Health Care

Briefly 7-8

Underestimated severity?

DURHAM , NC - MedPage Today noted biopsies may underestimate severity of prostate cancer in obese men. In a study of biopsies and surgical specimens of more than 1,100 men who had radical prostatectomy, obese men were significantly more likely than normal weight men to have cancers that became higher grade, said Dr. Stephen Freedland, of Duke University, and colleagues in Urology. "We know it's more difficult to diagnose prostate cancer in obese men because they have lower levels of prostate-specific antigen … and their larger-sized prostates make it more likely for a biopsy to miss the cancer," he said. "These findings suggest we could be missing even more high-grade disease among obese men." He and colleagues used the Shared Equal Access Regional Cancer Hospital database, a large-scale, multi-ethnic database on men at the Veterans Affairs Medical Centers in Los Angeles, Palo Alto, and San Francisco, in Augusta, GA, and at San Diego Naval Hospital. Investigators viewed a sample of 1,113 men who had radical prostatectomy from 1996, when extended biopsies became the protocol, to 2005. They found 27% had biopsy findings that after prostatectomy were upgraded, 11% had results downgraded.

ANN ARBOR, MI - HealthDay News noted being hydrated in summer is important for many reasons, including prevention of kidney stones, says Dr. Gary Faerber, associate professor of urology at the University of Michigan Health System. A lack of fluid can lead to kidney stones, and typical summer physical activities can loosen kidney stones and cause painful symptoms. "One of the best ways to prevent kidney stones is to stay hydrated over the entire 24-hour period. I recommend my patients have at least six to eight glasses of water a day, and I ask them to make sure they spread that over the entire day until night time. This is important year-round but especially in the summer. It is very important for people to be aware of how to prevent kidney stones because about 13% of men and 7% of women will have kidney stones sometime in their lives." He added: Reduce consumption of soda and iced tea, which contain an acid called oxalate that can increase the risk of certain kinds of kidney stones; drink lemonade, but not the powdery mix. Real lemonade has been shown to reduce the risk of kidney stones.

LOS ANGELES - The Los Angeles Times stated scientists perfected an inexpensive, efficient way to convert types A, B, and AB blood into type O universal donor blood that can be given to anyone. This promises to make transfusions safer and to ease shortages of type O blood. The team noted in Nature Biotechnology that it isolated bacterial enzymes that safely remove from red blood cells sugar molecules that provoke an immune reaction in the recipient. Scientists are doing clinical trials. Mismatching of blood causes at least half of all transfusion-related deaths. "Those issues could be resolved largely if there were a universally transfusible blood supply," said Douglas L. Clibourn, CEO of ZymeQuest Inc., Beverly , MA developer of the technology. Type A blood has one set of sugars, type B has another, type O has none. People with type A blood have antibodies against type B sugars, type B people have type A antibodies, and type O people have antibodies against both. If a person receives mismatched blood, antibodies attack red blood cells, with a potentially fatal breakdown of the cells.

WASHINGTON - Monday Morning in Washington, DC noted the Kaiser Family Foundation's Commission on Medicaid and the Uninsured updated the Medicaid at a Glance fact sheet with an overview of the Medicaid program, populations it serves, and services it covers (www.kff.org/medicaid/7235.cfm).

SUTTON, ENGLAND - Reuters Health noted adding chemotherapy to estrogen-blocking drug tamoxifen improves survival of early breast cancer, two studies by the Adjuvant Breast Cancer (ABC) Trials Collaborative Group found. By contrast, preventing estrogen secretion from the ovaries seems to offer no benefit for most women. In the trial, Dr. Judith Bliss, of the Institute of Cancer Research , and her team assessed outcomes of 1,991 patients ages 28-81, who received five years of tamoxifen therapy with or without standard chemotherapy. Some pre-menopausal women were treated with ovarian removal or suppression, which stops hormone secretions. The chemotherapy group experienced fewer recurrences of cancer, but the difference fell short of statistical significance, stated the Journal of the National Cancer Institute report. Still, chemotherapy did cut the overall risk of death 17%. The benefit emerged early, while it took at least five years for the survival benefit to become apparent, researchers note. Analysis showed chemotherapy gave the greatest survival benefit in women younger than 50, especially pre-menopausal women not treated with ovarian ablation or suppression.

JACKSONVILLE , FL - Denial is a common response to stress, an important coping and defense mechanism., or delay appropriate response to circumstances. Mayo Clinic Women’s HealthSource noted how denial can help or be a roadblock to good health. Denial is refusing to acknowledge painful or overwhelming external circumstances, avoiding facts, or minimizing consequences. Denial - or healthy skepticism - can help withhold judgment until all the facts are in. It prevents obsession with minor pains. When patients hear bad news, denying or suppressing it can offer needed time to grip challenges ahead. Gradually adjusting to major changes can lead to better decisions. Denial that prevents seeking treatment or leads to misuse of alcohol or drugs becomes harmful response. A woman who finds a lump in her breast and ignores it misses the benefit of early diagnosis and best chance for cure. Denying consequences of smoking or staying in an abusive relationship can jeopardize long-term health. It all comes down to finding a healthy balance.

NEW YORK - Women who get hot flashes have higher blood pressure than those who don't, states a Weill Cornell Medical College study. High blood pressure is a major risk factor for heart disease, responsible for half of all deaths among U.S. women 50 and older. "One-third of the women we studied reported hot flashes within the past two weeks. Among them, systolic blood pressure was significantly higher, even after adjusting for whether they were pre-menopausal, menopausal, or post-menopausal," says Dr. Linda Gerber, senior author, professor of public health and medicine, and director of biostatistics and research methodology at Weill. Previous research linked menopause to high blood pressure; this study, in Menopause: the Journal of the North American Menopause Society, may be the first to link hot flashes to high blood pressure. Portable monitors recorded blood pressure of 154 New York City women, 18-65, with no cardiovascular disease and either mild hypertension or normal blood pressure - 51 reported hot flashes. The women were found to have an age-adjusted mean systolic awake blood pressure of 141 and a mean systolic sleep blood pressure of 129 versus 132 and 119, respectively, for women not reporting hot flashes. randomized comparison of the addition of anti-depressants to standard mood stabilizers.

NORWICH , ENGLAND - MedPage Today noted routine screening of newborns for Cystic Fibrosis (CF) is cost-effective, scientists say. The cost of therapy for children diagnosed clinically was 60%-400% more than for those found by newborn screening, said Dr. Erika J. Sims, of the University of East Anglia, and colleagues. Treatment savings alone would offset 60%-73% of screening costs in a conservative estimate, they wrote in The Lancet. Prior studies tied early treatment due to screening by two months to better growth, fewer long-term therapies, and better cognitive development. In 2004, the U.S. Centers for Disease Prevention and Control recommended U.S. states add the test to existing newborn screening tests. At least 27 states did so; another four to seven are due to soon. In England , CF screening of newborns isn‘t routine. "If clear clinical benefit doesn’t always persuade governments to implement screening, cost benefits might," investigators wrote. "The costs of screening are an important part of such decision-making." The study had children one to nine years old with CF identified by screening within two months of birth or after clinical presentation without screening. Scientists figured costs of long-term and nebulized therapies and antibiotics based on the United Kingdom Cystic Fibrosis Database 2000-2002.

SEATTLE - MedPage Today noted one in three women with ovarian cancer may not get suggested comprehensive surgical treatment, scientists report. An analysis of hospital data from nine states shows 66.9% of all U.S. women admitted with ovarian cancer got optimal treatment, stated Dr. Barbara Goff, of the University of Washington , and colleagues, in the journal Cancer. Women 71 or older, African-American or Hispanic, or with Medicaid were most likely to be under-treated, she and colleagues said. Alternately, women cared for by surgeons who did many ovarian cancer treatments - defined as 10 or more cases a year - were more likely to get appropriate therapy, the team said. Findings bolster the argument that all women with ovarian cancer should be sent to specialist centers for their surgical care, the team said. "Referral of women with suspected ovarian cancer to expert centers for primary surgery would be an effective strategy to improve overall outcomes," Dr. Goff and colleagues argued, for ovarian cancer, "the key to high-quality care is appropriate surgical treatment."