Teenagers with positive attitudes about delaying sexual activity usually are less likely to become sexually active within the next year, according to a study in the January issue of the Archives of Pediatric and Adolescent Medicine, Reuters Health reports. Susan Gray of the Boston University School of Medicine and colleagues in 1999 surveyed 11,448 adolescents between ages 12 and 17 who reported never having had sexual intercourse. Of the 7,661 participants who also completed a follow-up survey in 2000, 7.5% of the boys and 10.1% of the girls reported having had sexual intercourse during the previous year, the researchers said.

The researchers used the “postponing sexual initiation” scale to identify teens at higher risk for initiating sexual intercourse. Gray said the scientifically-validated scale provided an accurate indication of the teens’ intent to initiate sexual activity. The boys and girls who indicated that they might or would initiate sex were significantly more likely to report having sex within the following year. According to Gray, the survey found that teens were less likely to initiate sexual activity if they:

Thought that their friends were not having sex;

Reported that they had not met the right partner;

Said that they had not been in a comfortable situation to have sex;

Reported that their parents and health care providers objected to it; and

Indicated that it was against their personal beliefs.The survey also indicated that the teens “were almost universally fearful of pregnancy and sexually transmitted infections,” Gray said, adding that the concern did not affect their decision to have sex in the next year.

The researchers said that the postponing sexual initiation scale might help pediatricians gauge adolescents’ views on the topic and be a valuable tool for measuring the effectiveness of sex education curricula, Reuters Health reports. “Teens’ beliefs and attitudes about sex determine their sexual intentions, and their sexual intentions determine their sexual activity,” Gray said, adding that parents and educators should do more than warn teens about pregnancy and STIs if they want to promote abstinence successfully (Hendry, Reuters Health, 1/10).

The abstract of the study is available online.

Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women’s Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women’s Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.

© 2007 The Advisory Board Company. All rights reserved. Continue reading →

UroToday – Consistent with a previous series of robotic-assisted laparoscopic radical prostatectomies (RALP) in over 2,500 patients, reported by Menon, et al., Dr. Vipul Patel presented his group’s data on 1,500 RALP patients and confirmed the high-quality outcomes of this procedure. In the online version of the Journal of Endourology, Dr. Patel reported on 1,500 men on whom he performed transperitoneal RALP.

The 6-port procedure began with ligation of the dorsal venous complex followed by bladder neck dissection and mobilization of the seminal vesicles. The cavernous nerves were released early in the operation – beginning at the prostatic apex and back to the base. The ligation of the pedicles was then accomplished. After removal of the prostate, the urethral anastomosis was performed using a double-armed 3-0 monocryl suture beginning posteriorly and continuing anteriorly on both sides. Patients underwent early return of diet and ambulation. Catheters were removed between days 4 and 7 following cystogram that demonstrated no anastomotic leak. Prospective data was collected including peri-operative variables, the EPIC questionnaire, SHIM scores, AUA symptom scores, pathology, OR time, EBL and length of hospital stay.

Mean OR time was 105 minutes, and mean EBL was 111cc. No patients received intraoperative blood transfusions and the post-operative transfusion rate was 0.4%. Remarkably, no patients required conversion to an open prostatectomy. In the first 25 cases there were 2 rectal injuries that were repaired primarily. The mean post-operative hematocrit change was 3.1 points with an average discharge hematocrit of 36%. Discharge to home occurred on post-operative day #1 in 97% of patients. Mean catheter time was 6.3 days and complications occurred in 63 patients (4.3%). The distribution of the most common complications were: hemorrhage in 8 patients, 22 anastomic leaks requiring longer catheter time, 5 episodes of urinary retention, 4 myocardial infarctions, 4 wound infections, 3 pulmonary embolisms, 3 incisional hernias, and 2 cases of deep venous thrombosis. Mean Gleason score was 6 and pathologic stage was T2a, T2b, T2c, T3a, T3b, and T4 in 15%, 3%, 60%, 14%, 6%, and 1%, respectively. Mean prostate volume was 50g. The positive surgical margin rate was 4% for pT2, 34% for pT3 and 40% for pT4. Distribution based on prostate volumes of 100gm revealed positive margin rates of 14.3%, 9.4%, and 5.9%, respectively.

These outcomes support the oncologic and peri-operative outcomes of RALP. Unfortunately, continence and potency outcomes are not reported in this article.

Patel VR, Palmer KJ, Coughlin G, Samavedi S
J Endourol. 2008 Oct;22(10):2299-305
doi:10.1089/end.2008.9711

UroToday Contributing Editor Christopher P. Evans, MD, FACS

UroToday – the only urology website with original content global urology key opinion leaders actively engaged in clinical practice.

To access the latest urology news releases from UroToday, go to:
www.urotoday

Copyright © 2008 – UroToday Continue reading →

Many cases of age-related neurodegenerative disease fall into the gray zone between big, defined diseases – Alzheimer’s or Parkinson’s, for example. Their diagnostic accuracy is low, researchers agree. That’s a problem, because mixed disease is not only common, but also quite different in its course from pathologically ‘pure’ disease. (Mixed disease is often worse.) But there’s also excitement and opportunity. The large overlap between established neurodegenerative diseases is ripe for scientific exploration, and recent advances at the genetic, clinico-pathologic, and molecular levels have turned it into a dynamic area of research. In particular, diseases such as Dementia with Lewy bodies and frontotemporal dementias are drawing intense interest as biomarker development branches out beyond Amyloid beta and tau, holding out a future where molecular-based diagnoses can define the pathogenic proteins that together drive a given person’s individual disease.

The Alzheimer Research Forum (www.alzforum), founded in 1996, is the web’s most dynamic scientific community dedicated to understanding Alzheimer disease and related disorders. Access to the web site is free to all. The Forum’s editorial priorities are as diverse as the needs of the research community. The web site reports on the latest scientific findings, from basic research to clinical trials; creates and maintains public databases of essential research data and reagents; and produces discussion forums to promote debate, speed the dissemination of new ideas, and break down barriers across the numerous disciplines that can contribute to the global effort to cure Alzheimer’s disease.

The ARF team of professional science writers and editors, information technology experts, web developers and producers all work closely with its distinguished and diverse Advisory Board to ensure a high quality of information and services. The Alzheimer Research Forum is an independent nonprofit organization supported by grants and individual donations. The web site does not endorse any specific product or scientific approach.

Source: Alzheimer Research Forum Foundation Continue reading →

The Premier healthcare alliance received the “Champion for Change” award from Practice Greenhealth (PGH) in recognition for leadership in advancing environmental best practices in healthcare. This marks the seventh consecutive year that Premier has been awarded this distinction.

The Champion for Change award is given to organizations that have demonstrated success in greening their own organizations and leadership in helping others improve their environmental stewardship. More than 80 Premier hospital alliance members were also honored by PGH across six categories.

Premier was selected for the award for its commitment to a clean environment, evidenced in its GreenHealthy™ program, led by the Premier Safety Institute . GreenHealthy includes Premier’s environmentally preferable purchasing program; an internal corporate-wide Yes to Green program; leadership education and “quick win” case studies on sustainability best practices; and SPHERE (Securing Proven Healthcare Energy Reduction (for the) Ecosystem), a collaborative climate and energy initiative to reduce the healthcare industry’s carbon footprint.

“According to the U.S. Environmental Protection Agency, pollution and other toxins in our environment can lead to neurological, respiratory, developmental and other chronic illnesses that are damaging the overall health of communities,” said Susan DeVore, Premier’s incoming president and CEO. “We are extremely proud of our environmental track record, which has successfully helped hospitals reduce greenhouse gas emissions; recycle floor coverings, lab solvents, and construction waste; purchase organically grown foods; and increase energy efficiency – all while improving the quality of patient care.”

Most recently, Premier launched its energy initiative, SPHERE, to help hospitals reduce their carbon footprint and energy costs with tools, resources and case studies for energy conservation, benchmarking energy consumption, and reverse auction purchasing strategies to purchase energy at a lower cost and include a portion from renewable sources. According to the Environmental Protection Agency, hospitals consume almost 50 billion kilowatt hours and spend almost $3 billion each year on electricity alone. If hospitals improved their energy efficiency by 30 percent, the annual electricity savings would be close to $1 billion, and 11 million fewer tons of carbon dioxide would be emitted – the equivalent of taking 2 million cars off the road.

“Premier and our members recognized early the need to reduce our energy consumption and rely more heavily on sustainable products and resources, and that foresight is paying off,” said Gina Pugliese, vice president, Premier Safety Institute. “Since launching our reverse energy auction program, we have delivered an estimated savings of more than $2.4 million to hospitals and avoided 10,500 tons of CO2 emissions.”

Details about the Premier’s environmental programs are available at premierinc/safety. Green Corner, one of Premier’s environmental Web resources, showcases hospital and supplier success stories about green initiatives that contribute to a safer, healthier community.

Source
Premier healthcare alliance Continue reading →

Heparin filled syringes that were tainted with Serratia marcescens bacteria have made at least 40 people ill in Illinois and Texas, and perhaps some other states. 20 of them were outpatients from Rush University Medical Center, Chicago, of whom 14 had to be hospitalized. They were all given antibiotics, responded well, and just one remains in hospital.

Heparin thins the blood; it is commonly used to clear out intravenous lines and catheters. Rush University says patients commonly use Heparin for cancer treatment, as well as several other conditions.

The batch which held the tainted syringes was made by Sierra Pre-Filled, Angier, North Carolina, USA. Authorities say Colorado, Florida and Pennsylvania have also received syringes from the same batch – however, no sicknesses linked to them have been reported in those states yet. Affected patients experience an elevated body temperature as well as chills. Although the condition has responded well to antibiotics, it can become serious.

Sierra Pre-Filled says it is working closely with the Centers for Disease Control and Prevention (CDC) as well as the FDA (Food and Drug Administration). The company has recalled the lot in question – Lot 070926H. Authorities and the company warn that more cases could appear until every syringe has been found and accounted for – it is crucial that doctors and health care professionals know about this alert.

Authorities say that anybody who does not feel well and thinks he/she was administered medication with one of these syringes should contact their doctor immediately.

It is still not known whether the syringes were the source of the contamination or the heparin medication. The CDC says it is working on the genetic fingerprinting on the bacteria to identify exactly how it may have contaminated the syringes.

About Serratia marcescens

S. marcescens is known to cause several eye infections, including conjunctivitis, keratitis, endophthalmitis, and tear duct infections. It is also commonly found in respiratory and urinary tracts of adults and children’s intestines. Most strains of this bacterium are resistant to the majority of antibiotics (fortunately, in this case, all patients responded well to the antibiotics).

S. marcescens is commonly present in the environment – it prefers damp conditions and thrives in bathrooms. Sometimes it can be identified in bathrooms with the naked eye when the tile grout becomes pinkish.

More information about S. marcescens

Continue reading →

The DH is to appoint a new ‘tsar’ with learning disabilities. They
will work alongside the current National Director for Learning
Disabilities Rob Greig.

As part of their role, the new tsar will co-chair, with Rob Greig,
the Learning Disabilities Taskforce.

National Director for Learning Disabilities, Rob Greig said:
“Appointing a person with learning disabilities to this salaried role
is a significant step forward. I hope other organisations follow our
lead and employ people with learning disabilities at the highest
possible level.”

Minister Liam Byrne spoke at the Learning Disabilities Today
conference today (Wednesday 23 November) and confirmed that ?40m
would continue to be identified for people with Learning Disabilities
through the Learning Disability Development Fund, which will be kept
in its present form until at least March 2008.

Minister Liam Byrne said: “To make sure that we are looking after
each other in society, we have to weave a web of care around the
individual. We have an ambitious agenda for people with learning
disabilities and are determined that they will have more choice and
independence in their lives.”

As part of the change to his role, from 1 April 2006, Rob Greig will
hand over the management of the Valuing People Support Team (VPST) to
the Care Services Improvement Partnership (CSIP), where the VPST are
based.

CSIP has appointed a new ‘National Programme Lead’ for learning
disabilities to champion the learning disability agenda within their
organisation. Sue Carmichael and Debra Moore, both currently Regional
Advisors within the VPST, will job share this role.

These changes bring the learning disability programme in line with
other teams, such as those for older people, mental health and
children, who have a dedicated National Director in addition to
senior people leading the change programme through CSIP.

Rob Greig said: “These moves will allow for more senior leadership
capacity around Valuing People and more resources to help the
Learning Disability Task Force take its work forward.”

Richard Humphries, Chief Executive of CSIP said “People with learning
disabilities face similar challenges to other people in society. They
want access to good healthcare, paid work, quality housing and to be
respected by the community as a whole. Bringing the VPST in to CSIP
will help us to achieve these things.”

Liam Byrne’s speech to Learning Disability Today conference is
available from:
dh Continue reading →

The Acting Administrator of the Centers for Medicare & Medicaid Services (CMS), Kerry Weems, announced that Wisconsin received approval to make important changes to BadgerCare, the State Children’s Health Insurance Program (SCHIP) in Wisconsin. These changes reflect the state’s ongoing efforts to restructure the BadgerCare program and its financing.

Congress is currently considering legislation that would reauthorize SCHIP nationally. CMS has urged Congress to focus legislation on enrolling poor children first, to eliminate SCHIP funding for adults and to strengthen requirements to avoid displacing private insurance coverage with SCHIP. The Wisconsin proposal was approved because it was consistent with these principles.

‘Today’s announcement shows how CMS and states can work together to ensure that children in low-income families have access to health insurance,’ said Weems.

With the approved changes, Wisconsin will be able to enroll children in families of four making up to $51,625 or 250 percent of the federal poverty level (FPL). The state initially had proposed expanding coverage to 300 percent of the federal poverty level, or $61,950 for family of four. However, to remain within the August 17, 2007, guidelines released by CMS to prevent ‘crowd out’ of private health insurance coverage at higher income levels, Wisconsin modified its request to seek approval to provide coverage to children in families earning up to 250 percent of FPL.

Wisconsin’s program also addresses ‘crowd out’ in SCHIP by requiring a waiting period prior to a family signing up for BadgerCare. Families that previously had access to employer-provided health insurance would be required to satisfy a longer period of uninsurance before signing up for BadgerCare. Additionally, Wisconsin has already moved two-thirds of the adults covered by BadgerCare into their Medicaid program and has agreed to move the remainder of adults off of the program.

‘We are making good progress in moving adults from SCHIP to Medicaid and focusing the program on poor children first,’ said Weems. ‘We look forward to continuing to work with Congress on SCHIP reauthorization.”

Wisconsin estimates that, through this expansion, an additional 7,600 children will be enrolled in BadgerCare. The state reported covering 56,627 children in low-income families in Fiscal Year 2006, and also estimates that about 92 percent of children below 200 percent of the federal poverty level have health insurance.

Centers for Medicare & Medicaid Services Continue reading →

A vaccine against pneumonia and invasive pneumococcal disease, a severe form of bacterial
infection, can substantially reduce hospital admissions and improve the survival of children in
developing countries, concludes a trial published in this week’s issue of The Lancet.

The
authors believe the vaccine should be made available to children in Africa, where rates of
severe invasive pneumococcal disease are up to ten times higher than in industrialised
countries.

Pneumonia causes an estimated 19% of the 10 million childhood deaths worldwide annually.

The bacterium Streptococcus pneumoniae is responsible for up to half of all cases of severe
childhood pneumonia in developing countries. It also causes serious bloodstream infections,
meningitis, and otitis media (inflammation of the middle ear).

Felicity Cutts (Medical Research Council, UK and WHO) and colleagues recruited children aged
6-51 weeks in The Gambia from August 2000 to February 2003. Children were randomly
assigned to receive either, three doses of diphtheria-tetanus-pertussis-Haemophilus
influenzae serotype b vaccine as a control (8719), or three doses of this tetravalent vaccine
mixed with a nine-valent pneumococcal conjugate vaccine (8718), with intervals of at least
25 days between doses. 333 of the 8189 children given the pneumococcal vaccine had an
episode of pneumonia confirmed by chest x-ray compared with 513 of 8151 in the control
group. The vaccine reduced the first episode of pneumonia diagnosed by chest x-ray by 37%
and reduced admissions to hospital by 15%. Disease caused by the types of pneumococcus
bacteria in the vaccine was lowered by 77% and overall child mortality by 16%.

The vaccine
also had a good safety profile.
Professor Cutts comments: “The trial results are highly promising, and provide us with a
clearer picture of the pneumococcal disease burden in Africa. In the control group, 65% of
invasive disease episodes were of serotypes contained in the nine-valent trial vaccine, and
48% were of serotypes in the licensed seven-valent vaccine. Vaccines containing more
serotypes could have an even greater effect. Identification of means to make pneumococcal
conjugate vaccines available as soon as possible to children who need them most is extremely
important.” (Quote by e-mail; does not appear in published paper)
In an accompanying commentary, Marilla Lucero and Gail Williams, write that studies on a
seven-valent (7PCV) and a nine-valent pneumococcal conjugate-vaccine (9PCV) in California
and South Africa, respectively found similar results on the impact of the vaccine against
pneumonia confirmed by chest x-ray. However, there is some uncertainty about the
comparability of results because of different methods used in reading radiographs.

The
Gambian trial had a higher reduction of incidence of radiological pneumonia and is the first to
show a reduction in hospital admissions and overall child mortality.

thelancet Continue reading →

The endocrinologic basis of pediatric critical illness hypergylcemia (CIH) differs depending on the disease processes. Researchers writing in BioMed Central’s open access journal Critical Care describe how both peripheral insulin resistance and primary beta-cell dysfunction can cause CIH in children.

Catherine Preissig and Mark Rigby from the Emory University School of Medicine, Atlanta, USA, studied 41 children receiving intensive care treatment. They found that those with respiratory failure only had CIH caused by elevated insulin resistance, while those with both respiratory and cardiovascular failure had CIH caused by primary beta-cell dysfunction. Preissig said, “Understanding the etiology of CIH may significantly impact disease course and therapeutic approach. Further studies must confirm whether insulin treatment is effective in both subgroups of patients”.

CIH is highly prevalent in pediatric critical illness; the authors estimate that approximately 20% of admissions to their ICU develop the condition. They found that as well as the etiological differences described above, patients with respiratory failure and cardiovascular failure also had more severe CIH than those with respiratory failure alone. Preissig concludes, “Understanding these differences and elucidating the pathogenesis of CIH may assist in developing individualized glycemic goals and treatment strategies in children with life-threatening illness or injury”.

###

Notes:

1. Hyperglycemia results from beta-cell dysfunction in critically ill children with respiratory and cardiovascular failure: a prospective observational study
Catherine M Preissig and Mark R Rigby
Critical Care (in press)


Article available at journal website: ccforum/

All articles are available free of charge, according to BioMed Central’s open access policy.

2. Critical Care is a high quality, peer-reviewed, international clinical medical journal. Critical Care aims to improve the care of critically ill patients by acquiring, discussing, distributing, and promoting evidence-based information relevant to intensivists. The journal is edited by Prof Jean-Louis Vincent (Belgium) and has an Impact Factor of 3.83

3. BioMed Central (biomedcentral/) is an STM (Science, Technology and Medicine) publisher which has pioneered the open access publishing model. All peer-reviewed research articles published by BioMed Central are made immediately and freely accessible online, and are licensed to allow redistribution and reuse. BioMed Central is part of Springer Science+Business Media, a leading global publisher in the STM sector.

Source: Charlotte Webber


BioMed Central Continue reading →

The Hall Technique, which uses preformed metal crowns pushed onto teeth with no dental injections or drilling, is favoured over traditional “drill and fill” methods by the majority of children who received it, reveals research published in the online open access journal BMC Oral Health. Tooth decay can be slowed, or even stopped, when it is sealed into the tooth by the crown.

Dr Nicola Innes, who led the Scottish research team at Dundee Dental Hospital and School, explained, “There has been a lot of debate in the UK over the best method to tackle tooth decay in children’s molars. Preformed metal crowns are not widely used in Scotland as they’re not viewed as a realistic option by dentists. We found, however, that almost all the patients, parents and dentists in our study preferred the Hall Technique crowns and also children benefited from them.”

Traditionally, dentists “freeze” a decayed tooth with an injection in the child’s gum, and then drill away the decay, and fill the cavity with a metal filling. This method can be uncomfortable for the child. The Hall Technique, however, is simple. The decay is sealed into the tooth by the crown and, as sugars in the diet are unable to reach it, the decay slows or even stops. 132 children in Tayside, Scotland, had one decayed tooth filled traditionally, and another decayed tooth managed with the Hall Technique. 77% of the children, 83% of carers and 81% of dentists preferred the Hall Technique to traditional “drill and fill” methods. Dentists reported that 89% of the children showed no significant signs of discomfort with the Hall Technique, compared with 78% for the traditional fillings.

Around one in two children in Scotland has visible tooth decay at the age of 5. Most children have to accept toothache as part of normal everyday life. Two years after receiving the Hall Technique crown, however, the children’s dental health significantly improved, with less pain, abscesses and failed fillings than with the traditional “drill and fill” methods.

Dr Innes concluded “Children, parents and dentists prefer the Hall Technique. It allows dentists to achieve a filling with a high quality seal, which means we can safely leave decay in baby teeth, and not be forced to drill it away. Hall crowns will not suit every child, or every decayed tooth in a child’s mouth, but dentists may find it a useful treatment option for managing decay in children’s back teeth.”

###

1. The Hall Technique uses preformed metal crowns (PMCs) filled with glass ionomer cement which are simply pushed onto the tooth with no caries removal as;

* PMC is cemented into place without tooth preparation or local anaesthetic injection

* Decayed dental tissue is not removed but sealed into tooth by PMC cement and so isolated from sugars in the diet.

2. Dentists ranked the degree of discomfort their patients experienced, and the children, their parents/carers and dentists stated if they preferred the Hall Technique or traditional methods of treatment.

3. A copy of the Hall Technique instruction manual can be found at: scottishdental/resources/HallTechnique.htm

4. The Hall Technique: A Randomized Controlled Clinical Trial of a Novel Method of Managing Carious Primary Molars in General Dental Practice; Acceptability of the Technique and outcomes at 23 months BMC Oral Health (in press)

Link to article. All articles are available free of charge, according to BioMed Central’s open access policy.

5. BMC Oral Health is an open access journal publishing original peer-reviewed research articles in all aspects of the prevention, diagnosis and management of disorders of the mouth, teeth and gums, as well as related molecular genetics, pathophysiology, and epidemiology. BMC Oral Health (ISSN 1472-6831) is indexed/tracked/covered by PubMed, CAS, Scopus, EMBASE, and Google Scholar.

6. BioMed Central (biomedcentral/) is an independent online publishing house committed to providing immediate access without charge to the peer-reviewed biological and medical research it publishes. This commitment is based on the view that open access to research is essential to the rapid and efficient communication of science.

Source: Charlotte Webber

BioMed Central Continue reading →