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Patient communication has room to grow, study shows

There's room - and need - for improvement in the discussions between doctor and patient that go into medical decision-making, according to research out on Monday. In four studies and a commentary published in JAMA Internal Medicine, the authors look at various aspects of doctors' dialogue with patients about prognoses, options and treatment preferences and find little consistency. And though not all patients want the responsibility of making treatment decisions, medical organizations have long promoted the idea of patient-centered care through shared decision-making, and the 2010 Affordable Care and Patient Protection Act that goes into effect next year incorporates the idea into law. What's more, “When physicians reach out and communicate to patients that their views are welcome, patients really like that a lot,” said Floyd Fowler, senior scientific advisor for the Informed Medical Decisions Foundation in Boston. But research in the past decade showed that U.S. patients with common medical conditions were not being adequately informed about their treatment options, so Fowler and his colleagues wanted to see if anything had changed recently. They surveyed 2,718 U.S. adults who were over 40 years old in 2011 and had seen a doctor for any of the five most commonly treated medical conditions - high blood pressure and cholesterol, prostate and breast cancer screenings and back and knee problems - during the previous two years. They found that doctors tended to discuss the pros and cons of surgeries, but not of cancer screenings or the choice of medication to treat high blood pressure or cholesterol. “Each decision has its own dynamic, and it's intriguing that the heart risk related discussions weren't very good,” said Fowler, the study's lead author. He added that doctors may view back and knee surgeries as more complicated treatments, which is why they were discussed in more detail. In a separate study of 207 kidney patients from two dialysis centers in Boston, researchers found that doctors rarely discussed very sick patients' prognoses or their eligibility for kidney transplants. Dialysis patients tend to have one- and five-year survival rates comparable to those of many cancer patients, Dr. Melissa Wachterman, a palliative care physician with the VA Boston Healthcare system, and her colleagues point out in their report. “Talking about prognosis is tough, but there are a lot of reasons why there is a benefit for patients to have this information if they want it,” Wachterman said. In their study, Wachterman's team interviewed 60 of the sickest dialysis patients and their doctors about expectations for the patients' survival and to what degree they had been discussed. The researchers found only two patients whose doctors may have discussed their prognosis with them, and that more than half of the doctors said they would refuse to discuss prognoses - even if patients asked. “I think we do a disservice to patients if we don't give them a sense that time could be short, because they have a lot that they want to do with the time they have left,” Wachterman said. In addition, the researchers found that while patients were good judges of whether or not they'd live another year, they tended to overestimate their long-term survival without their doctors' guidance. “I think - in the long term - having this kind of information can actually give people hope and the ability to plan,” Wachterman said. But not everyone may want to play an active role in their care, according to Dr. Mack Lipkin, a professor of medicine at the New York University School of Medicine and the Bellevue Hospital Center in New York City. “There are many people who want to be active participants in their care but there are also many people who prefer not to be so active,” said Lipkin, who wrote an editorial accompanying the new research. That's supported by a study of hospitalized patients, led by Hyo Jung Tak of University of Chicago, which found the vast majority wanted information on their illness and treatment options but more than 70 percent wanted doctors to make their medical decisions. Moreover, Tak's group found that patients who preferred to participate in decision-making were more expensive. They stayed, on average, an extra quarter day in the hospital and racked up $155 to $1,576 more in costs. Still, a study led by Dr. Harlan Krumholz, of Yale University School of Medicine in New Haven, Connecticut, surveyed 7,000 heart attack patients and found more than two-thirds preferred to play an active role in decision-making. A quarter of the respondents preferred to be the sole decision-maker. At the very least, Krumholz's report concludes, doctors “who aspire to provide patient-centered care” should ask patients about their decision-making preferences directly. Lipkin also said it's best to ask patients their preferences. “We think the first thing to do is ask the patient what they'd like to know, how they'd like to learn it and then tell them,” he said. Fowler added that patients who want to be a part of the decision process shouldn't be afraid to speak up, and he hopes they get used to sharing in the process as the Affordable Care Act emphasizes shared decision-making initiatives. “We're hoping these types of changes that are in the works really happen… and that when we repeat the study three or four years from now we'll start to see a difference. That would be great,” he said.source : http://www.foxnews.com/health/2013/05/28/patient-communication-has-room-to-grow-study-shows/

Research identifies a way to make cancer cells more responsive to chemotherapy

Dr. Shawn Li, PhD, and his team at Western’s Schulich School of Medicine & Dentistry, identified that a protein called Numb functions to promote the death of cancer cells by binding to and stabilizing a tumor suppressor protein called p53 -a master regulator of cell death. The scientists found when Numb is reduced or methylated by an enzyme called Set8, it will no longer protect p53. …

Heading to the beach? New SPF regulations issued by the FDA

In the summer of 2011, Andrea Syglowski noticed a mole she’d had her entire life was starting to look different. Concerned, she booked an appointment with a dermatologist, and within a week was diagnosed with stage-0 melanoma – an early phase of the deadliest type of skin cancer. A week later, Syglowski, a Philadelphia-based actress who is in her 20s, underwent surgery to remove the mole, leaving her with a five-inch scar on her leg. Syglowski said that while she used sunscreen before her diagnosis, she now realizes she didn’t always use it correctly. “I think all I knew was that I needed to have it on,” Syglowski told FoxNews.com. Skin cancer affects millions of people like Syglowski every year, but many remain confused about the basic rules of sunscreen application. However, the Food and Drug Administration (FDA) has recently implemented new changes to sunscreen labeling, which aim to clear up some of the confusion. Here’s what to look for on sunscreen labels this summer. ‘Broad spectrum’ protection There are two types of ultraviolet light: UVA and UVB rays.  Currently, all sunscreens contain UVB protection, which shields the skin against cancer-causing sunburns. But not all sunscreens are required to have UVA protection, which protects against both skin cancer and aging. “UVB is what causes a sun burn; UVA doesn’t sunburn you. But now, we want something more. We want sunscreens to prevent cancer and wrinkles in addition to sunburn,” Dr. James Spencer, a member of the American Academy of Dermatology and a board certified dermatologist in St. Petersburg, Fla., told FoxNews.com. According to the new FDA guidelines, new sunscreen labels can only claim that they offer “broad spectrum protection” if they protect against both UVA and UVB rays. “When we say broad spectrum, we mean we're covering both UVA and UVB as wide in the spectrum as we can cover,” pharmacist Ian Ginsberg, owner of C.O. Bigelow in New York City, told FoxNews.com. Furthermore, sunscreens can now only claim to “prevent cancer” and “prevent wrinkles” if they contain both UVA and UVB protection. “It turns out that UVA contributes to cancer and wrinkles but not to burns. So now we’re asking sunscreens to help (protect us) from cancer and wrinkles too; we want that UVA added in,” Spencer said. ‘Water resistant’ not ‘waterproof’ Waterproof sunscreen may sound like a great option, but according to Spencer, “there’s no such thing as waterproof.” Sunscreen companies must now remove the word “waterproof” from their labels and replace it with the phrase “water resistant,” according to the new FDA guidelines. A “water resistant” sunscreen will be less likely to wash off in water, but doctors warn that it still needs to be reapplied. To make sure people remember to lotion up again after getting wet, the FDA now requires all sunscreens to state whether they are water resistant for “40 minutes” or “80 minutes.” “So that gives you an idea…how long you’re good for; that’s useful information,” Spencer said. And if you’ve had the same tube of sunscreen for the entire summer – you’re doing something wrong. “One tube should only last two weeks, and if you’re going to the beach, (it should last) for a week,” Dr. Hooman Khorosani, assistant professor of dermatology and chief of division of Mohs, reconstructive and cosmetic surgery at the Icahn School of Medicine at Mount Sinai in New York City, who also treated Syglowski, told FoxNews.com. Don't forget to take note of the expiration date on your tube of SPF either. Expired sunscreen could be less effective.  “Most people throw these things in their beach bag and/or let them sit in direct sunlight for hours on end so you should live by the (expiration) date,” Ginsberg said.  SPF 30, not SPF 100 Resist the urge to reach for the highest SPF on the shelf.  It likely won’t offer any more protection, according to doctors. “An SPF 30 blocks 97 percent of UBV rays - SPF 45 blocks 98 percent. Once you get to 98 percent, it’s getting a little silly. And SPF 100 is a little misleading,” Spencer said. “You can’t get more than 100 percent blocked.” Spencer said the FDA is considering prohibiting sunscreens labeled higher than SPF 50, but due to objections from sunscreen companies, the change is still being negotiated.   In the meantime, Spencer recommends looking for an SPF of at least 30 and reapplying sunscreen every few hours. Syglowski – who has now been melanoma-free for nearly two years – says she is much more vigilant about sunscreen application and schedules regular skin checks with Khorosani – something she encourages other women to do as well. As for Khorosani, he said one technique seems to be particularly effective at encouraging patients to be vigilant about sun protection. “I have a photo of a patient who sat by the window every day. The left side of her face, which was facing the window, was being hit by (wrinkle-causing) UVA rays, so it looks like she’s 50. The right side looks like she’s 35,” Khorosani said. “All I need to do is show that photo to the women who come in.”  source : http://www.foxnews.com/health/2013/05/22/heading-to-beach-new-spf-regulations-issued-by-fda/

New tumor-killer shows great promise in suppressing cancers

This molecule is based on a natural protein present in human breast milk, which has been found to have strong and wide-ranging tumour killing properties when bound to certain lipids. Lipids are organic molecules like amino acids and carbohydrates, made up of carbon and hydrogen, and help to store energy and to form biological membranes. …

Poliovirus vaccine trial shows early promise for recurrent glioblastoma

The treatment, developed at Duke and tested in an ongoing phase 1 study, capitalizes on the discovery that cancer cells have an abundance of receptors that work like magnets drawing the poliovirus, which then infects and kills the cells. The investigational therapy, known as PVSRIPO, uses an engineered form of the virus that is lethal to cancer cells, while harmless to normal cells. …

Bunions should be blamed on genes, not shoes, study shows

Bunions are likely inherited and not caused by faulty footwear, Counsel and Heal reported. Bunions are a painful foot condition characterized by bony bumps that form on the joint at the base of the big toe.  Earlier research indicates that 23 percent of people 18 to 65 years of age and 36 percent of people over the age of 65 have bunions. The new study, published in the journal Arthritis Care and Research, analyzed information from 1,370 people, with an average age of 66 years old, who were enrolled in the Framingham Foot Study. Each participant received a foot exam between 2002 and 2008 to screen for bunions, toe deformities or plantar soft tissue atrophy, a breakdown of the fatty “cushion” under the ball of the foot, Counsel and Heal reported. The study found that 31 percent of participants had bunions and 30 percent had toe deformities like “hammer toes,” both of which were highly inheritable, depending on age and sex, especially among people of European descent. Twenty-eight percent had plantar soft tissue atrophy, but this condition was not found to inheritable.                 “Our study is the largest investigation of the heritability of common foot disorders in older adults, confirming that bunions and lesser toe deformities are highly inheritable in Caucasian men and women of European descent,” Dr. Marian Hannan from Hebrew SeniorLife and Harvard Medical School in Boston said in a news release. “These new findings highlight the importance of furthering our understanding of what causes greater susceptibility to these foot conditions, as knowing more about the pathway may ultimately lead to early prevention or early treatment,” she concluded. Click for more from Counsel and Heal.source : http://www.foxnews.com/health/2013/05/20/bunions-should-be-blamed-on-genes-not-shoes-study-shows/

Childhood ADHD tied to obesity decades later

Boys who are diagnosed with attention-deficit/hyperactivity disorder (ADHD) in elementary school are more likely to grow up to be obese adults than those who don't have the condition, a new study suggests. Researchers surveyed two groups of 41-year-old men and found those with a history of ADHD were 19 pounds heavier than their non-ADHD counterparts, on average. The findings are consistent with past studies that looked only at children or only at adults and linked ADHD to extra pounds, researchers said. “There's definitely been enough research now where it does appear there is some connection between these two disorders,” said Sherry Pagoto, who has studied ADHD and obesity at the University of Massachusetts Medical School in Worcester. Data for the new study came from 207 white boys with ADHD who were referred to a research clinic at around age eight and followed as they grew up. Ten years later another group of teenage boys without ADHD, who were otherwise similar to the original participants, were added to the study. By the time they were asked to report their weight at age 41, 111 men from each group were still in the study. On that survey, men with a history of ADHD reported weighing 213 pounds, on average, and 41 percent of them were obese. In comparison, men without ADHD weighed in at an average of 194 pounds, and 22 percent qualified as obese, Dr. F. Xavier Castellanos from the Child Study Center at NYU Langone Medical Center in New York and his colleagues wrote in Pediatrics. “As we learn more about the regions of the brain that may be implicated in obesity, they overlap with brain regions implicated in ADHD,” Castellanos told Reuters Health. “The reward system seems to be relevant to both conditions.” In addition, he added, “There is the speculation that the obesity is at least partly reflecting some of the impulsivity, poor planning and the difficulty in making choices” that come with ADHD. Pagoto, who was not involved in the new research, agreed that young people with the disorder could be more impulsive when it comes to their food choices and may also spend more time in front of screens than their peers. “Parents of children who have ADHD should pay special attention to how that child's weight is changing over time, knowing that they may be at greater risk for becoming obese,” she told Reuters Health. “If they're at higher risk of obesity, that may bring other things with it,” such as type 2 diabetes, she added. Contrary to the study team's hypothesis, they found that men who no longer had their childhood ADHD symptoms were especially likely to be obese - not those who still had persistent attention and hyperactivity problems. Pagoto agreed that finding was unexpected and said the study may simply have been too small to tease out reliable differences among adults with a history of ADHD. According to the U.S. Centers for Disease Control and Prevention, parents report that close to one in ten kids and teenagers has been diagnosed with ADHD. Boys are more than twice as likely to be diagnosed as girls. Castellanos recommended parents of children with ADHD make sure their kids are getting enough exercise and help them cut back on sugary drinks and other high-calorie food choices.source : http://www.foxnews.com/health/2013/05/20/childhood-adhd-tied-to-obesity-decades-later/

What do we eat? New food map will tell us

Do your kids love chocolate milk? It may have more calories on average than you thought. Same goes for soda. Until now, the only way to find out what people in the United States eat and how many calories they consume has been government data, which can lag behind the rapidly expanding and changing food marketplace. Researchers from the University of North Carolina at Chapel Hill are trying to change that by creating a gargantuan map of what foods Americans are buying and eating. Part of the uniqueness of the database is its ability to sort one product into what it really is - thousands of brands and variations. Take the chocolate milk. The government long has long classified chocolate milk with 2 percent fat as one item. But the UNC researchers, using scanner data from grocery stores and other commercial data, found thousands of different brands and variations of 2 percent chocolate milk and averaged them out. The results show that chocolate milk has about 11 calories per cup more than the government thought. The researchers led by professor Barry Popkin at the UNC School of Public Health, are figuring out that chocolate milk equation over and over, with every single item in the grocery store. It's a massive project that could be the first evidence of how rapidly the marketplace is changing, and the best data yet on what exact ingredients and nutrients people are consuming. That kind of information could be used to better target nutritional guidelines, push companies to cut down on certain ingredients and even help with disease research. Just call it “mapping the food genome.” “The country needs something like this, given all of the questions about our food supply,” says Popkin, the head of the UNC Food Research Program. “We're interested in improving the public's health and it really takes this kind of knowledge.” The project first came together in 2010 after a group of 16 major food companies pledged, as part of first lady Michelle Obama's campaign to combat obesity, to reduce the calories they sell to the public by 1.5 trillion. The Robert Wood Johnson Foundation agreed to fund a study to hold the companies accountable, eventually turning to UNC with grants totaling $6.7 million. Aided by supercomputers on campus, Popkin and his team have taken existing commercial databases of food items in stores and people's homes, including the store-based scanner data of 600,000 different foods, and matched that information with the nutrition facts panels on the back of packages and government data on individuals' dietary intake. The result is an enormous database that has taken almost three years so far to construct and includes more detail than researchers have ever had on grocery store items - their individual nutritional content, who is buying them and their part in consumers' diets. The study will fill gaps in current data about the choices available to consumers and whether they are healthy, says Susan Krebs-Smith, who researches diet and other risk factors related to cancer at the National Cancer Institute. Government data, long the only source of information about American eating habits, can have a lag of several years and neglect entire categories of new types of products - Greek yogurt or energy drinks, for example. With those significant gaps, the government information fails to account for the rapid change now seen in the marketplace. Now more than ever, companies are reformulating products on the fly as they try to make them healthier or better tasting. While consumers may not notice changes in the ingredient panel on the back of the package, the UNC study will pick up small variations in individual items and also begin to be able to tell how much the marketplace as a whole is evolving. “When we are done we will probably see 20 percent change in the food supply in a year,” Popkin says. “The food supply is changing and no one really knows how.” For example, the researchers have found that there has been an increase in using fruit concentrate as a sweetener in foods and beverages because of a propensity toward natural foods, even though it isn't necessarily healthier than other sugars. While the soda and chocolate milk have more calories on average than the government thought, the federal numbers were more accurate on the calories in milk and cereals. Popkin and his researchers are hoping their project will only be the beginning of a map that consumers, companies, researchers and even the government can use, breaking the data down to find out who is eating what and where they shop. Is there a racial divide in the brand of potato chips purchased, for example, and what could that mean for health? Does diet depend on where you buy your food - the grocery store or the convenience store…

Swine flu found in elephant seals

The H1N1 virus strain that caused a 2009 swine flu outbreak in humans was detected in northern elephant seals off the coast of central California. Scientists say this is the first time marine mammals have been found to carry the H1N1 flu strain, which originated in pigs. The seals seem to have picked up the virus while at sea, but it's unclear how this happened. “We thought we might find influenza viruses, which have been found before in marine mammals, but we did not expect to find pandemic H1N1,” Tracey Goldstein, an associate professor with the UC Davis One Health Institute and Wildlife Health Center, said in a statement. [10 Deadly Diseases That Hopped Across Species] “H1N1 was circulating in humans in 2009,” Goldstein added. “The seals on land in early 2010 tested negative before they went to sea, but when they returned from sea in spring 2010, they tested positive. So the question is where did it come from?” Contact with humans carrying the virus is unlikely when the elephant seals are at sea, because the creatures spend most of their time looking for food in a remote part of the northeast Pacific Ocean off the continental shelf. Exposure could have occurred through feces dumped out of shipping vessels passing through this area. The researchers noted in their report in the journal PLOS ONE this week that H1N1 has been detected in stool samples of hospital patients. Another possible avenue of transmission might have been contact with aquatic birds, thought to be reservoirs for other flu viruses, the researchers say. Goldstein and colleagues tested nasal swabs from more than 900 Pacific marine mammals from 10 different species from Alaska to California between 2009 and 2011. The elephant seals that were studied had been satellite tagged and tracked so that researchers could tell where they had been before and after they were tested for disease. H1N1 was detected in two northern elephant seals within days of their return to land after they went out to sea to forage for a few months. Antibodies to the virus were found in another 28 elephant seals. None of the seals had any signs of illness, which means marine mammals can be infected with zoonotic pathogens but be asymptomatic, the researchers said. The report recommends that people working with and around marine mammals need to take proper biosafety precautions to prevent exposure to diseases that could be quite harmful in humans, even if they don't cause illness in seals. The new research on marine mammals is part of an effort to understand emerging viruses in animals and people by the Centers of Excellence in Influenza Research and Surveillance program, funded by the National Institutes of Health. “The study of influenza virus infections in unusual hosts, such as elephant seals, is likely to provide us with clues to understand the ability of influenza virus to jump from one host to another and initiate pandemics,” Adolfo Garcia-Sastre, a professor of microbiology, said in a statement. Garcia-Sastre directs of the Global Health and Emerging Pathogens Institute at the Icahn School of Medicine, which collaborated with the team from UC Davis on the study. Copyright 2013 LiveScience, a TechMediaNetwork company. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.source : http://www.foxnews.com/health/2013/05/20/swine-flu-found-in-elephant-seals/