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Health & Fitness (233)

WASHINGTON (AP) -- Scientists wondering why some children and not others survived one of China's worst food safety scandals have uncovered a suspect: germs that live in the gut.

In 2008, at least six babies died and 300,000 became sick after being fed infant formula that had been deliberately and illegally tainted with the industrial chemical melamine. There were some lingering puzzles: How did it cause kidney failure, and why wasn't everyone equally at risk?

A team of researchers from the U.S. and China re-examined those questions in a series of studies in rats. In findings released Wednesday, they reported that certain intestinal bacteria play a crucial role in how the body handles melamine.

The intestines of all mammals teem with different species of bacteria that perform different jobs. To see if one of those activities involves processing melamine, researchers from the University of North Carolina at Greensboro and Shanghai Jiao Tong University gave lab rats antibiotics to kill off some of the germs - and then fed them melamine.

The antibiotic-treated rats excreted twice as much of the melamine as rats that didn't get antibiotics, and they experienced fewer kidney stones and other damage.

A closer look identified why: A particular intestinal germ - named Klebsiella terrigena - was metabolizing melamine to create a more toxic byproduct, the team reported in the journal Science Translational Medicine.

Previous studies have estimated that fewer than 1 percent of healthy people harbor that bacteria species. A similar fraction of melamine-exposed children in China got sick, the researchers wrote. But proving that link would require studying stool samples preserved from affected children, they cautioned.

Still, the research is pretty strong, said microbiologist Jack Gilbert of the University of Chicago and Argonne National Laboratory, who wasn't involved in the new study.

More importantly, "this paper adds to a growing body of evidence which suggests that microbes in the body play a significant role in our response to toxicity and in our health in general," Gilbert said.

© 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 THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED.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.
Thursday, 14 February 2013 06:35
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In a stunning example of when treatment might be worse than the disease, a large review of Medicare records finds that older people with small kidney tumors were much less likely to die over the next five years if doctors monitored them instead of operating right away.

Even though nearly all of these tumors turned out to be cancer, they rarely proved fatal. And surgery roughly doubled patients' risk of developing heart problems or dying of other causes, doctors found.

After five years, 24 percent of those who had surgery had died, compared to only 13 percent of those who chose monitoring. Just 3 percent of people in each group died of kidney cancer.

The study only involved people 66 and older, but half of all kidney cancers occur in this age group. Younger people with longer life expectancies should still be offered surgery, doctors stressed.

The study also was observational - not an experiment where some people were given surgery and others were monitored, so it cannot prove which approach is best. Yet it offers a real-world look at how more than 7,000 Medicare patients with kidney tumors fared. Surgery is the standard treatment now.

"I think it should change care" and that older patients should be told "that they don't necessarily need to have the kidney tumor removed," said Dr. William Huang of New York University Langone Medical Center. "If the treatment doesn't improve cancer outcomes, then we should consider leaving them alone."

He led the study and will give results at a medical meeting in Orlando, Fla., later this week. The research was discussed Tuesday in a telephone news conference sponsored by the American Society of Clinical Oncology and two other cancer groups.

In the United States, about 65,000 new cases of kidney cancer and 13,700 deaths from the disease are expected this year. Two-thirds of cases are diagnosed at the local stage, when five-year survival is more than 90 percent.

However, most kidney tumors these days are found not because they cause symptoms, but are spotted by accident when people are having an X-ray or other imaging test for something else, like back trouble or chest pain.

Cancer experts increasingly question the need to treat certain slow-growing cancers that are not causing symptoms - prostate cancer in particular. Researchers wanted to know how life-threatening small kidney tumors were, especially in older people most likely to suffer complications from surgery.

They used federal cancer registries and Medicare records from 2000 to 2007 to find 8,317 people 66 and older with kidney tumors less than 1.5 inches wide.

Cancer was confirmed in 7,148 of them. About three-quarters of them had surgery and the rest chose to be monitored with periodic imaging tests.

After five years, 1,536 had died, including 191 of kidney cancer. For every 100 patients who chose monitoring, 11 more were alive at the five-year mark compared to the surgery group. Only 6 percent of those who chose monitoring eventually had surgery.

Furthermore, 27 percent of the surgery group but only 13 percent of the monitoring group developed a cardiovascular problem such as a heart attack, heart disease or stroke. These problems were more likely if doctors removed the entire kidney instead of just a part of it.

The results may help doctors persuade more patients to give monitoring a chance, said a cancer specialist with no role in the research, Dr. Bruce Roth of Washington University in St. Louis.

Some patients with any abnormality "can't sleep at night until something's done about it," he said. Doctors need to say, "We're not sticking our head in the sand, we're going to follow this" and can operate if it gets worse.

One of Huang's patients - 81-year-old Rhona Landorf, who lives in New York City - needed little persuasion.

"I was very happy not to have to be operated on," she said. "He said it's very slow growing and that having an operation would be worse for me than the cancer."

Landorf said her father had been a doctor, and she trusts her doctors' advice. Does she think about her tumor? "Not at all," she said.

---

Online:

Kidney cancer info: HTTP://WWW.CANCER.NET/CANCER-TYPES/KIDNEY-CANCER

and HTTP://WWW.CANCER.GOV/CANCERTOPICS/TYPES/KIDNEY

Study: HTTP://GUCASYM.ORG

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Marilynn Marchione can be followed at HTTP://TWITTER.COM/MMARCHIONEAP © 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, 13 February 2013 06:22
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CHICAGO (AP) -- Want to know how much a hip replacement will cost? Many hospitals won't be able to tell you, at least not right away - if at all. And if you shop around and find centers that can quote a price, the amounts could vary astronomically, a study found.

Routine hip replacement surgery on a healthy patient without insurance may cost as little as $11,000 - or up to nearly $126,000.

That's what researchers found after calling hospitals in every state, 122 in all, asking what a healthy 62-year-old woman would have to pay to get an artificial hip. Hospitals were told the made-up patient was the caller's grandmother, had no insurance but could afford to pay out of pocket - that's why knowing the cost information ahead of time was so important.

About 15 percent of hospitals did not provide any price estimate, even after a researcher called back as many as five times.

The researchers were able to obtain a complete price estimate including physician fees from close to half the hospitals. But in most cases, that took contacting the hospital and doctor separately.

"Our calls to hospitals were often greeted by uncertainty and confusion," the researchers wrote. "We were frequently transferred between departments, asked to leave messages that were rarely returned, and told that prices could not be estimated without an office visit."

Many hospitals "are just completely unprepared" for cost questions, said Jaime Rosenthal, a Washington University student who co-authored the report.

Most hospitals aren't intentionally hiding costs, they're just not used to patients asking. That's particularly true for patients with health insurance who "don't bother to ask because they know insurance will cover it," said co-author Dr. Peter Cram, a researcher at the University of Iowa's medical school.

But he said that's likely to change as employers increasingly force workers to share more health care costs by paying higher co-payments and deductibles, making patients more motivated to ask about costs.

The study was published online Monday in JAMA Internal Medicine. A California study published last year about surgery to remove an appendix found similar cost disparities.

Commenting on the study, American Hospital Association spokeswoman Marie Watteau said hospitals "have a uniform set of charges. Sharing meaningful information, however, is challenging because hospital care is unique and based on each individual patient's needs."

She said states and local hospital associations are the best source for pricing data, and that many states already require or encourage hospitals to report pricing information and make that data available to the public.

U.S. insurance companies typically negotiate to pay less than the billing price. Insured patients' health plans determine what they pay, while uninsured patients may end up paying the full amount.

The study authors noted that Medicare and other large insurers frequently pay between $10,000 and $25,000 for hip replacement surgery.

Sean Toohey, a grains broker at the Chicago Board of Trade, had hip replacement surgery last summer at Loyola University Medical Center in Maywood, Ill. An old sports injury had worn out his left hip, causing "horrendous" pain on the job, where he's on his feet all day filling orders.

Toohey, 54, said his health insurance covered most of the costs, and it didn't occur to him to ask about price beforehand. He was back at work two weeks later and is pain free. That's what matters most to him.

"I never really looked or paid attention" to the cost, he said.

He paid about $7,900, but wasn't sure what the total bill amounted to.

The average charge for hip replacement surgery at Loyola is about $42,000, before the negotiated insurance rates. The most expensive items on a typical hip replacement bill include about $11,000 for the hip implant, said Richard Kudia, Loyola's vice president of patient financial services

Kudia said some patients do ask in advance about costs of surgery and other medical procedures, and those questions require "a little bit of research" to come up with an average estimate. Costs vary from center to center because "there is no standard pricing among hospitals across the country. Each hospital develops its own pricing depending on its market," he said.

An editorial accompanying the hip replacement study said "there is no justification" for the huge cost variation the researchers found.

A few online sites provide price comparisons for common medical procedures, but the editorial said that kind of information "is of almost no value" without information on hospital quality.

A proposed federal measure that would have required states to force hospitals to make their charges public failed to advance in Congress last year but could be revived this year, the editorial says.

"It is time we stopped forcing people to buy health care services blindfolded," the editorial said.

---

Online:

Journal: HTTP://WWW.JAMAINTERNALMED.COM

© 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, 12 February 2013 06:24
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WASHINGTON (AP) -- Michael Lee knew he was still in bad shape when he left the hospital five days after emergency heart surgery. But he was so eager to escape the constant prodding and the roommate's loud TV that he tuned out the nurses' care instructions.

"I was really tired of Jerry Springer," the New York man says ruefully. "I was so anxious to get out that it sort of overrode everything else that was going on around me."

He's far from alone: Missing out on critical information about what to do at home to get better is one of the main risks for preventable rehospitalizations.

"There couldn't be a worse time, a less receptive time, to offer people information than the 11 minutes before they leave the building," said readmissions expert Dr. Eric Coleman of the University of Colorado in Denver.

Hospital readmissions are miserable for patients, and a huge cost - more than $17 billion a year in avoidable Medicare bills alone - for a nation struggling with the price of health care.

Now, with Medicare fining facilities that don't reduce readmissions enough, the nation is at a crossroads as hospitals begin to take action.

"Patients leave the hospital not necessarily when they're well but when they're on the road to recovery," said Dr. David Goodman, who led a new study from the Dartmouth Atlas of Health Care that shows different parts of the country do a better job at keeping those people at home.

The Dartmouth study was commissioned by the Robert Wood Johnson Foundation, which then invited the AP as a partner to explore through focus groups it organized what happens at the hospital level that makes readmissions so difficult to solve.

In Portland, Ore., nurses at Oregon Health & Science University start teaching heart failure patients what they'll need to do at home on their first day in the hospital, instead of just on their last day.

In Salt Lake City, a nurse acts as a navigator, connecting high-risk University of Utah patients with community doctors for follow-up treatment and ensuring both sides know exactly what's supposed to happen when they leave the hospital.

Some techniques are emerging as key, Coleman said: Having patients prove they understand by teaching back to the nurse. Role-playing how they'd handle problems. Finding a patient goal to target, like the grandmother who wants her heart failure controlled enough that her feet don't swell out of her Sunday shoes.

----

You'd be mad at having to return your car to the mechanic within a month, yet rehospitalization after people get their hearts repaired too often is treated as business as usual, laments Dr. Ricardo Bello, a cardiac surgeon at New York's Montefiore Medical Center.

Heart surgeons try to prevent that by re-examining patients two to three weeks after they go home. But Montefiore patients tend to be readmitted sooner than that.

So last fall, Bello's team began a special clinic where nurses check heart surgery patients about a week after they go home, at no extra charge - and have a chance to re-teach those discharge instructions when people are more ready to listen.

Plus, for that first month at home, patients are supposed to wear a bracelet with a phone number to reach Montefiore's cardiac unit 24 hours a day with any worries.

"It changed my conception of dealing with a doctor," said Michael Lee, 60.

Montefiore surgeons repaired a life-threatening crack in Lee's aorta, the body's main blood vessel, but his recovery derailed days after getting home. He quit some medications. He was scared to wash the wound that ran from chest to navel, an infection risk. He developed a scary cough and called that special clinic in a panic.

It turned out the cough was a temporary nuisance - but nurses discovered a real threat: Lee's blood pressure was creeping up, a risk to his healing aorta. Those pills Lee quit were supposed to keep it extra low, a message he'd missed. And some hands-on instruction reassured Lee that he could handle his wound without tearing it.

Without the clinic, "he's definitely somebody we would have been called to see in the emergency room," said physician assistant Jason Lightbody.

-----

In heart failure, a weakly pumping heart allows fluid to build up until patients gasp for breath. Spotting subtle early signs like swelling ankles or creeping weight gain is crucial. But at the Oregon Health & Science University, nurse practitioner Jayne Mitchell spied as patients were told what to watch for as they were discharged - and they barely paid attention.

The new plan: Learn by doing.

Every morning, hospitalized patients weigh themselves in front of a nurse, record the result and get quizzed on what they'd do at home. Gained 2 pounds or more? Call the doctor for fast help. Lots of day-to-day fluctuation? A weekly log can help a doctor tell if a patient is getting worse or skipping medication or having trouble avoiding water-retaining salty food.

Step 2: These patients need a check-up a week after they go home. The hospital makes the appointment with a primary care doctor before they're discharged, to ensure they can get one.

And for some high-risk patients who live too far away to easily track, Mitchell is pilot-testing whether a high-tech option helps them stick with care instructions.

During that first vulnerable month at home, those patients record their morning weight, blood pressure and heart rate on a monitor called the Health Buddy. It automatically sends the information back to Mitchell's team at OHSU and also will flash instructions to the patient if it detects certain risks.

In Sun River, Ore., Richard W. Pasmore's phone rang one morning. Nurses three hours away in Portland saw that his weigh-in was high and adjusted his medications over the phone.

The 67-year-old Pasmore thinks it prevented a return to the hospital: "It kept them totally abreast of everything that was happening with me." And by the end of the month, he says he'd gotten in the habit of his morning heart failure checks.

---

At the University of Utah, nurse Stephanie Wallace links high-risk patients to the outside care that could keep them from returning. And she's the one whose phone rings when that care falls through.

Consider the single mother who couldn't afford post-hospital blood tests to make sure her blood-thinning medication was working properly, or time off work to get them and didn't speak enough English to seek help. When the woman missed her lab appointment, Wallace pieced together the trouble, helped her enroll in a program for low-income patients - and stressed the importance of sticking with this care.

"It's not that they don't understand why they're sick. They don't grasp the importance of why they need follow-up," Wallace said.

-----

The customized programs reflect the Dartmouth study's findings that there's great geographic variability in hospital readmissions.

In Miami, for example, more than a quarter of Medicare patients with heart failure returned to the hospital within a month in 2010, the latest data available. That's double the readmission rate for those patients in Provo, Utah.

In Dearborn, Mich., the readmission rate for pneumonia was 20 percent, twice that of hospitals in Salt Lake City.

"Every place is different and faces different challenges in terms of improving care after patients are discharged from the hospital," Goodman said.

---

Online:

Care About Your Care: HTTP://WWW.CAREABOUTYOURCARE.ORG

Dartmouth Atlas of Health Care: HTTP://WWW.DARTMOUTHATLAS.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, 11 February 2013 09:42
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NEW YORK (AP) -- Researchers have discovered the first U.S. cases of whooping cough caused by a germ that may be resistant to the vaccine.

Health officials are looking into whether cases like the dozen found in Philadelphia might be one reason the nation just had its worst year for whooping cough in six decades. The new bug was previously reported in Japan, France and Finland.

"It's quite intriguing. It's the first time we've seen this here," said Dr. Tom Clark of the Centers for Disease Control and Prevention.

The U.S. cases are detailed in a brief report from the CDC and other researchers in Thursday's New England Journal of Medicine.

Whooping cough is a highly contagious disease that can strike people of any age but is most dangerous to children. It was once common, but cases in the U.S. dropped after a vaccine was introduced in the 1940s.

An increase in illnesses in recent years has been partially blamed on a version of the vaccine used since the 1990s, which doesn't last as long. Last year, the CDC received reports of 41,880 cases, according to a preliminary count. That included 18 deaths.

The new study suggests that the new whooping cough strain may be why more people have been getting sick. Experts don't think it's more deadly, but the shots may not work as well against it.

In a small, soon-to-be published study, French researchers found the vaccine seemed to lower the risk of severe disease from the new strain in infants. But it didn't prevent illness completely, said Nicole Guiso of the Pasteur Institute, one of the researchers.

The new germ was first identified in France, where more extensive testing is routinely done for whooping cough. The strain now accounts for 14 percent of cases there, Guiso said.

In the United States, doctors usually rely on a rapid test to help make a diagnosis. The extra lab work isn't done often enough to give health officials a good idea how common the new type is here, experts said.

"We definitely need some more information about this before we can draw any conclusions," the CDC's Clark said.

The U.S. cases were found in the past two years in patients at St. Christopher's Hospital for Children in Philadelphia. One of the study's researchers works for a subsidiary of Johnson & Johnson, which makes a version of the old whooping cough vaccine that is sold in other countries.

---

JournaL: HTTP://WWW.NEJM.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.
Thursday, 07 February 2013 06:21
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NEW YORK (AP) -- Opponents are pressing to delay enforcement of the city's novel plan to crack down on supersized, sugary drinks, saying businesses shouldn't have to spend millions of dollars to comply until a court rules on whether the measure is legal.

With the rule set to take effect March 12, beverage industry, restaurant and other business groups have asked a judge to put it on hold at least until there's a ruling on their lawsuit seeking to block it altogether. The measure would bar many eateries from selling high-sugar drinks in cups or containers bigger than 16 ounces.

"It would be a tremendous waste of expense, time, and effort for our members to incur all of the harm and costs associated with the ban if this court decides that the ban is illegal," Chong Sik Le, president of the New York Korean-American Grocers Association, said in court papers filed Friday.

City lawyers are fighting the lawsuit and oppose postponing the restriction, which the city Board of Health approved in September. They said Tuesday they expect to prevail.

"The obesity epidemic kills nearly 6,000 New Yorkers each year. We see no reason to delay the Board of Health's reasonable and legal actions to combat this major, growing problem," Mark Muschenheim, a city attorney, said in a statement.

Another city lawyer, Thomas Merrill, has said officials believe businesses have had enough time to get ready for the new rule. He has noted that the city doesn't plan to seek fines until June.

Mayor Michael Bloomberg and other city officials see the first-of-its-kind limit as a coup for public health. The city's obesity rate is rising, and studies have linked sugary drinks to weight gain, they note.

"This is the biggest step a city has taken to curb obesity," Bloomberg said when the measure passed.

Soda makers and other critics view the rule as an unwarranted intrusion into people's dietary choices and an unfair, uneven burden on business. The restriction won't apply at supermarkets and many convenience stores because the city doesn't regulate them.

While the dispute plays out in court, "the impacted businesses would like some more certainty on when and how they might need to adjust operations," American Beverage Industry spokesman Christopher Gindlesperger said Tuesday.

Those adjustments are expected to cost the association's members about $600,000 in labeling and other expenses for bottles, Vice President Mike Redman said in court papers. Reconfiguring "16-ounce" cups that are actually made slightly bigger, to leave room at the top, is expected to take cup manufacturers three months to a year and cost them anywhere from more than $100,000 to several millions of dollars, Foodservice Packaging Institute President Lynn Dyer said in court documents.

Movie theaters, meanwhile, are concerned because beverages account for more than 20 percent of their overall profits and about 98 percent of soda sales are in containers greater than 16 ounces, according to Robert Sunshine, executive director of the National Association of Theatre Owners of New York State.

---

Follow Jennifer Peltz at HTTP://TWITTER.COM/JENNPELTZ

© 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 February 2013 06:23
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CHICAGO (AP) -- Commonly used steroid shots may worsen tennis elbow in the long run and increase chances that the painful condition will reappear, a small study found.

By contrast, patients who got dummy injections alone or with physical therapy were more likely to completely recover after a year and much less likely to have a recurrence than those given steroids.

While the Australian study results echo previous findings, injections of cortisone or similar steroids are still widely recommended by doctors to treat tennis elbow and similar conditions, probably because they can provide short-term pain relief.

The results from this study and others show that steroid shots shouldn't be the main treatment for tennis elbow, said researcher and co-author Bill Vicenzino the University of Queensland.

His study appears in Wednesday's Journal of the American Medical Association.

So-called tennis elbow is caused by repetitive activity or overuse of the arm, which can cause small tears in tendons that attach to the elbow bone. Rest, applying ice, and over-the-counter pain medicine can help relieve symptoms.

The study involved corticosteroids, often used medically to reduce inflammation. These are different from hormone-related anabolic steroids used to treat certain diseases but which are banned in many professional sports because they can build muscle and improve performance..

The researchers enrolled 165 adults aged 18 and older; each had tennis elbow in one arm for longer than six weeks. They were divided into four treatment groups: a single steroid injection; a shot of a dummy liquid; a steroid shot plus about eight weekly half-hour sessions of physical therapy; or a dummy injection plus physical therapy,

After four weeks, steroid patients fared best, but after one year, those who didn't get a steroid shot did better. All the patients who had physical therapy without steroids and 93 percent who got just dummy injections reported complete recovery or much improvement, versus about 83 percent of those who had steroids with or without physical therapy. A recurrence of tennis elbow was reported by about half of the patients in both steroid groups, compared with just 5 percent of the physical therapy patients and 20 percent in the placebo group.

Despite the differences, more than 80 percent of patients in each group were much better or recovered after one year, showing that tennis elbow generally improves over time regardless of treatment.

One reason steroid injections aren't always the best choice is that they reduce the pain without fixing the underlying problem, so patients are more likely to resume activity too soon, said Dr. Michael Perry, a sports medicine specialist at Northwestern Memorial Hospital in Chicago.

---

Online: JAMA: HTTP://WWW.JAMA.COM Tennis elbow: HTTP://TINYURL.COM/BVZG7CN © 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 February 2013 06:21
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