THE BELIEF:
Drinking flat soda can ease an upset stomach.
THE FACTS:
It is not often that a soft drink is seen as medicinal. But when it comes to stomach distress, many people view a cup of flat soda as just what the doctor ordered.
The quick and popular remedy -- usually in the form of cola, ginger ale or clear sodas -- is said to help settle the stomach with its slight fizz and replenish fluids and glucose lost by vomiting and diarrhea. Parents also find that children who are verging on dehydration but reluctant to consume any liquids are more amenable to soda.
However, research shows that may not be a great idea. In a recent study, British researchers conducted a review of the medical literature going back to the 1950s in search of scientific evidence supporting the claim. They found none. Then, after a biochemical analysis, they compared the contents of colas and other sodas with over-the-counter oral rehydration solutions containing electrolytes and small amounts of sugar.
The soft drinks, the authors found, not only contained very low amounts of potassium, sodium and other electrolytes, but also in some cases as much as seven times the glucose recommended by the World Health Organization for rehydration. "Carbonated drinks, flat or otherwise, including cola, provide inadequate fluid and electrolyte replacement and cannot be recommended," they said.
THE BOTTOM LINE:
Flat soda, a popular remedy for upset stomach, may do more harm than good.
Tuesday, June 10, 2008
Monday, June 9, 2008
No belly full of laughs: Bigger waistlines and stroke linked
The connection between belly fat and the brain intensified last week. Many Americans have obsessed about abdominal fat for, oh, decades. A new study from the Oakland, Calif.-based Kaiser Permanente Division of Research revealed that people who have large waistlines in their 40s are more likely to develop Alzheimer's disease and other dementia conditions in their 70s.
Individuals in the study with the biggest bellies had a risk factor two times that of the leanest people. And belly fat was deemed a more significant risk factor than family history, even if both parents suffered from Alzheimer's.
"If (baby boomers) are not frightened enough about heart disease, maybe they will worry about losing their mental function," said Dr. Sam Gandy, a spokesman for the Alzheimer's Association, in a wire service story.
Well, there's more than heart disease and Alzheimer's/dementia for the belly-fat worry list. In one of those findings covered by media outlets but not getting large headlines or much air time, a University of Southern California study presented at a medical conference in February connected excess abdominal fat among women 35 to 54 to a fast-rising rate of stroke among females in that age group. The rate has tripled in recent years, said USC neurologist Dr. Amytis Towfighi at the International Stroke Conference in New Orleans.
Female waistlines, on average, are two inches bigger than they were a decade ago. Plus, the USC study showed the percentage of women with "abdominal obesity" rose from 47 to 59 percent. Towfighi and other researchers commenting on the study generally agree that this abdominal fat and a continuing rise in obesity are at the root cause of causing more strokes.
A couple of points that got the attention of scientists and public health officials if not the media:
The stroke rate among middle-age men stayed about the same during the time period of federal data examined, which was 1999 to 2004.
While stroke generally is considered to be a disease among the elderly, the sudden spike in middle-age female stroke and belly-fat numbers (men's statistics stayed the same in both categories) alarms health care professionals.
There's more. Doctors have long considered men to be more susceptible to strokes in middle age, with women having strokes at more equal rates once they are five to 10 years into menopause.
It's clearly time to rethink the probabilities -- and maybe even consider that women with excess abdominal fat are even more at risk for stroke than men with expanded waistlines.
Women and stroke incidence were a topic at medical student rounds last week at Swedish Medical Center. Third-year University of Washington med student Corinne Taraska updated the group about the strong link between stroke and women with migraines who also take birth control medication and smoke cigarettes.
"Women who have regular migraine headaches with an aura, plus use birth control and smoke, are seven times more at risk for stroke than women who have regular migraines with an aura but don't smoke or use birth control," said Taraska, who will earn her medical degree this spring and spend a postgraduate year researching melanoma. "It's 10 times the risk if compared to women who don't have migraines."
About a third of all women suffer migraine headaches. The ratio is one in 10 among men.
"We have known for a long time that migraines are associated with higher risk for stroke," said Dr. Bill Likosky, director of the stroke program at Swedish. "What's new is the heightened adverse effect if you choose to use birth control medication or use tobacco."
Likosky acknowledged birth control is a personal decision, but emphasized not smoking "is within everyone's grasp" as a positive step to protect against stroke.
A stroke affects the brain and not the heart. It occurs when there is a loss of sufficient blood flow to the brain, typically caused by a blocked or ruptured artery in the neck region. Likosky said migraines, birth control medicine and smoking even one cigarette can have a clotting or clogging effect on the arteries. Putting two or all three together exacerbates the risk.
In the past decade there have been successful campaigns to raise awareness about the dangers of heart attacks and cardiovascular disease among women. Likosky said stroke awareness "cuts across gender lines" in that women just as much as men are reluctant to go to an emergency room with stroke symptoms -- either because those symptoms are not as jarring as crushing chest pain (which women typically don't feel during heart attack as well) or because people don't know the symptoms, period.
"We talk to people about the acronym FAST," said Likosky. "F is for face (numbness or weakness), A is for arms, S is for speech (or slurring) and T is for 'time is brain.' When in doubt, don't hesitate to call 911. There is a lot that can be done in the early hours of stroke treatment."
KNOW THE FIVE MAJOR SIGNS SIGNS OF STROKE
Here are the five major signs of stroke, as outlined by the National Institute of Neurological Disorders and Stroke:
Individuals in the study with the biggest bellies had a risk factor two times that of the leanest people. And belly fat was deemed a more significant risk factor than family history, even if both parents suffered from Alzheimer's.
"If (baby boomers) are not frightened enough about heart disease, maybe they will worry about losing their mental function," said Dr. Sam Gandy, a spokesman for the Alzheimer's Association, in a wire service story.
Well, there's more than heart disease and Alzheimer's/dementia for the belly-fat worry list. In one of those findings covered by media outlets but not getting large headlines or much air time, a University of Southern California study presented at a medical conference in February connected excess abdominal fat among women 35 to 54 to a fast-rising rate of stroke among females in that age group. The rate has tripled in recent years, said USC neurologist Dr. Amytis Towfighi at the International Stroke Conference in New Orleans.
Female waistlines, on average, are two inches bigger than they were a decade ago. Plus, the USC study showed the percentage of women with "abdominal obesity" rose from 47 to 59 percent. Towfighi and other researchers commenting on the study generally agree that this abdominal fat and a continuing rise in obesity are at the root cause of causing more strokes.
A couple of points that got the attention of scientists and public health officials if not the media:
The stroke rate among middle-age men stayed about the same during the time period of federal data examined, which was 1999 to 2004.
While stroke generally is considered to be a disease among the elderly, the sudden spike in middle-age female stroke and belly-fat numbers (men's statistics stayed the same in both categories) alarms health care professionals.
There's more. Doctors have long considered men to be more susceptible to strokes in middle age, with women having strokes at more equal rates once they are five to 10 years into menopause.
It's clearly time to rethink the probabilities -- and maybe even consider that women with excess abdominal fat are even more at risk for stroke than men with expanded waistlines.
Women and stroke incidence were a topic at medical student rounds last week at Swedish Medical Center. Third-year University of Washington med student Corinne Taraska updated the group about the strong link between stroke and women with migraines who also take birth control medication and smoke cigarettes.
"Women who have regular migraine headaches with an aura, plus use birth control and smoke, are seven times more at risk for stroke than women who have regular migraines with an aura but don't smoke or use birth control," said Taraska, who will earn her medical degree this spring and spend a postgraduate year researching melanoma. "It's 10 times the risk if compared to women who don't have migraines."
About a third of all women suffer migraine headaches. The ratio is one in 10 among men.
"We have known for a long time that migraines are associated with higher risk for stroke," said Dr. Bill Likosky, director of the stroke program at Swedish. "What's new is the heightened adverse effect if you choose to use birth control medication or use tobacco."
Likosky acknowledged birth control is a personal decision, but emphasized not smoking "is within everyone's grasp" as a positive step to protect against stroke.
A stroke affects the brain and not the heart. It occurs when there is a loss of sufficient blood flow to the brain, typically caused by a blocked or ruptured artery in the neck region. Likosky said migraines, birth control medicine and smoking even one cigarette can have a clotting or clogging effect on the arteries. Putting two or all three together exacerbates the risk.
In the past decade there have been successful campaigns to raise awareness about the dangers of heart attacks and cardiovascular disease among women. Likosky said stroke awareness "cuts across gender lines" in that women just as much as men are reluctant to go to an emergency room with stroke symptoms -- either because those symptoms are not as jarring as crushing chest pain (which women typically don't feel during heart attack as well) or because people don't know the symptoms, period.
"We talk to people about the acronym FAST," said Likosky. "F is for face (numbness or weakness), A is for arms, S is for speech (or slurring) and T is for 'time is brain.' When in doubt, don't hesitate to call 911. There is a lot that can be done in the early hours of stroke treatment."
KNOW THE FIVE MAJOR SIGNS SIGNS OF STROKE
Here are the five major signs of stroke, as outlined by the National Institute of Neurological Disorders and Stroke:
- Sudden numbness or weakness in the face, arm or leg, especially on one side.
- Sudden confusion or trouble speaking or understanding.
- Sudden trouble seeing in one or both eyes.
- Sudden trouble walking, dizziness or loss of balance.
- Sudden, severe headache with no known cause.
Sunday, June 8, 2008
Fake patients test Vermont medical students
The patient talked a mile a minute, hopped off the exam table, paced around and poked through the cupboards when the medical students entered the exam room.
The "patient" had spent hours training how to fake it - in the interest of science. It was "Mania Day" at the University of Vermont's medical school.
One part drama, two parts science as doctors-in-training test their diagnostic skills and bedside manner by assessing the ailments of patients played by real people in a program that's growing in popularity at U.S. medical schools.
"This environment allows them to practice and make mistakes in an environment conducive to learning before they go to the patient," said Tamara Owens, president of the Association of Standardized Patient Educators.
Most health care institutions now have some sort of standardized patient program or simulation center, practicing everything performing exams to suturing mannequins. Medical students now also are required to take a national exam involving standardized patients.
But the training does much more than prepare them for the test.
"The idea is that if we want every student to handle or work with a patient with a migraine, schizophrenia, bipolar, knee pain, back pain, we can't assume or hope that patients with those problems are going to present in the hospital or in the office," said Nicholas.
"So what we can do here is to create any kind of scenario that our clinical faculty want to teach."
Dr. Howard Barrows came up with the idea in the 1960s at the University of California at San Diego.
UVM, which Owens said considers to be one of the pioneers in the methodology, along with San Diego and University of Texas Medical Branch at Galveston, started doing it the 1970s to teach doctors how to perform pelvic exams in women. The school expanded the practice to other areas in the mid-1990s as it considered changing its curriculum and became clearer about the skills that students needed, said Cate Nicholas, director of the program.
"We really needed to spend more time on some real, basic clinical exam skills, professionalism - how do you present yourself to a patient - communication-interpersonal skills, history taking skills, physical exam skills, clinical reasoning," she said.
That's when the concept of practicing on fake patients was introduced.
The "patients" at UVM come from all backgrounds - nurses, dancers, actors, teachers, a boat maker - and need to have some level of acting ability to be effective.
They meet with doctors to learn how to act out their symptoms the same way others do, so that students get the same experience and can be assessed uniformly.
"It might take up to 8 to 12 hours of training to prepare them for a project," Owens said. "So it requires them to have the ability to recall at a 90 percent or better rate in order to be included in the project."
For $20 an hour, they not only act, they also instruct students and offer feedback.
"You can see them grow," said Jim Conan, a retired state trooper and sometime actor.
At first, Ben Higgins, 24, of Mount Desert, Maine, had a hard time interrupting his manic patient - Morris - with questions.
Played by Conan, Morris talked rapidly about a home office he was building, his inability to install the dropped ceiling, and asked Higgins to help. He repeated himself, lost focus and changed the subject. He mentioned that his girlfriend was going to kick him out and urged the doctor to call and reassure her he was fine.
Midway through the half-hour session, Higgins and fellow student Elizabeth Cipolla, of New York City, took time out to discuss his case. They decided to ask Morris about medication and sleep. A doctor who stepped into the room to observe advised them to ask about his work, his level of functioning, to determine his concentration level.
The students learned Morris had been taking Zoloft and had felt euphoric ever since, sleeping only several hours a night.
The students then presented a list of findings - from the patient's neat appearance to his rapid speech, energy level, euphoric mood, and warped sense of reality - to the doctor.
"When they're in role like that, it feels very real," Higgins said. "It's fun to have real situations like that, so you can practice and know how to try and work on skills to interact with someone who might be in a manic state or a really depressed state."
The "patient" had spent hours training how to fake it - in the interest of science. It was "Mania Day" at the University of Vermont's medical school.
One part drama, two parts science as doctors-in-training test their diagnostic skills and bedside manner by assessing the ailments of patients played by real people in a program that's growing in popularity at U.S. medical schools.
"This environment allows them to practice and make mistakes in an environment conducive to learning before they go to the patient," said Tamara Owens, president of the Association of Standardized Patient Educators.
Most health care institutions now have some sort of standardized patient program or simulation center, practicing everything performing exams to suturing mannequins. Medical students now also are required to take a national exam involving standardized patients.
But the training does much more than prepare them for the test.
"The idea is that if we want every student to handle or work with a patient with a migraine, schizophrenia, bipolar, knee pain, back pain, we can't assume or hope that patients with those problems are going to present in the hospital or in the office," said Nicholas.
"So what we can do here is to create any kind of scenario that our clinical faculty want to teach."
Dr. Howard Barrows came up with the idea in the 1960s at the University of California at San Diego.
UVM, which Owens said considers to be one of the pioneers in the methodology, along with San Diego and University of Texas Medical Branch at Galveston, started doing it the 1970s to teach doctors how to perform pelvic exams in women. The school expanded the practice to other areas in the mid-1990s as it considered changing its curriculum and became clearer about the skills that students needed, said Cate Nicholas, director of the program.
"We really needed to spend more time on some real, basic clinical exam skills, professionalism - how do you present yourself to a patient - communication-interpersonal skills, history taking skills, physical exam skills, clinical reasoning," she said.
That's when the concept of practicing on fake patients was introduced.
The "patients" at UVM come from all backgrounds - nurses, dancers, actors, teachers, a boat maker - and need to have some level of acting ability to be effective.
They meet with doctors to learn how to act out their symptoms the same way others do, so that students get the same experience and can be assessed uniformly.
"It might take up to 8 to 12 hours of training to prepare them for a project," Owens said. "So it requires them to have the ability to recall at a 90 percent or better rate in order to be included in the project."
For $20 an hour, they not only act, they also instruct students and offer feedback.
"You can see them grow," said Jim Conan, a retired state trooper and sometime actor.
At first, Ben Higgins, 24, of Mount Desert, Maine, had a hard time interrupting his manic patient - Morris - with questions.
Played by Conan, Morris talked rapidly about a home office he was building, his inability to install the dropped ceiling, and asked Higgins to help. He repeated himself, lost focus and changed the subject. He mentioned that his girlfriend was going to kick him out and urged the doctor to call and reassure her he was fine.
Midway through the half-hour session, Higgins and fellow student Elizabeth Cipolla, of New York City, took time out to discuss his case. They decided to ask Morris about medication and sleep. A doctor who stepped into the room to observe advised them to ask about his work, his level of functioning, to determine his concentration level.
The students learned Morris had been taking Zoloft and had felt euphoric ever since, sleeping only several hours a night.
The students then presented a list of findings - from the patient's neat appearance to his rapid speech, energy level, euphoric mood, and warped sense of reality - to the doctor.
"When they're in role like that, it feels very real," Higgins said. "It's fun to have real situations like that, so you can practice and know how to try and work on skills to interact with someone who might be in a manic state or a really depressed state."
Saturday, June 7, 2008
House Calls Making a Comeback
John Devine is 82 years old and has no interest in leaving home to socialize with others.
He'll pass on the so-called "senior activities" and get-togethers. He would rather read in the library of his assisted-living facility in Burien.
Wanting to stay home makes doctor visits and routine checkups a bit difficult, though. But Devine, a small, spry man with a Scottish brogue and a mischievous smile, has that taken care of. He has a doctor make a house call to him about once a month for a checkup and to help coordinate any other medical care he needs.
Once considered on the verge of extinction, house calls are making a comeback.
In 1997, The New England Journal of Medicine called doctor house calls a "vanishing practice." But eight years later, a Journal of the American Medical Association article found from 1998 to 2004 the annual number of house calls increased 43 percent, to just over 2 million. For Devine, who doesn't have major medical problems and jokes he specializes in inactivity, having a doctor come to him is ideal. Though a bit forgetful about everyday things, he can easily recite Shakespeare from memory.
"To hell with the medicine, it's wonderful having her here," Devine said, sitting in his blue recliner while his physician, Dr. Sarah Babineau, checked his blood pressure, listened to his heart and went over some medical concerns and upcoming appointments. "There's nothing like it. We can talk and have conversations and I get my checkups."
Babineau works part time for Providence ElderPlace, a nonprofit for older adults that aims to keep them out of nursing homes and living in the community. The costs often are cheaper than nursing homes, said the program's referral specialist, Corina Kroll. Medicare or Medicaid pay for most services, which include hospitalizations, dental, vision, home care and prescriptions. The program also provides transportation for members to see physicians and participate in activities at its Rainier Valley facility. And it provides house calls.
For those who pay out of pocket, the costs are between $3,700 and $4,200 a month, which includes housing.
After his checkup is complete, Devine's routine with Babineau, who he says reminds him of his three daughters, is to walk down the hall for some coffee, then sit briefly in front of the fireplace in the library. The slower pace gives her more time to really care for her patients.
"Seeing people in their environment I get a better grasp of what their lives are like," said Babineau, who also is a full-time family doctor at Swedish Medical Center. "(In the clinic) time crunch is a huge thing for me. At home, I get to share special moments with these patients."
She spends Mondays, Thursdays and occasional Wednesdays driving to see her 55 to 60 patients around the Seattle area. She has so many, she can usually only visit once a month, but will add more appointments if necessary. The patients' average age is 80 and many suffer from advanced dementia. One of her patients is a 100-year-old woman still living on her own on Capitol Hill.
"We take care of a really frail population and if they're living independently we keep an eye on them," Babineau said. "A lot of these people would fall through the cracks and would be sent to a nursing home otherwise."
Several other programs around Seattle offer home visits to older patients. Doctors Home Visits, which calls house calls "an old concept renewed," offers a service area from Seattle to Lynden, just a few miles south of the British Columbia border. Carena Inc., headquartered in downtown Seattle, provides house calls or workplace doctor visits to employees of companies who contract their services.
For 10 years, The Home Doctor, located in the Tacoma suburb of Lakewood, has provided house calls to more than 500 homes in the greater Puget Sound area. The service started in 1998 after someone called the clinic asking if a physician could make a home visit.
The next call was to Medicare and Medicaid for authorization, said Home Doctor President Charles Plunkett. Once they figured out how to bill patients, they started with one home and expanded. Physicians, nurse practitioners and podiatrists visit adult family homes, assisted living facilities, homes for the mentally ill, Alzheimer's residences and skilled nursing homes, Plunkett said.
"Caring for the elderly in all settings is expensive in dollars, time and emotion," Plunkett said. "Just getting Grandma' " (or Grandpa) to the physician takes a toll on the patient, the family member or caregiver. Patients with dementia become agitated when out of their environment. Just sitting in a doctor's waiting room is stressful and exposes this vulnerable population to increased risk of sickness and infection."
He said an increasing number of specialists are not accepting Medicare or are limiting the number of patients. And adult family home and assisted living operators serving those on Medicare and Medicaid are dealing with flat revenues and increasing expenses.
"Care management is needed, but only available with HMO and special needs plans," Plunkett said. "Families are left to fend for themselves" and learn what he calls a Byzantine system.
For Babineau, who tries to recruit patients from her full-time practice to join Providence ElderPlace's program, she said even for her -- someone who is a part of the health care system -- it is difficult to navigate.
"A lot of people caring for their parents are living on the edge and this helps," she said. "This is long-term care the way it should be."
He'll pass on the so-called "senior activities" and get-togethers. He would rather read in the library of his assisted-living facility in Burien.
Wanting to stay home makes doctor visits and routine checkups a bit difficult, though. But Devine, a small, spry man with a Scottish brogue and a mischievous smile, has that taken care of. He has a doctor make a house call to him about once a month for a checkup and to help coordinate any other medical care he needs.
Once considered on the verge of extinction, house calls are making a comeback.
In 1997, The New England Journal of Medicine called doctor house calls a "vanishing practice." But eight years later, a Journal of the American Medical Association article found from 1998 to 2004 the annual number of house calls increased 43 percent, to just over 2 million. For Devine, who doesn't have major medical problems and jokes he specializes in inactivity, having a doctor come to him is ideal. Though a bit forgetful about everyday things, he can easily recite Shakespeare from memory.
"To hell with the medicine, it's wonderful having her here," Devine said, sitting in his blue recliner while his physician, Dr. Sarah Babineau, checked his blood pressure, listened to his heart and went over some medical concerns and upcoming appointments. "There's nothing like it. We can talk and have conversations and I get my checkups."
Babineau works part time for Providence ElderPlace, a nonprofit for older adults that aims to keep them out of nursing homes and living in the community. The costs often are cheaper than nursing homes, said the program's referral specialist, Corina Kroll. Medicare or Medicaid pay for most services, which include hospitalizations, dental, vision, home care and prescriptions. The program also provides transportation for members to see physicians and participate in activities at its Rainier Valley facility. And it provides house calls.
For those who pay out of pocket, the costs are between $3,700 and $4,200 a month, which includes housing.
After his checkup is complete, Devine's routine with Babineau, who he says reminds him of his three daughters, is to walk down the hall for some coffee, then sit briefly in front of the fireplace in the library. The slower pace gives her more time to really care for her patients.
"Seeing people in their environment I get a better grasp of what their lives are like," said Babineau, who also is a full-time family doctor at Swedish Medical Center. "(In the clinic) time crunch is a huge thing for me. At home, I get to share special moments with these patients."
She spends Mondays, Thursdays and occasional Wednesdays driving to see her 55 to 60 patients around the Seattle area. She has so many, she can usually only visit once a month, but will add more appointments if necessary. The patients' average age is 80 and many suffer from advanced dementia. One of her patients is a 100-year-old woman still living on her own on Capitol Hill.
"We take care of a really frail population and if they're living independently we keep an eye on them," Babineau said. "A lot of these people would fall through the cracks and would be sent to a nursing home otherwise."
Several other programs around Seattle offer home visits to older patients. Doctors Home Visits, which calls house calls "an old concept renewed," offers a service area from Seattle to Lynden, just a few miles south of the British Columbia border. Carena Inc., headquartered in downtown Seattle, provides house calls or workplace doctor visits to employees of companies who contract their services.
For 10 years, The Home Doctor, located in the Tacoma suburb of Lakewood, has provided house calls to more than 500 homes in the greater Puget Sound area. The service started in 1998 after someone called the clinic asking if a physician could make a home visit.
The next call was to Medicare and Medicaid for authorization, said Home Doctor President Charles Plunkett. Once they figured out how to bill patients, they started with one home and expanded. Physicians, nurse practitioners and podiatrists visit adult family homes, assisted living facilities, homes for the mentally ill, Alzheimer's residences and skilled nursing homes, Plunkett said.
"Caring for the elderly in all settings is expensive in dollars, time and emotion," Plunkett said. "Just getting Grandma' " (or Grandpa) to the physician takes a toll on the patient, the family member or caregiver. Patients with dementia become agitated when out of their environment. Just sitting in a doctor's waiting room is stressful and exposes this vulnerable population to increased risk of sickness and infection."
He said an increasing number of specialists are not accepting Medicare or are limiting the number of patients. And adult family home and assisted living operators serving those on Medicare and Medicaid are dealing with flat revenues and increasing expenses.
"Care management is needed, but only available with HMO and special needs plans," Plunkett said. "Families are left to fend for themselves" and learn what he calls a Byzantine system.
For Babineau, who tries to recruit patients from her full-time practice to join Providence ElderPlace's program, she said even for her -- someone who is a part of the health care system -- it is difficult to navigate.
"A lot of people caring for their parents are living on the edge and this helps," she said. "This is long-term care the way it should be."
Friday, June 6, 2008
Bird flu detected in Hong Kong market
Hong Kong health workers slaughtered 2,700 poultry in a market Saturday after chickens were found to be carrying the dangerous H5N1 bird flu virus, officials said.
The slaughter may be extended to all live poultry in the territory if the virus is detected in any other locations, Secretary for Food and Health York Chow said.
"Since we have detected the virus in the market, we will cull all the chickens in this market," Chow told reporters. "If we find another positive detection in another market, then we will assume that the risk is much higher and we need to cull all the chickens in all the markets."
Hong Kong TV Cable showed health workers wearing protective gear placing live poultry from nine stalls into bags to prepare for the slaughter.
Routine bird flu checks detected the H5N1 virus in five samples of chicken waste. The samples were collected June 3 from three vendors in the market in the Sham Shui Po residential district, Chow said.
Health officials declared the market an infected area and suspended all sales of live poultry there, a government statement said.
Chow said authorities were tracing the origin of the infected chickens.
Chow also ordered a 21-day ban on the supply of live poultry from mainland China and from local farms.
Occasional H5N1 infections in wild birds are common in Hong Kong but the territory has not suffered a major outbreak of the disease since the virus killed six people in 1997.
That prompted the government to slaughter the territory's entire poultry population of about 1.5 million birds.
At least 241 people have died of bird flu worldwide since 2003, according to the World Health Organization.
Most human cases have been linked to contact with infected birds, but health experts worry the virus could mutate into a form that passes easily among humans, sparking a pandemic that might kill millions of people.
The slaughter may be extended to all live poultry in the territory if the virus is detected in any other locations, Secretary for Food and Health York Chow said.
"Since we have detected the virus in the market, we will cull all the chickens in this market," Chow told reporters. "If we find another positive detection in another market, then we will assume that the risk is much higher and we need to cull all the chickens in all the markets."
Hong Kong TV Cable showed health workers wearing protective gear placing live poultry from nine stalls into bags to prepare for the slaughter.
Routine bird flu checks detected the H5N1 virus in five samples of chicken waste. The samples were collected June 3 from three vendors in the market in the Sham Shui Po residential district, Chow said.
Health officials declared the market an infected area and suspended all sales of live poultry there, a government statement said.
Chow said authorities were tracing the origin of the infected chickens.
Chow also ordered a 21-day ban on the supply of live poultry from mainland China and from local farms.
Occasional H5N1 infections in wild birds are common in Hong Kong but the territory has not suffered a major outbreak of the disease since the virus killed six people in 1997.
That prompted the government to slaughter the territory's entire poultry population of about 1.5 million birds.
At least 241 people have died of bird flu worldwide since 2003, according to the World Health Organization.
Most human cases have been linked to contact with infected birds, but health experts worry the virus could mutate into a form that passes easily among humans, sparking a pandemic that might kill millions of people.
Thursday, June 5, 2008
Toe Implants offer Relief from Arthritis
Those who suffer from hallux rigidus, or degenerative arthritis of the big toe, have new reason to lace up their gym shoes. A new cartilage resurfacing implant may allow these patients to maintain their active lifestyle.
Hallux rigidus affects the large joint at the base of the big toe. While some joint wear and tear commonly occurs after age 30, doctors increasingly are seeing this type of arthritis in younger, more active patients, according to Dr. Howard Stone, a podiatrist with the North Shore Podiatry Group in Glenview, Lake Forest and Gurnee. Injury to the big toe joint also can cause arthritis.
People with arthritis of the big toe will have pain and stiffness while walking. Conservative treatments include wearing stiff-soled shoes or inserts. If those treatments don't work, options have included joint fusion or joint replacement. But both have drawbacks. The new Arthrosurface HemiCAP system was approved by the FDA in 2006 for treatment of moderate and advanced arthritis of the big toe. The system replaces damaged cartilage with contoured implants precisely matched to the patient's anatomy using three-dimensional mapping technology. Matching the curvature of the cartilage allows for proper function of the big toe joint.
Because the implant preserves the joint, it allows for an active lifestyle. Independent studies show that after this outpatient procedure, patients experience reduced pain, rapid recovery and significant range of motion. The HemiCAP implant also is being used in the shoulder, hip and knee. "This is the new wave of what's happening in orthopedics," said Dr. Howard Stone, a podiatrist with the North Shore Podiatry Group in Glenview, Lake Forest and Gurnee. "The implant is set into the same level of the remaining cartilage and acts as brand-new cartilage. You're not destroying the joint but resurfacing the joint.
"The procedure takes about 35 to 40 minutes for each foot, done a few months apart. It's done under twilight sedation, which falls between wakefulness and complete unconsciousness, and a local anesthetic. After the procedure, patients wear a removable cast for two weeks and then wear a gym shoe and begin physical therapy. Stone cautions that it's important to choose the patient properly. "This is for people with a moderate of amount of arthritis," he said. "If the joint is really destroyed, you can't do this." The implant should last around 20 years, about as long as an artificial joint, he said.
With joint fusion, surgeons remove the damaged joint between the two bones and allow the bones to grow together. Joint fusion eliminates arthritis pain, but it restricts movement of the big toe joint and limits the shoes that may be worn, especially for women. It's often used for older, less active patients.
Joint replacement involves replacing the joint surface with plastic, metal or a silicone compound. This procedure may relieve the pain and preserve joint motion. But artificial joints made of silicone can cause tissue reactions. And because so much bone and cartilage is removed, any future surgery is more difficult.As for the new treatment, "Long-term studies will show how effective this implant will be in allowing a patient to walk and how long the implant itself will last," said Dr. Tayeb S. Hussain, a podiatrist with Evanston Podiatric Surgeons who has done a few procedures. "I'd give it at least a year and a half until long-term studies are evaluated to know whether it's a standard procedure," he said.
"I reserve it for people with any cartilage deterioration. Women can return to wearing heels within three to four weeks. It's best for patients who have cartilage deterioration under age 60 who still want to be active."
Hallux rigidus affects the large joint at the base of the big toe. While some joint wear and tear commonly occurs after age 30, doctors increasingly are seeing this type of arthritis in younger, more active patients, according to Dr. Howard Stone, a podiatrist with the North Shore Podiatry Group in Glenview, Lake Forest and Gurnee. Injury to the big toe joint also can cause arthritis.
People with arthritis of the big toe will have pain and stiffness while walking. Conservative treatments include wearing stiff-soled shoes or inserts. If those treatments don't work, options have included joint fusion or joint replacement. But both have drawbacks. The new Arthrosurface HemiCAP system was approved by the FDA in 2006 for treatment of moderate and advanced arthritis of the big toe. The system replaces damaged cartilage with contoured implants precisely matched to the patient's anatomy using three-dimensional mapping technology. Matching the curvature of the cartilage allows for proper function of the big toe joint.
Because the implant preserves the joint, it allows for an active lifestyle. Independent studies show that after this outpatient procedure, patients experience reduced pain, rapid recovery and significant range of motion. The HemiCAP implant also is being used in the shoulder, hip and knee. "This is the new wave of what's happening in orthopedics," said Dr. Howard Stone, a podiatrist with the North Shore Podiatry Group in Glenview, Lake Forest and Gurnee. "The implant is set into the same level of the remaining cartilage and acts as brand-new cartilage. You're not destroying the joint but resurfacing the joint.
"The procedure takes about 35 to 40 minutes for each foot, done a few months apart. It's done under twilight sedation, which falls between wakefulness and complete unconsciousness, and a local anesthetic. After the procedure, patients wear a removable cast for two weeks and then wear a gym shoe and begin physical therapy. Stone cautions that it's important to choose the patient properly. "This is for people with a moderate of amount of arthritis," he said. "If the joint is really destroyed, you can't do this." The implant should last around 20 years, about as long as an artificial joint, he said.
With joint fusion, surgeons remove the damaged joint between the two bones and allow the bones to grow together. Joint fusion eliminates arthritis pain, but it restricts movement of the big toe joint and limits the shoes that may be worn, especially for women. It's often used for older, less active patients.
Joint replacement involves replacing the joint surface with plastic, metal or a silicone compound. This procedure may relieve the pain and preserve joint motion. But artificial joints made of silicone can cause tissue reactions. And because so much bone and cartilage is removed, any future surgery is more difficult.As for the new treatment, "Long-term studies will show how effective this implant will be in allowing a patient to walk and how long the implant itself will last," said Dr. Tayeb S. Hussain, a podiatrist with Evanston Podiatric Surgeons who has done a few procedures. "I'd give it at least a year and a half until long-term studies are evaluated to know whether it's a standard procedure," he said.
"I reserve it for people with any cartilage deterioration. Women can return to wearing heels within three to four weeks. It's best for patients who have cartilage deterioration under age 60 who still want to be active."
Wednesday, June 4, 2008
Too Much Medical Care Harmful?
Too much medical care could be harmful to your health.
That's what researchers concluded after examining the nations' hospitals and the care patients receive. Some hospitals and some areas of the country give patients more aggressive care -- meaning more tests, longer hospital stays and more procedures -- than others. And the extra treatment doesn't always translate to longer or better lives.
The 2008 Dartmouth Atlas of Health Care study, released Thursday, studied more than 4 million Medicare patients at nearly 3,000 hospitals across the country from 2001 through 2005 during the last two years of life.
The patients were 65 years and older and were treated for the top nine leading causes of death, including congestive heart failure, chronic pulmonary disease, cancer, dementia, coronary artery disease, chronic kidney failure, peripheral vascular disease, diabetes with organ damage and severe chronic liver disease.
The study found that depending on where patients lived and what hospital they went to, there were big discrepancies in how they were treated.
Researchers reasoned all medical care carries some risk, so the longer a patient is hospitalized and the more procedures and tests performed, the greater the risks, in addition to greater costs.
The more resources available at a hospital equaled more care and in turn, more chances for errors and complications, according to the study.
To help consumers better identify which hospitals are more or less aggressive with their care, Consumer Reports magazine launched the Consumer Reports Health Ratings Center, which ranks hospitals and soon will rate other health care providers.
Launched in conjunction with the Dartmouth study, the online tool at ConsumerReportsHealth.org lets consumers compare treatment approaches among hospitals for the nine serious chronic conditions in the study on a scale from 0 percent to 100 percent (the higher the percentage the more aggressive the treatment).
The percentile rank is based on the total number of hospital days and inpatient physician visits over the last two years of life. Next to each of the nearly 3,000 hospitals, there also are the patient out-of-pocket costs over the last two years of life.
For example, hospitals in New York and Los Angeles top the list of most aggressive care, while Scott & White Memorial Hospital in Temple, Texas, is the most conservative.
Seattle ranks on the lower, more conservative end of the spectrum when treating patients.
Of the 18 Seattle-area hospitals listed on the site, larger ones such as Swedish Medical Center, the University of Washington Medical Center and Virginia Mason had higher percentiles. They ranked 44 percent, 33 percent and 29 percent respectively.
Jefferson Healthcare in Port Townsend, St. Francis Hospital in Federal Way and Olympic Medical Center in Port Angeles ranked on the low end at 2 percent and 3 percent.
The numbers tend to be lower because the larger hospitals usually have more complicated cases, often referred to them by the smaller ones, according to the Washington Hospital Association.
The association said it was pleased with where Seattle and Washington as a whole fall on the Consumer Reports rankings, which indicates Seattle patients are getting the care they need and want, but are not getting a lot of unnecessary care.
"If we had any hospitals with exceptionally high scores, I would worry that patients were getting much more care than they needed or wanted," spokeswoman Cassie Sauer said.
"Spending hours and hours in medical appointments, tests and treatments -- particularly when there's no evidence they will make any difference -- could offer false hope, hurt quality of life, and create significant medical bills. I think many Americans assume that more care is better care, but that is certainly not always the case"
That's what researchers concluded after examining the nations' hospitals and the care patients receive. Some hospitals and some areas of the country give patients more aggressive care -- meaning more tests, longer hospital stays and more procedures -- than others. And the extra treatment doesn't always translate to longer or better lives.
The 2008 Dartmouth Atlas of Health Care study, released Thursday, studied more than 4 million Medicare patients at nearly 3,000 hospitals across the country from 2001 through 2005 during the last two years of life.
The patients were 65 years and older and were treated for the top nine leading causes of death, including congestive heart failure, chronic pulmonary disease, cancer, dementia, coronary artery disease, chronic kidney failure, peripheral vascular disease, diabetes with organ damage and severe chronic liver disease.
The study found that depending on where patients lived and what hospital they went to, there were big discrepancies in how they were treated.
Researchers reasoned all medical care carries some risk, so the longer a patient is hospitalized and the more procedures and tests performed, the greater the risks, in addition to greater costs.
The more resources available at a hospital equaled more care and in turn, more chances for errors and complications, according to the study.
To help consumers better identify which hospitals are more or less aggressive with their care, Consumer Reports magazine launched the Consumer Reports Health Ratings Center, which ranks hospitals and soon will rate other health care providers.
Launched in conjunction with the Dartmouth study, the online tool at ConsumerReportsHealth.org lets consumers compare treatment approaches among hospitals for the nine serious chronic conditions in the study on a scale from 0 percent to 100 percent (the higher the percentage the more aggressive the treatment).
The percentile rank is based on the total number of hospital days and inpatient physician visits over the last two years of life. Next to each of the nearly 3,000 hospitals, there also are the patient out-of-pocket costs over the last two years of life.
For example, hospitals in New York and Los Angeles top the list of most aggressive care, while Scott & White Memorial Hospital in Temple, Texas, is the most conservative.
Seattle ranks on the lower, more conservative end of the spectrum when treating patients.
Of the 18 Seattle-area hospitals listed on the site, larger ones such as Swedish Medical Center, the University of Washington Medical Center and Virginia Mason had higher percentiles. They ranked 44 percent, 33 percent and 29 percent respectively.
Jefferson Healthcare in Port Townsend, St. Francis Hospital in Federal Way and Olympic Medical Center in Port Angeles ranked on the low end at 2 percent and 3 percent.
The numbers tend to be lower because the larger hospitals usually have more complicated cases, often referred to them by the smaller ones, according to the Washington Hospital Association.
The association said it was pleased with where Seattle and Washington as a whole fall on the Consumer Reports rankings, which indicates Seattle patients are getting the care they need and want, but are not getting a lot of unnecessary care.
"If we had any hospitals with exceptionally high scores, I would worry that patients were getting much more care than they needed or wanted," spokeswoman Cassie Sauer said.
"Spending hours and hours in medical appointments, tests and treatments -- particularly when there's no evidence they will make any difference -- could offer false hope, hurt quality of life, and create significant medical bills. I think many Americans assume that more care is better care, but that is certainly not always the case"
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