgery as the gold standard for weight loss, then we should keep our eyes open about preemptively anticipating problems with patients and make special care considerations for certain subgroups," Dutson said.

    Bariatric surgery is not risk-free. Gastric-bypass operations, for example, carry the risk of blood clots, breathing problems, heart attacks, strokes, infections and allergic reactions to anesthesia, according to the National Institutes of Health.

    Still, Dutson believes that bariatric surgery is the safest way to reduce obesity and prevent related complications, such as diabetes. He described the operation as safer than a gall bladder removal.

    "It's ironically safer to undergo an operation than to not undergo an operation," he said.

    SOURCE: http://bit.ly/1p7pDN9 Journal of the American College of Surgeons, online August 11, 2014.

  • Knee replacement may go poorly for people who think life isn't fair

    By Kathryn Doyle

    NEW YORK (Reuters Health) - People who tend to blame others for their suffering and think setbacks in their lives are irreparable tend to report more pain after knee replacement surgery, according to a new study.

    This is not the first time feelings of personal injustice have been tied to longer recovery times and increased disability after injury, the authors write.

    "Pain is a complex phenomenon that is influenced by biological, social, and psychological factors," said lead author Esther Yakobov, a doctoral student in clinical psychology at McGill University in Montreal.

    "Studies conducted with patients who suffer from chronic pain because of an injury demonstrated that individuals who judge their experience as unfair, focus on their losses, and blame others for their painful condition also tend to experience more pain and recover from their injuries slower than individuals who do not," she told Reuters Health by email.

    But those studies had been with victims of injuries, where externalizing blame is a bit easier than for degenerative conditions like osteoarthritis, she noted.

    For the new study, a group of 116 men and women with severe osteoarthritis, between ages 50 and 85 years old and scheduled for knee replacement surgery in Canada, first filled out questionnaires assessing perceived injustice, how much they think about or worry about pain and their fear of movement or re-injury.

    They rated their agreement with statements like, "It all seems so unfair" and "I am suffering because of someone else's negligence."

    With another clinical questionnaire the patients gauged their pain levels and physical functioning.

    After the knee replacement surgeries, which were all deemed successful, the patients rated their pain and function again at a one-year checkup.

    The more a patient agreed before surgery that life seems unfair and others are to blame for their problems, the more pain they reported experiencing one year after surgery. That was true even when age, sex, other health conditions and pre-surgery pain levels were accounted for, according to the results in the journal Pain.

    The more the patient thought about pain and felt helpless because of it before surgery, the more severe their disability during recovery seemed to be.

    "A decade ago, we reported that preoperative anxiety and depression influenced the outcome after surgery," said Dr. Victoria Brander, a physical medicine and rehabilitation specialist at Northwestern Orthopaedic Institute in Chicago.

    This new study adds to the effort to refine the concept, identifying specific psychological characteristics that serve as risk factors for complicated or painful recovery, Brander, who was not part of the new study, told Reuters Health by email.

    "All of these psychological factors point to the fact that patients who perceive themselves as helpless, those who are afraid, those who feel loss of control, have a more difficult time," Brander said.

    "The contrary is also true - patients who exhibit high levels of 'self-efficacy' (that is, patients who have a high degree of confidence in their own ability to achieve a goal) appear to do best after knee replacement," she said.

    Osteoarthritis, the wearing away of cartilage, joint lining, ligaments and bone in a joint, affects one third of people over age 65 in the U.S., according to the Centers for Disease Control and prevention.

    Knee replacement surgery can relieve pain and restore mobility, but about 20 percent of patients will have a problematic recovery or intense pain, based on previous research.

    How individuals perceive pain as just or unjust can vary widely between patients, and it can be influenced by many factors, so it's hard to say if having a more negative outlook is common or uncommon, Yabokov said.

    Researchers don't yet know if people with more negative outlooks only perceive their pain as worse than others or if their psychological state affects the physiology of healing and actually leads to more pain, she said.

    Nevertheless, findings like this suggest patients should be screened for their psychosocial outlook before surgery, she said.

    "This might suggest the usefulness of screening patients in terms of 'catastrophizing,' perceived injustice, fear of movement, and recovery expectancies before treatment or surgery," she said. "With this screening information, appropriate psychological intervention that targets specific risk factors of each patient can then be matched to patients' needs."

    SOURCE: http://bit.ly/1qOr9BB Pain, online July 25, 2014.

Neonatal Articles

  • Fishery mislabeling could mean more mercury than buyers bargain for

    By Janice Neumann

    NEW YORK (Reuters Health) - That Chilean sea bass from the local grocery store could have twice the methylmercury that's expected - if it comes from a region other than indicated on the label, a new study says.

    While fish certified by the Marine Stewardship Council (MSC) is generally considered safe, seafood from regions with high levels of contamination are not. And researchers studying samples from U.S. retail stores found that many fish are indeed the species they are claimed to be, but not from the region claimed.

    "Chilean sea bass is already known to sometimes have high mercury levels," lead author Peter Marko, of the University of Hawai'i at Manoa, Honolulu, told Reuters Health.

    "If women are pregnant or nursing, they probably shouldn't buy that fish, to be safe," he said.

    Past research has found that fish sold in retail markets is not always the species it's advertised to be. And that even within a given species, mercury levels can vary widely.

    Methylmercury, the type of mercury found in fish, is an organic compound that can be absorbed into living tissue.

    Pregnant and nursing women and kids have been advised by the U.S. Food and Drug Administration to avoid shark, tilefish, swordfish and King Mackerel because these species have a mean mercury level of 0.73 to 1.45 parts per million. The FDA's limit for mercury in fish for human consumption is 1.0 ppm.

    Normally, the mercury content of Chilean sea bass, also known as Patagonian toothfish, is 0.35 ppm, according to the FDA.

    In the current study, published in the journal PLOS One, researchers used sea bass tissue samples from retailers in 10 U.S. states. They measured the total amount of mercury in 25 of the MSC-certified and 13 of the uncertified Chilean sea bass samples.

    They found that fish labeled as certified had less than half the mercury (0.35 ppm) of uncertified fish (0.89 ppm).

    But when the researchers excluded the fish that actually belonged to other species and were not genetically sea bass, they found no significant difference in the mercury levels of certified and uncertified fish.

    "We then said, 'that can't be because certified is supposed to come from South Georgia, where the mercury level is low, why do we see such a difference in mercury?'" said Marko, referring to a fishery area close to the South Pole and known to have less mercury contamination than fish from waters off South American. "It's these fishery stock substitutions," he said.

    The researchers tested the DNA of the fish and found those from outside the MSC-certified South Georgia/Shag Rocks fishery had twice as much mercury (0.63 ppm) as those genetically confirmed to be South Georgia stock (0.31 ppm).

    "Regular mercury exposure is potentially dangerous to developing nervous systems, so this and other studies like it are of greatest concern to pregnant women, children, and women planning on having children," Marko said in an e-mail.

    "Our study demonstrates that accurate labeling of seafood - not just with respect to what species but also what country or region the seafood came from - is essential to consumers, particularly in the aforementioned demographic, to make informed choices at the seafood counter," he said.

    Marko pointed out that fish from South American waters can have two-to-three times as much mercury as fish from MSC-certified regions.

    Roberta White, professor and chair of Environmental Health at Boston University School of Public Health, who was not involved in the study, told Reuters Health in a phone interview the findings were another reminder that consumers need to be careful when purchasing fish.

    "What's really disturbing is how do people choose to eat fish that are safe?" said White, who has studied the effects of industrial pollutants on the brain.

    "Everybody wants people to eat fish because it is good for the brain and heart, but we also don't want them to be poisoning their children because they're pregnant," she said.

    White said future studies needed to focus on different species of fish and the genetics within species, as well as variations in neurotoxicants. Other contaminants in fish could also pose a health danger, including Polychlorinated Biphenyls (PCBs), which are synthetic organic chemicals, organic tin and different pesticides, she said.

    "As this article points out, sometimes you think something is safe because of the way it's labeled and maybe it isn't, but that's true of all our food," White said.

    "This is where you have to start, the simple stuff," White said. "I think what's important about the study is the public health message that we need to be careful about this and figure it out," said White.

    SOURCE: http://bit.ly/1vBpKRH PLOS One, online August 5, 2014.

  • U.S. to propose birth control exception for religious companies -source

    By Caroline Humer

    (Reuters) - The Obama administration will ensure access to birth control coverage for employees of closely-held companies that object to contraception on religious grounds, proposing a new accommodation to health benefits mandated by the Affordable Care Act, a source familiar with the plan said on Friday.

    The move follows a Supreme Court ruling in June that allowed certain for-profit companies to refuse to cover contraceptives due to the religious beliefs of their owners.

    President Barack Obama's healthcare reform law requires companies to provide free birth control coverage as a preventive service included in their health plans.

    The U.S. Department of Health and Human Services had already provided an exception to non-profit groups with religious affiliations, such as certain universities or hospitals, in 2013. The exception requires insurers to cover the cost of birth control for employees of such organizations, separate from the benefits paid for by the employers.

    On Friday, it was expected to propose an extension of that rule to closely-held companies in rules published in the Federal Register, the source said.

    The rule is in direct response to the Supreme Court ruling in favor of Hobby Lobby Stores Ltd, a family-owned chain of craft stores, and Conestoga Wood Specialties Corp of Pennsylvania. The two companies combined employ nearly 14,000 people. The accommodation is expected to impact at nearly 50 additional companies who have filed similar lawsuits.

    At the time, the justices ruled that for-profit companies can make claims under a 1993 federal law called the Religious Freedom Restoration Act that was enacted to protect religious liberty. They had suggested that the government could extend the accommodation made for non-profit groups.

    HHS also proposed on Friday an interim rule for non-profits to lay out additional ways that these companies can provide notice to the government in writing of their religious objections to providing contraception coverage.

    The interim rule for non-profits is largely in response to a Supreme Court order in July, issued days after the Hobby Lobby ruling, that gave a temporary exemption to a Christian college in Illinois. It had said that the initial process for informing insurers of their religious standing also violated their beliefs.

  • U.S. EPA makes strides in air toxics but work remains in cities -report

    By Reuters Staff

    WASHINGTON (Reuters) - The United States has made progress in reducing dangerous air pollution since 1990 but work remains to reduce risks for the country's most overburdened urban areas, the U.S. Environmental Protection Agency's top official said on Thursday.

    The EPA released to Congress its second report on integrated air toxics, citing "substantial progress" toward reducing levels of contaminants such as arsenic, mercury and lead since it launched an Integrated Urban Air Toxics Strategy in 1999.

    Air toxics, also known as toxic air pollutants or hazardous air pollutants, are pollutants that may increase the risk of cancer or other serious health effects, such as birth defects.

    EPA Administrator Gina McCarthy pointed to milestones such as a 60 percent reduction in mercury from coal-fired power plants and an 84 percent cut in lead levels in outdoor air among the agency's accomplishments.

    But she told reporters that more work needs to be done to understand air toxics better and reduce remaining risks, which are most prevalent in low-income urban areas.

    "There is more that we have to do and more that we can do," McCarthy said on a conference call.

    The report she cited highlighted six areas where the current EPA air toxics program must improve, including emissions data; ambient data in more areas covering more pollutants; better monitoring technologies; and research on health impacts of air toxics.

    McCarthy said the agency is focused on addressing environmental justice by recognizing that some of the most economically disadvantaged communities are most at risk of the negative health effects of air pollution.

    The agency will complete studies of air toxic pollution in the neighborhoods of South Philadelphia and North Birmingham, Alabama, to get better data that can help inform local decision making.

    "Environmental justice is the core of EPA's mission - striving for clean water and healthy air for every American," McCarthy said.

    For the complete 139-page EPA report, see: http://www2.epa.gov/sites/production/files/2014-08/documents/082114-urban-air-toxics-report-congress.pdf

  • California law aims to protect rights of sperm donors, surrogates

    By Sharon Bernstein

    SACRAMENTO, Calif. (Reuters) - A bill aimed at protecting the parental and adoptive rights of non-traditional families in California was sent to Governor Jerry Brown on Wednesday in an effort to close gaps in a state law that have led to at least one high-profile legal case.

    The measure by San Francisco Assemblyman Tom Ammiano, a Democrat, would require sperm donors, surrogate mothers and the people with whom they work to have a child to fill out a series of forms detailing the rights and responsibilities of each person.

    "My bill represents an opportunity to have state law keep pace with the changes in reproductive technology," Ammiano said. "With a few simple changes, we can help families thrive without needless legal battles or expensive court actions."

    Legal issues around the parental rights of sperm donors have made headlines recently over a debacle involving actor Jason Patric, who donated sperm to a now-former girlfriend and is suing for the right to be part of the child's life. Under current law, sperm donors do not typically have parental rights unless otherwise agreed by the parties involved.

    Ammiano's bill would require people who use sperm donors or surrogate mothers to fill out a series of forms outlining the parental rights and responsibilities of the donor or surrogate before conception.

    The forms required under the legislation are designed to eliminate any gray area about who has the right to visit or care for a child conceived through in vitro or other non-traditional reproductive methods.

    The bill would also create an expedited adoption process for same-sex parents. The process is meant to protect families who move from California to states where a non-biological parent is not recognized under state law unless the child has been legally adopted.

    The measure also requires couples using a surrogate to spell out how they will pay for the medical expenses of the surrogate and the care of the newborn.

Neuroscience Articles

  • Fishery mislabeling could mean more mercury than buyers bargain for

    By Janice Neumann

    NEW YORK (Reuters Health) - That Chilean sea bass from the local grocery store could have twice the methylmercury that's expected - if it comes from a region other than indicated on the label, a new study says.

    While fish certified by the Marine Stewardship Council (MSC) is generally considered safe, seafood from regions with high levels of contamination are not. And researchers studying samples from U.S. retail stores found that many fish are indeed the species they are claimed to be, but not from the region claimed.

    "Chilean sea bass is already known to sometimes have high mercury levels," lead author Peter Marko, of the University of Hawai'i at Manoa, Honolulu, told Reuters Health.

    "If women are pregnant or nursing, they probably shouldn't buy that fish, to be safe," he said.

    Past research has found that fish sold in retail markets is not always the species it's advertised to be. And that even within a given species, mercury levels can vary widely.

    Methylmercury, the type of mercury found in fish, is an organic compound that can be absorbed into living tissue.

    Pregnant and nursing women and kids have been advised by the U.S. Food and Drug Administration to avoid shark, tilefish, swordfish and King Mackerel because these species have a mean mercury level of 0.73 to 1.45 parts per million. The FDA's limit for mercury in fish for human consumption is 1.0 ppm.

    Normally, the mercury content of Chilean sea bass, also known as Patagonian toothfish, is 0.35 ppm, according to the FDA.

    In the current study, published in the journal PLOS One, researchers used sea bass tissue samples from retailers in 10 U.S. states. They measured the total amount of mercury in 25 of the MSC-certified and 13 of the uncertified Chilean sea bass samples.

    They found that fish labeled as certified had less than half the mercury (0.35 ppm) of uncertified fish (0.89 ppm).

    But when the researchers excluded the fish that actually belonged to other species and were not genetically sea bass, they found no significant difference in the mercury levels of certified and uncertified fish.

    "We then said, 'that can't be because certified is supposed to come from South Georgia, where the mercury level is low, why do we see such a difference in mercury?'" said Marko, referring to a fishery area close to the South Pole and known to have less mercury contamination than fish from waters off South American. "It's these fishery stock substitutions," he said.

    The researchers tested the DNA of the fish and found those from outside the MSC-certified South Georgia/Shag Rocks fishery had twice as much mercury (0.63 ppm) as those genetically confirmed to be South Georgia stock (0.31 ppm).

    "Regular mercury exposure is potentially dangerous to developing nervous systems, so this and other studies like it are of greatest concern to pregnant women, children, and women planning on having children," Marko said in an e-mail.

    "Our study demonstrates that accurate labeling of seafood - not just with respect to what species but also what country or region the seafood came from - is essential to consumers, particularly in the aforementioned demographic, to make informed choices at the seafood counter," he said.

    Marko pointed out that fish from South American waters can have two-to-three times as much mercury as fish from MSC-certified regions.

    Roberta White, professor and chair of Environmental Health at Boston University School of Public Health, who was not involved in the study, told Reuters Health in a phone interview the findings were another reminder that consumers need to be careful when purchasing fish.

    "What's really disturbing is how do people choose to eat fish that are safe?" said White, who has studied the effects of industrial pollutants on the brain.

    "Everybody wants people to eat fish because it is good for the brain and heart, but we also don't want them to be poisoning their children because they're pregnant," she said.

    White said future studies needed to focus on different species of fish and the genetics within species, as well as variations in neurotoxicants. Other contaminants in fish could also pose a health danger, including Polychlorinated Biphenyls (PCBs), which are synthetic organic chemicals, organic tin and different pesticides, she said.

    "As this article points out, sometimes you think something is safe because of the way it's labeled and maybe it isn't, but that's true of all our food," White said.

    "This is where you have to start, the simple stuff," White said. "I think what's important about the study is the public health message that we need to be careful about this and figure it out," said White.

    SOURCE: http://bit.ly/1vBpKRH PLOS One, online August 5, 2014.

  • Self management may reduce blood pressure: study

    By Andrew M. Seaman

    NEW YORK (Reuters Health) - Even people at significant risk for heart attacks and strokes can take an active role in reducing their own high blood pressure, by measuring it themselves and adjusting their medications, according to a new study from the UK.

    Researchers found that patients who closely monitored their own blood pressure and medications, using detailed instructions from their doctors, lowered their readings more than patients who relied on their healthcare providers to take periodic readings and make medication changes.

    "We've previously done a study with a group of people with uncomplicated hypertension (or high blood pressure)," said Dr. Richard McManus, the report's lead author. "We wanted to see if that intervention would also work with people with greater coronary heart disease and in the elderly."

    The intervention consisted of patients creating a detailed plan with their doctor, measuring their own blood pressure daily and adjusting their medications according to their blood pressure readings and instructions in the plan.

    This new approach resulted in better management and lower blood pressure after a year, in part because doctors tend to be reluctant to change medications based on blood pressure readings recorded at a single healthcare visit, the researchers suggest.

    Healthcare providers don't always act on readings that are above target, McManus said.

    He and his colleague write in JAMA that other studies have found self monitoring of blood pressure may result in lower readings and many people in the UK already monitor their own blood pressure.

    For the new study, the researchers enrolled 552 patients with high blood pressure and a history of other significant health problems, such as strokes, heart attacks, diabetes and kidney disease. The patients were recruited from 59 doctors' offices in the UK and participated in the trial between 2011 and 2013.

    Normal blood pressure is considered to be a systolic (the top number) reading of 120 millimeters of mercury (mmHg) or less and a diastolic (the bottom number) of 80 mmHg or less, according to the U.S. National Institutes of Health.

    High blood pressure is usually defined as a systolic reading above 140 mmHg and a diastolic reading of 90m mmHg or more. Any reading between the normal and high categories is considered to be "prehypertension."

    Half of the patients were assigned to take part in the intervention and the other half were assigned to receive usual care, which consisted of periodic visits to their doctors for blood pressure readings and medication adjustment.

    At the beginning of the study, the participants in each group had an average blood pressure reading of about 144 mmHg over about 80 mmHg.

    Among patients in the self-management group, the number and types of medications taken tended to increase, so that after 12 months, they were taking, on average, 3.3 doses of medication a day compared to 2.6 in the usual care group.

    After 12 months, the systolic reading fell in both groups, but significantly more among those who took their own readings and managed their own medications.

    People in the usual care group saw their average systolic reading fall to about 138 mmHg after one year, compared to 128 mmHg among those in the intervention group.

    "These differences in blood pressure that were observed in this study were quite substantial," said Dr. Steven Nissen, chairman of the Robert and Suzanne Tomsich Department of Cardiovascular Medicine located on the main campus of Cleveland Clinic in Ohio.

    Any reduction in blood pressure of more than 2 or 3 mmHg is a noticeable difference, said Nissen, who wasn't involved in the new study but coauthored a commentary on it in the journal.

    While the results can't prove whether those in the intervention group went on to have fewer strokes and heart attacks, Nissen said lower blood pressure is tied to better long-term outcomes.

    He cautioned that not every person with blood pressure problems will be able to handle their own readings or medication management.

    "It just means you can't go into every community and expect every patient to have the sophistication and means to follow this type of algorithm," Nissen said.

    He added that people have difficulty controlling their blood pressure for a variety of reasons - not just that doctors won't adjust medication during office visits.

    For example, Nissen said, people in the U.S. may also have trouble accessing healthcare and affording prescriptions. He said self treatment is a potential option, however.

    "There are a lot of people out there with high blood pressure - a significant number of them (are) still above targeted readings despite treatment," McManus said. "This is an intervention that could be used in those people."

    He cautioned, however, that people need to talk with their doctors about this type of blood pressure management and should not attempt it on their own.

    SOURCE: http://bit.ly/1lwkHSh and http://bit.ly/1opxQqO JAMA, online August 26, 2014.

  • Tricking memory in lab animals stokes hope for PTSD

    By Sharon Begley

    NEW YORK (Reuters) - The frailty of remembrance might have an upside: When a memory is recalled, two research teams reported on Wednesday, it can be erased or rewired so that a painful recollection is physically linked in the brain to joy and a once-happy memory to pain.

    While lab rodents were used in the research, it adds to growing evidence that the malleability of memory might be exploited to treat disorders such as post-traumatic stress.

    In both studies, scientists focused on a phenomenon called reconsolidation. Discovered in the 1990s, it refers to the fact that when a memory is retrieved, its physical manifestation in the brain is so "labile," or changeable, that it can be altered. False memories can form, and the associated emotions can flip.

    "Recalling a memory is not like playing a tape recorder," said Susumu Tonegawa of the Massachusetts Institute of Technology, who led one of the studies. "It's a creative process."

    The MIT team decided to see how creative. They gave male mice a small electric shock when the animals wandered into one part of a cage, creating a memory linking that place to pain. In a different part, mice got to cavort with females, so they remembered that spot quite fondly.

    The mice had been engineered so specific brain neurons could be activated with light, a technique called optogenetics. Using lasers, the scientists reactivated the where, what and when of the memories, which are encoded in the hippocampus.

    While the shock memory was active and labile, the mice got to play with females. While the memory of socializing was active, they got a shock.

    That changed brain wiring, the scientists reported in the journal Nature. The memory of the shock became physically connected to neurons encoding pleasure; the memory of socializing connected to neurons encoding fear.

    "We could switch the mouse's memory from positive emotions to negative, and negative to positive," Tonegawa told reporters.

    More research is needed before anything similar could be used in people, MIT's Roger Redondo said, "but the circuits appear to be very similar" as in mice.

    In a separate study, researchers at Boston's McLean Hospital also exploited the malleability of reactivated memories to erase them completely.

    After training rats that a flash of light precedes a shock, the researchers turned on the light, reactivating the memory. They immediately gave the animals xenon gas, an anesthetic that blocks molecules involved in memory formation.

    That apparently jammed the machinery needed for memory reconsolidation, psychologist Edward Meloni and colleagues reported in the journal PLOS One: The rats forgot that light precedes a shock. Similarly trained rats not given xenon remembered just fine.

    Psychologist Elizabeth Phelps of New York University called both studies "interesting advances."

    But clear ethical issues involved in manipulating human memory remain, even for therapeutic purposes.

    "I think we are still a long way from translating this research to good clinical interventions," since memories that contribute to PTSD are "likely much more complex" than in mice and rats, Phelps said.

    SOURCE: http://bit.ly/1nDWhBE Nature and http://bit.ly/1tVYoEU PLOS One, online August 27, 2014.

  • Former U.S. swim star Van Dyken takes first steps since paralysis

    By Susan Heavey

    WASHINGTON (Reuters) - Olympic swimming champion Amy Van Dyken took her first steps this week since being paralyzed from the waist down when she severed her spinal cord in an all-terrain vehicle crash earlier this summer.

    In videos and images she posted online, Van Dyken is seen standing and starting to walk with the help a robotic exoskeleton device aimed at supporting patients' bodies and helping them move.

    "I feel good. Woo hoo!" she said in one video, posted late Thursday.

    "Here it is... I'm WALKING!!!" she wrote in another post.

    Another photograph shows Van Dyken, who won a total of six gold medals at the 1996 and 2000 Olympics, standing alongside her husband, former Denver Broncos punter Tom Rouen.

    Van Dyken's steps come just eight days after her release from a rehabilitation center in Colorado.

    In June, Van Dyken crashed her all-terrain vehicle near her Arizona home and was left with no movement in her legs despite several surgeries. Since then, she has vowed to one day walk again and has been active on social media documenting her recovery.

    It was not immediately clear what kind of exoskeleton device Van Dyken used. An assistant in one photo appears to be wearing a shirt with the logo for Indego, a wearable, motorized device sold by Parker Hannifin Corp markets for use in medical clinics.

    ReWalk Robotics Inc, which has plans take the company public, also sells a system for both clinical and personal use. It won approval from the U.S. Food and Drug Administration earlier this year to market it as long as it continues to gather data on its use.

    Such devices also have helped other paraplegics, including a man who earlier this summer kicked the first ball of the World Cup. A British woman in 2012 used a robotic exoskeleton to complete the London Marathon, although it took her 17 days.

  • U.S. EPA makes strides in air toxics but work remains in cities -report

    By Reuters Staff

    WASHINGTON (Reuters) - The United States has made progress in reducing dangerous air pollution since 1990 but work remains to reduce risks for the country's most overburdened urban areas, the U.S. Environmental Protection Agency's top official said on Thursday.

    The EPA released to Congress its second report on integrated air toxics, citing "substantial progress" toward reducing levels of contaminants such as arsenic, mercury and lead since it launched an Integrated Urban Air Toxics Strategy in 1999.

    Air toxics, also known as toxic air pollutants or hazardous air pollutants, are pollutants that may increase the risk of cancer or other serious health effects, such as birth defects.

    EPA Administrator Gina McCarthy pointed to milestones such as a 60 percent reduction in mercury from coal-fired power plants and an 84 percent cut in lead levels in outdoor air among the agency's accomplishments.

    But she told reporters that more work needs to be done to understand air toxics better and reduce remaining risks, which are most prevalent in low-income urban areas.

    "There is more that we have to do and more that we can do," McCarthy said on a conference call.

    The report she cited highlighted six areas where the current EPA air toxics program must improve, including emissions data; ambient data in more areas covering more pollutants; better monitoring technologies; and research on health impacts of air toxics.

    McCarthy said the agency is focused on addressing environmental justice by recognizing that some of the most economically disadvantaged communities are most at risk of the negative health effects of air pollution.

    The agency will complete studies of air toxic pollution in the neighborhoods of South Philadelphia and North Birmingham, Alabama, to get better data that can help inform local decision making.

    "Environmental justice is the core of EPA's mission - striving for clean water and healthy air for every American," McCarthy said.

    For the complete 139-page EPA report, see: http://www2.epa.gov/sites/production/files/2014-08/documents/082114-urban-air-toxics-report-congress.pdf

Oncology Articles

  • Robotic prostate removal tied to surgical changes, costs

    By Andrew M. Seaman

    NEW YORK (Reuters Health) - The introduction of robotic surgery for prostate cancer may have led to changes in the number of surgeons performing prostate removals and in the overall cost, according to a new study.

    With the technology being used more widely, fewer doctors are performing the procedure and the overall cost of prostate removal has gone up, researchers found.

    While studies examining the benefits and potential harms of robotic surgery have produced mixed results, the researchers write in BJU International that there is little information on how the innovation influenced prostate removal in the U.S.

    "We knew by anecdotal reports as well as the scientific literature that it had become relatively widespread but we didn't know how that had been done," said Dr. Steven Chang, the study's lead author from Harvard Medical School, Brigham and Women's Hospital and the Dana-Farber Cancer Institute in Boston.

    Robotic-assisted radical prostatectomy, which is the removal of the prostate with the help of a robot, began after U.S. regulators approved Intuitive Surgical, Inc.'s da Vinci Surgical System in 2000.

    Before that, surgeons would remove the prostate through a relatively large incision in so-called open surgery - or through a small incision with the help of a camera, in laparoscopic surgery.

    For the new study, the researchers used data on nearly 490,000 men who had their prostates removed between 2003 and 2010. Of those, 338,448 had open or laparoscopic surgery and 150,921 had robotic-assisted surgery.

    Overall, there was a dramatic increase in the number of prostate removals with the new technology. The proportion of surgeons doing at least half of their prostate removals with the robot increased from 0.7 percent in 2003 to about 42 percent by 2010.

    Surgeons who had been doing more than 24 prostate removals each year were the most likely to start using the new technology.

    The researchers also found that the number of surgeons performing prostate removals decreased during the study period from about 10,000 to 8,200.

    Chang said the finding that fewer surgeons are performing the procedure is likely because the ones who were only doing a few every year decided to stop altogether.

    "It was fairly obvious that the people who adopted this technology had a higher volume per year than people who did not adopt this technology," he said.

    "We have seen a concentration of da Vinci use among high volume surgeons, which we think is a positive for the healthcare system," said Dave Rosa, the executive vice president and chief scientific officer of Intuitive Surgical, Inc., in a statement emailed to Reuters Health.

    "Da Vinci use for radical prostatectomy has been shown to have clinical advantages over open prostatectomy in most of the dozens of comparative clinical studies published," Rosa added.

    The current study was not designed to analyze which type of surgery is safer or leads to fewer complications, Chang said.

    "I don't think anyone really knows that answer and I don't know if that study will ever be done," Dr. Jeff Karnes, who was not involved with the new study, told Reuters Health.

    When it comes to prostate removal, the surgeon's experience is likely more important than whether it's done with or without a robot, said Karnes, an urologist from the Mayo Clinic in Rochester, Minnesota.

    Chang and his colleagues also found that the introduction of the new technology was tied to an increase in overall U.S. spending on prostate removals.

    They write that the increase in cost is likely related to an increased number of prostate removals and increased cost for each procedure.

    Robotic-assisted prostate removals cost more than open surgeries throughout the study but the researchers found that the cost of the older surgical methods also increased toward the end of the study.

    They can't say, based on their data, why the cost of open or laparoscopic surgeries began to increase, but they suggest it may be due to slower surgeons continuing to use open surgeon or innovations in open surgery that drove the price up.

    Alternatively, Karnes said it could also be a result of riskier prostate removals, which take more time, needing open surgery.

    Intuitive Surgical, Inc.'s Rosa said a thorough study would take into account overall societal costs in an economic analysis. Those costs include how the patients faired after the procedure.

    "Costs can be calculated very differently in economic studies depending on the methodology used," he said.

    Chang said a goal in the future would be to do a more thorough cost analysis that includes more indirect costs.

    Overall, Karnes said he is not surprised by the results of the study.

    "We know that when a hospital acquires the technology the number of robot procedures go up in that hospital," he said.

    For patients faced with prostate removal, he said it's likely best to make a decision on open or robotic-assisted surgery based on the surgeon's experience and performance.

    SOURCE: http://bit.ly/1luyDMz BJU International, online August 26, 2014.

  • Medicaid payouts for office visits may influence cancer screening: study

    By Kathryn Doyle

    NEW YORK (Reuters Health) - In states where Medicaid pays doctors higher fees for office visits, Medicaid beneficiaries are more likely to be screened for breast, cervical or colorectal cancer, according to a new study.

    "States tend to vary in their reimbursement rates for different types of medical care services; some states may have low reimbursements for certain services and higher reimbursements for others," said lead author Dr. Michael T. Halpern of the Division of Health Services and Social Policy Research at RTI International at Washington, D.C.

    Medicaid, a health insurance program for low-income individuals, is jointly funded by the federal government and the individual states. Each state establishes its own coverage and reimbursement policies.

    Unexpectedly, states' reimbursement rates for specific screening tests weren't always associated with an increase in screening rates, Halpern and his team found.

    There is no reason to believe that reimbursing more for a certain test would lead to that test being used less, so there's probably something else going on to explain that relationship, which was specifically true for Pap tests, Halpern told Reuters Health by email.

    Researchers analyzed Medicaid data from 2007 for 46 states and the District of Columbia.

    In states with higher payments for office visits, cancer screenings were more common. But higher payments for the screenings themselves did not always mean the screenings were performed more often, according to results published in the journal Cancer.

    Nationwide, the median Medicaid reimbursement for an office visit is $37. (In other words, half the states pay doctors less than that.) The median Medicaid reimbursement was $24 for a Pap test, which can detect early cervical cancer, and $271 for a colonoscopy.

    These tests are all recommended for the age group of the people in the study, but since some of the tests are not recommended yearly and the study only includes data from 2007, it was not clear whether the Medicaid beneficiaries were receiving guideline-based screening, Halpern said.

    State by state, when screening test reimbursement rose by 20 percent, the odds of receiving a colonoscopy increased by 1.6 percent, the odds of getting a Pap test decreased by 0.8 percent, and a mammogram might be more or less likely depending on the type and location of the screening order.

    But when reimbursement for an office visit rose by 20 percent, so did screening rates, by 2 to 8 percent.

    "Many primary care physicians do not accept Medicaid patients or are able to provide care only to limited numbers of Medicaid beneficiaries, potentially due to low reimbursements for office visits," Halpern said. "By increasing Medicaid reimbursements for primary care physician office visits, more physicians may be able to provide care for Medicaid beneficiaries, thus increasing their likelihood of receive cancer screenings."

    For screenings like colonoscopy and mammography, the primary care doctor refers the patient to another provider for those tests, so the amount Medicaid reimburses for the tests generally doesn't have a financial benefit for the referring physician, he said.

    "The finding with higher Medicaid office fees is noteworthy, because it means that higher fees open physicians' doors to Medicaid patients and that is the first step to getting patients the care they need," said Stephen Zuckerman, senior fellow and co-director of the Health Policy Center of the Urban Institute. "Cancer screening is only on part of that."

    Doctors' time is limited, and economic incentives matter to them, Zuckerman told Reuters Health by email.

    "In a system with many payers, that means that it makes sense for physicians to see patients for whom they receive better compensation before they see other patients," he said.

    Fees are not the only incentives in scheduling patients, but they do play an important role, he said.

    "Since office visit fees have the most consistent relationship to receipt of cancer screening, it would be important to make sure those fees are sufficient to get Medicaid patients appropriate access to primary care services," Zuckerman said.

    SOURCE: http://bit.ly/1tOc4l9 Cancer, online August 25, 2014.

  • Prescription painkiller deaths fall in medical marijuana states

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Researchers aren't sure why, but in the 23 U.S. states where medical marijuana has been legalized, deaths from opioid overdoses have decreased by almost 25 percent, according to a new analysis.

    "Most of the discussion on medical marijuana has been about its effect on individuals in terms of reducing pain or other symptoms," said lead author Dr. Marcus Bachhuber in an email to Reuters Health. "The unique contribution of our study is the finding that medical marijuana laws and policies may have a broader impact on public health."

    California, Oregon and Washington first legalized medical marijuana before 1999, with 10 more following suit between then and 2010, the time period of the analysis. Another 10 states and Washington, D.C. adopted similar laws since 2010.

    For the study, Bachhuber, of the Philadelphia Veterans Affairs Medical Center and the University of Pennsylvania, and his colleagues used state-level death certificate data for all 50 states between 1999 and 2010.

    In states with a medical marijuana law, overdose deaths from opioids like morphine, oxycodone and heroin decreased by an average of 20 percent after one year, 25 percent by two years and up to 33 percent by years five and six compared to what would have been expected, according to results in JAMA Internal Medicine.

    Meanwhile, opioid overdose deaths across the country increased dramatically, from 4,030 in 1999 to 16,651 in 2010, according to the Centers for Disease Control and Prevention (CDC). Three of every four of those deaths involved prescription pain medications.

    Of those who die from prescription opioid overdoses, 60 percent have a legitimate prescription from a single doctor, the CDC also reports.

    Medical marijuana, where legal, is most often approved for treating pain conditions, making it an option in addition to or instead of prescription painkillers, Bachhuber and his coauthors wrote.

    In Colorado, where recreational growth, possession and consumption of pot has been legal since 2012 and a buzzing industry for the first half of 2014, use among teens seems not to have increased (see Reuters story of July 29, 2014 here: http://reut.rs/1o040NI).

    Medical marijuana laws seem to be linked with higher rates of marijuana use among adults, Bachhuber said, but results are mixed for teens.

    But the full scope of risks, and benefits, of medical marijuana is still unknown, he said.

    "I think medical providers struggle in figuring out what conditions medical marijuana could be used for, who would benefit from it, how effective it is and who might have side effects; some doctors would even say there is no scientifically proven, valid, medical use of marijuana," Bachhuber said. "More studies about the risks and benefits of medical marijuana are needed to help guide us in clinical practice."

    Marie J. Hayes of the University of Maine in Orno co-wrote an accompanying commentary in the journal.

    "Generally healthcare providers feel very strongly that medical marijuana may not be the way to go," she told Reuters Health. "There is the risk of smoke, the worry about whether that is carcinogenic but people so far haven't been able to prove that."

    There may be a risk that legal medical marijuana will make the drug more accessible for kids and smoking may impair driving or carry other risks, she said.

    "But we're already developing Oxycontin and Vicodin and teens are getting their hands on it," she said.

    If legalizing medical marijuana does help tackle the problem of painkiller deaths, that will be very significant, she said.

    "Because opioid mortality is such a tremendously significant health crisis now, we have to do something and figure out what's going on," Hayes said.

    The efforts states currently make to combat these deaths, like prescription monitoring programs, have been relatively ineffectual, she said.

    "Everything we're doing is having no effect, except for in the states that have implemented medical marijuana laws," Hayes said.

    People who overdose on opioids likely became addicted to it and are also battling other psychological problems, she said. Marijuana, which is not itself without risks, is arguably less addictive and almost impossible to overdose on compared to opioids, Hayes said.

    Adults consuming marijuana don't show up in the emergency room with an overdose, she said. "But," she added, "we don't put it in Rite Aid because we're confused by it as a society."

    SOURCE: http://bit.ly/1pYZf8d JAMA Internal Medicine, August 25, 2014

  • Mammography false alarms linked with later tumor risk

    By Ronnie Cohen

    NEW YORK (Reuters Health) - Women whose screening mammograms produce false alarms have a heightened risk of being diagnosed with breast cancer years later, but the reason remains mysterious, researchers say.

    An increased risk of breast cancer among women with a "false positive" mammogram has been reported before. What's new about this study is that the authors tried to figure out how much, if any, of the extra risk is simply due to doctors missing the cancer the first time they investigated the worrisome mammogram findings.

    But mistakes from doctors missing cancers explained only a small percentage of the increased risk, according to lead author My von Euler-Chelpin, an epidemiologist from the University of Copenhagen in Denmark.

    She told Reuters Health in a telephone interview that she could not explain most of the increased risk of later breast cancer in women with false-positive mammograms. (A mammogram is considered false positive when it suggests possible breast cancer but additional screenings or a biopsy fails to find it.)

    Of more than 58,000 Danish women who had mammography between 1991 and 2005, her study identified 4,743 women with suspicious findings that were eventually declared negative.

    By 2008, 295 of those 4,743 women had been diagnosed with breast cancer, von Euler-Chelpin and colleagues reported in Cancer Epidemiology.

    Radiologists reread the original mammograms and found that doctors had actually missed the cancer in 72 of the 295 women, for a false-negative rate of 1.5 percent. Even after taking those missed cancers into account, however, the researchers found that women with false-positive mammograms were still 27 percent more likely to be diagnosed with breast cancer years later, compared to women with only negative test results.

    The risk was slightly higher in women who had surgical biopsies that turned out to be negative.

    Von Euler-Chelpin thinks a smaller percentage of American women would have an elevated risk for breast cancer after a false-positive test because the U.S. has a higher rate of false positives than Denmark. The risk of a false-positive test over 10 mammograms ranges from 58 percent to 77 percent in the U.S., while it is around 16 percent in Denmark, the study says.

    Dr. Michael Alvarado, a breast cancer surgeon from the University of California, San Francisco, agreed that the risk of being diagnosed with breast cancer after a false positive mammogram is probably lower in the U.S. than in Denmark.

    "It's hard to translate the data to the U.S. population because we have such a different screening program, we tend to biopsy everything, and we're much more aggressive," he told Reuters Health. Alvarado was not involved in the current study.

    "Is there some inherent biology of the breast that makes it suspicious and it puts you at higher risk? I don't think anyone knows what it is," he said.

    Alvarado wondered if women who get false-positive mammograms should be followed more closely by their doctors, or if false-positive patients should be screened differently.

    Von Euler-Chelpin told Reuters Health the excess rate of breast cancer among women who have had false-positive mammograms points to the need to personalize screening programs for women - and Dr. Karla Kerlikowske agreed.

    Kerlikowske, from the University of California, San Francisco, is developing a risk calculator app to guide women in deciding how often to get mammograms. The calculator considers a range of factors, including age, race, previous breast cancer, family history and breast density. Kerlikowske was not involved in the current study.

    Although having had a false-positive mammogram is associated with a woman's breast cancer risk, Kerlikowske points out that the actual risk of being diagnosed with breast cancer remains low.

    The average five-year breast cancer risk for a 50-year-old white woman with no prior family history of breast cancer is 1.25 percent, the calculator shows. It ranges from less than 1 percent, to 2.70 percent, depending upon breast density, for the same woman with a history of a prior breast biopsy, regardless of whether the biopsy was positive or negative.

    "The absolute risk is still small," Kerlikowske said. "To me, it just says, now you have this risk factor, and you have to consider it with other risk factors."

    Von Euler-Chelpin agrees.

    "This paper is one little step on the way of trying to identify high-risk groups," she said. "The goal is to find more personalized screening programs for women."

    The American Cancer Society recommends that women be screened for breast cancer every year they are in good health starting at age 40. But a growing number of researchers have questioned the benefits of annual mammograms, and since 2009 the government-backed United States Preventive Services Task Force has recommended that screening be done every two years and be generally restricted to women aged 50 to 74.

    Women in Denmark between the ages 50 to 69 are invited to have screening mammograms every other year, Von Euler-Chelpin said.

    Getting a mammogram every other year instead of annually did not increase the risk of advanced breast cancer in women ages 50 to 74, according to a study Kerlikowske published last year (see Reuters story of March 18, 2013 here: http://reut.rs/1w7CMuh).

    The recommendation to reduce the frequency and delay the start of mammography screening was based on research showing the risk of false-positive results - which needlessly expose women to the anguish of a possible breast cancer diagnosis and the ordeal of further testing - outweighed the benefits of detecting cancers earlier.

    SOURCE: http://bit.ly/1wALk81 Cancer Epidemiology, online July 14, 2014.

  • Fewer U.S. youth using sunscreen new study finds

    By David Beasley

    ATLANTA (Reuters) - Fewer U.S. teenagers are using sunscreen, even as skin cancer rates increase, a study found.

    The percentage of high school students using sunscreen dropped from 67.7% in 2001 to 56.1% in 2011, according to the study by researchers at William Paterson University in New Jersey and published August 21 in the publication Preventing Chronic Disease.

    The study analyzed survey data from high school students collected for the Centers for Disease Control and Prevention's Youth Risk Behavior Surveillance System.

    The drop in sunscreen use occurred as melanoma, the most dangerous form of skin cancer, increased 1.6% annually among men from 2001 to 2010 and 1.4% among women, the study said.

    "It's alarming," said Corey Basch, assistant professor of public heath at William Paterson and one of the study's authors. "Given that the rates of skin cancer and melanoma are going up, we would have liked to have seen sun protection measures also going up."

    The CDC recommends using sunscreen and avoiding tanning beds to avoid developing skin cancer.

    Avoiding over-exposure to the sun is particularly important during childhood and adolescence, the study said.

    The findings point to the need for a greater push to inform teenagers on the dangers of sun exposure, said Basch.

    "What we really need is to change the mindset that having this artificially tanned skin is attractive," she said.

    In Australia, a massive public information campaign called "Slip Slop Slap" included handing out free sunscreen at beaches and was effective in increasing sun protection, Basch said. Television ads showed beachgoers wearing hats and shirts.

    "Over time, it really transformed how people envisioned a beach day," Basch said. "It was no longer just frying yourself, so to speak, on a beach in a string bikini."

    While the use of sunscreen by teenagers is dropping in the United States, so is the use of indoor tanning devices, the study said.

    From 2009 to 2011, the percentage of respondents using tanning devices dropped from 15.6% to 13.3%, the study said. However, the decrease was so small that it is not considered significant, Basch said.

    SOURCE: http://1.usa.gov/1nfLiOx

    Prev Chronic Dis 2014.

Orthopedic Articles

  • Knee replacement may go poorly for people who think life isn't fair

    By Kathryn Doyle

    NEW YORK (Reuters Health) - People who tend to blame others for their suffering and think setbacks in their lives are irreparable tend to report more pain after knee replacement surgery, according to a new study.

    This is not the first time feelings of personal injustice have been tied to longer recovery times and increased disability after injury, the authors write.

    "Pain is a complex phenomenon that is influenced by biological, social, and psychological factors," said lead author Esther Yakobov, a doctoral student in clinical psychology at McGill University in Montreal.

    "Studies conducted with patients who suffer from chronic pain because of an injury demonstrated that individuals who judge their experience as unfair, focus on their losses, and blame others for their painful condition also tend to experience more pain and recover from their injuries slower than individuals who do not," she told Reuters Health by email.

    But those studies had been with victims of injuries, where externalizing blame is a bit easier than for degenerative conditions like osteoarthritis, she noted.

    For the new study, a group of 116 men and women with severe osteoarthritis, between ages 50 and 85 years old and scheduled for knee replacement surgery in Canada, first filled out questionnaires assessing perceived injustice, how much they think about or worry about pain and their fear of movement or re-injury.

    They rated their agreement with statements like, "It all seems so unfair" and "I am suffering because of someone else's negligence."

    With another clinical questionnaire the patients gauged their pain levels and physical functioning.

    After the knee replacement surgeries, which were all deemed successful, the patients rated their pain and function again at a one-year checkup.

    The more a patient agreed before surgery that life seems unfair and others are to blame for their problems, the more pain they reported experiencing one year after surgery. That was true even when age, sex, other health conditions and pre-surgery pain levels were accounted for, according to the results in the journal Pain.

    The more the patient thought about pain and felt helpless because of it before surgery, the more severe their disability during recovery seemed to be.

    "A decade ago, we reported that preoperative anxiety and depression influenced the outcome after surgery," said Dr. Victoria Brander, a physical medicine and rehabilitation specialist at Northwestern Orthopaedic Institute in Chicago.

    This new study adds to the effort to refine the concept, identifying specific psychological characteristics that serve as risk factors for complicated or painful recovery, Brander, who was not part of the new study, told Reuters Health by email.

    "All of these psychological factors point to the fact that patients who perceive themselves as helpless, those who are afraid, those who feel loss of control, have a more difficult time," Brander said.

    "The contrary is also true - patients who exhibit high levels of 'self-efficacy' (that is, patients who have a high degree of confidence in their own ability to achieve a goal) appear to do best after knee replacement," she said.

    Osteoarthritis, the wearing away of cartilage, joint lining, ligaments and bone in a joint, affects one third of people over age 65 in the U.S., according to the Centers for Disease Control and prevention.

    Knee replacement surgery can relieve pain and restore mobility, but about 20 percent of patients will have a problematic recovery or intense pain, based on previous research.

    How individuals perceive pain as just or unjust can vary widely between patients, and it can be influenced by many factors, so it's hard to say if having a more negative outlook is common or uncommon, Yabokov said.

    Researchers don't yet know if people with more negative outlooks only perceive their pain as worse than others or if their psychological state affects the physiology of healing and actually leads to more pain, she said.

    Nevertheless, findings like this suggest patients should be screened for their psychosocial outlook before surgery, she said.

    "This might suggest the usefulness of screening patients in terms of 'catastrophizing,' perceived injustice, fear of movement, and recovery expectancies before treatment or surgery," she said. "With this screening information, appropriate psychological intervention that targets specific risk factors of each patient can then be matched to patients' needs."

    SOURCE: http://bit.ly/1qOr9BB Pain, online July 25, 2014.

  • Knee replacement may go poorly for people who think life isn't fair

    By Kathryn Doyle

    NEW YORK (Reuters Health) - People who tend to blame others for their suffering and think setbacks in their lives are irreparable tend to report more pain after knee replacement surgery, according to a new study.

    This is not the first time feelings of personal injustice have been tied to longer recovery times and increased disability after injury, the authors write.

    "Pain is a complex phenomenon that is influenced by biological, social, and psychological factors," said lead author Esther Yakobov, a doctoral student in clinical psychology at McGill University in Montreal.

    "Studies conducted with patients who suffer from chronic pain because of an injury demonstrated that individuals who judge their experience as unfair, focus on their losses, and blame others for their painful condition also tend to experience more pain and recover from their injuries slower than individuals who do not," she told Reuters Health by email.

    But those studies had been with victims of injuries, where externalizing blame is a bit easier than for degenerative conditions like osteoarthritis, she noted.

    For the new study, a group of 116 men and women with severe osteoarthritis, between ages 50 and 85 years old and scheduled for knee replacement surgery in Canada, first filled out questionnaires assessing perceived injustice, how much they think about or worry about pain and their fear of movement or re-injury.

    They rated their agreement with statements like, "It all seems so unfair" and "I am suffering because of someone else's negligence."

    With another clinical questionnaire the patients gauged their pain levels and physical functioning.

    After the knee replacement surgeries, which were all deemed successful, the patients rated their pain and function again at a one-year checkup.

    The more a patient agreed before surgery that life seems unfair and others are to blame for their problems, the more pain they reported experiencing one year after surgery. That was true even when age, sex, other health conditions and pre-surgery pain levels were accounted for, according to the results in the journal Pain.

    The more the patient thought about pain and felt helpless because of it before surgery, the more severe their disability during recovery seemed to be.

    "A decade ago, we reported that preoperative anxiety and depression influenced the outcome after surgery," said Dr. Victoria Brander, a physical medicine and rehabilitation specialist at Northwestern Orthopaedic Institute in Chicago.

    This new study adds to the effort to refine the concept, identifying specific psychological characteristics that serve as risk factors for complicated or painful recovery, Brander, who was not part of the new study, told Reuters Health by email.

    "All of these psychological factors point to the fact that patients who perceive themselves as helpless, those who are afraid, those who feel loss of control, have a more difficult time," Brander said.

    "The contrary is also true - patients who exhibit high levels of 'self-efficacy' (that is, patients who have a high degree of confidence in their own ability to achieve a goal) appear to do best after knee replacement," she said.

    Osteoarthritis, the wearing away of cartilage, joint lining, ligaments and bone in a joint, affects one third of people over age 65 in the U.S., according to the Centers for Disease Control and prevention.

    Knee replacement surgery can relieve pain and restore mobility, but about 20 percent of patients will have a problematic recovery or intense pain, based on previous research.

    How individuals perceive pain as just or unjust can vary widely between patients, and it can be influenced by many factors, so it's hard to say if having a more negative outlook is common or uncommon, Yabokov said.

    Researchers don't yet know if people with more negative outlooks only perceive their pain as worse than others or if their psychological state affects the physiology of healing and actually leads to more pain, she said.

    Nevertheless, findings like this suggest patients should be screened for their psychosocial outlook before surgery, she said.

    "This might suggest the usefulness of screening patients in terms of 'catastrophizing,' perceived injustice, fear of movement, and recovery expectancies before treatment or surgery," she said. "With this screening information, appropriate psychological intervention that targets specific risk factors of each patient can then be matched to patients' needs."

    SOURCE: http://bit.ly/1qOr9BB Pain, online July 25, 2014.

  • Knee replacement may go poorly for people who think life isn't fair

    By Kathryn Doyle

    NEW YORK (Reuters Health) - People who tend to blame others for their suffering and think setbacks in their lives are irreparable tend to report more pain after knee replacement surgery, according to a new study.

    This is not the first time feelings of personal injustice have been tied to longer recovery times and increased disability after injury, the authors write.

    "Pain is a complex phenomenon that is influenced by biological, social, and psychological factors," said lead author Esther Yakobov, a doctoral student in clinical psychology at McGill University in Montreal.

    "Studies conducted with patients who suffer from chronic pain because of an injury demonstrated that individuals who judge their experience as unfair, focus on their losses, and blame others for their painful condition also tend to experience more pain and recover from their injuries slower than individuals who do not," she told Reuters Health by email.

    But those studies had been with victims of injuries, where externalizing blame is a bit easier than for degenerative conditions like osteoarthritis, she noted.

    For the new study, a group of 116 men and women with severe osteoarthritis, between ages 50 and 85 years old and scheduled for knee replacement surgery in Canada, first filled out questionnaires assessing perceived injustice, how much they think about or worry about pain and their fear of movement or re-injury.

    They rated their agreement with statements like, "It all seems so unfair" and "I am suffering because of someone else's negligence."

    With another clinical questionnaire the patients gauged their pain levels and physical functioning.

    After the knee replacement surgeries, which were all deemed successful, the patients rated their pain and function again at a one-year checkup.

    The more a patient agreed before surgery that life seems unfair and others are to blame for their problems, the more pain they reported experiencing one year after surgery. That was true even when age, sex, other health conditions and pre-surgery pain levels were accounted for, according to the results in the journal Pain.

    The more the patient thought about pain and felt helpless because of it before surgery, the more severe their disability during recovery seemed to be.

    "A decade ago, we reported that preoperative anxiety and depression influenced the outcome after surgery," said Dr. Victoria Brander, a physical medicine and rehabilitation specialist at Northwestern Orthopaedic Institute in Chicago.

    This new study adds to the effort to refine the concept, identifying specific psychological characteristics that serve as risk factors for complicated or painful recovery, Brander, who was not part of the new study, told Reuters Health by email.

    "All of these psychological factors point to the fact that patients who perceive themselves as helpless, those who are afraid, those who feel loss of control, have a more difficult time," Brander said.

    "The contrary is also true - patients who exhibit high levels of 'self-efficacy' (that is, patients who have a high degree of confidence in their own ability to achieve a goal) appear to do best after knee replacement," she said.

    Osteoarthritis, the wearing away of cartilage, joint lining, ligaments and bone in a joint, affects one third of people over age 65 in the U.S., according to the Centers for Disease Control and prevention.

    Knee replacement surgery can relieve pain and restore mobility, but about 20 percent of patients will have a problematic recovery or intense pain, based on previous research.

    How individuals perceive pain as just or unjust can vary widely between patients, and it can be influenced by many factors, so it's hard to say if having a more negative outlook is common or uncommon, Yabokov said.

    Researchers don't yet know if people with more negative outlooks only perceive their pain as worse than others or if their psychological state affects the physiology of healing and actually leads to more pain, she said.

    Nevertheless, findings like this suggest patients should be screened for their psychosocial outlook before surgery, she said.

    "This might suggest the usefulness of screening patients in terms of 'catastrophizing,' perceived injustice, fear of movement, and recovery expectancies before treatment or surgery," she said. "With this screening information, appropriate psychological intervention that targets specific risk factors of each patient can then be matched to patients' needs."

    SOURCE: http://bit.ly/1qOr9BB Pain, online July 25, 2014.

Transplant Articles

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Women’s Health Articles

  • Fishery mislabeling could mean more mercury than buyers bargain for

    By Janice Neumann

    NEW YORK (Reuters Health) - That Chilean sea bass from the local grocery store could have twice the methylmercury that's expected - if it comes from a region other than indicated on the label, a new study says.

    While fish certified by the Marine Stewardship Council (MSC) is generally considered safe, seafood from regions with high levels of contamination are not. And researchers studying samples from U.S. retail stores found that many fish are indeed the species they are claimed to be, but not from the region claimed.

    "Chilean sea bass is already known to sometimes have high mercury levels," lead author Peter Marko, of the University of Hawai'i at Manoa, Honolulu, told Reuters Health.

    "If women are pregnant or nursing, they probably shouldn't buy that fish, to be safe," he said.

    Past research has found that fish sold in retail markets is not always the species it's advertised to be. And that even within a given species, mercury levels can vary widely.

    Methylmercury, the type of mercury found in fish, is an organic compound that can be absorbed into living tissue.

    Pregnant and nursing women and kids have been advised by the U.S. Food and Drug Administration to avoid shark, tilefish, swordfish and King Mackerel because these species have a mean mercury level of 0.73 to 1.45 parts per million. The FDA's limit for mercury in fish for human consumption is 1.0 ppm.

    Normally, the mercury content of Chilean sea bass, also known as Patagonian toothfish, is 0.35 ppm, according to the FDA.

    In the current study, published in the journal PLOS One, researchers used sea bass tissue samples from retailers in 10 U.S. states. They measured the total amount of mercury in 25 of the MSC-certified and 13 of the uncertified Chilean sea bass samples.

    They found that fish labeled as certified had less than half the mercury (0.35 ppm) of uncertified fish (0.89 ppm).

    But when the researchers excluded the fish that actually belonged to other species and were not genetically sea bass, they found no significant difference in the mercury levels of certified and uncertified fish.

    "We then said, 'that can't be because certified is supposed to come from South Georgia, where the mercury level is low, why do we see such a difference in mercury?'" said Marko, referring to a fishery area close to the South Pole and known to have less mercury contamination than fish from waters off South American. "It's these fishery stock substitutions," he said.

    The researchers tested the DNA of the fish and found those from outside the MSC-certified South Georgia/Shag Rocks fishery had twice as much mercury (0.63 ppm) as those genetically confirmed to be South Georgia stock (0.31 ppm).

    "Regular mercury exposure is potentially dangerous to developing nervous systems, so this and other studies like it are of greatest concern to pregnant women, children, and women planning on having children," Marko said in an e-mail.

    "Our study demonstrates that accurate labeling of seafood - not just with respect to what species but also what country or region the seafood came from - is essential to consumers, particularly in the aforementioned demographic, to make informed choices at the seafood counter," he said.

    Marko pointed out that fish from South American waters can have two-to-three times as much mercury as fish from MSC-certified regions.

    Roberta White, professor and chair of Environmental Health at Boston University School of Public Health, who was not involved in the study, told Reuters Health in a phone interview the findings were another reminder that consumers need to be careful when purchasing fish.

    "What's really disturbing is how do people choose to eat fish that are safe?" said White, who has studied the effects of industrial pollutants on the brain.

    "Everybody wants people to eat fish because it is good for the brain and heart, but we also don't want them to be poisoning their children because they're pregnant," she said.

    White said future studies needed to focus on different species of fish and the genetics within species, as well as variations in neurotoxicants. Other contaminants in fish could also pose a health danger, including Polychlorinated Biphenyls (PCBs), which are synthetic organic chemicals, organic tin and different pesticides, she said.

    "As this article points out, sometimes you think something is safe because of the way it's labeled and maybe it isn't, but that's true of all our food," White said.

    "This is where you have to start, the simple stuff," White said. "I think what's important about the study is the public health message that we need to be careful about this and figure it out," said White.

    SOURCE: http://bit.ly/1vBpKRH PLOS One, online August 5, 2014.

  • Death certificates would reflect gender identity under California bill

    By Reuters Staff

    SACRAMENTO, Calif. (Reuters) - Death certificates in California would be changed to reflect the gender identity of people at the time of their death rather than their sex at birth under a bill passed by lawmakers on Wednesday, the latest effort by the state to further the rights of transgender residents.

    The bill, which passed the state senate on Wednesday and has already passed the state assembly, must now go back to the assembly for final approval of amendments before it is sent to Democratic Governor Jerry Brown to be signed and become law.

    It is one of several measures aimed at furthering the family rights of LGBT Californians passed this session, including a measure allowing same-sex couples to be listed as mother, father or parent on a child's birth certificate.

    "Once we are deceased, we are often at the mercy of others to treat us with dignity," said California Assembly Speaker Toni Atkins, a Democrat from San Diego. "The very least we can do is ensure individuals are given basic human dignity by honoring their authentic selves when they pass so that more pain is not inflicted upon grieving loved ones or the community."

    Under the bill, an official filling out a death certificate would have to respect evidence that the deceased person had changed gender identity, including health records showing treatment for gender transition, court approval for a name change, an advanced healthcare directive or other documents.

    Last year, the legislature passed other laws protecting transgender rights, including one that allows minors to participate in school athletics and use restrooms in accordance with their chosen gender.

  • Shift work linked to greater diabetes risk

    By Shereen Lehman

    NEW YORK (Reuters Health) - People who work night shifts, or constantly changing shifts are more likely to develop type 2 diabetes compared to non-shift workers, suggests a new analysis of previous studies.

    The risk was highest for men and people who worked rotating shifts, but the reasons for those differences remain unclear, researchers say.

    "Shift work is very common in modern society," the study's senior author Zuxun Lu told Reuters Health in an email.

    "Over the past decades, a few epidemiological studies have assessed the association between shift work and the risk of diabetes mellitus with the inconsistent results," said Lu, a researcher at Tongji Medical College, Huazhong University of Science and Technology in Wuhan, China.

    The lack of a definitive summary of previous results prompted Lu's team to assess what's known, they write in the journal Occupational and Environmental Medicine.

    About 15 million Americans are shift workers, according to the U.S. Centers for Disease Control and Prevention. And diabetes affects about 30 million Americans, or about 9 percent of the total population.

    Lu and colleagues combined and re-analyzed the data from 12 previous studies that looked at the association between shift work and chances of developing diabetes. The studies included a total of 226,652 participants and 14,595 people with diabetes.

    The studies were published between 1983 and 2013. Six of the studies were conducted in Japan, with two each from the U.S. and Sweden and one each from Belgium and China.

    Shift work includes working nights, evenings, rotating shifts or irregular shifts - anything other than working typical daytime hours, the authors note.

    Based on their analysis, the risk of diabetes was increased by 9 percent overall for shift workers, compared to people who had never been exposed to shift work.

    Male shift workers had a 28 percent greater risk of developing diabetes than their female counterparts. And people who worked rotating shifts had a 42 percent greater risk of diabetes compared to non-shift workers.

    It's not known how long the participants in those studies had been shift workers, which limits the authors' ability to interpret their results.

    The new analysis doesn't prove that shift work causes diabetes or explain how it might do so, they acknowledge.

    "More prospective cohort studies with long follow-up periods are warranted to replicate our findings and reveal the underlying biological mechanism," Lu said.

    He speculated that shift work may interfere with eating and sleeping patterns and disrupt circadian rhythms.

    "Some studies have shown that insufficient sleep and poor sleep quality may develop and exacerbate insulin resistance," Lu said.

    Insulin resistance is a condition in which the body doesn't use insulin properly to process blood sugar. It's also sometimes called "pre-diabetes."

    In addition, previous studies show that shift work is associated with weight gain, increase in appetite and body fat, which are major risk factors for diabetes Lu and his coauthors write.

    "The overall literature in this subject right now has been fairly convincing that there is in fact an association between a misalignment of circadian rhythm and risk for diabetes," Dr. Peter Butler told Reuters Health.

    Butler directs the Larry L. Hillblom Islet Research Center at the David Geffen School of Medicine at the University of California, Los Angeles.

    Butler, who was not involved in the study, said he wasn't surprised that the authors found rotating shifts tended to have more of an effect. "If your circadian rhythms aren't synchronized, it's not at all surprising that bad things would happen.".

    But, Butler said, it's not a problem for most people and that most people on night shifts don't get diabetes.

    "Probably about 20 percent of us are vulnerable for diabetes, and what I think probably happens is the people who get diabetes in relation to shift work are the ones who were vulnerable to getting diabetes anyway," he said.

    "It's not like if you are one of the 80 percent who's lucky enough to not be vulnerable and you go on shift work you are now going to get diabetes - it's more a question if you are one of the unlucky ones who are predisposed to diabetes, then shift work may nudge you over that fence," Butler added.

    He said avoiding rotating shifts might be a good idea for people who have a strong family history of diabetes. But people who are at risk and have to work rotating shifts can still reduce the likelihood that they'll get diabetes.

    "You can counter the risks for diabetes," he said. "There are many risks that come into play and circadian misalignment is just one risk, but if you counter that by regular exercise and good diet, you'd reduce that risk very substantially."

    SOURCE: http://bit.ly/1s4yYnh Occupational and Environmental Medicine, online July 16, 2014.

  • Medicaid payouts for office visits may influence cancer screening: study

    By Kathryn Doyle

    NEW YORK (Reuters Health) - In states where Medicaid pays doctors higher fees for office visits, Medicaid beneficiaries are more likely to be screened for breast, cervical or colorectal cancer, according to a new study.

    "States tend to vary in their reimbursement rates for different types of medical care services; some states may have low reimbursements for certain services and higher reimbursements for others," said lead author Dr. Michael T. Halpern of the Division of Health Services and Social Policy Research at RTI International at Washington, D.C.

    Medicaid, a health insurance program for low-income individuals, is jointly funded by the federal government and the individual states. Each state establishes its own coverage and reimbursement policies.

    Unexpectedly, states' reimbursement rates for specific screening tests weren't always associated with an increase in screening rates, Halpern and his team found.

    There is no reason to believe that reimbursing more for a certain test would lead to that test being used less, so there's probably something else going on to explain that relationship, which was specifically true for Pap tests, Halpern told Reuters Health by email.

    Researchers analyzed Medicaid data from 2007 for 46 states and the District of Columbia.

    In states with higher payments for office visits, cancer screenings were more common. But higher payments for the screenings themselves did not always mean the screenings were performed more often, according to results published in the journal Cancer.

    Nationwide, the median Medicaid reimbursement for an office visit is $37. (In other words, half the states pay doctors less than that.) The median Medicaid reimbursement was $24 for a Pap test, which can detect early cervical cancer, and $271 for a colonoscopy.

    These tests are all recommended for the age group of the people in the study, but since some of the tests are not recommended yearly and the study only includes data from 2007, it was not clear whether the Medicaid beneficiaries were receiving guideline-based screening, Halpern said.

    State by state, when screening test reimbursement rose by 20 percent, the odds of receiving a colonoscopy increased by 1.6 percent, the odds of getting a Pap test decreased by 0.8 percent, and a mammogram might be more or less likely depending on the type and location of the screening order.

    But when reimbursement for an office visit rose by 20 percent, so did screening rates, by 2 to 8 percent.

    "Many primary care physicians do not accept Medicaid patients or are able to provide care only to limited numbers of Medicaid beneficiaries, potentially due to low reimbursements for office visits," Halpern said. "By increasing Medicaid reimbursements for primary care physician office visits, more physicians may be able to provide care for Medicaid beneficiaries, thus increasing their likelihood of receive cancer screenings."

    For screenings like colonoscopy and mammography, the primary care doctor refers the patient to another provider for those tests, so the amount Medicaid reimburses for the tests generally doesn't have a financial benefit for the referring physician, he said.

    "The finding with higher Medicaid office fees is noteworthy, because it means that higher fees open physicians' doors to Medicaid patients and that is the first step to getting patients the care they need," said Stephen Zuckerman, senior fellow and co-director of the Health Policy Center of the Urban Institute. "Cancer screening is only on part of that."

    Doctors' time is limited, and economic incentives matter to them, Zuckerman told Reuters Health by email.

    "In a system with many payers, that means that it makes sense for physicians to see patients for whom they receive better compensation before they see other patients," he said.

    Fees are not the only incentives in scheduling patients, but they do play an important role, he said.

    "Since office visit fees have the most consistent relationship to receipt of cancer screening, it would be important to make sure those fees are sufficient to get Medicaid patients appropriate access to primary care services," Zuckerman said.

    SOURCE: http://bit.ly/1tOc4l9 Cancer, online August 25, 2014.

  • After men, lesbians report the most orgasms during sex

    By Ronnie Cohen

    NEW YORK (Reuters Health) - Single lesbians report having orgasms more often than heterosexual women but both gay and straight men still come out on top of the climax chart, a new report says.

    Researchers at the Kinsey Institute for Research in Sex, Gender, and Reproduction at Indiana University in Bloomington analyzed responses from 2,850 single Americans to online questionnaires. The survey was sponsored by the online dating company Match.com, although participants were not drawn from users of the site.

    The men and women in the study ranged in age from 21 to more than 80 years old.

    Men reported having an orgasm during sex with a familiar partner 22.2 percent more often than women, the study found.

    But lesbian women said they reached climax during sex 13.1 percent more often than heterosexual women, according to the findings published in the Journal of Sexual Medicine.

    "Women's orgasms are less predictable than men's and they vary with sexual orientation and men's don't," lead researcher Justin Garcia told Reuters Health.

    In 1966, pioneering sex researchers Masters and Johnson suggested that straight men could learn a lot about how to guide their partners to orgasm from lesbian women, said Garcia, an Indiana University gender studies professor.

    Consequently, he told Reuters Health, his study's finding that lesbians have more orgasms than heterosexual women came as no surprise.

    "There are still pretty strong sexual double standards in America and they infiltrate the bedroom," he said.

    Nicole Prause, who studies human sexual behavior at the University of California, Los Angeles, agrees that sexual double standards that favor pleasuring men continue to prevail. But she questioned the validity of the current study's data on lesbians because she believes women often believe they are having an orgasm when in fact they are not.

    "I would be shocked if they're not over-counting," Prause told Reuters Health. She was not involved with the current study.

    "I don't think they're lying," she said. "I think they really believe they're having orgasm. If they're having fun, keep having fun. But there's a science issue that hasn't been addressed."

    When both men and women reach orgasm they have eight to 12 measurable contractions, Prause said. But researchers don't measure them.

    "How do women learn what an orgasm is?" she asked. "Your parents aren't talking to you about it. Where would you learn? I don't know. Maybe they're reporting orgasms just when they're having a pleasurable sensation."

    The authors of the current study say there is a dearth of data on rates of orgasm across sexual orientations.

    In the new study, single men reported experiencing orgasm during sex with a familiar partner on average 85.1 percent of the time, while women reported orgasm 62.9 percent of the time.

    Familiar partners exclude unfamiliar sexual "hookups," like those common among students on college campuses, Garcia said.

    "We know that in hookups, where men and women don't know their partners, the orgasm rates are lower," he said. It's also known that that orgasm rates are higher in men and women in committed relationships, he said.

    His data showed hardly any difference between the frequency of orgasm reported by heterosexual and gay men. Heterosexual men said they had an orgasm 85.5 percent of the time, and gay men reported orgasms 84.7 percent of the time.

    Heterosexual women reported orgasm during sex with a familiar partner 61.6 percent of the time, while homosexual women reported orgasm significantly more often - 74.7 percent of the time, the study found.

    The surprising finding for Garcia, he said, was among bisexual men and women. Compared to other men, bisexual men reported a lower, though not significantly, orgasm rate of 77.6 percent, the study found.

    Bisexual women also reported a lower rate - 58 percent - than other women.

    The reason for bisexuals' lower orgasm rates remains unclear, Garcia said. He said the data underscore the need for more information about the health of sexual minorities.

    Prause also would like to learn more about sexual minorities and orgasm. But she is skeptical about the usefulness of the current study's self-reported data.

    "I want to believe that women know their own bodies and I want to believe the lesbian effect is there. I'm glad they think they're having a better time," she said.

    Along with the disadvantage of using self-reported data, the study was also limited by the fact that participation required access to a computer. In addition, the authors note, they "did not include the categories of 'queer' or 'asexual' or a variety of other categories that more fully encompass people's sexual identities."

    Prause called for studies, like one she is doing in Pittsburgh, that actually measure orgasm contractions and check the validity of self-reports. Those studies are difficult to do, she said, because universities, including UCLA, are reluctant to allow people to reach orgasm in laboratories.

    "There's a very simple and straightforward way to measure the presence of orgasm," Prause said, "but no one's doing it."

    SOURCE: http://bit.ly/XFZHOi The Journal of Sexual Medicine, online August 18, 2014.