Most Women Don’t Need Regular Pelvic Exams, New Guidelines State

By Amy Norton

HealthDay Reporter

MONDAY, June 30, 2014 (HealthDay News) — The annual pelvic exam has long been a routine part of women’s health care, but new guidelines say there’s no good reason for it.

The recommendations, laid out by the American College of Physicians (ACP), advise against pelvic exams for women who aren’t pregnant and have no symptoms of a potential problem.

The reason? There’s no good evidence the screening exams benefit women, the ACP said.

“I think a lot of women will be relieved by this [recommendation], especially since it’s based on scientific evidence,” said Dr. Linda Humphrey, a member of the ACP’s Clinical Practice Guidelines Committee, which devised the new advice after reviewing 32 studies on the benefits and harms of routine pelvic exams.

Humphrey stressed that the new guidelines apply only to pelvic exams, and that women should continue to have cervical cancer screenings.

For decades, American women have routinely had a yearly pelvic exam. The aim, doctors have said, is to spot cancers of the pelvic organs, infections, and abnormalities such as ovarian cysts or uterine fibroids.

But the ACP team found that no studies have actually tested the accuracy of pelvic exams in screening for most of those conditions.

The researchers did find three studies focused on screening for ovarian cancer in average-risk women. And there was no evidence of a benefit. One study did, however, find that 1.5 percent of women screened ended up having unnecessary surgery.

A larger number of studies tried to weed out the potential harms of routine pelvic exams.

Across eight surveys, anywhere from 11 percent to 60 percent of women called pelvic exams painful or uncomfortable. And in seven studies, 10 percent to 80 percent of women cited fear, anxiety or embarrassment.

One concern, Humphrey said, is that some women will skip their annual “well-woman” visit altogether, just to avoid the pelvic exam.

So how did pelvic exams become so routine in the absence of evidence? “In medicine, a lot of things have been done because we think they might help,” Humphrey said.

“The reasoning behind why clinicians are doing it has never been very clear,” said Dr. George Sawaya, a professor of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco.

Instead, the pelvic exam is more like a “ritual” than an evidence-based practice, said Sawaya, who cowrote an editorial published with the new guidelines in the July 1 issue of the Annals of Internal Medicine.

The reason women have the exam yearly is because it has been traditionally coupled with Pap testing for cervical cancer, Sawaya noted. However, experts no longer recommend annual Pap tests, and instead say women at average risk of cervical cancer can have them every three years, starting at age 21.

Humphrey added that if women want to be screened for a sexually transmitted disease, like gonorrhea or chlamydia, that can be done with a urine test or vaginal swab instead of a pelvic exam.

The ACP represents U.S. internists, but many women get their pelvic exams from gynecologists — who have their own professional guidelines, last updated in 2012.

Those guidelines, from the American College of Obstetricians and Gynecologists (ACOG), are much less direct: On one hand, ACOG says all women age 21 and older should have an annual pelvic exam. But the guidelines go on to acknowledge that “no evidence supports or refutes” the annual screening exam — and that the decision is ultimately up to women and their doctors.

A spokesperson for ACOG said the group did not want to make a “blanket statement” against an exam that might benefit “a lot of women.” And in a written statement, ACOG said its guidelines “complement” the new ones from the ACP.

According to Sawaya, the ACP research review does leave questions open. For one, none of the studies looked at the accuracy of pelvic exams in screening for noncancerous growths.

So, Sawaya writes in the editorial, it’s “reasonable” to disagree with the ACP’s advice.

But he said it’s also reasonable for women to ask their doctor whether a routine pelvic exam is necessary, and to ask for more information on the possible benefits and risks.

If the annual pelvic exam was retired, that should trim health care costs — though the exact figure is unclear, the ACP says. The exam is not especially pricey (Medicare pays about $38 for one), but if millions of women are getting one each year, the costs add up.

In 2013, the ACP says, the United States spent $2.6 billion in “preventive gynecologic examinations.” About one-third of that went toward unnecessary Pap tests in women younger than 21, while an “indeterminate” percentage went toward other unnecessary pelvic exams, according to the ACP.

More information

ACOG has more on women’s annual check-ups.

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HIV Prevention Drug Truvada Might Lower Genital Herpes Risk, Too

By Randy Dotinga

HealthDay Reporter

MONDAY, June 30, 2014 (HealthDay News) — A combination drug used to treat and prevent HIV — Truvada — may have an additional benefit: lowering the risk of a genital herpes infection, a new study suggests.

Researchers found that African heterosexuals who were at risk of getting HIV from their partners were about 30 percent less likely to get infected with genital herpes if they took the drug tenofovir alone or with emtricitabine. Truvada is made from the combination of these two drugs.

The study isn’t likely to lead physicians to use tenofovir — alone or in combination with emtricitabine — solely to prevent herpes, one infectious-disease specialist said.

“No one is going to use tenofovir specifically to reduce herpes. There are some side effects and the drug is not cheap. It will only be used as prevention for HIV — not herpes — for high-risk people,” said Dr. Myron Cohen, associate vice chancellor for Global Health at the University of North Carolina School of Medicine in Chapel Hill, who’s familiar with the new research.

Still, “it is beneficial that oral tenofovir can reduce the risk of acquiring genital herpes as well as HIV,” said study lead author Dr. Connie Celum, director of the International Clinical Research Center at the University of Washington, especially considering that genital herpes boosts the risk of HIV infection.

Previous research from the U.S. Centers for Disease Control and Prevention has suggested that the use of Truvada, along with other preventive measures such as consistent condom use, can cut the risk of HIV transmission by as much as 90 percent.

The current study is part of research initially launched to gain a greater understanding of how tenofovir can be used to prevent HIV infection. HIV and herpes infections often occur together. And previous research suggested that a vaginal gel made with tenofovir could cut the risk of genital herpes by about 50 percent, according to background information in the new study.

That led the researchers to wonder if oral tenofovir alone or as part of Truvada could help prevent herpes infections, too.

The type of herpes the researchers looked for in this study was herpes simplex 2 (HSV). This type of herpes is a common cause of genital herpes, according to the CDC. Herpes simplex 1 is another type of herpes, and it commonly causes cold sores, according to the CDC.

The new study tracked almost 1,500 adults who randomly received tenofovir, tenofovir with the AIDS drug emtricitabine (Truvada), or a placebo. None of the study participants had HIV or herpes simplex 2 when the study began. Researchers monitored the participants from the initial enrollment period of 2008 to 2010, until 2011.

The risk of getting herpes simplex 2 was reduced by 24 percent for those taking tenofovir alone, and by 36 percent for those taking the Truvada combination, compared to those taking placebo.

Those results aren’t strong enough to warrant the use of tenofovir alone or in combination solely for herpes prevention, according to Cohen. He added that tenofovir “is not designed to reduce herpes acquisition.”

So why does it matter if tenofovir prevents genital herpes? Because it’s a very common infection and can pave the way for other medical problems.

“About 20 percent of adults in the U.S. have genital herpes infection, and about 50 percent of adults in Africa,” study lead author Celum said. “Previous studies have indicated that genital herpes increases the risk of becoming HIV-infected by about two-fold.”

The cost of the tenofovir combination drug is about $100 a year in Africa and $1,000 per month in the United States, she said.

The next step for research is to determine if tenofovir can provide protection against HIV and herpes when administered through vaginal and rectal gel and in a vaginal ring, she said. Researchers also want to know if the drug can prevent people with HIV from getting herpes.

As for cold sores — herpes simplex virus 1 — she said tenofovir may have an effect on it, too. Previous research using tenofovir in a vaginal gel reduced the risk of both herpes simplex 1 and 2.

The study is in the July 1 issue of the Annals of Internal Medicine.

More information

For details about genital herpes, try the U.S. Centers for Disease Control and Prevention.

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Study: Common HIV Drug May Boost Suicide Risk

By Alan Mozes

HealthDay Reporter

MONDAY, June 30, 2014 (HealthDay News) — A medication commonly used to treat HIV appears to double the risk that patients will develop suicidal thoughts or take their lives, new research contends.

The finding concerns the anti-HIV drug efavirenz, which is marketed as Sustiva.

Prior investigations indicated that efavirenz might boost suicide risk because of a negative impact on the central nervous system. The new investigation is the first to pinpoint a link to suicidal thoughts, attempts and completion, the researchers said.

“Efavirenz is a very important and effective antiretroviral medication that is the foundation for much of HIV therapy worldwide,” said study co-author Dr. Joseph Eron, of the University of North Carolina Center for AIDS Research at Chapel Hill.

“Our study demonstrated a clear association between efavirenz and suicidality,” he said.

Although that risk seems very small, he said, it appears to be persistent, lasting as long as patients take the drug. Antiretroviral treatment typically is lifelong, helping people with the AIDS-causing virus live healthier lives.

“Clinicians should be aware of this ongoing risk, and talk to their patients to assess suicidality,” Eron added. That means looking for any history of depression or suicidal thoughts or attempts, the study noted.

For the study, published in the July issue of Annals of Internal Medicine, the researchers analyzed data from four previous antiretroviral investigations conducted between 2001 and 2010.

Nearly three-quarters of study participants were men, with an average age of 37. Roughly one-third had a history of psychiatric problems or had been treated with some form of psychiatric medication in the month before joining one of the studies.

Taken together, more than 3,200 HIV patients had been receiving treatment that included efavirenz, while nearly 2,100 were taking antiretroviral combinations that didn’t include the drug.

Patients were tracked for a little less than two years on average.

The research team concluded that the risk for suicide among the efavirenz group was roughly twice that of the non-efavirenz group.

Suicide risk was observed for 62 patients, 47 of whom were taking efavirenz, the study authors reported.

Of nine recorded suicides, eight were in the efavirenz group, the investigators found. But the researchers didn’t prove that efavirenz causes suicidal behavior, they only found an association between the two.

Based on the findings, Eron and his colleagues said patients and physicians would be well-advised to consider the increase in suicide risk when deciding whether or not to begin or continue a treatment containing efavirenz.

“In settings where alternative therapies are not available, the benefits of efavirenz-based therapy with management of depression will usually outweigh the risks of no treatment, especially for people with low CD4 cell counts,” he said. Declining CD4 cell counts indicate the immune system is weakening.

However, “good alternatives to efavirenz exist for patients who may need to start, or to switch to, another therapy,” Eron added.

Dr. Jeffrey Laurence, senior scientific consultant for programs at the AIDS research advocacy organization amfAR in New York City, agreed.

“This is certainly a very powerful HIV drug, and it’s been the backbone of a one-pill-a-day treatment, which is very popular, particularly among newly diagnosed patients,” Laurence said.

“But since it was first approved it’s been known that it provokes all sorts of psychiatric manifestations, particularly nightmares,” he added.

Other effective treatments for the AIDS-causing virus exist, including pills that can be taken in a similar one-a-day fashion, he said.

“The message here is that if you have a history of psychiatric problems — certainly of suicidal ideation — and if you find yourself taking this pill and these kinds of thoughts don’t go away in a matter of weeks, then it’s time to think about taking a different medication,” Laurence said.

More information

For more about HIV treatment, visit AIDS.gov.

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Many U.S. Vets Suffer Chronic Pain, Take Narcotic Painkillers: Study

By Dennis Thompson

HealthDay Reporter

MONDAY, June 30, 2014 (HealthDay News) — Nearly half of U.S. soldiers returning home are caught in the grip of chronic pain, with a substantial number of them relying on addictive narcotic painkillers to help them cope, a new study finds.

About 44 percent of the members of an Army infantry brigade reported chronic pain even three months after returning from their tour of duty in Afghanistan or Iraq, nearly double the estimate for the civilian population. Civilian chronic pain rates are about 26 percent.

Soldiers also are nearly four times more likely than civilians to use prescription narcotics to treat their pain, according to the report published online June 30 in the journal JAMA Internal Medicine. About 15 percent of soldiers in the brigade reported using narcotic painkillers within the last month, compared to 4 percent of civilians.

“War is really hard on the body,” said study author Lt. Cmdr. Robin Toblin, a clinical research psychologist at the Walter Reed Army Institute of Research in Silver Spring, Md. “People come home with a lot of injuries, and as you can imagine they experience a lot of pain. There seems to be a large unmet need of management, treatment and assessment of chronic pain.”

Combat injuries appear to be the main cause of chronic pain among returning soldiers. The study defined chronic pain as pain lasting 90 days or more. Those who have endured a combat injury are nearly three times more likely to report chronic pain and twice as likely to take narcotic painkillers, the researchers reported.

Soldiers also were twice as likely to report chronic pain if they suffer from depression or post-traumatic stress disorder.

Toblin and her colleagues collected their data in 2011, using confidential surveys filled out by almost 2,600 soldiers in the same infantry brigade.

Another expert welcomed the study.

“This gives us the first complete snapshot of an entire battalion. It really highlights the extent of the problem the Department of Defense is presented with, in terms of better managing pain,” said Dr. Wayne Jonas, a retired Army lieutenant colonel and president and CEO of Samueli Institute, a non-profit health research organization.

Among the soldiers reporting chronic pain, 48 percent said their pain had lasted a year or longer, and 55 percent said they suffered daily or constant pain.

It’s likely that soldiers’ chronic pain is undertreated, given that chronic pain is undertreated in the civilian population, said Jonas, who wrote an editorial accompanying Toblin’s study.

“In the military, pain is seen as a sign of weakness so many people don’t report it,” he said. “It’s being undertreated, and it’s being treated too often using medications that aren’t meant to be used on a long-term basis.”

Toblin and Jonas were troubled by the heavy use of narcotic painkillers, particularly since 44 percent of the soldiers reporting use of painkillers said they had little to no pain during the previous month.

“This might imply that opioids are working to mitigate pain, but it is also possible that soldiers are receiving or using these medications unnecessarily,” the researchers wrote in their report.

Military medical officials struggle to balance the need for pain management against the risks of addiction, Toblin said.

“You want to be able to treat people appropriately for their pain, but you don’t want them to become addicted,” she said.

Painkillers have become “fast food for pain management,” Jonas said. “When you need pain relief, you can throw something at it, but it’s not necessarily good for you to use them all the time.”

Jonas said the defense department has started looking into other techniques for handling pain, such as yoga, tai chi or music therapy.

“You can train people in these things, and they can learn to self-manage their pain, rather than just pop a pill,” he said.

He said the defense department is also evaluating programs that would train its medical officials in acupuncture — right down to medics in the field practicing acupuncture.

“It’s really about integration,” he said. “It’s not about avoiding drugs. It’s about more appropriate use of drugs, in conjunction with other pain management tools.”

More information

For more on chronic pain, visit the U.S. National Institutes of Health.

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Childhood Malnutrition Linked to High Blood Pressure Later in Life: Study

MONDAY, June 30, 2014 (HealthDay News) — Young children who are severely malnourished may be at greater risk for having high blood pressure later in life, new research suggests.

Poor nutrition starting before birth to the age of 5 may affect the development of the heart, the study authors reported.

“If nutritional needs are not met during this time, when structures of the body are highly susceptible to potentially irreversible change, it could have long-term consequences on heart anatomy and blood flow later in life,” study senior author Terrence Forrester, UWI Solutions for Developing Countries at the University of the West Indies, Jamaica, said in an American Heart Association news release.

“We are concerned that millions of people globally who suffer malnutrition before or after birth are at increased risk of hypertension in later life,” Forrester said.

However, it’s important to note that while this study showed an association between malnourishment in childhood and a higher blood pressure as an adult, it didn’t prove that too little food in childhood was the cause of the higher blood pressure.

The researchers examined 116 adults who were malnourished as children growing up in Jamaica. Specifically, they assessed their height, weight and blood pressure. The researchers also performed echocardiograms or imaging tests to evaluate their heart function.

The researchers compared the results with information compiled on 45 men and women who were not malnourished as children. All of the adults in the study were between ages 20 and 39 years.

The study revealed the adults who had not been adequately nourished as children were at greater risk for high blood pressure. Those who grew up without enough food had higher diastolic blood pressure — that’s the bottom number in a blood pressure reading.

Adults who were malnourished as children also had greater resistance to blood flow in smaller blood vessels. And, their hearts pumped less efficiently.

The researchers warned that high blood pressure is a major risk factor for heart disease and stroke.

Although childhood hunger is most prevalent in developing countries, the U.S. Department of Agriculture reported that 8.3 million children lived in homes where there may not have been enough food to meet their needs in 2012.

The study was published online June 30 in the journal Hypertension.

More information

The World Health Organization provides more information on childhood nutrition.

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Nursing Home Care May Be Out of Reach for Many Aging ‘Boomers’: Study

MONDAY, June 30, 2014 (HealthDay News) — With higher rates of illness but fewer adult children to care for them, many of America’s baby boom generation may find themselves unable to pay for the nursing home care they need, a new study warns.

Already, a growing number of older Americans are developing chronic diseases but can’t cover the costs of long-term care in a nursing facility, the U.S. National Institute on Aging-funded report says.

The statistics represent “an approaching crisis in caregiving,” Richard Suzman, director of the NIA’s Division of Behavioral and Social Research, said in an agency news release.

“Baby boomers had far fewer children than their parents. Combined with higher divorce rates and disrupted family structures, this will result in fewer family members to provide long-term care in the future,” Suzman explained. “This will become more serious as people live longer with conditions such as cancer, heart disease and Alzheimer’s.”

The analysis of national data revealed that chronic diseases such as high blood pressure, heart disease, lung disease and diabetes rose among older Americans between 1998 and 2008.

By 2008, 41 percent of older adults had three or more chronic conditions, 51 percent had one or two, and only 8 percent had none, according to the NIA-funded Census Bureau study.

While rates of smoking and excessive drinking have fallen among Americans aged 65 and older, the percentage of overweight and obese seniors has risen, the report notes. Between 2003 and 2006, 72 percent of older men and 67 percent of older women were overweight or obese.

Obesity boosts the risk of diabetes, arthritis, mobility problems and even death, according to the report.

The NIA investigation also looked at the costs of nursing home care and older Americans’ ability to pay for it. In 2010, the average cost of a private room in a nursing home was $229 a day — or almost $84,000 per year.

However, the NIA team calculated that less than one-fifth of seniors can afford to live in a nursing home for more than three years, and nearly two-thirds can’t afford even one year.

Medicare covers short-term nursing home care for older and disabled patients after they’ve been hospitalized, and Medicaid covers long-term nursing home care for low-income seniors who qualify. In 2006, Medicaid paid for 43 percent of long-term nursing home care.

This all means that “most of the long-term care provided to older people today comes from unpaid family members and friends,” Suzman said.

There are currently more than 40 million Americans who are 65 and older, and that number is expected to grow to 83.7 million (one-fifth of the U.S. population) by 2050, according to the study.

“We hope this report will serve as a useful resource to policymakers, researchers, educators, students and the public at large,” Enrique Lamas, the Census Bureau’s associate director for demographic programs, said in the news release.

More information

There’s more on healthy aging at the U.S. Centers for Disease Control and Prevention.

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Bad Weather May Dampen Will to Exercise

MONDAY, June 30, 2014 (HealthDay News) — Local weather affects Americans’ levels of exercise and their risk for obesity, a new study suggests.

Researchers found that adults in counties with hot summers are less physically active and more likely to be obese, especially if the summers are also humid or rainy.

Adults also get less exercise and are more likely to be obese in counties where winters are especially cold, according to the researchers at the University of Texas at Austin.

They said their findings — published in the July issue of the American Journal of Public Health — help explain why people in certain regions of the United States are more likely to be obese than those in other areas.

Many of the counties where exercise levels are lowest and obesity rates highest are in the Southeast, where summers are hot and wet, and many of the counties with the highest levels of exercise and the lowest obesity rates are in the mountain West, where summers are cool and dry, the researchers noted.

“Living in Texas as I do, the results really resonated for me,” study co-author Paul von Hippel, an assistant professor in the School of Public Affairs, said in a university news release.

“Around June or July here, it starts getting hard to think about going outside for a jog — or even a brisk walk — after work, which is close to the hottest part of the day. You have to come up with a strategy for staying active in the summer. Are you going to get out in the early morning, which is the coolest part of the day? Are you going to swim? Or are you going to do something indoors, like basketball or ice skating or just walking on a treadmill?”

City planners and developers who want to encourage physical activity need to take local weather into account.

“Some planners are more thoughtful about that than others,” von Hippel said. “A great example of thoughtful planning is the hike-and-bike trail along Lady Bird Lake in Austin, Tex. It’s shady, it’s next to water and it attracts thousands of walkers, runners and bikers on the hottest summer days.”

The impact of local weather on obesity remained even after the researchers controlled for other factors, such as urban sprawl, population characteristics, parks, stores and restaurants.

“In a sense, the importance of weather is obvious, but we looked at some other ‘obvious’ things, and they didn’t pan out,” von Hippel said.

“For example, going in we knew that Coloradans were exceptionally thin and active, so we expected to find that hills and mountains encourage physical activity. But it turns out that terrain matters very little for activity or obesity. In some mountainous areas, like Colorado, people are very active, but in others, such as West Virginia, they aren’t.”

More information

The U.S. Centers for Disease Control and Prevention has more about physical activity.

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Supreme Court: Some Companies Don’t Have to Cover Birth Control

MONDAY, June 30, 2014 (HealthDay News) — Family-owned companies don’t have to comply with a provision of the Affordable Care Act that requires them to offer insurance coverage for contraception if that requirement violates their religious principles, the U.S. Supreme Court ruled Monday.

The 5-4 decision was in response to lawsuits filed by two companies — Hobby Lobby Stores Inc. and Conestoga Wood Specialties Corp. — that argued that the Affordable Care Act’s birth control provision ran counter to their religious views.

Hobby Lobby Stores is owned by the Green family, who are evangelical Christians. The Oklahoma-based company — with more than 15,000 full-time workers in approximately 600 stores in 41 states — and the Green family said their “religious beliefs prohibit them from providing health coverage for contraceptive drugs and devices that end human life after conception,” the Associated Press reported.

Pennsylvania-based Conestoga Wood Specialties is owned by a Mennonite family. The company makes wood cabinets and has 950 employees.

The contraceptive methods opposed by the two companies include the emergency contraceptives Plan B and ella, and two intrauterine devices (IUDs). The companies said they objected to such birth-control measures because they block a fertilized egg’s ability to attach to the uterus.

Hobby Lobby and Conestoga Wood Specialties said they were willing to cover contraceptives that don’t involve a fertilized egg, the AP said.

Nearly 50 other businesses had joined the lawsuit, the AP reported.

The Supreme Court emphasized that Monday’s ruling only applies to companies under the control of just a few people where there’s no real difference between the business and its owners — basically, family-owned companies, the news service said.

Justice Samuel Alito wrote the majority opinion. He said the decision is confined to contraceptives under the health care law, the AP reported. “Our decision should not be understood to hold that an insurance-coverage mandate must necessarily fall if it conflicts with an employer’s religious beliefs,” he said.

The New York Times reported that the ruling raises the possibility of challenges from other companies to laws that may be said to violate their religious beliefs.

The Supreme Court’s decision is the first time that the high court has ruled that profit-seeking businesses can hold religious views under federal law. And it leaves the Obama administration looking for a different way of providing free contraception to women who are covered under objecting companies’ health insurance plans, the AP reported.

Under the Affordable Care Act, the controversial health-reform law signed by President Barack Obama in 2010, contraception is among preventive services that must be provided at no extra charge.

Numerous groups — including approximately 200 Catholic employers, archdioceses and organizations — had been granted a temporary exemption from the contraception provision, pending the Supreme Court’s decision.

In March, the Catholic Benefits Association — which includes archdioceses, an insurance company and a nursing home across almost 2,000 Catholic parishes nationwide — filed a lawsuit stating that the provision was a violation of its religious objections to contraception and abortion-inducing drugs, the AP reported.

Under the Affordable Care Act, sometimes called Obamacare, health plans must offer at no extra charge all forms of birth control for women that have been approved by federal regulators.

More information

To learn more about the Affordable Care Act’s contraception provision, visit HealthCare.gov.

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Sperm Donor Age May Not Affect Infertility Treatment Success: Study

MONDAY, June 30, 2014 (HealthDay News) — A sperm donor’s age doesn’t affect the chances of a live birth resulting from fertility treatments using donor sperm, a new study says.

There is emerging evidence that sperm quality declines as men age. However, the new study’s findings support previous research showing that a couple’s chances of having children are much more dependent on the age of the female than of the male, researchers said.

The results also show that the quality of donor sperm — rather than the donor’s age — is the important factor in the success of fertility treatments, the study authors said.

“It’s sperm quality rather than male age that matters,” said principal investigator Dr. Meenakshi Choudhary, from the Newcastle Fertility Centre at Life, Newcastle upon Tyne, United Kingdom.

The researchers analyzed more than 39,000 first fertility treatment cycles with donated sperm that were performed in the United Kingdom between 1991 and 2012. The treatment included either in-vitro fertilization (IVF) or donor insemination.

The live birth rate from IVF was about 29 percent among women ages 18 to 34 and about 14 percent among women over age 37. However, there was no link between the live birth rates in these two age groups and the age of the sperm donors.

Similar findings were made for donor insemination, according to the study that’s to be presented this week at the annual meeting of the European Society of Human Reproduction and Embryology, in Munich, Germany. Research presented at meetings are generally considered preliminary until published in a peer-reviewed journal.

“Our results suggest that, up to the age of 45, there is little effect of male age on treatment outcome, but sperm donors are a selected population based on good sperm quality,” Choudhary said in a society news release.

“Our study shows that we are good at selecting the right sperm donors with the right sperm quality — and that’s why we found no difference in live birth rate despite the increasing age of sperm donors. This confirms the view that a man’s age doesn’t matter in achieving a live birth provided his sperm quality is good,” she said.

More information

The U.S. National Institute of Human Health and Child Development has more about infertility treatments.

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A Laptop May Boost a Hospitalized Child’s Recovery

By Dennis Thompson

HealthDay Reporter

MONDAY, June 30, 2014 (HealthDay News) — A hospital can be a lonely and stressful place for a sick child recuperating from a serious illness, but researchers say relief from boredom and isolation is just a mouse click away.

Kids who regularly videoconference with family and friends exhibit significantly reduced stress by the end of their hospital stay, a study published online June 30 in Pediatrics reports.

“This social connection is important to their state of mind, health and well-being,” said senior author Dr. James Marcin, director of the pediatric telemedicine program at University of California, Davis, Children’s Hospital. “The kids love it, and the parents love it. They are happier and more likely to participate in rehab.”

UC Davis Children’s Hospital provides loaner laptops to children expected to have an extended stay in the hospital. It will even ship a loaner webcam to parents located far away who don’t have one, Marcin said.

The laptops are loaded with many videoconferencing options — Skype, Yahoo and such — so the kids and parents can use a program they might already have at home.

Doctors have seen much anecdotal evidence that videoconferencing can help keep up a kid’s spirits. And earlier studies have shown that in-person family visits can decrease stress and improve recovery times, researchers said in background information.

This new study aimed to see if virtual visits could provide those same health benefits, Marcin said.

The study included 367 patients at UC Davis Children’s Hospital. The average child in the study was nearly 10 years old, stayed about 12 days in the hospital, and lived about 73 miles away.

About two-thirds of the patients took advantage of the hospital’s videoconferencing program, while the other third did not. Researchers assessed the patients’ stress levels upon their admission and discharge, and compared one group to the other.

Children who kept in touch with people using videoconferencing had 37 percent more reduction in stress by the time they left the hospital, compared with children who didn’t videochat, researchers found.

The notion of offering kids a video connection to friends and family is “probably one of the best things since sliced bread,” said Alan Hilfer, director of psychology at Maimonides Medical Center in New York City. “As far as I’m concerned, there’s no downside to this.”

Hilfer said the program goes hand-in-hand with other efforts to reduce the isolation felt by child patients, such as lengthening visiting hours in pediatric wards.

“We all know the mood of a child dramatically affects recovery rates,” Hilfer said. “Kids in a good mood with a positive outlook tend to get better faster.”

UC Davis has provided videoconferencing for kids for about a decade, its technology evolving from clunky old videophones to sleek new laptops, Marcin said.

He recalled a girl who had been hit by a car and lost her leg in the mid-2000s. Her long struggle in the hospital led her to become very surly, a nurse’s nightmare.

“The thing she said she missed the most was her school classmates,” he said. The hospital set up a videophone in a room at her school, and at lunchtime her friends could visit with her.

“It was a game-changer in terms of her affect and her participation in rehab,” Marcin said. “She became a complete joy to care for.”

The proliferation of Wi-Fi and high-speed Internet makes it relatively easy for a hospital to offer such videoconferencing to child patients, Hilfer said.

“I hope it catches on,” he said.

But Marcin noted that times are tight in health care, and “if you can’t bill for it, it’s tough to get personnel to do it.”

Also, kids may be slightly ahead of the curve than the doctors caring for them, he added. “They’re very engaged in their social media world,” Marcin said. “I think health care has to catch up with that.”

More information

For more information on childhood stress, visit the Nemours Foundation.

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Kids With ADHD More Likely to Abuse Drugs: Analysis

By Steven Reinberg

HealthDay Reporter

MONDAY, June 30, 2014 (HealthDay News) — Children suffering from attention-deficit/hyperactivity disorder (ADHD) are more than twice as likely to try and abuse drugs, a new analysis finds.

However, that does not mean that the medications that are prescribed to treat the most common childhood disorder in the United States play a part in that increased risk.

In fact, “one of the main points [of the finding] is that treating ADHD both with behavioral techniques and medications seems to lower the risk of substance abuse,” said analysis co-author Dr. Sharon Levy, director of the adolescent substance abuse program at Boston Children’s Hospital.

Although stimulants used to treat ADHD can be addictive, there is no evidence that using them increases the risk of substance abuse, Levy said.

These medications include amphetamines, such as Adderall or Dexedrine, and methylphenidates, like Concerta, Metadate CD or Ritalin.

Levy did caution that these stimulant medications can sometimes be misused. As much as 23 percent of school-aged children are approached to sell, buy or trade their ADHD medications, the researchers noted.

“Pediatricians need to make a careful diagnosis before prescribing and use safe prescribing practices and counseling to minimize diversion and misuse of these drugs,” Levy said.

The analysis of existing medical literature was published online June 30 and in the July print issue of the journal Pediatrics.

Dr. Michael Duchowny, a pediatric neurologist at Miami Children’s Hospital, said, “Children with ADHD need to be counseled about the risk of substance abuse.”

Although the association between ADHD and the risk of substance abuse is known, the reasons for the increased risk aren’t, he said. And while the new study found an association, it did not prove cause-and-effect.

“Obviously, the medications that are used to treat ADHD have the potential for abuse, but the vast majority of children with ADHD do not develop a substance abuse problem,” Duchowny said. “More research has to be done to find out why some children are more susceptible than others.”

It is possible that the same biology that causes ADHD also puts some children at a higher risk for substance abuse, he added.

Other social factors may also contribute to increased risk, the researchers noted.

Among these are that children with ADHD are more likely to struggle in school and turn to drugs to escape anxiety about their difficulties.

Having problems in school may also put these kids with others who have problems and are also at risk for alcohol and drug use, the researchers noted.

“Parents need to be aware that the medications prescribed for ADHD have the potential for abuse. They also have to be aware of the symptoms of substance abuse, and distinguish those from ADHD,” Duchowny said.

“Counseling is important, and awareness is the key to preventing the problems,” he added.

Dr. Robert Dicker is associate director of the division of child and adolescent psychiatry at Zucker Hillside Hospital, in Glen Oaks, N.Y. He said that “special care is needed in treating children who have both ADHD and a substance use disorder. Attention should also be paid to utilizing the stimulant medications with the lowest relative abuse potential or the use of nonstimulant medications.”

In the United States, 8 percent of all children have been diagnosed with ADHD.

More information

Visit the U.S. Institute of Mental Health for more on ADHD.

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Gut Cells May Be Coaxed to Make Insulin for People With Type 1 Diabetes

MONDAY, June 30, 2014 (HealthDay News) — Scientists are hopeful that cells inside the human gut might someday be retrained to produce insulin, the metabolic hormone that’s lacking in people with type 1 diabetes.

The team from Columbia University Medical Center in New York City said their findings hold promise for the development of a new treatment for type 1 diabetes that does not involve stem cells.

For people with type 1 diabetes, their body’s natural insulin-producing cells, known as pancreatic beta cells, are destroyed by their immune system. For the past 20 years, scientists have been trying to help the body make new insulin-producing cells that replace those that are lost to the disease.

“The search for the ‘holy grail’ is to produce a source of insulin producing cells either for transplantation or to convert the body’s own cells to make sufficient insulin,” said one expert, Dr. Derek LeRoith, professor of medicine and diabetes at the Icahn School of Medicine at Mount Sinai, in New York City.

Right now, “insulin injections must be used to replace this lack in insulin production and release,” said LeRoith, who was not involved in the new research.

Insulin-producing cells have been created before using stem cells, but these cells do not yet fully function like natural insulin-producing cells, the Columbia research team explained.

However, by simply turning off a particular gene, the Columbia scientists were able to convert cells in the human gut into cells that make insulin. They said the findings suggest that “reeducating” existing cells may be an easier way to replace the cells lost in type 1 diabetes than creating new cells using stem cell technology.

“People have been talking about turning one cell into another for a long time, but until now we hadn’t gotten to the point of creating a fully functional insulin-producing cell by the manipulation of a single target,” study senior researcher Dr. Domenico Accili, a professor of medicine at Columbia, said in a university news release.

Prior research conducted by the team at Columbia involving mice revealed that intestinal cells could be turned into insulin-producing cells. Insulin made by the transformed gut cells was then released into the bloodstream and effectively controlled the blood sugar levels in diabetic mice. The research was subsequently confirmed by another team of scientists.

The Columbia team’s latest findings found this technique also hold promise for the treatment of type 1 diabetes in human cells.

In conducting the study, published online June 30 in Nature Communications, the researchers re-created a tissue model of the human intestine using stem cells. They then retrained the gut cells to make insulin by turning off a particular gene, known as the FOXO1 gene.

According to Accili’s team, the genetically engineered cells began emitting insulin in about a week. The study’s authors also pointed out that the cells only released the insulin in response to sugar.

“By showing that human cells can respond in the same way as mouse cells, we have cleared a main hurdle and can now move forward to try to make this treatment a reality,” Accili said.

For his part LeRoith called the study “exciting.”

“This study and others like it may form the basis of future development of insulin producing cells that could be used in ‘curing’ type 1 diabetes,” he said.

The research is very early, and laboratory studies don’t always translate into success in humans. However, the researchers remain hopeful. Accili said that the next step in developing a new type 1 diabetes treatment involves to find a drug that can block the FOXO1 gene in the human gut.

More information

The American Diabetes Association provides more information on type 1 diabetes.

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‘Sexting’ Linked to Sex in Middle School

By Randy Dotinga

HealthDay Reporter

MONDAY, June 30, 2014 (HealthDay News) — Middle school students who send sexually explicit text messages and photos to one another are more likely to have sex than those who don’t “sext,” a new study finds.

A survey of young teens in Los Angeles found that 40 percent who’d sent explicit messages or photos said they’d been sexually active compared to just 5 percent of other kids with cellphones that could display text messages.

“The surprise is that for younger kids — 11- to 13-year-olds — sexting is not an alternative to real-life sexual activity. It’s actually a part of it,” said study author Eric Rice, an assistant professor at the University of Southern California, Los Angeles.

“Also, kids who reported 100 or more text messages per day were much more likely to report sexting, so being an excessive texter may be an indication of risky behaviors,” Rice added.

“Sexting” refers to sexually explicit messages sent via computer or cellphone — in this case with or without images. Some sexts may just be explicitly flirtatious, while others include nudity.

Experts disagree about the level of risk posed by “sexting,” and there’s no definitive proof that the electronic messages are a gateway to early sexual activity.

“Sexting isn’t harmful unto itself, but it can have harmful implications,” Rice said. “It can ruin reputations and cause legal problems and may encourage kids to be more sexually active.”

For the study, researchers surveyed more than 1,300 students aged 10 to 15 in the Los Angeles school district in 2012. Among those who answered questions about their ethnicity and sexuality, 60 percent were Latino and 96 percent were heterosexual.

The researchers adjusted their statistics so they’d better reflect the ethnic makeup of the school district.

More than two-thirds of the students owned their own cellphone. Three-fourths had access to a cell phone that could display text messages, according to the study, published online June 30 and in the July print issue of the journal Pediatrics.

Only a minority of kids with access to texting admitted to sexting. Twenty percent said they’d received a sexually explicit message or photo, and 5 percent said they’d sent one.

But young teens who received sexts were six times more likely to report having had sex, defined as either oral, vaginal or anal intercourse, according to the study.

Those who sent sexts were about four times more likely to report sexual activity.

The study has caveats, however. For one thing, self-reported information may be biased. “Sexual behavior is notoriously difficult to measure because you’re relying on people reporting about themselves,” said Amy Hasinoff, an assistant professor at the University of Colorado, Denver, who studies sexting.

Hasinoff cautions parents not to worry excessively about kids who spend a lot of time texting. “I don’t know that texting a lot is a particular problem,” she said.

“We need to think of cellphones as a way that kids communicate. You’d never say kids are talking to their classmate too much at recess, or that they used 1,000 words at recess, and that’s excessive,” she added.

What should parents do?

“Start talking to your kids about sexting early. If you suspect that your child is sexting, be aware that he or she is probably also sexually active,” study author Rice said.

“Remember that teen pregnancy and sexually transmitted diseases can be prevented, but teens need to be educated in thoughtful ways by parents, teachers and pediatricians,” Rice added.

The study says parents may wish to “openly monitor” their kids’ cellphones. But Hasinoff said “that sends the exact wrong message.”

Parents should talk about the importance of privacy and serve as role models, she said. “We want to be teaching kids to respect the privacy of other kids and develop the sense that privacy really matters,” she explained.

Kids should also learn about the need to gain consent for any kind of sexual behavior, including sending someone sexually explicit photos, she added.

More information

The American Academy of Pediatrics has more about how to discuss sexting with your teen.

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