Certain women may miss out on routine tests that screen for early signs of breast cancer.

Elderly women, women with publicly funded health insurance and women who don’t go to an obstetrician and gynecologist for routine exams are all less likely than others to get a clinical breast exam and a recommendation for a mammogram.

“A physician’s recommendation is why many women undergo screening in the first place,” said Rajesh Balkrishnan, the Merrell Dow professor of pharmacy at Ohio State University. “Foregoing these exams can increase a woman’s risk of developing an advanced stage of breast cancer. There are several reasons why a physician may not give a patient a clinical breast exam or recommend a mammogram.”

Balkrishnan led a study that uncovered some of these possible reasons. The findings are online at the website of the journal Breast Cancer Research and Treatment.

The researchers gathered data from the National Ambulatory Medical Care Survey (NAMCS), a database run by the Centers for Disease Control and Prevention. The NAMCS contains information on a nationally representative sample of practicing physicians and patient visits throughout the United States. The researchers restricted their data set to physician office visits by women 40 and older from 1996 through 2004.

During that time, these women made an estimated 2.5 billion office visits, and physicians performed some 198 million clinical breast exams and made 110 million recommendations for mammograms. During a clinical breast exam, a physician feels the breast and surrounding tissue for any irregularities.

The researchers created a number of categories in order to determine which women were more likely to receive a clinical breast exam or a recommendation for a mammogram. The categories included patient age, a history of breast surgery or breast cancer diagnosis, type of insurance coverage and physician specialty.

The researchers found that women who see an ob-gyn for routine check ups were 18 times more likely to receive a clinical breast exam than if they visited any other kind of physician, including internists or family physicians. Ob-gyns were also 13 times more likely to recommend that their patients schedule a mammogram.

The type of insurance coverage a woman had was also a decisive factor. Compared to women with private health insurance, women with public health insurance (such as Medicaid and Medicare) were up to 30 percent less likely to receive a clinical breast exam. Doctors were up to 55 percent less likely to recommend that these women schedule a mammogram.

“Almost every medical association in the country recommends that a woman 45 and older get screened annually or at least every two years,” Balkrishnan said. “Medicare and Medicaid pay for at least a portion of the cost of both exams for covered individuals. But patients and physicians may not be aware of this.”

“Even if physicians are aware of this, they may receive lower payouts from Medicare and Medicaid,” said Monali Bhosle, a study co-author and a graduate research associate in Ohio State’s department of pharmacy practice and administration.

Age also played a determining role. Women younger than 75 were roughly 1.5 times more likely to receive a clinical breast exam, and up to twice as likely to get a recommendation for a mammogram.

“We confirmed another commonly held belief – that elderly patients are less likely to get these screenings than younger patients,” Balkrishnan said. “This may be due to increasing dependence on federal forms of health care insurance. Also, physicians may feel that early detection and treatment may not be cost-effective, that such treatment may not help to prolong life at this age.”

Women with a history of breast surgery for any reason were 28 times more likely to receive a clinical breast exam, but only slightly more likely (1.6 times) to receive a recommendation for a mammogram. Women with a previous breast cancer diagnosis were 22 times more likely to get a clinical breast examination by their doctor, and four times more likely to get a recommendation for a mammogram.

“The effectiveness of mammography screening is usually lower in women who had breast cancer surgery,” Bhosle said. “Mammography picks up irregularities in the tissue, and these irregularities may be due to the aftermath of surgery and the body’s healing process. That may be a reason why doctors didn’t recommend that many of these women get a mammogram.

“But clinical breast exams are simple and inexpensive as compared with mammography,” she continued. “Researchers believe that regular exams are comparable to yearly mammograms in detecting breast cancer. Since women with a history of breast cancer and surgery are at higher risk for breast cancer, physicians may prefer the clinical breast exam over a mammogram.”

Balkrishnan and Bhosle conducted the study with Electra Paskett, the Marion N. Rowley Professor of Cancer Research in the School of Public Health at Ohio State and other colleagues from Ohio State and the University of Texas School of Public Health.

###

Holly Wagner

Contact: Rajesh Balkrishnan

Ohio State University

FAO is mobilizing its teams of experts to help ascertain if the new strain of H1N1 virus, which already killed many people in Mexico, has a direct connection to pigs.

FAO is also deploying a team of experts of the FAO OIE (World Organisation for Animal Health) Crisis Management Centre – Animal Health (CMC-AH), to Mexico this week to help the government assess the epidemiologic situation in the pig production sector.

Full alert

The UN agency has also requested its technical staff around the world be on full alert, immediately report any influenza-like illness in swine stocks and forward specimens to FAO/OIE reference laboratories.

At present, transmission seems to be occurring solely from humans to humans; so far evidence that the new strain of influenza A virus has entered the human population directly from pigs has not been established. Further analysis is planned to gain better insight into the situation.

No food chain threat

“There is no evidence of a threat to the food chain; at this stage it is a human crisis and not an animal crisis, but we have to be alerted and prepared,” said FAO Chief Veterinary Officer Joseph Domenech.

“The first actions FAO and others must take are to ascertain if the new strain is circulating in pigs, establish if there are any direct linkages between the illness in the human population and animals and explain how this new virus has obtained genetic materials from human, bird and pig influenza strains,” he said.

Governments urged to step up surveillance

FAO is working in close coordination with the World Health Organisation and OIE and other national and international actors involved at all stages of the organization’s operations to ensure maximum efficiency in this worrying turn of events.

FAO urges Governments and the international community to step up disease surveillance in swine.

Source:
Jill Ersner
Food And Agriculture Organization Of The United Nations
Further information on Swine Flu

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University of Iowa researchers have shown for the first time that an anti-depressant and a form of talk therapy each can prevent or delay the onset of depression in people who have had acute stroke.

The findings will appear in the May 28 issue of the Journal of the American Medical Association. Previous studies on this type of prevention had not shown positive results; however, this new study, in contrast, was larger and double-blinded. The research was funded by the National Institute of Mental Health, part of the National Institutes of Health.

“Prevention has been a goal of psychiatry for a long time,” said the study’s principal investigator Robert G. Robinson, M.D., professor and head of psychiatry at the University of Iowa Carver College of Medicine. “It is the first time a double-blinded randomized study has shown it is possible to prevent a psychiatric disorder in patients without previous illness.”

The study involved 176 participants treated from July 2003 through October 2007 at University of Iowa Hospitals and Clinics, the University of Chicago, and the Burke Rehabilitation Hospital in White Plains, New York. Participants ranged in age from 50 to 90 and did not currently have depression. They began participation in the study within three months of having a stroke and received treatment for 12 months.

Participants were randomly assigned to one of three treatment groups: the antidepressant escitalopram (Lexapro), placebo (inactive substance) and Problem-Solving Therapy, a form of talk therapy developed for use in older people. Neither participants nor the researchers initially knew which patients received the antidepressant and which received the placebo, making it a “double-blind” study.

Approximately 22 percent of the participants on placebo developed depression. In comparison, only 8.5 percent of those who received the antidepressant developed depression, and 12 percent of those who received talk therapy developed depression.

Side effects from the drug treatment were benign, with no significant differences in side effects seen among the three groups. One limitation of the study was that it did not include post-stroke patients who had other life-threatening illness such as heart disease or cancer.

Previous research by Robinson, UI and other investigators has shown that depression following stroke is significantly associated with impaired physical and cognitive recovery and with increased death rates. According to an American Heart Association report published in the journal Circulation in 2006, nearly 700,000 people have a stroke each year in the United States. More than one in three stroke survivors develop depression, creating a significant health care challenge, Robinson said.

“When we look at the results of our current study — that we can prevent the development of depression — and our previous data on how antidepressants improve longer-term survival, we believe the implication is that the vast majority patients with acute stroke would benefit from receiving antidepressant treatment,” said Robinson, who also holds the Paul W. Penningroth Chair of Psychiatry.

Robinson said, based on the findings, seven post-stroke patients would need to be given antidepressant to prevent one case of depression, and nine patients would need to receive talk therapy to prevent one case of depression. He noted, as a point of comparison, that among men with high cholesterol, 40 patients must be treated with a statin for five years to ward off one heart attack.

“With baby boomers aging, there will be an explosion in the elderly population, which is the group most likely to suffer stroke,” Robinson said. “If we could prevent depression, which has previously been shown to have very negative consequences on stroke recovery, family support and rehabilitation efforts, and if we could also increase the long term survival, then it would be a major advance in the care of patients with stroke.”

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View drug information on Lexapro.

A Worcester Polytechnic Institute (WPI) research team has received a four-year, $1.4 million award from the National Institutes of Health (NIH) to continue a groundbreaking study of arterial plaque. This research could lead to tools that will enable physicians to predict the likelihood of plaque rupture, which is responsible for most heart attacks and strokes. Led by Dalin Tang, PhD, professor of mathematical sciences and biomedical engineering at WPI, the team is collaborating with researchers at Washington University in St. Louis and the University of Washington in Seattle on the research, which combines sophisticated computer modeling with an array of diagnostic technologies to more accurately chart the development of atherosclerotic plaque (fatty deposits) in the coronary arteries.

Arterial plaques are complex structures made up of cholesterol and other fats, calcium, fibrin (a protein that helps blood clot), and other materials. When they reach an advanced stage, plaques may develop a thin, membranous or fibrous cap. When this is torn open, it releases the contents of the plaque into the bloodstream. Plaque rupture causes some 60 percent of sudden, unexpected heart attacks. While the link between plaque build-up and cardiovascular disease has long been recognized, the factors that cause plaques to form, grow and rupture have been less clearly understood.

Better understanding the evolution of arterial plaque is important, Tang says, given the central role it plays in cardiovascular disease. As plaque deposits grow they cause a narrowing of arteries (called stenosis), which diminishes the amount of oxygen and nutrients blood can carry to the body and puts increasing stress on the heart. When plaques rupture, a blood clot (thrombosis) typically forms at the site and may block the artery. Such a blockage in a coronary artery leading to the heart is called a myocardial infarction or a heart attack. A similar blockage of the carotid artery leading to the brain is a stroke.

Tang and his team are arguably the leading research group studying how plaque components, fluid forces and structural forces, collectively, conspire to cause plaque rupture. Using computational models, magnetic resonance imaging (MRI) scans of volunteers, and histological studies of diseased arteries, they have spent several years investigating mechanisms governing plaque progression and factors and indices that could be used to predict potential plaque rupture. Tang published the first paper about this multi-component plaque model in 2004.

The new NIH award will enable the team to extend this research. Combining such techniques as patient-specific, image-based computational modeling, intravascular ultrasound (IVUS), angiography, MRI, and mechanical testing to analyze atherosclerotic coronary plaques, the team aims to zero in on what factors–including the forces from blood flow, pressure, and heart motions–best assess quantitatively which of those plaques are most likely to rupture.

Since 60 percent of all heart attacks and strokes are caused by such ruptures and occur without advanced notice, doctors err on the side of caution and may recommend more surgical remedies than are actually necessary, Tang says. In fact, he notes, only one out of 20 carotid endarterectomies (removal of plaque from an artery) currently performed is likely necessary (in other words, only one plaque would actually rupture).

Currently, the trigger for these surgeries is a high level of arterial stenosis. However, with better diagnostic approaches, the trigger might, instead, be identification of arterial plaque with a high potential to rupture, with plaque morphology, tissue components, and mechanical forces all taken into consideration. By developing better diagnostic tools, Tang and his team hopes to improve plaque assessment techniques for early diagnosis, treatment and prevention of cardiovascular disease.

In addition to Tang, WPI co-investigators on the grant are Kristen L. Billiar, associate professor of bioengineering and tissue engineering, and Joseph Petruccelli, professors of statistics. Jie Zheng, assistant professor of radiology at Washington University’s Mallinckrodt Institute of Radiology, is principal investigator at WU. Roger Kamm, Germeshausen professor of mechanical engineering and biological engineering at MIT is a consultant on the grant.

Source:
Michael Dorsey

Worcester Polytechnic Institute

Intense, individually tailored dietary treatment for acutely hospitalized elderly has a significant impact on mortality, according to a new study by researchers at Ben-Gurion University of the Negev.

The intervention study just published in the prestigious Journal of the American Geriatric Society showed higher death rates six months after discharge (11.6 percent) of the control group compared to the intervention group’s death rate of 3.8 percent, which received intensive nutritional treatment designed and implemented by a registered dietician.

The study recruited 259 hospitalized adults aged 65 and older who were nutritionally at risk. After six months, the rise in the mini-nutritional assessment score (an indicator of nutritional status) was significantly higher in the intervention group than in the control group.

According to BGU researcher Dr. Danit R. Shahar, “This is the first study that used an individually tailored dietary treatment for acutely hospitalized elderly people. The results indicate that intense dietary treatment reduces mortality and can help reduce the need for re-hospitalization.”

In the study, a dietician met each patient upon admission to the hospital. The dietitian then followed the patient in his home, visiting three times after discharge.

The study dieticians (case managers) were the decision-makers regarding appropriate treatment and set up treatment goals. The basic approach was to develop a dietary menu based on inexpensive food sources and recipes.

Patients had monthly contact by telephone to improve cooperation and prevent dropout from the study. The dieticians performed follow up assessment three to six months after discharges for all patients.

While the overall dropout rate was 25.8 percent, a standard range for elderly studies, after six months the rise in the mini-nutritional assessment score (an indicator of nutritional status) was significantly higher in the intervention group than in the control group.

The study was supported by the Israel National Institute for Health Policy and Health Services Research.

Source:
American Associates, Ben-Gurion University of the Negev

Congress is “taking new whacks” at the tobacco industry with its proposed 61-cent increase in the federal tobacco tax to pay for the reauthorization and expansion of SCHIP, AP/Long Island Newsday reports. According to AP/Newsday, although the cigarette industry “is quietly working against” the SCHIP bill, “it lacks the clout it once wielded.”

To lobby against the tax increase, Philip Morris USA is sponsoring a Web site, mailings and a toll-free number urging individuals to contact their lawmakers and ask them to sustain President Bush’s veto. The company’s advertising materials state, “Taxing smokers is unfair.” Philip Morris has asked tobacco growers, retailers and wholesalers to contact their lawmakers as well, according to spokesperson Bill Phelps.

Despite the efforts, the proposed tax increase “is not an issue” in the SCHIP negotiations, according to Democratic and Republican leaders, and “both houses have signaled a willingness to raise the cigarette tax if other provisions of a children’s health bill can be resolved,” according to AP/Newsday.

Ron Pollack, executive director of Families USA, said that the tobacco industry “has tried to do things more quietly, largely because they obviously know how popular a tobacco tax is” (Babington, AP/Long Island Newsday, 11/10).

Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

If Dr. Doolittle is famous for talking to animals, then here’s a story that might make him hold his tongue: According to new research published online in The FASEB Journal, scientists have successfully fused human stem cells derived from subcutaneous adipose (fat) tissue with muscle cells from rat hearts. Not only did these cells “talk” to form new muscle cells altogether, but they actually beat.

“Recovery of regenerative cells located in the stromal vascular fraction of a patient’s own subcutaneous tissue is relatively simple and can be used for self-healing,” said Christopher Alt, Ph.D., a researcher involved in the work from the Department of Molecular Pathology at the University of Texas in Houston. “A patient’s quality of life can be improved by application of those recovered regenerative cells to the heart, as well as to bone, tendons, non-healing wounds and joints.”

Using newborn rats, scientists studied the combination of rat heart muscle cells (cardiomyocytes) and human adipose (fat) stem cells derived from human subcutaneous adipose tissue. They found that the two fused and formed new heart muscle cells with several nuclei. When kept in a culture environment, these cells beat. These new cells exhibited an ability to compensate for a loss of cardiomyocytes as following a myocardial infarction, via fusion with cardiomyocytes. Furthermore, this study shows that contrary to previous findings suggesting that genetic modification of certain embryonic genes in adult stem cells is required as a prerequisite for turning into heart cells, the human stem cells used in this study were not genetically modified.

“Much work is still ahead before this method can be applied to humans, but the hope is that this technique might eventually make heart transplants unnecessary,” said Gerald Weissmann, M.D., Editor-in-Chief of The FASEB Journal. “This study not only shows the power of stem cell fusion technology, but also that cardiac regeneration is on the horizon.”

Notes:

Details:
Roxana Metzele, Christopher Alt, Xiaowen Bai, Yasheng Yan, Zhi Zhang, Zhizhong Pan, Michael Coleman, Jody Vykoukal, Yao-Hua Song, and Eckhard Alt

Human adipose tissue-derived stem cells exhibit proliferation potential and spontaneous rhythmic contraction after fusion with neonatal rat cardiomyocytes
FASEB J March 2011 25:830-839; doi:10.1096/fj.09-153221.

Source:
Cody Mooneyhan
Federation of American Societies for Experimental Biology

For patients with type 1 diabetes who need a kidney transplant, simultaneous pancreas-kidney (SPK) transplantation offers a higher survival rate than other options but with some increased risks, reports a study in an upcoming edition of the Clinical Journal of the American Society of Nephrology (CJASN). “This study helps patients with type 1 diabetes and their providers decide upon the best transplant treatment option,” comments Alexander Wiseman, MD (University of Colorado).

The study included nearly 6,900 type 1 diabetics undergoing SPK transplantation. When SPK transplant was successful with both organs functional at one year, the long-term survival rate was 89 percent, compared to 80 percent for patients receiving a kidney from a living donor and 65 percent for those receiving a kidney (but not pancreas) from a deceased donor (All SPK transplants came from deceased donors). However, SPK recipients were about two percent more likely to die during the first year after transplantation. There was also a ten to fifteen percent chance that the transplanted pancreas would fail during the first year. When this happened, the long-term survival rate dropped to 74 percent.

Patients with type 1 diabetes and advanced kidney disease face a difficult decision, according to Wiseman: “Should they try to get on the waiting list for SPK and assume the greater surgical risk, or should they accept a kidney from a living donor and live with continued diabetes?” If they opt for kidney transplant alone, they then must decide whether to undergo a separate pancreas transplant later on. In Wiseman’s study, even this option did not lead to better survival than successful SPK transplantation.

The new findings help to guide this decision by comparing the benefits and risks of the various transplant options. “Overall, the chances for better long-term success favor the SPK option, particularly if the waiting time for an SPK is not long this varies with regions of the United States.”

The study is limited by a lack of information on why the SPK recipients lived longer one theory is that improved diabetes control helped avoid cardiovascular disease. In addition, although the study provides important new evidence that survival rate is higher after successful SPK transplantation, it does not help in predicting which patients will have a successful SPK transplant.

The authors reported no financial disclosures.

Source: American Society of Nephrology (ASN)

About 2,050 randomly selected Medicare beneficiaries will begin to test an application for financial assistance under the new prescription drug benefit through a new pilot program, the… Cleveland Plain Dealer reports. Under the Medicare prescription drug benefit, which will take effect in 2006, beneficiaries with annual incomes at or less than 150% of the federal poverty level and assets that do not exceed a certain level will qualify for at least partial discounts on premiums, deductibles and other fees. Beneficiaries who are dually eligible for Medicare and Medicaid will not have to pay the fees. The Social Security Administration must contact Medicare beneficiaries who might quality for discounts on the fees, and the agency plans to use the pilot program to identify potential problems with the 16-question application. However, according to SSA spokesperson Mary Mahler, the agency will not have time to correct any problems before 20 million additional applications are mailed to Medicare beneficiaries this year. She said that SSA will work to address problems with the application through outreach and publicity campaigns. “The issue is confusion about what this is all about to begin with,” Mahler said, adding, “We want to see how many people fill it out and if they have problems with the application.” Medicare beneficiaries involved in the pilot program who do not return applications within two weeks will receive telephone calls from SSA.

Criticism
Robert Hayes, director of the Medicare Rights Center, called the application “badly flawed,” adding, “We and other consumer groups gave Social Security a good deal of comments on how to simplify the applications, and these comments were largely ignored.” He said that several questions on the application are long and confusing, which could prompt Medicare beneficiaries not to complete the application. Hayes also criticized a warning on the application that says Medicare beneficiaries who provide false information “may be sent to prison or may face other penalties, or both.” He said, “These are very poor people getting these letters. They are older and sicker than the average person on Medicare and least able to dig through the lengthy application” (Jaffe, Cleveland Plain Dealer, 3/21).

Rx Drug Card Program
In related news, the Orlando Sentinel on Monday examined how many low-income Medicare beneficiaries who qualify for a $600 subsidy under the Medicare prescription drug discount card program remain unaware of the available financial assistance. According to the federal government, an estimated seven million Medicare beneficiaries qualify for the $600 subsidy for 2005, but only 1.73 million of those had enrolled as of Feb. 28. Eligible Medicare beneficiaries who enroll before March 31 will receive the full $600 subsidy, and those who enroll after that date will receive a $150 to $450 subsidy for the remainder of the year based on the date of enrollment. Medicare is working to educate beneficiaries about the subsidy before the March 31 deadline. However, according to Tricia Neuman, a Kaiser Family Foundation vice president and director of its Medicare Policy Project, “This is just a hard population to reach.” She added, “A key obstacle is that anytime you offer a new benefit, there’s a huge learning curve until a large number of people really know about it and then go through the process of applying for it” (Shelton, Orlando Sentinel, 3/21).

“Reprinted with permission from kaisernetwork kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Peyronie’s disease is characterized by a plaque, or hard lump, that develops on the upper or lower side of the penis in layers containing erectile tissue. It starts with an inflammation and can develop into a hardened scar. Symptoms may develop slowly or appear overnight and they consist of reduced flexibility, pain, curved and shortened penis during erection. The curvature of the penis generally leads to lowered self-esteem and makes sexual intercourse difficult, almost impossible.

Some of the factors involved in Peyronie’s disease can be: the existence of an infection, genetic predisposition, vascular problems, consumption of specific medicines, diabetes, hypertension, etc.
The plaque itself is benign, or noncancerous. However, if not treated, the disease may lead to serious erectile dysfunction.

At first, the line of treatment for Peyronie’s disease was to “watch and wait” to see whether the penile curvature resolved itself or worsened. When the latter occurred, the patient was given vitamin E treatment, even though its positive outcome is not scientifically proved.

Researchers also have injected chemical agents into the plaques, a procedure that also lacks scientific studies that confirm its effectiveness.

A more effective way of curing Peyronie’s disease is surgery, a last resort procedure which raises the patient’s risk of experiencing complete loss of erectile function, rigidity and shortening of the penis.

Fortunately, surgery is not the only option to treat Peyronie’s diseases. Andromedical, a Spanish medical company, markets the andropenis®, a medical device using the principle of traction to straighten the penis with no side effect, as long as it is used on a penis in flaccidity. The first outcome should appear within three weeks of treatment and after 6 to 7 months, the patient will notice full results: a correction of up to 70 per cent curvature. Thanks to its efficiency, the andropenis® is recognized by famous doctors worldwide, such as Wendy Hurn, Urology Specialist Practitioner, Bristol Royal Infirmary, UK.

Several scientific studies have confirmed the effectiveness of the andropenis® for patients with Peyronie’s disease. Apart from rectifying penile curvatures, the andropenis® can also be used as a penile postoperative treatment in order to avoid scar retraction and especially to achieve a penis enlargement of 3 to 4 centimetres (1.2 to 1.6 inches) in length as well as a girth increase of 1,5 centimetre (0.6 inch) with a 97.5 percent rate of efficiency as demonstrated by independent scientific research around the globe.

www.andromedical