Delaine's General Health Blog: October 2011

Monday, October 31, 2011

MF Global Bankruptcy: Activity Curtailed, Bank Reveals Exposure

Last Updated 4:23 p.m.EDT, Thu October 20, 2011

Source: http://www.medicaldaily.com/news/20111031/7720/mf-global-bankruptcy-ny-fed-cme-group-jefferies-primary-dealer.htm

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Rwanda LMIS Project Manager | John Snow, Inc.

Monday, October 31st, 2011 | Posted by

RWA ? Kigali, The following minimum qualifications are required for this position: ? Master?s degree in management information systems, or a combination of education and relevant experience in MIS project manageme

Posted by on Oct 31 2011. Filed under Careers & Opportunities. You can follow any responses to this entry through the RSS 2.0. You can leave a response or trackback to this entry

Source: http://www.globalhealthhub.org/2011/10/31/rwanda-lmis-project-manager-john-snow-inc/

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GM mosquitoes show fever promise

30 October 2011 Last updated at 16:56 ET

By Richard Black Environment correspondent, BBC News

Woman with dengue Pakistan is the latest country to see a dengue outbreak, with thousands of cases in Lahore alone

Genetically modified mosquitoes could prove effective in tackling dengue fever and other insect-borne diseases, a UK-based scientific team has shown.

The male mosquitoes are modified so their offspring die before reproducing.

In a dengue-affected part of the Cayman Islands, researchers found the GM males mated successfully with wild females.

In Nature Biotechnology journal, they say such mating has not before been proven in the wild, and could cut the number of disease-carrying mosquitoes.

Dengue is caused by a virus transmitted by the Aedes aegypti mosquito as it bites.

The World Health Organisation (WHO) estimates that there may be 50 million cases each year, and the incidence is rising, with some countries reporting what the WHO terms "explosive" outbreaks.

As yet, there is no vaccine.

Radiation damage

As far back as the 1940s, it was realised that releasing sterile males into the wild could control insects that carried disease or were agricultural pests.

Aedes aegypti flying The Aedes aegypti mosquitoes that carry dengue cannot be curbed by bednets or indoor spraying

When females breed with the sterile males rather than wild fertile ones, there will be no viable offspring, meaning there are fewer mosquitoes around to transmit the disease.

In the 1950s, the screwworm fly was eradicated from the Caribbean island of Curacao using males sterilised by radiation.

But the technology has not worked so well with disease-carrying insects.

Generally, the sterilising process weakens the males so much that they struggle to mate; the wild males are dominant.

Oxitec, a company spun off from Oxford University, uses a genetic engineering approach.

Offspring of their GM males live through the larval stage but die as pupae, before reaching adulthood.

In the latest study, the research group - which includes scientists from Imperial College London and the Liverpool School of Tropical Medicine - released batches of GM mosquitoes in 2009 in an area of the Cayman Islands where Aedes aegypti are common, and dengue sometimes present.

A proportion of the eggs collected from the study area in subsequent weeks carried the introduced gene, meaning the biotech mosquitoes had mated successfully.

The GM males made up 16% of males in the study area, and fathered 10% of the larvae; so they were not quite as successful as the wild males, but not significantly worse.

"We were really surprised how well they did," said Luke Alphey, Oxitec's chief scientific officer and a visiting professor at Oxford University.

"For this method, you just need to get a reasonable proportion of the females to mate with GM males - you'll never get the males as competitive as the wild ones, but they don't have to be, they just have to be reasonably good."

Larvae The GM larvae also carry a fluorescent gene that distinguishes them from wild relatives

"This study is the first to show that the mosquito population could be suppressed this way," said Dr Raman Velayudhan, a WHO dengue expert.

"The fitness level is much better [compared with previous attempts] - it is almost the same as in wild mosquitoes," he told BBC News.

Cognizant that genetic engineering is a technology that carries the potential for risks as well as benefits, the WHO is finalising guidance on how GM insects should be deployed in developing countries, which it expects to release by the end of the year.

Insectary The "death gene" is turned off during rearing in Oxford - and turned on in the field

The field seems to be hotting up, with other research groups recently creating Anopheles mosquitoes that are immune to the malaria parasite they normally carry, and making male Anopheles that lack sperm.

Malaria is a prime target for these approaches simply because it is such an important disease; but arguably it is more needed in diseases such as dengue where there are few alternatives.

"For malaria, there are effective alternatives like bednets, but they won't work for dengue because the mosquitoes bite during daytime," said Dr Alphey.

"We don't advocate [GM mosquitoes] as a 'magic bullet' that will solve all dengue in one go, so the question is how it fits in as part of an integrated programme - and for dengue, it would be a huge component of an integrated programme."

Funding for the Oxitec approach has come from a number of sources including private investors, charities, Oxford University and governments, and the Cayman Islands authorities were willing to take part in the field trial.

Death by feedback

The genetic approach used to create the mosquitoes is a system known as tetracycline-controlled transcriptional activation (tTA).

The tTA gene is spliced into the insect's genome in such a way that the protein it makes increases the gene's activity - a positive feedback loop.

The cells make more and more tTA protein - and in doing so, have little capacity for making any other proteins. Eventually, this kills the insects.

When the male larvae are reared at Oxitec, this process is turned off by keeping them in water containing the antibiotic tetracycline, which inhibits the feedback process.

When the males breed in the wild, however, tTA genes in their offspring are fully active.

In principle, a process that allows larvae to hatch and stay alive for many days should be more advantageous that the traditional approach of producing infertile eggs, as the larvae will consume food that could otherwise be used by viable larvae from the union of wild males and females.

The next step in the work is to demonstrate that deploying GM males does suppress the insect population enough that it is likely to have an impact on dengue incidence.

Dr Alphey said results from a project last year in the Cayman Islands suggested this had been achieved.

Follow Richard on Twitter

Source: http://www.bbc.co.uk/go/rss/int/news/-/news/science-environment-15491228

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DoH could hand pharmacists power to alter GP scrips unilaterally

By Tom Moberly, 31 October 2011

Under DoH proposals, pharmacists would be able to change how medicines are named on the prescription and directions for their use without contacting the prescriber.

Wessex LMCs chief executive Dr Nigel Watson said the move could cause problems for patients and affect legal clinical responsibility for prescribing.

'I can see why they?d want to do it, and it might work well in some situations, but there would be issues,? he said.

'If you?re the one that prescribes you hold legal responsibility,? he said. ?If I?ve done something wrong, I would much sooner know about it.

'Sometimes a patient ends up with a quirky dose for good clinical reasons.'

Dr Watson added that queries about prescriptions helped develop relationships between GPs and pharmacists.

He said that, despite the huge number of prescriptions processed by his practice, there were few problems.

Dr Bill Beeby, chairman of the GPC prescribing subcommittee, said the subcommittee had yet to discuss the plans.

'Personally, I think it might have value in some situations,? he said. ?But I have some concerns about it.'

Dr Beeby said changes such as allowing pharmacists to supply twice as many 250mg tablets in place of 500mg ones could be helpful. But changes to duration of treatment could cause problems, he warned.

Details of the proposals are included in a consultation from the Medicines and Healthcare products Regulatory Agency, which is open for comments until 17 January 2012.

Source: http://www.gponline.com/channel/news/article/1101364/doh-hand-pharmacists-power-alter-gp-scrips-unilaterally/

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Telemedicine in the Accountable Care Era


By Sanjeev Arora, M.D.	October 31, 2011
Innovative New Mexico program leverages IT to link academic medical center, underserved rural populations.

The opinions expressed by authors do not necessarily reflect the policy of Health Forum Inc. or the American Hospital Association.

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Source: http://www.hhnmag.com/hhnmag/HHNDaily/HHNDailyDisplay.dhtml?id=8280001004

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The People of Poor Economics

By BillGatesNotes

Read the rest here:
The People of Poor Economics

Posted by BillGatesNotes on Oct 31 2011. Filed under Policy & Systems, Uncategorized. You can follow any responses to this entry through the RSS 2.0. You can leave a response or trackback to this entry

Source: http://www.globalhealthhub.org/2011/10/31/the-people-of-poor-economics-2/

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Are You Playing a Game of Chicken?


By Matthew Weinstock	October 27, 2011
CIOs at the CHIME Fall Forum urged to take leadership role in the transition to ICD-10.

SAN ANTONIO, TEXAS ? "The train is moving at a high speed, do you want to play a game of chicken or take the wheel?" That was Albert Oriol's rhetorical question to CIOs who work at hospitals that have been slow to pay attention to the transition to ICD-10.

Oriol, CIO at Rady Children's Hospital in San Diego, speaking on a panel at the CHIME Fall Forum, said that CIOs may have to fill the leadership void if no other executive takes ownership of the issue. At Rady, Oriol is fortunate to serve with the CFO and assistant CMO on an ICD-10 steering committee. "It is shared ownership," he said. In fact, Rady began work on its transition to ICD-10 a little more than two years ago, yet Oriol said the organization still has a long way to go before crossing the finish line.

Rady isn't necessarily alone. A KLAS report issued last week suggests that only 9 percent of health care providers "are over halfway there in terms of being fully prepared for ICD-10." Oriol and his fellow panelist Carole McEwan, project manager at SSM Healthcare, urged the more than 700 attendees gathered in San Antonio to view ICD-10 as an organizationwide event. It's not just about coding or IT. It should also be viewed as a way to vastly improve clinical documentation, which is something we discussed in our September cover story.

ICD-10 isn't the only topic of conversation at this meeting. Today's sessions will focus on using IT to bring costs under control, meeting meaningful use requirements and improving clinical efficiency. We'll have ample coverage of these topics in Friday's report.

One thing that isn't necessarily on the agenda, but is on people's minds is CIO burnout. Health care is going through some major changes and a lot is riding on new technologies and major implementations. I spoke with a handful of people during the coffee breaks and at the opening reception and almost all talked about the tremendous pressure on hospital IT departments. How they ? and the rest of the executive team ? manage the workload in the months and years ahead will be critical to an organization's ability to thrive in the future.

Matthew Weinstock is senior editor of Hospitals & Health Networks. Follow his tweets at www.twitter.com/hhnmag.

The opinions expressed by authors do not necessarily reflect the policy of Health Forum Inc. or the American Hospital Association.

in general. All comments will be reviewed by a moderator before being posted.

Source: http://www.hhnmag.com/hhnmag/HHNDaily/HHNDailyDisplay.dhtml?id=1920002372

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4 Blunders to Avoid at Your New Dentist?s

BY: Anastasia Turchetta

?Help me help you.? That may be a cliche, but when it comes to seeing a new dentist, the better prepared you are, the better able he?ll be to help you in your quest for healthy teeth. Below are five common missteps I often see -- avoiding these mistakes allows you to set the foundation for the best oral health care ? and who doesn?t want that!

You arrive empty-handed.
Don?t� waste time filling out your health history and insurance forms at your dentist?s office: Download them from her website and fill them out beforehand. (Don?t forget to bring them with you!) If your dentist doesn?t have a website, request the forms by email when you call up to make your appointment.
You hide an illness or a major surgery.
Research shows a link between oral health and overall health, and certain health conditions, such as diabetes, can impact your mouth. What?s more, more than 400 medications contribute to dry mouth and other oral health problems. So when you talk to your dentist, fully disclose your health history and current medications -- including dosage. If you?ve had heart surgery or joint replacements within two years, your dentist needs to know to give you the proper antibiotics prior to dental treatment.
You leave your X-rays or charts behind.
These files are important, as they can help your new dentist pick up where the old one left off and track your gum health over time. Dentists usually keep these on file for seven years, so ask your old practice to email or snail-mail them to your new dentist.
You suffer in silence.
Many people?s greatest fear is going to the dentist. But you don?t have to simply grin and bear it -- dental practices have a variety of options to ease your anxiety, from nitrous oxide to general anesthesia. Just let us know!

Source: http://www.oralcareandhealthdaily.com/blog/new_dental_blunders/index.html

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Concerns remain as NHS commissioning board established in shadow form

By Susie Sell, 31 October 2011

Mr Farrar: ?NCB faces a number of potential bear traps.'

The Board, led by NHS chief executive Sir David Nicholson, becomes a shadow NHS special health authority from 31 October, and will become a statutory organisation from April 2012, a year ahead of the date when clinical commissioning groups will assume full control of NHS budgets.

NHS Confederation chief executive Mike Farrar said the NCB must be a success otherwise the NHS as a whole will face a 'very big problem'.

He said in its early actions the NCB must work to avoid the danger of being seen as unaccountable to the public and overbearing to the health service.

It must therefore work to demonstrate public accountability and clinical leadership and show that it will not hold on to power or drown commissioners in guidance and bureaucracy, he said.

He added that the Board must also empower new clinical commissioners, not stifle their enthusiasm.

Mr Farrar said: ?The creation of a national body with a single-minded focus on making the system work for patients and taxpayers is a major opportunity. However, the Board faces a number of potential bear traps.

?The Board will require the strength and vision to lead the system through the most significant financial challenges the NHS has ever faced. It will need to support new commissioners in managing complex, strategic change including the reconfiguration of many acute hospital services.

Source: http://www.gponline.com/channel/news/article/1101321/concerns-remain-nhs-commissioning-board-established-shadow-form/

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IVF May Raise Risk for Less Aggressive Ovarian Cancer

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Study Shows Increased Risk for 'Borderline' Ovarian Tumors in Women Who Had In Vitro Fertilization

By Sonya Collins
WebMD Health News

Reviewed by Laura J. Martin, MD

Oct. 27, 2011 -- Women who undergo ovarian stimulation as part of IVF (in vitro fertilization) treatment may be more likely to develop "borderline" ovarian tumors, but not invasive ovarian tumors, later in life, Dutch researchers report.

The researchers defined borderline ovarian tumors as low-grade ovarian cancer that is far less aggressive than invasive ovarian cancer.

The new study is published online in Human Reproduction. It's the first study to compare ovarian cancer rates among women with fertility problems who had gotten IVF and those who had not.

It's not yet clear if ovarian stimulation causes those borderline tumors, or if the risk applies to current IVF treatment.

Meanwhile, the researchers aren't calling for any changes in IVF use.

"We are talking about an increase in a special type of tumor that has an excellent prognosis," Flora van Leeuwen, a professor at The Netherlands Cancer Institute, tells WebMD. "The wish to have a child dominates the fear of a rare tumor that does not cause death."

Tracking Ovarian Tumors

The new study included more than 25,000 Dutch women who had been unable to conceive for at least one year. All but about 6,000 of them had undergone IVF treatment at least once between 1983 and 1995.

The women filled out surveys. The researchers also tracked the medical records of the women for 15 years, on average. During that time, women who had gotten IVF were twice as likely as the other women to develop any type of ovarian cancer -- particularly borderline ovarian tumors.

"Borderline tumors have low malignant potential. They are not what patients consider ovarian cancer. They are very different from 'real' ovarian cancer. That's a really important distinguishing factor," says Carolyn Runowicz, MD, a gynecologic oncologist and past president of the American Cancer Society. Runowicz was not involved with the Dutch study.

Borderline tumors do not spread to the surrounding tissue like invasive, or metastatic, cancers do. The tumors grow and must be surgically removed, but they would not require chemotherapy or lead to death, Runowicz tells WebMD.

Borderline tumors make up 15% to 30% of all ovarian cancers in the general population, according to the study. This was also true in the non-IVF group followed in the study. But in the IVF group, borderline tumors made up nearly 50% of the ovarian cancers.

Still, the odds of getting any type of ovarian cancer were low, even with IVF. The risk is similarly low in the U.S. Most U.S. women diagnosed with ovarian cancer are older than 60, and it accounts for only 3% of all women's cancers. About 12 in 100,000 women were diagnosed with ovarian cancer in the U.S. in 2006.

Never having children increases the risk for ovarian cancer, so women with fertility problems are already at greater risk. Researchers have questioned for some time whether IVF treatment increases that risk.

Role of IVF

There is still the possibility that something about fertility issues, rather than IVF treatment, makes women more likely to develop borderline ovarian tumors.

"You could easily reason that the ovaries of the women in the IVF group are more resistant to pregnancy than the other subfertile [women with fertility problems] group. It could be that there is some connection between severity of infertility and risk for a tumor," says Joe Leigh Simpson, MD, a gynecologist and past president of the American Society for Reproductive Medicine.

The results of the Dutch study are also based on IVF treatments used before 1995. Today's IVF treatments are different. "Enormous changes have occurred in the last 10-15 years. It's not necessary to stimulate women's ovaries as heavily as we did at one time," Simpson says.

SOURCES: van Leeuwen, F. Human Reproduction, online, Oct. 27, 2011.Carolyn Runowicz, MD, associate dean for women's affairs, Herbert Wertheim College of Medicine, Florida International University.Flora van Leeuwen, professor, department of epidemiology, The Netherlands Cancer Institute.Joe Leigh Simpson, MD, associate executive dean of academic affairs, Herbert Wertheim College of Medicine, Florida International University. �2011 WebMD, LLC. All Rights Reserved.

Source: http://www.medicinenet.com/guide.asp?s=rss&a=151008&k=Womens_Health_General

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The Six IOM Aims Up Close and Personal


By Cynthia Hedges Greising	October 27, 2011
The author learns what a difference safe, timely, efficient, effective and patient-centered care can make.

Like some people, I can tell a story about a not-so-great hospital encounter. But I also can describe exemplary hospital encounters ? when efficient and safe, evidence-based care was delivered by nurses who provided tender attention and doctors who listened and patiently explained their diagnoses.

My oldest child's first few years of life were filled with at least one life-or-death diagnosis, a "simple" heart operation that proved anything but, and many visits to multiple specialists during which my husband and I saw the vast spectrum of care, from extraordinary to excruciating. To some people, the Institute of Medicine's Six Aims may seem like a talking point or abstract policy recommendation. But for the people at the heart of our health system ? the patients and their families ? the six pillars are of real-life concern. They can make the difference between successful outcomes and unsuccessful ones. They can help make a hospital stay a satisfying ? even exceptional ? experience.

Four Weeks, Three Hospitals

My firstborn, Wesley, was delivered by emergency cesarean section at a small Chicago hospital, now shuttered. After a week in the neonatal intensive care unit at this hospital, he was still severely jaundiced, feeding poorly and lethargic. Sensing something was wrong, the attending physician ordered a nursery-to-nursery transfer to a large hospital in another part of Chicago. Wesley spent three weeks there ? a hospital stay that dragged as staff struggled to diagnose his problem.

At our request for a second opinion, Wesley was transferred to a large academic medical center in another part of Chicago. A top specialist at this hospital finally diagnosed our baby's condition as idiopathic neonatal hepatitis. Our son spent only one night at this hospital before he was discharged with vitamins and medications. We had follow-up appointments there throughout the first year of his life, as his initial malady slowly but steadily cleared.

Four weeks, three hospitals: This was my son's first month of life. Wesley had several other medical issues and he and I, occasionally with my husband, spent much of his newbie life visiting several pediatric specialists at a fourth hospital. We became regulars at this hospital, which is dedicated to treating children and home to most of the clinicians treating our son.

Twenty-one years, a handful of surgical procedures, including one to repair a hole in his heart, and hundreds of hospital visits later, Wesley sees "just" two specialists annually now ? an ophthalmologist and orthopedist ? both of whom have followed him since the early months of his life.

Applying the Six IOM Aims

Thinking back to my son's early years, I am grateful for the excellent inpatient and outpatient care at hospitals, which helped make him a happy and healthy young man today. When he received exemplary care, the hospital was following at least five of the IOM's Six Aims for improving health care ? safe, timely, efficient, effective and patient-centered. (The sixth aim, equitable, wasn't something we could discern as individuals.) Likewise, when we felt care was inadequate, it typically fell short of one or more of the aims.

Safe: Neonatal and pediatric intensive care units are incredibly busy places, filled with machines and apparatuses and physicians and nurses caring for the youngest and tiniest of patients. At every hospital where our son stayed, precautions were taken to ensure patient safety. For example, my husband and I had to "scrub" from our fingernails to our upper arms and wear a paper gown before visiting our child. Though I worried a time or two during our many hospital visits, Wesley remained free of any health careassociated infections.

Timely: A long wait, particularly difficult with a toddler or infant, can negatively impact the overall patient-family experience. A couple of our specialists had hospital waiting rooms packed with patients and long wait times. On those occasions, the round trip to and from the hospital, with waiting time, could take half a day ? all for a 15-minute visit with the doctor. The positive experiences at certain clinics show that, with good planning, long waits can be shortened, an extra bit of work that makes the clinic run more efficiently while endearing the doctor to a patient.

Efficient: The third (and last) children's hospital we visited during Wesley's first month was a model of efficiency. It was a welcome change from the previous hospital, where test after test was ordered and results kept coming back negative. A few tests were repeated, apparently a result of communication failure among different clinicians who saw our child.

My husband prevented that from happening in one case. Noticing a nurse practitioner at our son's bedside preparing to do a spinal tap, he asked her: "Hasn't that test already been done, and didn't it turn up negative?" "Yes," she answered. My husband inquired further: "Why is the test being repeated? How many spinal taps have you done before?" The NP ended up not doing the spinal tap.

With Wesley undergoing one test after another, perhaps we had prevented at least one unnecessary procedure. Costs could be eliminated and patient care improved with more holistic monitoring of each patient's history.

At the last hospital ? where efficiency and professional accomplishment reigned ? we were relieved that no tests were ordered. Specialists at that hospital reviewed the tests done at the previous hospitals, examined Wesley and told us he was going home the next day. He would be coming back for follow-up treatments, and his progress would be monitored carefully. The joy of hearing those words ? that we all were going home after four weeks of mystery and worry ? is impossible to describe.

Effective: When the second hospital narrowed the causes of Wesley's initial problems to jaundice and poor feeding, we began investigating the best doctors to treat him. That led us to the specialist at the third hospital, where we discovered that a battery of previously ordered tests could have been ruled out before they were performed. Hearing the specialist talk about the hospital's work in treating children with similar symptoms reassured us that Wesley would be receiving evidence-based care and that ? at last ? someone seemed to know how to help him get well. This reliance on data and willingness to trust the work of other health care professionals made us feel more confident in the care he was receiving.

Patient-centered: One source of great comfort to my husband and me, as new parents during that first long month our son was hospitalized, was being able to call the hospital's NICU to check on his health or learn of the latest test results. After a long day at the hospital, checking in with one of the nurses late in the evening helped us stay connected to Wesley and his care.

When our son finally received a diagnosis by a top specialist in the field, my husband and I ? being seasoned health care consumers by now ? asked many questions and took lots of notes. The specialist listened to our questions and answered patiently. This type of engagement helps ensure follow-through with a medication or therapeutic regime and can improve compliance and outcomes and prevent readmission.

Toward an Exceptional Patient Experience

The Institute for Healthcare Improvement's recent report,"Achieving an Exceptional Patient and Family Experience of Inpatient Hospital Care," states that "respectful, empathetic relationships in combination with clinical quality are essential to achieving exceptional experiences." We have developed this kind of relationship with several of the physicians and nurses who have treated our son and, when the clinical quality is high, the entire experience can indeed be "exceptional."

Before Wesley was born, I had not spent much time in hospitals. Four weeks after his birth, I was a discerning patient parent, having experienced exceptional patient care and, at times, less than that. Many patients and families receiving care in hospitals today are not aware of the IOM's Six Aims, but they know quality care when they receive it. If all health care leaders and providers work to achieve these aims, experiences throughout hospitals and health care systems will be uniformly better.

Cynthia Hedges Greising is a communications specialist with the Health Research & Educational Trust, an AHA affiliate.

AHA's Hospitals in Pursuit of Excellence promotes quality improvement in health care and provides a variety of resources, including hospital case studies that apply the six IOM aims in such disciplines as care coordination, efficiency and patient safety. Visit www.hpoe.org.

The opinions expressed by authors do not necessarily reflect the policy of Health Forum Inc. or the American Hospital Association.

in general. All comments will be reviewed by a moderator before being posted.

Source: http://www.hhnmag.com/hhnmag/HHNDaily/HHNDailyDisplay.dhtml?id=1180005158

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More Evidence Shows Newer Forms of 'Pill' Raise Clot Risk, FDA Says

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THURSDAY, Oct. 27 (HealthDay News) -- The U.S. Food and Drug Administration on Thursday said it "remains concerned" that a newer generation of birth control pills may raise the odds for serious blood clots more than older forms of the Pill.

The announcement concerns oral contraceptives containing a newer type of progestin hormone called drospirenone, which includes Bayer's Yaz or Yasmin. According to the FDA, the new study found a higher risk of venous thromboembolisms (VTEs) -- potentially dangerous clots -- in women on the drospirenone-containing pills vs. those on older forms of oral contraceptives.

The FDA-funded review involved the medical histories of more than 800,000 American women, all of whom were on some type of birth control between 2001 and 2008. The study found that women taking the newer oral contraceptives experienced a higher rate of clots than women on older forms of the contraceptive pill.

The review also found that women on two other forms of birth control -- the Ortho Evra patch from Johnson & Johnson and the Nuvaring vaginal ring from Merck -- had a higher rate of clots.

For now, the FDA is not advising that most women switch to another form of contraception. "If your birth control pill contains drospirenone, do not stop taking it without first talking to your health care professional," the agency said. "Contact your health care professional immediately if you develop any symptoms of blood clots, including persistent leg pain, severe chest pain or sudden shortness of breath. If you smoke and are over 35 years of age, you should not take combination oral contraceptives because they increase the risk that you could experience serious cardiovascular events, including blood clots."

Thursday's announcement was not the FDA's first word on this issue, nor is likely to be the last. The agency issued a similar warning in September, and in a statement released Thursday said that, "given the conflicting nature of the findings from six published studies evaluating this risk, as well as the preliminary data from the FDA-funded study," it plans to host a public meeting on the issue on Dec. 8.

The announcement Thursday comes a day after the release of a study in BMJ that also found newer birth control pills were tied to a higher risk for clots.

In that study, researchers reviewed data on all Danish women, aged 15 to 49, who were not pregnant between January 2001 and December 2009. During that time, more than 4,200 first episodes of VTEs occurred.

Women taking birth control pills with a newer progestin hormone had twice the risk of clots compared to those who took the older form of contraceptive pills.

Compared to women who did not use birth control pills, the risk of VTE was three times higher among those who used pills with levonorgestrel and six times higher among those who took pills with drospirenone, desogestrel or gestodene.

But the absolute risk of VTE associated with taking the newer pills remained relatively low, about 10 per 10,000 women, according to the University of Copenhagen researchers.

For every 2,000 women who switched from using newer pills to pills with levonorgestrel, there would be one less case of clots a year.

While some doctors may choose to prescribe birth control pills with a lower risk whenever possible, it is crucial not to exaggerate the risk of VTE, Dr. Philip Hannaford of the University of Aberdeen in Scotland, wrote in an accompanying editorial in the journal.

"Oral contraceptives are remarkably safe and may confer important long-term benefits in relation to cancer and mortality," he said in a journal news release.

-- HealthDay Staff

SOURCES: Oct. 27, 2011, statement, U.S. Food and Drug Administration; Oct. 26, 2011, BMJ, online

Source: http://www.medicinenet.com/guide.asp?s=rss&a=150995&k=Womens_Health_General

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Sunday, October 30, 2011

Many Young Adults Unaware They're Developing Heart Disease

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THURSDAY, Oct. 27 (HealthDay News) -- A new study warns that many young adults have undetected thickening of the arteries -- or atherosclerosis -- which can lead to heart disease, stroke and death.

Researchers examined 84 young men and 84 young women, aged 18 to 35, with no known cardiovascular disease or risk factors such as diabetes, smoking, high blood pressure, high blood cholesterol or family history of premature heart disease.

Even though the participants had none of these traditional risk factors for atherosclerosis, many had other signs of the condition such as greater waist circumference and dangerous visceral fat covering the internal organs within the abdomen and chest, according to the Heart and Stroke Foundation of Canada study.

The findings, presented Oct. 25 at the Canadian Cardiovascular Congress in Vancouver, verify earlier research that found that as many as 80% of young Americans killed in war or in car accidents had premature and hidden (subclinical) atherosclerosis.

"The proportion of young, apparently healthy adults who are presumably 'the picture of health' who already have atherosclerosis is staggering," study author Dr. Eric Larose, an interventional cardiologist and an assistant professor at Laval University in Canada, said in a foundation news release.

The findings show that measures of visceral fat are greater predictors of atherosclerosis than simply checking body mass index (BMI), a measurement that takes into account height and weight. People with higher amounts of visceral fat have more atherosclerosis -- even if they're young and apparently healthy -- and can benefit from preventive changes in lifestyle.

"We know obesity is a bad thing but we're dropping the ball on a large proportion of young adults who don't meet traditional measures of obesity such as weight and BMI," Larose said.

He noted that assessing visceral fat levels is easy to do in a doctor's office. It's just a matter of measuring waist circumference.

"My message to young adults is that you are not superhuman, you're not immune to risk factors," Dr. Beth Abramson, a foundation spokesperson, said in the news release. "It's important to manage your risk factors at all ages. Lifestyle will eventually catch up with you. You are never too young to prevent heart disease."

Research presented at meetings should be considered preliminary until published in a peer-reviewed medical journal.

-- Robert Preidt

SOURCE: Heart and Stroke Foundation of Canada, news release, Oct. 25, 2011

Source: http://www.medicinenet.com/guide.asp?s=rss&k=DailyHealth&a=150983

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U.N. Calls For Concerted Efforts On Food Security Issues; Australia Drives Food Security As Commonwealth Meeting Theme

Friday, October 28, 2011

"United Nations officials [on Thursday] called for concerted efforts to ensure the world's fast-growing population has enough food, stressing that global food production will have to double by 2050 when the planet is expected to host one billion inhabitants," according to the U.N. News Centre.�"Secretary-General Ban Ki-moon stressed that guaranteeing sustainable food and nutrition security for all will require the full engagement of governments and the private sector" and "said he was encouraged by the renewed political interest in food security, including the prominence that is being given to the issue by the Group of 20 of the world's largest economies," the news service adds (10/27).

In related news, "Australia has flagged food security as a major theme at the 80th meeting of Commonwealth heads of government, backing a push by the United Nations," Dow Jones/Wall Street Journal reports. "Soaring commodities prices have hit poorer countries hard in recent years with figures from the World Bank estimating the higher costs pushed some 70 million people into poverty in 2010-2011," the news service writes, adding, "Australia plans to set up a new A$36 million international center for food security to share expertise with African nations" (Curran, 10/28).

The Kaiser Daily Global Health Policy Report is published by the Kaiser Family Foundation. 2011 Henry J. Kaiser Family Foundation. All rights reserved. The report summarizes the latest, most relevant information on U.S. global health policy developments and related news from hundreds of sources. Access today's full report or sign up for an email subscription to the Daily Report.

Source: http://feeds.kff.org/~r/kff/kdghpr/~3/2RruTVxghXw/GH-102811-Food-Security-Push.aspx

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Is It Hunger ? or Just Appetite?

BY: Densie Webb

Is it hunger or appetite that has you poking around in the fridge at midnight or making an impromptu run to the ice cream shop two hours after dinner? What?s the difference, you say? It?s like understanding the difference between love and lust. Sure, they?re related, but just like confusing lust with love can cause you to choose a bad partner, confusing appetite with hunger can drive you to choose bad food.

The Hunger vs. Appetite Test
Have a sudden overwhelming desire for chocolate cheesecake? The one that?s sold by the slice down at the corner bakery -- and nothing else will do? Think before you take the plunge. If hunger is driving you, then other, more healthful foods should sound appetizing as well, like sliced strawberries, a fresh pear or low-fat yogurt with low-fat granola, to name a few. To determine if a food craving has you in its grips, consider your interest in munching on anything you normally like to eat.

If nothing but that chocolate cheesecake sounds good, then you?re not really hungry at all. Your appetite has taken control. After all, when you?re hungry and your stomach is rumbling, a slice of fresh apple with peanut butter or a juicy peach sound like heaven on earth.

Satisfy Your Fix
Unlike hunger, appetite is not your body begging for fuel. It?s a desire for food based on emotions, habits, moods, sights, smells and memories. So ask yourself what you?re really craving. Company? Call a friend. Stress relief? Go for a walk. Even a change in location or activity can quell a habit-based craving -- such as the tendency to snack while lounging on the sofa or watching TV (or both!).

It takes a little practice to recognize the difference between hunger and appetite, especially if you?ve mixed up the two for years. But once you know how, making healthy food choices is a whole lot easier.

Source: http://www.oralcareandhealthdaily.com/blog/hunger_or_appetite/index.html

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Syria warns: "Whole region" could burn

(AP)�

BEIRUT - Syrian President Bashar Assad warned against Western intervention in his country's 7-month-old uprising, saying such action would trigger an "earthquake" that "would burn the whole region."

Assad comments, published in an interview with Britain's Sunday Telegraph, were made against a backdrop of growing calls from anti-regime protesters for a no-fly zone over Syria and increasingly frequent clashes between government troops and army defectors, the latest of which left at least 30 troops dead Saturday.

"Syria is the hub now in this region. It is the fault line, and if you play with the ground you will cause an earthquake," Assad said. "Do you want to see another Afghanistan, or tens of Afghanistans?"

Assad's remarks appeared to reflect his regime's increasing concern about foreign intervention in the country's crisis after the recent death of Libyan dictator Moammar Gadhafi, who was toppled by a popular uprising backed by NATO airstrikes.

Syrian opposition leaders have not called for an armed uprising like the one in Libya and have for the most part opposed foreign intervention, and the U.S. and its allies have shown little appetite for intervening in another Arab nation in turmoil. But with the 7-month-old revolt against Assad stalemated, some Syrian protesters have begun calling for a no-fly zone over the country because of fears the regime might use its air force now that army defectors are becoming more active in fighting the security forces.

Syrian troops shell Homs after protests
Syrian forces fire on rallies, killing 30
Syrians seek int'l protection from "executioner"

The British-based Syrian Observatory for Human Rights said a clash Saturday night in the restive central city of Homs between soldiers and gunmen believed to be army defectors left at least 20 soldiers dead and 53 wounded. It also said gunmen ambushed a bus carrying security officers late Saturday in the northwestern province of Idlib, killing at least 10 security agents. One attacker was also killed.

The Associated Press could not verify the activists' accounts. Syria has banned most foreign media and restricted local coverage, making it impossible to get independent confirmation of the events on the ground. Syria's state-run news agency SANA, said seven members of the military and police, who were killed in Homs and the suburbs of Damascus were buried Sunday.

The Local Coordination Committees, another activist group, said Sunday that 343 people, including 20 children, have been killed in Syria since Oct. 16, when the Cairo-based Arab League gave Damascus a 15-day deadline to enact a cease-fire. A meeting was scheduled for later Sunday in Qatar between an Arab committee set up by the 22-member Arab League and a Syrian delegation expected to be headed by Foreign Minister Walid al-Moallem.

The unrest in Syria could send unsettling ripples through the region, as Damascus' web of alliances extends to Lebanon's powerful Hezbollah movement, the militant Palestinian Hamas and Iran's Shiite theocracy.

Unlike Gadhafi, Assad enjoys a number of powerful allies that give him the means to push back against the outside pressure. A conflict in Syria risks touching off a wider Middle East conflict with arch foes Israel and Iran in the mix. Syria wouldn't have to look far for prime targets to strike, sharing a border with U.S.-backed Israel and NATO-member Turkey.

In case of an international intervention, Assad and his main Mideast backer, Iran, could launch retaliatory attacks on Israel or -- more likely -- unleash Hezbollah fighters or Palestinian militant allies for the job. To the north, Turkey has opened its doors to anti-Assad activists and breakaway military rebels, which also could bring Syrian reprisals.

Assad alluded to those concerns at home and abroad, saying "any problem in Syria will burn the whole region. If the plan is to divide Syria, that is to divide the whole region."

A Yemeni female protestor shows her hand with Arabic that reads "we will prevail" and the colors of pre-Gadhafi Libya, Syria, Yemen, Tunisia ,and Egypt during a demonstration demanding the resignation of Yemeni President Ali Abdullah Saleh in Sanaa, Yemen, Wednesday, Oct. 26, 2011.

(Credit: AP Photo)

The uprising against the Syrian regime began during a wave of anti-government protests in the Arab world that toppled autocrats in Tunisia, Egypt and Libya. The U.N. says that Assad's crackdown has left more than 3,000 people dead since the uprising began in mid-March.

Facing an unprecedented threat to his rule, Assad is desperate to show that only he can guarantee security in a troubled region where failed states abound.

In a show of support to Assad's regime, thousands of Syrians carrying the nation's flag and Assad posters rallied Sunday in a major square in the southern city of Sweida, some 70 miles (110 kilometers) south of Damascus, near the Jordanian border. There have been two similar massive pro-Assad demonstrations in recent days in the capital Damascus and the coastal city of Latakia.

Assad said that Western countries "are going to ratchet up the pressure, definitely." He was apparently referring to a wave of sanctions that were imposed by the European Union and the U.S.

"But Syria is different in every respect from Egypt, Tunisia, Yemen. The history is different. The politics is different," Assad said.

The Syrian president described the uprising as a "struggle between Islamism and pan-Arabism." He was referring to his ruling Baath party's secular ideology and the Muslim Brotherhood that was crushed by his regime in 1982.

"We've been fighting the Muslim Brotherhood since the 1950s and we are still fighting with them," Assad said.

Assad also spoke to Russia's state Channel One television, and in an interview broadcast Sunday hailed Moscow's veto of a European-backed U.N. Security Council resolution on Syria that aimed to impose sanctions on Damascus.

"We are relying on Russia as a country with which we have strong historic ties," Assad said.

The measure vetoed by Russia and China earlier this month would have been the first legally binding resolution against Syria since Assad's forces began attacking civilian protesters.

Source: http://feeds.cbsnews.com/~r/CBSNewsMain/~3/kXg3eo9KGfA/

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Doubt cast over use of patient and colleague surveys in revalidation

By Susie Sell, 28 October 2011

The research found certain groups of doctors were at risk of obtaining lower scores based on their personal characteristics, rather than true variation in their professional performance.

It showed GPs, locum doctors and those who had not graduated in the UK or South Asia received poorer scores from colleagues.

Doctors who had trained in South Asia or outside the EU were likely to score lower in patient surveys than doctors who had trained in the UK, it said.

The study concluded that caution is needed when considering patient and colleague feedback regarding doctors? professionalism.

Study lead Professor John Campbell said it was ?heartening? that the research found that the age, sex and ethnicity of a doctor were not key factors affecting patient and colleague survey scores.

He said: ?It may be that doctors who have qualified overseas face challenges in becoming attuned to UK patients and the UK health service.

?The main message from our findings is one of caution ? that the public, the regulator and the medical profession must be careful about how the results of such questionnaires are used.?

But GMC chief executive Niall Dickson admitted that the research shows the results of patient and colleague surveys should be ?treated with care?.

He said: ?Being aware and taking account of how patients and colleagues view your practice is important for every doctor but it is only one part of the supporting information that doctors will bring to their appraisals.

It will be considered alongside all the other information about a doctor's practice and is not something which you can 'pass' or 'fail'. It assesses an individual doctor?s strengths and areas for development to help them improve their practice ? it is not a way of comparing doctors with one another.?

Source: http://www.gponline.com/channel/news/article/1101104/doubt-cast-use-patient-colleague-surveys-revalidation/

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Medical Errors and the Fear Factor


By Haydn Bush	October 26, 2011
Is your clinical staff avoiding reporting errors and near-misses for fear of embarrassment?

In recent years, a growing number of hospitals have developed reporting systems to allow staff to report both medical errors, near-misses and other safety incidents after they occur. By encouraging staff to speak up about the day-to-day ups and downs of the clinical process, patient safety experts argue that hospitals can identify potential gaps in quality and initiate performance improvement efforts before a major incident occurs. By their very nature, the key to the success of these monitoring systems is buy-in from clinical staff, who are often the ones charged with reporting errors and near-misses.

But a new survey published by Johns Hopkins suggests that the fear of embarrassment and potential professional trouble may be keeping many clinicians from reporting these critical issues. The survey, which solicited responses from physicians, nurses and radiation specialists at three U.S. hospitals, found that few nurses and physicians said they routinely submitted online reports on errors and near-misses. For respondents who did not use error reporting systems, getting colleagues into trouble, potential liability and the fear of embarrassment in front of co-workers were all cited as potential barriers.

In a statement that accompanied the report, researcher Kendra Harris, M.D., an oncology radiation resident at Johns Hopkins, said that the key to persuading clinicians to participate ? and not avoid reporting at all costs ? lies in assuring them that the reports are there to illuminate systemic issues and find solutions, not to identify and punish staff for mental lapses.

"These systems should not be viewed as punitive; rather, they're a critical way to improve therapy," says Harris. "You can't manage what you can't measure."

On the other hand, 90 percent of respondents told Johns Hopkins researchers they'd observed near-misses or errors, and most respondents agreed that error reporting is their responsibility.

"Respondents recognized that error events should be reported and that they should claim responsibility for them," Harris says. "The barriers we identified are not insurmountable."

While the Johns Hopkins survey is unscientific, I was intrigued to learn that many clinicians are still distrustful of reporting near-misses and errors. Any time I see a presentation on error reporting or listen to an advocate describe a reporting system, the impression I get is that no serious system includes any punitive action or identification for voluntary reporting. Many health care systems, after all, model their safety and error reporting systems on the Crew Resource Management tactics used by the airline industry, which emphasize empowering all members of the team to speak up about potential lapses or near-misses. So it's somewhat surprising to learn that fear of being singled out or punished for reporting potential harm is still a barrier for many clinicians.

Additional information on the survey is available here.

Haydn Bush is senior online editor for Hospitals & Health Networks Magazine.

The opinions expressed by authors do not necessarily reflect the policy of Health Forum Inc. or the American Hospital Association.

in general. All comments will be reviewed by a moderator before being posted.

Source: http://www.hhnmag.com/hhnmag/HHNDaily/HHNDailyDisplay.dhtml?id=5330005884

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RCGP poster presented by GP's daughter

By Tom Moberly, 28 October 2011

Charlotte Wilson with her poster on display at the RCGP conference

The poster was entitled ?How patient experience of primary health care is related to UK government policies and general practice developments?.

Click here to see the poster

She worked with her mother, GP Dr Jill Wilson, on the research.

Dr Wilson is a GP trainer and educator in Somerset.

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Source: http://www.gponline.com/channel/news/article/1101083/rcgp-poster-presented-gps-daughter/

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The Six IOM Aims Up Close and Personal


By Cynthia Hedges Greising	October 27, 2011
The author learns what a difference safe, timely, efficient, effective and patient-centered care can make.

Four Weeks, Three Hospitals

Applying the Six IOM Aims

Toward an Exceptional Patient Experience

Cynthia Hedges Greising is a communications specialist with the Health Research & Educational Trust, an AHA affiliate.

The opinions expressed by authors do not necessarily reflect the policy of Health Forum Inc. or the American Hospital Association.

in general. All comments will be reviewed by a moderator before being posted.

Source: http://www.hhnmag.com/hhnmag/HHNDaily/HHNDailyDisplay.dhtml?id=1180005158

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