Judge rules University of Louisville's hospital is public and subject to Open Records Act; it may appeal

The University of Louisville's hospital is a public entity, a Jefferson Circuit Court judge has ruled in a lawsuit filed to get access to the university's deals with other health providers.

Judge Martin McDonald ruled yesterday in favor of The Courier-Journal, WHAS-TV and the American Civil Liberties Union, noting that the university makes or approves all appointments to University Hospital's board of directors. The university had argued that the board, and thus the hospital, was not a public agency under the state Open Records Act.

The hospital said it might appeal the ruling. McDonald gave it 30 days to give him the records being sought, along with arguments about why they should be exempt" under exceptions to the law, reports The C-J's Andrew Wolfson. "He gave the news organizations at the ACLU 20 days to respond to any claimed exemptions." The hospital has said revealing contracts would put it at a competitive disadvantage.

The suit began after the university refused to let the plaintiffs see records related to its proposed merger with Jewish Hospital & St. Mary's HealthCare and Lexington-based St. Joseph Health Care System. Gov. Steve Beshear vetoed the merger on grounds that a public hospital should not be bound by a religious organization's health-care policies. This month the hospital announced a new deal with KentuckyOne Health, which includes the faith-based entities, but said reproductive services would not be affected despite a policy of "respect" for Catholic health directives. (Read more)

After several groups say Pap smears aren't needed every year, ob/gyns recommend an annual 'well-woman' visit

Though several groups have said women don't need a Pap smear every year, obstetricians and gynecologists still recommend an annual "well-woman" visit and annual pelvic exams for all females over 21.

These new recommendations by the American College of Obstetricians and Gynecologists were published Monday. They come a few months after the American Cancer Society, the U.S. Preventive Services Task Force and other groups said most women only need a Pap smear every three years starting at age 21. After the age of 30, they can get them less often if they also get tests for the human papillomavirus, known to cause cervical and other cancers.

The visit "can be used to check blood pressure and weight, update immunizations, counsel patients on healthy lifestyles, screen for sexually transmitted infections and other health problems, perform breast exams and build relationships between doctors and patients," reports Kim Painter for USA Today.

But some critics question if these visits are just a way to make money. "We estimate that about $8 billion a year is spent on preventive yearly physicals of all kinds," said Ateev Mehrotra, a professor at the University of Pittsburgh School of Medicine. "The question is whether we could spend those $8 billion more wisely." (Read more)

Mothers should try to go to full term in their pregnancies, but many are unaware of the risks of early delivery, UK study finds

Illustration by Michelle Kumata via KRT

Babies who are born before the full term of 40 weeks may have health problems later in life, since important brain development takes place in the very last stages of pregnancy. As such, mothers should try to avoid being induced early or having elective C-sections.

A study conducted at the University of Kentucky College of Communication and Information found women often don't realize the important development that takes place at the end of pregnancy, write UK doctoral student Sarah Vos and H. Dan O'Hair, dean of the college, for the Lexington Herald-Leader.

Evidence shows that early, elective births are expensive. One study found reducing the number of elective births before 39 weeks of gestation to less than 2 percent of all U.S. births would save $1 billion each year.

But many women are uncomfortable at the end of their pregnancy, are anxious to know their children are healthy, and may even ask for early induction of labor because employers aren't flexible about time off. Sometimes doctors and other providers induce women early for their convenience.

Encouraging women to go full term and telling them the disadvantages of early labor — problems feeding and a higher incidence of Sudden Infant Death Syndrome — can influence their decision. As Vos and O'Hair conclude, "Babies are worth the wait." (Read more)

Premenstrual syndrome and premenstrual dysphoric disorder (review)

Premenstrual syndrome

Premenstrual syndrome is defined as recurrent psychological and physical symptoms that occur during the luteal phase of menses and resolve with menstruation. It affects 20-30% of premenopausal women.

Premenstrual dysphoric disorder

Premenstrual dysphoric disorder includes affective or somatic symptoms that cause severe dysfunction in social or occupational activity. It affects 3-8% of premenopausal women.

Proposed etiologies (causative factors) include:

- increased sensitivity to normal cycling levels of estrogen and progesterone
- increased aldosterone and plasma renin activity
- neurotransmitter abnormalities, particularly serotonin

The Daily Record of Severity of Problems is one tool with which women may self-report premenstrual symptoms.

Symptom relief is the goal, and there is limited evidence for the use of:

- calcium
- vitamin D
- vitamin B6 supplementation

Serotonergic antidepressants (SSRIs) (citalopram, escitalopram, fluoxetine, sertraline, venlafaxine) are first-line pharmacologic therapy.

References:

Premenstrual syndrome and premenstrual dysphoric disorder. Biggs WS, Demuth RH. Am Fam Physician. 2011 Oct 15;84(8):918-24.

Image source: OpenClipArt.org, public domain.

What is a Mastectomy

What is a Mastectomy

Simply means taking the breast mastectomy. However, breast cancer surgery, might not always be due to be taken of the breast. Surgeons at the part to be taken from the breast surgery facilities to the extent used to pay attention. Only tumor size and from of the breast leads to little change taken. However, the same is not the case for each tumor. The doctors will do surgery, which would indicate the status of the patients Usually open and the most Successful operation.

Wedge Cross Section: with the tumor tissue to be around

Partial mastectomy: close to half of the breast to be part of

Simple or full mastectomy: the breast and some underarm glands taken

Radical mastectomy: the breast and armpit glands to be great

The Lancet: Commonest cause of maternal death is post-partum haemorrhage - one woman dies every 7 minutes

99% of all deaths in childbirth are in the least developed countries - 45 million women deliver without a skilled birth attendant every year, a situation in which the greatest number of maternal deaths occur.

The commonest single cause of maternal death is from post-partum haemorrhage, from which one woman dies every 7 minutes.


Health Technologies to Save Mothers. PATH.org video.

References:
Maternal mortality: one death every 7 min. The Lancet, Volume 375, Issue 9728, Pages 1762 - 1763, 22 May 2010.

What's new in obstetrics and gynecology from UpToDate

35% of UpToDate topics are updated every four months. The editors select a small number of the most important updates and share them via "What's new" page. I selected the brief excerpts below from What's new in obstetrics and gynecology:

Obstetrics

Influenza vaccination with inactivated vaccine is recommended for pregnant women, regardless of the stage of pregnancy. The 2010-2011 influenza vaccine is trivalent and includes antigens from both the 2009 pandemic H1N1 influenza virus and seasonal influenza viruses.

Use of acetaminophen during pregnancy was associated with a reduction in neural tube defects, as well as cleft lip/palate and gastroschisis. These data support the safety of acetaminophen for relief of fever and pain.

Gynecology

Like CA 125, human epididymal secretory protein E4 (HE4) is a promising biomarker for ovarian cancer. In contrast to CA 125, HE4 levels do not appear to be elevated in women with endometriosis, and thus can be useful to rule out ovarian cancer in patients with endometriosis and a pelvic mass suspected to be an endometrioma.

Sterilization does not impact sexual function. Sexual function appears to be unchanged or improved in women following tubal sterilization.

Botulinum toxin may be useful for overactive bladder syndrome (onabotulinumtoxinA, Botox®). Detrusor injection of botulinum toxin (BoNT) had a transient effect. The average time between injections was 8 to 12 months.

References:
What's new in obstetrics and gynecology. UpToDate.

Image source: Wikipedia, GNU Free Documentation License.

Sexual life expectancy is longer for men than women

A BMJ study of middle aged and older adults showed that men were more likely than women to be sexually active, report a good quality sex life, and be interested in sex.

These gender differences increased with age and were greatest among the 75 to 85 year old group: 38.9% of men compared with 16.8% of women were sexually active, 70.8% versus 50.9% of those who were sexually active had a good quality sex life, and 41.2% versus 11.4% were interested in sex.

People in very good or excellent health were 1.5 to 1.8 times more likely to report an interest in sex than those in poorer health. At age 30, sexually active life expectancy was 34.7 years for men and 30.7 years for women compared with 14.9 to 15.3 years for men and 10.6 years for women at age 55.

At age 55, men in very good or excellent health on average gained 5-7 years of sexually active life compared with their peers in poor or fair health. Women in very good or excellent health gained 3-6 years compared with women in poor or fair health.

References:

Sex, health, and years of sexually active life gained due to good health: evidence from two US population based cross sectional surveys of ageing. BMJ 2010;340:c810.

Image source: OpenClipart.org, public domain.