En los pacientes de Medicare es común que se repitan los tests

NUEVA YORK (Reuters Health) – La mitad o más de los

beneficiarios de Medicare repiten los tests cardíacos,

pulmonares, estomacales o vesical en tres años, señala un

estudio.

Esas pruebas no deberían repetirse. Es más, en algunos

casos, como el ecocardiograma o la prueba de esfuerzo cardíaco,

existen recomendaciones en contra de su uso rutinario.

“Nos sorprendió la frecuencia con la que se repiten estas

pruebas”, dijo el autor principal, doctor H. Gilbert Welch, del

Instituto para las Políticas de Salud y la Práctica Clínica de

Dartmouth, New Hampshire. “O esos pacientes desarrollan nuevas

enfermedades continuamente o hay médicos que repiten los

estudios como rutina”.

Con su equipo analizó el uso de seis tests en 743.478

beneficiarios de Medicare: ecocardiograma (ultrasonido

cardíaco), prueba de esfuerzo cardíaco, test de función

pulmonar, tomografía de tórax, cistoscopía (exploración de la

vejiga con una sonda) y endoscopía superior (examen el tracto

gastrointestinal superior).

Todas las pruebas eran diagnósticas, es decir que se

realizan en personas con síntomas para que los médicos puedan

realizar un diagnóstico. Cuestan entre 200 y más de 1000

dólares.

En el período 2004-2006, entre el 7 por ciento (cistoscopía)

y el 29 por ciento (ecocardiograma) de los adultos mayores se

habían realizado esos tests por lo menos una vez.

A menudo, esos exámenes se repetían: el 35 por ciento de los

pacientes a quienes se le había indicado una endoscopía del

tracto superior volvió a hacerse la prueba en tres años. Lo

mismo ocurrió con el 55 por ciento que se había realizado un

ecocardiograma. Para el resto de los exámenes, los resultados

estuvieron dentro de ese rango.

El intervalo promedio para la repetición de los tests fue de

entre cuatro y 14 meses, según publica el equipo en Archives of

Internal Medicine.

Welch aclaró que la única excepción médica para repetir

estas pruebas es cuando los pacientes desarrollan un nuevo

conjunto de síntomas que los médicos controlan después de la

primera prueba. Pero los incentivos económicos suelen lograr que

se pidan más exámenes, sin importar la finalidad.

En el caso de un ecocardiograma, por ejemplo, “si es un

cardiólogo quien lo solicita y lo va a interpretar (…) quizás

exista un incentivo económico para sobreutilizar la prueba”,

dijo la doctora Rachel Werner, de University of Pennsylvania,

Filadelfia. “El hecho es que cobramos más por hacer más”,

agregó. Y no siempre es lo mejor.

“Los pacientes comprendieron la importancia de no usar

medicamentos innecesarios. Pero pienso que la noción

generalizada es que un test diagnóstico nunca hará daño”, dijo

Welch. Pero agregó: “Cuando lo realizamos, podríamos distraernos

con un resultado circunstancial”. Son esos resultados los que

exigen nuevas pruebas y, quizás, un tratamiento innecesario.

Su equipo halló también que las ciudades donde se realizaba

la mayor cantidad de pruebas diagnósticas iniciales también

registraban los porcentajes más altos de repetición de esos

tests.

FUENTE: Archives of Internal Medicine, online 19 de

noviembre del 2012.

Seniors/Aging News Headlines – Yahoo! News

Read More..

UK public sector borrowing rises

21 November 2012 Last updated at 06:39 ET

The government borrowed much more than expected in October, reducing the chances that the UK will hit its deficit reduction target in 2012-13.

UK public sector net borrowing, excluding financial interventions, hit £8.6bn in October, the Office for National Statistics (ONS) said.

That marked a sharp rise from the £5.9bn borrowed in October 2011.

This is the last set of borrowing figures before the chancellor’s Autumn Statement on 5 December.

The headline figure was worse than expected – analysts had forecast borrowing of £6bn.

Corporation tax receipts fell nearly 10% in October, a month when there is usually a heavy inflow to boost the public coffers.

A rise in day-to-day departmental spending also contributed to the higher borrowing.

For the seven months of the financial year so far, borrowing has reached £73.3bn, excluding the one-off effects from the transfer of Royal Mail pension assets.

That is £5bn higher than the same time last year.

A spokesperson for the Treasury said: “The economy is healing, but it still faces many challenges.

“These numbers illustrate that, but also show the government’s plans to bring spending under control are on track for the year.”

But Labour’s shadow chief secretary to the Treasury, Rachel Reeves, said the chancellor was borrowing billions more to pay for the cost of his economic failure.

“Having failed on jobs and growth, the government is now failing on the deficit too,” she said.

‘Wrong direction’ Continue reading the main story

AAA-rating

The best credit rating that can be given to a borrower’s debts, indicating that the risk of borrowing defaulting is minuscule.

Chris Williamson, chief economist at Markit, said the low tax receipts reflected the disappointing performance of the economy, which is experiencing weak growth and weak consumer spending.

He told the BBC that he could see no chance of the government now hitting its deficit target of £120bn for 2012-13. Current projections suggest this year’s deficit would come in closer to £130bn.

“So it’s moving totally in the wrong direction,” he said.

“The longer-term prospects are looking much more disappointing than the Office for Budget Responsibility and the government were hoping when they first set these targets out back in March.”

He added that Chancellor George Osborne was likely to announce increases in taxes, further cuts in spending, or a combination of the two, when he delivers his Autumn Statement.

Chris Williamson, Chief Economist at Markit

However, analysts at Credit Suisse said the figures were disappointing but not disastrous.

“To some extent, this poor reading was mitigated by improvements in last month’s figure, which was around £0.8bn lower (less borrowing) than previously thought.

“In addition, the good news is that the poor figure appears to have been driven by expenditure rather than receipts data. This suggests that the weakness in the numbers may not be due to weaker GDP performance feeding into weaker tax receipts.”

They also pointed out that, overall, central government receipts were up 1.8% on the year to October, while expenditure was up 7.4%.

BBC News – Business

Read More..

U.S. fiscal impact of great concern to Canada: Canada’s Harper

TORONTO (Reuters) – Any fiscal problems that would significantly slow the U.S. economy would be of great concern to Canada, Canadian Prime Minister Stephen Harper said on Monday.

The United States needed a credible medium-term fiscal plan, Harper said at a business forum in Ottawa, adding that he was following the U.S. fiscal debate with “great interest.”

(Reporting by Solarina Ho)

Canada News Headlines – Yahoo! News

Read More..

Interpublic exits Facebook

(Reuters) – Interpublic Group of Cos said it sold its remaining investment in Facebook Inc for $ 95 million in cash.

Interpublic said it expects to record a pre-tax gain of $ 94 million. It had recorded a pre-tax gain of $ 132.2 million for the third quarter of last year from the sale of half of its 0.4 percent stake in Facebook.

Interpublic paid less than $ 5 million for the stake in 2006.

Shares of Facebook, which debuted with a market value of more than $ 100 billion in May, have lost nearly half their value since then on concerns about money-making prospects.

“We decided to sell our remaining shares in Facebook as our investment was no longer strategic in nature,” Chief Executive Michael Roth said in a statement.

Interpublic also authorized an increase in its existing share repurchase program to $ 400 million from $ 300 million. The company repurchased shares worth $ 151 million, as of September 30.

Shares of the company were up 1 percent at $ 10 on the New York Stock Exchange on Tuesday.

Facebook shares were marginally up at $ 23.00 on the Nasdaq.

(Reporting by Sruthi Ramakrishnan in Bangalore; Editing by Joyjeet Das)

Internet News Headlines – Yahoo! News

Read More..

Phillip Phillips looks at life beyond “American Idol”

LOS ANGELES (Reuters) – Like the 10 winners before him, Phillip Phillips faces the uneven road from “American Idol” victor to pop-chart mainstay.

After the success of his Top 10 hit, “Home,” the Georgia native is facing a new challenge – to replicate the mainstream successes of past “Idol” winners Carrie Underwood and Kelly Clarkson on his debut album, “The World from the Side of the Moon,” released on Monday by Interscope Records.

Phillips, 22, spoke to Reuters about making his first proper studio album, what he might do differently on a second one, and whether he could have won “Idol” with this season’s panel of judges.

Q: How do you plan to transition from “American Idol” winner to a mainstream music career?

A: “It’s pretty funny that you mention that because the majority of the people I meet don’t even know that I was on ‘Idol.’ It’s really cool to hear that. When I go home, people ask, ‘What’ve you been doing? I’ve heard your song,’ but they don’t even know that I’ve been on ‘Idol.’”

Q: Your first single “Home” has gone twice platinum. You’ve said that it isn’t a song you would have written yourself. What’s your relationship now with your first hit?

A: “It’s amazing how well it has done, and I look at all the stories that I hear like how it has helped families out with their situation, or something’s happened with their kid, mom or dad, or if their child’s overseas in the war. Something like that’s pretty amazing how many different stories come out of it.”

Q: Did you have any ideas on how you wanted to develop your sound finally getting into a big-time studio?

A: “I already had the songs written, and it was just a matter of throwing in ideas and then just trimming it down to what felt right, because we only had three weeks to do this album. So it was kind of pressured, but that kind of helped out as well. It didn’t make us overthink anything.”

Q: Was there anything in particular you wanted to achieve?

A: “I wanted to make it similar to what I did on the show – a horn section and some rock. I tried to be a little artistic. I just wrote what came from my heart and what felt right.”

Q: Unlike many of the other contestants, you went into “Idol” as a songwriter, how many of the album’s songs did you write?

A: “I think five. Some of the co-writes, (the writers) really just kind of pushed me, so I kind of wrote most of those myself. But it was a lot of fun; it was a great experience.”

Q: Would you do anything differently next time?

A: “It’s still early, but I’d definitely want a little more time to do it. But that’s really about it, because three weeks is just really quick, and also I have just so many other things going on. … It was very kind of stressful and hopefully for the next record I’ll have a little more time.”

Q: What would that time allow you to do in the studio?

A: “Just being able to listen to it a little more. We all knew that it sounded really good but also having to listen to, like 17 songs in a row. You say, ‘Yeah that sounds great’ but you listen to it more and more and (say) ‘Maybe I would’ve brought this instrument down a little bit or brought it up a little bit more.’”

Q: Would you have fared any differently on ‘Idol’ with the current judges Nicky Minaj and Mariah Carey?

A: “I don’t know. I’m curious to see how they’re going to judge. It’s a completely different panel this year. … I don’t really know how I would’ve turned out. Maybe I’ll have to go out and audition again (laughs).”

Q: Would you have had to change your roots-y style?

A: “Naw, I would’ve still been the same dude. If they wouldn’t have sent me through, they wouldn’t have sent me through. And if they did, that’d be awesome.”

(Reporting By Eric Kelsey, editing by Jill Serjeant and Gunna Dickson)

Music News Headlines – Yahoo! News

Read More..

No increase in heart disease after food poisoning

NEW YORK (Reuters Health) – Despite earlier evidence tying an outbreak of E. coli infections in Canada to later heart disease, an expanded follow up study finds no link between the two.

“Although we definitely want to avoid anyone getting infected in the first place, this new information is reassuring for those who develop an infection from E. coli O157:H7,” Dr. Amit Garg, one of the authors of the study, said in a press release issued by the Canadian Medical Association Journal (CMAJ), which published the study.

This strain of E. coli bacteria polluted the drinking water supply of Walkerton, Ontario in May of 2000, sickening more than 2,300 people and resulting in seven deaths.

Food-borne E. coli infections – which affect about 265,000 people each year in the U.S., according to the Centers for Disease Control and Prevention – can damage the kidneys and lead to high blood pressure. That has raised concerns that they might also contribute to heart disease and stroke.

“There’s anecdotal evidence that certain infections immediately predate heart attack or stroke,” said Dr. Deepak Bhatt, the chief of Cardiology at VA Boston Healthcare System, who was not involved in the study.

“It’s not been clear whether it’s the infection or inflammation (from the infection) or coincidence,” Bhatt, also a professor at Harvard Medical School, told Reuters Health.

To see whether an E. coli outbreak could increase the risk of heart disease and stroke, Garg, a professor at Western University, Lawson Health Research Institute in London, Ontario, and his colleagues collected data on affected individuals from the 2000 event at a health clinic where they had annual visits.

Initially, the group seemed to have a higher risk for heart disease and stroke compared to people who had not suffered an E. coli infection. The researchers point out, however, that nearly half of the participants dropped out of the study, making those findings difficult to interpret.

In the current study, the group included 153 people who experienced severe illness during the outbreak, 414 people with mild illness, 331 people from Walkerton who did not get sick and more than 11,000 people who lived in neighboring towns that were spared from the E. coli outbreak.

In the decade following the outbreak, people who became severely sick were no more likely to later suffer a heart attack or stroke than people who lived outside of Walkerton.

In contrast, people who suffered a mild illness were actually 36 percent less likely to die from heart disease or stroke than residents of the surrounding communities.

Among people with a mild reaction to the infection, about 6 percent died during the study period, compared to about 10 percent of people who lived outside of the outbreak.

The reason is not totally clear. The authors write in their study that perhaps people in the mild-illness group didn’t get that sick from the infection – and also had a lower risk of cardiovascular death – because they were healthier than average.

(Garg would not agree to an interview with Reuters Health unless he was able to review major portions of this article in advance, a practice that violates Reuters’ policy to protect journalistic independence.)

STILL UNCLEAR?

The results from the study don’t necessarily mean infections don’t increase the risk of cardiovascular disease, said Dr. Liam Smeeth, a professor at the London School of Hygiene and Tropical Medicine, who was not part of the study.

Smeeth told Reuters Health that research has shown that any impact on the coronary arteries from infection and subsequent inflammation is short-lived, and perhaps the numbers in the Walkerton study were not big enough, or the increased risk not large enough, to be detected.

“It’s not crystal clear because it was a relatively small study,” he said.

Bhatt agreed that the findings don’t prove or disprove the idea that infections could be involved in heart disease, and it’s also possible that the type of infection might matter.

He said that it’s important to rule out the types that don’t contribute.

“I think the study’s important because it makes it very, very much less likely that gastrointestinal infections in some way are linked to atherosclerosis, and I think that finding is useful because probably investigators in the future shouldn’t focus on this area as far as causes of atherosclerosis and heart attack and stroke,” he said.

SOURCE: http://bit.ly/Te450j CMAJ, online November 19, 2012.

Diseases/Conditions News Headlines – Yahoo! News

Read More..

Wall Street edges up as bargain hunting offsets HP, France

NEW YORK (Reuters) – Stocks inched higher on Tuesday, reversing earlier declines after bargain hunters stepped in to buy beaten-down shares and offset the impact of Hewlett-Packard‘s accounting charge and France losing its triple-A credit rating.

The S&P 500 briefly dipped below its 200-day moving average at 1,382, but recovered to trade slightly above the key technical level, which is seen as a support mark.

Stocks rallied for the last two days on optimism that Washington politicians could agree on a deal to avoid the U.S. “fiscal cliff.” But the gains followed two weeks of sharp losses.

“We got into a very oversold condition on just about any indicator and then you had intraday reversals in just about all the indexes,” said Jeffrey Saut, Raymond James Financial‘s chief investment strategist in St. Petersburg, Florida.

Shares of McDonald’s shot up 1.3 percent to $ 86.11, leading the Dow industrials’ slim advance.

Moody’s Investors Service cut France’s sovereign rating by one notch to Aa1 after the market’s close on Monday, citing an uncertain fiscal outlook as a result of the weakening economy.

While the move was expected after Standard & Poor’s made a similar downgrade in January, it was a reminder of the headwinds buffeting the global economy and the danger of contagion by the euro zone’s debt crisis.

Hewlett-Packard Co shares tumbled 10.5 percent to a 10-year low at $ 11.91 as the computer and printer maker swung to a fourth-quarter loss. The company said it took an $ 8.8 billion charge related to its acquisition of software firm Autonomy, citing “serious accounting improprieties.

A bright spot for the economy came in data showing U.S. housing starts rose to their highest rate in more than four years in October, suggesting the housing market’s recovery was gathering momentum. The PHLX housing sector index <.HGX> jumped 2.4 percent, led by PulteGroup Inc , up 4.8 percent at $ 16.67.

The Dow Jones industrial average <.DJI> was up 10.34 points, or 0.08 percent, at 12,806.30. The Standard & Poor’s 500 Index <.SPX> was up 2.17 points, or 0.16 percent, at 1,389.06. The Nasdaq Composite Index <.IXIC> was up 3.41 points, or 0.12 percent, at 2,913.48.

The S&P 500 index had fallen 5.3 percent between election day two weeks ago and the start of the rebound as angst over a possible U.S. budget deal drove investors to sell stocks and limit the impact of expected tax increases on capital gains and dividends.

President Barack Obama and congressional leaders hope to start serious negotiations after the Thanksgiving holiday on Thursday to avoid the “fiscal cliff,” a series of mandatory tax hikes and spending cuts that would go into effect early next year – if a deal is not reached – and could push the U.S. economy back into recession.

(Additional reporting by Chuck Mikolajczak Editing by W Simon, Kenneth Barry and Jan Paschal)

Business News Headlines – Yahoo! News

Read More..

Oklahoma Compounding Pharmacy Laws Some of Strictest in Nation

Jerrod Roberts, owner of Flourish Integrative Pharmacy, wants people to know that it is not the science of compounding that is behind the current U.S. meningitis outbreak, but some of the people working in the industry who are not following protocol, such as at the New England Compounding Center, NECC, at the center of the outbreak, reported NewsOK.com .

Oklahoma Protects the Public with Strict Regulations for Pharmacies

Loyd Allen, editor-in-chief of the International Journal of Pharmaceutical Compounding headquartered in Edmond, Okla., and a pharmacist of 50 years duration, has been active in helping the state’s legislators develop policy and regulations for pharmacies over the years. Regulations have been in place for 40 years requiring pharmacists practicing in Oklahoma to take continuing education classes in order to renew their licenses, long before most other states put the mandate into practice.

Air quality must be monitored in the state’s compounding pharmacies, and monitor specific parts of a facility for microorganisms. Allen explained to NewsOK.com that all the regulations would mean nothing if there weren’t inspectors to monitor facilities’ adherence to the standards. Allen also told the news source that had the U.S. Food and Drug Administration had closed the NECC in 2006 when poor adherence to sanitation standards was present, the current fungal meningitis outbreak would have been averted.

Why Do We Have Compounding Pharmacies?

In the 18th and 19th centuries, all pharmacies were compounding pharmacies; there were no pharmaceutical manufacturers. But as the population grew and the demand for prescription medications increased, pharmaceutical companies emerged and grew, reducing the need for the corner druggist to compound all his customer’s prescription drugs.

Allen explains though that as the big pharmaceutical companies grew and merged, there were some drugs still needed but no longer manufactured. Couple that with the growing number of medications for which there is a shortage each year, and you can see the continued need for compounding pharmacies.

A compounding pharmacy is regulated to manufacture, package and distribute medications prescribed by a physician for a particular patient. What NECC was doing, in addition to having unsanitary conditions, was manufacturing and distributing medications in mass quantities, overriding its licensure requirements.

Fungal Meningitis Outbreak 2012 Victim Count Continues to Rise

Oklahoma is not one of the 19 states that received shipments of NECC’s tainted drug to its outpatient facilities. Meanwhile, in states such as Michigan, Tennessee, Virginia and Florida, nearly 14,000 people exposed to potentially tainted spinal and joint injections wait and watch for symptoms that may or may not develop.

The case count for fungal meningitis is now 490, with 34 resultant deaths and 11 cases of peripheral joint infection.

A number of people who have developed the fungal infection are considering, or have already filed lawsuits, according to PRweb . Congress continues to delve into exactly how this public health disaster occurred and the FDA has asked for additional regulations to increase its authority over compounding pharmacies nationally.

Smack dab in the middle of the baby boomer generation, L.L. Woodard is a proud resident of “The Red Man” state. With what he hopes is an everyman’s view of life’s concerns both in his state and throughout the nation, Woodard presents facts and opinions based on common-sense solutions.

Medications/Drugs News Headlines – Yahoo! News

Read More..

Infographic: California’s Katrina?

The scenario is known as “California’s Katrina.” An earthquake or superstorm causes Gold Rush-era earthen levees to collapse. Saltwater from San Francisco Bay floods the Sacramento-San Joaquin River Delta, displacing half a million lowland Californians, poisoning the water supply for as many as 28 million more who live in Los Angeles, San Diego, and Silicon Valley, and ruining farmland that produces 11 percent of the nation’s agricultural value. The eighth-largest economy in the world could be sunk for months, even years.

There are two competing proposals to avert all this. The first is to bypass the delta with tunnels carrying fresh water to Southern California. The second is to upgrade the existing levees. A bill that would have required an official cost-benefit analysis of these approaches got shot down in the state legislature. Civil engineers at University of California at Davis don’t think the levees can be earthquake-proofed. Delta landowners, fearful the levees will no longer be maintained if the tunnels were built, have refused surveyors access to their land.

In this fight, if someone doesn’t win, everyone will lose.

Businessweek.com — Top News

Read More..

Canada pledges again to balance budget by 2015

OTTAWA/NEW YORK (Reuters) – The Canadian government on Friday reiterated its intention to balance its budget by 2015, three days after projecting there would be deficits until 2016-17.

In separate appearances in Quebec City and New York, Prime Minister Stephen Harper and Finance Minister Jim Flaherty were at pains to say they still intended to end the red ink by 2015.

“It remains the government’s plan, intention, to balance the budget prior to the next federal election. The recent economic and fiscal update by the minister indicates we are actually very close to that objective,” Harper told reporters in Quebec City. The next election is in October 2015.

Flaherty’s fall fiscal update on Tuesday had pushed back the target date for eliminating the deficit by a year, to 2016-17, citing a weak global economy.

But the minister said in a speech in New York that the government was on track to balance the budget in the next two to three years, barring major external events, and he later clarified that he intended a balanced budget by 2015.

“The prime minister’s always correct,” he chuckled.

He sought to explain the discrepancy by saying the fiscal update had built in a C$ 3 billion ($ 3 billion) contingency cushion, meaning there was an underlying surplus of C$ 1.2 billion for 2015-16. He said the projection of a C$ 1.8 billion deficit amounted to about half a percent of the C$ 275 billion federal budget.

“There’s lots of water to go under the bridge between now and then,” he said.

The opposition New Democratic Party noted the discrepancy in a release headlined: “Stephen Harper makes stuff up about balancing the budget.”

It pointed out that balancing the budget by the next election was not the same as balancing it by 2016-17.

As it is, even the 2015-16 timetable is a year later than offered in the Conservative campaign for reelection in May 2011. They had promised a balanced budget by 2014-15, followed by major personal income tax relief before the 2015 election.

Flaherty’s timetable drew criticism this week from the Canadian Taxpayers Federation, which said the minister had become expert at kicking the can down the road.

The projections could be thrown out of whack if the United States goes off the fiscal cliff, a set of automatic tax hikes and spending cuts that are to be triggered on January 2 if legislators and the White House cannot agree on a more nuanced budget deal.

Flaherty said U.S. failure to avert the fiscal cliff would cause a significant and immediate decline in Canada’s gross domestic product, and he would counter it.

Referring to a possible economic shock from Europe or the United States, he said: “If that were to happen and if the Canadian economy were to be pushed back into recession with the resulting danger for higher unemployment and the danger always of a prolonged recession, then we would act.”

He added: “We would not stand by and let that happen. The kinds of measure we can take: there are various tax measures we can take, there are measures with respect to stimulus we can take, these are things that we have done before and we can do again.”

On Tuesday, Flaherty spoke of having prepared various contingency plans.

(Additional reporting by Louse Egan; Editing by David Gregorio)

Canada News Headlines – Yahoo! News

Read More..