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Health & Fitness (239)

You might not want to rush into knee surgery. Physical therapy can be just as good for a common injury and at far less cost and risk, the most rigorous study to compare these treatments concludes.

Therapy didn't always help and some people wound up having surgery for the problem, called a torn meniscus. But those who stuck with therapy had improved as much six months and one year later as those who were given arthroscopic surgery right away, researchers found.

"Both are very good choices. It would be quite reasonable to try physical therapy first because the chances are quite good that you'll do quite well," said one study leader, Dr. Jeffrey Katz, a joint specialist at Brigham and Women's Hospital and Harvard Medical School.

He was to discuss the study Tuesday at an American Academy of Orthopaedic Surgeons conference in Chicago. Results were published online by the New England Journal of Medicine.

A meniscus is one of the crescent-shaped cartilage discs that cushion the knee. About one-third of people over 50 have a tear in one, and arthritis makes this more likely. Usually the tear doesn't cause symptoms but it can be painful.

When that happens, it's tough to tell if the pain is from the tear or the arthritis - or whether surgery is needed or will help. Nearly half a million knee surgeries for a torn meniscus are done each year in the U.S.

The new federally funded study compared surgery with a less drastic option. Researchers at seven major universities and orthopedic surgery centers around the U.S. assigned 351 people with arthritis and meniscus tears to get either surgery or physical therapy. The therapy was nine sessions on average plus exercises to do at home, which experts say is key to success.

After six months, both groups had similar rates of functional improvement. Pain scores also were similar.

Thirty percent of patients assigned to physical therapy wound up having surgery before the six months was up, often because they felt therapy wasn't helping them. Yet they ended up the same as those who got surgery right away, as well as the rest of the physical therapy group who stuck with it and avoided having an operation.

"There are patients who would like to get better in a `fix me' approach" and surgery may be best for them, said Elena Losina, another study leader from Brigham and Women's Hospital.

However, an Australian preventive medicine expert contends that the study's results should change practice. Therapy "is a reasonable first strategy, with surgery reserved for the minority who don't have improvement," Rachelle Buchbinder of Monash University in Melbourne wrote in a commentary in the medical journal.

As it is now, "millions of people are being exposed to potential risks associated with a treatment that may or may not offer specific benefit, and the costs are substantial," she wrote.

Surgery costs about $5,000, compared with $1,000 to $2,000 for a typical course of physical therapy, Katz said.

One study participant - Bob O'Keefe, 68, of suburban Boston - was glad to avoid surgery for his meniscus injury three years ago.

"I felt better within two weeks" on physical therapy, he said. "My knee is virtually normal today" and he still does the recommended exercises several times a week.

Robert Dvorkin had both treatments for injuries on each knee several years apart. Dvorkin, 56, director of operations at the Coalition for the Homeless in New York City, had surgery followed by physical therapy for a tear in his right knee and said it was months before he felt no pain.

Then several years ago he hurt his left knee while exercising. "I had been doing some stretching and doing some push-ups and I just felt it go `pop.'" he recalls. "I was limping, it was extremely painful."

An imaging test showed a less severe tear and a different surgeon recommended physical therapy. Dvorkin said it worked like a charm - he avoided surgery and recovered faster than from his first injury. The treatment involved two to three hour-long sessions a week, including strengthening exercises, balancing and massage. He said the sessions weren't that painful and his knee felt better after each one.

"Within a month I was healed," Dvorkin said. "I was completely back to normal."

---

AP Medical Writer Lindsey Tanner in Chicago contributed to this report. --- Marilynn Marchione can be followed on Twitter at HTTP://TWITTER.COM/MMARCHIONEAP Lindsey Tanner can be followed on Twitter at HTTP://WWW.TWITTER.COM/LINDSEYTANNER © 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
Tuesday, 19 March 2013 07:33
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LONDON (AP) -- Young men who have served in the British military are about three times more likely than civilians to have committed a violent offense, researchers reported Friday in a study that explores the roots of such behavior.

The research found that merely being sent to Iraq or Afghanistan made no difference in rates of violent crime later on. Instead, a key predictor was violent behavior before enlisting. Combat duty also raised the risk, as did witnessing traumatic events during deployment or misusing alcohol afterward.

Still, the vast majority - 94 percent - of British military staff who return home after serving in a combat zone don't commit any crimes, researchers told reporters at a briefing.

The study found little difference in the lifetime rates of violent offenses between military personnel and civilian populations at age 46 - 11 percent versus almost 9 percent. Among younger men, however, being in the military seemed to make a difference: Nearly 21 percent of the military group under age 30 had a conviction for a violent offense in their lifetime compared to fewer than 7 percent of similarly aged men in the general population, according to British crime statistics.

"The problem is that some of the qualities you want in a soldier are the same ones that get people arrested for violent behavior," said Walter Busuttil, director of medical services for Combat Stress, a British veterans' charity that was not part of the study. Busuttil said many of those recruited into the army are from disadvantaged backgrounds where violence is more common.

The research was published online Friday in the medical journal Lancet. Researchers at the Institute of Psychiatry at King's College London looked at data from more than 13,800 U.K. military personnel and veterans and compared that to records of violent crimes ranging from verbal threats to assaults and homicides. Some people were followed for up to seven years. Nearly 1,500 women were included, though they were mostly in noncombat roles.

Deirdre MacManus, the study's lead author, said combat experience seemed to matter when they compared violent crime rates among military personnel. "Being deployed in itself wasn't a risk factor for violent offenses but being exposed to multiple traumas, like seeing someone get shot, increased the risk by 70 to 80 percent," she said, compared to someone who hadn't witnessed such a harrowing ordeal.

Researchers said other studies have made similar findings.

Britain currently has some 5,000 soldiers in the NATO-led mission fighting in Afghanistan and it is the second-largest foreign contingent after the U.S. It withdrew its soldiers from Iraq in 2009 after six years. The U.K. Ministry of Defense has been under pressure to develop more mental health programs for veterans after reports of returning servicemen committing crimes, like the 2012 case of an ex-soldier in Leeds jailed for shooting his landlady after fighting in Afghanistan. He had been diagnosed with post-traumatic stress disorder but had not been monitored or treated.

In the U.S., there have been numerous cases of veterans committing violent crimes, including a Marine charged with killing six people in California last year. Soldiers from a single Army unit in Colorado killed 11 people over a few years after their return home. An Army report in 2009 placed part of the blame on the psychological trauma of fierce combat in Iraq. And this week, a U.S. Senate panel heard women in the military describe sexual assaults by fellow soldiers.

American researchers said it is possible the same links the British study found between fighting in a war and violent crime exist in the U.S. but that there isn't enough data yet.

"For some soldiers, it's hard to stop being a warrior," said Brett Litz, a psychology professor at Boston University who studies veterans' issues. "What happens during a war may be a prescription for a small percentage of men to get into trouble," he said. "They may find it very difficult to switch out of a wartime mindset."

But given the differences between Britain and the U.S., Litz said it was impossible to predict what effects would be seen in the United States. "Maybe the economy is better here, maybe the (department of defense) does a better job with transition, maybe (the) culture is different especially with respect to alcohol," Litz said.

"There will be a lot of returning soldiers who have to be reintegrated and unfortunately there is no quick fix," he said.

----

Online:

HTTP://WWW.THELANCET.COM/JOURNALS/LANCET/ARTICLE/PIIS0140-6736(12)60354-2/ABSTRACT

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Monday, 18 March 2013 11:04
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WASHINGTON (AP) -- Pricey robotic surgery shouldn't be the first or even second choice for most women who need a hysterectomy, says advice issued Thursday to doctors who help those women decide.

The preferred method: Operate through the vagina, using standard tools rather than a robot, said Dr. James Breeden, president of the American College of Obstetricians and Gynecologists.

Increasingly, women are seeing ads that say a robot could help their doctor perform a hysterectomy more easily. And Breeden said doctors are reporting patients who demand that approach or say they'll take their business elsewhere.

But for routine hysterectomies, the vaginal method lets women leave the hospital just as quickly, without spending nearly as much money, Breeden said Thursday in a statement setting out the position of the nation's largest group of OB/GYNs.

When that's not possible, a laparoscopic hysterectomy - so-called keyhole surgery, operating through a few small incisions in the abdomen - is the second least invasive and costly option, he said.

"It is important to separate the marketing hype from the reality when considering the best surgical approach," Breeden said, adding: "There is no good data proving that robotic hysterectomy is even as good as, let alone better than, existing and far less costly minimally invasive alternatives."

The robotic method is similar to that keyhole operation except the doctor uses a computer to control robotic arms that hold the surgical tools, theoretically easier to move in tight quarters. Breeden said there may be advantages to robotic techniques for "unusual and complex clinical conditions," such as cancer operations that require extensive surgery to find and remove lymph nodes - but that needs additional research.

About 600,000 U.S. women a year undergo a hysterectomy. Traditionally, doctors removed the uterus through a large abdominal incision that meant a long recovery. Today, minimally invasive surgery is encouraged although many women still get the older open surgery for a variety of reasons.

Thursday's statement is sure to prove controversial with doctors who have embraced the technology. But it comes after a major study last month found robotic surgery adds at least $2,000 to the cost of a hysterectomy without improving outcomes. Breeden said another study found surgeons perform 50 to 90 robotic hysterectomies before becoming as good at it as they are with other minimally invasive methods.

Manufacturer Intuitive Surgical Inc. said its da Vinci robot system allows some women who otherwise would need an old-fashioned open hysterectomy - because of obesity, scarring or other complexities - to instead have a smaller operation.

--- Online:

ACOG: HTTP://WWW.ACOG.ORG © 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
Monday, 18 March 2013 11:02
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WASHINGTON (AP) — Diners will have to wait a little longer to find calorie counts on most restaurant chain menus, in supermarkets and on vending machines.

The head of the Food and Drug Administration says writing a new menu labeling law "has gotten extremely thorny" as the agency tries to figure out who should be covered by it.

The 2010 health care law charged the FDA with requiring restaurants and other establishments that serve food to put calorie counts on menus and in vending machines. The agency issued a proposed rule in 2011, but the final rules have since been delayed as some non-restaurant establishments have lobbied hard to be exempt.

The FDA has said the rules may come out this spring, but the agency may not meet that deadline.
Tuesday, 12 March 2013 02:25
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NEW YORK (AP) -- Health officials are reporting an alarming increase in some dangerous superbugs at U.S. hospitals.

These superbugs from a common germ family have become extremely resistant to treatment with antibiotics. Only 10 years ago, such resistance was hardly ever seen in this group.

Infections from these superbugs are still uncommon. But in the first six months of last year, nearly 200 U.S. hospitals - about 4 percent - saw at least one case, the Centers for Disease Control and Prevent reported Tuesday.

"I would call them a major threat emerging in our hospitals," said Dr. Arjun Srinivasan, an infectious disease expert at the CDC.

Health officials call them "nightmare bacteria" that have now been seen in 42 states and threaten to spread their resistance to more and more of their bacterial brethren.

"We only have a limited window of opportunity to stop spread" of these superbugs, said CDC Director Dr. Tom Frieden. At a press conference Tuesday, he said he was "sounding an alarm."

The CDC urged hospital workers to watch for the infections and take steps to prevent passing the germs to other patients.

The report did not include better-known superbugs like the staph infection MRSA or the intestinal bug known as C-diff, which have plagued hospitals.

It focused on the superbugs that have emerged from one specific bacteria group. At least five of the 70 kinds in that family have developed resistance to a class of antibiotic called carbapenems - considered one of the last lines of defense against hard-to-treat bugs.

Some of those bacteria seem to have terrifying potential. Among them: Klebsiella pneumoniae, a bug that killed at least seven patients at a federal research hospital in Bethesda, Md.; and those made resistant by a gene called NDM-1, named for New Delhi.

The bacteria usually live harmlessly in the gut but can cause pneumonia, and urinary tract and bloodstream infections if they get into other parts of the bodies of patients with weakened immune systems. As many as half the patients who get the bloodstream infections die, Srinivasan said.

However, CDC did not provide figures on deaths attributed to these superbugs.

In 2001, U.S. hospitals reported that only 1 percent of samples from the bacterial family were resistant to the antibiotic carbapenems. By 2011, it had risen to 4 percent.

It was more of an issue in the nation's 400 specialized, long-term hospitals - 18 percent of them reported seeing such a superbug. The Northeast had the most, followed by the South.

U.S. health officials are keeping a close eye on the NDM-1 superbugs, which first showed up in India in 2010 and have been seen as more of a concern in other parts of the world. Of the 30 cases in the U.S., about half have been reported since July, including eight patients at a Denver hospital.

--- Online:

CDC report: HTTP://WWW.CDC.GOV/VITALSIGNS

© 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
Wednesday, 06 March 2013 07:03
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NEW YORK (AP) -- A new study offers more compelling evidence that life expectancy for some U.S. women is actually falling, a disturbing trend that experts can't explain.

The latest research found that women age 75 and younger are dying at higher rates than previous years in nearly half of the nation's counties - many of them rural and in the South and West. Curiously, for men, life expectancy has held steady or improved in nearly all counties.

The study is the latest to spot this pattern, especially among disadvantaged white women. Some leading theories blame higher smoking rates, obesity and less education, but several experts said they simply don't know why.

Women have long outlived men, and the latest numbers show the average life span for a baby girl born today is 81, and for a baby boy, it's 76. But the gap has been narrowing and data from the Centers for Disease Control and Prevention has shown women's longevity is not growing at the same pace as men's.

The phenomenon of some women losing ground appears to have begun in the late 1980s, though studies have begun to spotlight it only in the last few years.

Trying to figure out why is "the hot topic right now, trying to understand what's going on," said Jennifer Karas Montez, a Harvard School of Public Health sociologist who has been focused on the life expectancy decline but had no role in the new study.

Researchers also don't know exactly how many women are affected. Montez says a good estimate is roughly 12 percent.

The study, released Monday by the journal Health Affairs, found declining life expectancy for women in about 43 percent of the nation's counties.

The researchers, David Kindig and Erika Cheng of the University of Wisconsin, looked at federal death data and other information for nearly all 3,141 U.S. counties over 10 years. They calculated mortality rates for women age 75 and younger, sometimes called "premature death rates," because many of those deaths are considered preventable.

Many counties have such small populations that even slight changes in the number of deaths produce dramatic swings in the death rate from year to year. To try to stabilize the numbers, the researchers computed some five-year averages. They also used statistical tricks to account for factors like income and education.

They found that nationwide, the rate of women dying younger than would be expected fell from 324 to 318 per 100,000. But in 1,344 counties, the average premature death rate rose, from 317 to about 333 per 100,000. Deaths rates rose for men in only about 100 counties.

"We were surprised" by how much worse women did in those counties, and by the geographic variations, Kindig said.

The study wasn't the first to reach those conclusions. Two years ago, a study led by the University of Washington's Dr. Christopher Murray also looked at county-level death rates. It too found that women were dying sooner, especially in the South.

Some other studies that focused on national data have highlighted steep declines in life expectancy for white women who never earned a high school diploma. Meanwhile, life expectancy seems to be growing for more educated and affluent women. Some experts also have suggested smokers or obese women are dragging down life expectancy.

The Murray and Kindig studies both spotlight regional differences. Some of the highest smoking rates are in Southern states, and the proportion of women who failed to finish high school is also highest in the South.

"I think the most likely explanation for why mortality is getting worse is those factors are just stronger in those counties," Murray said, adding that abuse of Oxycontin and other drugs also may add to the problem.

Some also think the statistics could reflect a migration of healthier women out of rural areas, leaving behind others who are too poor and unhealthy to relocate. That would change the rate, and make life expectancy in a county look worse, explained Bob Anderson of the CDC's National Center for Health Statistics

"We shouldn't jump to the conclusion that more people are getting sicker in these geographic areas than previously," he said.

But that is open to debate. Migration didn't seem to affect male death rates. Murray disagrees with the theory, saying he has tracked a great deal of movement from urban areas to less-populated counties.

---

Online:

University of Wisconsin study, HTTP://CONTENT.HEALTHAFFAIRS.ORG

University of Washington search site for specific county life expectancies, HTTP://BIT.LY/13CGCLA

© 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
Tuesday, 05 March 2013 06:20
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WASHINGTON (AP) -- A baby born with the virus that causes AIDS appears to have been cured, scientists announced Sunday, describing the case of a child from Mississippi who's now 2 1/2 and has been off medication for about a year with no signs of infection.

There's no guarantee the child will remain healthy, although sophisticated testing uncovered just traces of the virus' genetic material still lingering. If so, it would mark only the world's second reported cure.

Specialists say Sunday's announcement, at a major AIDS meeting in Atlanta, offers promising clues for efforts to eliminate HIV infection in children, especially in AIDS-plagued African countries where too many babies are born with the virus.

"You could call this about as close to a cure, if not a cure, that we've seen," Dr. Anthony Fauci of the National Institutes of Health, who is familiar with the findings, told The Associated Press.

A doctor gave this baby faster and stronger treatment than is usual, starting a three-drug infusion within 30 hours of birth. That was before tests confirmed the infant was infected and not just at risk from a mother whose HIV wasn't diagnosed until she was in labor.

"I just felt like this baby was at higher-than-normal risk, and deserved our best shot," Dr. Hannah Gay, a pediatric HIV specialist at the University of Mississippi, said in an interview.

That fast action apparently knocked out HIV in the baby's blood before it could form hideouts in the body. Those so-called reservoirs of dormant cells usually rapidly reinfect anyone who stops medication, said Dr. Deborah Persaud of Johns Hopkins Children's Center. She led the investigation that deemed the child "functionally cured," meaning in long-term remission even if all traces of the virus haven't been completely eradicated.

Next, Persaud's team is planning a study to try to prove that, with more aggressive treatment of other high-risk babies. "Maybe we'll be able to block this reservoir seeding," Persaud said.

No one should stop anti-AIDS drugs as a result of this case, Fauci cautioned.

But "it opens up a lot of doors" to research if other children can be helped, he said. "It makes perfect sense what happened."

Better than treatment is to prevent babies from being born with HIV in the first place.

About 300,000 children were born with HIV in 2011, mostly in poor countries where only about 60 percent of infected pregnant women get treatment that can keep them from passing the virus to their babies. In the U.S., such births are very rare because HIV testing and treatment long have been part of prenatal care.

"We can't promise to cure babies who are infected. We can promise to prevent the vast majority of transmissions if the moms are tested during every pregnancy," Gay stressed.

The only other person considered cured of the AIDS virus underwent a very different and risky kind of treatment - a bone marrow transplant from a special donor, one of the rare people who is naturally resistant to HIV. Timothy Ray Brown of San Francisco has not needed HIV medications in the five years since that transplant.

The Mississippi case shows "there may be different cures for different populations of HIV-infected people," said Dr. Rowena Johnston of amFAR, the Foundation for AIDS Research. That group funded Persaud's team to explore possible cases of pediatric cures.

It also suggests that scientists should look back at other children who've been treated since shortly after birth, including some reports of possible cures in the late 1990s that were dismissed at the time, said Dr. Steven Deeks of the University of California, San Francisco, who also has seen the findings.

"This will likely inspire the field, make people more optimistic that this is possible," he said.

In the Mississippi case, the mother had had no prenatal care when she came to a rural emergency room in advanced labor. A rapid test detected HIV. In such cases, doctors typically give the newborn low-dose medication in hopes of preventing HIV from taking root. But the small hospital didn't have the proper liquid kind, and sent the infant to Gay's medical center. She gave the baby higher treatment-level doses.

The child responded well through age 18 months, when the family temporarily quit returning and stopped treatment, researchers said. When they returned several months later, remarkably, Gay's standard tests detected no virus in the child's blood.

Ten months after treatment stopped, a battery of super-sensitive tests at half a dozen laboratories found no sign of the virus' return. There were only some remnants of genetic material that don't appear able to replicate, Persaud said.

In Mississippi, Gay gives the child a check-up every few months: "I just check for the virus and keep praying that it stays gone."

The mother's HIV is being controlled with medication and she is "quite excited for her child," Gay added.

© 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
Monday, 04 March 2013 06:37
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