Wall Street Journal 1/31) Health Blog, Jacob Goldstein wrote that “[y]oung women with larger breasts are at higher risk for type 2 diabetes later in life, even after accounting for differences in weight and waist size,” according to a study published in the Canadian Medical Association Journal.

Researchers “analyzed data from more than 90,000 American wom[e]n participating in the Nurses Health Study II, comparing the rate of diabetes in middle age with bra-cup size at age 20.” After adjusting for various factors, they “found that risk increased with breast size, with women who reported wearing a D cup or larger at 58 percent greater risk than those who reported wearing an A cup or smaller.”

 “Your blood sugar is 360.  Don’t ask me how I know.”

FDA informed healthcare professionals and consumers of important revisions to the WARNINGS and PRECAUTIONS sections of the prescribing information for Chantix regarding serious neuropsychiatric symptoms experienced in patients taking Chantix.

 Your average Chantix patient

These symptoms include changes in behavior, agitation, depressed mood, suicidal ideation, and attempted and completed suicide. While some patients may have experienced these types of symptoms and events as a result of nicotine withdrawal, some patients taking Chantix who experienced serious neuropsychiatric symptoms and events had not yet discontinued smoking. In most cases, neuropsychiatric symptoms developed during Chantix treatment, but in others, symptoms developed following withdrawal of Chantix therapy. See the FDA Information for Healthcare Professionals Sheet for recommendations and considerations for healthcare professionals on using Chantix therapy for patients. 

Read the complete 2008 MedWatch Safety Summary including a link to the FDA Public Health Advisory, Healthcare Professional Information Sheet and the prescribing information for Chantix regarding this issue at:

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Authorities in Slovenia are investigating after a piece of human tongue was served up in a hospital canteen.

A doctor at the town hospital in Izola in southern Slovenia complained about the strange looking piece of meat in his meal after he ordered a chicken risotto in the hospital canteen.

The doctor insisted it was not chicken, and after a row with staff the piece of meat was sent for tests – which later showed it was part of a human tongue.

Health inspectors have closed the restaurant and are reviewing hygiene standards.

Managers said the small piece of tongue could have been accidentally dropped into the food by a doctor who had come into the canteen straight after treating a patient.

They also said that it could have been added to the food supplies before they were delivered to the hospital.

The spokesman told the main Slovenian daily paper Delo: “I can say clearly that we have never used patients parts in any of our dishes.”fax payday no loan 25bad loan credit 2500cash 26 payday 38 loan advancemortgage loans credit bad 2nddebt consolidation mortgage 2nd loan2nd kingdom mortgage apply united loansrefinance 2nd mortgage home loanloan payday canadian 31 online 45 Map

in PEDIATRICS Vol. 121 No. 2 February 2008, pp. 244-252

Krista L. Yorita, MPH^a, Robert C. Holman, MS^a, James J. Sejvar, MD^a, Claudia A. Steiner, MD, MPH^b and Lawrence B. Schonberger, MD, MPH^a

^a Division of Viral and Rickettsial Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
^b Healthcare Cost and Utilization Project, Center for Delivery, Organization, and Markets, Agency for Healthcare Research and Quality, Rockville, Maryland

OBJECTIVE. This study describes the burden and epidemiologic features of infectious disease hospitalizations among infants in the United States.

METHODS. Hospitalizations with an infectious disease listed as a primary diagnosis for infants (<1 year of age) in the United States during 2003 were examined by using the Kids’ Inpatient Database. National estimates of infectious disease hospitalizations, hospitalization rates, and various hospital parameters were examined.

RESULTS. During 2003, an estimated 286739 infectious disease hospitalizations occurred among infants in the United States and accounted for 42.8% of all infant hospitalizations. The national infectious disease hospitalization rate was 7010.8 hospitalizations per 100000 live births, or 1 infectious disease hospitalization for every 14 infants. The median length of stay was 3 days, and stays totaled >1 million hospital days for infants. Infectious disease hospitalization rates were highest among boys and nonwhite infants. The most commonly listed diagnoses among the infant infectious disease hospitalizations included lower respiratory tract infections (59.0%), kidney, urinary tract, and bladder infections (7.6%), upper respiratory tract infections (6.5%), and septicemia (6.5%). The median cost of an infectious disease hospitalization was $2235, with total annual hospital costs of approximately $690 million, among infants in the United States.

CONCLUSIONS. Infectious disease hospitalizations among infants account for substantial health care expenditures and hospital time in the United States, with respiratory disease hospitalizations constituting more than one half of all hospitalizations. Younger infants, boys, and nonwhite infants were at increased risk for infectious disease hospitalization. Measures to reduce racial disparities and the occurrence of respiratory tract infections should substantially decrease the infectious disease burden among infants.

Journal:  PEDIATRICS Vol. 121 No. 2 February

2008, pp. 229-234

by Elizabeth Pfoh, BA^a, Michael R. Wessels, MD^b, Donald Goldmann, MD^b and Grace M. Lee, MD, MPH^a,b  

^a Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts
^b Division of Infectious Diseases, Children’s Hospital, Boston, Massachusetts

OBJECTIVE. Our aim was to describe the morbidity, medical costs, and nonmedical costs associated with group A streptococcal pharyngitis in school-aged children.

METHODS. Our study population included parents of children diagnosed as having group A streptococcal pharyngitis at 2 pediatric practice sites in the Boston, Massachusetts, metropolitan area. Telephone interviews were conducted with parents of eligible children, who were asked questions about health care utilization, medications, and time missed from work or school, for calculation of medical and nonmedical costs associated with illness.

RESULTS. One hundred thirty-five parents completed interviews between October 2005 and January 2006. Older children were significantly more likely to present with headache, compared with those 5 years of age. No significant differences between older and younger children were found for rates of sore throat, fever, abdominal pain/nausea/vomiting, or rash. Children missed a mean of 1.9 days (range: 0–7 days) of school/day care, and 42% of parents missed a mean of 1.8 days of work. A second parent or caregiver also missed a mean of 1.5 days in 14% of families. The total societal cost per case of group A streptococcal pharyngitis was $205 (medical: $118; nonmedical: $87).

CONCLUSIONS. The societal cost of group A streptococcal pharyngitis is substantial, with almost one half being attributable to nonmedical costs. Through extrapolation from this experience, the total cost of group A streptococcal pharyngitis among children in the United States ranges from $224 to $539 million per year. loan repayment program nursingloan bankruptcy after obtainseneca oconee savings assn sc loanloans first omaha mortgageloans linepersonal onloan online processorloans payday payments online flexiblea open payday loan business Map

Journal Abstract:  PEDIATRICS Vol. 121 No. 2 February 2008, pp. e260-e268

by Sheela Sathyanarayana, MD, MPH^a,b, Catherine J. Karr, MD, PhD^a,b, Paula Lozano, MD, MPH^b, Elizabeth Brown, PhD^c, Antonia M. Calafat, PhD^d, Fan Liu, MS^e and Shanna H. Swan, PhD^e

^a Departments of Occupational and Environmental Health Sciences
^b Pediatrics
^c Biostatistics, University of Washington, Seattle, Washington
^d Centers for Disease Control and Prevention, Atlanta, Georgia
^e Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, New York

OBJECTIVES. Phthalates are man-made chemicals found in personal care and other products. Recent studies suggest that some phthalates can alter human male reproductive development, but sources of infant exposure have not been well characterized. We investigated the relationship between phthalate metabolite concentrations in infant urine and maternal reported use of dermally applied infant care products.

METHODS. We measured 9 phthalate metabolites in 163 infants who were born in 2000–2005. An infant was considered to have been exposed to any infant care product that the mother reported using on her infant within 24 hours of urine collection. Results of multiple linear regression analyses are reported as the ratio of metabolite concentrations (with 95% confidence intervals) in exposed and unexposed infants. We standardized concentrations by forming z scores and examined combined exposure to multiple metabolites.

RESULTS. In most (81%) infants, 7 phthalate metabolites were above the limit of detection. Exposure to lotion was predictive of monoethyl phthalate and monomethyl phthalate concentrations, powder of monoisobutyl phthalate, and shampoo of monomethyl phthalate. Z scores increased with number of products used. Most associations were stronger in younger infants.

CONCLUSIONS. Phthalate exposure is widespread and variable in infants. Infant exposure to lotion, powder, and shampoo were significantly associated with increased urinary concentrations of monoethyl phthalate, monomethyl phthalate, and monoisobutyl phthalate, and associations increased with the number of products used. This association was strongest in young infants, who may be more vulnerable to developmental and reproductive toxicity of phthalates given their immature metabolic system capability and increased dosage per unit body surface area.

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From MMWR February 1, 2008 / 57 (Early Release);1-2 

CDC is investigating an outbreak of acute allergic-type reactions among patients who have undergone hemodialysis since November 19, 2007. The majority of reactions have occurred among adult hemodialysis patients, with onset within minutes of initiating a hemodialysis session. Although the cause of the outbreak is unknown and remains under investigation, the majority of reactions occurred in patients who received intravenous heparin produced by Baxter Healthcare Corporation (Deerfield, Illinois). Baxter voluntarily recalled nine lots of heparin multidose vials after learning of these adverse events among patients who received heparin during dialysis. This report describes the ongoing investigation.

CDC was first notified on January 7, 2008, by the Missouri Department of Health and Senior Services (MDHSS) of allergic-type reactions among pediatric hemodialysis patients that occurred beginning November 19, 2007, at a pediatric hospital. The reactions had been reported to MDHSS by a health-care provider at the hospital. The symptoms occurred within minutes of dialysis initiation and included facial swelling, tachycardia, hypotension, urticaria, and nausea. A total of eight episodes of acute allergic-type reactions have been identified as occurring among four patients at the pediatric hospital during November 19, 2007–January 15, 2008. These reactions were reviewed by a clinical allergist and were determined to be consistent with anaphylactic or anaphylactoid reaction.

Upon learning of the initial cluster, CDC solicited reports of similar allergic-type reactions among hemodialysis patients nationally through nephrology e-mail lists and public health notifications. In response to these case-finding measures, CDC was contacted on January 9, 2008, by a dialysis supply company that had received reports during the previous 2-week period of approximately 50 similar reactions among adult hemodialysis patients at dialysis facilities in six states. A second supply company reported learning of similar reactions from dialysis facilities as early as December 10, 2007. CDC alerted the Food and Drug Administration (FDA) to these nationwide reports of allergic-type reactions on January 9, 2008, and has been collaborating with FDA on the investigation.

As part of the investigation, CDC has created a working case definition for these reactions. A confirmed case of acute allergic-type reaction has been defined as an episode of anaphylactic or anaphylactoid reaction characterized by angioedema (particularly swelling of lips/mouth, tongue, throat, or eyelids) or urticaria. A probable case has been defined as an episode that includes at least two of the following signs and symptoms: 1) generalized or localized sensations of warmth; 2) numbness or tingling of the extremities; 3) difficulty swallowing; 4) shortness of breath, audible wheezing, or chest tightness; 5) low blood pressure/tachycardia; or 6) nausea or vomiting.

Of the episodes reported as of January 30, CDC has identified 65 confirmed or probable cases among 53 hemodialysis patients that occurred during November 19, 2007–January 21, 2008, at 19 dialysis facilities in 12 states. CDC currently is investigating an additional 36 possible cases. Most reactions resolved after interruption of the dialysis session or treatment with diphenhydramine or steroids at the facility. Other than the eight episodes reported by MDHSS, all cases have occurred among adults.

One common factor among the cases being investigated was receipt of heparin (1,000 units/mL) from 30-mL or 10-mL vials manufactured by Baxter. Intravenous heparin is administered during most hemodialysis sessions to prevent clotting of the access and dialysis circuit. In 61 (94%) of the 65 cases, the affected patient received Baxter heparin during hemodialysis. Dialyzers from four different companies were being used when the reactions occurred. The most commonly used dialyzers, manufactured by Fresenius Medical Care (Waltham, Massachusetts), were being used in 26 (40%) of the episodes. Other exposures have not been ruled out as potential causes of the reactions, and CDC is conducting additional epidemiologic studies to examine those exposures.

On January 17, 2008, Baxter announced a voluntary recall of nine lots of heparin, based on reports the company had received (1). All nine lots were produced at a single plant; eight of the nine lots were produced during September–November 2007. Despite the January 17 recall, an additional reaction occurred on January 21, 2008, after a hemodialysis patient was administered Baxter heparin from one of the recalled lots. CDC has found indications of delays in removing the recalled lots of heparin from distribution, which might result in continued exposures. In addition, these reactions might not be limited to hemodialysis settings. One cardiac-care facility has reported seven allergic-type reactions among cardiac patients who received heparin from lots that were later recalled. CDC and state health departments are investigating these reactions.

Reported by: G Turabelidze, MD, Missouri Dept of Health and Senior Svcs; A Elward, MD, Washington Univ School of Medicine; M Jones, BJC Healthcare, St. Louis, Missouri. PR Patel, MD, M Arduino, DrPH, C Gould, MD, N Shehab, PharmD, K Sunkavalli, MPH, Div of Healthcare Quality Promotion, National Center for Preparedness, Detection, and Control of Infectious Diseases; S Schillie, MD, D Blossom, MD, A Kallen, MD, J Jaeger, MD, EIS officers, CDC.

Editorial Note:

The temporal and geographic distribution of these reactions in a discrete population of patients suggests common exposure to a health-care product with wide distribution in the United States. Previous clusters of acute allergic-type reactions among hemodialysis patients have been attributed to certain types of dialyzer membranes, ethylene oxide (used by the manufacturer as a sterilant), angiotensin-converting enzyme inhibitors, and the reuse of dialyzers (2,3). However, based on preliminary findings, these previously recognized causes of allergic-type reactions in dialysis patients are unlikely to explain this outbreak. Heparin is a biologic product rarely associated with anaphylactic reactions (4).

CDC is conducting additional case-finding activities and epidemiologic studies to define the scope of the outbreak and is exploring options for laboratory testing to further characterize these reactions. Health-care providers should 1) immediately discontinue use of and segregate the recalled lots of heparin, 2) report medication reactions to MedWatch, the online FDA reporting system for adverse medication events,* and 3) report to their state or local health departments any acute allergic-type reactions that have occurred since November 2007 in patients receiving hemodialysis or intravenous medication infusion. Health departments are asked to report reactions to CDC by telephone (404-639-4514 or 404-639-4273) or e-mail (dblossom@cdc.gov or ppatel@cdc.gov).

References

1. Baxter Healthcare Corporation. Urgent product recall. Rockville, MD: Food and Drug Administration; 2008. Available at http://www.fda.gov/medwatch/safety/2008/heparin_recall_01-17-2008.pdf.
2. Arduino MJ. CDC investigations of noninfectious outbreaks of adverse events in hemodialysis facilities, 1979–1999. Semin Dial 2000;13: 86–91.
3. CDC. Epidemiologic notes and reports of acute allergic reactions associated with reprocessed hemodialyzers—Virginia, 1989. MMWR 1989;38:873–4.
4. Berkun Y, Haviv YS, Schwartz LB, Shalit M. Heparin-induced recurrent anaphylaxis. Clin Exp Allergy 2004;34:1916–8.