Main Category: Cosmetic Medicine / Plastic Surgery
Also Included In: Seniors / Aging;  Dermatology;  Women’s Health / Gynecology
Article Date: 26 Jan 2012 – 1:00 PST

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Human skin is the body’s first line of defense and often mirrors the health, nutritional status and age of a person. Over time, skin shows signs of aging due to the gradual breakdown of collagen and elastin. However, skin can be rebuilt and made healthier no matter one’s age. Natural supplement Pycnogenol® (pic-noj-en-all), an antioxidant plant extract from the bark of the French maritime pine tree, was found to improve skin hydration and elasticity in women in a clinical trial published this month in Skin Pharmacology and Physiology.

The study was conducted at the Leibniz Research Institute for Environmental Medicine (IUF) in Dusseldorf, Germany and examined 20 healthy women, aged 55 – 68 years. Participants were given 75 mg of Pycnogenol® per day, over a period of 12 weeks. Skin hydration, skin elasticity and skin fatigue were assessed by non-invasive biophysical methods at trial start and after six and 12 weeks. In addition, at the beginning and again after 12 weeks of Pycnogenol® supplementation, each time, a biopsy was obtained to assess gene expression of HAS-1 and COL1A1 and COL1A2. The study found that:

• Pycnogenol® elevated COL1A1 by 29 percent and COL1A2 by 41 percent and increased hyaluronic acid production in skin by 44 percent
• Pycnogenol® enhanced skin elasticity by 25 percent, in addition to skin hydration by eight percent, and was especially noticeable in women who had dry skin from the start, with an increase of 21 percent
• Pycnogenol® decreased skin fatigue considerably
• Pycnogenol® reduced skin wrinkles by three percent and increased skin smoothness by six percent

“To date, Pycnogenol® is the only natural supplement that stimulates hyaluronic acid production in human skin. And, we are encouraged by the molecular evidence confirmed in this study that shows nutritional supplementation with Pycnogenol® benefits human skin,” explains Dr. Jean Krutmann, the lead researcher from the Leibniz Research Institute in Dusseldorf, Germany.

Study results confirmed Pycnogenol® improved skin at a physiological and molecular level. Pycnogenol® increased hyaluronic acid in women by 44 percent after 12 weeks of supplementation. Hyaluronic acid binds large quantities of water in the skin and in other tissues, such as cartilage. An increased amount of hyaluronic acid explains the increased skin hydration, higher elasticity and overall smoother skin appearance found in women taking Pycnogenol®.

“This exciting and technically advanced investigation with women representing actual consumer profiles greatly supports our efforts for targeting the skin beauty category for both dietary supplements and functional foods,” says Victor Ferrari, CEO of Horphag Research, exclusive worldwide suppliers of Pycnogenol®, who welcomes the publication.

According to Ferrari, beauty from within has been a driver in Horphag’s business for the last several years, with Asian markets providing numerous Pycnogenol® products in the skincare field. This study joins a sizable and largely expanding portfolio of already established skin research on Pycnogenol®. It confirms previous indications that Pycnogenol® improves human skin conditions, including promoting glowing skin and reducing the appearance of over-pigmentation and skin inflammation, resulting in a more even complexion.

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Main Category: Women’s Health / Gynecology
Article Date: 25 Jan 2012 – 0:00 PST

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Working mothers may be busy, but they like it that way. A recent study of employed moms finds that most would work even if they didn’t have to, but they’re also looking for new ways to negotiate the demands of mothering and the pressures to be an “ideal” employee.

Unlike earlier research, the study – published in the February issue of Gender & Society – finds that many employed mothers emphasize the benefits they, and their children, receive from their paid work. Both married and single mothers said they found more fulfillment (and gained self confidence) in paid work than in parenting – and this is an essential reason why they do not stay at home with their children. Most women – regardless of their class, race/ethnicity, or marital status, said they would work (at least part time) even if they didn’t have to. The study was conducted by Karen Christopher, an associate professor of Women’s/Gender Studies and Sociology at the University of Louisville.

Over the past several decades, mothers’ employment rates have risen sharply. By 2010, approximately two-thirds of North American mothers with young children worked outside of the home. Unlike many previous studies on working mothers, the new research looks at a more diverse, young group of mothers, including women from both Canada and the U.S., as well as women with different racial/ethnic backgrounds, class and marital status. Most women in the study were born between 1970 and 1985. Prof. Christopher interviewed 40 working mothers, each with at least one child under the age of 5; over half the women had two children.

Although the women enjoy their careers, they also place limits on how much they work so that they can remain connected to their children. Many women sought out jobs (even high-powered professionals, such as lawyers) with employers who would not demand that they work overtime or nights on a regular basis. Several women stressed that they only work “reasonable” hours. For example, Jana, an African American nurse with one child, said that she was unwilling to trade in her 8-hour shifts for 10-hour shifts and receive overtime pay. At the same time, whether they were married or single, African-American or white, lower, middle income, or higher income – almost all of the mothers interviewed by Prof. Christopher said they wanted to work. Prof. Christopher argues that while these moms are not spending intensive amounts of time with their kids, they see themselves as involved parents who are “in charge” of their children’s lives.

For these women, a new emphasis on their own needs as people helped supersede any feelings of guilt or ambivalence over working for pay. “About one-third of the 40 employed mothers expressed some ambivalence or guilt over their employment, but most employed mothers justified their paid work by saying it made them more fulfilled people, in addition to better mothers,” Prof. Christopher says. “So, these mothers are not only reframing what good mothering entails, they also frame employment in ways different than do earlier studies of mothers.”

Some Things Haven’t Changed

The paper cites research showing that mothers with male partners still perform about twice as much child care and housework as their partners. In addition, Prof. Christopher suggests that inflexible workplaces and inadequate public policies are constraining North American mothers’ (and fathers’) ability to combine employment with involved parenting.

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Main Category: Pain / Anesthetics
Also Included In: Women’s Health / Gynecology
Article Date: 25 Jan 2012 – 0:00 PST

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Women report more-intense pain than men in virtually every disease category, according to Stanford University School of Medicine investigators who mined a huge collection of electronic medical records to establish the broad gender difference to a high level of statistical significance.

Their study, published online in the Journal of Pain, suggests that stronger efforts should be made to recruit women subjects in population and clinical studies in order to find out why this gender difference exists.

The study also shows the value of EMR data mining for research purposes. Using a novel database designed especially for research, the Stanford scientists examined more than 160,000 pain scores reported for more than 72,000 adult patients. From these, they extracted cases where disease-associated pain was first reported, and then stratified these findings by disease and gender.

“None of these data were initially collected for research, but this study shows that we can use it in that capacity,” said Atul Butte, MD, PhD, the study’s senior author.

The medical literature contains numerous reports indicating that women report more pain than men for one or another particular disease, noted Butte, a professor of systems medicine in pediatrics. “We’re certainly not the first to find differences in pain among men and women. But we focused on pain intensity, whereas most previous studies have looked at prevalence: the percentage of men vs. women with a particular clinical problem who are in pain. To the best of our knowledge, this is the first-ever systematic use of data from electronic medical records to examine pain on this large a scale, or across such a broad range of diseases.”

The study’s first authors were Butte’s graduate student Linda Liu and postdoctoral scholar David Ruau, PhD, who splits his time between Butte’s group and that of co-author Martin Angst, MD, professor of anesthesia. David Clark, MD, PhD, a professor of anesthesia, was another co-author.

Electronic medical records are deployed in about 1-2 percent of hospitals now, but that should approach 100 percent within the next few years as the United States continues to move toward EMRs, Butte said. Thus, large-scale research using clinically collected data will become increasingly feasible.

In this case, the scientists tapped an existing data archive that has been designed specifically for ease of research: the Stanford Translational Research Integrated Database Environment, or STRIDE. Pioneered by the medical school’s chief information officer, Henry Lowe, MD (who is also an associate professor of systems medicine in pediatrics and director of Stanford’s Center for Clinical Informatics), STRIDE aggregates clinical data on patients cared for at Stanford Hospital & Clinics and Lucile Packard Children’s Hospital, making this data searchable for approved research projects.

Butte’s team selected only adult records and looked for gender-related differences in pain intensity as reported on 1-to-10 scales, in which a zero stands for “no pain” and 10 for “worst imaginable.” Their search algorithm combed through de-identified EMR data for more than 72,000 patients, and came up with more than 160,000 instances, ranging across some 250 different disease categories, in which a pain score had been reported.

“If someone’s reporting that they’re in pain, they’re probably going to be given medication, which might reduce any subsequently measured pain score,” said Butte. To get pain estimates that weren’t as confounded by subsequent pain-relief medications or procedures, his group analyzed only the first pain-intensity score reported by a patient per encounter with a hospital-associated health professional.

The search identified 47 separate diagnostic categories for which there were more than 40 pain reports for each gender. The sample included more than 11,000 individual adult patients, of which 56 percent were women and 51 percent of them white. The researchers were able to further analyze these 47 categories by condensing them into 16 disease clusters: “musculoskeletal and connective tissue” (in which the biggest gender differences in reported pain intensity were observed), “circulatory” and so forth.

“We saw higher pain scores for female patients practically across the board,” said Butte. Those reported differences were not only statistically significant, but also clinically significant. “In many cases, the reported difference approached a full point on the 1-to-10 scale. How big is that? A pain-score improvement of one point is what clinical researchers view as indicating that a pain medication is working.”

While the overall results tended to confirm previous clinical findings – for example, that female fibromyalgia or migraine patients report more pain than their male counterparts – the search also unearthed previously unreported gender differences in pain intensity for particular diseases, for example acute sinusitis and “cervical spine disorders,” more commonly known as neck pain.

The study’s results come with a few caveats. First, the investigators made the assumption that patients’ pain hadn’t already been treated – for example, that they hadn’t already self-medicated with over-the-counter painkillers – by the time they showed up in the emergency room, doctor’s office or neighborhood health clinic (or, equivalently, that the men and women were equally likely to have done so).

Other possible confounders include the setting in which pain was reported, Butte said. “Will an 18-year-old male report the same pain intensity with or without his mom present, or in the presence of a male vs. a female nurse? We can’t be sure.” But the sheer size of the study probably washes these concerns out at least to some extent, he said.

The third caveat is perhaps the most controversial. “It’s still not clear if women actually feel more pain than men do,” said Butte. “But they’re certainly reporting more pain than men do. We don’t know why. But it’s not just a few diseases here and there, it’s a bunch of them – in fact, it may well turn out to be all of them. No matter what the disease, women appear to report more-intense levels of pain than men do.”

To get to the bottom of this, Butte’s team plans to search EMRs to see if they can find some objective measurement – an already commonly measured blood-test variable, for instance – that correlates highly with reported pain. “We want to find a biomarker for pain,” he said.

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Main Category: HIV / AIDS
Also Included In: Women’s Health / Gynecology;  Public Health
Article Date: 25 Jan 2012 – 0:00 PST

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A spoonful of medicine goes down a lot easier if there is a dog or cat around. Having pets is helpful for women living with HIV/AIDS and managing their chronic illness, according to a new study from the Frances Payne Bolton School of Nursing at Case Western Reserve University.

“We think this finding about pets can apply to women managing other chronic illnesses,” said Allison R. Webel, instructor of nursing and lead author of the article, “The Relationship Between Social Roles and Self-Management Behavior in Women Living with HIV/AIDS,” which appears in the online journal Women’s Health Issues.

Webel set out to better understand how women manage their HIV/AIDS and stay on track to take their medications, follow doctors’ orders and live healthy lifestyles. She conducted 12 focus groups with 48 women to find out what they did to stay healthy. The women had an average age of 42, about 90 percent had children, and more than half were single.

During the focus groups, six predominant social roles emerged that helped and hindered these women in managing their illness: pet owner, mother/grandmother, faith believer, advocate, stigmatized patient, and employee. All roles had a positive impact except stigmatized patient, which prevented women from revealing their illness and seeking out appropriate supports.

“Much information is available about the impact of work and family roles, but little is known about other social roles that women assume,” Webel said.

Being a pet owner was an important surprise, added Webel, who collaborated with co-author Patricia Higgins, a professor of nursing at Case Western Reserve University.

“Pets – primarily dogs – gave these women a sense of support and pleasure,” Webel said.

When discussing the effect their pets have on their lives, the women weighed in. “She’s going to be right there when I’m hurting,” a cat owner said. Another said: “Dogs know when you’re in a bad mood…she knows that I’m sick, and everywhere I go, she goes. She wants to protect me.”

The human and animal bond in healing and therapy is being recognized, Webel said, as more animals are visiting nursing homes to connect to people with dementia or hospitals to visit children with long hospital stays.

Being a pet owner is just one social aspect of these women’s lives. “We found the social context in which this self-management happens is important,” Webel said.

Another strong role to emerge was advocate. Participants wanted to give back and help stop others from engaging in activities that might make them sick, the researchers report.

While roles as mothers and workers are well documented, “less-defined social roles also have a positive impact on self-management of their chronic illness,” Webel said.

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Editor’s Choice
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Main Category: Pain / Anesthetics
Also Included In: Women’s Health / Gynecology
Article Date: 23 Jan 2012 – 13:00 PST

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The idea that men suffer more when in pain than women could well be a myth, according to a new report written by Stanford University researchers in the Journal of Pain. The authors say that their large study found that even though women are able to endure childbirth, an ordeal that males never have to go through, their findings showed that overall, males appear to endure pain better than women.

The researchers stress that even though theirs is a very large study, its findings are not conclusive.

Atul Butte and team set out to determine how 47 common health problems affect males and females in pain scores. In a study, involving over 72,000 patients of both sexes, they found that females reported experiencing higher levels of pain in 39 of them, 14 more than men.

Butte said:

“We saw higher pain scores for female patients practically across the board. In many cases, the reported difference approached a full point on the one-to-10 scale.”

A difference of one point in the pain score is significant, the authors explained; enough to make doctors decide that a pain medication is effective.

In comparison to males, female patients tend to be more sensitive to pain related to breathing, circulation, digestion and joint conditions or disorders. Women also reported (in this study) higher levels of pain than men in migraines and neck pain.

The scientists stressed that they did not find out whether the female patients had been on any pain medication before being asked to rate their pain.

If females are enduring higher levels of pain than their male counterparts, it is important that health care professionals take this into account, the authors added.

The researchers said:

“Our data support the idea that sex differences exist, and they indicate that clinicians should pay increased attention to this idea.”

Butte said that perhaps males, because of their upbringing and the macho image they may feel compelled to project, are not being totally honest about the levels of pain they experience and how they are affected.

Pain is a difficult symptom to measure accurately. It depends on the sufferer’s subjective reporting.

Butte said:

“Men may be under-reporting it, say if they are being seen
by a female nurse.”

Previous studies had shown that the way a woman perceives pain may change, depending on where she is in her menstrual cycle; mainly because of varying estrogen blood levels. Estrogen levels in females peak just before ovulation, and go back to normal as soon as the egg is released.

When a female is giving birth, her levels of estrogen rise considerably. Rising estrogen levels trigger the release of endorphins, which in turn raise a human’s tolerance for pain.

Written by Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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Main Category: Women’s Health / Gynecology
Also Included In: Endocrinology
Article Date: 24 Jan 2012 – 0:00 PST

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Women’s emotional responses can vary significantly premenstrually. They may become depressed or grumpy during menstruation or the premenstrual phase, known as premenstrual syndrome (PMS). Roughly 75% of reproductive-age women report premenstrual mood swings or physical discomfort. Brain scans show a significant increase in activity in the medial orbitofrontal cortex related to emotional processing premenstrually, even if women’s emotional responses do not vary significantly. The relationship between estrogen and emotion was first investigated over 100 years ago, and it has been shown that estrogen can improve mood. Research has shown that during prepuberty, boys are twice as likely as girls to need psychotherapy. However, the opposite is true postpubertally. Women are twice as likely to develop anxiety or depressive disorders compared to men. Women’s increased vulnerability to depressive disorders typically occurs between the beginning of puberty and the age of 55, in concert with estrogen level changes. In addition, it is believed that about 95% of women have recurrent psychosis or a noticeable increase in negative emotions along with the fluctuation in endogenous estrogen level. Therefore, understanding the relationship between estrogen level changes and cyclical mood disorders can provide a theoretical basis for improving female physical and mental health.

In their paper titled “Estrogen Impacts on Emotion: Psychological, Neuroscience and Endocrine Studies”, Professor Luo Yue-Jia from the College of Brain and Cognitive Sciences of Beijing Normal University and Dr. Chen Chunping from the Institute of Psychology of the Chinese Academy of Sciences systematically reviewed research in the fields of neuroscience, psychology and endocrinology. The paper was published in Science China: Life Sciences. The authors hope the study will contribute to a better understanding of how estrogen affects female mood.

Estrogen has a wide range of effects on the body and brain. It exerts influence on the central nervous system through complex mechanisms of physiology and psychology. It can affect the generation and efficiency of neurotransmitters in the amygdala, hippocampus and prefrontal lobes, which are important brain areas related to emotion and cognition. It also plays a role in changing emotional behavior by acting on the hypothalamus-pituitary-adrenal (HPA) axis. The genetic transcription of estrogen receptors can modulate emotional behavior, and estrogen can influence emotional processing via neuropsychological factors. It enhances the coding of emotion and recognition accuracy for facial expressions. Estrogen can also affect emotional arousal and change the intensity of emotional experiences.

Clinicians have long recognized estrogen’s therapeutic potential for mood change. Self-rated depression scores among oophorectomized women with depressive symptoms are significantly decreased by administration of estrogen, alone or in combination with the selective serotonin reuptake inhibitor fluvoxamine. In addition, estrogen replacement therapy is often used in postmenopausal women to improve mood, energy level and general well-being. However, estrogen is not simply a natural “physiological protectant”. Some have reported that estrogen administration does not improve mood and even causes fear and anxiety. Therefore, the impact of estrogen on emotion varies and may depend on the individual’s current state and the situation.

The authors believe that hormones do not exert an absolute and singular effect on the body. They regulate physical and psychological changes in numerous dimensions. Thus, the influence of estrogen on women’s emotion is related to multiple systems. If we achieve a comprehensive understanding of the internal mechanisms related to emotional changes and estrogen, we can provide a theoretical support system to help address female emotional disorders. The authors also believe that the psychological, neurological and endocrine systems are interdependent. Therefore, an effective blending of psychology, biology and physiology is needed. This was the original intention of the paper.

Currently, a team led by Professor Luo Yue-Jia in cooperation with Professor Huang Ruiwang from South China Normal University continues to carry out related studies using electroencephalograms and magnetic resonance imaging as well as behavioral and biochemical techniques. In addition to the study of the relationship between estrogen and emotion, we have extended the research to ovarian hormones and complex social cognition.

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Main Category: Nutrition / Diet
Also Included In: Public Health;  Women’s Health / Gynecology
Article Date: 22 Jan 2012 – 0:00 PST

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Grandmothers and other senior female family members should play a key role in nutrition and health programmes for children and women in non-Western societies. However, they are often overlooked by health organisations that don’t understand the importance of their role or see them as an obstacle to promoting good nutrition and health practices.

Those are the key finding of an extensive literature review published in the January issue of Maternal and Child Nutrition.

Community health specialist Dr Judi Aubel reviewed literature covering 60 different cultural contexts in 35 Asian, African and Latin American countries between 1995 and 2010. These included published studies in academic journals, together with unpublished material from non-governmental organisations, international development agencies and universities.

The literature, in English, French and Spanish, came from a broad range of fields, including anthropology, nursing and public health.

“My review revealed that few non-Western programmes have actively engaged grandmothers in child and mother nutrition and health programmes, despite the fact that their involvement and influence in such matters is much more significant than conventionally assumed by policy makers and programme planners” says Dr Aubel.

“The extensive research findings I studied from rural and urban areas of Africa, Asia and Latin America reveal the decisive role of grandmothers, at both household and community levels, in all matters related to mother and child nutrition and health” adds Dr Aubel, co-founder of The Grandmothers Project, a not-for-profit agency that promotes the health and development of communities in the three regions.

“The literature also reveals that, contrary to popular belief, grandmothers are not always set in their ways when it comes to nutrition and health. A few nutrition and health programmes have actively engaged grandmothers and shown them to be a valuable resource.”

The term grandmother is used in Dr Aubel’s review as a generic term to refer to maternal and paternal grandmothers, aunts, elder co-wives and other senior women in the family who are involved in providing support and care for children and their mothers.

The three key findings of her review of non-Western societies of Africa, Asia and Latin America are that:

1. Grandmothers play a central role in providing care for women and children and in advising younger women and male family members on nutrition and health matters, especially during pregnancy, childbirth and when children are infants or still young.
2. Social networks of senior women provide a collective influence on maternal and child nutrition-related practices, especially when women are pregnant or have recently given birth.
3. Fathers and grandfathers usually play secondary, supportive roles in non-emergency situations when it comes to maternal and infant nutrition, but their involvement generally increases in crisis situations, when special logistical and/or financial support are required.

“Despite the fact that grandmothers and other senior women are very involved in the nutrition and health of women and children, national and international policies and programmes rarely target or involve them” says Dr Aubel.

“My review clearly shows that there is a large gap between how those planning public health campaigns for non-Western settings view family dynamics and how they actually work in practice.”

As a result of her review, Dr Aubel makes four key recommendations:

1. Further research should be carried out in non-Western cultural settings in order to understand the roles, norms, communication networks and decision-making patterns in household and community settings.
2. Health professionals and community workers need to re-examine their perceptions of both culture and grandmothers, so that they view grandmothers as resources rather than obstacles.
3. Health training curricula should be revised to provide more focus on how local families and cultural systems promote health and nutrition.
4. Additional research is needed to validate or reject the key findings of this review in specific non-Western cultures.

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I am continually moved by the fearlessness of some of the couples I see in my practice who are willing to step outside of their emotional comfort zones to create a different way of relating to each other.

One useful exercise I suggest they do with me is to brainstorm a list of effective communication behaviours and attitudes which they believe humans are capable of doing. I then ask how often, when there was tension in their families of origin, they actually experienced these behaviours. I have not had many couples answer that they witnessed their parents effectively communicating when stressed. Most of us have not had healthy modelling for dealing with relationship conflicts. It is therefore natural (but not necessarily useful) that we react to stress according to the biological wiring brought about by millions of years of evolution.

This means that under stress, effective communication is statistically exceptional.

I describe many of the couples I see in my practice as normal couples who are working at becoming exceptional. Yet what I mean by exceptional is that they are learning and practicing rare and unnatural skills.

It is natural to defend ourselves when our partner is critical. It is natural to protect ourselves when we feel emotionally hurt. It is natural to avoid emotional pain that reminds us of similar hurtful experiences in our past. It is natural to feel alone when our partner goes into withdrawal to protect themselves.

But it is unnatural to practice emotional restraint. It is unnatural to be patient, understanding and curious when our partner has been triggered and acts out against us. It’s also unnatural to recognize and then acknowledge that we communicate ineffectively when we, rightly or wrongly, feel “under attack.” When we admit to our partner that our actions were ineffective instead of expecting them to change, we are really being exceptional and totally unnatural.

What has been shown in the research by John Gottman is that effective and courageous couples, known as the “masters in relationships”, often practice the unnatural in consistent ways. This means they continually stretch themselves to grow and manage their own reactivity. Practicing in this way means they cannot fail to become exceptional, because they’re actively learning from any mistakes they make. They take calculated risks, over and over again. They practice new relationship skills to stay true to their own higher values as well as their personal and couple goals. In doing so, they slowly rewire their brains thereby creating new repertoires of behaviour to modify their inbuilt reactions to stress. This is the process that distinguishes the masters in relationships from the disasters in relationships.

When your partner gets triggered, when you get triggered, can one of you avoid overreacting? A teacher of mine once said to me that a successful relationship is created when only one partner goes crazy at a time. These words have stayed with me. A good relationship is nearly impossible if we both overreact at the same time.

The formula is simple but not easy. We all must practice to listen, to be honest with compassion, to be curious about our partner’s stresses, uncertainties and fears  as well as about their joys, hopes, goals, and values. We need to strive to stay in alignment with how we aspire to be as an effective partner. Take the initiative. One of us always has to go first. If we keep waiting for our partner to change the dynamic between us, unhappy patterns of interaction will continue for years.

It’s all about practice, and more practice of these unnatural acts. It’s precisely exercises like these which build the muscles to develop a successful relationship.

Main Category: Bones / Orthopedics
Also Included In: Seniors / Aging;  Women’s Health / Gynecology
Article Date: 20 Jan 2012 – 0:00 PST

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More than 250,000 hip fractures occur every year in the U.S., often resulting in hospitalization, surgery, nursing-home admission, long-term disability, and/or extended periods of rehabilitation. Independent existing medical conditions (otherwise known as comorbidities) significantly increase the treatment cost and length of hospitalization for older adults who have sustained a hip fracture, according to a new study recently published in the Journal of Bone and Joint Surgery.

“The purpose of our investigation was to gain a better understanding of the coexisting medical conditions that impact the cost of treating patients with hip fractures and how those conditions affect the overall cost and duration of hospitalization,” said orthopaedic surgeon Kevin P. Black, MD, one of the study’s authors and C. McCollister Evarts Professor and Chair, Orthopaedics and Rehabilitation, Penn State College of Medicine.

Specific Study Details Researchers gathered hospital-discharge information from a 2007 Agency for Healthcare Research and Quality (AHRQ) report which included data from 1,044 hospitals in 40 states. The study involved 32,440 patients, and included information on race, sex, hospitalization cost, length of stay, age, type of hip fracture sustained, and type of surgical hip fracture treatment. Almost 80 percent of patients were age 75 or older, 72.3 percent were female, 87.9 percent were Caucasian, 4.3 percent were Hispanic, and 3.7 percent were black.

Patients most commonly had two or three comorbidities. Only 4.9 percent of patients had no comorbidities. High blood pressure, affecting 67 percent of patients, was by far the most common comorbid condition. Others, listed from more common to less common, included:

• deficiency anemias (disorders caused by a lack of certain nutrients, such as iron or vitamin B12);
• fluid and electrolyte disorders;
• chronic lung diseases;
• uncomplicated diabetes;
• neurological disorders;
• hypothyroidism (a condition in which the thyroid gland does not produce enough thyroid hormone); and
• congestive heart failure.

Key Study Findings Comorbidities significantly raise the cost of hospitalization and length of hospital stay, according to the study. Hip fracture patients who were very thin or malnourished had the greatest increased costs, followed by those with pulmonary circulatory disorders (disorders of blood flow to and from the lungs). Recent weight loss or malnutrition also had the greatest effect on length of hospitalization, increasing the hospital stay by 2.5 days. Congestive heart failure increased the hospital stay by 1.1 days, and pulmonary circulation disorders, by 0.9 day. Fluid and electrolyte disorders, paralysis, and conditions contributing to blood clots also lengthened hospitalization significantly.

The study results may have major implications for doctors, hospitals, and payors, according to Dr. Black.

“Current reimbursement to hospitals only considers if a patient is categorized as having a major comorbidity, a comorbidity, or no comorbidity,” said Dr. Black. “Our study demonstrates that specific comorbidities significantly increase costs and length of stay associated with the treatment of hip fractures.”

Two major issues deserve further investigation, said Dr. Black.

“First, we need to better understand the total cost of caring for hip-fracture patients. Our study focused only on acute hospitalization, but care typically extends well beyond this, since many patients are discharged to rehabilitation and skilled-nursing facilities,” said Dr. Black. “Second, this study did not investigate the quality or outcomes of care. As our population ages, there is reason to believe that the number of hip fractures will increase. Having a better understanding of the comorbidities that affect hip-fracture patients hopefully will lead to the development of strategies to more effectively care for these patients.”

In an effort to prevent hip fractures, Dr. Black and the American Academy of Orthopaedic Surgeons (AAOS) suggest the following fall-prevention strategies:

• Keep floors clear of clutter.
• Wear low-heeled, rubber-soled shoes.
• Make sure all rooms are well-lit.
• Walk on the grass when the sidewalks are slippery.
• Make sure rugs have skid-proof backs.
• Have grab bars installed on the bathroom walls near the bathtub or shower and toilet.
• Use a nonskid bath mat in the shower or bathtub.
• Make sure the stairs are well-lit and have handrails on both sides.

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Main Category: Bones / Orthopedics
Also Included In: Women’s Health / Gynecology;  Seniors / Aging
Article Date: 20 Jan 2012 – 0:00 PST

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The U.S. Preventive Services Task Force and other organizations have recommended that women ages 65 and older be routinely screened for osteoporosis using bone mineral density (BMD) screening. However, how often women should be screened is a topic that remains controversial and undecided, with no definitive scientific evidence to provide guidance.

Now a new study led by Margaret L. Gourlay, MD, MPH of the University of North Carolina at Chapel Hill School of Medicine finds that women aged 67 years and older with normal bone mineral density scores may not need screening again for 15 years.

“If a woman’s bone density at age 67 is very good, then she doesn’t need to be re-screened in two years or three years, because we’re not likely to see much change,” Gourlay said. “Our study found it would take about 15 years for 10 percent of women in the highest bone density ranges to develop osteoporosis.”

“That was longer than we expected, and it’s great news for this group of women,” Gourlay said.

Gourlay, an assistant professor in UNC’s Department of Family Medicine, presented these results in a study published in the Jan. 19, 2012 issue of The New England Journal of Medicine.

In the study, Gourlay and study co-authors analyzed data from 4,957 women aged 67 years and older that were collected as part of the longest-running osteoporosis study in the U.S., the Study of Osteoporotic Fractures. These women were enrolled in the study from 1986 to 1988 when they were 65 years or older, and had bone mineral density (BMD) testing starting about two years later. All had bone mineral density testing at least twice during the study period; some were tested up to five times over a period of 15 years.

For the analysis, women were categorized by BMD T-scores, which compare a person’s bone mineral density to the expected bone density of a healthy young adult (about age 30). Women with osteoporosis (those with a T-score of -2.5 or lower) or past hip or clinical vertebral (spine) fractures were excluded because current guidelines recommend treatment for all women in those groups. Women who had already received treatment for osteoporosis were also excluded. The remaining women were placed in three groups according to their baseline BMD T-scores at the hip. The high risk group was women with T-scores ranging from -2.49 to -2.00, while the moderate risk group had T-scores from -1.99 to -1.50. The low risk group included two T-score ranges: T-scores -1.49 to -1.01, and normal BMD (those with T-scores of -1.00 or higher).

The researchers calculated estimated times for 10 percent of the women in each T-score group to transition to osteoporosis. For the high risk group, the estimated time was 1.1 years, while it was about 5 years for the moderate risk group and slightly over 15 years for the low risk group. They found that in those same time periods, only 2 percent or less of women had hip or clinical vertebral fractures, which are the most important fractures doctors try to prevent by screening for osteoporosis.

The study concluded that baseline BMD is the most important factor for doctors to consider in determining how often a patient should be screened. It also suggests that older postmenopausal women with a T-score -2.0 and below will transition to osteoporosis more rapidly, while women with T-scores higher than -2.0 may not need screening again for 5 to 15 years, Gourlay said. “Doctors may adjust these time intervals for a number of reasons, but our results offer an evidence-based starting point for this clinical decision.”

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