Wednesday, January 23, 2013

Nutrition tips every senior should know to keep muscles strong

http://www.emaxhealth.com/1020/nutrition-tips-every-senior-should-know-keep-muscles-strong

Nutrition tips every senior should know to keep muscles strong
By Kathleen Blanchard RN on January 22, 2013


The group looked at studies that were conducted worldwide to identify ways to prevent sarcopenia - gradual loss of muscle mass - that happens as we grow older.

The good news is there are steps to take that can ensure we all stay strong in our senior years, which translates to lower risk of disability from falls, fractures and increased quality of life through independent living.

The most important nutritional factors that help maintain muscle strength with aging include protein, Vitamin D and eating a diet that balances high acid nutrients. You also want to get plenty of B vitamins; especially B12 and folic acid, also known as folate or vitamin B9.

Zombie allusions: They just keep on coming-ACE is, apparently, not the place...

http://www.firstcoastnews.com/video/default.aspx?bctid=2114274163001&odyssey=mod%7Cnewswell%7Ctext%7CFRONTPAGE%7Cfeatured


ACE Hardware hammers zombie movie shot at store

From U Manchester: How Can One be Both a Philosophical Ethicist and a Democrat?

http://www.ncbi.nlm.nih.gov/pubmed/23338041


 2013 Jan 22. [Epub ahead of print]

How Can One be Both a Philosophical Ethicist and a Democrat?

Source

Centre for Social Ethics and Policy, School of Law, University of Manchester, Oxford Road, Manchester, M13 9PL, UK, malcolm@oswald.com.

Abstract

How can one be both a philosophical ethicist and a democrat? In this article I conclude that it can be difficult to reconcile the two roles. One involves understanding, and reconciling, the conflicting views of citizens, and the other requires the pursuit of truth through reason. Nevertheless, an important function of philosophy and ethics is to inform and improve policy. If done effectively, we could expect better, and more just, laws and policies, thereby benefiting many lives. So applying philosophical thinking to policy is an important job. However, it comes with substantial difficulties, not least in reconciling, or choosing between, competing philosophical theories. Despite the importance of the task, and the apparent obstacles, there is relatively little literature on how to apply ethics to real-world policy-making. Democracies need ethicists who can engage in democratic debate and bridge the gap between philosophy and public policy. I offer some tactics here.

Tuesday, January 22, 2013

"Governor Heineman just performed one of the biggest flip-flops that we've in Nebraska political history" (HT:PC)

http://www.newser.com/article/da3vcdug2/neb-governor-notifies-federal-officials-he-approved-new-canadian-pipeline-route-through-state.html


Neb. governor notifies federal officials he approved new Canadian pipeline route through state

Neb. governor OKs Keystone XL route through state


"Governor Heineman just performed one of the biggest flip-flops that we've in Nebraska political history," said Jane Kleeb, executive director of the group Bold Nebraska.

From Texas A&M: Why doctors, insurers and patients grapple over cancer screenings

http://news.tamhsc.edu/2013/01/17/why-doctors-insurers-and-patients-grapple-over-cancer-screenings/


Why doctors, insurers and patients grapple over cancer screenings



COM: I understand that those affect levels of risk. But look at it this way. Let’s assume I agree that costs should be contained, that the underserved need health care too, and so on, but I also really don’t want to let a tumor get past me undetected until it’s too late. Why would it not be in my best interest – my personal interest – to have every test there is, for every type of cancer? You brought in the distinction between seeing a population and seeing an individual. Could a screening test ever be a bad option?
Avery: Healthy living is the better option. And yes, too much screening can be bad for your health, for several reasons.
First of all, there are false positives. These include true false positive results in a test, but a lot are due to laboratory error. Over the years when I’ve chased some of these false positives down, it has usually ended up being a bad laboratory. You send the same test to another lab and it ends up being negative. A false positive means you may end up having an invasive and dangerous procedure you didn’t need.
Second, context matters. In most of these screening tests, we’re looking at biomarkers. When we’re looking at blood, we can see the red blood cells, and if there aren’t enough red cells you’re anemic. But let’s say you’ve got chest pain, and you draw blood for a biomarker and it shows muscle enzymes going up; that doesn’t automatically mean you’ve had a heart attack. You’ve got to do it in combination with an electrocardiogram and risk history.
COM: So the test itself does not tell the whole story.
Avery: Right.

The time bomb in Obamacare? George Will discussing Thom Lambert's (U Chicago Law '98) Cato article (HT:SD)

http://www.washingtonpost.com/opinions/george-will-the-time-bomb-within-obamacare/2013/01/18/673a113c-6108-11e2-9940-6fc488f3fecd_story.html


The time bomb in Obamacare?




A willow, not an oak. So said conservatives of Chief Justice John Roberts when he rescued the Affordable Care Act (ACA) — a.k.a. Obamacare — from being found unconstitutional.
But the manner in which he did this may have made the ACA unworkable, thereby putting it on a path to ultimate extinction.
This plausible judgment comes from professor Thomas A. Lambert of the University of Missouri Law School, writing in Regulation, a quarterly publication of the libertarian Cato Institute.

"athletes had to choose between succeeding in sports and obeying the law"

http://www.thenewatlantis.com/publications/how-to-think-about-our-steroid-supermen


How to Think About Our Steroid Supermen

Lance Armstrong, the Baseball Hall of Fame, and the Meaning of Sports


As we gather distance from our athletes’ feats of a decade ago, we must come to grips with how to treat those giants we once worshipped. This week, Lance Armstrong alternatingly apologized and made excuses in front of Oprah’s cameras. Last week, Barry Bonds and Roger Clemens were denied induction into the Baseball Hall of Fame. As we cajole our once-sainted into the national atonement ritual and as we deny immortality to the players we once cheered, we need to ask why. We can only punish correctly if we correctly perceive the dimensions of the sin. If we get the crime wrong, we will err in the punishment. Unfortunately, the public discussion of the problem of doping — at least as presented in the work of many sportswriters — lacks a clear understanding of the moral meaning of sports and athletic achievement.
.................
Tom Verducci shares the concern for fairness, but argues that the playing field actually was not level during the steroid era: “The hundreds who played the game clean were harmed. Many lost jobs, money and opportunity by choosing to play the game clean. I think of them every time I get a Hall of Fame ballot.” But why would anyone choose to play the game “clean” when being “dirty” carries no official sanction from the sport? One possibility is that some performance-enhancing drugs, while not explicitly banned during that era by Major League Baseball, were not legal in the United States and therefore athletes had to choose between succeeding in sports and obeying the law.
................
In choosing to use performance-enhancing drugs these men chose to participate not in sport but in a spectacle that  bears only a mocking resemblance to true athletic achievement. As such, we cannot induct them into our temples of great sportsmen, nor can we consider them the best sportsmen in a corrupted era. Armstrong, Bonds, Clemens, and the rest all chose to be supermen rather than sportsmen. They cannot be both.

Richard Epstein: Unions vs. Our Kids (HT:MN)

http://www.hoover.org/publications/defining-ideas/article/138386



January 22, 2013

Unions vs. Our Kids

In New York City, bus drivers go on strike at the expense of children with disabilities.
People who spend any time in New York City are quick to inure themselves to the vicissitudes of everyday life. But even the hard-of-heart have found it difficult to respond to the personal accounts of the thousands of families that have been dislocated by the decision of Local 1181 of the Amalgamated Transit Union to initiate a school bus strikethis past Wednesday. Some 8,800 drivers and matrons, whose incomes average about $35,000 per year, went on strike, shutting down about 70 percent of the City’s 7,700 school bus routes.
...................

In dealing with this issue, the common response is to treat the system of collective bargaining as a social given and then to make anguished pleas for the parties to come back to the bargaining table on this, as on so many other issues. But a more sober look at the overall consequences of this strike indicates that a much more radical cure is needed to deal with the situation.
The institution of collective bargaining has much more traction in the industrial sector, where strikes were intended to shut down mines and factories. In these settings, both parties can take steps to minimize the effects of long lay-offs. Thus, in the run-up to the strikes, plants can run at full bore, allowing the firm to store inventory, while workers fatten their wallets to prepare for the lean days ahead.


The yearly prevalence of findings in endoscopy of the lower part of the gastrointestinal tract

http://www.ncbi.nlm.nih.gov/pubmed/23326676


 2012;2012:527634. doi: 10.5402/2012/527634. Epub 2012 Dec 27.

The yearly prevalence of findings in endoscopy of the lower part of the gastrointestinal tract.

Source

Department of Internal Medicine and Gastroenterology, Zaans Medisch Centrum, P.O. Box 210, 1500 EE Zaandam, The Netherlands.

Abstract

Introduction. Endoscopy of the colon and rectum is increasingly used. Aim of the Study. All consecutive endoscopies of the colon and rectum were studied in order to assess the yearly prevalence of significant endoscopic diagnoses. 
Methods. All consecutive endoscopies of the colon and rectum were included. Endoscopies were done with endoscopes of Olympus. Significant endoscopic diagnoses were defined as colorectal cancer, polyps, diverticuli, large sessile polyps, and inflammatory bowel disease. 
Results. In 20 years a total of 24431 endoscopies were done. The yearly number of sigmoidoscopies was mean 96, range of 42-370. The number of colonoscopies was mean 1126, range of 643-1912. The number of colonoscopies significantly increased. The number of colonoscopies on request of an internist or gastroenterologist showed a slow but steady increase. Successful caecal intubation rose from 70% to 92% in 2011. Since 1996 there is a steep increase in the percentage of procedures with abnormalities. The number of cancer and polyps increased in twenty years. No great changes were seen in inflammatory bowel disease. 
Conclusion. Colonoscopy is a procedure with a high diagnostic yield. The number of patients with tumours rose in twenty years.

Monday, January 21, 2013

Exercise Addiction

http://www.ncbi.nlm.nih.gov/pubmed/23329605


 2012 Dec 21. [Epub ahead of print]

Exercise Addiction.

Source

Department of Kinesiology, University of the Fraser Valley, 33844 King Road, Abbotsford, BC, V2S-7M8, Canada, emilio.landolfi@ufv.ca.

Abstract

This article examines the nature of exercise addiction. It presents a broad, congruent and discerning narrative literature review with the aim of providing a deeper understanding of the condition 'exercise addiction', including symptoms and options for treatment. In addition, guidelines are provided with respect to 'healthy' levels of exercise. Criteria used for determining the eligibility of studies evaluated in the review included the provision of relevant information in studies identified using pertinent search terms. The review highlights some of the key distinctions between healthy levels of exercise and exercise addiction. The findings suggest that an individual who is addicted to exercise will continue exercising regardless of physical injury, personal inconvenience or disruption to other areas of life including marital strain, interference with work and lack of time for other activities. 'Addicted' exercisers are more likely to exercise for intrinsic rewards and experience disturbing deprivation sensations when unable to exercise. In contrast, 'committed' exercisers engage in physical activity for extrinsic rewards and do not suffer severe withdrawal symptoms when they cannot exercise. Exercisers must acquire a sense of life-balance while embracing an attitude conducive to sustainable long-term physical, psychological and social health outcomes. Implementation of recommendations by the Canadian Society for Exercise Physiology, which states that all apparently healthy adults between 18 and 64 years of age should accumulate at least 150 minutes of moderate (5 or 6 on a scale of 0-10) to vigorous (7 or 8 on a scale of 0-10) intensity aerobic physical activity per week in bouts of 10 minutes or more, also expressed as 30 minutes per day distributed over 5 days per week, would be a good start.

Does a higher frequency of difficult patient encounters lead to lower quality care? (Study: No)

http://www.ncbi.nlm.nih.gov/pubmed/23326819

 2013 Jan;62(1):24-9.

Does a higher frequency of difficult patient encounters lead to lower quality care?

Source

Newton-Wellesley Hospital, Newton, MA, USA. Email: perryan@post.harvard.edu.

Abstract

This study would suggest it does not. Despite physician burnout, dissatisfaction, and related stresses associated with challenging practices, investigators found that quality of care was unaffected.

From U Southampton: New horizons in the pathogenesis, diagnosis and management of sarcopenia

http://www.ncbi.nlm.nih.gov/pubmed/23315797


 2013 Jan 11. [Epub ahead of print]

New horizons in the pathogenesis, diagnosis and management of sarcopenia.

Source

Academic Geriatric Medicine, University of Southampton, Southampton, UK.

Abstract

Sarcopenia is the age-related loss of skeletal muscle mass and function. It is now recognised as a major clinical problem for older people and research in the area is expanding exponentially. One of the most important recent developments has been convergence in the operational definition ofsarcopenia combining measures of muscle mass and strength or physical performance. This has been accompanied by considerable progress in understanding of pathogenesis from animal models of sarcopenia. Well-described risk factors include age, gender and levels of physical activity and this knowledge is now being translated into effective management strategies including resistance exercise with recent interest in the additional role of nutritional intervention. Sarcopenia is currently a major focus for drug discovery and development although there remains debate about the best primary outcome measure for trials, and various promising avenues to date have proved unsatisfactory. The concept of 'new tricks for old drugs' is, however, promising, for example, there is some evidence that the angiotensin-converting enzyme inhibitors may improve physical performance. Future directions will include a deeper understanding of the molecular and cellular mechanisms of sarcopenia and the application of a lifecourse approach to understanding aetiology as well as to informing the optimal timing of interventions.

Are teenagers at risk for developing cardiovascular disease in later life?

http://www.ncbi.nlm.nih.gov/pubmed/23314517


 2013 Jan 12:1-6. doi: 10.1515/ijamh-2013-0010. [Epub ahead of print]

Are teenagers at risk for developing cardiovascular disease in later life?

Abstract

Abstract 
Background: The aim of this study is to measure the occurrences of the following risk factors: tobacco use, levels of physical activity, levels of physical inactivity, and body mass index (BMI) among adolescents in Trinidad. 
Methods: A two-stage random sampling process was used to select schools and students. Data were collected using a pretested self-administered questionnaire and included age, gender, ethnicity, tobacco use, levels of physical activity, levels of physical inactivity, BMI, and frequency of fast food consumption. 
Results: Overall, 44.6% of the 1896 adolescents already had more than two risk factors associated with cardiovascular disease (CVD). The most prevalent risk factor was the consumption of fast food (79.8%), while the least was smoking (12.0%). Out of the 75.4% physically active students, 47.6% spent more than 30 min in daily physical activity. In addition, 30.4% of the study population was overweight and obese, with the majority being 14 years of age (p=0.003). Overall, the overweight and obese students spent a significant amount of time watching television, playing video/computer games and talking on the phone, and frequently consumed fast food (p<0.001). 
Conclusion: The study found a significant number of teenagers in Trinidad presenting with more than two risk factors that may lead to CVD. Based on previous research, these findings have undoubtedly placed the students well within the models used to predict heart disease later in life.

U Colorado: Chemosensors in the nose: guardians of the airways

http://www.ncbi.nlm.nih.gov/pubmed/23280357


 2013 Jan;28(1):51-60. doi: 10.1152/physiol.00035.2012.

Chemosensors in the nose: guardians of the airways.

Source

Department of Cell & Developmental Biology, Rocky Mountain Taste & Smell Center, University of Colorado School of Medicine, Aurora, Colorado.

Abstract

The G-protein-coupled receptor molecules and downstream effectors that are used by taste buds to detect sweet, bitter, and savory tastes are also utilized by chemoresponsive cells of the airways to detect irritants. Here, we describe the different cell types in the airways that utilize taste-receptor signaling to trigger protective epithelial and neural responses to potentially dangerous toxins and bacterial infection.

From Ohio State study "suggests elevated popular music involvement is a risk factor with respect to younger adolescents' substance use behavior"

http://www.ncbi.nlm.nih.gov/pubmed/23311876

 2013 Jan 11. [Epub ahead of print]

Prospective Influence of Music-Related Media Exposure on Adolescent Substance-Use Initiation: A Peer Group Mediation Model.

Source

a School of Communication , The Ohio State University , Columbus , Ohio , USA.

Abstract

The present study tests prospective effects of music-related media content (from television, Internet, and magazines) on youth alcohol, cigarette, and marijuana use initiation. Indirect effects through association with substance-using peers were tested in a 4-wave longitudinal data set (2,729 middle school students for the alcohol model, 2,716 students for the cigarette model, and 2,710 students for the marijuana model) from schools across the United States. In so doing, the authors examine theoretical claims regarding socialization mechanisms for effects of popular music listenership on substance use initiation. Results supported direct effects on alcohol and cigarette uptake, and indirect effects through association with substance-using peers on all 3 substances. This research, in combination with prior studies by several research teams, suggests elevated popular music involvement is a risk factor with respect to younger adolescents' substance use behavior. This influence is in part explained by the role of music-related media content in socialization to substance-using peer groups.

From Johns Hopkins: Cigarette Smoking and Onset of Mood and Anxiety Disorders

http://www.ncbi.nlm.nih.gov/pubmed/23327282


 2013 Jan 17. [Epub ahead of print]

Cigarette Smoking and Onset of Mood and Anxiety Disorders.

Source

Ramin Mojtabai and Rosa M. Crum are with the Department of Mental Health and Rosa M. Crum is with the Department of Epidemiology, Bloomberg School of Public Health, and both authors are with the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD.

Abstract

Objectives. We examined the association between regular cigarette smoking and new onset of mood and anxiety disorders. 
Methods. We used logistic regression analysis to detect associations between regular smoking and new-onset disorders among 34 653 participants in the longitudinal US National Epidemiologic Survey on Alcohol and Related Conditions (2001-2005). We used instrumental variable methods to assess the appropriateness of these models. 
Results. Regular smoking was associated with an increased risk of new onset of mood and anxiety disorders in multivariate analyses (F(df)( = 5,61) = 11.73; P < .001). Participants who smoked a larger number of cigarettes daily displayed a trend toward greater likelihood of new-onset disorders. Age moderated the association of smoking with most new-onset disorders. The association was mostly statistically significant and generally stronger in participants aged 18 to 49 years but was smaller and mostly nonsignificant in older adults. 
Conclusions. Our finding of a stronger association between regular cigarette smoking and increased risk of new-onset mood and anxiety disorders among younger adults suggest the need for vigorous antismoking campaigns and policy initiatives targeting this age group. 

From Columbia U: Stillbirth: Knowledge and Practice among U.S. Obstetrician-Gynecologists

http://www.ncbi.nlm.nih.gov/pubmed/23329563


 2013 Jan 17. [Epub ahead of print]

Stillbirth: Knowledge and Practice among U.S. Obstetrician-Gynecologists.

Source

Department of Obstetrics and Gynecology, Columbia University, New York, New York.

Abstract

Objective To determine knowledge of U.S. obstetrician-gynecologists (OBGYNs) and individual and institutional practices regarding stillbirth.
Study Design We surveyed 1,000 members of the American College of Obstetricians and Gynecologists regarding their knowledge of risk factors and causes of stillbirth and self-rated performance in stillbirth management.
Results Of the 499 who responded, 365 currently practiced obstetrics. Knowledge regarding epidemiology, risk factors, and effective interventions to reduce stillbirth was only fair. About 30% of respondents were unaware that preeclampsia, advanced maternal age, elevated α-fetoprotein, multiple gestation, cigarette smoking, illicit drug use, and being postterm increased risk. Tests to identify stillbirth causes were not performed consistently. Forty-two percent of respondents did not review test results to determine cause. Most hospitals did not have protocols for stillbirth evaluation nor preprinted forms to obtain appropriate stillbirth tests. Stillbirth audits with feedback were rarely performed.
Conclusions OBGYN knowledge and institutional practice regarding stillbirth could be substantially improved. Residency programs need improved education regarding stillbirth. Hospitals and their OBGYN departments should focus more on stillbirth through continuing education programs and grand rounds and develop stillbirth management protocols and standardized order sheets to appropriately evaluate stillbirths. Audits that evaluate cause of death and preventability with a feedback loop focused on improvement in care should be considered.

Health telemarketing? "participants...reported that they would use one or more of the proactive support services offered" (No findings showing they did, though)

http://www.ncbi.nlm.nih.gov/pubmed/23134686


 2012 Nov 7;12:953. doi: 10.1186/1471-2458-12-953.

Increasing the use of preventative health services to promote healthy eating, physical activity and weight management: the acceptability and potential effectiveness of a proactive telemarketing approach.

Source

School of Medicine and Public Health, The University of Newcastle, NSW, Australia. luke.wolfenden@hnehealth.nsw.gov.au

Abstract

BACKGROUND:

Telephone based interventions are effective in promoting health behaviours. The use of telephone based support services to promote healthy eating, activity or weight loss, however, are currently under-utilised. The aim of this study was to assess the acceptability and potential effectiveness of a telemarketing approach in increasing community use of proactive services to encourage healthy eating, physical activity and weight loss.

METHODS:

The study employed a cross sectional design. Eligible consenting participants completed a 15 minute telephone survey conducted by trained telephone interviewers using computer assisted telephone interviewing technology.

RESULTS:

Overall, 87% of participants considered it acceptable for a health service to contact people by telephone to offer assistance to help them lose weight, eat healthily or be more physically active. Among participants with inadequate fruit and vegetable intake, physical activity or who were overweight, 64%, 54% and 61% respectively reported that they would use one or more of the proactive support services offered. Females and those from non -English speaking households who did not eat sufficient serves were significantly more likely to report that they would use support services.

CONCLUSIONS:

The findings suggest that proactive telemarketing of health services to facilitate healthy eating, physical activity or weight loss is considered highly acceptable and may be effective in encouraging service use by more than half of all adults with these behavioural risks.

From U Graz: Frontal brain asymmetry and transient cardiovascular responses to the perception of humor

http://www.ncbi.nlm.nih.gov/pubmed/23274171


 2012 Dec 26. pii: S0301-0511(12)00279-7. doi: 10.1016/j.biopsycho.2012.12.004. [Epub ahead of print]

Frontal brain asymmetry and transient cardiovascular responses to the perception of humor.

Source

Department of Psychology, Biological Psychology Unit, Karl-Franzens University, Graz, Austria. Electronic address: ilona.papousek@uni-graz.at.

Abstract

The study examined the relationship of individual differences in prefrontal brain asymmetry, measured by the EEG in resting conditions, to the individual's responsivity in the context of humor (n=42). Several weeks after the EEG recording, immediate cardiovascular responses to the perception of humor and behavioral indicators of humor processing were obtained in an experimental paradigm involving non-verbal cartoons. Relatively greater resting activity in the left than right prefrontal cortex, particularly at the ventrolateral positions, was associated with faster detection of humor, a more pronounced cardiac response to the perception of humor (heart rate and cardiac output), and more accessible internal positive affective states (indicated by faster reports of amusement levels). The study confirms and extends findings of the relevance of prefrontal brain asymmetry to affective responsivity, contributing evidence in the domain of positive affect and humor, and demonstrating relationships to the immediate cardiovascular response pattern to an emotional event.

The pun conundrum

http://www.bbc.co.uk/news/magazine-21011778


The pun conundrum


To pun or not to pun, that is the question. The lowest form of wordplay, or an ancient art form embraced by the likes of Jesus and Shakespeare, asks Sally Davies.


Where good humour and refreshments abound, puns seem to follow.

Yet this neat little linguistic device - which exploits the multiple meanings of words or phrases that sound the same or similar - is considered by its detractors to be as irritating as it is irrepressible.
.......................

But regardless of its rationale, punning is clearly more than a mere linguistic fillip. And there may be reason to hope that the internet will restore its reputation. The efflorescence of punnery on social networking sites like Twitter, Tumblr and Reddit, which bulge with the fruits of meme generators, suggests that puns have become acceptable as part of the online conversation.

It may be only a matter of time until the pun rises once again. But for now, its future is an impunderable question.


Michigan: Three new fungal meningitis infections

http://www.minbcnews.com/news/story.aspx?id=850264#.UP1VIic36Jo

Three new meningitis infections

Michigan health officials have reported three more infections in the past week linked to contaminated steroids supplied by a Massachusetts pharmaceutical company.
LANSING (AP) --  
The Michigan Department of Community Health says at least 244 people have been infected with illnesses including fungal meningitis that are part of a national disease outbreak. The steroids are used in injections to treat neck and back pain.

Restricting indications for sinonasal computed tomography in children with cystic fibrosis

http://www.ncbi.nlm.nih.gov/pubmed/23329091

 2013 Jan 1;139(1):54-8. doi: 10.1001/jamaoto.2013.1063.

Restricting indications for sinonasal computed tomography in children with cystic fibrosis.

Abstract

OBJECTIVES To evaluate whether a low rate of exposure to sinonasal computed tomographic (CT) scans can be achieved when strict criteria are applied for their use in children with cystic fibrosis (CF) and to emphasize the importance of limiting radiation exposure in the context of the current longer life expectancy in this group of patients. 
DESIGN Retrospective chart review. SETTING Tertiary care children's hospital. 
PATIENTS The study included 277 children who were regularly followed up in the CF clinic in the last 11 years (mean duration of follow up, 7.87 years), 33 of whom underwent sinonasal CT. 
MAIN OUTCOME MEASURES Indications used for scanning, health professional (ear, nose, and throat specialist or pulmonologist) ordering the test, eventual modifications of ongoing treatment according to CT results, and time lapse between CT scanning and surgery. 
RESULTS Of 277 children with CF, 33 (12%) underwent a total of 39 sinonasal CT scans during the follow-up period (0.018 scans per patient per year of follow-up). Twenty-nine of the CT scans (74% of all cases, 90% of CT scans ordered by the ear, nose, and throat surgeon) were performed in the preoperative context and demonstrated the extent of the polypoid disease whenever present (26 cases [90%]) and the cause of nasal obstruction (20 cases [69%]). The mean period between the scanning and the surgery was 57 days (range, 0.10-173 days). Computed tomographic scans that were not meant for preoperative planning were performed in 10 cases (26%). The indications were disease evaluation (10%), ruling out a mucocele (5%); pre-lung transplantation status (5%), ruling out an intraorbital complication (3%); and headache investigation (3%). The results of the scans did not modify the management of the disease in those patients. 
CONCLUSIONS With the use of stringent criteria, it is possible to achieve a low rate of exposure to sinonasal CT scans in the population of children with CF. The main indication should be the preoperative planning regarding anatomy, extent of disease, and sites of nasal obstruction. The use of CT scans for disease evaluation does not seem to appreciably modify the treatment course and could be avoided.

Screening mammograms: Study suggests "result notification letters alone are inadequate"

http://www.ncbi.nlm.nih.gov/pubmed/23324987

 2013 Jan 17. [Epub ahead of print]

How do Breast Imaging Centers Communicate Results to Women with Limited English Proficiency and Other Barriers to Care?

Source

Division of General Internal Medicine and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1611 NW 12th Ave., Suite 356, Miami, FL, 33101, USA, emarcus@med.miami.edu.

Abstract

Research suggests that women with Limited English Proficiency (LEP) and ethnic minority women are at increased risk of being inadequately informed of their mammogram result. The purpose of this study is to explore breast imaging centers' communication practices and assess how these centers accommodate women with low literacy and LEP. A 35-question survey was distributed to a national association of more than 700 breast health centers. Descriptive analysis of the overall sample and Fisher's exact or Chi squared testing to distinguish differences between subgroups were performed. Respondents from 206 centers completed questionnaires. 29 % of respondents stated that more than a quarter of their patients were black, 27 % of respondents stated that more than a quarter of their patients were Hispanic/Latina, and 13 % of respondents stated that more than a quarter of their patients had LEP. Overall, 18 % of respondents reported they do not routinely telephone patients with results, 15 % do not have multilingual staff or translators available to answer questions, and 69 % send result letters in English only. Of note, 69 % use patient navigators. Centers reported systemic strengths and barriers to clear communication of mammography results. Our findings are consistent with past investigations identifying a general need to improve the communication of breast imaging results and suggesting that result notification letters alone are inadequate in ensuring that every woman understands her personal results and follow-up plan.