Wednesday, November 18, 2009

New breast cancer screening guidelines create confusion and controversy.

The U.S. Preventive Services Task Force (USPSTF) has updated their 2002 recommendation statement on screening for breast cancer in the general population, and the new statement has created a loud controversy among physicians, cancer survivors, women's health advocates and, inevitably, politicians. Making its debut in the midst of a hotly debated healthcare reform bill the timing could hardly be worse.

About the USPSTF:

The USPSTF was established in 1984 to "evaluate the benefits of individual services based on age, gender, and risk factors for disease; make recommendations about which preventive services should be incorporated routinely into primary medical care and for which populations; and identify a research agenda for clinical preventive care." The USPSTF is an independent, voluntary body, and "...recommendations made by the USPSTF are independent of the U.S. government, and they should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services."

Here is the outline of the new recommendations:

  • The USPSTF recommends against routine screening mammography in women aged 40 to 49 years. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms.
  • The USPSTF recommends biennial screening mammography for women aged 50 to 74 years.
  • The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older.
  • The USPSTF recommends against teaching breast self-examination (BSE).
  • The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination (CBE) beyond screening mammography in women 40 years or older.
  • The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of either digital mammography or magnetic resonance imaging (MRI) instead of film mammography as screening modalities for breast cancer.

The primary controversy revolves around the statements against routine screening in women through their 40's, and biennial (rather than annual) screening between 50 to 74 as well as the recommendation against teaching breast self-examination.
The position of the Task Force is that the routine annual screening for breast cancer can cause "...psychological harms, unnecessary imaging tests and biopsies in women without cancer, and inconvenience due to false-positive screening results." They also note the overdiagnosis of cancer that would not become clinically apparent during a woman's lifetime, and unnecessary early treatment of breast cancer that may become clinically apparent but would not actually shorten a woman's life. Although "...false-positive test results, overdiagnosis, and unnecessary earlier treatment are problems for all age groups, false-positive results are more common for women aged 40 to 49 years, whereas overdiagnosis is a greater concern for women in the older age groups." They also state that there is adequate evidence that teaching breast self examination (BSE) is associated with harms that are "at least small."

However, The American Cancer Society "...continues to recommend annual screening using mammography and clinical breast examination for all women beginning at age 40. Our experts make this recommendation having reviewed virtually all the same data reviewed by the USPSTF, but also additional data that the USPSTF did not consider."
Many physicians and women's health advocates are also either confused or seem to be  misinterpreting the recommendations to insinuate that women shouldn't -or won't be allowed to- have a screening at all until they're 40; Dr. John Larrinaga, Medical Director at the Ross Breast Center states: "It doesn't make sense on any level for any person to put their heads in the sand like an ostrich and say we shouldn't be checking ourselves or shouldn't be vigilant about the disease...This is just wrong, this is not scientifically supported." Dr. Ann Marie Shorter, a radiologist with a specialty in breast care says "The statistics are meaningless when it comes to breast cancer deaths if it's your wife, your best friend; these guidelines are a travesty. They don't make sense."
And Rep. Debbie Wasserman Schultz (D-Fla.) "blasted" the report, saying "We can't turn literally 20 years of recommendations ...upside down, and discourage women from becoming familiar with the look and feel of their breasts," and "We can't allow the insurance industry to continue to drive healthcare decisions"

Given the current climate of political diversity on the healthcare bill, the controversy isn't likely to die soon. Meanwhile, breast cancer continues to be the most common form of cancer among women in the US, with about 192,370 new cases of invasive breast cancer expected to be diagnosed in 2009. In our opinion, the best guideline is the old adage: If in doubt, check it out.

Signs and symptoms of breast cancer may include:

  • A breast lump or thickening that feels different from the surrounding tissue
  • Bloody discharge from the nipple
  • Change in the size or shape of a breast
  • Changes to the skin over the breast, such as dimpling
  • Inverted nipple
  • Peeling or flaking of the nipple skin
  • Redness or pitting of the skin over your breast, like the skin of an orange

When to see a doctor:
If you find a lump or other change in your breast — even if a recent mammogram was normal — make an appointment with your doctor.

Tuesday, November 17, 2009

Uninsured trauma patients are much more likely to die --

Uninsured trauma patients are much more likely to die --

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Food Allergies on the Rise in US Children... maybe.

A new cross-sectional survey of data on food allergy among children published online November 16, 2009 in Pediatrics shows that the prevalence of self-reported food allergies in the U.S. increased by 18% from 1997 to 2007, and outpatient visits to medical facilities for treatment of food allergies nearly tripled from 1993 to 2006. The study was the first to make nationally representative trend estimates of food allergy prevalence and healthcare utilization in the U.S. It also took the unusual step of characterizing some food allergy characteristics according to race and ethnicity.The study found that increases in food allergy prevalence were found across gender, age, and race, and findings include:
  • Between 2003 and 2006, children were taken for an estimated average of 317,000 food allergy-related visits per year to emergency rooms and outpatient departments and doctors offices
  • Hospitalizations of children with diagnoses related to food allergy increased from an average of 2,600 discharges per year during the period of 1998 to 2000 to 9,500 discharges per year from 2004 to 2006
  • Black children were twice as likely as white children to test positive for peanut allergies on blood tests and were nearly twice as likely to have detectable signs of milk allergies.
  • Black children were four times as likely as white children to have detectable antibodies for shellfish. While not as likely to have food allergies as black children, Hispanic children were more likely to have food allergies than were white children.
But are allergies really on the rise?

According to previous reports, true food allergies are not as common as most people believe and only affect about 2% of children, although they are more common in younger children. And fortunately, most younger children will outgrow these food allergies by the time they are three years old.
More common than food allergies is food intolerance, which can cause vomiting, diarrhea, spitting up, and skin rashes. An example of such a reaction occurs in children with lactose intolerance, which occurs because of a deficiency of the enzyme lactase, which normally breaks down the sugar lactose. Children without this enzyme or who have a decreased amount of the enzyme, develop symptoms after drinking lactose containing food products, such as cow's milk. However, because this reaction does not involve the immune system, it is not a real food allergy.

One theory of interest suggests the recent rise could be related to a phenomenon known as the hygiene hypothesis, according to the Food Allergy and Anaphylaxis Network. "Because children in our culture are exposed to fewer germs than their bodies are used to dealing with, the immune system is deprived of the full-time germ-fighting job they have to do, and [immune systems] misidentify food as harmful" she says.
After identifying food as harmful, the body reacts by trying to fight the food—resulting in an allergic reaction with symptoms ranging from relatively benign ones, like hives, rashes and tingling in the mouth, to terrifying ones, like swelling in the throat, difficulty breathing and loss of consciousness.

However the study notes that "Several national health surveys indicate that food allergy prevalence and/or awareness has increased among US children in recent years."
And researcher Amy M. Branum, MSPH, of National Center for Health Statistics at the CDC adds "Reported food allergy is increasing among children of all ages, among boys and girls, and among children of different races/ethnicities, however, it cannot be determined how much of the increases in estimates are truly attributable to increases in clinical disease and how much are attributable to increased awareness by physicians, other health care providers, and parents."

So the reality is that while there may be some actual increase in allergic reactions to our children's food, the study suggests more of an increase in the general awareness and reporting of food allergies.

About Food Allergies:

Some food allergies result in immediate, severe and even life-threatening symptoms (such as severe peanut allergy), whereas others cause symptoms which may take longer to develop (for example, gluten allergy, also known as coeliac disease). They can result in immediate, severe and even life-threatening symptoms (such as severe peanut allergy), whereas others cause symptoms which may take longer to develop (for example, gluten allergy, also known as coeliac disease).
The diagnosis of a food allergy isn't always straightforward. Many food allergy symptoms can also be caused by a number of other conditions and it may take some time before the problem food is identified and your doctor can confirm that you have an allergy.

The only treatment for food allergy is not to eat the problem food. A registered dietitian can help you identify and remove a problem food from your diet and replace it with alternatives, to make sure you don't miss out on essential nutrients. Your dietitian can also explain what you need to look for on food labels and when eating out. Symptoms of mild food allergies, such as a rash or runny nose, may be treated with antihistamines. However, it's important that you only take medicines for your allergy on the advice of your doctor. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

Friday, September 25, 2009

AIDS Vaccine Breakthrough Provides New Hope

A new clinical trial has produced a combination of two genetically engineered vaccines- neither of which had worked before in humans- that was declared a qualified success after six years of testing on more than 16,000 volunteers in Thailand. Those who were vaccinated became infected at a rate nearly one-third lower than the others.
The trial used a combination of ALVAC HIV - from Sanofi-Aventis, the French pharmaceutical company - as "prime" vaccine, with a second vaccine booster called AIDSVAX B/E, developed by GenVax of the US, and since ceded to the non-profit group Global Solutions for Infectious Diseases. It was overseen by the Thai authorities, with US military support. The work, beginning in 2003, was complex, involving initial interviews of 60,000 people aged 18-30 from the Rayong and Chon Buri provinces, before 16,402 initially took part. Almost 0.8 per cent contracted HIV, including 51 per cent who were vaccinated and 74 per cent who were not.

But the findings leave many questions unanswered: most importantly, while those who were vaccinated had a lower rate of HIV infections, it had no effect in reducing the "viral load" or presence of HIV for those who had been vaccinated. This reinforces uncertainty over the mechanism by which vaccines affect the human immune system. There are also uncertainties about the longer term probability of infection and the development of HIV in those who have been vaccinated, and the effects in other groups at higher risk of HIV including sex workers, gay men and intravenous drug users.
"We don't really know why and how this vaccine worked and did what it did," said Dr. Alan Bernstein, executive director of the Global HIV Vaccine Enterprise, an alliance of AIDS scientists, governments and donors.
"This trial is raising more questions almost than it's answering," he said. "It's opened the door and it's opened up a whole lot of questions that are answerable and will be answered over the next months and years to come."
Because of the long time frame, health advocates warn that people should not count on a potential vaccine to treat and contain infections.
An estimated 33.2 million people around the world were living with HIV in 2007, according to the Joint United Nations Program on HIV/AIDS. The Centers for Disease Control and Prevention estimates that about 1.1 million adults and adolescents were living with diagnosed or undiagnosed HIV infection in the United States at the end of 2006.

Tuesday, August 4, 2009

Tai Chi for Stroke Survivors

According to reported global estimates, 15 million people suffer from a stroke each year, resulting in 5.5 million deaths, with 5 million left permanently disabled. Typical disabilities following stroke include poor neuromuscular control, hemodynamic imbalance, and negative mood state.
Tai Chi is an ancient Chinese activity and philosophical exercise aimed at harmonizing the mind and body. It consists of a series of 108 flowing movements used to stimulate the body's flow of natural energy, bringing about a state of self-awareness, health and calmness. There are many versions of Tai Chi. The most popular include Yang, Chen, Wu and Sun. They are named for the families that introduced them.
Tai Chi is associated with better balance, lower blood pressure, and improved mood, which are important for stroke survivors.
People who have survived strokes may be faced with lingering problems including maintaining their balance. This is more than just an annoyance and uncomfortable feeling that interferes with their quality of life. It also raises the risk of debilitating and possibly fatal falls. But researchers from the University of Illinois at Chicago (UIC) have found tai chi is a drug-free way to treat these stroke-caused balance problems. Earlier research has previously shown tai chi can improve balance and reduce falls among healthy elders. So, while at the Hong Kong Polytechnic University, Christina Hui-Chan, and her colleague Stephanie Au-Yeung decided to see if tai chi would also help stroke survivors. They studied 136 research subjects in Hong Kong who had suffered a stroke more than six months earlier. The participants were randomly placed into two groups for 12 weeks. The control group practiced breathing, stretching and other exercises that included sitting and walking. The tai chi group practiced a simplified form of the ancient martial art consisting of coordinated movements of the head, trunk and limbs that require concentration and attention to balance.
At the end of the 12 week study, the research subjects were given several balance tests. Both the tai chi and the control group performed about the same on a test that involved the ability to stand, walk and sit back down. However, when tested on their ability to maintain balance while shifting weight, leaning in different directions, and standing on moving surfaces to simulate a crowded bus, the tai chi group clearly out-performed the control exercise group. The results of the research are set for publication in a forthcoming issue of the journal Neurorehabilitation and Neural Repair. "The tai chi group did particularly better in conditions that required them to use their balance control," Hui-Chan, professor and head of physical therapy at UIC, said in a statement to the media. "In only six weeks, we saw significant improvements. The ability to shift your weight is very important because all reaching tasks require it." In addition to improving balance, Hui-Chan explained tai chi also improves strength and cardiovascular fitness. What's more, tai chi classes can provide seniors with healthy group interactions that help prevent social isolation, too. She added that most people can learn the art of tai chi if they are taught by a trained instructor. The National Institutes of Health (NIH) is also showing interest in the benefits of tai chi. The NIH's National Center for Complementary and Alternative Medicine (NCCAM) is currently sponsoring studies to find out more about tai chi's effects, how it works, and diseases and conditions for which it may be most helpful.
Source: Natural News: Tai Chi Provides Natural Treatment for Stroke Damage by Sherry Baker, Health Sciences Editor

Friday, June 12, 2009

H1N1 "Swine" flu

AMedivision Editorial

Image of the newly identified H1N1 influenza virus from the CDC Influenza Laboratory.

When the current novel H1N1influenza virus first made its public debut in April 2009, splashing across worldwide news headlines like a herald of impending Armageddon, many people reacted in understandable panic. Political figuresincited media flurries about the use of public transportation, there was talk ofclosing the US/Mexican border, and in Egypt officials embarked on the less than noble task ofmassacring their country's entire pig population based on the unfortunate misnomer of “swine flu”. But the outcry soon subsided, partially in thanks to the predominating worries over a global economic crisis and the fact that the majority of people infected with novel H1N1 simply recover. In truth, as soon as H1N1 was discoveredThe World Health Organization (WHO) andThe Centers for Disease Control and Prevention (CDC) instigated emergency response measures which undeniably limited the spread of the virus. For now.

Why a Pandemic?

On June 11 2009,WHO declared H1N1 a phase 6 pandemic. This essentially means that the virus is spreading in at least 3 countries by verified human-to-human transmission and that a global pandemic is under way, not that the virus has become more severe or more deadly. However, it is hoped that the new designation will help speed production of avaccine. To put things in perspective, ordinary influenza viruses -the kind that spread around the office every season- infect about 1 billion people worldwide and kill an estimated 500,000 each year. To date there are about28,774 cases of H1N1 reported globally, with 147 reported fatalities.
However it should be noted that influenza activity typically does not reach its peak in the U.S. until January or February.

Why is it so Dangerous?
The frightening aspect of any new influenza virus is the possibility that it mayevolve into something more deadly, more contagious or more drug resistant. In 1889 between 1 and 4 million people died from aH2N2 influenza strain: in 1918 another strain of H1N1, the"Spanish flu" killed between 50 and 100 million people and infected almost one third of the world's population. As recently as 1969 anH3N2 strain of influenza killed an estimated 1 million people.

This version of H1N1 is a novel strain of influenza which we have never been vaccinated or naturally immunized against. Health officials have warned that the virus could mutate into a more virulent form, putting greater numbers of people at risk. In May 2009WHO declared that the virus must be closely monitored especially in the southern hemisphere, as it could mix with ordinary seasonal influenza and change in unpredictable ways:a leading virologist from the University of Hong Kong has described the new H1N1 influenza virus as "very unstable", meaning it could mix and swap genetic material when exposed to other viruses, and the CDC reminded us that the 1918 flu epidemic which killed hundreds of thousands in the United States alone was preceded by a mild "herald" wave of cases in the spring, followed by devastating waves of illness in the fall.

Fortunately, current analysis shows that the virus is most similar to strains that cause mild symptoms in humans leading experts to suggest that it is unlikely to cause severe symptoms for most people. And as of early June 2009, the CDC reported "encouraging news" regarding any mutations to date by announcing thatsamples of the virus from points around the globe are still "genetically identical" to the strain found in the United States.

About H1N1:
H1N1 is a subtype of influenza virus A and the most common cause of influenza (flu) in humans. Virus strains are categorized according to two proteins found on the surface of the virus: hemagglutinin (H) and neuraminidase (N): strains are assigned an H and N number based on which forms of these proteins the strain contains. Only H 1, 2 and 3, and N 1 and 2 are commonly found in humans.
The current strain, on which this attention is focused, is thought to be a mutation -or reassortment- of four already known strains: one endemic in humans, one endemic in birds, and two endemic in pigs. The outbreak was first detected in Mexico on March 18, 2009.

Protecting Yourself:
The signs of infection with this strain of H1N1 are currently similar to other forms of influenza, and include fever, coughing, headaches, pain in the muscles or joints, sore throat, chills, fatigue and runny nose. Diarrhea and vomiting have also been reported in some cases. People at higher risk of serious complications included people age 65 years and older, children younger than 5 years old, pregnant women, and people of any age with underlying medical conditions, such as asthma, diabetes, obesity, heart disease, or a weakened immune system.
In children, emergency warning signs that need urgent medical attention include:
  • Fast breathing or trouble breathing
  • Bluish or gray skin color
  • Not drinking enough fluids
  • Severe or persistent vomiting
  • Not waking up or not interacting
  • Being so irritable that the child does not want to be held
  • Flu-like symptoms improve but then return with fever and worse cough
In adults, emergency warning signs that need urgent medical attention include:
  • Difficulty breathing or shortness of breath
  • Pain or pressure in the chest or abdomen
  • Sudden dizziness
  • Confusion
  • Severe or persistent vomiting
  • Flu-like symptoms improve but then return with fever and worse cough

  • The CDC has advised sick people to stay home from work, school, or social gatherings and to generally limit contact with others to avoid infecting them.
  • Little data is available on the risk of airborne transmission specific to this particular virus. Masks may be of benefit in "crowded settings" or for people who are in "close contact" with infected persons, but this hasn’t been proven.
  • Infection can be caused by touching a surface contaminated with flu viruses and then touching the eyes, nose, or mouth. The CDC has advised avoiding such contact and frequent washing of hands with soap and water or with alcohol-based hand sanitizers, especially after being out in public.
  • The leading international health agencies stressed that the "influenza viruses are not known to be transmissible to people through eating processed pork or other food products derived from pigs”.
Take these everyday steps to protect your health:
  • Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
  • Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.
  • Avoid touching your eyes, nose or mouth. Germs spread this way.
  • Try to avoid close contact with sick people.
  • Stay home if you are sick for 7 days after your symptoms begin or until you have been symptom-free for 24 hours, whichever is longer. This is to keep from infecting others and spreading the virus further.

Tuesday, May 12, 2009

Salt in the News

Despite long recognized health concerns, our love affair with salt hasn't abated. If anything it's gotten worse: Current news reports detail popular restaurant meals with as much as 4 times the recommended maximum daily salt levels.

Source: Center for Science in the Public Interest (CSPI) "Heart Attack Entrées with Side Orders of Stroke" Overly Salty Restaurant Meals Present Long-Term Health Risks for All, and Immediate Danger for Some.

Since at least 6000 BC people have used salt as a preservative, seasoning, dietary supplement and even as currency. In fact, the two major components of salt - Chloride and Sodium - help regulate the fluid balance of the body and are necessary for the survival of all known living creatures, including humans.
However the reality is that we only need about 460 - 920 milligrams (mg) of salt per day. Most health organizations recommend a maximum of about 2400 mg, and people with high blood pressure, African Americans and people middle-aged and older should consume no more than 1,500 mg of sodium daily according to the government’s dietary advice.
Currently the average consumption in the US is as much as 4800 mg per day- twice the recommended maximum. So why are we eating so much?
A large part of the problem is our society's reliance on processed and prepared foods. According to a recent report by the Center For Science in the Public Interest (CSPI) , 85 out of 102 meals from popular US restaurant chains contained more than the recommended maximum sodium level in a single serving, with some containing as much as 4 times the amount. For example, the "Admiral's feast" from the Red Lobster chain of restaurants contains app. 7,106 mg of salt.

The health risks:
Your kidneys regulate the amount of sodium kept in your body. When levels are high, they excrete the excess amount in urine. If your kidneys can't eliminate enough sodium it begins to accumulate in your blood, increasing the blood volume and subsequently the pressure in your arteries. Certain diseases such as congestive heart failure, cirrhosis and chronic kidney disease can lead to an inability to regulate sodium.
According to the American Heart Association, "... a 1200 mg decrease in daily sodium intake would result in 6 percent fewer cases of new heart disease, 8 percent fewer heart attacks, and 3 percent fewer deaths per year. Even larger health benefits are projected for African Americans, who are more likely to have high blood pressure and whose blood pressure may be more sensitive to salt. Among African Americans, new heart disease cases would be reduced by 10 percent, heart attacks by 13 percent and deaths by 6 percent."
In addition, new studies have linked dietary factors -including sodium intake- to a sudden increase in kidney stones in pediatric patients as well as adults.
Up to 65 percent of kidney stones are formed when oxalate, a byproduct of certain foods, binds to calcium in the urine. The two biggest risk factors for this binding process are not drinking enough fluids and eating too much salt; both increase the amount of calcium and oxalate in the urine.
Excess salt has to be excreted through the kidneys, but salt binds to calcium on its way out, creating a greater concentration of calcium in the urine and the kidneys.

How to cut sodium:
You can cut your sodium intake in several ways:

  • Eat more fresh foods and fewer processed foods. Fresh fruits and vegetables are naturally low in sodium, and fresh meats are much lower in sodium than processed luncheon meat, bacon, hot dogs, sausage and ham.
  • Opt for low-sodium products. If you do buy processed foods, select those that have reduced sodium.
  • Remove or reduce salt from recipes whenever possible. You can leave out the salt in many casseroles, stews and other main dishes. Providing a shaker on the table will allow guests to use as much - or as little- as their tastes require.
  • Limit your use of salty condiments. Salad dressings, sauces, dips, ketchup, mustard and relish all contain sodium.
  • Use herbs, spices and other flavorings to enhance foods.
  • Use salt substitutes carefully. Some salt substitutes or light salts contain a mixture of table salt (sodium chloride) and other compounds. To achieve that familiar salty taste, you may use too much of the substitute and actually not use less sodium. In addition, many salt substitutes contain potassium chloride, which can be harmful if you have kidney problems, congestive heart failure or high blood pressure that cause potassium retention.

Your taste for salt is acquired, so it's reversible. If you decrease your use of salt gradually your taste buds will easily adjust. Start by using no more than 1/4 teaspoon (1 milliliter) of added salt daily, and then gradually decrease that to as little as possible. As you use less salt, your preference for it lessens, allowing you to enjoy the taste of food itself.

Thursday, May 7, 2009

Welcome to Health For Us

Health For Us is the Medivision weblog for current news and innovations in medicine, medical technology and healthcare education.
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