Archive for the ‘Health’ Category
March 9th, 2012 | 
Author: A majority of respondents to a Welsh government consultation said they were in favour of changing the law on organ donation.
Welsh ministers want a soft opt-out system so everyone's organs are available for donation when they die unless they have said otherwise.
The health minister published a summary of responses to the proposals on Thursday.
It showed 52% of respondents in favour and 39% against.
The government is expected to publish a bill in June to bring in a system of presumed consent for organ donation.
It wants the system – the first of its kind in the UK – to be in place in 2015.
Health Minister Lesley Griffiths said: "I am aware the subject of organ donation is highly emotive and that many people have strong views on the issue.
"The Welsh government is committed to introducing a soft opt-out system of organ donation which, evidence suggests, could increase the number of organ donations by up to 25%."
She said on average one person a week in Wales dies while waiting for a transplant because a suitable donor cannot be found.
The consultation did not ask respondents directly whether they supported the proposals – but 1,124 of the submissions did indicate a view, with 642 in favour and 482 opposed.
However, 485 responses were in the form of a standard letter circulated by the Opt For Life campaign, an alliance of charities supportive of the opt-out system.
A BBC Wales/ICM opinion of 1,000 people in Wales last week found 63% of people in favour and 31% against the policy.
The consultation asked a number of questions about implementing the policy, including which factors should be taken into account when determining whether an individual lived in Wales and how the wishes of families should be taken into account.
The government also held 13 public meetings as part of the implementation consultation process.
Campaigners argue an opt-out system would increase the number of organs available for transplant, but critics have said there is no evidence that changing the law will work.
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Story By: by Scott Hensley
Nurse Susan Peel gives a whooping cough vaccination to a student at Inderkum High School in Sacramento, Calif., in 2011. Now it seems likely such shots will become routine for senior citizens, too.
Now just about everybody should be getting vaccinated against whooping cough.
Advisers to the Centers for Disease Control and Prevention are recommending all adults 65 and older be immunized against whooping cough, or pertussis.
The panel is expanding an earlier recommendation that seniors be vaccinated if they have contact with very young infants. Adults and teens have been on the recommended list for years already.
The so-called T-DAP vaccine protects against tetanus, diphtheria and whooping cough. It’s routinely given to children starting at 2 months. But three shots, usually done by 6 months, are needed to be sure a child’s immune system can fight off the bacteria that cause pertussis.
To protect the youngest and most vulnerable children, it’s important that relatives and other people in the community be vaccinated to prevent spread of whooping cough.
Researchers believe whooping cough occurs more frequently in older adults than has been previously recognized. That may help explain outbreaks of pertussis in California and other states in recent years.
Also, research has shown that immunity to the bacteria that cause whooping cough can wear off over time. That’s why adults need to get booster shots.
The CDC usually follows the advice of its advisory panels and could issue formal recommendations later this year. In 2009, there were 16,000 cases of whooping cough in the U.S, with 16 deaths.
Story By: Fresh Air from WHYY
A map of neurons of the mouse retina, reconstructed automatically by artificial intelligence from electron microscopic images.
Sebastian Seung is a professor of computational neuroscience at MIT and an investigator at the Howard Hughes Medical Institute.
On connectomes
“A connectome is a map between neurons inside a nervous system. You can imagine it as being like the map that you see in the back of the pages of in-flight magazines. Imagine that every city in that map is replaced by a neuron and every airline route between cities is replaced by a connection.”
On the Jennifer Aniston neuron
“Sometimes people with seizures don’t respond well to medications, and the only way for them to respond is for surgeons to remove the part of the brain from which the seizures originate. So [a computational neuroscientist] got permission to also record the signals of single neurons inside human subjects before doing the operating. So what the experimenters did was they showed the people pictures of celebrities and places and other kinds of objects, and they found that the neurons in the areas that they recorded from, which is in the medial temporal lobe … responded highly selectively. They would respond to only a few pictures out of a large collection of many pictures. And in particular, there was one neuron in one person that responded only to pictures of Jennifer Aniston â not to Halle Berry, not to Julia Roberts, and one great finding said that this neuron did not respond to pictures of Jennifer Aniston with Brad Pitt. … It would be overstating the case to say this neuron only responds to Jennifer Aniston because the experimenters didn’t have time to show the person all possible celebrities. But it seems safe to say that this neuron responds to only a small fraction of celebrities.”
A diffusion spectrum image shows the brain wiring in a healthy human adult.
On neural networks
“Your brain is this vast network of neurons, communicating through signals. And as far as neuroscientists can tell, these signals that are passed around the network are reflecting the processing of all of our mental processes â your thoughts, your feelings, your perceptions and so on.”
On regenerative neurons
“If you have brain damage, and lots of neurons are killed, those neurons won’t grow back except in [the dentate gyrus of the hippocampus, which is thought to help new memories form, and the olfactory bulb, which is involved in sense of smell]. So you could view it from a very pessimistic viewpoint. On the other hand, it’s entirely possible that medical advances in the future will somehow activate regenerative powers in the brain. If these regenerative powers exist in [those] two areas, why not awaken them in other areas of the brain? So there’s also an optimistic kind of spin on this.”
We often worry about lying awake in the middle of the night – but it could be good for you. A growing body of evidence from both science and history suggests that the eight-hour sleep may be unnatural.
He attributes the initial shift to improvements in street lighting, domestic lighting and a surge in coffee houses – which were sometimes open all night. As the night became a place for legitimate activity and as that activity increased, the length of time people could dedicate to rest dwindled.
Russell Foster, a professor of circadian [body clock] neuroscience at Oxford, shares this point of view.
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Story By: by Ted Burnham
A health worker injects a woman with a shot of Depo Provera, a quarterly contraceptive injection, at a health clinic in Busia, Uganda, in 2009.
Women living with HIV, or at high risk of infection, should continue to use hormone injections to prevent pregnancy, the World Health Organization said Thursday.
But the advice stressed that couples should use an additional protective method, like condoms, to prevent HIV transmission between partners.
The update comes after an expert review of data on the link between hormone injections and HIV transmission. A study in Lancet Infectious Diseases last year found that hormone injections nearly doubled the chance that a woman would pass HIV to her partner, or contract it from an infected partner, as Shots reported.
The study was particularly worrisome for African communities, as NPR’s Richard Knox reported. Hormone injections are the most popular form of contraception in Africa, which according to a 2009 UN report is also home to 23 million people living with HIV or AIDS â almost 70 percent of the world’s total.
That put public health officials in a bind. Unintended pregnancies carry lots of risks, so women’s access to contraception is a high priority. And hormone injection is particularly convenient for African women. It’s discreet, lasts for months and there are no pills to keep track of.
But HIV prevention is also a major concern, and it wasn’t immediately clear how health officials would pursue both goals.
At the end of January, WHO convened a panel of 75 experts from 18 countries to go over all of the relevant scientific literature on hormone injections and HIV.
They concluded that women in at-risk populations should continue using hormone injection to prevent pregnancy, in keeping with WHO’s 2009 guidelines.
But the panel reiterated that condoms are the most reliable method for preventing both HIV and pregnancy, so couples in which one partner is infected should always use a condom, regardless of their use of other contraceptives.
Yesterday’s statement confirmed that WHO’s Guidelines Review Committee had accepted the panel’s recommendations, but did not shed much light on the basis for the decision.
Shots turned to Amy Tsui, professor at Johns Hopkins Bloomberg School of Public Health and director of the Bill and Melinda Gates Institute for Population and Reproductive Health, for help understanding the decision.
Tsui, who was not involved in the deliberations, says the literature hasn’t provided solid evidence that hormone injections really do increase HIV risk.
“Some of the issues have to do with the usual science banter” about study design, both in the Lancet study and in others, Tsui says. While some studies have found a link, she says, others have not. Few of the studies were designed specifically to test for that relationship.
Tsui agrees with the WHO’s support for further research into the possibility that the risk is real. But for now, she says, “on the whole it looks safe.”
There are 40,000 individual stories from the women in Britain with PIP implants.
Debbie Lewis is one of them and she agreed to let us film her replacement surgery.
The 43-year-old hairdresser from Buckinghamshire decided to have implants about eight years when she and her husband separated.
She said: "I always wanted bigger boobs and when we separated I thought I'm going to treat myself."
The original surgery cost her £4,000 and within a year or so she'd had the implants changed twice.
This was because she experienced a known side-effect called 'capsular contraction', when the tissue around the implant hardens causing discomfort and distortion.
In November 2011 Debbie noticed a lump under her arm. She was told one of her implants had leaked into a lymph node.
Soon afterwards the PIP scandal erupted, with the French Government recommending all women there to have them removed.
Debbie says she could have opted to have her implants removed under the NHS -but it would have taken too long to organise.
She also said that she has lost so much breast tissue from previous implant replacement that she felt she had no option but to have new implants.
Her surgery cost £6,000 and she is not sure how she will pay for it.
"I have taken out two credit cards and I will have to worry about that later – what was crucial for me was to get these disgusting things out of me."
Her operation lasted one and a half hours. The swollen lymph nodes were removed and then the ruptured implant was taken out. Cosmetic surgeon, David Crawford said: "The implant shell looked like a thin beach ball. It was not a good quality product."
The silicone filler from the ruptured implant had turned yellow and begun to break up. By contrast the second implant emerged intact and undamaged. This underlines the dilemma facing women.
If scans suggest their implants are intact, should they opt for surgery? This is what's recommended by the French government, as a precaution. But a committee of experts here has suggested there is no need for routine removal
Debbie Lewis says she accepts that many people will have little sympathy for women who had PIP implants for breast enlargement – just one in 20 patients in Britain had the implants for reconstructive surgery following cancer.
The British Association of Aesthetic Plastic Surgeons has called for a ban on advertising for cosmetic surgery and said that it preyed on women in a vulnerable state, such as following a divorce.
"Rubbish" is Debbie Lewis' response. Despite all the problems she does not regret having surgery. "They've given me a lot of pleasure and self-confidence, for example going on the beach in my bikini."
She says she is looking forward to life without PIP implants and will now campaign to highlight the plight of women affected by the scandal.
Talks between ministers and medical leaders have taken place over concerns about changes to the NHS in England.
The BBC also understands some colleges are not convinced a hardening of their position is the right move. The Royal College of Surgeons has made it clear it would not sign up to the draft statement.
The academy, which in the autumn said it had serious concerns about the plans, particularly in the areas of accountability, competition and training, is now due to meet the three key health unions on Thursday night.
The academy confirmed it had had discussions about its "continuing concerns", but would not be making a statement at the moment.
But the government has indicated it was ready to push ahead with the changes regardless of what happens.
A Department of Health spokesman said: "There will always be some people who oppose changes to the status quo in the NHS.
"We have listened and we have made changes which have been widely welcomed including by professional bodies. But this process cannot go on forever. Changes are needed and we want the NHS to be able to make them in the interests of patients."
The developments came after the prime minister and Labour leader Ed Miliband clashed during Prime Minister's questions on Wednesday.
Mr Miliband said it was time for the bill should be scrapped.
Story By: by Jenny Gold
Dr. David Gross, medical director of the sleep lab at the National Rehabilitation Hospital in Washington, D.C., says more than three-quarters of the patients who come to his lab are diagnosed with apnea.
But the testing isn’t cheap: Each night at a hospital sleep lab can cost $1,900 and is usually mostly covered by a patient’s health insurance. Some patients end up spending two nights at the lab â one to test for apnea and the second to try the CPAP machine.
Dr. Fred Holt, an expert on fraud and abuse and a medical director of Blue Cross Blue Shield in North Carolina, says some patients aren’t having basic exams done first and are therefore being prescribed expensive tests they don’t need. Not everyone who snores has a chronic disorder, he says. In other cases, Holt says, the labs prescribe CPAP machines right away without first suggesting other strategies that could reduce apnea, such as losing weight or sleeping on your side.
“We are spending more and more money on sleep testing and treatment,” he says, “and like anything else in health care, there are unscrupulous people out there who are more than happy to do testing and treatment that might be of questionable value. This might be because of naiveté on the part of the physician, or unfortunately, it could be done for the sake of improving the cash flow of the business.”
It’s no secret that the sleep business can be lucrative for physicians. A website for Aviisha, a sleep testing company, has a special page for physicians showing a picture of a doctor with a stack of money in his lab coat pocket. And in February, the American Academy of Sleep Medicine is offering a seminar on the “business of sleep medicine for physicians” at a golf resort in Arizona.
While many sleep centers offer comprehensive care for sleep disorders, others are largely focused on overnight sleep testing, according to Dr. Nancy Collop, president of the academy. “A lot of people have gotten into the sleep business specifically to do that procedure,” she says. The goal of the academy’s accreditation process, she says, is to make sure sleep labs are offering more, because “many patients may not even need a sleep study.”
Helen Darling, president of the National Business Group on Health, which represents large employers offering health insurance to their workers, says the tests are driving up the cost of premiums. “This is a good example of something where we have technology, we have financial incentives to use more of it then we’ve historically done. You have enough problems, including a growing obesity epidemic, and you sort of put together the so-called perfect storm for driving up overuse and health care costs.”
Doctors should focus instead on common-sense approaches to sleep apnea, she says, like losing weight, before turning to expensive testing and medical devices.
Another option is a home sleep test, which costs less than a fifth as much as a lab test, and is considered effective for most patients. Medicare began paying for home sleep tests in 2008, but the tests have had only modest growth.
“I believe lab tests, as opposed to the home tests, are being wildly overprescribed,” says Michael Backus, senior vice president of American Imaging Management, a subsidiary of WellPoint.
Right now, 99 percent of the sleep tests given to WellPoint patients are done in the lab, he says, but “it should be 70 percent at home and 30 percent in the lab.” Backus adds that the majority of patients who are diagnosed with apnea and then given CPAP machines stop using them within the first year.
Some insurers, including WellPoint, are changing the way they pay for sleep testing to curb the costs. Many now require a special pre-authorization. They also ask the doctor whether a patient qualifies for a home sleep test instead of one at the lab. Those changes are now widespread among Massachusetts insurers and are having an effect on the sleep industry in the state.
Dr. Lawrence Epstein, the chief medical officer of Sleep HealthCenters in Massachusetts, says the labs have already experienced a 20 percent drop in the number of patients coming in for testing. While the past decade was focused on industry growth, he says it’s “now going to be about consolidation and provision of better quality, more efficient care.”
Sleep HealthCenters has shut down three of its 15 sleep labs, and more closures may be on the way. Epstein says the company is focusing more on “sleep wellness,” including treating and managing sleep disorders, and less on testing. The key, he says, is to become more efficient without decreasing access to care for patients who need it.
Story By: Steve Inskeep and Julie Rovner
Several steps in the 2010 health care overhaul law have been implement. But what impact will the presidential election and the Supreme Court have on it?
Story By: by Michelle Andrews
If patients and doctors both have easy access to the notes the doctor takes during their office visits, will it change their behavior?
That’s a question that an experiment called OpenNotes aims to answer by letting patients of more than 100 primary care doctors in three states see the notes online.
In December, researchers reported the results of surveys taken before the project started in 2010 in which patients and physicians were asked about their attitudes toward making such information available.
Published in the Annals of Internal Medicine, the study found that while patients were very gung ho to see the notes â more than 90 percent expected them to be helpful â physicians were much likely to think that notes sharing was a potential Pandora’s box of trouble.
“Notes are the things people never see,” says Jan Walker, a nurse at Beth Israel Deaconess Medical Center in Boston and the study’s lead author. “Yet if you have a lab result or a radiology result, the notes are the information that provides context for why this was done in the first place.”
OpenNotes is funded by the Robert Wood Johnson Foundation, which also is an underwriter of NPR.
Researchers are still analyzing the results of the year-long study. But Walker says what’s beginning to emerge is that the effect of seeing physician notes in black and white can be huge. A notation describing a patient as “obese,” for example, may be much more effective than a physician’s verbal instruction to lose weight at bringing home the seriousness of a problem and the need to do something about it.
“It’s very motivating,” says Walker. Seeing the doctor’s notes can help remind a patient about what was said during a visit that may have been fraught with anxiety. Instead of having to rely on a patient’s vague description of the appointment, office visit notes can give caregivers the lowdown on someone’s health.
“Someone comes home and says the visit was fine, but the notes say their heart failure was a bit worse,” says Walker. It’s not necessarily all good, however. In the study, up to a third of participating physicians said opening up their notes might change the way they documented such sensitive topics as obesity, substance abuse, mental health problems or cancer. And about the same proportion of the doctors surveyed for the project decided not to take part in it.
Meanwhile, patients said they might withhold information that they didn’t want recorded in the notes. So in some instances, opening up the communication process could actually limit what gets communicated. Go figure.