Study Big hospitals better for preemies
Thu, 24 May 2007 03:09:24 GMTBy MIKE STOBBE, AP Medical Writer
Thousands of sickly newborns could be saved each year if officials closed some of the nation's smaller neonatal intensive care units, according to a new study that suggests larger hospitals are better able to treat the infants.
Extremely premature babies were up to twice as likely to survive when treated at a busy, advanced-care center instead of one of the many community hospitals that have opened NICUs in recent years.
Even among the most advanced centers, those that handled the most babies had the best survival records, said Ciaran Phibbs, lead author of the study appearing in Thursday's http://www.hospitalcompare.hhs.gov and http://www.calhospitalcompare.org may help.
Debby Rogers, vice president of quality and emergency services for the California Hospital Association, said closing NICUs carries some risk.
Residents of some rural areas have limited access to advanced medical services, and it's better for them to have limited NICU care than no such care at all, she said.
Phibbs said his team considered that argument, and found 92 percent of the births in 2000 occurred in urban areas with more than 100 such deliveries each year.
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On the Net:
New England Journal: http://www.nejm.org
Woman upbeat after internal decapitation
Wed, 23 May 2007 21:36:11 GMTLINCOLN, Neb. - Most days are good, some not for a woman who is recovering from what has been called "internal decapitation." Shannon Malloy suffered "atlantooccipital dislocation" — that's what doctors call it. The force of her head hitting a car dashboard separated her skull from her spine.
Though rare, it's more common in children and is usually found during autopsies.
Speaking from her mother's home in Denver, Malloy, 30, said she remembers no pain from the crash near Tecumseh in southeast Nebraska on Jan. 25.
"I remember being slumped over and not being able to respond," she said.
She was a passenger in the car. She would not provide details of the accident, she said, because she's suing an insurer.
"Stay alive," Malloy said she told herself while still in the car. "I can't die."
She said she heard her boyfriend, Graham Neary, say to her: "Please stay with me."
"Then I don't remember much until the paramedics pulled me out of the car," Malloy said.
She recalls parts of her next three weeks at a Lincoln hospital, on a ventilator, unable to talk.
"At some point in the ICU, I remember writing a note , asking if I was paralyzed.
"She said, 'No.'"
Surviving the catastrophic injury has become more common because of faster protection of the airway and better spinal isolation at accident scenes.
Malloy also suffered a broken pelvis and ankle.
Yet she remains mostly upbeat.
"My family keeps joking that I must be brain-damaged because I'm so positive," she said.
After three weeks in intensive care and two weeks of rehabilitation, she walked out to begin her new life with daunting physical challenges.
Her eyes remain crossed, awaiting surgery.
She can turn her head only an inch side to side, but the restrictive halo apparatus she was wearing came off April 13.
She can't swallow yet.
"My esophagus muscle is so tight that even water won't pass through," she said. "I can't even swallow my own spit."
No surgeries have been scheduled to address her vision or inability to swallow.
Money remains a problem, as has the paperwork required to get help from Medicaid.
Sometimes, Malloy said, "I feel like I'm on the outside looking in. At other times, I wish I was on the outside looking in."
"I'm not a religious person, but there's a reason for me to be here," she said. "And I've got to find out what that reason is and fulfill it."
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Information from: Lincoln Journal Star, http://www.journalstar.com
Hospitals to study child seizures
Wed, 23 May 2007 21:40:43 GMTWASHINGTON - When children suffer life-threatening seizures, doctors have minutes to decide which of two drugs to use to try to save them — with no good research on which works better.
Eleven hospitals around the country are beginning a special study to finally answer that question: A computer will randomly assign patients to get either Valium or Ativan within five minutes of arriving in the emergency room.
Because of the time crunch, doctors won't seek parents' permission first. Children brought to those emergency rooms with the unrelenting seizures known as "status epilepticus" will be enrolled in the study automatically.
The http://www.nichd.nih.gov/news/releases/study_pediatric_seizure_QA_052207.cfm
Ban kept for gay men donating blood
Wed, 23 May 2007 22:05:43 GMTWASHINGTON - Gay men remain banned for life from donating blood, the government said Wednesday, leaving in place — for now — a 1983 prohibition meant to prevent the spread of http://www.fda.gov/cber/faq/msmdonor.htm
Wed, 23 May 2007 10:41:20 GMT
By Krittivas Mukherjee
MUMBAI - A barrage of kisses on Shilpa Shetty's cheeks, paintings of naked Hindu gods, Valentine's Day, Fashion TV and sex education -- all are unacceptable according to India's increasingly sensitive moral police.
Small but growing and ever more vocal groups of cultural vigilantes are attacking anything that does not conform to their notion of purity and morality, from paintings, books and films to modern dress, Western attitudes and even beauty salons.
It is an assault some ascribe to the dislocation caused by a booming economy, and the gap between an affluent, urban youth embracing Western values and the more traditional rest of society, whether older or poorer.
&;Lopsided economic growth has created a dispossessed population which cannot relate to Western cultural values and norms,&; said S. Parasuraman, head of the Tata Institute of Social Sciences. &;The political class exploits this.&;
More often than not, the religious card gets played.
As the Hindu nationalist Bharatiya Janata Party tries to reach out to the moderate centre of Indian politics and redefine itself after its national election defeat in 2004, its radical fringe is looking for issues to reinvigorate itself.
With a profusion of 24-hour television news channels, these groups get disproportionate air time and publicity which media analysts say only emboldens them further.
Earlier this month, an art student was beaten up and his exhibition destroyed for portraying Hindu deities in the nude. The student, Chandramohan, was himself arrested on charges of offending religious sentiments, but later freed on bail.
No charges have been laid against the vandals, who were surely encouraged by the success of like-minded radicals in forcing one of India's top painters, M.F. Husain, into exile about a year ago for a similar offence.
In April, effigies of Hollywood star Richard Gere and Bollywood actress and &;Celebrity Big Brother&; winner Shilpa Shetty were burnt after they kissed at a public event. An Indian court even ordered Gere's arrest to face charges of obscenity.
Meanwhile, anything from Valentine's Day to sex education in schools is denounced as an alien Western import. Lovers are beaten up for kissing or even holding hands in public.
&;Western countries are fighting psychological warfare to influence Indian youth,&; said Abhimanyu Gulati, a BJP leader.
&;We are saving the country from cultural anarchy and they call us the Indian Taliban.&;
UNEQUAL LIBERALISM?
But Hindu radicals are not the only ones trying to reshape society through direct action.
In Kashmir, an 18-year-old insurgency against Indian rule has radicalized a section of the Muslim population -- with the encouragement of neighboring Pakistan.
Muslim women activists have raided and shut down beauty salons and even attacked women who don't wear the burqa.
Many Indians see the radicals as a national embarrassment. But politicians, police and the courts have often turned a blind or conniving eye.
The book and film &;The Da Vinci Code&; was banned in several states after protests by Christian groups. Dance bars were banned in 2005 in the western state of Maharashtra because they were said to corrupt young minds and breed prostitution.
And in New Delhi, the central government occasionally bans channels like Fashion TV or AXN for showing too much female flesh or too many raunchy advertisements.
Part of the problem, according to commentators like Vir Sanghvi and Pratap Bhanu Mehta, is that India has failed to engage in serious debate about the balance between art and religion, and between freedom of expression and the defense of religious sentiments.
&;There is a perception, right or wrong, that when Hindu gods or goddesses are lampooned, free speech is mobilized as an argument; but a lampooning of Islamic symbols is seen as an anti-minority move,&; Mehta wrote in the Indian Express.
For Mehta, the right of free expression should apply equally.
&;I find it the height of impropriety and hubris that we humans are in the business of protecting our gods rather than the other way round.&;
Liberals in India fail to apply the same standards to all religions, agrees Sanghvi, and have never engaged in any serious debate about what should be allowed to be shown in public.
&;Our problem in India is that we have no standards, no barriers and no sense of what is acceptable and what is not,&; he wrote.
&;Each time the issue erupts we engage in the same finger-pointing debates, and call each other names.&;
China virus outbreak kills third child
Thu, 24 May 2007 13:42:01 GMTBEIJING - A viral disease that has broken out in eastern China's Shandong province has killed a third child, Xinhua said on Thursday, raising doubts over earlier claims that the epidemic may have been contained.
The news agency said that an 11-month-old boy had developed a fever and blisters before dying on Tuesday in a hospital in Linyi city, where 1,263 cases of &;hand, foot, and mouth disease&; have been reported since April.
The virus, which typically causes painful blisters around the mouth and throat and hands and feet, had already claimed the lives of a 14-month-old boy earlier this month and a two-year-old girl on April 29.
Xinhua cited the provincial health bureau as saying that the outbreak of the virus, which is highly contagious among children but not normally fatal, was &;slowing down.&; The government earlier said it had been contained.
The local government has launched a campaign to remind parents to take preventive measures such as frequent handwashing.
Chinese bloggers in Shandong said in early May that 26 children had died in the outbreak. Local media said authorities in Linyi had denied that figure.
Diabetes complications frequently afflict elderly
Thu, 24 May 2007 18:24:44 GMTNEW YORK - People who develop diabetes late in life often suffer from a range of diabetes-related complications, and their life expectancy is shorter than that of nondiabetic individuals of the same age, a new study shows.
The investigators, Dr. Frank A. Sloan, of Duke University in Durham, North Carolina, and colleagues point out in the Archives of Internal Medicine that &;little is known about the impact of diabetes mellitus in elderly populations.&;
The researchers examined illness and mortality rates in 33,772 Medicare beneficiaries with diabetes and in 25,563 similar people without diabetes over a 14 year period.
The death rate was over 9 percentage points higher among the people with diabetes than the control patients. Being newly diagnosed as diabetic translated into a loss of life expectancy of just over 2 years.
Overall, 92 percent of the diabetes group experienced an adverse health event compared with 72 percent of the control group.
Disorders affecting the legs and complications associated with surgery were higher among patients with diabetes. Furthermore, 58 percent of those with diabetes were diagnosed with heart failure, compared with 34 percent of the control group. While kidney disease and retinal eye disorders were less common, both increased markedly in the diabetic group.
&;Although the present data provide no insight into the cause of these patterns, the burden of diabetes mellitus complications on the individual and on the health care system is enormous,&; the researchers conclude.
SOURCE: Archives of Internal Medicine, May 14, 20077.
Lumpectomy safe for younger breast cancer patients
Thu, 24 May 2007 18:23:13 GMTBy Will Boggs, MD
NEW YORK - Breast cancer tends to be more aggressive when it occurs in younger women, and doctors often advise radical surgery. Now, however, a study shows that breast-conserving treatment, commonly known as lumpectomy, is safe for women younger than 40.
Acceptable outcomes, &;almost comparable to the rates observed among patients older than 40 years, can be obtained if high-quality surgery and radiotherapy are combined with chemotherapy,&; Dr. Adri C. Voogd from Maastricht University in the Netherlands told Reuters Health.
Voogd and colleagues evaluated the outcomes of 758 women 40 years of age or younger who underwent this course of treatment between 1988 and 2002.
Ninety-five women developed a local recurrence of breast cancer during follow-up, the researchers report in the medical journal Cancer, and an additional 17 women had recurrences diagnosed after the cancer was found to have spread to other sites in the body.
&;Of the local recurrences that were identified in our study, the large majority occurred at or near the site of the primary tumor, and only 7% developed elsewhere in the breast,&; the researchers explain. &;This suggests that, at least in young women, most local recurrences are not new primary tumors, but are more likely to be true recurrences, originating from residual tumor tissue.&;
The team calculates that local recurrence rates were 9% at 5 years and 18% after 10 years.
&;With our findings, we hope to have taken away some of the fears and make breast conservation a more acceptable treatment option for young women with breast cancer,&; Voogd said.
SOURCE: Cancer, May 15, 2007.
