Health Agency Chief Apologizes for Federal Website Woes

By Karen Pallarito

HealthDay Reporter

TUESDAY, Oct. 29 (HealthDay News) -- The head of the federal agency responsible for HealthCare.gov issued a public apology Tuesday for problems that have plagued the health insurance website since its Oct. 1 launch.

"I want to apologize to you that the website has not worked as well as it should," Marilyn Tavenner, administrator of the U.S. Centers for Medicare and Medicaid Services, told members of the House of Representatives' Ways and Means Committee at a hearing on the Affordable Care Act.

Tavenner told the committee that the website problems were being fixed.

"We are seeing improvements each week, and as we've said publicly, by the end of November, the experience on the site will be smooth for the vast majority of users," she said.

Last week, the Obama administration announced that a "punch list" of website fixes have been identified and were being implemented to eliminate the bugs in the system and improve the consumer shopping experience.

Tavenner's apology comes one day before the Obama administration's top health official, Health and Human Services Secretary Kathleen Sebelius, is scheduled to testify before the House Energy and Commerce Committee.

Sebelius is expected to face tough questioning from committee members about the troubled rollout of the federal marketplace, a key component of the historic and controversial Affordable Care Act that is intended to bring health coverage to millions of uninsured Americans.

The law requires most Americans to have health insurance or pay tax penalties. But in light of the HealthCare.gov website foul-up, many Republicans and some Democrats are seeking a one-year delay of the penalties.

Tavenner admitted that the website's "initial experience has not lived up to our expectations or the expectations of the American people, and it is not acceptable."

"We are committed to improving the performance and have already made progress," she said, citing efforts to debug the site, add capacity and improve the consumer shopping experience.

Rep. Dave Camp (R-Mich.), chairman of the committee, repeatedly asked Tavenner for the number of people who have actually enrolled in health plans through the federal and state marketplaces. HealthCare.gov handles insurance registration for 36 states; the remaining 14 states and the District of Columbia operate their own sites.

"We will not have those numbers until mid-November," Tavenner said, noting that the initial number is expected to be small.

Camp expressed concern about preventing a spike in premiums if not enough young adults enroll in coverage. Tavenner said health-plan rates for 2014 are "very competitive."

The successful enrollment of younger, healthier adults is considered vital to the success of the Affordable Care Act -- sometimes called Obamacare -- because their premiums are expected to help offset the cost of care required by older, sicker Americans.

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Gardening, Housework May Help Boost Your Heart Health

Study of Swedish seniors found a reduced death risk of up to 30 percent

By Steven Reinberg

HealthDay Reporter

TUESDAY, Oct. 29 (HealthDay News) -- Activities such as gardening, do-it-yourself projects and housework may be as good as formal exercise when it comes to reducing the risk for heart attack and stroke, Swedish researchers say.

For people 60 and older, just keeping busy with daily activities can reduce the risk of cardiovascular problems by nearly 30 percent and even prolong life, they added.

Being on your feet and active cuts the time spent sitting around, pointed out lead researcher Elin Ekblom-Bak, of the Swedish School of Sport and Health Sciences and the Karolinska Institute, in Stockholm.

"Sitting is mainly replacing time you spend in daily activity and vice versa," Ekblom-Bak said. A recent study found long periods of sitting actually increased the risk for diabetes, cardiovascular disease and death, she noted.

"The results of this study showed that activities of daily life are as important as regular intentional exercise for older adults for cardiovascular health and longevity," she said.

But that doesn't mean formal exercise isn't important. "We saw that those who exercised regularly and that also had a daily physically active life had the lowest risk of all," Ekblom-Bak explained.

The time people spend exercising, however, is only a small part of the day, which leaves a lot of time for daily activities or sitting, she added.

For the new study, researchers collected data on more than 3,800 men and women in Sweden who were born in 1937 and 1938. Participants were asked about their lifestyle, which included information on their diet, whether they smoked or drank alcohol, and how physically active they were.

The participants were also asked how often they took part in activities, such as gardening, do-it-yourself projects, car maintenance and blackberry picking over the past year. They were also asked about any exercise they did.

To see how heart-healthy they were, the researchers examined the participants and took blood samples to assess levels of fat and sugar. They also checked for high levels of blood-clotting factor, which is linked to a raised heart attack and stroke risk.

During more than 12 years of follow-up, 476 of the participants died from or experienced a first heart attack or stroke, and 383 died from other various causes.

People whose daily activities kept them moving reduced their risk of a heart attack or stroke by 27 percent and the risk of dying from any cause by 30 percent, compared to people who spent the least amount of time on their feet.

"Promoting daily life activities is as important as recommending regular exercise for older adults for cardiovascular health and longevity," Ekblom-Bak said.

"This is particularly important for older adults as they tend to spend a greater portion of their active day performing non-exercise physical activity, as they often find it difficult to achieve recommended exercise intensity levels," she said.

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Activity, Brace May Ease Arthritis Pain

Oct. 30, 2013 (San Diego) -- Osteoarthritis can be painful, but exercise can improve the quality of life for people with OA or those at high risk for it, according to new research.

For people who have OA of the knee, a simple brace can ease pain greatly, another new study says.

Both studies were presented this week at the annual meeting of the American College of Rheumatology in San Diego.

OA, or the ''wear-and-tear'' arthritis linked with age, is the most common form of arthritis. Its symptoms include joint pain and stiffness. 

Even a little exercise can help, says study researcher Kai Sun, MD. She is a researcher at Northwestern University in Chicago.

She compared the quality of life in three groups:

Inactive peopleThose who did some exerciseThose who did the recommended 150 minutes of moderate to vigorous exercise each week

"The overall quality of life is better with each increasing level of physical activity," she says.

At the study start and then 2 years later, patients answered questions about their quality of life. This included their energy levels,  social interactions, and general health.

People who exercised some said they had 10 more days of good health a year.

People who met the recommended guidelines reported 20 more days of good health a year.

For people with a form of knee osteoarthritis that affects the kneecap, wearing a knee brace may help pain, says David  Felson, MD, MPH. He is a professor of medicine and epidemiology at Boston University School of Medicine.

Knee OA is marked by progressive damage to the joint cartilage, the cushioning material at the end of long bones. The damage can lead to weakened muscles, pain, and swelling.

Patients who wore a knee brace said it reduced pain by about 40% over 6 weeks, Felson says. Based on the study, he recommends a soft Neoprene-like brace, with a hole for the knee cap.

A doctor can best diagnose knee OA, he says.

Felson reports working as a consultant for Knee Creations. Arthritis Research U.K. funded the study. 

The findings of both studies make sense, says Milton Helfenstein Jr., MD, a professor of rheumatology at the Federal University of Sao Paulo in Brazil. 

He recommends both aerobic exercise and strength training for his patients. He tailors the recommendation to their weight and level of fitness. He suggests that someone who hasn't been exercising start with 15 minutes, three times a week, and work up.

Helfenstein also recommends knee braces for patients with the type of knee OA studied, patellofemoral OA. But he is not certain everyone would keep the brace on for the average of 7 hours that the patients in the study did.

He says the brace stabilizes the knee, reducing friction between joints. This lessens the pain.

These findings were presented at a medical conference. They should be considered preliminary, as they have not yet undergone the ''peer review'' process, in which outside experts scrutinize the data prior to publication in a medical journal.

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Screening for HPV May Be Better Than Pap Test, Study Suggests

Screening offered greater protection against cervical cancer three years after either test was given

By Robert Preidt

HealthDay Reporter

SATURDAY, Nov. 2 (HealthDay News) -- Screening for the human papillomavirus (HPV) is more effective than Pap tests for protecting women against invasive cervical cancer, a new study suggests.

HPV causes most cases of cervical cancer. In a Pap test, cells from the cervix are examined under a microscope for abnormalities that can lead to cervical cancer. In HPV-based screening, the cells are initially tested for HPV.

If cell changes or HPV are detected in either type of screening, the patient is notified and undergoes further screening and examination, followed by treatment if needed.

In this study, researchers analyzed data from four clinical trials in Europe that compared the Pap test and HPV-based screening. The data came from more than 175,000 women, aged 20 to 64, who were followed for an average of six and a half years after having one of the screening tests.

Both methods provided similar levels of protection against invasive cervical cancer for the first two and a half years after the screening tests. But for the remainder of the follow-up period, HPV screening offered 60 percent to 70 percent greater protection than Pap test screening, according to the study.

The findings were published in the journal The Lancet and presented Saturday at a European meeting of experts in cervical cancer control and HPV-associated diseases.

The increased protection offered by HPV screening was particularly notable in women aged 30 to 35. The researchers also found that HPV screening every five years was most protective against invasive cancers of the cervix, compared with Pap test screening done every three years.

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Treating Rheumatoid Arthritis Early May Cut Damaging Effects

Study suggests that delaying treatment leads to more joint inflammation, disability down the road

By Robert Preidt

HealthDay Reporter

SATURDAY, Oct. 26 (HealthDay News) -- Immediate and effective treatment for rheumatoid arthritis reduces the risk that patients will have joint damage and disability within a few years, a new study suggests.

The findings show the need for doctors to discourage patients from delaying treatment, according to the researchers at the Hospital for Special Surgery in New York City.

"We need to educate people diagnosed with rheumatoid arthritis about this. Some want to delay treatment because they are afraid. They haven't wrapped their heads around the fact that they have this disease, or they are reluctant to start taking medication. Some resort to non-medicinal approaches, many of which have limited effect," study lead investigator and rheumatologist Dr. Vivian Bykerk said in a hospital news release.

"Unfortunately, I have seen too many people delay effective treatment approaches and they come back a year later very disappointed, often with joint damage that could have been prevented. The longer you have inflammation in the joints, the more likely you are to have joint damage, and it is going to impact how you function down the road," she added.

The study included 833 patients with early rheumatoid arthritis -- defined as having symptoms for a year or less. Six months into the study, the patients were classified as having achieved low disease activity or not. Low disease activity means that joint pain, swelling and other signs of inflammation are significantly reduced.

The 56 percent of patients who achieved low disease activity at six months were much less likely to have joint damage and disability at two years, according to the findings to be presented Monday at the annual meeting of the American College of Rheumatology/Association of Rheumatology Health Professionals in San Diego.

"We believe there is a window in which people have a much better chance of getting rheumatoid arthritis under good control, often with less intense therapy, and the window is within the first three months of developing joint inflammation," Bykerk said.

These findings show the need for doctors to warn patients about the hazards of delaying therapy and to follow patients more often in the early stages of treatment, she added.

Research presented at medical meetings is considered preliminary until published in a peer-reviewed journal.

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Sebelius Says 'Hold Me Accountable' for Website 'Debacle'

By Karen Pallarito

HealthDay Reporter

WEDNESDAY, Oct. 30 (HealthDay News) -- U.S. Health and Human Services Secretary Kathleen Sebelius on Wednesday claimed responsibility for the failed rollout of HealthCare.gov and committed to fixing the website's many software and system problems.

"I am as frustrated and angry as anyone with the flawed launch of HealthCare.gov," Sebelius testified before the House of Representatives' Energy and Commerce Committee. "So let me say directly to these Americans: You deserve better, I apologize. I'm accountable to you for fixing these problems."

Sebelius, who testified under oath, appeared before members of Congress for the first time since the troubled Oct. 1 rollout of the federal health insurance marketplace that's intended to let millions of uninsured Americans purchase health-care coverage.

The secretary's much-anticipated remarks came amid a rising chorus of GOP calls in the House and Senate seeking her resignation. Sen. Lamar Alexander (R-Tenn.) on Tuesday joined at least two other Senators in calling for her to step down.

Sebelius is the second member of the Obama administration to testify this week. On Tuesday, Marilyn Tavenner, administrator of the Centers for Medicare and Medicaid, issued a public apology in testimony before the House Ways and Means Committee and discussed efforts to improve the website within a month.

On Wednesday, Sebelius admitted that "end-to-end" testing of the website had been inadequate. Now that problems are being identified and resolved, she said she expects HealthCare.gov to be functioning optimally by the end of November.

But in opening remarks, Energy and Commerce Committee Chairman Fred Upton (R-Mich) said the site was down early Wednesday morning when "we were hit with an error message."

Rep. Henry Waxman (D-Calif.), the committee's second-most senior member, compared the website glitches to early problems with the rollout of Medicare's prescription drug program, which took effect Jan. 1, 2006. He urged his fellow committee members "to stop hyperventilating."

As with the prescription drug program, "the early glitches with this program will soon be forgotten," he said.

The federal website is the entry point for millions of Americans in 36 states to enroll in health insurance plans that take effect in 2014 under the Affordable Care Act. People in 14 states and the District of Columbia may enroll through state-based health insurance exchanges, or marketplaces.

But since Day One, consumers attempting to access HealthCare.gov have experienced long wait times, timeouts and error messages, making it difficult to enroll for health-care coverage online.

In a heated exchange, Rep. Marsha Blackburn (R-Tennessee) pressed Sebelius for the names of people "responsible for this debacle."

"Hold me accountable for the debacle. I'm responsible," Sebelius said.

Along with the website foul-up, many committee members grilled the secretary on another issue: recent cancellations of individual health insurance policies.

Recalling President Barack Obama's oft-repeated promise to Americans that "if you like your health plan, you can keep it," Republican members told stories of constituents receiving cancellation notices from their insurers.

"We know that in the individual market, a number of the plans being sold are not 'grandfathered' and are not currently meeting the (health reform) law," Sebelius acknowledged.

Historically, people with individual insurance policies could be "locked out, priced out, dumped out" of their coverage. But new protections under the Affordable Care Act will prevent such abuses, she said.

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Broccoli Salad Kits Recalled by Taylor Farms

More than 5,000 pounds of broccoli salad kit products are being recalled by Taylor Farms because they contain salad dressing that may be contaminated with Listeria, the U.S. Department of Agriculture says.

The kits were shipped to distributors and delis for sale to consumers in Connecticut, Delaware, Maryland, Massachusetts, New Jersey, New York and Vermont, CNN reported.

The recalled products are boxes labeled "TAYLOR FARMS BROCCOLI CRUNCH WITH BACON AND DRESSING," with the case codes 310151 or 310153. They were produced on October 21, 22 and 23, and bear the establishment number EST. 34522 inside the USDA mark of inspection, the USDA said.

Listeria bacteria can cause a serious infection called listeriosis, which typically affects pregnant women, older adults, infants, and adults with weakened immune systems, CNN reported. The USDA said there have been no reports of illnesses associated with the recalled products.

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Lyrica May Ease Pain for Depressed Fibromyalgia Patients

Study finds drug safe, effective in combination with antidepressants

By Kathleen Doheny

HealthDay Reporter

MONDAY, Oct. 28 (HealthDay News) -- Fibromyalgia and depression often go hand in hand, and a new study finds that the drug Lyrica helps ease pain in patients being treated for both conditions.

Lyrica (pregabalin) is approved in the United States to treat fibromyalgia and nerve pain from diabetes and herpes, but little was known about its safety and effectiveness when also taken with antidepressants, the researchers explained.

"For those people with fibromyalgia who also have depression, which is very common, and who take an antidepressant but still have pain, taking [Lyrica] can reduce the severity of the pain while they continue on their antidepressant," said study author Dr. Lesley Arnold, professor of psychiatry and behavioral neuroscience at the University of Cincinnati College of Medicine.

"And it appears to be safe and tolerable for most people," Arnold added.

Arnold is scheduled to present the findings this week at the American College of Rheumatology annual meeting in San Diego. She is a consultant for Pfizer, the maker of Lyrica, and other pharmaceutical companies, including Takeda, Eli Lilly, AstraZeneca and others.

Fibromyalgia is a long-term syndrome that involves pain at different points throughout the body and tenderness in the joints, muscles, tendons and other soft tissues. The syndrome has been linked to fatigue, sleep problems, anxiety and depression, but its cause is unknown. Women aged 20 to 50 are most often affected.

The new study was done because the original research on Lyrica for fibromyalgia indications excluded people taking antidepressants, Arnold said. About 50 percent to 70 percent of those with fibromyalgia report a lifetime history of depression, and about one in four has taken antidepressants, Arnold said said.

For the new study, Arnold's team evaluated 197 patients, mostly women, with diagnosed fibromyalgia. Their average pain level was at least four on a scale of zero to 10, with 10 being the worst. All also had clinical depression and were taking antidepressants. Their average age was 50.

The researchers randomly assigned the patients to two six-week treatments, with a two-week break in between. Patients either got Lyrica or placebo the first six weeks, then received the other treatment for the next six-week period. They didn't know which treatment they were getting.

Lyrica was started at a dose of 150 milligrams (mg) a day and increased to 300 mg to 450 mg, based on response.

At the start, the average pain score was 6.7 of 10. After taking Lyrica, the pain score dropped to 4.84 and after taking the placebo it fell to 5.45. The drug worked better than placebo. "It was a noticeable improvement in pain," Arnold said.

Side effects with the drug included dizziness and drowsiness, Arnold said. Four serious adverse effects occurred but were unrelated to the drug, she said.

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Flu Can Kill Even Healthy Children, Study Finds

Unvaccinated kids are at greater risk, CDC researcher says

By Steven Reinberg

HealthDay Reporter

MONDAY, Oct. 28 (HealthDay News) -- Children, even those without severe medical conditions, can die from the flu in as little as three days after symptoms appear, U.S. health officials warn.

Between 2004 and 2012, flu complications killed 830 children in the United States, many of whom were otherwise healthy, according to the U.S. Centers for Disease Control and Prevention.

Most striking is that 35 percent of these children died before being hospitalized or within the first three days of developing symptoms, according to the report published online Oct. 28 in Pediatrics.

"We found these influenza-related deaths can occur in children with and without medical conditions and in children of all ages, and that very few of these children have been vaccinated," said lead author Dr. Karen Wong, a CDC medical epidemiologist.

Researchers who reviewed those deaths found that only 22 percent with a high-risk medical condition and just 9 percent without a significant medical condition had been vaccinated.

Wong doesn't know why so many children die so fast. "About a third of these children die within the first three days of their first reported symptoms," she said.

One expert wasn't surprised that many otherwise healthy children who died did so before being admitted to the hospital.

"First, parents don't realize that flu can be fatal," said Dr. Marcelo Laufer, a pediatric infectious diseases specialist at Miami Children's Hospital.

Second, parents of children with chronic diseases "know the system better, so they come earlier than healthy patients," he said.

Because flu can progress so quickly, prevention is really the best strategy, Wong said. "And that's why we recommend every child 6 months or older get vaccinated every year," she said.

Because an infant under 6 months of age can't be given flu vaccine, Wong said it is vital that pregnant women get a flu shot to help protect their newborn, and that everyone likely to be near the baby also be vaccinated so they can't pass flu to the infant.

Wong said children who get the flu need to be watched carefully. She recommends getting in touch with the child's doctor when symptoms start.

"That's especially true for kids with high-risk medical conditions and for very young children," she explained. "These children are at especially high risk for flu complications."

Laufer, however, said a phone call to the doctor isn't enough. "It's very difficult for a pediatrician on the other side of the phone to understand how sick the child really is," he said.

Parents should take their child to the doctor or emergency department if they're sicker than what one would expect with a common cold, he said.

"Parents should realize that influenza is much more than sniffles," Laufer added. "A kid with influenza is a kid who is very sick, is a kid who is lethargic, has decreased appetite, is not drinking as much and not urinating as much in addition to other flu symptoms," he said.

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Pennsylvania Governor Talks Up Plan To Expand Medicaid His Way

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Certain Rheumatoid Arthritis Drugs May Also Protect Patients' Hearts, Studies Find

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Balance Training Seems to Prevent Falls by Elderly

Researchers base findings on review of 17 studies

By Robert Preidt

HealthDay Reporter

TUESDAY, Oct. 29 (HealthDay News) -- Exercise programs meant to prevent falls in seniors may also help prevent injuries caused by falls, according to a new review.

Fall-related injuries are common among seniors and a major cause of long-term pain and disability. They also increase the risk of having to go to a nursing home and have a high economic cost.

The new findings, published online Oct. 29 in the journal bmj.com, suggest that "reducing the risk of falling and improving protective responses during a fall may be an important and feasible means of preventing fractures and other serious injuries in the elderly," the study authors wrote in a journal news release.

Well-designed exercise programs can prevent falls in seniors living at home, but there is a lack of evidence on whether such programs can help prevent fall-related injuries, said French researchers Fabienne El-Khoury and colleagues.

In this review, they analyzed 17 studies that looked at whether fall-prevention exercises lowered seniors' risk of fractures and other injuries caused by falls. More than 4,000 participants were involved in all.

Tai Chi was the exercise in two of the studies, but most of them used gait, balance, strength and functional training, which involves workouts that help people do normal daily activities.

Most of the programs reduced fall-related injuries and appeared to significantly curb falls that lead to fractures, serious injuries and medical care.

Balance training was emphasized in all of the exercises that were effective in preventing falls, the researchers noted.

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U.S. Malaria Cases Hit 40-Year High

Almost all the cases came from travelers to Africa, India, CDC says

By Robert Preidt

HealthDay Reporter

THURSDAY, Oct. 31 (HealthDay News) -- Malaria cases in the United States hit a 40-year high in 2011, federal health officials reported Thursday.

There were 1,925 cases of malaria that year, the highest number since 1971. That represents a 14 percent increase from 2010 to 2011.

Five people died from malaria or associated complications in 2011, according to a U.S. Centers for Disease Control and Prevention report.

Nearly 70 percent of the cases were imported from countries in Africa, and nearly two-thirds (63 percent) of those cases were acquired in West Africa. For the first time, India was the country from which the most cases were imported, CDC officials said.

"Malaria isn't something many doctors see frequently in the United States, thanks to successful malaria elimination efforts in the 1940s," CDC director Dr. Thomas Frieden said in an agency news release. "The increase in malaria cases reminds us that Americans remain vulnerable and must be vigilant against diseases like malaria because our world is so interconnected by travel."

Malaria is caused by a parasite transmitted by the bite of infected mosquitoes. There were about 219 million cases of malaria worldwide in 2010 and about 660,000 deaths from the disease.

Common symptoms of the disease include fever, headache, back pain, chills, increased sweating, muscle pain, nausea, vomiting, diarrhea and cough. Untreated infections can quickly lead to coma, kidney failure, respiratory problems, and death, the CDC said.

"Malaria is preventable. In most cases, these illnesses and deaths could have been avoided by taking recommended precautions," Dr. Laurence Slutsker, director of CDC's division of parasitic diseases and malaria, said in the news release.

Americans who travel to regions where malaria is present can protect themselves by taking antimalarial drugs and by using insect repellant, insecticide-treated bed nets, and protective clothing.

"We have made great strides in preventing and controlling malaria around the world. However, malaria persists in many areas and the use of appropriate prevention measures by travelers is still very important," Slutsker said.

The findings were published in the Nov. 1 issue of the CDC's Morbidity and Mortality Weekly Report.

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Why Insurers Cancel Policies, And What You Can Do When It Happens

Affordable Care Act: Cancellations ExplainedWhy Insurers Cancel Policies, And What You Can Do When It HappensWebMD News from Kaiser Health News

By Julie Appleby

Wed, Oct 30 2013

News that health insurers are ending the policies of what could be millions of Americans has rattled consumers and added to the debate over the health care law.

If you or a family member has been notified that your individual policy is being cancelled at year’s end, you may be stunned and upset.

House Republicans sparred with Health and Human Services Secretary Kathleen Sebelius Wednesday over the cancellations, with Sebelius saying the law generally didn’t require insurers to discontinue plans if they were in effect at the time of the law’s enactment in March 2010.

No one knows how many of the estimated 14 million people who buy their own insurance are getting such notices, but the numbers are substantial. Some insurers report discontinuing 20 percent of their individual business, while other insurers have notified up to 80 percent of policyholders that they will have to change plans.

Here is a guide to help you understand the bigger picture, including why your premiums and benefits are likely to change next year and what you should consider as you shop for a new policy.

Q. Why is this happening?

A. The so-called individual market was targeted by the health care law because it didn’t work well for many people who do not get coverage through an employer, particularly those who were older or had health problems. The latter were often rejected for coverage, charged more or had their conditions excluded from coverage.  Some policies were so skimpy they provided only the barest of coverage when someone did fall ill.

Starting Jan. 1, insurers can no longer reject people who are sick or charge them more than the healthy under the Affordable Care Act. They must also beef up policies to meet minimum standards and add benefits, such as prescription drug coverage, maternity care and mental health services.

Q. Why am I getting this notice?

A. Most likely your plan didn’t meet all the standards of the federal health law.  One type of policy being discontinued by Florida Blue, for example, did not cover hospitalizations or emergency room visits and paid a maximum of $50 toward doctor visits.  It’s possible your plan also had deductibles and other potential expenses - such as copayments for doctors and hospital care -- that exceeded the law’s annual out-of-pocket maximum of $6,350 for individuals or $12,700 for families. Insurers may have just decided to end certain types of policies, something they have always had the ability to do. Some policies that fail to meet the law’s standards can still be sold, but only if the insurer decides to continue them and they are “grandfathered,” meaning you purchased one before March 2010 and neither you nor the insurer has made any substantial change since then.  Adjusting an annual deductible, which many people do each year to keep down their premiums, is a change that could end grandfathered status.

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See expert answers to questions about health reform.

A guide to what's changing under the new law.

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Saturday Is National Prescription Drug Take-Back Day

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Single Dose of HPV Vaccine May Be Enough to Guard Against Cervical Cancer

Researchers found women who only got 1 of 3 recommended Cervarix doses still showed immune response 4 years later

By Dennis Thompson

HealthDay Reporter

MONDAY, Nov. 4 (HealthDay News) -- Just one dose of a human papillomavirus (HPV) vaccine may be enough to provide long-term protection against cervical cancer in women, a new study suggests.

The HPV vaccine is currently recommended as a three-dose series, but doctors have found it difficult to finish out the series for many girls.

However, the researchers discovered active human papillomavirus antibodies in Costa Rican women four years after they had received only one dose of Cervarix, a vaccine that protects against two HPV strains.

The study also found that women who received two doses six months apart appeared to have just as much antibody protection against HPV as those who received three doses.

Funded by the U.S. National Cancer Institute (NCI), the study was published in the November issue of Cancer Prevention Research.

HPV vaccination rates in the United States are low. In 2012, only about 54 percent of girls even received one dose, and just 33 percent went on to receive all three shots, according to a recent report from the U.S. Centers for Disease Control and Prevention.

But the impact of only having to get one or two doses of the vaccine would be felt most in developing countries, where cervical cancer death rates are higher but the high cost of the vaccine makes it difficult to protect all women.

"Vaccination with two or even one vaccine dose could simplify the logistics and reduce the cost of vaccination in the developing world, where more than 85 percent of cervical cancer occurs and it is the most common cause of cancer death in women," said study author Mahboobeh Safaeian, an investigator in the NCI's division of cancer epidemiology and genetics.

More than 275,000 women die from cervical cancer each year worldwide, making it the sixth-leading cause of cancer death, according to the World Health Organization. In the United States, active screening programs have reduced the cervical cancer death rate to about 3,900 women a year, according to the CDC.

HPV vaccine doses run about $130 apiece, according to the American Cancer Society, and cost is a big consideration, one expert noted.

"If you reduce the cost by a third, you can give it to three times as many people," said Dr. Shashikant Lele, clinical chief of gynecologic oncology at Roswell Park Cancer Institute, in Buffalo, N.Y. "If one dose is adequate to protect, we can vaccinate three times the number of women with the same amount of money."

Researchers made these findings during a clinical trial to test the effectiveness of Cervarix in women from Costa Rica.

They measured immune response to the vaccine in blood samples drawn from 78, 192 and 120 women who received one, two and three doses of the vaccine, respectively.

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RA Strategy: Treat Early, but With What Medicines?

Oct. 30, 2013 (San Diego) -- Most experts agree it’s best to treat rheumatoid arthritis early -- and some say aggressively -- as soon as the diagnosis is made.

But debate continues about what medications are best to use first, and in what combinations. Some experts think patients should use three medications, known as triple DMARDs (disease-modifying antirheumatic drugs), from the start. Others favor starting with a single medication.

The old mantra ''start low, go slow" is out the door, says Kam Nola, PharmD. She is an associate professor of pharmacy at Lipscomb University's College of Pharmacy in Nashville.

About 1.3 million Americans have RA, a chronic and potentially disabling disease that causes pain, stiffness, and swelling, and limits how joints work. The American College of Rheumatology recommends starting with methotrexate (Rheumatrex, Trexall) alone for most patients, then switching or adding other drugs if necessary. These include other DMARDs, as well as the more expensive injected biologics.

At a news conference Tuesday at the annual meeting of the American College of Rheumatology, several researchers shared study findings that looked at specific treatment strategies.

Here is what they found:

Using three traditional DMARD medications works better than a single drug, says Pascal de Jong, PhD. He is a researcher at Erasmus Medical Center in the Netherlands. He looked at 281 patients who had had symptoms less than 6 months.The patients received one of four treatments:

 Triple therapy included methotrexate, sulfasalazine and hydroxychloroquine, with corticosteroids either by pills or a muscle injection. Single therapy was methotrexate alone with either corticosteroid treatment.

''We saw that if you started the combination of DMARDs, you achieved low disease activity after 3 months," de Jong says. "It's very important to have disease control very early." The results lasted for a year.

Another plus of the triple regimen, he says: "If you start with the combination of DMARDS, you can more often taper the medications [as symptoms improve]."

The DMARD triple treatment was also more cost-effective, de Jong says. Those on it stayed more productive at work, he also found.

The triple DMARD treatment gives results similar to biologic drugs known as anti-TNFs (anti-tumor necrosis factor agents). This was true whether patients used the drugs in combination with methotrexate from the beginning, or if they added them 6 months later as a next step.

A benefit of the triple therapy: It’s less expensive, says researcher Kaleb Michaud, PhD, an assistant professor at the University of Nebraska Medical Center. Michaud looked at how cost-effective the treatments were. He also at looked at the patients’ quality of life. While all strategies worked equally well, the triple strategies were most cost-effective over the long term. The biologics cost nearly twice as much, Michaud says. In the future, this information could help doctors and their patients choose treatment options when cost is an issue.  

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Affordable Care Act Navigators Bypass Glitches

Affordable Care Act Navigators Bypass GlitchesThe serious problems that plague the Affordable Care Act web site have thrown thousands of health insurance \"navigators\" into uncharted waters. These designated helpers are making do by turning to handwritten applications, telephone hotlines, and outreach efforts.http://img.webmd.com/dtmcms/live/webmd/consumer_assets/site_images/article_thumbnails/news/2013/10_2013/obamacare_navigators_keeping_busy/69x75_obamacare_navigators_keeping_busy.jpgWebMD Health News

Nov. 1, 2013 -- The serious problems that plague the federal Affordable Care Act web site have thrown thousands of health insurance "navigators" into uncharted waters. These designated helpers are making do by turning to handwritten applications, telephone hotlines, and outreach efforts, say officials with programs in Ohio, Wyoming, and Nebraska.

"The technical difficulties with Healthcare.gov have led us to direct more traffic to the toll-free number and paper applications than we expected," says Amber Hansen, a coordinator with Community Action of Nebraska. "But culturally, many Nebraskans seem to be more comfortable using the toll-free number than the online service."

Like it or not, that may be the best option at the moment for thousands of Americans who need to apply for health insurance policies for 2014 but have been stymied by technical problems.

Thirty-six states are relying on the federal government to provide the online infrastructure for their residents to apply for coverage. But healthcare.gov has been largely unusable because of major technical problems.

Some of the web sites for the remaining 14 states and Washington, D.C., which are running their own Marketplaces, have had technical problems, too.

The New York Times reported this week that federal web site problems were stopping applications from being properly processed and were preventing some agents and brokers from registering so they could provide coverage.

The government-funded helpers known as navigators, assisters, and counselors don't have a magic wand to help them bypass the technical problems. But navigators have been trained, so they're still able to provide information, often with the help of web sites that explain the system and are still accessible, says Rebecka Brayton, a navigator coordinator with the Wyoming Senior Citizens organization.

"The federal web site has slowed our efforts, but we are working around it until such time it is able to catch up," Brayton says. "We are simply going to paper applications until we can do everything electronically.  I have also had great success with the call center and encourage people to use that if they would like to enroll that way."

Like Wyoming Senior Citizens, many social service agencies, health organizations, and religious groups have received government grants to offer navigator-type services to their communities. And like other parts of the Affordable Care Act, navigators have become a hot topic in political circles, especially in states dominated by legislators who aren't friendly to the Affordable Care Act.

Florida officials have debated whether navigators will get access to private information. In Ohio, officials created regulations that blocked navigators from quickly becoming certified to do their jobs.

The Ohio Association of Foodbanks, which received a federal grant of more than $3 million to provide helper services through a coalition of 12 organizations, has sent about 32 navigator employees through training and certification, executive director Lisa Hamler-Fugitt says. The association expects to reach the target of 40 helpers soon.

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Study of Twins Shows How Smoking Ages the Face

Siblings who smoked had more wrinkles, creases, droops and jowls

By Dennis Thompson

HealthDay Reporter

WEDNESDAY, Oct. 30 (HealthDay News) -- A study comparing the faces of identical twins confirms what many smokers fear -- the habit does prematurely age a person's skin, taking a serious toll on looks even after just five years.

Researchers from Case Western Reserve University in Ohio used the annual Twins Day Festival in Twinsburg, Ohio, to identify 79 pairs of twins in which one sibling smoked and the other didn't.

The twins who were smokers showed many more signs of skin aging, the researchers found. Their faces featured more wrinkles, creases, droops and jowls.

"Smoking harms virtually every organ in the body, including your skin," said Danny McGoldrick, vice president for research at the Campaign for Tobacco-Free Kids. "Whether you are doing it for vanity or your health, one of the most important health decisions of your life is not to start smoking, or to quit if you have."

The research team attended the Twins Day Festival every year between 2007 and 2010, eventually finding 79 pairs of twins to compare. The twins filled out questionnaires regarding their smoking and lifestyle, and professional photographers snapped individual pictures of them both.

A panel of three plastic surgeons then analyzed the twin's facial features, grading the amount of aging they saw in each person's face using a standardized assessment tool. The researchers used questionnaire results to control for other factors that might prematurely age skin, including sun damage, alcohol use and work stress.

Twins who smoke, when compared to their nonsmoking siblings, had worse scores for baggy eyes, baggy cheeks, smile lines and wrinkles along their upper and lower lips.

Researchers also compared the faces of twins who both smoke, but one of the pair had been smoking for at least five years longer than his or her sibling. They found more baggy eyes, baggy cheeks and lower-lip wrinkles in twins who had been smoking longer.

The judges identified the smoking twin as appearing older in photographs 57 percent of the time compared with the nonsmoking twin, and the twin who had smoked for a longer period of time was identified as older about 64 percent of the time.

The premature aging caused by smoking seemed to mainly affect the lower two-thirds of a person's face, the authors said. There were no apparent differences between smokers and nonsmokers when it came to forehead wrinkles or crow's feet, for example.

The study was published in the November issue of the journal Plastic and Reconstructive Surgery.

Smoking can affect a person's skin tone by robbing cells of needed oxygen, said Dr. Cheryl Healton, president and CEO of the anti-tobacco advocacy group Legacy.

"It's widely known that tobacco causes cardiac problems and disrupts oxygenation," Healton said. "Getting good oxygenation really affects a person's complexion."

Smoking also might cause wrinkles, folds and droops by damaging connective fibers like collagen and elastin that help maintain skin elasticity, the researchers added.

"A less taut skin envelope cannot counteract the effects of gravity," they said.

Healton said people should heed the findings as yet another reason to quit smoking immediately. As the study found, even five years can make a difference, she said.

"It's really bad to smoke, and it definitely affects your appearance," she said. "Not smoking is good for your looks."

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Blood Test for Pancreatic Cancer Shows Promise in Early Trial

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Scientists Report Transplant Advance for Type 1 Diabetes

Used in single patient, special chamber may allow implantation of insulin-producing cells without rejection

By Serena Gordon

HealthDay Reporter

MONDAY, Oct. 28 (HealthDay News) -- Using a specially designed chamber, an international research team has transplanted islet cells into a patient with type 1 diabetes.

The new technique avoided having to use immune-suppressing medications, while still allowing the islet cells to function and make insulin. In theory, the chamber "hid" the transplanted islet cells from the patient's immune system, the researchers explained.

Islet cells are normally found in the human pancreas. One critical function of these cells is producing insulin -- a hormone crucial for metabolizing the carbohydrates in food. In people with type 1 diabetes, an autoimmune disease, the islet cells have been destroyed by the body's own immune system.

"In order to transplant replacement cells, heretofore, the immune response to the foreign cells has had to be controlled with immunosuppression," explained study co-author Dr. Norman Block.

Now, he said, senior study author Dr. Stefan Bornstein "has found a way to implant foreign cells and protect them without using immunosuppression" -- drugs to dampen the immune system.

Medications used to suppress the immune system can come with significant risks and side effects.

The study was released online Oct. 28 in the Proceedings of the National Academy of Sciences.

Because their bodies lack working islet cells, people with type 1 diabetes no longer produce enough insulin to survive. They must take daily insulin injections or receive their insulin through a small catheter underneath the skin that's attached to an insulin pump.

Maintaining the proper levels is a difficult task. Too much insulin, and blood sugar levels can drop to dangerously low levels that at their worst can cause seizures and even death. Too little insulin, and blood sugar levels run high. Over time, these high levels can put someone with diabetes at risk of complications, such as vision problems and kidney disease.

Needed levels of insulin vary from person to person, and according to the types of food someone eats, how much they eat, how much they exercise and what type of stress they face.

Because islet cells can currently only be transplanted with the use of immune-suppressing drugs, the implant procedure is limited to patients who have difficult-to-control diabetes and experience repeated episodes of life-threatening low blood sugar levels. Immune-suppressing drugs have potential side effects, including the risk of infection and certain cancers.

To try to make the implant procedure available to more people, the researchers designed a semi-permeable chamber to house the islet cells, with the hope that the immune system wouldn't be able to "see" the new foreign cells.

However, when islet cells are first transplanted, they haven't established their own blood supply and aren't able to get oxygen when they're hiding in the chamber. For that reason, the current version of the device had an oxygen port on the outside of the body attached via tubing that had to be refilled daily by the patient for as long as a month or two, Block explained.

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So You Found An Exchange Plan. But Can You Find A Provider?

On Some Plans, Providers Are LimitedSo You Found An Exchange Plan. But Can You Find A Provider?WebMD News from Kaiser Health News

By Fred Mogul, WNYC

Fri, Nov 1 2013

Consumers shopping for coverage on the new health insurance exchanges have been focused on the lowest-cost options. But some shoppers are trying to determine which plans offer the widest array of doctors and hospitals - and are finding that can be trickier than it sounds.

John Batteiger applied for insurance coverage on the New York State exchange. But after he'd selected a plan, he had second thoughts: He'd forgotten to check if the plan he picked included a hospital near him.

Batteiger is 54 and healthy. But all things being equal, he figures, why not make sure his neighborhood hospitals are considered "in-network" with his insurance plans?

Turned out that wasn't so easy to figure out on his own. So he and Elisabeth Benjamin, a health exchange "navigator," are in a Manhattan office doing some digging.

After a little hunting and pecking, Batteiger learns that a nearby hospital, Lenox Hill, was not in the first plan he chose. Eventually he did find a plan that includes Lenox - and also brings his monthly premium down from about $290 to $230 per month.

"To save $60 a month - that's a really great thing," Batteiger says.

It's safe to say, however, that not everyone will be so lucky. New York City has a lot of hospitals to choose from, but many of them are considered in-network for only a few insurance plans. Sarah Thomas, vice president of public policy and communications at the National Committee for Quality Assurance, says health plans get better deals by limiting the number of in-network hospitals.

"If a health plan can say, 'Instead of five hospitals in this city, we're gonna have three,' than those three hospitals in the network can give some discounts to the health plan," she explains.

Insurers and hospitals are often locked in a tug-of-war over prices. Smaller clinics and doctors’ offices have a lot less leverage than hospitals - but they also need to make decisions about which insurance networks to join. And many are sitting on the sidelines.

Dr. Neil Calman, president of Family Health Institute, serves low-income residents in the Bronx, many of whom have complex health needs. He says some of the plans are offering "extremely low" medical reimbursement rates.

"They claim they are putting their premiums out on the street at a very low rate to make them affordable," he says. "But we can't afford to see these patients for the same amount of money that a private doctor in his office with one assistant can."

Calman accepts five plans. A handful of others wanted to pay him less than what he receives from Medicaid.

A trade association of New York doctors polled its members and found that three-fourths of them are either not participating in exchange plans or are unsure if they are.

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New Drug Shows Early Promise in Treating Parkinson's Psychosis

Pimavanserin may have fewer side effects than current therapy, study suggests

By Steven Reinberg

HealthDay Reporter

THURSDAY, Oct. 31 (HealthDay News) -- Many people living with Parkinson's disease suffer from hallucinations and delusions, but an experimental drug might offer some relief without debilitating side effects.

The drug -- pimavanserin -- appears to significantly relieve these troubling symptoms, according to the results of a phase 3 trial to test its effectiveness.

Such symptoms affect as many as half of the estimated 7 million to 10 million Parkinson's patients around the world, according to study background information.

Currently, patients are treated with antipsychotic drugs such as clozapine and quetiapine, which worsen Parkinson's motor symptoms, hasten mental decline, increase the risk of stroke and can be life-threatening, authors of the new study said.

Their study was published in the Nov. 1 online issue of The Lancet and funded by Acadia Pharmaceuticals, the makers of pimavanserin.

"There are no first-line approved treatments for psychosis in people with Parkinson's disease," said lead researcher Dr. Clive Ballard, a professor of age-related diseases at King's College, London.

"Existing antipsychotics are either ineffective or not tolerated. Pimavanserin is not yet licensed, but could potentially offer a change in the treatment of these distressing and impactful symptoms," he said.

An expert not involved with the study talked about the need for a medication alternative.

"The Parkinson's disease community has been waiting for a potentially new approach for the treatment of psychosis and hallucinations," said Dr. Michael Okun, national medical director of the National Parkinson Foundation.

"Pimavanserin may offer a relatively safe and reasonably efficacious choice for many patients in the situation where the current therapies are not adequate," Okun added.

The new drug works differently from other antipsychotics, study author Ballard said.

Pimavanserin blocks certain receptors -- called serotonin 5-HT2A receptors -- in the neocortex of the brain. This part of the brain is responsible for sensory perceptions, conscious thought and language, and is associated with hallucinations and delusions, Ballard explained.

For the trial, Ballard's team randomly assigned 199 Parkinson's patients suffering from disease-associated psychosis to daily doses either of pimavanserin or an inactive placebo pill.

After 43 days, patients taking pimavanserin showed a significant improvement on a scale of psychotic symptoms compared to those given a placebo -- 37 percent versus 14 percent.

However, this early study only provided short-term results, another expert pointed out.

Frances Weaver, director of the Center for Management of Complex Chronic Care at Hines VA Hospital, in Illinois, said although the trial was promising, more needs to be known about the long-term picture for this drug.

"The follow-up was only 43 days," she said. "It will be important to examine the long-term effects of this medication as psychosis is an ongoing problem which will likely require the patient to remain on medications for the rest of his life. Questions about long-term tolerability and effectiveness still need to be answered."

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Early HIV Treatment a Win-Win, Researchers Report

A cost-effective way to help patients stay healthy and prevent virus transmission, study finds

By Robert Preidt

HealthDay Reporter

WEDNESDAY, Oct. 30 (HealthDay News) -- Providing early antiretroviral drug treatment for recently infected HIV patients and their uninfected sexual partners is a cost-effective way to help patients stay healthy and prevent transmission of HIV, a new study finds.

The study, published Oct. 31 in the New England Journal of Medicine, looked at HIV patients in India and South Africa. Some of the patients received early antiretroviral therapy while the start of treatment was delayed for other patients. HIV is the virus that causes AIDS.

During the first five years of the study, 93 percent of those who received early antiretroviral therapy survived, compared with 83 percent of those whose treatment was delayed. Life expectancy was nearly 16 years for those in the early treatment group, compared with nearly 14 years for those in the delayed treatment group.

During the first five years, the potential costs of infections -- particularly tuberculosis -- prevented by early treatment of HIV patients in South Africa outweighed the costs of antiretroviral therapy drugs, suggesting that the early treatment strategy would reduce overall costs.

This was not the case in India, where the costs of treating HIV-related infections are less. Even so, early antiretroviral therapy in India was projected to be cost-effective according to established standards, the researchers said.

They also found that across patients' lifetimes, early antiretroviral therapy was very cost-effective in both countries. While most of the benefits of early treatment were seen in the HIV-infected patients -- fewer illnesses and deaths -- there were also added health care and economic cost savings from reducing HIV transmission, according to the study.

"By demonstrating that early HIV therapy not only has long-term clinical benefits to individuals but also provides excellent economic value in both low- and middle-income countries, this study provides a critical answer to an urgent policy question," study corresponding author Dr. Rochelle Walensky, of the Massachusetts General Hospital Division of Infectious Disease, said in a hospital news release.

"HIV-infected patients live healthier lives, their partners are protected from HIV, and the investment is superb," she added.

Walensky, a professor of Medicine at Harvard Medical School, said the findings point to a need to "redouble international efforts" to provide early antiretroviral therapy to any HIV-infected person who can benefit from it.

Her colleague, Dr. Kenneth Freedberg, director of the Medical Practice Evaluation Center at Massachusetts General, agreed.

"Some people have questioned whether providing early [antiretroviral therapy] to all who need it would be feasible in resource-limited countries," he said in the news release. "We've shown that in countries like South Africa, where it actually saves money in the short-term, the answer is 'yes.' We believe that continued international public and private partnerships can make this true in other countries as well."

Freedberg said such an investment could bring about dramatic decreases in infections and illness that could save millions of lives over the next decade.

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A Blood Test for Fibromyalgia?

Oct. 28, 2013 -- A new blood test may predict fibromyalgia, a condition that can be hard to diagnose.

Research about the new test was presented Sunday at the annual meeting of the American College of Rheumatology in San Diego.

EpicGenetics of Santa Monica, Calif., developed the test, called the FM/a test, says Bruce Gillis, MD, MPH. Gillis is the company’s CEO and an assistant professor of medicine and emergency medicine at the University of Illinois College of Medicine.

"It is objective, very accurate, and definitive," he says.

But the test’s high price tag -- $744 -- may keep its use limited for now, one expert says.

"Due to the cost and my lack of experience with this new test, I would initially use it in patients in whom I suspect as having fibromyalgia but lack some of the classic features, making the diagnosis more difficult," says Scott Zashin. Zashin is a clinical professor of medicine at the University of Texas Southwestern Medical School, Dallas.

Fibromyalgia causes widespread pain, tenderness, and stiffness in the muscles and connective tissues. The cause is not known. Six million people or more in the U.S. may have it, Gillis says. Usually doctors take a medical history and note symptoms. Often, it is a diagnosis made after excluding other diseases.

"The biggest problem is the skepticism that physicians have that don't believe that fibromyalgia is a real medical ailment," Gillis says. Often, he says, they label the patient as being depressed or being a hypochondriac.

"What our test does more than anything else is legitimize the diagnosis," Gillis says.

The test measures proteins in the body that lessen pain. "In patients with fibromyalgia, they cannot produce normal quantities of these proteins," Gillis says.

The test developers compared the blood test results in:

Ninety-three percent of the people who had fibromyalgia were identified correctly with the test, Gillis says, and 89% of those who did not were correctly identified.

Zashin, who is not involved with the company, says additional studies will be helpful. "If results could be verified, I would discuss the test with patients in whom the diagnosis of fibromyalgia is being considered to determine if they wanted to obtain the information provided by the testing,'' he says.

These findings were presented at a medical conference. They should be considered preliminary, as they have not yet undergone the "peer review" process, in which outside experts scrutinize the data prior to publication in a medical journal.

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Sugary Drinks and Rheumatoid Arthritis Linked?

Nov. 1, 2013 (San Diego)- Women who drink one or more sugar-sweetened sodas a day might raise their risk of getting rheumatoid arthritis, according to a new study that links RA risk to the sugary habit. The study does not prove cause and effect.

Other studies have linked sugary drinks to higher risks of obesity, diabetes, and heart disease, among other health problems.

The new study is believed to be the first to look at sugary beverages and RA. It did not include diet sodas.

About 1.3 million Americans have RA, a chronic and potentially disabling disease that causes pain, stiffness, and swelling in the joints, and limits how well they work.

''We found an association only for sugar-sweetened beverages," says Yang Hu, a researcher at Harvard School of Public Health who conducted the study. Hu presented the findings this week at the American College of Rheumatology annual meeting.

The link does not mean that sodas cause RA, Hu says. He says drinking sodas could reflect other lifestyle habits known to boost RA risk, such as smoking.

The American Beverage Association, an industry group, disputes the findings.

Hu and his colleagues looked at data from two large studies of nurses, which have evaluated diets and other data for decades.

Hu looked at the diet and other health information from about 173,000 women during two different time periods. Every 4 years, the women reported how many sugary beverages they drank. This included regular colas with sugar, caffeine-free colas with sugar, and non-cola sodas. Diet soda was not included.

During the time periods studied, 883 women were diagnosed with RA. Hu found those who drank one or more sugar-sweetened beverages a day, compared to those who drank either none or less than one a month, had a higher risk of getting a form of RA known as seropositive. It is often a more severe form of the disease.

The way the study was done has limitations. People often don’t accurately remember  what they ate or drank in the past.

The American Beverage Association says it needs more detail to fully evaluate the study. 

“The National Institute of Arthritis and Musculoskeletal and Skin Diseases notes that while the causes of rheumatoid arthritis are not known, genetic and hormonal factors are considered the most likely causes and women are more likely than men to develop this autoimmune inflammatory disease,” its statement says.

The study is interesting and the link is potentially plausible, says Eric Ruderman, MD, professor of medicine at Northwestern University Feinberg School of Medicine. He reviewed the findings but was not involved in the study.

"We're always looking at what drives risk in RA,'' he says. The disease has both genetic and environmental components, experts know. Those factors weren't taken into account in the study. The next step, he says, is to ''drill down into the pathology and try to understand why.''

The National Institutes of Health funded the study.

These findings were presented at a medical conference. They should be considered preliminary, as they have not yet undergone the "peer review" process, in which outside experts scrutinize the data prior to publication in a medical journal.

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Smaller Belly, Less Deli May Reduce Kidney Disease Risk, Study Finds

Processed foods are usually high in harmful phosphorus additives

By Robert Preidt

HealthDay Reporter

FRIDAY, Nov. 1 (HealthDay News) -- Losing belly fat and limiting processed foods and other sources of dietary phosphorus might help reduce your risk of kidney disease, a new study finds.

Phosphorus is added to many processed foods to enhance their flavor and extend their shelf life. High levels of phosphorus are also naturally found in animal, dairy and vegetable proteins, said study leader Dr. Alex Chang, of Johns Hopkins University in Baltimore.

The study of nearly 500 overweight or obese adults enrolled in a healthy-lifestyle program found that a shrinking waistline and lower consumption of dietary phosphorus were associated with reduced levels of protein in the urine (albuminuria), which is an early sign of kidney disease.

After six months, participants' waistlines shrunk an average of 1.7 inches and they had a 25 percent reduction in urine protein. The researchers also found that a 314-milligram reduction in phosphorus excretion resulted in an 11 percent decrease in urine protein.

The study appeared in the November issue of the American Journal of Kidney Diseases.

Other studies have suggested that weight loss may slow kidney disease progression, but this is the first research study to support losing belly fat and limiting phosphorus consumption as a possible way to prevent kidney disease from developing in the first place, Dr. Joseph Vassalotti, chief medical officer at the National Kidney Foundation, said in a foundation news release.

"A good rule of thumb is that if the food comes in a package, it's likely to be high in phosphorus," he said. "Approximately 90 percent of phosphorus additives are absorbed by the body."

To limit phosphorus consumption, look for the root letters "PHOS" on food labels. But phosphorus isn't always listed on food labels, Vassalotti said, so you need to know likely sources. They include:

Processed foods such as dark colas, cereals and flavored watersDairy products such as cheese, milk, cream, ice cream and yogurtAnimal protein such as deli meats, organ meats, meat tenderizers, oysters and sardinesDried beans, lentils, peas, nuts and seeds (including peanut butter and other nut butters), cocoa (including chocolate-based drinks and puddings)

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More Weight Gain in Pregnancy Tied to Higher Autism Risk for Kids: Study

However, this doesn't mean more weight causes neurodevelopmental disorder, authors stress

By Alan Mozes

HealthDay Reporter

MONDAY, Oct. 28 (HealthDay News) -- Modest weight gain during pregnancy might be a sign for autism risk among newborns, new research suggests.

Investigators took pains to stress that it is not weight gain itself that is being tagged as a cause of autism. Nor do the current findings reflect in any way on how pre-pregnancy weight might affect the future offspring of mothers-to-be.

Instead, the study team believes that a small rise in weight occurring while pregnant might be an indication that some broad and complex process -- perhaps involving hormone and inflammation irregularities -- is underway, of which weight gain is a reflection.

If so, then weight gain during pregnancy might serve as an easily recognizable marker for a constellation of events that collectively increase the risk for autism.

"Although weight gain during pregnancy was associated with autism risk, the modest difference in weight gain found suggests that weight gain serves as a marker rather than a cause for autism," said study lead author Dr. Deborah Bilder, a pediatrician and assistant professor in the department of psychiatry at the University of Utah, in Salt Lake City.

"As a marker, it would share an underlying cause with autism, such as hormone imbalance or inflammation," Bilder added.

The study was published online Oct. 28 and in the November print issue of the journal Pediatrics.

The authors said that, unlike in the past, autism is no longer deemed to be a rare disorder, with estimates suggesting that some form of autism affects about one in 88 children in the United States.

Autism spectrum disorders are neurodevelopmental disabilities that can range from mild to more severe. Children with autism display social problems, communication difficulties, and restricted and repetitive patterns of behavior.

For their study, the team focused on two groups of children with autism in Utah.

The first group included 128 children, while the second included 288 children. Maternal weight-gain patterns during pregnancy were analyzed in both groups. The first group's results were stacked up against those of nearly 11,000 mothers of healthy children of a similar age and gender. The second group's results were compared against maternal weight gains leading up to the birth of each autistic child's healthy siblings.

Small increases in weight -- in 5-pound increments -- while pregnant were linked to a slightly higher but significant risk for autism among the offspring. By contrast, body-mass index (a measurement of body fat based on height and weight) at the start of pregnancy was not associated with a higher risk for autism.

There was an average difference of only about 3 pounds in weight gain when comparing mothers of children with and without autism, the study found.

Bilder reiterated that when it comes to autism risk, weight gain during pregnancy should not be seen as the culprit but rather the canary in the coal mine. She cautioned against any dietary changes based on the findings.

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Childhood Obesity Again Tied to Earlier Puberty in Girls

Study compared onset age of breast development in 1997 and now

By Amy Norton

HealthDay Reporter

MONDAY, Nov. 4 (HealthDay News) -- U.S. girls are developing breasts at a younger age compared to years past, and obesity appears to explain a large share of the shift, a new study suggests.

Researchers found that between 2004 and 2011, American girls typically started developing breasts around the age of 9. And those who were overweight or obese started sooner -- usually when they were about 8 years old.

The numbers are concerning, the researchers said -- especially since the typical age at breast development is younger now than it was in a similar study from 1997. The main reason: Girls are heavier now than they were in the '90s.

"This is another manifestation of America's high body-mass index," said lead researcher Dr. Frank Biro, of Cincinnati Children's Hospital Medical Center. Body-mass index (BMI) is a measure of body fat based on a ratio of height to weight.

The findings, reported online Nov. 4 and in the December print issue of the journal Pediatrics, add to evidence that American children are hitting puberty earlier than in decades past. The rising tide of childhood obesity has been suspected as a major cause, but the new study gives more hard data to support the idea.

Biro said, however, that excess pounds do not seem to be the full explanation. And it's possible that other factors -- such as diet or chemicals in the environment -- play a role.

Why should people worry that puberty is coming sooner now than in years past? There is a concern when young kids look older than they are, and are possibly treated that way, Biro said.

Studies have found that girls who mature early are more likely to be influenced by older friends, start having sex sooner and have more problems with low self-esteem and depression. "Just because you're developing more quickly physically doesn't mean you're maturing emotionally or socially," Biro said.

Plus, early puberty has been tied to long-term health risks. For women, an earlier start to menstruation has been linked to a heightened risk of breast cancer. It's not clear why, but some researchers suspect that greater lifetime exposure to estrogen might be one reason.

Biro said earlier puberty also has been tied to increased risks of high blood pressure, heart disease and diabetes in adulthood. It's hard, though, to know whether earlier puberty is to blame since obese kids tend to start puberty earlier, and obese children often become obese adults, he said.

Dr. Patricia Vuguin, a pediatric endocrinologist at the Steven and Alexandra Cohen Children's Medical Center in New Hyde Park, N.Y., said it's not known if it's the earlier development or the obesity itself that causes the increased risk of those conditions.

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Children With Head Injuries May Be Prone to Depression

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Can Marathons Temporarily Hurt the Heart?

Small study found cardiac changes, but they were reversible and less likely with proper training

By Kathleen Doheny

HealthDay Reporter

THURSDAY, Oct. 31 (HealthDay News) -- The thousands of runners who will take part in the New York City Marathon on Sunday most likely believe they are strengthening their cardiovascular system by participating. But new research suggests the strain of a 26.2 mile-run can temporarily damage heart muscle.

That's what Dr. Eric Larose, from the Quebec Heart and Lung Institute at Laval University, found after studying 20 marathon runners, aged 18 to 60, who had each run an average of eight marathons. Larose evaluated the athletes before and right after the Quebec City Marathon, and again three months later.

It turns out strenuous exercise can harm heart tissue, causing inflammation and other problems, particularly among runners who had lower fitness levels and less training, Larose reports in the October issue of the Canadian Journal of Cardiology.

However, he is quick to stress that "there is no permanent damage." Even so, he said, ''there is a cost to running a marathon, there is a cost to everybody."

At the peak of their training, the men and women in Larose's study put in about eight hours of running and logged about 38 miles a week, on average. Larose used MRIs, blood tests and other measures to assess heart function among the runners.

After the race, half of the runners showed a decline in left and right ventricular function -- defined as the operation of the pumping chambers of the heart that take blood to the lungs and the rest of the body.

When a big area of the heart was affected, there was also swelling and reduced blood flow.

The heart changes were more common in those runners who had lower fitness levels and less training. But the damage was temporary. For instance, the 10 runners with left ventricular decline had MRI scans three months later, and all had returned to their pre-race function.

"Age was not a predictor" of cardiac problems, Larose said. Training was. The less the runners trained, the more changes in the heart.

"When you don't train as you should, you are going to get these changes," he said.

Coaches recommend slowly increasing mileage by increments during training to acclimate yourself to longer distances. Training programs are widely available online for novices and veteran runners.

Two experts who reviewed the research had opposite reactions to the finding.

"This study helps to further elucidate the potential cardiac dangers caused by excessive endurance exercise," said Dr. James O'Keefe, a sports cardiologist at the Mid-America Heart Institute, in Kansas City, Mo.

He supported the idea of vigorous exercise but disagreed that more is better. "Shoot for about 30 to 60 minutes a day of moderate or vigorous exercise, or 150 minutes accumulated over each week," he said.

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Can You Have Both Rheumatoid Arthritis and Gout?

Nov. 4,  2013 (San Diego) -- Rheumatoid arthritis and gout, another form of arthritis, may occur together, despite previous thinking that having both is rare, according to new research.

Based on the new findings, doctors should consider looking for gout in RA patients, says study researcher Christina Petsch of the University of Erlangen-Nuremberg in Germany.

Both are inflammatory conditions. You get gout when uric acid builds up in joints, bones, and tissue. Gouty arthritis causes inflammation in the joints, often in the big toe.

RA affects the joints, surrounding tissues, and sometimes other organs.

Petsch evaluated 100 men and women, average age 63, who'd been diagnosed with RA. On average, they had RA for nearly 9 years. All had high blood levels of uric acid.

Petsch used a scan to look for uric acid deposits in their feet. She found that 13% of the patients had positive scans.

Even though the scan was positive, it doesn't mean for sure the patients have gout. The result could have been a false-positive.

Men were more likely to have both conditions than women.

These findings were presented at a medical conference. They should be considered preliminary, as they have not yet undergone the "peer review" process, in which outside experts scrutinize the data prior to publication in a medical journal.

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Perrigo Recalls Infant Pain and Fever Reliever

Safety concerns have prompted Perrigo to recall 18 batches of an over-the-counter pain and fever reliever for infants that is sold under brand names including Babies R Us and Care One.

The U.S.-wide recall covers batches of acetaminophen infant suspension liquid, 160mg/5mL sold in 2 oz. and 4 oz. bottles packaged with oral syringes. Some of the products may contain syringes without dose markings, according to the U.S. Food and Drug Administration.

Using a syringe without dose markings could result in infants receiving an incorrect dose of the medicine, the agency said.

Consumers who discover that the product has a syringe without dose markings should not use the product. They should call Perrigo at 1-800-719-9260 for more information, the FDA said.

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In Alabama, Lack Of Competition May Be Behind Insurance Premium Costs

Lack of Competition, High Rates in AlabamaIn Alabama, Lack Of Competition May Be Behind Insurance Premium CostsWebMD News from Kaiser Health News

By Jay Hancock

Fri, Nov 1 2013

MONTGOMERY, Ala. -- The letters landed in early October, cancelling health plans for thousands of BlueCross BlueShield of Alabama members and offering to enroll them in new coverage at often substantially higher cost.

"I thought my plan might go up like $30. I didn't know it was going to [nearly] double" to $478 a month, said Merry Hardy, who is self-employed and lives in Alexander City, in the middle of the state. "I'm thinking, please God, let Obamacare fail."

BlueCross, like Hardy, blames the Affordable Care Act, which it says disallows current, less expensive insurance for about 80,000 of its Alabama customers starting next year.

But others see insurance market dynamics as a big part of the problem. Because it covers about 90 percent of the Alabama individuals and families who buy policies directly, BlueCross faces little competition and few reasons to lower prices, critics say.

In the Huntsville area, where only BlueCross and Humana offer plans through the federal government's online exchange, the least expensive, medium-level "silver" policy for a 50-year-old costs $352 a month. A hundred miles north in Nashville, Tenn., where four insurers compete, the least expensive silver policy costs $253, or 28 percent less. These prices don’t take into account the federal tax credit subsidy many buyers will receive.

Beyond Alabama 

People in other states face similar situations. Single companies dominate individual insurance in New Hampshire, Arkansas, North Carolina and elsewhere, leaving few options for consumers in the health act's online marketplaces. 

An analysis of the three dozen states relying on the federal marketplace shows that, on average, the least expensive silver plan costs 34 percent more in regions with one or two insurers selling through the marketplace than in regions with at least eight insurers.

The cancellation letters have hardened opinion against the health overhaul in a state where barely one voter in three cast a 2012 ballot for President Barack Obama.

"We're doing a good thing by getting people enrolled in affordable health coverage and it's a shame that other people are hearing their premiums are going up," said Lauren Banks, who is overseeing AIDS Alabama’s program to sign people up for the law's new coverage options. "It's definitely hurting our efforts."

Aside from ads urging people to enroll, BlueCross, an independent nonprofit, is saying little except that existing plans won't comply with the law in 2014 and that new requirements such as accepting consumers with medical problems are affecting premiums. CEO Terry Kellogg declined to grant an interview.

KHN's Examination Of Cancellation Letters

Kaiser Health News reviewed nine cancellation letters sent to largely healthy consumers from ages 22 to 63 across the state who buy health insurance directly from Alabama BlueCross. The company offered new plans at price increases ranging from 38 percent to 100 percent - before government subsidies are factored in.

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See expert answers to questions about health reform.

A guide to what's changing under the new law.

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U.S. Preemie Birth Rate Continues to Fall: Report

But, rate still highest among industrialized countries

By Robert Preidt

HealthDay Reporter

FRIDAY, Nov. 1 (HealthDay News) -- The preterm birth rate in the United States fell for a sixth consecutive year in 2012 -- and that 11.5 percent rate is a 15-year low, a new report says.

Six states -- Alaska, California, Maine, New Hampshire, Oregon and Vermont -- earned an "A" on the March of Dimes' annual premature birth report card because their preterm birth rates met the group's 9.6 percent goal.

A premature birth is one that occurs before 37 weeks of pregnancy. Health consequences can include breathing problems, developmental delays and cerebral palsy. Prematurity is also a leading cause of newborn death.

Since 2006, about 176,000 fewer premature babies have been born in the United States, potentially saving the nation about $9 billion in health and societal costs, according to the report released Friday.

But even though last year's U.S. preterm birth rate was the lowest since 1998, the nation again earned a "C" on the report card.

"Although we have made great progress in reducing our nation's preterm birth rate from historic highs, the U.S. still has the highest rate of preterm birth of any industrialized country. We must continue to invest in premature birth prevention because every baby deserves a healthy start in life," Dr. Jennifer Howse, president of the March of Dimes, said in a news release from the group.

"A premature birth costs businesses about 12 times as much as uncomplicated healthy birth. As a result, premature birth is a major driver of health insurance costs not only for employers," she noted.

The preterm birth rate in the United States peaked in 2006 at 12.8 percent after climbing steadily for more than two decades, according to the U.S. National Center for Health Statistics. Almost all states had lower preterm birth rates in 2012 when compared to 2006.

Blacks had the highest preterm birth rate in 2012, at 16.5 percent. That was down from 18.5 percent in 2006 and was the lowest in more than 20 years. While the gap between blacks and whites has slowly narrowed, the preterm birth rate among blacks is still more than 1.5 times higher than among whites.

The report also assessed states' progress in reducing risk factors for preterm birth and found the following:

37 states, the District of Columbia and Puerto Rico reduced the percentage of uninsured women of childbearing age.35 states and the District of Columbia reduced the percentage of women of childbearing age who smoke.28 states, the District of Columbia and Puerto Rico lowered the late preterm birth rate (infants born between 34 and 36 weeks gestation).

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Sunny Regions Reflect Lower ADHD Rates: Study

Researchers wonder whether sunlight protects children, adults from distracted behavior

By Brenda Goodman

HealthDay Reporter

TUESDAY, Oct. 29 (HealthDay News) -- Sunny days can be a big distraction for those who are tethered to their desks, but a new study suggests that sunlight may actually lower the prevalence of attention-deficit/hyperactivity disorder (ADHD).

Scientists mapped the number of ADHD diagnoses across the United States and in nine other countries. They compared those rates to the intensity of sunlight those regions receive year-round.

Regions that got the most sun had rates of ADHD diagnoses that were about half as high as regions that got the least, according to the research.

"The maps line up almost perfectly," said study author Martijn Arns, director of Brainclinics, in the department of experimental psychology at Utrecht University in Nijmegen, Netherlands.

In the United States, the sunniest states were in the Southwest and West and included Arizona, California, Colorado, Nevada, New Mexico and Utah. Rates of ADHD diagnoses in those states ranged from 6 percent to 8 percent. In the darkest states, which included a swath of the Northeast, rates of ADHD ranged from 10 percent to 14 percent.

The relationship between ADHD and sunlight held steady even after researchers adjusted their data to control for other factors that might account for differing rates of ADHD diagnoses, such as race, poverty and the male-to-female ratio in each area.

Researchers even considered whether vitamin D, which is produced in the body after exposure to sunlight, might account for the differences, but they said a prior study ruled that out.

They also examined whether more sunlight might be tied to lower rates of other kinds of mental disorders, including depression and autism. It wasn't.

The researchers admitted that the link could just be a coincidence, and there isn't necessarily a cause-and-effect relationship between sunny climates and lower rates of ADHD diagnosis. But since some children and adults with ADHD have disrupted body clocks, which are regulated by light, they believe the relationship deserves further investigation.

Arns said about 80 percent of adults and about one-third of children with ADHD have trouble falling asleep at night. Some studies have found that these night-owl tendencies are driven by a delayed peak in the sleep hormone melatonin.

Melatonin seems to be especially disrupted by the blue wavelengths of visible light, Arns said. Energy-saving LED light bulbs, as well as the screens of tablets, smartphones and computers emit blue light. When people use those devices in the evening, it can delay melatonin release and disrupt sleep.

But Arns said people who live in sunny climates may get some natural protection from this sleep upset because they get a healthy dose of bright light in the morning, which keeps their body clocks on track.

He's currently exploring ways to test his theory.

An expert who was not involved in the study, which was published in the Oct. 15 issue of the journal Biological Psychiatry, said he's not sure melatonin is the best explanation.

Children in sunny climates may spend more time playing outside, for example, said Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at the Steven & Alexandra Cohen Children's Medical Center in New Hyde Park, N.Y.

"There's a small but growing literature talking about exercise as a way to moderate ADHD and hyperactivity," Adesman said. "There could be other variables that are responsible."

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