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In rating pain, women are the more sensitive
sex
It has long been known that certain pain-related conditions, like
fibromyalgia, migraine and irritable bowel syndrome, are more
common in women than in men. And chronic pain after childbirth is
surprisingly common; the Institute of Medicine recently found that
18 percent of women who have Caesarean deliveries and 10 percent
who have vaginal deliveries report still being in pain a year
later.
But new research from Stanford University suggests that even when
men and women have the same condition — whether it’s a back
problem, arthritis or a sinus infection — women appear to suffer
more from the pain.
There is an epidemic of chronic pain: Last year, the Institute of
Medicine estimated that it afflicts 116 million Americans, far
more than previously believed. But these latest findings, believed
to be the largest study ever to compare pain levels in men and
women, raise new questions about whether women are shouldering a
disproportionate burden of chronic pain and suggest a need for
more gender-specific pain research.
The study, published Monday in The Journal of Pain,
analyzes data from the electronic medical records of 11,000
patients whose pain scores were recorded as a routine part of
their care. (To obtain pain scores, doctors ask patients to
describe their pain on a scale from 0, for no pain, to 10, “worst
pain imaginable.”)
For 21 of 22 ailments with sample sizes large enough to make a
meaningful comparison, the researchers found that women reported
higher levels of pain than men. For back pain, women reported a
score of 6.03, men 5.53. For joint and inflammatory pain, it was
women 6.00, men 4.93. Women reported significantly higher pain
levels with diabetes, hypertension, ankle injuries and even sinus
infections.
For several diagnoses, women’s average pain score was at least one
point higher than men’s, which is considered a clinically
meaningful difference. Over all, their pain levels were about 20
percent higher than men’s.
Unfortunately, the data don’t offer any clues as to why women
report higher pain levels. One possibility is that men have been
socialized to be more stoic, so they underreport pain. But the
study’s senior author, Dr. Atul Butte, an associate professor at
Stanford’s medical school, said that explanation probably did not
account for the gender gap.
“While you can imagine such a bias,” he said, “across studies,
across thousands of patients, it’s hard to believe men are like
this. You have to think about biological causes for the
difference.”
An extensive 2007 report by the International Association for the
Study of Pain cited studies showing that sex hormones may play a
role in pain response. In fact, some of the gender differences,
particularly regarding headache and abdominal pain, begin to
diminish after women reach menopause.
Research also suggests that men and women have different responses
to anesthesia and pain drugs, reporting different levels of
efficacy and side effects. That bolsters the idea that men and
women experience pain differently.
One reason for the lack of information about sex differences is
that many pain studies, in both animals and humans, are done only
in males. One analysis found that 79 percent of the animal studies
published in a pain journal over a decade included only male
subjects, compared with 8 percent that used only female animals.
In addition, experiments testing pain in men and women have shown
that they typically have different thresholds for various types of
pain. In general, women report higher levels of pain from pressure
and electrical stimulation, and less pain when the source is from
heat.
Melanie Thernstrom, a patient representative on the Institute of
Medicine pain committee from Vancouver, WA, said the newest
research “really highlights the need for more treatment and better
treatment that is gender-specific, and the need for far more
research to really understand why women’s brains process pain
differently than men.”
Visit the New York Times for the article. 
No flu shots for most late-thirtysomethings
during swine flu outbreak
Flu season may be a few months old, but peak season is yet to
come. And new research has found that a large number of people at
risk may still be refusing to protect themselves. Flu normally
hits hardest in January or February, and infectious disease
specialists say so far, this season has been very mild. But there
are reports that nine people have died from swine flu this season
in Mexico – where the first swine flu outbreak began back in 2009,
ultimately claiming 17,000 lives worldwide.
Despite knowing how potentially deadly swine flu could be, a new
report has found that only 20 percent of adults in their late 30s
said they got a flu shot during the 2009 outbreak. In a survey,
researchers from the University of Michigan asked approximately
3,000 adults between the ages of 36 and 39 – members of the age
group known as Generation X – questions about how they responded
to the 2009 swine flu pandemic, such as how they kept informed
about the illness and whether they got flu shots to protect
themselves or their family members.
The researchers have been following this same group of people for
25 years, and every year they survey them about their attitudes
and behaviors related to different issues. Their work is known as
the Longitudinal Study of American Youth (LSAY). According to the
latest results delving into attitudes about the flu vaccine, only
1 in 5 adults got a flu shot, but nearly 65 percent said they were
moderately concerned about the swine flu, and about 60 percent
said they kept informed about it.
“This was the first epidemic that was relevant to this age group,”
said Jon Miller, director of LSAY at the University of Michigan.
“We were interested in how they used their prior science knowledge
and prior education to make sense of this thing.” Adults in this
age group, he explained, are very adept at gathering information
from a variety of sources, including newspapers, magazines, online
and from family, friends and colleagues. While they managed to
stay abreast of what was happening with the disease outbreak, the
majority of them did not get flu shots. Though a larger number of
the cohort with young children at home did get the flu shot to
prevent the swine flu.
Miller added the researchers did not ask the survey participants
why they didn’t get vaccinated, but he and other experts say a
number of factors likely came into play. One reason is because
supplies were limited for some time during that flu season.
Despite their increased vulnerablity, adults in their late 30s may
have been confused by changing public health messages about who
should be vaccinated.
Another reason many late-thirtysomethings didn’t get flu shots
despite their knowledge of the risks posed by swine flu is that
they often display a trait well-known in adolescents.
“A lot of people have not matured as quickly as we would hope and
one of the issues that is prevalent in adolescents and many adults
is a certain level of belief that they are omnipotent and more
powerful than things out there.” Miller hopes the study’s findings
can shed some light on better ways to reach out to Generation Xers
when it comes to preparing for future epidemics.
Visit ABC News for the article. 
Healthcare delivery to be analyzed as U.S.
agency expands view
A
U.S. agency formed to compare the effectiveness of drugs and
medical devices plans a broader agenda that also will study
subjects such as whether care provided by nurse-practitioners is
as good as that of doctors. The agency, called the
Patient-Centered Outcomes Research Institute, was created by the
2010 healthcare legislation. Republican opponents of the law say
the institute will lead to government-directed rationing as it
judges treatments.
The agency may spend as much as $2.5 billion on research through
2019, the Congressional Budget Office estimates. Comparing
treatments will be one of five broad areas the agency plans to
explore, its leaders said. Other research priorities include
treatment disparities among people of differing races, gender and
other characteristics; health-care systems, including the quality
of care provided by nurses and physician’s assistants; how to
communicate the best care options to patients and doctors and
shortening delays between lab discoveries and their clinical use.
“It is by design a very, very broad set of priorities,” Carolyn
Clancy, the director of the U.S. Agency for Healthcare Research
and Quality and board member of the new institute, said Jan. 18 at
a meeting in Jacksonville, FL.
The institute plans to announce an initial round of about 40
grants, drawn from 856 applications, in March. (Bloomberg News)
Visit the Salt Lake Tribune for the article. 
Technology that predicts disease spread in mass
gatherings
Hosts of mass gatherings (MGs) could benefit from new
opportunities that would assist in the preparation and response to
threats of infectious diseases, as revealed by the fifth paper on
MGs health in The Lancet Infectious Diseases Series. One of
these opportunities would be to couple surveillance systems that
use the Internet to identify outbreaks of infectious diseases
around the globe in near real-time with a novel technology, which
can track and predict global population movements through
commercial air travel. The authors have described an analysis of
potential threats to the 2012 Olympic Games using this novel
approach.
Lead author, Kamran Khan from St Michael’s Hospital in Toronto,
Canada explains: “An integrated platform of this kind could help
identify infectious disease outbreaks around the world that could
threaten the success of MGs at the earliest possible stages,
provide insights into which of those outbreaks are most likely to
result in disease spread into the MG, and identify the most
effective public health measures to mitigate the risk of disease
importation and local spread, all in near real-time.”
The Global Public Health Intelligence Network (GPHIN) and
HealthMap are novel disease surveillance tools that use informal
internet data sources like online news outlets, in order to detect
early reports of disease outbreaks and for monitoring global
disease activity. In contrast to traditional surveillance systems,
i.e. government reports, which can be subject to delays in
reporting and poor sensitivity, the novel surveillance tools have
the potential to overcome these limitations.
Furthermore, the authors comment that understanding global air
travel patterns before, during and after MGs are vital, given that
this is the main mode of transport to and from MGs, and refer to
Bio.Diaspora, a novel technology that can track worldwide air
travel patterns to predict the worldwide spread of infectious
diseases.
The system can be utilized to predict the amount of travelers, as
well as their global origins from MGs. Therefore, in areas where
large population movements to the MG host city are expected, the
system is able to direct disease surveillance activities to
specific global locations.
By applying this method, Khan and his team discovered that the
vast majority of passengers traveling to Vancouver for the 2010
Winter Olympic Games originated from only 25 cities. Consequently,
the real-time infectious disease surveillance efforts were then
aimed on those particular cities to monitor and evaluate potential
threats before, during, and immediately after the Games.
The fifth paper in this series describes how this method will be
applied for the first time in London at the 2012 Olympic Games,
for real risk assessment and planning purposes. It will assist UK
public health officials in prioritizing which global outbreaks
require the greatest attention at the time of the Games.
Visit Medical News Today for the article. 
Jury: Hospital must pay Garth Brooks $1M for
not building women’s center to honor his mom
CLAREMORE, OK — An Oklahoma hospital in Garth Brooks’ hometown
must pay $1 million to the country singer because it failed to
build a women’s health center in honor of his late mother, jurors
ruled Tuesday evening. Jurors ruled that the hospital must return
a $500,000 donation to Brooks plus pay him $500,000 in punitive
damages in Brooks’ breach-of-contract lawsuit against Integris
Canadian Valley Regional Hospital in Yukon. Brooks said he thought
he’d reached a deal in 2005 with the hospital’s president, James
Moore, but sued after learning the hospital wanted to use the
money for other construction projects.
The hospital argued that Brooks gave it unrestricted access to the
$500,000 donation and only later asked that it build a women’s
center and name it after his mother, Colleen Brooks, who died of
cancer in 1999.
During the trial, Brooks testified that he thought he had a solid
agreement with Moore. Brooks said the hospital president initially
suggested putting his mother’s name on an intensive care unit, and
when Brooks said that wouldn’t fit her image, Moore suggested a
women’s center.
“This case is about promises: promises made and promises broken,”
lawyer John Hickey told jurors shortly before they started
deliberating. “Mr. Brooks kept his promise. Integris never
intended to keep their promise and never built a new women’s
center.”
But hospital attorney Terry Thomas said Brooks’ gift initially
came in anonymously and unrestricted in 2005. He also noted that
Brooks couldn’t remember key details of negotiations with the
hospital’s president — including what he’d been promised — when
questioned during a deposition after filing his lawsuit in 2009.
(Associated Press)
Visit the Washington Post for the article. 
Obama says healthcare jobs will be hard to
create
In his State of the Union address that barely mentions healthcare,
President Obama hits on the message heard repeatedly from the
healthcare industry: If you want more jobs, don’t cut off federal
funding. Obama implores Congress not to “gut” investments in
research, so American can maintain its spot as a world leader in
medical innovation. That line will earn applause from the
pharmaceutical and medical device industries, but it won’t be
enough to deliver a health care economy that delivers a “fair
shot” to everyone.
The president held out the continued possibility of saving
healthcare costs with Medicare reform. “As I told the speaker this
summer, I’m prepared to make more reforms that rein in the long
term costs of Medicare and Medicaid, and strengthen Social
Security, so long as those programs remain a guarantee of security
for seniors,” Obama said. “But in return, we need to change our
tax code so that people like me, and an awful lot of members of
Congress, pay our fair share of taxes. Tax reform should follow
the ‘Buffett Rule’: If you make more than $1 million a year, you
should not pay less than 30 percent in taxes.”
And he rebutted Republican accusations that his signature 2010
health reform law amounts to socialized medicine. “I’m a Democrat.
But I believe what Republican Abraham Lincoln believed: That
government should do for people only what they cannot do better by
themselves, and no more,” he said. “That’s why our healthcare law
relies on a reformed private market, not a government program.”
Obama makes it clear that he sees the giant healthcare sector as a
place ripe for jobs growth. The American Association of Medical
Colleges projects a shortage of 90,000 doctors over the next 10
years. It’s more than double that for the nursing industry, where
the American Nursing Association sees a potential shortage of
260,000 nurses by 2025. These shortfalls will only be worsened as
an additional 30 million people get health insurance under the
2010 health reform law.
But a national workforce commission established under the
healthcare law has been chronically underfunded by Congress. The
training programs that will be needed to fix these shortages have
a slim to little chance of getting any funds. Appropriators have
no room to give precious federal dollars to new programs while
they are slashing old sacred cows in the austere spending
environment that has reigned on Capitol Hill since Republicans
took the House in 2011.
And while investments in research are nice, what medical device
companies want even more is for Congress to take back a $20
billion tax it imposed on the industry to help cover the cost of
the health reform law. Stephen Ubl, president of Advamed, a
medical device lobbying association, says the tax is already
causing layoffs.
Obama doesn’t get a break from hospitals either. The American
Hospital Association says a coming 2 percent cut to Medicare and
other cuts will cost them 278,000 jobs as revenue drops from
Medicare and Medicaid. In the health care world, federal funds are
the spigot for job creation, and no State of the Union speech is
going to change the spending environment on Capitol Hill.
Visit the National Journal for the article. 
CDC launches electronic antibiotic tracking
system
The Centers for Disease Control and Prevention (CDC) recently
launched a new electronic antibiotic tracking system allowing
hospitals to make better decisions about how to improve antibiotic
use and compare themselves to other hospitals. Previously this
tracking was only available in doctors offices. The tracking
system is part of the CDC’s National Healthcare Safety Network.
Any hospital that participates in the National Healthcare Safety
Network can use this tool by working directly with its pharmacy
software vendor to transmit data electronically from drug
administration or barcoding records. There is no manual data
entry, thus saving a facility time and money.
In conjunction with Get Smart About Antibiotics Week, the CDC has
announced a partnership with the Institute for Healthcare
Improvement to pilot-test a tool to help hospitals implement
practical strategies to improve antibiotic use. The pilot testing
is currently under way in eight U.S. hospitals.
Visit AORN for the article. 
Avastin, Sutent increase breast cancer stem
cells, U-M study shows
Cancer treatments designed to block the growth of blood vessels
were found to increase the number of cancer stem cells in breast
tumors in mice, suggesting a possible explanation for why these
drugs don’t lead to longer survival, according to a new study by
researchers at the University of Michigan Comprehensive Cancer
Center. Results of the study appear online in the Proceedings
of the National Academy of Sciences Early Edition.
The drugs Avastin and Sutent have been looked at as potential
breast cancer treatments. But while they do shrink tumors and slow
the time till the cancer progresses, the effect does not last, and
the cancer eventually regrows and spreads.
“This study provides an explanation for the clinical trial results
demonstrating that in women with breast cancer antiangiogenic
agents such as Avastin delay the time to tumor recurrence but do
not affect patient survival. If our results apply to the clinic,
it suggests that in order to be effective, these agents will need
to be combined with cancer stem cell inhibitors, an approach now
being explored in the laboratory,” says study author Max S. Wicha,
M.D., director of the U-M Comprehensive Cancer Center.
The FDA recently revoked approval of Avastin for treating breast
cancer, although the drug is approved for use in other types of
cancer. The reversal was in response to clinical trials showing
that the drug’s benefit was short-lived, with breast cancer
patients quickly relapsing and the cancer becoming more invasive
and spreading further throughout the body. Overall, the drug did
not help patients live any longer.
The current study suggests the possibility of combining
anti-angiogenesis drugs with a cancer stem cell inhibitor to
enhance the benefit of this treatment. The researchers are testing
this approach in mice and preliminary data looks promising.
Visit UM for the article. 
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