Male Heart Disease May Be Linked to Mom's Lifetime Nutrition Risk associated, in part, with mother's body size, placenta size and shape at birth, researchers say

Male Heart Disease May Be Linked to Mom's Lifetime Nutrition Risk associated, in part, with mother's body size, placenta size and shape at birth, researchers say By Alan Mozes THURSDAY, June 2 (HealthDay News) -- A man's heart disease risk after the age of 40 may be linked, at least in part, to his mother's body size and placenta size when he was born, a new study suggests. "Chronic disease is the product of a mother's lifetime nutrition and the early growth of her child," study lead author Dr. David Barker, a professor of clinical epidemiology at the University of Southampton in the United Kingdom, said in a news release from the European Society of Cardiology. "It is not simply a consequence of poor lifestyles in later life. Rather, it is a result of variations in the normal processes of human development." The finding is reported online June 1 in the European Heart Journal by Barker, who is also a professor in cardiovascular medicine at Oregon Health and Science University, and colleagues. Indications of the maternal influence on the heart disease risk of male offspring stem from an analysis involving nearly 7,000 Finnish men who were born in Helsinki between 1934 and 1944. At that time, birth records included notations on the baby's size, the placental surface size, and other information on the mother's weight, height and age, and previous pregnancies. (The placenta -- a temporary organ that lines the uterus and feeds the baby in the womb -- is expelled at birth.) The investigators found that male heart disease risk in late adulthood appeared to rise among: Men whose mothers were short, pregnant for the first time and had relatively oval placentas (indicating that the placental development had been disrupted). Men whose mothers were tall and heavy and had relatively small placentas (which might have restricted the infants' growth mid-gestation). Men whose mothers were tall with a lower-than-normal body mass index and whose placentas were heavy relative to birth weight (the mothers' BMIs suggest that their nutrition was poor during pregnancy, Barker explained). Regardless of which combination was in play, those men with the greatest likelihood for developing heart disease as adults had tended to be relatively thin at birth. This fact, the authors suggested, was an indication that malnourishment was a factor at the time of birth. "We have been able to show for the first time that a combination of the mother's body size and the shape and size of the placental surface predicts later heart disease," Barker said. Going forward, the research team intends to study abnormal development of the heart by examining pregnant women's nutritional habits and body characteristics alongside prenatal growth patterns and placenta sizes at birth.

Radiation Exposure

Radiation Exposure Radiation is energy that travels in the form of waves or high-speed particles. It occurs naturally in sunlight and sound waves. Man-made radiation is used in X-rays, nuclear weapons, nuclear power plants and cancer treatment. If you are exposed to small amounts of radiation over a long time, it raises your risk of cancer. It can also cause mutations in your genes, which you could pass on to any children you have after the exposure. A lot of radiation over a short period, such as from a radiation emergency, can cause burns or radiation sickness. Symptoms of radiation sickness include nausea, weakness, hair loss, skin burns and reduced organ function. If the exposure is large enough, it can cause premature aging or even death. You may be able to take medicine to reduce the radioactive material in your body. Environmental Protection Agency

Younger Docs More Likely to Prescribe Drugs for Heart Disease: Study But their patients are not better off than those of older docs who stress lifestyle changes

Younger Docs More Likely to Prescribe Drugs for Heart Disease: Study But their patients are not better off than those of older docs who stress lifestyle changes By Robert Preidt MONDAY, May 23 (HealthDay News) -- Older doctors are more likely to recommend lifestyle changes for patients with heart disease risk factors, while younger doctors are more likely to prescribe medications, a new study finds. But despite seeing doctors that prescribed more medications, the patients of younger doctors had no better control of their heart disease risk factors, according to the study by Italian researchers in the June issue of the International Journal of Clinical Practice. "Although younger doctors prescribed more drugs, this did not result in significantly better control of their patients' major CV [cardiovascular] risk factors, suggesting that other factors have an important role to play in the clinical management of CV risk, including lifestyle changes," Professor Massimo Volpe from the Faculty of Medicine at Sapienza University in Rome said in a journal news release. Volpe and his colleagues looked at the attitudes and prescribing habits of 1,078 family physicians, cardiologists and diabetes specialists, along with data from nearly 10,000 of their outpatients, whose average age was 67. The study found that 75 percent of the patients had high blood pressure, making it the most common cardiovascular disease risk factor. That was followed by abnormal lipid levels (cholesterol and/or fat in the blood), which affected 59 percent of patients, and diabetes (37 percent). Blood pressure drugs were the most commonly prescribed medications -- by 83 percent of doctors younger than 45, 78 percent of doctors aged 46-55, and 80 percent of doctors over 55. Younger doctors were also more likely to prescribe diabetes drugs, lipid-lowering and anti-platelet agents than older doctors. Older doctors were most likely to recommend lifestyle changes. For example, doctors over 55 were most likely to tell patients to quit smoking and doctors aged 46 to 55 were most likely to recommend a healthier diet and exercise. "We believe these findings have important implications for the ongoing professional education of doctors treating patients with CV risk," Volpe added. SOURCE: International Journal of Clinical Practice, news release, May 16, 2011

Too Many Kids Getting Antibiotics for Asthma But researchers found fewer were prescribed when doctors educated parents during visits

Too Many Kids Getting Antibiotics for Asthma But researchers found fewer were prescribed when doctors educated parents during visits TUESDAY, May 24 (HealthDay News) -- Although guidelines don't recommend antibiotics for asthma, almost 1 million children with the respiratory condition are prescribed the medications each year in the United States, a new study finds. "We are trying to reduce unnecessary antibiotic prescriptions, and this suggests that we as pediatricians are prescribing them way too often," said lead researcher Dr. Ian M. Paul, an associate professor of pediatrics at the College of Medicine of Pennsylvania State University in Hershey. Why doctors are prescribing antibiotics for asthma is not clear, Paul said. One reason might be that doctors treating severe asthma attacks "feel the need to cover all their bases by also prescribing antibiotics," he suggested. Sometimes parents may ask doctors to give their child antibiotics, but it doesn't seem to be a big factor, Paul noted. "It probably exists to some degree in clinical practice, but I don't think it happens all that frequently -- certainly not in one in every six visits for asthma," he said. "The one encouraging finding was, when asthma education was delivered as part of the visit, antibiotics were less likely to be prescribed," he added. When asthma education was not part of the visit, 19 percent of the time antibiotics were prescribed, compared with 11 percent when asthma education was given. "This suggests that we can educate families and patients and explain the causes of asthma and, hopefully, reduce unnecessary antibiotic prescribing," Paul said. The dangers of overprescribing antibiotics are that it promotes the development of antibiotic-resistant bacteria and there are side effects for the drugs themselves, Paul pointed out. The report was published in the May 23 online edition of Pediatrics. For the study, Paul's team used data from the National Ambulatory Medical Care Surveys and National Hospital Ambulatory Medical Care Survey to see the rate of antibiotics prescribed for children between 1998 and 2007. Over that time, there were some 60.4 million medical care visits for children with asthma for which no prescription for antibiotics was warranted. However, antibiotics were prescribed 16 percent of the time, the researchers found. Primary care doctors were most likely to prescribe antibiotics, while emergency department doctors were least likely to prescribe them, Paul said. Other factors that were linked with increased antibiotic prescribing included use of inhaled corticosteroids and being treated in the winter, the researchers noted. However, when visits to primary care doctors included asthma education, the rate of antibiotic prescribing went down, Paul stated. In a second study in the same journal, Belgian investigators led by Dr. Kris De Boeck, from the department of pediatric pulmonology and infectious diseases at the University Hospital of Leuven, found similar overprescribing of antibiotics to asthmatic children. These researchers found children treated with asthma medications were 1.9 times more likely to also get a prescription for antibiotics, compared with children not treated with asthma drugs. In fact, 35.6 percent of children who were prescribed asthma drugs were also prescribed antibiotics, the researchers found. "This finding highlights the need for educational opportunities to inform clinicians that such co-prescription should be limited," the authors concluded. Commenting on both studies, Dr. Paul Krogstad, a professor of pediatric infectious diseases at the University of California, Los Angeles, and co-author of an accompanying journal editorial, said that "these articles indicate that asthma medications and antibiotics were very commonly prescribed in tandem both here and in Belgium, which conflicts with domestic and international recommendations that point out that antibiotics have no routine use in the care of asthmatics." Antibiotic overuse confuses patients and family, Krogstad said. "They don't understand the true nature of asthma as an inflammatory, not an infectious disorder," he explained. In addition, overprescribing antibiotics entails personal and societal risks, Krogstad said. "Personal risks include allergic reactions, side effects, drug interactions and expense. Societal costs include medication-related costs and selection for drug-resistant bacteria. Antibiotic overuse is being reduced, but this remains an area where improvement is sorely needed," he said. SOURCES: Ian M. Paul, M.D., associate professor, pediatrics, College of Medicine, Pennsylvania State University, Hershey, Pa.; Paul Krogstad, M.D., professor, pediatric infectious diseases, University of California, Los Angeles; May 23, 2011, Pediatrics, online

FDA Advisers Urge Infant Doses for Kids' OTC Fever Relievers Would better protect those under 2 who use products like Children's Tylenol, experts say

FDA Advisers Urge Infant Doses for Kids' OTC Fever Relievers Would better protect those under 2 who use products like Children's Tylenol, experts say WEDNESDAY, May 18 (HealthDay News) -- U.S. health advisers recommended Wednesday that dosing instructions should be added to the labels of medicines containing the widely used pain reliever and fever reducer acetaminophen to better protect children under the age of 2. In a 21-0 vote, the panel of U.S. Food and Drug Administration advisers called for adding dosing information for children 6 months to 2 years old to over-the-counter medicines such as Children's Tylenol and similar products containing acetaminophen, the Associated Press reported. Currently, the labels of such medications have dosing instructions for children aged 2 and up. For kids under 2, the labels on the liquid medicines simply tell parents to "ask a doctor." The FDA advisers said the lack of specific dosing recommendations can lead to confusion, with parents unintentionally giving too much of the medicine to children under age 2. Acetaminophen-related overdoses are most common among children younger than 2, and have increased over the past decade, according to FDA data. Wednesday's vote focused only on a small group of single-ingredient products, including J&J's Children and Infants' Tylenol, Novartis' Triaminic, Prestige Brands' Little Fevers and assorted drugstore brands, the AP said. In a second vote Wednesday, the panel recommended unanimously that these medicines should also include dosing information based on children's weight -- considered the most accurate way to determine the proper dose. Nearly all over-the-counter manufacturers already include a dosing table with both weight and age. But the FDA advisers said instructions must emphasize that weight is the preferred approach, the AP reported. In a third vote, the advisers recommended 17-3, with one abstention, that the FDA consider requiring a single dosage for children's solid acetaminophen tablets, the news service said. While the FDA is not required to follow the recommendations of its advisory panels, it usually does so. The American Academy of Pediatrics (AAP) and drug manufacturers are both strongly in favor of giving parents the additional dosing information. "If we give parents better information, they will be able to give enough of the medicine to work well, at the same time minimizing the side effects," said Dr. Daniel Frattarelli, a pediatrician in Dearborn, Mich., who chairs the academy's drug committee and who planned to testify before the joint, two-day meeting of the FDA's Nonprescription Drugs Advisory Committee and the Pediatric Advisory Committee. "Parents want to do the right thing for their children," he said. "We as a medical community have to give them that information so they are able to do this." Although the evidence shows that acetaminophen is safe for young children, parents have to be careful with it, pediatricians noted. Giving too much can be toxic to the liver, causing poisoning and even liver failure. In 2010, there were 270,000 reported overdoses of acetaminophen, according to the American Association of Poison Control Centers. Dosing errors involving children's acetaminophen products accounted for almost 7,500 cases -- nearly 3 percent. In an ideal world, the parents of infants and toddlers would still consult with their pediatrician or pharmacist to get the proper medication dosing, said Dr. William Basco, director of general pediatrics at the Medical University of South Carolina. But the reality is that many parents aren't doing that and are instead guessing about proper dosing. "There is no benefit to having parents guess at the right dose," Basco said. Drug makers, including McNeil Consumer Healthcare, which makes Tylenol, also support the change. "McNeil is committed to encouraging the appropriate and safe use of medicines in children, including adding new dosing information on the OTC pediatric acetaminophen label to assist caregivers and health-care providers in appropriately dosing children, especially those 6 to 23 months of age," the company wrote in materials submitted to the FDA. By way of comparison, drugs containing ibuprofen -- another heavily used over-the-counter fever reducer -- already include dosing information for children under age 2. Children's medications containing acetaminophen have been sold over-the-counter since 1959, and dosing information for children has been on the labels since the 1970s, according to McNeil. Back then, doses for kids were somewhat crude -- children 12 and up were advised to take the adult dose, kids 6 to 12 were told to take half that, and kids younger than 6 were told to take a quarter of the adult dose. Since then, as physicians have learned more about the medications, dosing recommendations for infants and toddlers have become more refined and now should be based on weight, not age, according to the AAP. (Age is still listed on package labeling, the AAP explained.) Kids' weights can range widely at any given age, so the correct dose for a child on the heavier side may not be the correct dose for a smaller child of the same age. Though acetaminophen is safe even in newborns if used correctly, the drug makers and the AAP called for expanding the labeling information for children 6 months old and up. Parents should still be encouraged to consult with their physicians before giving medication to younger children, especially those under the age of 3 months, Frattarelli said. Fevers of more than 100.4 degrees need to be taken very seriously in infants, whose immune systems are not fully developed and whose vaccinations haven't yet fully kicked in, he explained. Earlier this month, the Consumer Healthcare Products Association, a trade association for over-the-counter drug-makers, agreed to sell only one concentration of acetaminophen in products for infants and children to prevent dosing errors. Previously, for example, Infant's Tylenol liquid drops were much more concentrated than Children's Tylenol, which could easily lead to confusion if parents didn't read the label or know there was a difference. Drug-makers agreed to phase out the infant drops concentration starting in the middle of this year. In any given week, about 23 percent of kids under age 2 are given acetaminophen, according to background information from McNeil. "Acetaminophen dosing errors are a rare but potentially very severe adverse event that could lead to liver failure or even death for kids," said Dr. Richard Dart, president of the American Association of Poison Control Centers, in a news release. "This decision will lessen the chance that parents will give their children the wrong dose." SOURCES: William Basco, M.D., director, general pediatrics, Medical University of South Carolina, Charleston; Daniel Frattarelli, M.D., pediatrician, Dearborn, Mich., and chair, American Academy of Pediatrics Committee on Drugs; U.S. Food and Drug Administration Web site; Associated Press

Is My Child at Risk for Kidney Disease?

Is My Child at Risk for Kidney Disease? Some diseases and conditions put children at risk for kidney disease. A urine test is used to check for kidney disease before symptoms appear. Read more to learn about risk factors, the urine test, and treatment for kidney disease. What do the kidneys do? Your child has two kidneys. Their main job is to filter wastes and extra water from the blood. Wastes and water pass through the kidneys and leave the body as urine. The kidneys also make hormones that help the body make blood and keep the bones strong. What is kidney disease? Infections or other health problems can cause kidney disease. When a child has kidney disease, the kidneys may not work normally. This may lead to a harmful buildup of wastes in the body. How can I find out if my child has kidney disease? A urine test can be used to check for kidney disease if your child is at risk. Testing is important because early kidney disease often has no symptoms. Your child will urinate in a cup, and the sample will be tested for kidney disease. What does the urine test look for? The urine test checks for albumin. Albumin is a protein in your child’s blood that is too big to pass through healthy kidneys. If your child’s kidneys are damaged, small amounts of albumin can pass into the urine through the kidneys. In general, the more albumin there is in the urine, the more damaged the kidneys are. What does high urine albumin mean? A high urine albumin level may mean that your child has kidney disease. Your health care provider may do other tests for kidney disease, including a blood test, which checks how well the kidneys are filtering. Can kidney disease be treated? Kidney disease has many possible causes. The first step is to learn the cause of the kidney disease. Medicine and other treatments usually can’t undo the damage that has been done, but they may help prevent more harm. Your provider may ask you to take your child to a nephrologist—a doctor who treats patients with kidney disease. How do I know if my child is at risk for kidney disease? Your child may be at risk for kidney disease if he or she: is overweight has pain in the back, side, or lower belly complains of burning or pain when urinating, has changes in the urine, or often wets his or her pants has unexplained fever has swelling in the feet, ankles, or legs wakes up with swollen eyelids becomes dehydrated often has a family member with kidney disease Other conditions that may put your child at increased risk for kidney disease include: SGA (small for gestational age) a growth disorder diabetes high blood pressure rickets (soft bones caused by too little vitamin D) other conditions that run in families, such as polycystic kidney disease, Alport Syndrome, or heart disease

FDA clears first test to diagnose Q fever in military personnel serving overseas

FDA clears first test to diagnose Q fever in military personnel serving overseas The U.S. Food and Drug Administration today cleared the first nucleic acid amplification test to diagnose the early stages of Q fever infections in military personnel serving overseas. The Chemical Biological Medical System Joint Project Management Office within the U.S. Department of Defense funded the development of this test, which identifies and detects the bacteria that cause Q fever (Coxiella burnetii) within four hours. The test was developed by Idaho Technology Inc. Q fever is an emerging infectious disease among U.S. soldiers serving in Iraq and worldwide. Q fever can cause acute or chronic illness in humans, who usually acquire infections after contact with infected animals or exposure to contaminated environments. If diagnosed early, most people with Q fever fully recover after treatment with appropriate antibiotics. Failure to treat an infection can, however, result in serious chronic illness. The FDA cleared this test to be used on the Defense Department’s Joint Biological Agency Identification and Diagnostic System (JBAIDS), a multiple use instrument that can be used for the rapid detection of numerous bacteria and viruses, such as the bacteria that cause Q fever. The test is performed on the JBAIDS instrument and determines if Coxiella burnetii DNA is present in a patient’s blood sample. Use of the test is limited to designated Department of Defense laboratories equipped with the JBAIDS. “It’s important that the FDA protect our troops from biothreats using innovative diagnostics,” said Jeffrey Shuren, M.D., director of the FDA’s Center for Devices and Radiological Health. “Q fever bacteria is considered a biothreat agent in part due to the fact that fewer than 10 organisms need to be inhaled to cause infection and its ability to withstand open environments.” According to the U.S. Centers for Disease Control and Prevention, Q fever was first recognized as a human disease in Australia in 1935 and in the United States in the early 1940s. The “Q” stands for “query”—at that time, the causative agent was unknown. Idaho Technology Inc. is based in Salt Lake City.

Research offers simpler, effective treatment option for latent TB infection

Research offers simpler, effective treatment option for latent TB infection Results from one of the largest U.S. government clinical trials on tuberculosis preventive therapy to date suggest that treatment for latent tuberculosis (TB) infection – normally a difficult and lengthy regimen – may soon be easier than ever before in countries with low-to-medium incidence of TB. The trial results showed that a supervised once-weekly regimen of rifapentine and isoniazid taken for three months was just as effective as the standard self-administered nine-month daily regimen of isoniazid, and was completed by more participants. The multi-country, CDC-sponsored trial tested the effectiveness of this new preventive TB treatment regimen (using currently available anti-TB drugs) among persons with latent TB infection who are at high risk for progression to TB disease. The results were presented today at the American Thoracic Society International Conference in Denver by principal investigator Timothy Sterling, M.D., of Vanderbilt University. “Although the standard regimen is very effective in treating latent TB infection, ensuring that those who need treatment both begin and complete the lengthy, cumbersome isoniazid regimen is challenging,” said CDC Director Thomas R. Frieden, M.D. “New, simpler ways to prevent TB disease are urgently needed, and this breakthrough represents one of the biggest developments in TB treatment in decades.” Latent TB infection occurs when a person has TB bacteria in his or her body, but does not have symptoms and cannot transmit the bacteria to others. However, if the bacteria become active, the person will develop TB disease, become sick, and may spread the disease to others. Although not everyone with latent TB infection will develop TB disease, some people, such as those with weakened immune systems, are at higher risk of progression to TB disease. The new regimen to treat latent TB reduces the doses required for treatment from 270 daily doses to 12 once-weekly doses, making it much easier for patients to take. In the United States, the number of persons with TB disease is at an all-time low (11,181 total cases were reported in 2010); however, approximately 4 percent of the U.S. population, or 11 million people, are infected with the TB bacterium. TB continues to disproportionately affect racial/ethnic minorities and foreign-born individuals in this country. “If we are to achieve TB elimination in the United States, we must address the large number of people in this country with latent TB infection,” said Kevin Fenton, M.D., director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. “By effectively treating latent TB infection, not only can we reduce the potentially deadly consequences among those individuals, but we can also prevent many others from ever becoming infected.” One of the largest TB prevention trials to date The study lasted approximately 10 years and included 8,053 participants over the age of 2 who lived in countries with low or medium TB incidence, with the majority from the United States or Canada. Additional participants were located in Brazil and Spain. Because of a known drug interaction between some anti-HIV drugs and rifapentine, HIV-infected persons taking antiretrovirals were not eligible for enrollment in the study. Participants were randomized to receive one of two preventive treatment options – a regimen consisting of three months of once-weekly rifapentine 900 milligrams and isoniazid 900 milligrams given with supervision (that is, directly observed therapy), or the current standard regimen used to treat latent TB infection, consisting of nine months of daily isoniazid 300 milligrams, which was not supervised (that is, self-administered by the participant). Each participant was evaluated for treatment-related adverse events, adherence to treatment, survival, and development of TB disease for a total of 33 months after the date of their enrollment. The new regimen was found to be safe and as effective as the standard regimen in preventing new cases of TB disease, with very few cases of TB disease developing in either study arm. Seven cases occurred among those receiving the new treatment regimen compared to 15 among those receiving the standard treatment. Additionally, the percentage of participants completing the new, shorter regimen was substantially higher (82 percent) than the percentage completing the standard regimen (69 percent). Next steps in implementation Given the promise of these results, CDC has already held an expert consultation to review the data and begin working on new guidelines for its use in the United States. Researchers caution that these results are only directly applicable to countries with low-to-medium incidence of TB. Additional studies will likely be needed before this new regimen can be recommended in countries with a high incidence of TB, especially those with high HIV prevalence and where the risk of TB re-infection is greater. The research was conducted through the TB Trials Consortium (TBTC), a CDC-funded partnership of domestic and international clinical investigators who conduct research on the prevention and treatment of TB.

Fewer Men Having Surgery to Treat Enlarged Prostate: Study The rate of those with related acute kidney failure has skyrocketed

Fewer Men Having Surgery to Treat Enlarged Prostate: Study The rate of those with related acute kidney failure has skyrocketed By Robert Preidt TUESDAY, May 17 (HealthDay News) -- Some men with enlarged prostate may not be receiving sufficient treatment and could suffer severe complications as a result, according to a new study. Although more men are receiving oral treatment for enlarged prostate, the rate of men operated on for the condition declined over a nine-year period and the rate of discharges for men for enlarged prostate with acute kidney failure has skyrocketed, researchers found. Non-cancerous enlargement of the prostate -- called benign prostatic hyperplasia (BPH) -- is a common condition that affects millions of men in the United States each year. It can cause lower urinary tract symptoms ranging from frequent and painful urination to urinary retention, which can lead to kidney failure if left untreated. Treatments include oral therapies and minimally invasive surgery. In this analysis of U.S. hospital patient data, University of California, San Diego researchers found that the prevalence of BPH increased between 1998 and 2007 but discharges of patients treated for primary BPH decreased. During that same period, discharges for patients who had surgery for BPH decreased 51 percent, discharges for patients with primary BPH with acute renal (kidney) failure increased more than 300 percent, and discharges for primary BPH with urinary retention, stones, or infection remained about the same. The study was slated to be presented Tuesday during a special press conference at the American Urological Association's annual scientific meeting. "Oral therapies for BPH are a common first-line treatment that can be effective in many men. However, it is imperative that patients be treated promptly if the drugs aren't working," press conference moderator Dr. Kevin McVary said in a news release. "In many cases, surgical treatment for BPH can help prevent urinary retention, which can ultimately lead to acute renal failure that can be life-threatening," he added. Because the study is being presented at a medical meeting, the results should be considered preliminary until published in a peer-reviewed journal. SOURCE: American Urological Association, news release, May 17, 2011

Are All Those Handshakes at Graduation Hazardous to Your Health? No, say researchers who found only harmless bacteria on students' hands in 93% of cases

Are All Those Handshakes at Graduation Hazardous to Your Health? No, say researchers who found only harmless bacteria on students' hands in 93% of cases By Mary Elizabeth Dallas FRIDAY, May 20 (HealthDay News) -- One graduation ceremony may include thousands of handshakes, but new research shows this casual contact is not likely to increase your risk of exposure to harmful bacteria. Maryland students who shook a total of 5,209 hands while graduating from schools across the state in 2008 had only a slight risk of acquiring disease-causing bacteria, according to research from scientists at the Johns Hopkins Bloomberg School of Public Health. The study examined the risk of acquiring pathogenic bacteria such as Staphylococcus aureus and methicillin-resistant Staphylococcus aureus (MRSA) through shaking hands at graduation ceremonies ranging from elementary school to college. Researchers swabbed participants' hands before and immediately following graduation to identify any disease-causing (pathogenic) bacteria. They detected only three instances of Staphylococcus aureus out of the thousands of handshakes -- a rate of 0.019 pathogens per handshake -- and found that 93 percent of the bacteria were harmless. The study is in the June issue of the Journal of School Nursing. "A single handshake offers only a small risk of acquiring harmful bacteria," said Dr. David Bishai, a professor with the Bloomberg School's department of population, family and reproductive health in a university news release. "Our study indicates when shaking hands, the rate of hand contamination among graduating students to be 100 times lower than the 17 percent rate observed among health workers caring for patients known to be colonized with MRSA." Reasons for the lower rate of contamination at graduations include the "much briefer and less-extensive contact in a handshake" than contact with hospital patients, according to Bishai. "Based on the evidence from this study, the probability of acquiring bacterial pathogens during handshaking could be lower than is commonly perceived by the general public," concluded Bishai. "With a lower bound estimate of one bacterial pathogen acquired in 5,209 handshakes, the study offers the politicians, preachers, principals, deans and even amateur hand shakers some reassurance that shaking hands with strangers is not as defiling as some might think." SOURCE: Johns Hopkins Bloomberg School of Public Health, news release, May 16, 2011

FDA approves Incivek for hepatitis C

FDA approves Incivek for hepatitis C The U.S. Food and Drug Administration today approved Incivek (telaprevir) to treat certain adults with chronic hepatitis C infection. Incivek is used for patients who have either not received interferon-based drug therapy for their infection or who have not responded adequately to prior therapies. Incivek is approved for use with interferon therapy made up of peginterferon alfa and ribavirin. The current standard of care for patients with chronic hepatitis C infection is peginterferon alfa and ribavirin taken for 48 weeks. Less than 50 percent of patients respond to this therapy. The safety and effectiveness of Incivek was evaluated in three phase 3 clinical trials with about 2,250 adult patients who were previously untreated, or who had received prior therapy. In all studies patients also received the drug with standard of care. In previously untreated patients, 79 percent of those receiving Incivek experienced a sustained virologic response (i.e. the infection was no longer detected in the blood 24 weeks after stopping treatment) compared to standard treatment alone. The sustained virologic response for patients treated with Incivek across all studies, and across all patient groups, was between 20 and 45 percent higher than current standard of care. The studies indicate that treatment with Incivek can be shortened from 48 weeks to 24 weeks in most patients. Sixty percent of previously untreated patients achieved an early response and received only 24 weeks of treatment (compared to the standard of care of 48 weeks). The sustained virologic response for these patients was 90 percent. When a person achieves a sustained virologic response after completing treatment, this suggests that the hepatitis C infection has been cured. Sustained virologic response can result in decreased cirrhosis and complications of liver disease, decreased rates of liver cancer (hepatocellular carcinoma), and decreased mortality. “With the approval of Incivek, there are now two important new treatment options for hepatitis C that offer a greater chance at a cure for some patients with this serious condition,” said Edward Cox, M.D., M.P.H, director, Office of Antimicrobial Products in FDA’s Center for Drug Evaluation and Research. “The availability of new therapies that significantly increase responses while potentially decreasing the overall duration of treatment is a major step forward in the battle against chronic hepatitis C infection.” According to the U.S. Centers for Disease Control and Prevention, about 3.2 million people in the United States have chronic hepatitis C infection, a viral disease that causes inflammation of the liver that can lead to diminished liver function or liver failure. Most people with hepatitis have no symptoms of the disease until liver damage occurs, which may take several years. Most liver transplants performed in the United States are due to progressive liver disease caused by hepatitis C virus infection. After the initial infection with hepatitis C (HCV), most people develop chronic hepatitis C. Some will develop cirrhosis of the liver over many years. Cirrhosis can lead to liver damage with complications such as bleeding, jaundice (yellowish eyes or skin), fluid accumulation in abdomen, infections, or liver cancer. People can get HCV in a number of ways, including: exposure to blood that is infected with the virus; being born to a mother with HCV; sharing a needle; having sex with an infected person; sharing personal items such as a razor or toothbrush with someone who is infected with the virus, or from unsterilized tattoo or piercing tools. Incivek is a pill taken three times a day with food. Incivek should be taken for the first 12 weeks in combination with peginterferon alfa and ribavirin. Most people with a good early response to the Incivek combination regimen can be treated for 24 weeks rather than the recommended 48 weeks of treatment with the standard of care. Incivek is part of a class of drugs referred to as protease inhibitors, which work by binding to the virus and preventing it from multiplying. The most commonly reported side effects in patients receiving Incivek in combination with peginterferon alfa and ribavirin include rash, low red blood cell count (anemia), nausea, fatigue, headache, diarrhea, itching (pruritus), and anal or rectal irritation and pain. Rash can be serious and can require stopping Incivek or all three drugs in the treatment regimen.

7 Tips for Cleaning Fruits, Vegetables

7 Tips for Cleaning Fruits, Vegetables Fruits and vegetables are an important part of a healthy diet. Your local markets carry an amazing variety of fresh fruits and vegetables that are both nutritious and delicious. As you enjoy fresh produce, it is important to handle these products safely in order to reduce the risks of foodborne illnes. For more videos, visit the FDA's YouTube channel. Federal health officials estimate that nearly 48 million people are sickened by food contaminated with harmful germs each year, and some of the causes might surprise you. Although most people know animal products must be handled carefully to prevent illness, many don’t realize that produce can also be the culprit in outbreaks of foodborne illness. In recent years, the United States has had several large outbreaks of illness caused by contaminated fruits and vegetables—including spinach, tomatoes, and lettuce. Glenda Lewis, an expert on foodborne illness with the Food and Drug Administration, says fresh produce can become contaminated in many ways. During the growing phase, fruits and veggies may be contaminated by animals, harmful substances in the soil or water, and poor hygiene among workers. After produce is harvested, it passes through many hands, increasing the contamination risk. Contamination can even occur after the produce has been purchased, during food preparation, or through inadequate storage. FDA says to choose produce that isn’t bruised or damaged, and make sure that pre-cut items—such as bags of lettuce or watermelon slices—are either refrigerated or on ice both in the store and at home. In addition, follow these recommendations: Wash your hands for 20 seconds with warm water and soap before and after preparing fresh produce. Cut away any damaged or bruised areas before preparing or eating. Gently rub produce while holding under plain running water. There’s no need to use soap or a produce wash. Wash produce BEFORE you peel it, so dirt and bacteria aren’t transferred from the knife onto the fruit or vegetable. Use a clean vegetable brush to scrub firm produce, such as melons and cucumbers. Dry produce with a clean cloth or paper towel to further reduce bacteria that may be present. Throw away the outermost leaves of a head of lettuce or cabbage. Lewis says consumers should store perishable produce in the refrigerator at 40 degrees or below. This article appears on FDA's Consumer Updates page, which features the latest on all FDA-regulated products. Posted May 23, 2011

Mexican flu pandemic study supports social distancing Fogarty research published in PLoS Medicine

Mexican flu pandemic study supports social distancing Fogarty research published in PLoS Medicine Eighteen-day periods of mandatory school closures and other social distancing measures were associated with a 29 to 37 percent reduction in influenza transmission rates in Mexico during the 2009 pandemic. The research was carried out by scientists at the Fogarty International Center at the National Institutes of Health and published in PLoS Medicine. The social distancing measures implemented by the Mexican health authorities in spring 2009 were effective in reducing disease transmission by more than one-third, the study found. Social distancing interventions can be implemented during unusual infectious diseases outbreaks and include school closing, closure of movie theaters and restaurants, and the cancellation of large public gatherings. Mexico implemented a nationwide mandatory school closure policy during an 18-day period in late April and early May 2011. The United States implemented school closure interventions on a local basis during the 2009 pandemic, but the impact of these interventions has yet to be evaluated. The study was led by Gerardo Chowell, Ph.D., a Fogarty investigator and faculty member at Arizona State University, Tempe. His team provides the first comprehensive epidemiological description of the age, geographical and severity patterns of the 2009 pandemic in Mexico. The authors applied mathematical modeling to influenza surveillance data compiled by a large private health system, the Mexican Institute for Social Security, which covers 40 percent of the population. A three-wave pandemic profile was identified throughout Mexico. The initial wave occurred in spring 2009 in the Mexico City area. A second wave was noted in summer 2009 in the southeastern region. Finally, a third wave occurred in fall 2009. The onset of the third pandemic wave in fall 2009 occurred within two to five weeks of the beginning of the fall school term, coinciding with increased disease incidence among school-age children. The hardest hit were the very young, not the elderly who are typically at high risk with influenza. There were a few cases reported among seniors during the pandemic period, but the most severe influenza-related infections were seen in those 5 to 14 years old, as well as in infants. Overall, the researchers’ findings highlight variation in pandemic influenza incidence and severity among age groups, and reveal the importance of school cycles on the transmission dynamics of this disease. The importance of school—children for pandemic influenza transmission is based on the findings that school closure effectively reduced influenza transmission in spring 2009 in Mexico, together with a large increase in influenza cases among school children coinciding with schools reopening. The study suggests that school closure and other measures could be useful to mitigate future influenza pandemics. "We believe this study has implications for improving preparedness plans in future pandemics," said Chowell. Noting that, in a previous influenza pandemic in the 19th century, the majority of deaths occurred two years after the initial wave, he emphasized that "we must remain vigilant and continue to monitor the circulation and health burden of the pandemic A/H1N1 and co-circulating influenza viruses in the coming years."

Transient Ischemic Attack Also called: Mini-stroke, TIA

Transient Ischemic Attack Also called: Mini-stroke, TIA A transient ischemic attack (TIA) is a stroke that comes and goes quickly. It happens when a blood clot blocks a blood vessel in your brain. This causes the blood supply to the brain to stop briefly. Symptoms of a TIA are like other stroke symptoms, but do not last as long. They happen suddenly, and include Numbness or weakness, especially on one side of the body Confusion or trouble speaking or understanding speech Trouble seeing in one or both eyes Loss of balance or coordination Most symptoms of a TIA disappear within an hour, although they may last for up to 24 hours. Because you cannot tell if these symptoms are from a TIA or a stroke, you should get to the hospital quickly. TIAs are often a warning sign for future strokes. Taking medicine, such as blood thinners, may reduce your risk of a stroke. Your doctor might also recommend surgery. NIH: National Institute of Neurological Disorders and Stroke

Rickets Also called: Rachitis

Rickets Also called: Rachitis Rickets causes soft, weak bones in children. It usually occurs when they do not get enough vitamin D, which helps growing bones absorb important nutrients. Vitamin D comes from sunlight and food. Your skin produces vitamin D in response to the sun's rays. Some foods also contain vitamin D, including fortified dairy products and cereals, and some kinds of fish. Your child might not get enough vitamin D if he or she Has dark skin Spends too little time outside Has on sunscreen all the time when out of doors Doesn't eat foods containing vitamin D because of lactose intolerance or a strict vegetarian diet Is breastfed without receiving vitamin D supplements Can't make or use vitamin D because of a medical disorder such as celiac disease In addition to dietary rickets, children can get an inherited form of the disease.

CT Scans Also called: CAT scan

CT Scans Also called: CAT scan Computed tomography (CT) is a diagnostic procedure that uses special X-ray equipment to create cross-sectional pictures of your body. CT images are produced using X-ray technology and powerful computers. The uses of CT include looking for Broken bones Cancers Blood clots Signs of heart disease Internal bleeding During a CT scan, you lie still on a table. The table slowly passes through the center of a large X-ray machine. The test is painless. During some tests you receive a contrast dye, which makes parts of your body show up better in the image. NIH: National Cancer Institute

Bowlegs and Knock-Knees

Bowlegs and Knock-Knees Toddlers’ legs often have a bowed appearance. In fact, many children have bowing of the legs until they are about two years old, then they’ll look knock-kneed until they are about six years of age. At times, children may not have straight lower legs until they are nine or ten years old. Bowlegs and knock-knees usually are variations of normal, and require no treatment. Typically, a child’s legs will straighten naturally by the teen years. Bracing, corrective shoes, and exercise are rarely helpful, and may hinder a child’s physical development and cause unnecessary emotional stress. Rarely, bowlegs or knock-knees are the result of a disease. Arthritis, injury to the growth plate around the knee, infection, tumor, Blount’s disease (a growth disorder of the shinbone), and rickets all can cause changes in the curvature of the legs. Here are some signs that suggest a child’s bowlegs or knock-knees may be caused by a serious problem: The curvature is extreme. Only one side is affected. The bowlegs get worse after age two years. The knock-knees persist after age seven years. Your child also is unusually short for his age. If your child fits any of these descriptions, talk to your pediatrician. In some cases, treatment, including referral to a pediatric orthopedist, may be needed. Author Steven P. Shelov, M.D., M.S., FAAP

Narcotic Bowel Syndrome An under-recognized pain condition

Narcotic Bowel Syndrome An under-recognized pain condition Narcotics are drugs, usually opiates such as morphine or oxycodone, which can relieve pain. In the U.S. narcotics are commonly prescribed for treating patients with pain, usually injuries, sudden painful conditions, or cancer. However, persons with chronic functional GI disorders should not be treated with narcotics, though this at times is done. We are learning that under some circumstances and with some individuals, the use of narcotics can actually cause pain. Over time, narcotics can slow the bowel, and lead to symptoms of constipation, bloating, or nausea. This relates to the well known effects of narcotics on the bowel, opiate bowel dysfunction. In addition in about 5−10% of individuals, narcotics may actually sensitize the nerves and make pain worse. This is narcotic bowel syndrome (NBS). In a review article by a group from the University of North Carolina (UNC), this subset of opiate bowel dysfunction called narcotic bowel syndrome is described. This under-recognized syndrome may be becoming more prevalent because of increasing use of narcotics for chronic painful disorders as well as lack of awareness that increased sensation to pain may be caused by long-term narcotic use. The syndrome is characterized by chronic or periodic abdominal pain that gets worse when the effect of the narcotic drug wears down. In addition to pain, which is the primary feature, other symptoms may include... nausea, bloating, periodic vomiting, abdominal distension, and constipation. Identifying the Condition The UNC group has developed the following diagnostic criteria for narcotic bowel syndrome: ► Chronic or frequently recurring abdominal pain that is treated with acute high-dose or chronic narcotics and all of the following: The pain worsens or incompletely resolves with continued or escalating dosages of narcotics; There is marked worsening of pain when the narcotic dose wanes and improvement when narcotics are re-instituted (soar and crash); There is a progression of the frequency, duration, and intensity of pain episodes; The nature and intensity of the pain is not explained by a current or previous GI diagnosis. The key to diagnosis is the recognition that long-term or increasing dosages of narcotics lead to continued or worsening symptoms rather than benefit. Treatment The UNC group has also developed a treatment approach. The narcotic is withdrawn and substituted with effective alternative medications to help manage the pain and the bowel symptoms until the narcotics are removed from the system. This requires the doctor and patient working closely together. The doctor must take time to explain the condition, the reasons for withdrawing the narcotics, and the alternative treatment plan. The treatment process usually takes a week or two in the hospital but may take several weeks or months outside the hospital to implement satisfactorily, with the doctor staying in touch with the patient during this period. The UNC group has submitted a presentation for 2011 Digestive Disease Week (DDW) where they report the results of their detoxification of 30 patients who had narcotic bowel syndrome. Most (almost 90%) had clinically significant reduction in bowel and other bodily pains at the end of the detoxification. However about 50% of these patients were back on narcotics 6 weeks later. This latter finding highlights the importance of addressing this serious medical issue to the health care community and society in general. Narcotic bowel syndrome was first reported over 25 years ago, but it remains under-recognized. There is a general lack of knowledge among health care providers about long-term effects of narcotics to increase pain and motility disturbances. Plus, it is difficult to tell the difference between pain that results from narcotics and the pain that is being treated. Narcotics have a role in medical care but there are times where the risks outweigh the benefits. If your doctor suggests a narcotic to treat pain from a functional GI disorder, be sure to ask about narcotic bowel syndrome. Mutual understanding of risk, as well as benefit, is an important part of any treatment. Reference: Grunkemeier DMS, Cassara JE, Dalton CB, Drossman DA. The narcotic bowel syndrome: clinical features, pathophysiology, and management. Clin Gastroenterol Hepatol 2007;5:1126-1139.

Over-the-Counter Medicines Also called: Non-prescription drugs, OTC medicines

Over-the-Counter Medicines Also called: Non-prescription drugs, OTC medicines Over-the-counter (OTC) medicines are drugs you can buy without a prescription. Some OTC medicines relieve aches, pains and itches. Some prevent or cure diseases, like tooth decay and athlete's foot. Others help manage recurring problems, like migraines. In the United States, the Food and Drug Administration decides whether a medicine is safe enough to sell over-the-counter. Taking OTC medicines still has risks. Some interact with other medicines, supplements, foods or drinks. Others cause problems for people with certain medical conditions. If you're pregnant, talk to your health care provider before taking any medicines. It is important to take medicines correctly. More medicine does not necessarily mean better. You should never take OTC medicines longer or in higher doses than the label recommends. If your symptoms don't go away, it’s a clear signal that it's time to see your healthcare provider. Food and Drug Administration

End-of-Life Care Differs Between U.S., Canada, Study Finds Researchers say data comparison could help guide improvements in care

End-of-Life Care Differs Between U.S., Canada, Study Finds Researchers say data comparison could help guide improvements in care By Robert Preidt WEDNESDAY, May 18 (HealthDay News) -- End-of-life care for older people with advanced lung cancer differs in the United States and in the Canadian province of Ontario, a new study says. U.S. patients receive far more chemotherapy, while patients in Ontario make much more use of hospital and emergency room services, according to the analysis of data from the U.S. government and the Ontario Cancer Registry. The information was collected from people 65 and older who died from non-small-cell lung cancer between 1999 and 2003. Health-care services were used extensively by patients in both countries, particularly in the last month of life. More than twice as many people in Ontario died in a hospital (48.5 percent vs. 20.4 percent), even though most patients in Ontario have said they want to die at home, the study reported. Elderly people in both the United States and Canada receive government-financed health care, but there are differences in end-of-life coverage. In the United States, hospice care for qualified patients is covered by Medicare. Ontario has no hospice program comparable to what's available in the United States, but the province provides palliative care through hospital acute-care units, outpatient services and home health care. According to the researchers, lack of hospice services in Canada contributes to Ontario's higher rates of hospital and emergency room visits and in-hospital deaths. The findings, published online May 18 in the Journal of the National Cancer Institute, could help show health planners and policy makers where changes in practices or programs could improve care for dying patients, the researchers said. End-of-life care also varies from region to region in the United States and Canada, Dr. David Goodman, of the Dartmouth Institute for Health Policy and Clinical Practice, wrote in an accompanying journal editorial. In addition, patient preferences vary from person to person, and these preferences often go unheard, he said. The best type of end-of-life care, Goodman said, involves the patient in the decision making. SOURCE: Journal of the National Cancer Institute, news release, May 18, 2011

FDA Advisers Urge Infant Doses for Kids' OTC Fever Relievers Would better protect those under 2 who use products like Children's Tylenol, experts say

FDA Advisers Urge Infant Doses for Kids' OTC Fever Relievers Would better protect those under 2 who use products like Children's Tylenol, experts say WEDNESDAY, May 18 (HealthDay News) -- U.S. health advisers recommended Wednesday that dosing instructions should be added to the labels of medicines containing the widely used pain reliever and fever reducer acetaminophen to better protect children under the age of 2. In a 21-0 vote, the panel of U.S. Food and Drug Administration advisers called for adding dosing information for children 6 months to 2 years old to over-the-counter medicines such as Children's Tylenol and similar products containing acetaminophen, the Associated Press reported. Currently, the labels of such medications have dosing instructions for children aged 2 and up. For kids under 2, the labels on the liquid medicines simply tell parents to "ask a doctor." The FDA advisers said the lack of specific dosing recommendations can lead to confusion, with parents unintentionally giving too much of the medicine to children under age 2. Acetaminophen-related overdoses are most common among children younger than 2, and have increased over the past decade, according to FDA data. Wednesday's vote focused only on a small group of single-ingredient products, including J&J's Children and Infants' Tylenol, Novartis' Triaminic, Prestige Brands' Little Fevers and assorted drugstore brands, the AP said. In a second vote Wednesday, the panel recommended unanimously that these medicines should also include dosing information based on children's weight -- considered the most accurate way to determine the proper dose. Nearly all over-the-counter manufacturers already include a dosing table with both weight and age. But the FDA advisers said instructions must emphasize that weight is the preferred approach, the AP reported. In a third vote, the advisers recommended 17-3, with one abstention, that the FDA consider requiring a single dosage for children's solid acetaminophen tablets, the news service said. While the FDA is not required to follow the recommendations of its advisory panels, it usually does so. The American Academy of Pediatrics (AAP) and drug manufacturers are both strongly in favor of giving parents the additional dosing information. "If we give parents better information, they will be able to give enough of the medicine to work well, at the same time minimizing the side effects," said Dr. Daniel Frattarelli, a pediatrician in Dearborn, Mich., who chairs the academy's drug committee and who planned to testify before the joint, two-day meeting of the FDA's Nonprescription Drugs Advisory Committee and the Pediatric Advisory Committee. "Parents want to do the right thing for their children," he said. "We as a medical community have to give them that information so they are able to do this." Although the evidence shows that acetaminophen is safe for young children, parents have to be careful with it, pediatricians noted. Giving too much can be toxic to the liver, causing poisoning and even liver failure. In 2010, there were 270,000 reported overdoses of acetaminophen, according to the American Association of Poison Control Centers. Dosing errors involving children's acetaminophen products accounted for almost 7,500 cases -- nearly 3 percent. In an ideal world, the parents of infants and toddlers would still consult with their pediatrician or pharmacist to get the proper medication dosing, said Dr. William Basco, director of general pediatrics at the Medical University of South Carolina. But the reality is that many parents aren't doing that and are instead guessing about proper dosing. "There is no benefit to having parents guess at the right dose," Basco said. Drug makers, including McNeil Consumer Healthcare, which makes Tylenol, also support the change. "McNeil is committed to encouraging the appropriate and safe use of medicines in children, including adding new dosing information on the OTC pediatric acetaminophen label to assist caregivers and health-care providers in appropriately dosing children, especially those 6 to 23 months of age," the company wrote in materials submitted to the FDA. By way of comparison, drugs containing ibuprofen -- another heavily used over-the-counter fever reducer -- already include dosing information for children under age 2. Children's medications containing acetaminophen have been sold over-the-counter since 1959, and dosing information for children has been on the labels since the 1970s, according to McNeil. Back then, doses for kids were somewhat crude -- children 12 and up were advised to take the adult dose, kids 6 to 12 were told to take half that, and kids younger than 6 were told to take a quarter of the adult dose. Since then, as physicians have learned more about the medications, dosing recommendations for infants and toddlers have become more refined and now should be based on weight, not age, according to the AAP. (Age is still listed on package labeling, the AAP explained.) Kids' weights can range widely at any given age, so the correct dose for a child on the heavier side may not be the correct dose for a smaller child of the same age. Though acetaminophen is safe even in newborns if used correctly, the drug makers and the AAP called for expanding the labeling information for children 6 months old and up. Parents should still be encouraged to consult with their physicians before giving medication to younger children, especially those under the age of 3 months, Frattarelli said. Fevers of more than 100.4 degrees need to be taken very seriously in infants, whose immune systems are not fully developed and whose vaccinations haven't yet fully kicked in, he explained. Earlier this month, the Consumer Healthcare Products Association, a trade association for over-the-counter drug-makers, agreed to sell only one concentration of acetaminophen in products for infants and children to prevent dosing errors. Previously, for example, Infant's Tylenol liquid drops were much more concentrated than Children's Tylenol, which could easily lead to confusion if parents didn't read the label or know there was a difference. Drug-makers agreed to phase out the infant drops concentration starting in the middle of this year. In any given week, about 23 percent of kids under age 2 are given acetaminophen, according to background information from McNeil. "Acetaminophen dosing errors are a rare but potentially very severe adverse event that could lead to liver failure or even death for kids," said Dr. Richard Dart, president of the American Association of Poison Control Centers, in a news release. "This decision will lessen the chance that parents will give their children the wrong dose." SOURCES: William Basco, M.D., director, general pediatrics, Medical University of South Carolina, Charleston; Daniel Frattarelli, M.D., pediatrician, Dearborn, Mich., and chair, American Academy of Pediatrics Committee on Drugs; U.S. Food and Drug Administration Web site; Associated Press

Robotic Surgery Oversold on Hospital Websites, Study Contends Like any procedure, outcome depends on surgeon's skill, expert says

Robotic Surgery Oversold on Hospital Websites, Study Contends Like any procedure, outcome depends on surgeon's skill, expert says FRIDAY, May 20 (HealthDay News) -- Many hospitals tout the benefits of robotic surgery on their websites without solid scientific evidence to back up those claims, Johns Hopkins researchers report. In fact, four out of 10 hospitals in the study only used manufacturers' claims that robotic surgery is better than conventional surgery, an assertion that the researchers said is unproven and misleading. The findings are especially troubling since consumers depend on hospital websites for reliable, trustworthy information, the study authors said. "Hospital websites are a trusted source of medical information for the public," said lead researcher Dr. Marty Makary, an associate professor of surgery at Hopkins. "This is the first time we've seen industry create content, with disclosures, and put it on the official hospital website to educate patients about treatment options," he said. "To me, that's a very scary trend." Robotic surgery has grown more than 400 percent over the past four years, Makary pointed out. "It's one of the great modern crazes," he said. "And the public is driven by the idea that more technology means better care." Proponents say robot-assisted surgeries require smaller incisions, are more precise and result in less pain and shorter hospital stays. The study authors said those claims are unsubstantiated. The growth of robotic surgery has been driven by hospital marketing, Makary said. "Marketing a robot has become a very successful strategy for hospitals. It implies the hospital has state-of-the-art care," he said. "Patients may perceive the hospital is on the cutting edge because they do robotic surgery." Makary noted that often hospitals do not mention the material on their website was provided by the manufacturer, and the sites often fail to mention the risks associated with robotic surgery. Risks include being under anesthetic longer and needing to have a second incision to place the robotic arm, he said. In addition, the researchers looked at the claims made about the benefits of robotic surgery on these sites. "Frankly, the claims are overstated," Makary said. "Improved cancer outcomes -- that's ridiculous." Thirty-two percent of the sites claimed that robotic surgery improved cancer outcomes, the researchers found. Makary pointed out that in the studies of robotic surgery, patients suffer as many complications as they do with conventional surgery. Eighty percent of the robotic surgeries done in the United States are urological and gynecological, Makary said. There have been no randomized trials in these areas comparing robotic and conventional surgery, he said. "To me, this is exactly what is wrong with American health care," Makary said. "We are adopting technology without being up front about the outcomes to consumers. And we adopt technology before we properly evaluate it." The report is published in the May online edition of the Journal for Healthcare Quality. For the study, Makary's team looked at the websites of 400 hospitals with 200 beds or more. They looked for whether robotic surgery was available and what information was provided on the hospital's website in June 2010. They wanted to see how many hospitals used photos and text directly from the manufacturer of the device and what claims were made about the efficacy of robotic surgery. The researchers found 41 percent of the websites detailed the availability of robotic surgery and how it worked. In addition, 37 percent of these sites had the information on the home page and 66 percent had a link to another page. The information on 73 percent of these sites came directly from the manufacturer and 33 percent offered a direct link to the manufacturer's site, Makary's group found. Moreover, 89 percent of these sites said that robotic surgery was better than conventional surgeries. The claims included less pain (85 percent), shorter recovery (86 percent), less scarring (80 percent) and less blood loss (78 percent). No hospital website mentioned risks associated with the surgery. Chris Simmonds, senior director of marketing services at Intuitive Surgical Inc., the maker of the da Vinci Surgical System, which is the most widely used robotic system, acknowledged that the company does provide ready-made marketing materials for hospital websites. Simmonds disputed Makary's findings, however. The evidence of the benefits of robotic surgery is well-documented, Simmonds said. "All the indicators in terms of length of stay, blood loss, complications and cancer control are all better," he said. The company does tell hospitals the system does provide better patient outcomes, he said. Dr. David B. Samadi, chief of robotics and minimally invasive surgery at Mount Sinai Medical Center in New York City, said that "there is some truth to what Makary says." "There is a lot of misinformation on some of the websites out there, and patients have to really dig in and make sure the information is correct," he said. However, the key to successful robotic surgery is the same as any other surgery, namely the skill and experience of the surgeon, Samadi said. "This technology in the hands of an experienced surgeon is a great tool, but if you don't have the adequate training it could be quite dangerous," he said. The procedure is being oversold, Samadi added, and it is sometimes being done by inexperienced surgeons. "It's up to patients to get a second opinion," he said. Before undergoing robotic surgery, patients need to understand the risks and benefits and be confident that the surgeon is well-trained and performs many such procedures each year, he said. SOURCES: Marty Makary, M.D., M.P.H., associate professor, surgery, Johns Hopkins University School of Medicine, Baltimore; David B. Samadi, M.D., chief, robotics and minimally invasive surgery, Mount Sinai Medical Center, New York City; Chris Simmonds Sr., director, marketing services, Intuitive Surgical Inc., Sunnyvale, Calif.; May 2011 Journal for Healthcare Quality, online

Antihistamines What are antihistamines?

Antihistamines What are antihistamines? Antihistamines are medicines that help stop allergy symptoms, such as itchy eyes, sneezing and a runny nose. Sometimes, an antihistamine can also help itchy rashes (especially hives). Why did my doctor give me a prescription when I could buy an over-the-counter antihistimine? Compared to over-the-counter medicines, prescription antihistamines are less likely to have side effects, such as drowsiness, dry mouth or blurry vision. They are better for older people, children during school hours, and people who work with machinery or drive cars. Can I take my prescription antihistamine with other medicines? You shouldn't take prescription antihistamines if you also are taking certain other prescription drugs, such as erythromycin (an antibiotic), itraconazole or ketoconazole. When your doctor gives you a prescription, always ask if it's safe to use with the other medicines you're taking. Your pharmacist can also tell you which medicines you shouldn't take with a prescription antihistamine. If you aren't sure, ask the pharmacist or your doctor before taking another medicine. Can I share my prescription antihistamines with friends who have allergies? No. You should never share a prescription medicine with another person. Your doctor has examined you and has picked a medicine that is right only for your problem. Some antihistamines can cause serious side effects if they are given to people who are taking another medicine, or who should not take antihistamines for another reason. Source Written by familydoctor.org editorial staff. American Academy of Family Physicians

Hip Replacement Also called: Hip arthroplasty

Hip Replacement Also called: Hip arthroplasty Hip replacement is surgery for people with severe hip damage. When you have a hip replacement, the surgeon removes damaged cartilage and bone from your hip joint and replaces them with new, man-made parts. This can relieve pain, help your hip joint work better, and improve your walking and other movements. Your doctor may recommend it if you have hip damage and pain, and physical therapy, medicines and exercise don't help. The most common problem after surgery is hip dislocation. Because a man-made hip is smaller than the original joint, the ball can come out of its socket. The surgery can also cause blood clots and infections. After a hip replacement, you might need to avoid certain activities, such as jogging and high-impact sports. NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases

Antibiotics

Antibiotics Antibiotics are powerful medicines that fight bacterial infections. Used properly, antibiotics can save lives. They either kill bacteria or keep them from reproducing. Your body's natural defenses can usually take it from there. Antibiotics do not fight infections caused by viruses, such as Colds Flu Most coughs and bronchitis Sore throats, unless caused by strep If a virus is making you sick, taking antibiotics may do more harm than good. Each time you take antibiotics, you increase the chances that bacteria in your body will be able to resist them. Later, you could get or spread an infection that those antibiotics cannot cure. When you take antibiotics, follow the directions carefully. It is important to finish your medicine even if you feel better. Do not save antibiotics for later or use someone else's prescription.

Laboratory Tests

Laboratory Tests If you've ever had to give a tube of blood or a little cup of urine in your doctor's office, you've had a laboratory test. Laboratory tests check a sample of your blood, urine or body tissues. A technician or your doctor analyzes the test samples to see if your results fall within the normal range. The tests use a range because what is normal differs from person to person. Many factors affect test results. These include Your sex, age and race What you eat and drink Medicines you take How well you followed pre-test instructions Your doctor may also compare your results to results from previous tests. Laboratory tests are often part of a routine checkup to look for changes in your health. They also help doctors diagnose medical conditions, plan or evaluate treatments, and monitor diseases.

Constipation

Constipation Constipation means that a person has three or fewer bowel movements in a week. The stool can be hard and dry. Sometimes it is painful to pass. At one time or another, almost everyone gets constipated. In most cases, it lasts a short time and is not serious. There are many things you can do to prevent constipation. They include Eating more fruits, vegetables and grains, which are high in fiber Drinking plenty of water and other liquids Getting enough exercise Taking time to have a bowel movement when you need to Using laxatives only if your doctor says you should Asking your doctor if medicines you take may cause constipation It's not important that you have a bowel movement every day. If your bowel habits change, however, check with your doctor. NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Experts Issue 'Top 5' List for Better Primary Care To streamline and save money, reduce unnecessary antibiotics, screenings, report authors urge

Experts Issue 'Top 5' List for Better Primary Care To streamline and save money, reduce unnecessary antibiotics, screenings, report authors urge MONDAY, May 23 (HealthDay News) -- Cutting back on unnecessary antibiotics, delaying wasteful imaging for lower back pain and foregoing annual ECG screenings for healthy, low-risk patients are among the actions that could help streamline primary care, experts say. Perhaps taking a page from David Letterman's Top 10 list, the authors of a new report came up with a "Top 5" list of action items for each of the primary care disciplines -- family medicine, internal medicine and pediatrics -- to help save money and conserve health resources. Many physicians are already behind the suggestions, according to the report, which appears online May 23 in the Archives of Internal Medicine. "I have seen many instances where I thought clinicians were not making the right and wisest decisions in ways that were not good for patients' health and not good for prudent use of finite resources," said Dr. Stephen Smith, one of the report's authors and professor emeritus of family medicine at the Warren Alpert School of Medicine at Brown University in Providence, RI. Smith is also a member of the National Physicians' Alliance (NPA), a group of 22,000 doctors promoting affordable and quality healthcare, which put together the lists. None of the suggestions are particularly new, having been validated by scores of studies, yet few clinicians seem to be implementing them, Smith said. Here are the Top Five recommendations for each discipline: For family medicine: Avoid imaging for lower back pain for six weeks unless red flags are present. Cut back on prescribing antibiotics for sinus infections, since most are viral. Avoid cardiac screening in patients who are low risk and have no symptoms. Do not do Pap tests for cervical cancer in women under 21 or those who have had a hysterectomy for benign disease. Confine bone density scans known as dual-energy X-ray absorptiometry (DEXA) for osteoporosis to women aged 65 and over and for men 70 and older who also have risk factors, such as those who have already had fractures . For internal medicine: Defer imaging for lower back pain. Do not order blood chemistry panels (a set of 8 blood tests to assess kidney function, blood sugar and other health indicators) or urinalysis in healthy adults with no symptoms, since blood lipids (fats) tests alone yield most positive results. Forego cardiac screening in healthy patients. Prescribe generic statins (cholesterol-lowering drugs) before brand-name ones Limit bone-density screening to older, at-risk patients . In pediatrics: Avoid giving antibiotics for sore throats unless a test definitely turns up the bacteria Streptococcus (strep throat) Avoid imaging for minor head injuries without risk factors such as loss of consciousness. Take a wait-and-see attitude towards middle-ear infections before referring the patient to a specialist. Recommend that parents not give their children over-the-counter cough-and-cold medicines. Make sure patients with asthma are using corticosteroid medicines properly, as this will cut down on episodes. The report was funded by a grant from the American Board of Internal Medicine Foundation. Several of the items -- those involving cardiac screening, overuse of antibiotics, bone-density scans and lower-back imaging -- appeared in more than one category. But one item -- not doing blood chemistry panels and urinalysis among healthy adults without symptoms -- enjoyed only weak support from the practicing physicians who field-tested the suggestions. The Top 5 lists will now be distributed to all NPA members. The researchers are also hoping to get funding to set up demonstration sites, creating training videos to help physicians hone their communication skills and finding ways to get patients on board, Smith said. "These are certainly important issues," said Dr. Lawrence C. Kleinman, a primary care physician and associate professor of pediatrics at Mount Sinai School of Medicine in New York City. But he also pointed out that "the lists were done with some nuance, which [is] valuable and important to incorporate in the understanding of this." As the report authors point out, Kleinman noted, it's not that all antibiotic use is bad, just that, in the case of sore throats, there should be a verification that the infection is really strep throat before prescribing them. Similarly, imaging for head injuries would need to be done for children with loss of consciousness or other risk factors. SOURCES: Stephen R. Smith, M.D., professor emeritus of family medicine, Warren Alpert School of Medicine, Brown University, Providence, RI; Lawrence C. Kleinman, M.D., a primary care physician and associate professor of pediatrics at Mount Sinai School of Medicine in New York City; May 23, 2011 online edition, Archives of Internal Medicine

Blood Transfusion and Donation

Blood Transfusion and Donation Every year, nearly 5 million people in the United States receive life-saving blood transfusions. During a transfusion, you receive whole blood or parts of blood such as Red blood cells - cells that carry oxygen to and from tissues and organs Platelets - cells can be used to control bleeding Plasma - liquid part of the blood that helps blood clot Some people worry about getting sick from giving or receiving blood. It is possible, but is very rare. The Food and Drug Administration and other organizations that collect blood make sure that blood is safe. Every single donation is tested for HIV/AIDS, Hepatitis C, syphilis and several other diseases that can be transmitted through blood. Some people who know they may need blood during surgery donate their own ahead of time. That is the safest type of transfusion.

Probiotic yogurt no help for kids' constipation

Probiotic yogurt no help for kids' constipation By Amy Norton NEW YORK (Reuters Health) - A yogurt aimed at easing digestion with the help of "good" bacteria may not be much help for children's chronic constipation, a new study suggests. The study, of 159 children with persistent constipation, looked at whether an Activia-brand yogurt could help make the kids more "regular." Activia yogurts and other cultured dairy products contain a strain of friendly bacteria, or probiotic, called Bifidobacterium lactis, which is thought to help regulate the digestive system. Some studies of adults have found the products to help ease chronic constipation. But in the new study, researchers found that the probiotic yogurt was no better than a non-cultured dairy product without probiotics in easing kids' constipation. Over three weeks, children who were randomly assigned to eat the probiotic yogurt each day did start to have more bowel movements, on average. But so did children in the comparison group. In both groups, children went from having fewer than two bowel movements per week, on average, to about four per week. It's not clear why both groups improved to a similar degree, according to the researchers. But based on the findings, the probiotic cannot be recommended for children's constipation, lead researcher Dr. Merit M. Tabbers told Reuters Health in an email. Some parents may still want to try it or other probiotic products, noted Tabbers, a pediatric gastroenterologist at Emma Children's Hospital in Amsterdam. And it's possible, the researcher said, that for certain kids, probiotics will help. But for now, Tabbers said, "there is not sufficient evidence to support a general recommendation about the use of probiotics in the treatment of childhood constipation." The study, which appears in the journal Pediatrics, was funded by Paris-based Danone (Dannon in the U.S.), which makes Activia. Two co-researchers on the study work for the company. The findings are based on 159 children who were 7 years old, on average, and had been suffering from constipation for at least two months. They were randomly assigned to have two servings of either the probiotic yogurt or the non-probiotic every day for three weeks. In the end, both groups showed similar improvements. Tabbers said that children in the comparison group did better than expected. One reason might be the general attention that kids in both study groups received, the researcher explained. All of the children were told, for example, they should try to go to the bathroom after each meal. In general, less-than-ideal bathroom habits -- like trying to "hold" it in -- are thought to underlie many cases of constipation in children. That and other differences between children's constipation and adults' might help explain why the probiotic appears to have different effects in kids and adults, according to Tabbers. Typically, Tabbers said, the first step in easing children's constipation includes teaching them better bathroom habits and making diet changes, like adding more fiber-rich foods such as fruits and vegetables. If that fails, a doctor might prescribe laxatives. If parents want to try a probiotic, Tabbers said, they still can. But if there's no improvement within a few weeks, they should move on, according to the researcher. One theory on why probiotics might help with constipation is that the products help restore any imbalances in the natural, friendly bacteria dwelling in the gut. However, Tabbers said, researchers don't know whether the gut bacteria in healthy children differ from those of children with constipation. "Further research should therefore also focus on the composition of the microbiota in healthy and constipated children," Tabbers said. SOURCE: http://bit.ly/jL7FF8 Pediatrics, online May 23, 2011.