Very obese wait longer for transplant
Thu, 20 Dec 2007 04:06:24 GMT
By ALEX DOMINGUEZ, Associated Press Writer
BALTIMORE - Very obese people who need a kidney transplant are far less likely to get one than normal weight people, and when they do, their wait is an average of a year to 18 months longer, a new study found.
The reason seems to be both economic and medical. Very obese people have a greater risk for complications, and the transplant centers often must bear the additional cost of treating those problems.
The study showed that morbidly obese patients — those who average about 100 pounds over their ideal weight — were 44 percent less likely to get a transplant than normal weight patients. Those just slightly less obese were 28 percent less likely to get a transplant, the researchers found.
The results also mean very obese patients are more likely to die; each year about 8 percent of all patients waiting for a transplant die.
The research was based on an analysis of records of 132,353 patients on the national kidney transplant waiting list between 1995 and 2006. The work was published Wednesday in the Journal of the American Society of Nephrology.
Obesity can be a reason to exclude a potential transplant recipient because of the risk for complications.
However, once someone has been accepted for the waiting list, that patient is supposed to progress to the top as time passes, said Dr. Dorry Segev, the Johns Hopkins University transplant surgeon who led the study.
Segev said he did not believe doctors or transplant staff were consciously choosing slimmer candidates over obese patients. However, he said two factors may be combining to create the bias.
The main insurer for kidney transplants, Medicare, pays a fixed rate regardless of the difficulty of each case, meaning the transplant hospital bears the burden of added costs for complications. And transplant centers with lower survival rates risk losing Medicare funding.
"I don't think any of this is conscious," Segev said. "It would be hard to imagine any of us in our field would deliberately act against the welfare of our patients. That's not what we do, but there are all sorts of subconscious forces that are happening and there's clearly an unintended bias in practice."
Segev's group found the wait to get a transplant increased along with the patient's body mass index, a height-weight formula. Non-obese patients waited on average 39 months, the overweight waited 40 months, the obese waited 42 months, and the severely and morbidly obese, waited 51 and 59 months, respectively, the researchers found.
Transplant centers normally won't give an organ to a patient with a body mass index over 40, which is morbidly obese, said Dr. Benjamin Philosophe, head of transplantation division at the University of Maryland Medical Center. Such patients are at higher risk for a number of complications.
However, Philosophe said he and many doctors "will give them the benefit of the doubt that they will lose the weight and will put them on the list hoping that while they lose that weight they will accumulate waiting time."
Patients who fail to lose weight can be placed on inactive status, Philosophe said.
Also clouding the issue is the fact the database maintained by the United Network for Organ Sharing does not capture all details on patient condition, said Dr. Kenneth Andreoni of the University of North Carolina School of Medicine, vice chairman of the UNOS kidney transplantation committee.
For example, whether a candidate has diabetes is simply a yes or no checkoff. The lack of more detail on diabetes and other conditions can make it difficult to draw conclusions, he said.
The UNOS official noted that obese patients who never would have been referred for a transplant in the past are now put on the waiting list and rules changes have taken effect over the 11 years studied.
Green tea may cut prostate cancer risk
Thu, 20 Dec 2007 04:06:08 GMT
TOKYO - Drinking several cups of green tea every day may help keep prostate cancer from spreading, according to a study funded by the Japanese government.
A study of nearly 50,000 Japanese men aged 40-69 found that those who drank five or more cups of green tea a day reduced their risk of having progressive prostate cancer by half, compared with those who drank a cup or less, according to the Epidemiology and Prevention Division of the National Cancer Center in Tokyo.
The study, carried out between 1990 and 2004 and released Wednesday, was the first to suggest green tea can help keep prostate cancer from spreading, the center said.
Catechin, a substance abundantly contained in green tea, may have inhibited cancerous cell growth or helped reduce testosterone, according to the research team.
Lead more likely to harm immigrant kids
Wed, 19 Dec 2007 23:34:11 GMT
NEW YORK - A new report showed Wednesday that immigrant children are five times more likely to suffer from lead poisoning than U.S.-born children in New York City.
The study in the January issue of the American Journal of Public Health also found that children who lived abroad within the previous six months — especially children from the Dominican Republic, Haiti, Mexico and Pakistan — were 11 times more likely to have lead poisoning.
The city's Department of Health and Mental Hygiene said it is the first such study to look at lead poisoning in New York City's immigrant children.
The report studied 406 children in 2002, half of whom had lead poisoning. The study's author, Dr. Jessica Leighton, says it is likely the children were poisoned in their native countries, where regulations on environmental contaminants are not as strict.
Patients with drug resistant TB at large
Thu, 20 Dec 2007 03:32:21 GMT
By CLARE NULLIS, Associated Press Writer
CAPE TOWN, South Africa - South African authorities have threatened to use police in door-to-door searches to compel 23 patients with highly infectious, drug resistant tuberculosis to return to the hospital they escaped from last week.
The patients had complained that they wanted to spend Christmas with their families. Some had been in the hospital for more than 18 months.
Eastern Cape health department spokesman Siyanda Manana said Wednesday that court orders would be delivered to the patients' homes Thursday.
"If they do not return immediately, department officials will be accompanied by members of the South African Police Service in a door-to-door search," he said.
In all, 49 patients fled from the Jose Pearson hospital near the coastal city of Port Elizabeth last week by cutting a gap through the wire fence surrounding the isolation unit.
In the interim, 26 have returned to the hospital of their own accord.
"I think that those who returned are aware that they are putting themselves and their families at risk," said Manana, according to the South African Press Association.
The mass escape highlighted the problems faced by South Africa as it struggles to cope with an epidemic of virtually incurable TB that feeds off the AIDS virus and kills most of its victims. South Africa has an estimated 5.4 million people living with the AIDS virus.
There have been around 400 confirmed cases of the incurable strain known as XDR-TB, or extremely drug resistant TB. But activists say the actual number is probably much larger, because testing methods are not sophisticated enough to detect the new strain and many people die before they can be diagnosed.
Several provinces in South Africa have been forced to take legal action to force drug resistant TB patients to stay in the hospital. Earlier this year in Cape Town, for instance, authorities had to confine a minibus taxi driver — who was a potential risk to hundreds of people every day — after he insisted he could not afford the loss of wages by committing himself to a hospital.
Although forced confinement of patients violates most medical ethics, authorities say they have no choice but to put the wider public good above individual rights. Confinement for XDR-TB is at least six months.
Some patients have been at the Jose Pearson institution for more than a year while others have been there more than 18 months.
Tension started mounting early in December when patients insisted they be released to spend the holiday season with their families.
As a compromise, the hospital agreed to release those considered slightly less infectious for a limited period under strict supervision. Patients not released were promised a function with their families at the hospital.
It was unclear what prompted the patients to break out. The hospital has since changed its security firm and increased the number of watchmen.
South African authorities say they do not have the resources to enforce isolation and treatment, as in the United States, because the number of patients is far too high.
